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Appendicitis Treatment and Medications

Medically reviewed by Anis Rehman, MD
Physician
Updated Nov. 17, 2021  •  Published Jun. 18, 2020
Fact Checked

Appendicitis is swelling of the appendix, a small tube-like pouch attached to the lower right side of the colon. Nearly all cases of appendicitis are acute appendicitis, in which an infection causes the swelling. The symptoms of acute appendicitis come on suddenly and progress rapidly in the first 48 hours.

Acute appendicitis is a medical emergency. The appendix has a high risk of rupturing, and the risk rapidly increases as time passes. Rupture of an inflamed appendix threatens to spread the infection and can result in sepsis, a potentially life-threatening condition where swelling occurs throughout the body.

In almost all cases, acute appendicitis requires an appendectomy (surgical removal of the appendix).

Acute appendicitis is one of the most common causes of abdominal pain. Around 7 in 100 people will experience acute appendicitis at some point in their lives. There are no particular risk factors, but appendicitis occurs most commonly in people between the ages of 10 and 30, and the incidence is higher in men than women.

Because the condition progresses rapidly, getting emergency medical treatment is urgent. Knowing what appendicitis is, identifying its symptoms, and understanding its treatment options can help someone with appendicitis avoid life-threatening complications.

What is the appendix, and where is it located?

The appendix is a thin, worm-shaped tube about four inches long attached to the bottom of the lower right side of the colon. Called the cecum, this part of the colon looks like a sink or bowl sunk below the opening where the small intestine feeds into the large intestine. The rest of the large intestine rises upwards towards the chest. The appendix lies at the bottom of that bowl.

Scientists don’t fully understand what the appendix does. For a long time, the appendix was considered a useless vestige. Researchers now think the appendix does have a function but aren’t sure what it is. One theory is that the appendix serves an immune purpose by harboring the white blood cells to handle possible colon infections. Another is that the appendix is an emergency “safe house” for beneficial gut bacteria.

What causes appendicitis?

Whatever its function, the appendix secretes mucus into the cecum. Mucus production is largely what that whole area of the colon does. The mucus produced by the cecum lubricates the intestinal walls. The appendix, though, is very thin. It can be easily blocked, usually by a stone formed of fecal material (a fecalith), foods such as unchewed fruit seeds, or by tumors, parasites, or an overgrowth of white blood cells. Stones, though, are the usual culprit.

Once blocked, mucus builds up the appendix. As the appendix swells, blood flow gets cut off (ischemia), and appendiceal tissues die, which fires up an infection. Bacteria multiply inside the appendix, swelling the appendix even more, and resulting in the classic symptoms of appendicitis.

This is the stage health professionals call uncomplicated appendicitis. The infection is limited to the appendix and can be quickly resolved by surgically removing the appendix.

If unchecked, eventually the swelling will tear a hole somewhere in the appendix wall. The infection will seep out as an abscess or break out and infect the rest of the abdominal cavity surrounding the intestines, called the peritoneum.

A peritoneal infection, or peritonitis, is a serious and potentially life-threatening condition requiring aggressive emergency medical treatment. Even worse, the ruptured appendix may fill the bloodstream with the inflammatory substances the immune system uses to fight off infections, a condition called sepsis. Swelling happens throughout the body, threatening vital organs. Sepsis can rapidly progress to organ failure, anaphylaxis (a hazardous drop in blood pressure), and death.

This stage—after the appendix has ruptured—is called complicated appendicitis. About 17% to 32% of acute appendicitis cases progress to perforation and complications. Even with surgery, patients with complicated appendicitis are seven times more likely to die than patients with uncomplicated appendicitis. Time is of the essence once appendicitis symptoms present.

How is appendicitis diagnosed?

Knowing the symptoms of appendicitis can save a life. The symptoms of appendicitis usually come on quite suddenly and progress rapidly. The first symptoms start developing in the first 12 to 24 hours, and appendix ruptures become a significant risk after 48 hours.

On a physical examination, a healthcare professional is looking for the definitive symptoms of appendicitis:

  • Abrupt onset of Abdominal pain that starts around the belly button and localizes to the right lower quadrant of the abdomen,
  • Rebound pain in that same area,
  • Nausea,
  • Loss of appetite

To test for rebound pain, the healthcare provider will apply pressure to the appendix. Rebound pain is the jolt of pain felt when the pressure is removed. It is a unique sign of appendicitis or peritonitis.

Other symptoms might include a dry tongue, bad breath, constipation, diarrhea, and flushing.

The definitive symptoms, though, are the five listed above. Doctors often use a scale called the Alvarado score to diagnose appendicitis. The five warning signs listed above add up to a score high enough on the Alvarado scale to move straight to surgery without any other tests or imaging.

Other tests will be done, though. Not all the definitive symptoms will be present. The emergency physician will ask for imaging tests, blood tests, and urine tests to confirm a diagnosis.

A CT scan provides the clearest picture of an inflamed appendix. However, time constraints and the patient’s medical condition may call for an ultrasound, MRI, or X-rays. For instance, the physician will use ultrasound on pregnant women and children.

Blood tests will count white blood cells. A urine test can help determine if the pain has another cause, such as a urinary tract infection (UTI) or an ectopic pregnancy, which are sometimes confused with appendicitis.

All this time, however, the clock is ticking. The physician will analyze the images and tests in the context of the symptoms to determine the risk of appendicitis. If this risk is low, the patient will probably be admitted for observation and put on antibiotics.

If the risk is high, things will move pretty fast.

Appendicitis treatment options

The surgical removal of the appendix is the primary treatment for acute appendicitis. This surgery is called an appendectomy or appendicectomy.

A laparoscopy—surgery using a small tube inserted into the abdomen through a small hole called a laparotomy—can treat uncomplicated appendicitis. Complicated appendicitis involving an abdominal abscess or advanced infection may require an open appendectomy.

Laparoscopic appendectomy has fewer complications than an open appendectomy. It involves less pain, fewer complications, and faster recovery time than open surgery.

Survival rates for uncomplicated appendicitis after surgery are excellent. However, mortality increases more than seven-fold for patients who go into surgery with complicated appendicitis.

Sometimes, however, patients are misdiagnosed. In the middle of the appendectomy, the surgeon will discover the appendix is perfectly healthy. Although the procedure is then unnecessary, the surgeon may still remove the healthy appendix as a preventative measure. The removal of a healthy appendix based on a misdiagnosis is called a negative appendectomy. It happens quite frequently. Up to 1 in 7 appendectomies are unnecessary.

Increasingly, however, patients at lower risk may be treated only with antibiotics and pain relievers. The patient will be observed for one or two days and released if the symptoms improve. Most low-risk patients fully recover on antibiotic therapy alone. However, they are at high risk for another appendiceal infection in the future.

Appendicitis medications

The last two decades have seen dramatic rethinking of the role medications play in treating acute appendicitis. Pain relievers and antibiotics were once used sparingly, but now may be used to treat appendicitis alone without surgery.

Pain relief medications

At one time, healthcare professionals believed that pain medications made diagnosing appendicitis difficult, delaying a definitive diagnosis when every hour matters. The primary symptoms, after all, are pain symptoms. Some health sites still warn about taking pain relief medications before going to the emergency room. However, we now know that pain relievers do not influence diagnosis, so there’s no reason to suffer while waiting for the doctor or surgery.

It is now standard practice to immediately administer pain medications such as opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), or acetaminophen upon admission to an emergency room.

Antibiotics

The use of antibiotics was and still is controversial. Until recently, the only treatment option was an appendectomy, and antibiotics were used to prevent infection of surgical wounds. However, the high rates of negative appendectomies, which has hovered around 20% to 25% over the last few decades, is cause for concern. So intravenous antibiotics are now administered almost immediately and may be the only treatment necessary to treat the infection in some patients.

Most patients receive intravenous antibiotics as soon as they get an appendicitis diagnosis to prevent infection of surgical wounds. Intravenous antibiotics are usually continued for 24 hours after surgery to prevent complications.

Increasingly, healthcare professionals are relying on antibiotic treatment alone for lower-risk patients. Research has shown that antibiotic therapy for lower-risk patients is highly successful and doesn’t involve surgical complications.

The downside, however, is that the patient is at risk for appendiceal infection in the future. About 40% of patients with uncomplicated appendicitis who receive only antibiotics need surgery within the next year. Compare this to 8.5% of appendectomy patients who require a second surgical procedure in a year.

A whole menagerie of bacteria, including Escherichia, Pseudomonas, Peptostreptococcus, Bilophila, and Bacteroides, cause appendicitis. Therefore, a variety of wide-spectrum antibiotics can fight off the infection, including:

Healthcare providers follow a well-established protocol and their own experience when prescribing antibiotics, so using any of these medications will depend on several factors.

What is the best medication for appendicitis?

Drug treatment for appendicitis both before and after surgery focuses on eliminating the infection or relieving pain. Because appendicitis infection involves several different types of bacteria, healthcare providers will prescribe broad-spectrum antibiotics. There is, however, no “best” antibiotic for appendicitis. Physicians follow a protocol when prescribing antibiotics for appendix infections. They will also tailor the prescription to the patient’s history of antibiotic sensitivity. Prescription NSAIDs can adequately manage pain both before and after surgery.

Best medications for appendicitis
Drug Name Drug Class Administration Route Standard Dosage Common Side Effects
Zosyn (piperacillin-tazobactam) Antibiotic Oral 50 ml of 3-0.375 grams every 6 hours Diarrhea, headache, constipation
Rocephin (ceftriaxone) Antibiotic Injection 4-8, 250 mg injections in 2 daily doses Rash, nausea, diarrhea
Flagyl (metronidazole) Antibiotic Oral Dose depends on weight Nausea, headache, loss of appetite
Ultram (tramadol) Opioid Oral 1, 50 mg tablet twice per day Dizziness, nausea, constipation
Diclofenac NSAID Oral 2-3, 50 mg tablets divided into 2 daily doses Abdominal pain, constipation, diarrhea

The standard dosages above are from the United States Food and Drug Administration (FDA). Your healthcare provider will determine the right dosage for you based on your medical condition, response to treatment, age, and weight. Other possible side effects exist.

What are the common side effects of appendicitis medications?

Different classes of medications have different side effects. However, this is not a complete list, and you should consult with a healthcare professional for possible side effects and drug interactions based on your specific situation.

Typical side effects of oral antibiotics are upset stomach, intestinal problems, nausea, and loss of appetite. Reactions to antibiotics are a significant concern since at least 1 in 15 people have allergies to one or more types of antibiotics. These reactions could be life-threatening, so the physician will tailor the prescription to the patient’s history of sensitivity reactions.

NSAIDs are the pain relief medication of choice for appendicitis, but opioids might be prescribed before surgery if the pain is severe. NSAIDs are widely available, inexpensive, and safe. Usual side effects involve the gastrointestinal system and bleeding since NSAIDs are blood thinners.

What is the best home remedy for appendicitis?

The best home remedy for acute appendicitis is an immediate trip to the emergency room. Most patients with acute appendicitis who visit the hospital will leave with their appendix removed. After surgery, home care will help speed the healing process:

  • Rest when tired.
  • Walk a bit every day but avoid strenuous activity.
  • Avoid lifting anything that will cause strain.
  • Eat a regular diet if it doesn’t cause stomach upset.
  • Drink plenty of fluids.
  • Do not take medicines unless the healthcare professional has prescribed them or cleared them for use.
  • Keep the surgical wounds clean and dry. They can be washed carefully one or two days after surgery and patted dry.
  • Take all medications exactly as directed by the healthcare provider. Antibiotics should be taken for the full term of the prescription.
  • Healthcare providers will give the patient a list of conditions or symptoms that require a call to the doctor. Keep this list nearby and call your doctor if any of these occur.

Frequently asked questions about appendicitis

What does appendicitis feel like?

Appendicitis usually starts as a dull pain around the belly button. After a while, the pain radiates to the lower right quadrant of the abdomen. The pain becomes intense in a few hours. Rebound pain in the area is very common: when the area is pressed down, a jolt of pain is felt when the pressure is released.

How does a doctor diagnose appendicitis?

A physician will primarily base the diagnosis on the physical symptoms: abdominal pain, rebound pain, nausea, fever, and loss of appetite, as well as other possible symptoms. Imaging, such as a CT scan, MRI, or ultrasound, will be done to confirm the diagnosis. Blood tests and urinalysis can confirm the diagnosis and rule out other possible diagnoses, such as an ectopic pregnancy or urinary tract infection.

Can appendicitis be cured naturally?

There is no time to cure appendicitis naturally. The appendix is tiny, and the infection builds rapidly. After 36 hours, the risk of a perforation from untreated acute appendicitis is 2%, and that risk rises 5% every 12 hours afterward. Perforation can expand and worsen the infection of the abdominal cavity (peritoneum), which can lead to permanent damage or death if left untreated.

What relieves appendix pain?

Hospital staff will give the patient pain medications, usually as an injection, either right away or after the doctor makes a diagnosis. Most hospitals use NSAIDs, like diclofenac, but if the pain is severe, an opioid or opiate will be used.

What foods to avoid if you have appendicitis?

If a person believes they have acute appendicitis, it is time to visit an emergency room immediately. Do not worry about foods to avoid. No particular food prevents, triggers, helps, or worsens appendicitis. After surgery, patients can eat a regular diet if they can tolerate it. Bland food is advised if eating causes nausea, gas, or abdominal pain.

What are the side effects of having your appendix removed?

An appendectomy, even a laparoscopic appendectomy, is a significant trauma for the body. After surgery, patients can expect to feel tired for several days. The abdomen will probably be swollen and tender for a few days. The patient may have gas, constipation, diarrhea, and a sore stomach after eating.

In the case of a laparoscopic appendectomy, gas is inserted into the abdomen. The leftover gas causes abdominal swelling and pain, but it also irritates a nerve that causes shoulder pain.

Patients who have had laparoscopic surgery will feel well enough to return to work and resume normal activities in one to three weeks, but recovery from an open appendectomy may require two to four weeks.

Can appendicitis be treated with medication?

Because a significant number of appendectomies result in the removal of a healthy appendix, physicians are increasingly treating low-risk cases with antibiotics alone. The success rate is high, but about 40% of patients treated with antibiotics end up having follow-up surgery in a year.

Can you reverse appendicitis?

Appendicitis can and has been reversed with antibiotics, but only in the lowest-risk patients. The only effective way to treat appendicitis is to have the appendix removed.

What triggers appendicitis?

A blockage of the appendix triggers appendicitis. This blockage can be caused by a stone formed of fecal material (a fecalith), parasites, tumors, or eosinophilia (too many white blood cells in one place). Plant seeds particularly if not chewed properly can also block the appendix. Once blocked, the appendix swells with mucus, blood flow gets cut off, and tissues begin to die. Bacteria can thrive in this environment and cause an infection.

Related resources for appendicitis

Medically reviewed by Anis Rehman, MD
Physician

Dr. Anis Rehman is an American Board of Internal Medicine (ABIM) certified physician in Internal Medicine as well as Endocrinology, Diabetes, and Metabolism who practices in Illinois. He completed his residency at Cleveland Clinic Akron General and fellowship training at University of Cincinnati in Ohio. Dr. Rehman has several dozen research publications in reputable journals and conferences. He also enjoys traveling and landscape photography. Dr. Rehman frequently writes medical blogs for District Endocrine (districtendocrine.com) and hosts an endocrine YouTube channel, District Endocrine.

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