Antibiotics may not reduce infections in severe appendectomies

Antibiotic use after surgery for complicated appendicitis may do more harm than good.

Washington: Routine use of post-operative antibiotics in complicated cases of acute appendicitis do not reduce infections after surgery, according to a new study.

Researchers also found that patients who receive antibiotics after surgery for complicated appendicitis may have to remain in the hospital up to one day longer than similar patients who do not receive antibiotics.

Researchers at Los Angeles Biomedical Research Institute (LA BioMed) and Olive View-University of California, Los Angeles Medical Centre studied the outcomes over five years for 410 adults with complicated appendectomies, or those where the appendix was found to be perforated or gangrenous.

Post-operative antibiotics were administered to 274 of those patients, or 66.8 per cent.

The study compared patients who received post-operative antibiotics to those who had not received the medications and found no significant difference in wound complications among the two groups.

The 274 patients who received post-operative antibiotics had slightly longer hospital stays - an average of about one day longer - than the patients who did not receive the medication.

"Our study indicates antibiotics may not be necessary following surgery for complicated appendicitis," said corresponding author, Dennis Y Kim, LA BioMed lead researcher.

"Antibiotics are not without risks, costs or complications. While further study is needed, surgeons and physicians may wish to re-examine or be more selective in deciding which patients may potentially benefit from post-operative antibiotic therapy for complicated appendicitis," said Kim.

In the US, acute appendicitis affects more than 250,000 patients annually, and the overall lifetime risk of acute appendicitis is 6 per cent to 20 per cent, according to the researchers.

Complicated appendicitis, which is defined as a finding of a gangrenous or perforated appendix during surgery, may occur in up to one-third of patients presenting with acute appendicitis, researchers said.

"The traditional teaching is that all patients with complicated appendicitis receive post-operative antibiotics to reduce the risk of wound infection or deep organ space infection," said Kim.

"But the medical profession is beginning to re-examine the role of antibiotics for treating other common acute surgical disease processes, and our study shows this re-evaluation is warranted in complicated appendectomies," Kim said.

The study was published in the American Journal of Surgery.