A new review suggests that routinely prescribing antibiotics after hospital discharge may provide little benefit for children recovering from complicated acute appendicitis (CAA). The findings add to growing concerns about unnecessary antibiotic exposure and its potential role in adverse effects and antimicrobial resistance.
Complicated appendicitis, which includes perforated or gangrenous cases, is one of the most serious forms of appendicitis in children and often requires surgery followed by intravenous antibiotics during hospitalization. However, many hospitals also prescribe oral antibiotics after discharge as a precaution against delayed infections, despite a lack of clear consensus on their effectiveness.
Researchers from Spain conducted a systematic review and meta-analysis to evaluate whether oral home antibiotics reduce the risk of post-surgical complications. The study, published in the World Journal of Pediatrics, analyzed data from 14 observational studies involving 26,174 pediatric patients treated surgically for complicated appendicitis.
Researchers found no significant reduction in intra-abdominal abscesses (RR 1.23), overall infectious complications (RR 1.19), or hospital readmissions (RR 1.07) among children receiving oral antibiotics after discharge. Because all confidence intervals crossed the threshold for statistical significance, the results suggest that routine post-discharge antibiotics do not provide a proven benefit in preventing major complications.
Interestingly, a separate sensitivity analysis indicated that children discharged without antibiotics had a slightly lower risk of hospital readmission, raising questions about whether routine antibiotic use may sometimes offer no advantage or even contribute to unwanted outcomes.
The authors emphasized that the findings should not replace clinical judgment but rather encourage a more selective and evidence-based approach. They noted that many children continue to receive antibiotics after discharge because complicated appendicitis is considered high risk, yet current evidence does not demonstrate a consistent reduction in major complications.
The study also highlights the limitations of existing research. No randomized controlled trials were identified, meaning the available evidence is based entirely on observational studies that may be influenced by treatment-selection bias and other confounding factors.
Researchers say the findings could support antibiotic stewardship efforts by helping hospitals reduce unnecessary antibiotic use, minimize medication-related side effects, and combat antimicrobial resistance. However, they stress that large, well-designed randomized clinical trials are urgently needed to determine whether specific groups of children may still benefit from post-discharge antibiotic therapy.
