What is the duration of antibiotic therapy for perforated acute appendicitis (inflammation of the appendix)?

From the Guidelines

The recommended duration of antibiotic therapy for perforated acute appendicitis is typically 3-5 days (option B). This recommendation is based on the most recent and highest quality evidence, which suggests that longer postoperative courses of antibiotics do not prevent surgical site infections (SSI) compared to shorter courses 1. The optimal course of antibiotics remains to be identified, but current evidence suggests that a period of 3–5 days for adult patients is generally sufficient following appendectomy for complicated acute appendicitis, including perforated cases 1. Key points to consider include:

• Postoperative broad-spectrum antibiotics are suggested, especially if complete source control has not been achieved 1.
• Discontinuation of antibiotics after 24 h seems safe and is associated with shorter length of hospital stay and lower costs 1.
• In patients with intra-abdominal infections who had undergone an adequate source control, the outcomes after fixed-duration antibiotic therapy (approximately 3–5 days) are similar to those after a longer course of antibiotics 1. The recommendation to limit antibiotic therapy to 3-5 days is based on high-quality evidence and aims to balance the need for effective infection control with the risks of antibiotic overuse, such as resistance and adverse effects 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Antibiotic Course Duration for Perforated Acute Appendicitis

• The duration of antibiotic courses for perforated acute appendicitis can vary, but studies suggest that shorter courses may be as effective as longer ones 2, 3.
• A study published in 2023 found that a shortened course of Amoxicillin/Clavulanate (5-8 days) was not associated with a higher risk of readmission compared to a prolonged course (10-14 days) 2.
• Another study from 2020 found that a shorter duration of antibiotics (3-5 days) was as effective as a traditional longer duration of antibiotics in treating acute complicated appendicitis 3.
• The optimal duration of antibiotic therapy for perforated appendicitis is still a topic of debate, but the available evidence suggests that shorter courses may be sufficient in many cases 2, 3.
• The choice of antibiotic regimen may also play a role in determining the duration of therapy, with some studies suggesting that broad-spectrum antibiotics may be effective for shorter durations 4, 5.

Specific Duration Recommendations

• Based on the available evidence, the recommended duration of antibiotic therapy for perforated acute appendicitis may be:

• 3-5 days 3
• 5-7 days 2

• However, the optimal duration may depend on individual patient factors and the specific antibiotic regimen used 2, 3.