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Updated: Jan 9, 2026

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Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis.

Charles C van Rossem1, Marc H F Schreinemacher2, Anna A W van Geloven1

  • 1Department of Surgery, Tergooi Hospital, Hilversum, the Netherlands.

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|November 19, 2015
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Summary

For acute complicated appendicitis, extending antibiotic treatment to 5 days did not reduce infectious complications. Shorter antibiotic durations may be safe for nonperforated cases, simplifying appendectomy care.

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Area of Science:

  • Surgical Infectious Diseases
  • Clinical Pharmacology
  • Evidence-Based Medicine

Background:

  • Optimal antibiotic duration post-appendectomy for acute complicated appendicitis is not well-defined.
  • Current practices vary, leading to potential overuse of antibiotics.
  • Reducing antibiotic exposure is crucial to combat antimicrobial resistance.

Purpose of the Study:

  • To evaluate the impact of postoperative antibiotic duration on infectious complications following laparoscopic appendectomy for acute complicated appendicitis.
  • To identify risk factors for infectious complications in this patient group.

Main Methods:

  • A prospective, observational, multicenter cohort study involving 1975 patients across 62 Dutch hospitals.
  • Analysis focused on 415 patients who received prolonged postoperative antibiotics ( > 24 hours) for complicated appendicitis.
  • Regression analyses were used to compare 3-day versus 5-day antibiotic regimens and identify risk factors.

Main Results:

  • No significant difference in infectious complications or intra-abdominal abscesses was observed between 3-day and 5-day antibiotic treatment groups (OR 0.93, P=.88; OR 0.89, P=.81, respectively).
  • Appendix perforation was the sole independent risk factor for infectious complications (OR 4.90, P=.01) and intra-abdominal abscess (OR 7.46, P=.009).

Conclusions:

  • Extending postoperative antibiotic treatment to 5 days offers no additional benefit in reducing infectious complications after laparoscopic appendectomy for acute complicated appendicitis.
  • Consideration should be given to restricting antibiotic duration in cases of nonperforated complicated appendicitis.