After adequate source control, four days of antibiotics is usually enough

For complicated intra-abdominal infection, including perforated appendicitis, the randomised STOP-IT trial found that a fixed course of about four days after adequate source control gave outcomes similar to continuing until fever, leucocytosis and ileus had resolved. Major guidelines now favour short courses once the source is controlled.

The exception is the patient whose source is not controlled. Persisting fever or a rising white count after four days is a reason to look for a collection, not to extend antibiotics by default.

• Write a stop date when you start antibiotics for complicated intra-abdominal infection.
• Aim for about four days after adequate source control in most adults.
• If the patient is not improving at day four, image for a collection before extending antibiotics.
• For simple appendicitis that has been removed, postoperative antibiotics are usually unnecessary.

Why it matters

Prolonged postoperative antibiotics add resistance and C. difficile risk without improving outcomes once the source is dealt with.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.