Optimizing Antibiotic Therapy for Complicated Appendicitis: A Systematic Review of Short versus Prolonged Courses.

INTRODUCTION

Complicated appendicitis often requires postoperative antibiotics, yet the ideal duration remains unclear. Prolonged use may increase risks without added benefits. This study aimed to determine whether short-course antibiotics (≤5 d) are as effective and safe as longer courses in patients undergoing appendectomy for complicated appendicitis.

METHODS

We searched PubMed, Embase, Scopus, Web of Science, and Cochrane Library from inception through April 2025. Randomized controlled trials and cohort studies comparing short versus prolonged postoperative antibiotic duration were included. Primary outcomes were intra-abdominal abscess, surgical site infection, mortality, readmission, reoperation, and hospital length of stay. The DerSimonian and Laird random-effects model was used for meta-analysis.

RESULTS

Thirteen studies with a total of 5325 patients were included. No statistically significant variations were found between the groups in intra-abdominal abscess (odds ratio [OR] = 0.967; 95% confidence interval [CI]: 0.770-1.236; P = 0.838), surgical site infection (OR = 0.983; 95% CI: 0.677-1.425; P = 0.929), mortality (OR = 1.315; 95% CI: 0.269-6.419; P = 0.735), or readmission (OR = 1.046; 95% CI: 0.620-1.765; P = 0.867). However, the short-course group showed a significantly shorter hospital stay (mean difference = -1.907 d; 95% CI: -3.302 to -0.512; P = 0.007).

CONCLUSIONS

Short-course postoperative antibiotic therapy is safe and noninferior to longer regimens for complicated appendicitis. It significantly reduces hospital length of stay and may lower antibiotic-related complications. Standardizing short-course protocols can improve patient outcomes and support global antibiotic stewardship.