Breaking the Antibiotic Habit: Shorter Treatments for Complicated Appendicitis

Background: Patients with acute complicated appendicitis, including gangrenous or perforated appendicitis and/or the presence of an abscess formation, usually require surgery followed by antibiotics. The optimal duration of antibiotic therapy for those infections is debatable; prolonged courses are practiced at other institutions.

Objectives: We undertook this systematic review and comparison to assess the efficacy of various durations of postoperative antibiotic therapy on patients healing from complicated acute appendicitis. The endpoint was defined as overall infections, length-of-sickness hospitalization (LOS), and readmissions in randomizing-controlled scan trials that tested different periods for which a patient received antibiotics after surgery.

Methods: A comprehensive search included MEDLINE, Cochrane Library, Web of Science, Embase, PubMed, and Google Scholar. We included studies with randomized controlled trials, cohort studies, and cohort and observational studies that compared various durations of postoperative antibiotics among adults or children suffering from complicated appendicitis. Results: Data was extracted and analyzed for infection rates, LOS, and readmission outcomes.

Results: We included 13 studies with 4,675 participants in the meta-analysis. The meta-analysis found that short-term antibiotic therapy (≤5 days) is as effective as longer courses (> five days) in the prevention of postoperative infections. Patients in both the short- and long-term groups experienced similar rates of surgical site infections, intra-abdominal abscesses, and new-onset sepsis. Short-term therapy was also linked to a shorter LOS and comparable readmission rates.