Safety and efficacy of short-course intravenous antibiotics after complicated appendicitis in selected patients

Kroon, Hidde M.; Kenyon-Smith, Tim; Nair, Gavin; Virgin, James; Juszczyk, Karolina; Hollington, Paul

doi:10.1080/00015458.2021.1940726

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…For patients with uncomplicated appendicitis, most surgeons recommend against the administration of additional postoperative antibiotics [8] . The STOP-IT trial demonstrated that a 4-day antibiotic course resulted in equivalent patient outcomes as an 8-day course [9] ; and other authors confirm that a short antibiotic course was as effective as a long course [10] .…”

Section: Discussionmentioning

confidence: 97%

Wound infection and subsequent port-site hernia following laparoscopic appendectomy: A case report and surveillance data analysis

Jeddeloh

Velji-Ibrahim

Stock

et al. 2022

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 97%

Wound infection and subsequent port-site hernia following laparoscopic appendectomy: A case report and surveillance data analysis

Jeddeloh

Velji-Ibrahim

Stock

et al. 2022

International Journal of Surgery Case Reports

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“…This study emphasized the importance of intraoperative source control, which was significantly associated with the occurrence of an intraabdominal abscess [ 18 ]. Further studies as well as a recent meta-analysis, which included the two aforementioned large observational studies along with five additional studies (three of which were randomized controlled trials), also concluded that extended postoperative antibiotic use may not be linked to a reduced risk of intraabdominal infection [ 20 , 21 , 29 , 30 ]. However, the mentioned meta-analysis acknowledged the limitation of results due to heterogeneity between studies and underpowered trials [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Antibiotic treatment after appendectomy for acute complicated appendicitis to prevent intrabdominal abscess and wound infections

Laverde,

Maak,

Langheinrich

et al. 2024

Langenbecks Arch Surg

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Introduction The purpose of this analysis was to investigate the most appropriate duration of postoperative antibiotic treatment to minimize the incidence of intraabdominal abscesses and wound infections in patients with complicated appendicitis. Materials and methods In this retrospective study, which included 396 adult patients who underwent appendectomy for complicated appendicitis between January 2010 and December 2020 at the University Hospital Erlangen, patients were classified into two groups based on the duration of their postoperative antibiotic intake: ≤ 3 postoperative days (group 1) vs. ≥ 4 postoperative days (group 2). The incidence of postoperative intraabdominal abscesses and wound infections were compared between the groups. Additionally, multivariate risk factor analysis for the occurrence of intraabdominal abscesses and wound infections was performed. Results The two groups contained 226 and 170 patients, respectively. The incidence of postoperative intraabdominal abscesses (2% vs. 3%, p = 0.507) and wound infections (3% vs. 6%, p = 0.080) did not differ significantly between the groups. Multivariate analysis revealed that an additional cecum resection (OR 5.5 (95% CI 1.4–21.5), p = 0.014) was an independent risk factor for intraabdominal abscesses. A higher BMI (OR 5.9 (95% CI 1.2–29.2), p = 0.030) and conversion to an open procedure (OR 5.2 (95% CI 1.4–20.0), p = 0.016) were identified as independent risk factors for wound infections. Conclusion The duration of postoperative antibiotic therapy does not appear to influence the incidence of postoperative intraabdominal abscesses and wound infections. Therefore, short-term postoperative antibiotic treatment should be preferred.

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“…A recent prospective randomized study suggested, however, a 24-hour postoperative antibacterial treatment to be noninferior in complicated appendicitis with no increased risk of infectious complications compared with extended antibiotic therapy 4 . Studies comparing different durations of postoperative antibacterial therapy have used exclusively intravenous administration of antibiotics 4–8 . However, there seems to be no consensus as to the optimal route of postappendectomy antibiotics 9 .…”

mentioning

confidence: 99%

Short Postoperative Intravenous Versus Oral Antibacterial Therapy in Complicated Acute Appendicitis – A Pilot Non-Inferiority Randomized Trial

Lipping,

Saar,

Reinsoo

et al. 2023

Annals of Surgery

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Objective: The purpose of this study is to investigate noninferiority of postoperative oral administration of antibiotics in complicated appendicitis. Background: Recent investigations have used exclusively intravenous administration of antibiotics when comparing outcomes of postoperative antibacterial therapy in complicated appendicitis. We hypothesized that oral antibacterial treatment results in noninferior outcomes in terms of postoperative infectious complications as intravenous treatment. Methods: In this pilot, open-label, prospective randomized trial, all consecutive adult patients with complicated appendicitis including gangrenous appendicitis, perforated appendicitis, and appendicitis with periappendicular abscess between November 2020 and January 2023 were randomly allocated to 24-hour intravenous administration of antibiotics versus 24-hour oral administration of antibiotics after appendectomy. Primary outcomes included 30-day postoperative complications per Comprehensive Complication Index (CCI). Secondary outcome was hospital length of stay (HLOS). Follow-up analysis at 30 days was conducted per intention to treat and per protocol. The study was registered at ClinicalTrials.gov (NCT04947748). Results: A total of 104 patients were enrolled with 51 and 53 cases allocated to the 24-hour intravenous and the 24-hour oral treatment group, respectively. Demographic profile and disease severity score for acute appendicitis (DSS) were similar between the study groups. There were no significant differences between the study groups in terms of 30-day postoperative complications. Median CCI did not differ between the study groups. HLOS was similar in both groups. Conclusions: In the current pilot randomized controlled trial, the 24-hour oral antibiotic administration resulted in noninferior outcomes when compared to 24-hour intravenous administration of antibiotics after laparoscopic appendectomy in complicated appendicitis.

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Safety and efficacy of short-course intravenous antibiotics after complicated appendicitis in selected patients

Cited by 4 publications

References 18 publications

Wound infection and subsequent port-site hernia following laparoscopic appendectomy: A case report and surveillance data analysis

Wound infection and subsequent port-site hernia following laparoscopic appendectomy: A case report and surveillance data analysis

Antibiotic treatment after appendectomy for acute complicated appendicitis to prevent intrabdominal abscess and wound infections

Short Postoperative Intravenous Versus Oral Antibacterial Therapy in Complicated Acute Appendicitis – A Pilot Non-Inferiority Randomized Trial

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