After appendicectomy for uncomplicated appendicitis, a single preoperative dose of prophylactic antibiotic is enough. Continuing antibiotics afterwards does not reduce wound infection or intra-abdominal abscess, and it adds cost, side effects and resistance pressure.
The decision rests on the surgeon's operative finding, so record it clearly. A normal or inflamed appendix without gangrene or perforation needs no further antibiotics. Gangrenous or perforated appendicitis, or an abscess, needs a short postoperative course, typically a few days and guided by clinical recovery rather than a fixed long course.
- Give a single prophylactic dose before incision.
- Record the operative grade: normal, inflamed, gangrenous, perforated or abscess.
- Stop antibiotics after surgery for uncomplicated appendicitis.
- Give a short postoperative course for gangrenous or perforated appendicitis.
- Review the need for antibiotics daily rather than prescribing a fixed long course.
Why it matters
The operative note decides whether a patient needs more antibiotics, so it has to say what was found.
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