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Antibiotic therapy has been proposed as an alternative to surgery for uncomplicated appendicitis. In 2020, the Comparison of Outcomes of Antibiotic Drugs and Appendectomy (CODA) trial reported that the 30-day general health status of patients treated with antibiotics was comparable to the appendectomy group; however, 29 percent of medically-treated patients required appendectomy by 90 days. Longer-term data from this trial now confirm high rates of subsequent appendectomy after initial medical therapy: 40 percent at one year, 46 percent at two years, and 49 percent at three and four years. Given these high appendectomy rates, we continue to suggest surgery for uncomplicated appendicitis and reserve antibiotic therapy for those who are medically unfit for or decline surgery.