Antibiotics-First Registry

For the past 100 years appendectomy has been the primary treatment for appendicitis, but new scientific evidence is challenging the notion that surgery is the best treatment for the disease. Increasingly, the surgical community is questioning whether antibiotics alone (an “antibiotics-first” strategy) is a reasonable alternative to appendectomy.

Success with antibiotics-alone in Navy personnel developing appendicitis at sea (who did not have access to an operating room) supported this strategy. Additionally, five randomized trials involving over 1,000 patients in Europe have shown that an antibiotics-first approach is likely safe.

It is currently unknown if the benefits of avoiding an operation with the antibiotics-first approach are outweighed by the potential burden to the patient. For example, there is a possibility of recurrent appendicitis, more days of antibiotics, lingering symptoms, or uncertainty that may impact quality of life.

While appendectomy remains the standard treatment for appendicitis, CERTAIN believes clinicians should inform all patients about the evidence related to the antibiotics-first strategy. Given the uncertainty about the risks and benefits of the antibiotics-first strategy, it is recommended that all patients treated in this way be followed in registries or trials. To that end, CERTAIN is collaborating with a team from University of California, Los Angeles to build a nationwide registry to capture information about patient outcomes following an antibiotics-first approach for appendicitis.

About the registry:

    • Data Capture – The registry captures information about clinical conditions, clinical course, and clinical outcomes for patients treated with an antibiotics-first approach.
    • Data Quality – The registry collects data from initial hospitalization up to one year follow-up to track outcomes over time, and provides a venue for physicians and patients to report outcomes on those previously treated with antibiotics-first.
    • No Cost – Participation in the registry is free of charge.
    • Anonymous – The registry does not require individually identifiable data. No information about patients or clinicians will be identified to anyone. Upon completing an entry in the registry, you will be given a unique code allowing you to update information in the future. It is important to record and retain this code for completeness of follow-up data.
    • Quarterly Reporting – On a quarterly basis, CERTAIN will publicly share findings. For a small fee (to support the program) clinicians can recieve a copy of their registry results in a periodic report.

Get Involved

If you are a clinician who is interested in becoming an advisor or collaborating on future research in this area, please contact us to get involved. 


If you are a clinician who sometimes treats appendicitis with an antibiotics-first approach, we encourage you to contribute to our growing registry. 

Patients & Caregivers

If you or someone you care for has been treated for appendicitis with antibiotics, please share your experience by completing a short survey. Click on the link below.

Patient Handout

The registry does not contain data through intervention or interaction with the individual patient or identifiable private information. Under Code of Federal Regulations (45 CFR 46), this is not considered human subject research. 

The University of Washington Human Subjects Divisions does not require institutional review of this registry. We encourage you to confer with your local institutional review board prior to participating. Learn more.