Postoperative antibiotics can be de-escalated after laparoscopic surgery for complex appendicitis

Appendicitis is the most common surgical emergency globally, and surgery remains the mainstay of treatment in more than 98% of cases. 1 Bhangu A Søreide K Di Saverio S Assarsson JH Drake FT Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015; 386: 1278-1287 Summary Full Text Full Text PDF PubMed Scopus (606) Google Scholar , 2 Herrod PJJ Kwok AT Lobo DN Randomized clinical trials comparing antibiotic therapy with appendicectomy for uncomplicated acute appendicitis: meta-analysis. BJS Open. 2022; 6zrac100 Crossref PubMed Scopus (8) Google Scholar However, variations in management are extremely common and are under-researched. For example, there is little agreement over the best preoperative diagnostic strategy, the role of antibiotics as a primary treatment, and how to best implement laparoscopic appendicectomy in low-income and middle-income countries. Evidence regarding the duration of antibiotics after surgery is scarce, and cautious behaviours tend to result in longer courses being prescribed. Postoperative antibiotics are justified if they reduce complications; otherwise, they exacerbate costs, increase antimicrobial resistance, delay discharge from hospital, and have a carbon consequence. 2 days versus 5 days of postoperative antibiotics for complex appendicitis: a pragmatic, open-label, multicentre, non-inferiority randomised trial2 days of postoperative intravenous antibiotics for complex appendicitis is non-inferior to 5 days in terms of infectious complications and mortality within 90 days, based on a non-inferiority margin of 7·5%. These findings apply to laparoscopic appendicectomy conducted in a well resourced health-care setting. Adopting this strategy will reduce adverse effects of antibiotics and length of hospital stay. Full-Text PDF