From the Guidelines
Yes, antibiotics are indicated for acute appendicitis patients who are going to undergo surgery. The most recent and highest quality study, published in 2020 in the World Journal of Emergency Surgery 1, recommends a single preoperative dose of broad-spectrum antibiotics in patients with acute appendicitis undergoing appendectomy. This recommendation is based on high-quality evidence and has a strong strength of recommendation.
Key Points
- Preoperative antibiotics should be administered within 60 minutes before surgical incision to reduce the risk of surgical site infections and postoperative intra-abdominal abscess.
- The choice of antibiotic should cover both aerobic and anaerobic organisms commonly found in the gastrointestinal tract, as these are the likely pathogens in appendicitis.
- For uncomplicated appendicitis, postoperative antibiotics are not recommended, as stated in the 2020 update of the WSES Jerusalem guidelines 1.
- The optimal timing of preoperative antibiotic administration may be from 0 to 60 min before the surgical skin incision, as supported by previous studies 1.
Antibiotic Regimens
Typical regimens include a single dose of a broad-spectrum antibiotic, with the specific choice depending on factors such as patient allergy history and local resistance patterns.
- A single dose of broad-spectrum antibiotics given preoperatively has been shown to be effective in decreasing wound infection and postoperative intra-abdominal abscess, with no apparent difference in the nature of the removed appendix, as stated in the study 1. It is essential to follow the most recent guidelines and adjust the antibiotic regimen according to the specific clinical scenario and local microbiological patterns.
From the Research
Antibiotic Use in Acute Appendicitis
- The use of antibiotics in acute appendicitis is a topic of ongoing research and debate 2, 3, 4, 5, 6.
- Patients with acute appendicitis should receive preoperative, broad-spectrum antibiotics, according to a systematic review published in 2014 2.
- The use of postoperative antibiotics is only recommended in cases of perforation, and treatment should then be given intravenously, for a minimum period of 3-5 days for adult patients, until clinical signs such as fever resolve and laboratory parameters such as C-reactive protein curve and white blood cell (WBC) start to decline 2.
Surgical Management
- Laparoscopic appendectomy remains the most common treatment for acute appendicitis, but increasing evidence suggests that broad-spectrum antibiotics can successfully treat uncomplicated acute appendicitis in approximately 70% of patients 3.
- Specific imaging findings on computed tomography (CT), such as appendiceal dilatation or presence of appendicoliths, identify patients for whom an antibiotics-first management strategy is more likely to fail 3.
- Surgical management should be recommended in patients with CT findings of appendicolith, mass effect, or a dilated appendix who are fit for surgery 3.
Antibiotic Regimens
- The optimal antibiotic regimen for acute appendicitis is not known, but oral antibiotics have been shown to be effective and safe in managing uncomplicated acute appendicitis 5.
- A randomized clinical trial published in 2021 found that treatment with 7 days of oral moxifloxacin compared with 2 days of intravenous ertapenem followed by 5 days of levofloxacin and metronidazole resulted in treatment success rates greater than 65% in both groups 5.
- Carbapenems have been shown to be effective in decreasing complications and hospital stay following complicated acute appendicitis surgery, compared to ciprofloxacin/metronidazole 6.