Although many patients receive antibiotic therapy for appendicitis, it is unclear if this treatment can be administered to elderly patients. We aimed to assess the outcomes of antibiotic therapy for appendicitis in elderly patients aged ≥80 years.

During this 4-year study, we enrolled 26 elderly patients who initially received antibiotic therapy. Of these, 3 were suspected to have complicated appendicitis. Antibiotic therapy consisted of second-generation cephalosporin and metronidazole that was administered for 4 days with a 24-hour fasting period. We evaluated the rates of treatment failure and recurrence.

Mean age was 83.5 years, and 57.7% (15/26) of patients had comorbidities. One patient (4.8%) failed to respond to antibiotic therapy and underwent subsequent appendectomy. During the median follow-up period of 17 months, 5 patients (20%) experienced recurrence; 3 underwent appendectomy and 2 received a new course of antibiotics.

Antibiotic therapy without surgery may be a safe and effective treatment for appendicitis in selective patients aged ≥80 years. This is a good treatment option in patients with high operative risk.