Complicated appendicitis: Is there a minimum intravenous antibiotic requirement? A prospective randomized trial

The proper duration of postoperative intravenous (IV) antibiotics in patien ts suffering complicated (perforated or gangrenous) appendicitis is debatab le. Some advocate a set minimum number of IV antibiotic days whereas others discontinue IV antibiotics depending on the patient's clinical course rega rdless of the length of therapy. Our objective was to determine whether the re are differences in morbidity and resource utilization between the two tr eatment methodologies. Ninety-four patients with intraoperative findings of complicated appendicitis were included. In all patients IV antibiotics wer e discontinued on the basis of clinical factors. However, Group 1 patients were given a minimum 5-day IV antibiotic course whereas Group 2 patients ha d no minimum IV antibiotic requirement. Group 1 patients received more IV a ntibiotics than Group 2 patients did (5.9 vs 4.3 days; P = 0.014). Infectio us complications were not statistically different between the two groups (1 3.0% in Group 1 and 12.5% in Group 2). Average hospital stay was also not s tatistically different between the two groups. The data suggest that a prot ocol with no minimum IV antibiotic requirement in patients with complicated appendicitis does not increase morbidity. Furthermore, the protocol arm wi th no minimum IV antibiotic requirement led to less IV antibiotic use but d id not significantly decrease hospital stay.