Antibiotic Duration for Non-Perforated Acute Appendicitis
For non-perforated (uncomplicated) acute appendicitis, postoperative antibiotics are NOT recommended—only a single preoperative dose is indicated, making the answer D (Less than 2 days). 1
Surgical Management of Uncomplicated Appendicitis
The 2020 WSES Jerusalem Guidelines provide a strong (1A) recommendation against postoperative antibiotics for patients with uncomplicated appendicitis. 1 This represents the highest quality evidence with clear guidance that distinguishes between non-perforated and perforated cases.
Preoperative Antibiotic Protocol
- A single preoperative dose of broad-spectrum antibiotics should be administered 0-60 minutes before surgical incision. 2
- Second or third-generation cephalosporins (cefoxitin or cefotetan) are appropriate choices for uncomplicated cases. 1
- No postoperative antibiotics are needed after appendectomy for simple, non-perforated appendicitis. 1, 2
Evidence Supporting Single-Dose Approach
A randomized controlled trial of 269 patients with non-perforated appendicitis compared single-dose preoperative antibiotics versus extended courses (3-dose and 5-day regimens). The postoperative infection rate was not significantly different between groups (6.5% single-dose vs 6.4% three-dose vs 3.6% five-day), but antibiotic-related complications were significantly more common with prolonged therapy. 3
Complicated (Perforated) Appendicitis—The Key Distinction
For perforated or complicated appendicitis with adequate source control, antibiotics should NOT be prolonged beyond 3-5 days postoperatively. 1
Duration for Complicated Cases
- Even for complicated appendicitis, 24 hours of postoperative antibiotics appears safe and reduces hospital length of stay without increasing complications. 1
- The STOP-IT trial demonstrated that fixed-duration therapy of approximately 4 days produced similar outcomes to 8-day courses in complicated intra-abdominal infections. 1
- Meta-analysis showed no significant difference in intra-abdominal abscess rates between ≤3 days versus >3 days of antibiotics (OR 0.81). 1
Pediatric Considerations
Children with non-perforated appendicitis should receive a single broad-spectrum antibiotic preoperatively, with no postoperative antibiotics required. 1, 2
For pediatric complicated appendicitis, early switch to oral antibiotics is recommended if clinically improving, with total duration less than 7 days. 2
Common Pitfalls to Avoid
- Do not confuse non-perforated with perforated appendicitis—the distinction is critical, as only complicated cases require postoperative antibiotics 1
- Avoid reflexive postoperative antibiotic prescribing for simple appendicitis—this increases costs, hospital stay, and antibiotic-related complications without reducing infection rates 3
- Do not extend antibiotics beyond 3-5 days even for complicated cases with adequate source control—longer courses provide no additional benefit 1
Answer to Multiple Choice Question
The correct answer is D (Less than 2 days). For non-perforated acute appendicitis, only a single preoperative dose is recommended, with no postoperative antibiotics. 1, 2 The note provided in the question correctly identifies this distinction: uncomplicated appendicitis requires less than 2 days (actually just one preoperative dose), while perforated cases require 7-10 days (though current evidence supports 3-5 days maximum). 1