Antibiotics for Appendicitis

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Note: controversies are not meant to have a “right” answer – they are to see how most people are practicing. Would love your comments also regarding your thought processes and the evidence behind your decisions. We can learn from each other!

A recent randomized controlled trial by the CODA collaborative found a 10-day course of antibiotics to be non-inferior to appendectomy in adult, with 30-day health status as the primary outcome. By 90 days of follow-up, 29% of the antibiotics group had undergone appendectomy. Complications were more common in the antibiotics group, but not in the subgroup with no appendicolith.

If you were seeing a young healthy male with acute appendicitis of short duration, afebrile, normal labs, no appendicolith, mild pain, tolerating oral intake, would you consider treating with antibiotics only?