Duration of post-operative antibiotic treatment in acute complicated appendicitis: systematic review and meta-analysis

Dhruvesh M. Ramson, Hugh Gao, Jahan C. Penny-Dimri, Zhengyang Liu, Jacqueline Nguyen Khong, Carla B. Caruana, Ryan Campbell, Sarah Jackson, Luke A. Perry

Research output: Contribution to journalReview ArticleResearchpeer-review

1 Citation (Scopus)


Background: Appendicitis is the most frequent aetiology of acute abdominal pain requiring surgical treatment, with an estimated lifetime risk between 7% and 8%. Antibiotics play a substantial role in treatment, and there is considerable debate regarding the duration of antibiotics in treating appendicitis. Methods: We searched multiple databases from inception until June 2019 for peer-reviewed studies that compared different durations of antibiotic treatment after appendicectomy for acute complicated appendicitis in adults. We dichotomized reported data into short- and extended-term antibiotic use and controlled for different definitional thresholds in the meta-analysis. We generated risk ratios using restricted maximum likelihood methods and mixed effects modelling for each outcome of interest. Results: Four observational studies involving 847 participants were included in the meta-analysis. For the primary outcomes of intra-abdominal infection, we did not find a statistically significant difference between extended- and short-term antibiotic strategies for intra-abdominal infection (Risk ratio 0.92, 95% confidence interval (CI) 0.49–1.74). Three randomized controlled trials involving 291 participants were included in a separate meta-analysis. We found that extended antibiotic usage was not associated with a statistically significant reduced risk for intra-abdominal infection (RR 0.52, 95% CI 0.21–1.29) or surgical site skin infection (RR 1.44, 95% CI 0.43–4.81). Conclusion: This systematic review and meta-analysis found that extended post-operative antibiotic treatment may not be associated with a reduced risk of intra-abdominal infection; however, meta-analysis was significantly limited by heterogeneity between studies and underpowered trials. Further large randomized controlled trials are needed to confirm these findings.

Original languageEnglish
Pages (from-to)1397-1404
Number of pages8
JournalANZ Journal of Surgery
Issue number7-8
Publication statusPublished - Jul 2021
Externally publishedYes


  • antibiotics
  • appendicectomy
  • appendicitis
  • general surgery
  • intra-abdominal infection
  • post-operative

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