Rationale for the Trial This trial has the potential to significantly alter clinical practice for one of the most common acute health conditions in children. A finding of non-inferiority of treatment with antibiotics compared to appendectomy would be transformative for the healthcare of children with acute appendicitis in Canada and abroad, including low- and middle-income countries. Reducing the need for surgery in the treatment of childhood appendicitis represents the potential for cost savings for the healthcare system, and will enable improved access for children with non-emergent conditions who are awaiting surgery.