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Twenty-four hour versus extended antibiotic administration after surgery in complicated appendicitis

A randomized controlled trial

Saar, Sten, MD; Mihnovitš, Vladislav, MD; Lustenberger, Thomas, MD; Rauk, Mariliis, MD; Noor, Erast-Henri, MD; Lipping, Edgar, MD; Isand, Karl-Gunnar, MD; Lepp, Jaak, MD; Lomp, Andrus, MD; Lepner, Urmas, MD, PhD; Talving, Peep, MD, PhD

Journal of Trauma and Acute Care Surgery: January 2019 - Volume 86 - Issue 1 - p 36–42
doi: 10.1097/TA.0000000000002086

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.

From the Division of Acute Care Surgery, Department of Surgery (S.S., M.R., E.H.N., E.L., K.G.I., J.L., P.T.), North Estonia Medical Centre, Tallinn; School of Medicine, University of Tartu (S.S., V.M., A.L., U.L., P.T.), Tartu, Estonia; and Division of Trauma, Hand and Reconstructive Surgery (T.L.), Goethe University Hospital, Frankfurt/Main, Germany.

The abstract was presented as an oral presentation at the 77th Annual Meeting of the American Association for the Surgery of Trauma, September 26-29, 2018 in San Diego, California.

Address for reprints: Peep Talving, MD, PhD, Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, J. Sütiste tee 19, Tallinn, 13419, Estonia; email:

© 2019 Lippincott Williams & Wilkins, Inc.