A 2-day regimen of postoperative intravenous antibiotics was noninferior to 5 days of treatment in patients with complex appendicitis, researchers report. The conclusion is based on a noninferiority margin of 7.5% for infectious complications and mortality within 90 days. The authors caution that these findings apply to laparoscopic appendicectomy conducted in a well-resourced healthcare setting. “Adopting this strategy will reduce adverse effects of antibiotics and length of hospital stay,” they add.
Conducted in 15 Dutch hospitals, the pragmatic, open-label trial randomized patients 8 years of age or older with complex appendicitis to 2 days or 5 days of postoperative intravenous antibiotics. “Between April 12, 2017, and June 3, 2021, 13,267 patients were screened and 1,066 were randomly assigned, 533 to each group,” the authors write. “31 were excluded from intention-to-treat analysis of the 2-day group and 30 from the 5-day group owing to errors in recruitment or consent. Appendicectomy was done laparoscopically in 955 (95%) of 1,005 patients. The telephone follow-up was completed in 664 (66%) of 1,005 patients. The primary endpoint occurred in 51 (10%) of 502 patients analysed in the 2-day group and 41 (8%) of 503 patients analysed in the 5-day group (adjusted absolute risk difference 2.0%, 95% CI −1.6 to 5.6). Rates of complications and re-interventions were similar between trial groups. Fewer patients had adverse effects of antibiotics in the 2-day group (45 [9%] of 502 patients) than in the 5-day group (112 [22%] of 503 patients; odds ratio [OR] 0.344, 95% CI 0.237 to 0.498). Re-admission to hospital was more frequent in the 2-day group (58 [12%] of 502 patients) than in the 5-day group (29 [6%] of 503 patients; OR 2.135, 1.342 to 3.396). There were no treatment-related deaths.”