SRS248 - Post-operative antibiotics in acute complicated appendicitis: a systematic review

Abstract Introduction Acute appendicitis is a common surgical emergency, with complicated cases associated with higher risks of infection and morbidity. While preoperative antibiotics are well established, the optimal postoperative antibiotic regimen remains unclear, with significant variability in choice, route, and duration. This review evaluates recent evidence on postoperative antibiotic stewardship in complicated appendicitis. Methods This systematic review followed PRISMA guidelines and was registered with PROSPERO. A comprehensive search of PubMed and the Cochrane Library identified studies on postoperative antibiotic use following appendicectomy. Two independent reviewers screened studies, including RCTs, cohort studies, and observational studies. Data on study characteristics, interventions, and outcomes were extracted. Risk of bias was assessed using RoB 2 and ROBINS-I tools, and evidence certainty was graded using GRADE. Results Eleven studies involving 8361 participants were included. Short-course intravenous antibiotics were non-inferior to prolonged regimens in preventing infections and reducing hospital stays. Factors such as disease severity and surgical complexity influenced the need for extended antibiotic use. In selected cases, oral antibiotics were as effective as intravenous therapy. Conclusions Shorter intravenous antibiotic courses and early transition to oral antibiotics are effective in managing complicated appendicitis, leading to shorter hospital stays and reduced healthcare costs without increasing complications. Individualised treatment based on patient risk factors and intraoperative findings is essential. These findings support antimicrobial stewardship initiatives and highlight the need for further research, especially in high-risk populations.