6/28/23, 12:43 AM APPIC Pathway Feedback Search Clinical Topics Home Studies APPIC APPIC Disease Acute appendicitis Trial question Is a short 2-day course of postoperative antibiotics noninferior to a standard 5-day course in patients with complex appendicitis? Study design Multi-center Open label RCT Population 1005 patients Inclusion criteria: patients, aged 8 years, with complex appendicitis Key exclusion criteria: no informed consent; interval appendectomy; clinical suspicion of severe sepsis; conservative treatment of acute appendicitis; immunocompromised state; pregnancy Interventions N=502 short 2-day course (intravenous cefuroxime/metronidazole 1,500/500 mg TID or ceftriaxone/metronidazole once daily 2,000 mg/TID 500 mg for 48 hours according to local antibiotic policy) N=503 standard 5-day course (intravenous cefuroxime/metronidazole 1,500/500 mg TID or ceftriaxone/metronidazole once daily 2,000 mg/TID 500 mg for 5 days according to local antibiotic policy) Primary outcome Rate of infectious complications and death within 90 days 10.0 % 10 8 7.5 % 5 0 % https://web.pathway.md/studies/reciHWrrVNwnN1c6N 1/2 6/28/23, 12:43 AM APPIC Pathway 5.0 % Difference not exceeding nonferiority margin 2.5 % 0.0 % Short 2-day course Standard 5-day course Difference not exceeding nonferiority margin in the rate of infectious complications and death within 90 days (10% vs. 8%; AD 2%, 95% CI -1.6 to 5.6) Secondary outcomes Borderline significant increase in hospital readmission (12% vs. 6%; OR 2.135, 95% CI 1.34 to 3.4) Borderline significant decrease in adverse effects of antibiotics (9% vs. 22%; OR 0.344, 95% CI 0.24 to 0.5) Conclusion In patients, aged 8 years, with complex appendicitis, short 2-day course was noninferior to standard 5-day course with respect to the rate of infectious complications and death within 90 days. Reference Elisabeth M L de Wijkerslooth, Evert-Jan G Boerma, Charles C van Rossem et al. 2 days versus 5 days of postoperative antibiotics for complex appendicitis: a pragmatic, open-label, multicentre, non- inferiority randomised trial. Lancet. 2023 Jan 17;S0140-6736(22)02588-0. Open reference URL https://web.pathway.md/studies/reciHWrrVNwnN1c6N 2/2