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Q: A friend was recently treated with antibiotics for appendicitis. I thought appendicitis required an operation. What’s changed?

A: For more than 100 years, appendicitis was considered an emergency that required immediate surgery to remove the appendix (an appendectomy). Today a course of antibiotics offers a safe alternative in many cases.

Before we had CT scans and ultrasounds, doctors had to diagnose appendicitis based on the patient’s symptoms and the physical exam. Good diagnosticians got it right about 85 percent of the time.

So it was very acceptable to remove a normal appendix once out of every seven surgeries. That’s because surgeons were most worried about missing a severely infected appendix or one that had ruptured. Nobody would consider running a study to compare antibiotics alone to surgery for symptoms of acute appendicitis.

But when CT scans came into common use, doctors had a great tool to help diagnose the cause of abdominal pain. With the detailed pictures CT scans provide, doctors can determine who has “mild” inflammation of the appendix that has little chance of developing into an abscess or rupturing.

This opened the door to consider antibiotic treatment as an alternative to immediate appendectomy. Doctors began offering antibiotics to some patients with simple appendicitis.

Nine years ago, researchers launched a formal study comparing the two strategies. The study included 530 adults with simple appendicitis diagnosed by CT scan. They were randomly assigned to have surgery right away or to take antibiotics.

The researchers just reported the long-term study results in the Journal of American Medical Association. For those that were assigned to antibiotic treatment, 39 percent had recurrent appendicitis over the next five years. Most recurrences occurred within the first 12 months.

The surgery patients in the study had a traditional open appendectomy. Today it’s more common to have a laparoscopic procedure. This is done through small incisions. Recovery is much faster than with the larger incision needed for open appendectomy.

When I had appendicitis three years ago, I was offered antibiotics or surgery. I chose immediate laparoscopic appendectomy. I didn’t want risk a recurrence, especially since I like to travel, and I was able to adapt my work schedule without much hassle.

Someone else with appendicitis might have different priorities. He or she may find it very inconvenient to have immediate surgery, and would rather postpone an operation, or not have one at all unless appendicitis recurs.

Howard LeWine, M.D., is an internist at Brigham and Women’s Hospital in Boston and assistant professor at Harvard Medical School. For additional consumer health information, please visit www.health.harvard.edu.

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