Twenty-four hour versus Extended Antibiotic Administration After Surgery in Complicated Appendicitis: A Randomized Controlled Trial

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-hour) antibiotic administration compared to extended treatment after source control in complicated appendicitis in a prospective single-center open-label randomized controlled trial. Methods After IRB approval, all consecutive adult patients (age ≥18 years) with complicated appendicitis including gangrenous appendicitis, perforated appendicitis, and appendicitis with periappendicular abscess between 5/2016 and 2/2018 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). HLOS was significantly reduced in the short therapy group (61 ± 34 vs. 81 ± 40 hours, p=0.005). Conclusions 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 Level II, Randomized Controlled Trial Conflict of interest: None to declare Funding: None Email addresses: Sten Saar MD stensaars@gmail.com Vladislav Mihnovitš MD mihnovits.vladislav@gmail.com Thomas Lustenberger MD tom.lustenberg@gmail.com Mariliis Rauk MD mariliis.rauk@gmail.com Erast-Henri Noor MD erast.noor@gmail.com Edgar Lipping MD elipping@gmail.com Karl-Gunnar Isand MD isandkarl@gmail.com Jaak Lepp MD Jaak.Lepp@regionaalhaigla.ee Andrus Lomp MD andrus.lomp@gmail.com Urmas Lepner MD, PhD Urmas.Lepner@kliinikum.ee Peep Talving MD, PhD peep.talving@ut.ee Correspondence to: Peep Talving, MD, PhD, FACS, Division of Acute Care Surgery, Department of Surgery, North Estonia Medical Centre, J. Sütiste tee 19, Tallinn, Estonia, 13419. Email: peep.talving@ut.ee. Telephone: +3726171619 The abstract is accepted 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, USA. © 2018 Lippincott Williams & Wilkins, Inc.

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