In chronic appendicitis, elective surgical removal of the appendix is recommended after diagnosis. Most cases of chronic appendicitis develop from acute appendicitis, where fibrosis and chronic inflammatory cell infiltration of the appendiceal wall occurs, and the lumen of the appendix narrows or even becomes occluded, preventing the appendix from emptying and causing frequent pain. Some appendiceal lumens may also contain fecaliths, or the appendix may be adherent and the lumen narrowed. When chronic appendicitis is inflamed, surgical removal is usually recommended. If surgery is not appropriate, antibiotics such as intravenous ceftriaxone sodium and levofloxacin plus ornidazole should be given. If surgery and fluids are not available, oral antibiotics such as cotrimoxazole and cefdinir may be prescribed and hospitalization may be sought for further treatment. If the chronic appendicitis attack is mild, the inflammation can often be brought under control with stronger antibiotic treatment. If the condition worsens, it is important to seek hospitalization for surgery or intravenous anti-infective treatment.