Optimum duration of prophylactic antibiotics in acute non-perforated appendicitis

ANZ J Surg. 2005 Jun;75(6):425-8. doi: 10.1111/j.1445-2197.2005.03397.x.


Background: The effect of extended prophylactic antibiotic therapy on postoperative infective complications such as wound infection and intra-abdominal abscess for non-perforated appendicitis is poorly defined.

Methods: In a randomized controlled trial of 269 patients aged 15-70 years with non-perforated appendicitis undergoing open appendicectomy; 92 received single dose preoperative (group A), 94 received three-dose (group B) and 83 received 5-day perioperative (group C) regimens of cefuroxime and metronidazole. Postoperative infective complication was the primary endpoint. Secondary outcomes included length of hospital stay and complications related to antibiotic therapy.

Results: The rate of postoperative infective complication was not significantly different among the groups (6.5% group A, 6.4% group B, 3.6% group C). The duration of antibiotic therapy had no significant effect on the length of hospital stay. Complications related to antibiotic treatment were significantly more common for 5-day perioperative antibiotic group (C) compared with single dose preoperative antibiotic group (A) (P = 0.048).

Conclusion: Single dose of preoperative antibiotics is adequate for prevention of postoperative infective complications in patients with non-perforated appendicitis undergoing open appendicectomy. Prolonging the use of antibiotics can lead to unnecessary antibiotic related complications.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / administration & dosage
  • Anti-Infective Agents / administration & dosage
  • Antibiotic Prophylaxis / methods*
  • Appendectomy
  • Appendicitis / surgery*
  • Cefuroxime / administration & dosage
  • Female
  • Humans
  • Length of Stay
  • Male
  • Metronidazole / administration & dosage
  • Middle Aged
  • Postoperative Complications / prevention & control
  • Premedication
  • Surgical Wound Infection / prevention & control
  • Time Factors
  • Treatment Outcome


  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Metronidazole
  • Cefuroxime