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

Joe C Elhage1, Ahmed Hussein Abdelbaset2, Marafi Jammaa Ahmed3

  • 1Faculty of Medicine, American University of Beirut, Beirut, Lebanon.

The Journal of Surgical Research
|November 21, 2025
PubMed
Abstract

Insights

Short-course antibiotics (≤5 days) are as effective and safe as longer durations for complicated appendicitis. This approach significantly reduces hospital stays and supports antibiotic stewardship.

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.
Keywords:
AppendectomyComplicated appendicitisIntra-abdominal abscessMeta-analysisPostoperative antibioticsShort-course therapySurgical site infection

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