The appropriate antibiotic treatment in the APPIC trial is as follows:


– Cefuroxime 1500 mg 3dd IV

– Metronidazole 500mg 3dd IV

click here for the alternative regime Ceftriaxone-Metronidazole.

Dosage for children (<18yrs):
– Cefuroxime 100mg/kg/day, max. 4.5g/day in 3 doses.
– Metronidazole 30mg/kg/day, max. 1.5g/day in 3 doses

Total number of doses: 6 in arm A (48h) and 15 in arm B (5d)

 CO-INTERVENTION: one daily dose of gentamicin is allowed, if indicated according to local hospital protocol. Other antibiotics are not allowed.

SWITCH ANTIBIOTICS: if indicated based on intraoperative culture results, it is allowed to switch to a different antibiotic regimen.

 PROLONGATION/RESTART ANTIBIOTICS: only in case of a (suspected) infectious complication, based on additional (laboratory and/or imaging) tests is it allowed to prolong or restart antibiotic treatment. A raised pulse or body temperature alone is not enough.

* Two or more of the following: body temperature <36.0°C or >38.0°C; heart rate > 100bpm; respiratory rate > 20/min; WBC <4×109 or >12×109 cells/L.
** As appropriate according to Dutch guidelines and local hospital protocols.
*** Depending on source of infection different antibiotic regimes may be indicated and/or invasive source control therapy, such as percutaneous drainage of an abscess.