Cessation of Antibiotics for Complicated Appendicitis at Discharge Does Not Increase Risk of Post-operative Infection

Infographic · Jul 2024 · 1 min read

In brief

Retrospective study comparing outcomes in pediatric complicated appendicitis with and without discharge antibiotics. No significant differences found in postoperative infections or length of stay, suggesting discontinuing home antibiotics at discharge is safe in clinically stable patients.

Discontinuing home antibiotics after complicated pediatric appendicitis did not increase post-operative infection rates (7% vs 7.4%, p=1.0)
Response-based inpatient IV antibiotics until clinical improvement may be sufficient without home antibiotic continuation
Eliminating home antibiotics did not affect length of stay (4.5 vs 3.95 days) or secondary outcomes including readmission
Current practice of routine home antibiotics for complicated appendicitis (83% in pre-protocol cohort) lacks evidence support
Protocol change reduced antibiotic exposure without compromising safety, potentially decreasing C. difficile risk and antibiotic resistance

Written by the GCMD Library team from the infographic.

A clinical comparison chart displaying three treatment modalities arranged horizontally. Each section contains anatomical illustrations of the esophagus and lower esophageal sphincter, with color-coded success rate indicators (green for high success, yellow/orange for moderate) and complication metrics shown in graphical format below each approach.

Katie W. Russell, David E. Skarda, Trahern W. Jones, Douglas C. Barnhart, Scott S. Short

Purpose: The utilization of home antibiotic therapy following surgery for complicated pediatric appendicitis is highly variable. In 2019, we stopped home antibiotic therapy in this cohort at our institution. We sought to evaluate our outcomes following this protocol change.

Methods: We queried our institutional NSQIP Pediatrics data for all children undergoing appendectomy for complicated appendicitis between January 2015 and May 2022. We identified two cohorts: those discharged with home antibiotics (1/1/15-4/30/19) and those discharged with no home antibiotics (5/1/19-4/30/22). Both groups were treated with response based parenteral antibiotics while hospitalized and discharged when clinically well. Our primary outcome was postoperative deep organ space infection requiring intervention (drainage, aspiration, reoperation, or antibiotics). Secondary outcomes included length of stay, superficial site infection, Clostridium difficile colitis, ER visits, post-operative CT imaging, and readmission.

Results: There were 185 patients in the home antibiotic group (83% discharged with antibiotics) and 121 patients in the no home antibiotic group (8.3% discharged with antibiotics). There were no significant differences in deep organ space infection requiring intervention (7% vs. 7.4%, p = 1.0). Our length of stay was not different (4.5 days vs. 3.95 days, p = 0.32), nor were other secondary outcomes or patient characteristics. All patients had documented follow-up.

Conclusions: We did not identify differences in deep organ space infections, length of stay or other events after eliminating home antibiotic therapy in our complicated appendicitis cohort. The use of home antibiotics following surgery for complicated appendicitis should be reconsidered.

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