Acute appendicitis has successfully been treated with appendectomy for over a century. With the rise of antibiotic treatment, a debate has emerged over the superior treatment. This literature review analyzes antibiotic treatment of acute appendicitis and its potential benefits and risks compared with open and laparoscopic appendectomy. This literature review also evaluates the indications and contraindications; complications; recurrence; and cost of surgical and antibiotic treatment of acute appendicitis. Antibiotic treatment has a lower complication rate than surgical treatment but a 27% chance of recurrence within one year; whereas, surgical treatment has a near-perfect resolution rate. Antibiotic treatment has a smaller financial burden due to lower treatment and societal costs. Providers and patients should factor these results into their joint decision, selecting either appendectomy to reduce recurrence risk, or antibiotic treatment to limit costs and complication risk.