A new systematic review and meta-analysis published in BMC Surgery by Yousef Kurdi and colleagues has found that postoperative antibiotics do not offer additional benefits in patients with uncomplicated appendicitis. The study analyzed data from 14 studies conducted over the last 15 years and concluded that preoperative antibiotics alone are sufficient to achieve optimal surgical outcomes. The findings suggest that extending antibiotic use into the postoperative period may increase adverse effects without improving recovery or reducing infection risks.
The researchers observed that preoperative prophylaxis with antibiotics such as metronidazole, cefoxitin, and cefuroxime significantly reduced the risk of postoperative complications and shortened hospital stays. In contrast, postoperative antibiotic regimens were linked to higher rates of adverse events, including Clostridium difficile infections, surgical site complications, and urinary tract infections. Patients who received only preoperative antibiotics demonstrated faster recovery, fewer infections, and shorter hospital stays, emphasizing the efficacy and safety of single-phase a use.
The authors highlight that limiting antibiotic administration to the preoperative phase aligns with antimicrobial stewardship principles aimed at reducing unnecessary antibiotic exposure and preventing resistance. The study underscores the importance of updating clinical guidelines to reflect evidence that preoperative antibiotics are adequate for managing uncomplicated appendicitis. By doing so, healthcare systems can enhance patient safety, minimize costs, and promote responsible antibiotic use. Despite some variability across study designs, the meta-analysis provides robust evidence supporting a shift in practice toward more judicious antibiotic management in surgical care.
Keywords: uncomplicated appendicitis, postoperative antibiotics, preoperative antibiotics, antimicrobial stewardship, surgical infection prevention, BMC Surgery.
Reference: Kurdi, Y., Alqahtani, R., Bin Khunayn, N., Alharbi, L., Alanazi, S., & Alqahtani, N. (2025). Evaluating the necessity of post-operative antibiotics in uncomplicated appendicitis: A systematic review and meta-analysis. BMC Surgery, 25, 517. https://doi.org/10.1186/s12893-025-03272-2
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