Antibiotics after appendix removal did not reduce the risk of infection
A retrospective cohort study by U.S. researchers found that antibiotic use after surgical treatment of nonperforative appendicitis did not improve outcomes in children with gangrenous, purulent, or exudative manifestations. As reported in JAMA Surgery, antibiotic administration in the postoperative period did not reduce the risk of surgical site infection and hospital re-visits.
Appendicitis is considered the most common abdominal surgical emergency in children, accounting for the highest relative burden of surgical site infections in pediatric surgery. The treatment of appendicitis is also associated with intensive antibiotic use; it ranks third in the total number of days of antibiotic treatment in hospitalized children, behind only pneumonia and cystic fibrosis.
Whether continuing antibiotics after surgery in children with nonperforated appendicitis with gangrenous, purulent, or exudative manifestations is beneficial remains controversial. Studies of this issue show mixed results, but there is still no consensus on the rational use of antibiotics (both medically and economically).
Shawn Rangel's team at Harvard Medical School evaluated whether the use of antibiotics in the postoperative period is associated with improved outcomes in children with non-perforative appendicitis with gangrenous, purulent, or exudative manifestations. Researchers examined data from 958 children from 16 U.S. hospitals, of whom 573 children received postoperative antibiotics.
In an unadjusted analysis, compared with children who did not receive antibiotics postoperatively, children who received antibiotics were more likely to develop more severe disease (gangrenous) and longer duration of surgery. After adjusting for age and disease severity, there was no difference between the groups.
The researchers also found no correlation between hospital-level infection rates and the frequency of antibiotic use in the postoperative period or the average duration of antibiotic use in the postoperative period. There was no significant difference between the frequency of repeat visits and antibiotic prescriptions in the postoperative period.
The results of this study suggest that prescribing antibiotics in children in the postoperative period for the treatment of non-perforative appendicitis does not increase the likelihood of favorable outcomes. Potentially, these findings could help reduce the irrational use of antibacterial drugs.
Antibiotics have obvious adverse effects. In particular, American and Danish scientists have shown that antibiotic use by mothers and infants is associated with an increased risk of eosinophilic esophagitis in the latter.