Appendicitis is the most common surgical condition in children. Although appendectomy has traditionally been the mainstay of treatment, recent research has focused on antibiotic management as a possible treatment. This chapter summarizes the existing comparative articles on medical versus operative management for early, acute appendicitis. Based on the currently available published literature, we recommend: patients with early, acute appendicitis should undergo operative management if appropriate surgical candidates. The main reasons for this recommendation include the relatively high recurrence rate, complications or side effects of antibiotic treatment, and risk of missing either complicated appendicitis or a carcinoid tumor. However, antibiotic treatment is a safe and effective treatment approach particularly in the short-term and thus can be used in patients with higher operative risks, in cases of hospital resource concerns, or clinician or parental preferences.