Optimizing Antibiotic Therapy for Complicated Appendicitis: A Systematic Review of Short versus Prolonged Courses

Area of Science:

• Infectious Diseases
• Surgical Outcomes
• Pharmacotherapy

Background:

• Complicated appendicitis frequently necessitates postoperative antibiotics, but optimal duration is debated.
• Prolonged antibiotic use may introduce risks without clear benefits in appendicitis treatment.

Purpose of the Study:

• To evaluate the efficacy and safety of short-course (≤5 days) versus longer-course postoperative antibiotics for complicated appendicitis.
• To compare key clinical outcomes including infection rates, mortality, and hospital stay.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, Embase, Scopus, Web of Science, Cochrane Library) up to April 2025.
• Included randomized controlled trials and cohort studies comparing short-course versus prolonged antibiotic durations post-appendectomy.
• Meta-analysis utilized the DerSimonian and Laird random-effects model for outcome assessment.

Main Results:

• Thirteen studies involving 5325 patients were analyzed.
• No significant differences were observed in intra-abdominal abscess, surgical site infection, mortality, or readmission rates between short-course and prolonged antibiotic groups.
• The short-course antibiotic group demonstrated a significantly shorter hospital length of stay (mean difference = -1.907 days).

Conclusions:

• Short-course postoperative antibiotic therapy is non-inferior and safe for managing complicated appendicitis.
• Implementing short-course protocols can reduce hospital length of stay and potentially mitigate antibiotic-related complications.
• Standardizing short-course antibiotic regimens enhances patient outcomes and promotes effective antibiotic stewardship.