Short-course antibiotics after appendectomy for complicated appendicitis show similar infection risk to long-course therapy

BACKGROUND: Short-course antibiotic (SCA) therapy after appendectomy for complicated appendicitis (CA) has gained increasing attention, but its safety and efficacy remain insufficiently supported by meta-analyses. This study aimed to evaluate whether SCA therapy is as safe and effective as conventional long-course antibiotic (LCA) therapy following appendectomy for CA. METHODS: A comprehensive literature search was conducted to identify randomized controlled trials (RCTs) and observational studies comparing different durations of postoperative antibiotic therapy for CA. Data were analyzed using RevMan 5.3 for meta-analysis, and the GRADE approach was applied to assess the quality of evidence for key outcomes. RESULTS: Four RCTs and nine observational studies involving 3,251 patients were included. The meta-analysis revealed no significant increase in the risk of surgical site infection (SSI) (RR = 1.19, 95% CI: 0.52 to 2.73, P = 0.67, low-quality evidence) or intra-abdominal abscess (IAA) (RR = 1.18, 95% CI: 0.92 to 1.51, P = 0.19, moderate-quality evidence) with less than 3-day SCA therapy compared to LCA therapy. Secondary outcomes showed no significant differences between the two regimens (moderate to very-low quality evidence). However, SCA therapy was associated with a shorter length of hospital stay (low-quality evidence). CONCLUSION: For patients with CA, less than 3-day SCA therapy does not increase the risk of SSI or IAA. Moreover, reducing the duration of antibiotic use may help minimize unnecessary antibiotic consumption.