Twenty-four hour versus extended antibiotic administration after surgery in complicated appendicitis: A randomized controlled trial

Abstract

BACKGROUND Recent investigations noted noninferiority in short-course antimicrobial treatments following source control in abdominal infections. We set out to investigate noninferiority of a short and fixed (24 hours) antibiotic administration compared to extended treatment after source control in complicated appendicitis in a prospective single-center open-label randomized controlled trial. METHODS After Institutional Review Board (IRB) approval, all consecutive adult patients (age, ≥ 18 years) with complicated appendicitis including gangrenous appendicitis, perforated appendicitis, and appendicitis with periappendicular abscess between May 2016 and February 2018 were randomly allocated to antibacterial therapy limited to 24 hours (short) vs. >24 hours (extended) administration after appendectomy. Primary outcomes included composite postoperative complications and Comprehensive Complication Index (CCI). Secondary outcome was hospital length of stay (HLOS). Follow-up analysis at 1 month was conducted per intention and per protocol. RESULTS A total of 80 patients were enrolled with 39 and 41 cases allocated to the short and the extended therapy group, respectively. Demographic profile and disease severity was similar between the study groups. Overall rate of complications was 17.9% and 29.3% in the short and extended group, respectively (p = 0.23). Mean CCI did not differ between the study groups (p = 0.29). Hospital length of stay was significantly reduced in the short therapy group (61 ± 34 hours vs. 81 ± 40 hours, p = 0.005). CONCLUSION In the current prospective randomized investigation, the short (24 hours) antibiotic administration following appendectomy did not result in a worse primary outcome in complicated appendicitis. The short interval administration resulted in a significant reduction in HLOS with a major cost-saving and antibacterial stewardship perspective. LEVEL OF EVIDENCE Therapeutic Level IV.

Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines

“…Mean complication index did not differ between the study groups ( P = 0.29), whereas hospital length of stay was significantly reduced in the short therapy group (61 ± 34 h vs 81 ± 40 h, P = 0.005). Based on the results of this RCT, 24 h of antibiotic therapy following appendectomy does not result in worse primary outcomes in complicated AA, but results in a significant reduction in length of hospitalization, with a major cost-saving and antibacterial stewardship benefits [ 225 ].…”

Duration of post‐operative antibiotic treatment in acute complicated appendicitis: systematic review and meta‐analysis

“…Three of the studies were RCTs of parallel design comparing various durations of post‐operative antibiotic therapy following appendicectomy for acute complicated appendicitis 20–22 . Saar et al .…”

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“…Mean complication index did not differ between the study groups (P=0.29), whereas hospital length of stay was significantly reduced in the short therapy group (61±34 h vs 81±40 h, P=0.005). Based on the results of this RCT, 24 h of antibiotic therapy following appendectomy does not result in worse primary outcomes in complicated AA, but results in a significant reduction in length of hospitalization, with a major costsaving and antibacterial stewardship benefits [225].…”