Can the postoperative routine of intravenous/oral antibiotics after acute appendectomy in children with perforated appendicitis be shortened?

Löfgren P, Berge E, Jivegård L, Khan J, Magnusson K, Sjöström S, Stadig S, Wallerstedt SM
Record ID 32018012865
Original Title: [Kan behandlingstiden med intravenös/oral antibiotika efter appendektomi hos barn som opererats på grund av perforerad appendicit förkortas?]
Authors' objectives: Background Acute appendicitis is one of the most common causes for surgery in children worldwide. In Region Västra Götaland, between 320 and 420 children (<18 years of age) are surgically treated every year and about 75 of these have a perforated appendix. In the latter subgroup, 8‒20% experience complications, mostly because of intraabdominal abscess formation. To prevent complications, intravenous antibiotics are prescribed when a perforated appendix is suspected, requiring in-hospital administration postoperatively. In recent years, there is a trend to switch to oral antibiotics as soon as the child can eat after surgery, but recommendations in guidelines are not consistent. Length of postoperative intravenous/oral antibiotic treatment varies considerably between hospitals. Question at issue For children undergoing acute appendectomy due to perforated appendicitis, is a shortened postoperative routine of intravenous/oral antibiotics non-inferior regarding the risk of intraabdominal abscess, and does it affect mortality, ileus, need for intensive care, sepsis, readmission, adverse drug reactions, wound infections, length of stay, and health-related quality of life?
Authors' results and conclusions: Conclusion Non-inferiority regarding the risk of intraabdominal abscess was not shown for a shortened postoperative routine of antibiotic treatment, but a routine of intravenous antibiotics below 5 days, is unlikely to imply an increased risk that exceeds 12.5 percentage points. A shortened postoperative routine of intravenous antibiotics may not affect the risk of readmission and complications to antibiotic treatment, but it probably reduces the length of hospital stay. No conclusions can be drawn regarding the critical and important outcomes mortality, ileus, and surgical site infection. Given the sparsity of evidence and the fact that the condition is not uncommon, further well-designed studies are considered highly warranted.
Authors' methods: Methods Two authors performed literature searches (October 2023) in Medline, Embase, the Cochrane Library, and Cinahl. They independently assessed the abstracts, and selected, in consensus, full-text articles to be sent to the other authors, who then decided in consensus on inclusion or exclusion. The included studies were critically appraised, and data were extracted. Studies without major risk of bias formed the basis for the conclusions. Meta-analyses were performed when applicable using random effects models. The non-inferiority margin for intraabdominal abscess was set beforehand, using the margin applied in a recent randomised controlled trial (RCT); the 95% confidence interval (CI) of the risk difference was not allowed to exceed 7.5 percentage points. Certainty of evidence was assessed according to GRADE. The study protocol was preregistered with PROSPERO (CRD42024501215).
Project Status: Completed
Year Published: 2024
English language abstract: An English language summary is available
Publication Type: Full HTA
MeSH Terms
  • Child
  • Appendicitis
  • Anti-Bacterial Agents
  • Antimicrobial Stewardship
  • Appendectomy
  • Length of Stay
  • Abdominal Abscess
  • Surgical Wound Infection
  • Antibiotic treatment
Organisation Name: The Regional Health Technology Assessment Centre
Contact Address: The Regional Health Technology Assessment Centre, Region Vastra Gotaland, HTA-centrum, Roda Straket 8, Sahlgrenska Universitetssjukhuset, 413 45 GOTHENBORG, Sweden
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