“Uncomplicated and complicated appendicitis are currently distinguished as 2 different disease entities that require different treatments. The role of antibiotic treatment as an alternative for surgery in simple or uncomplicated appendicitis has been studied in adults and, more recently, in children. Acute complicated appendicitis with necrosis or perforation of the appendix is treated by appendectomy and usually followed by additional antibiotic
treatment aimed at reducing postoperative infectious complications. Restriction and proper use of antibiotics are important for reducing and preventing harmful adverse effects to the patients and preventing antibiotic resistance. In American guidelines, an antibiotic length of 4 to 7 days is advised after complicated appendicitis. To our knowledge, few studies have
investigated the reduction of antibiotic administration after appendectomy and these were mostly performed in children. Restricting antibiotic duration to fewer than 5 days after surgery in complicated appendicitis is seldom done, fearing infectious complications. However, 3 days of antibiotic treatment has been observed to be feasible and safe in a retrospective cohort of adults with complicated appendicitis.”

“The results of this study are in accordance with the results of an observational cohort study and a small randomized clinical trial comparing 3 and 5 days of antibiotic treatment in secondary peritonitis in which half of the patients had a complicated appendicitis. The importance of restricting antibiotic treatment when possible was pointed out in a report
of the World Health Organization, concluding that the most important reason for antibiotic resistance is the misuse of and overtreatment with antibiotics.
Switching to oral antibiotics can be considered when diet resumption is sufficient. In the current cohort, this switch was not applied in most patients, leading to a significantly
shorter hospital stay in the 3-day group. This is not only beneficial to the patient, but this reduction of hospital stay can lead to a substantial cost reduction, although no cost analyses were conducted in this study. On a macroeconomic level, shortening of antibiotic treatment duration could lead to a cost reduction in this frequent disease.”

van Rossem, Charles C et al. “Antibiotic Duration After Laparoscopic Appendectomy for Acute Complicated Appendicitis.” JAMA surgery vol. 151,4 (2016): 323-9.