Longer antibiotic course no help in complicated appendicitis, study suggests

Last Updated: 2015-11-25

By David Douglas

NEW YORK (Reuters Health) - A longer antibiotic course is not associated with a reduction in infectious complications after laparoscopic appendectomy for complicated appendicitis, according to Dutch researchers.

"Our postoperative antibiotic study shows that a standard short antibiotic treatment of 3 days is sufficient," Dr. Charles C. van Rossem of Tergooi Hospital, Hilversum, told Reuters Health by email.

Dr. van Rossem and colleagues analyzed data from 62 Dutch hospitals on 1,415 patients who had been treated laparoscopically. In 415, antibiotic treatment was continued for more than 24 hours because of acute complicated appendicitis.

The duration of antibiotics as prescribed directly after surgery varied between two and six days. The most frequently prescribed duration was three or five days, the researchers report in JAMA Surgery, online November 18.

There was no difference in infectious complications or intra-abdominal abscess development between the 75 patients who received antibiotics for three days and the 191 who received treatment for five days. However, those on the three-day regimen had a shorter hospital stay.

On multivariable regression analysis, perforation of the appendix was the only independent risk factor for developing an infectious complication (odds ratio, 4.90) and intra-abdominal abscess (OR, 7.46).

Thus, concluded Dr. van Rossem, "Lengthening beyond day 3 can be considered based on absence of clinical recovery but in most cases this is not necessary. A shortening of the antibiotic course leads to a reduction of hospital stay, costs and possible side effects and resistance of antibiotics."

Commenting on the findings by email, Dr. Henry Rice of Duke University Medical Center in Durham, North Carolina, told Reuters Health that the topic is of "great public health concern given how many people have appendicitis, and this paper adds in a major fashion to the evolving literature in this area. This type of study really does help clinicians and families understand the role of antibiotic therapy as an adjunct to surgery in cases of perforated appendicitis."

However, Dr. Rice, who is professor of surgery, pediatrics, and global health, cautioned that the study "is strictly observational, and it is always hard to determine whether the people in each treatment arm (shorter or longer term antibiotics) are really equivalent. It may be that the sicker people got longer antibiotics, and that if longer antibiotics were not used that the abscess rate in that group may be even higher than if they received shorter antibiotics."

He concluded, "Lots of other questions are raised as well but not specifically answered in this study, such as the cost implications of adopting or modifying antibiotic care practice patterns, the role of early transition to oral antibiotics and discharge, all of which are important in this common disease. But it does support a role for 'big data' to address these important questions."

SOURCE: http://bit.ly/1SjsluH

JAMA Surg 2015.