Duration of Moxifloxacin for Acute Appendicitis
For uncomplicated acute appendicitis treated non-operatively with moxifloxacin, administer 400 mg orally once daily for 7 days total. 1
Treatment Duration Based on Clinical Context
Non-Operative Management (Uncomplicated Appendicitis)
- Moxifloxacin 400 mg once daily for 7-10 days total is the recommended duration when used as monotherapy for uncomplicated acute appendicitis 1
- The WSES Jerusalem Guidelines specify that most randomized controlled trials included a minimum of 48 hours of intravenous antibiotics followed by oral antibiotics for a total duration of 7-10 days 1
- For patients with beta-lactam allergy requiring moxifloxacin specifically, the regimen is moxifloxacin 400 mg once every 24 hours as part of the 7-10 day course 1
Perioperative/Postoperative Use
- Single preoperative dose only for patients undergoing appendectomy for uncomplicated appendicitis—no postoperative antibiotics are recommended 1
- For complicated appendicitis with adequate source control: 3-5 days maximum postoperatively—do not prolong beyond this duration 1
Complicated Intra-Abdominal Infections (Including Perforated Appendicitis)
- 5-14 days total duration for complicated intra-abdominal infections, including appendicitis with perforation 2
- The FDA label specifies moxifloxacin 400 mg every 24 hours for 5-14 days for complicated intra-abdominal infections 2
Evidence Supporting 7-Day Duration
The APPAC II trial specifically evaluated oral moxifloxacin 400 mg daily for 7 days as monotherapy for uncomplicated acute appendicitis, demonstrating a treatment success rate of 70.2% at 1 year and 63.4% at 3 years 3, 4. While this failed to demonstrate noninferiority compared to IV-then-oral regimens, the 7-day duration represents the most rigorously studied oral monotherapy protocol 3, 4.
Critical Clinical Considerations
Key caveat: Non-operative management with antibiotics is only appropriate for CT-confirmed uncomplicated appendicitis without appendicolith 1. The presence of an appendicolith significantly increases failure rates and warrants surgical intervention 1.
Failure rate: Approximately 23-30% of patients initially treated with antibiotics will require appendectomy during the acute episode, and an additional 11-14% will experience recurrence within the first year 3, 5, 4. By 3 years, overall treatment success drops to approximately 63-65% 4.
Monitoring requirement: Patients who do not show clinical improvement within 24 hours of antibiotic initiation should proceed to appendectomy 6.
Age consideration: For patients ≥40 years old treated non-operatively, colonoscopy and interval CT scan are recommended due to the 3-17% incidence of appendiceal neoplasms in this age group 1.