The treatment of acute appendicitis in remote environments without the capability of surgical intervention appears to be effective when using antibiotic protocols active against both aerobic and anaerobic bacteria. A review of nine such cases treated with various antibiotic protocols was conducted and demonstrated good response in all patients. This aggressive medical management frequently resulted in complete resolution of symptoms in patients who later required elective appendectomy or who had recurrences, with similar symptoms requiring acute appendectomies. A strong index of suspicion for appendicitis must be maintained in these cases and one must rely on the medical documentation of the initial episode and proceed with a thorough surgical evaluation.