What is the typical duration of moxifloxacin (moxifloxacin) therapy for acute appendicitis?

Duration of Moxifloxacin for Acute Appendicitis

For uncomplicated acute appendicitis treated non-operatively, moxifloxacin 400 mg orally once daily should be administered for 7 days total. 1, 2, 3

Non-Operative Management (Antibiotic-Only Treatment)

For patients with CT-confirmed uncomplicated appendicitis without appendicolith who choose non-operative management:

• Moxifloxacin 400 mg orally once every 24 hours for 7 days is the recommended regimen 1, 3
• This represents the total duration of therapy, with no intravenous component required when using moxifloxacin specifically 1, 3
• The APPAC II trial demonstrated 70.2% treatment success at 1 year using this exact 7-day oral moxifloxacin regimen 3
• At 3-year follow-up, treatment success was 63.4% with oral moxifloxacin monotherapy 4

Critical prerequisites for non-operative management:

• CT confirmation of uncomplicated appendicitis is mandatory 1
• Absence of appendicolith on imaging (appendicolith presence increases failure rates to 47-60%) 5
• No abscess, perforation, or signs of complicated disease 1
• Patient must understand the 23-39% recurrence risk over 5 years 5

Operative Management (Appendectomy)

For patients undergoing appendectomy:

• Uncomplicated appendicitis: Single preoperative dose of moxifloxacin 400 mg only, with no postoperative antibiotics 1, 6
• Complicated appendicitis with adequate source control: Moxifloxacin 400 mg daily for maximum 3-5 days postoperatively 1, 6
• Prolonged courses beyond 5 days provide no additional benefit when source control is adequate 6

Alternative Regimens When Moxifloxacin Not Used

The broader guideline recommendations for non-operative management include:

• Most randomized trials used minimum 48 hours intravenous antibiotics followed by oral antibiotics for total duration of 7-10 days 5, 1
• The FDA label for moxifloxacin specifies 5-14 days for complicated intra-abdominal infections when used in that context 2

Special Considerations

For patients ≥40 years old treated non-operatively:

• Colonoscopy and interval CT scan are mandatory due to 3-17% incidence of appendiceal neoplasms in this age group 1

Important caveats:

• The APPAC II trial failed to demonstrate noninferiority of oral moxifloxacin compared to IV ertapenem followed by oral levofloxacin/metronidazole, though both groups exceeded 65% success rates 3
• Treatment failure requiring appendectomy occurred in 23-30% of patients on initial antibiotic therapy in population-based studies 7
• Recurrent appendicitis after initial successful antibiotic treatment occurs in approximately 11-14% at 1 year 5, 7