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Abstract
Background
Postoperative antibiotic treatment of varying length is routinely used in perforated appendicitis to reduce the risk of complications. In the pediatric population, outcomes of shortened antibiotic regimens have not been specifically reviewed.
MethodsMedline, Embase, the Cochrane Library, and CINAHL were searched (October 2023): P, patients: Children with perforated appendicitis; I, intervention and C, comparison: Antibiotic regimen below (I) and above (C) a defined number of days; O, outcomes, focus: Patient risks and benefits. For the main outcome (intra-abdominal abscess), non-inferiority was assessed.
ResultsThree randomized controlled trials (RCTs; 215 children) and one non-randomized study (288 children) fulfilled the PICO criteria. Regarding intra-abdominal abscess, pooling data from two RCTs (<5 vs. 5 days of intravenous antibiotics; 16 (17%) vs. 15 [15%] events) resulted in a wide 95% confidence interval (risk difference: −8 to 12 percentage points) not meeting the predefined non-inferiority margin of 7.5. One RCT (2 vs. 5 days of intravenous antibiotics) provided data regarding readmissions (9 vs. 7 events) and complications to antibiotic treatment (8 vs. 9 events). Two RCTs (<5 vs. 5 days of intravenous antibiotics) reported significantly shorter length of stay in the intervention group.
ConclusionThis systematic review shows neither non-inferiority nor an increased risk of intra-abdominal abscess with a shortened postoperative antibiotic regimen. There may be no difference regarding readmission rates and treatment-related complications. Shorter regimens probably offer the advantage of reduced hospital stay. Due to substantial uncertainties, further RCTs are needed to define the optimal duration of antibiotics in children.
Keywords antibiotic - children - meta-analysis - perforated appendicitis - systematic review Contributors' StatementP.L. and S.S. conceived the study, and L.J. and S.M.W. designed it. P.L., E.B., L.J., S.S., and S.M.W. took part in the process of including and excluding articles. P.L. and S.M.W. extracted data from the included studies, which were checked by E.B., L.J., and S.S. E.d.W. contributed data from an RCT.[17] P.L., E.B., L.J., S.S., and S.M.W. assessed the study quality. S.M.W. performed the meta-analyses. P.L. and S.M.W. drafted the manuscript, and all authors revised it for intellectual content. The authors approved the final version of the article.
This systematic review and meta-analysis does not require ethical approval.
‡ Deceased
Received: 08 September 2024
Accepted: 08 November 2025
Article published online:
24 December 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
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