Acute appendicitis is one of the most common surgical emergencies among children, and complicated acute appendicitis (CAA), including perforation or gangrenous disease, carries a high risk of infection and prolonged hospital stay. Although intravenous antibiotics during hospitalization are standard treatment, the role of home oral antibiotics (OHA) after discharge remains controversial. Many hospitals continue home oral antibiotics (OHA) to prevent late-onset infections, but this practice varies by surgeon and facility. At the same time, unnecessary antibiotic exposure can cause side effects, disrupt gut flora, and increase the risk of infections. clostridioides difficile It causes infections and contributes to antimicrobial resistance. These concerns have prompted calls for stronger evidence about the real-world value of post-discharge antibiotics for children with CAA.
Researchers from the Department of Pediatric Surgery, Complejo Asistencial de Leon University, Spain, and Pediatric Surgery, Niño Jesús University Hospital, Madrid, Spain, published their findings online. World Pediatric Journal January 27, 2026 (DOI: 10.1007/s12519-025-01008-z). This study evaluated whether post-discharge OHA reduces infectious complications and readmission compared to non-home antibiotics (NHA) in children treated surgically for CAA.
The researchers searched PubMed, Web of Science, Scopus, Ovid, and Cochrane Central from database inception until March 2025, and the reviews were prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO). Fourteen observational studies involving 26,174 pediatric patients were included. Importantly, no randomized controlled trials (RCTs) were identified, highlighting the limited strength of evidence currently available. A random effects meta-analysis was conducted for intra-abdominal abscess (IAA), surgical site infection (SSI), OSI, and readmission.
Across pooled analyses, OHA did not significantly reduce the risk of IAA, OSI, or readmission. The pooled risk ratios were 1.23 for IAA, 1.19 for OSI, and 1.07 for readmission, with 95% confidence intervals all above the null threshold. Although SSI appeared to be lower in the OHA group in the overall analysis, this signal disappeared in sensitivity analyzes restricted to studies using crude patient-level exposure data, suggesting that protocol differences and confounding may have shaped the results. Exposure limitation analysis showed that children discharged without antibiotics had a slightly lower risk of readmission, suggesting possible harm from routine OHA.
The authors stated that these findings should not be interpreted as a call to abandon clinical judgment, but as evidence that automatic continuation of antibiotics after discharge requires stronger justification. They said the review shows a consistent gap between common practice and proven benefits. Children with CAA are often given antibiotics and sent home because they are at risk for the disease, but the available evidence does not show a reliable reduction in major complications. They also emphasized that the certainty of the evidence remains very low, primarily because the included studies were all observational and susceptible to confounding by indication.
This study supports a more selective, evidence-based approach to post-discharge care of children with CAA. For hospitals, the results can inform antibiotic stewardship programs, discharge pathways, and shared decision-making with families. Reducing unnecessary OHAs, combined with clear discharge criteria and follow-up plans, may help reduce medication burden, limit adverse events, and address antimicrobial resistance without compromising recovery. However, the authors emphasize that high-quality multicenter RCTs are urgently needed to determine which children truly benefit from antibiotics after hospital discharge. Until then, the routine use of OHA after surgery for pediatric CAA is not supported by current evidence.
sauce:
Chinese Academy of Sciences
Reference magazines:
Arredondo Montero, J., Rico Jiménez, M. (2026). Home oral antibiotic use after discharge in complicated pediatric appendicitis: a systematic review and meta-analysis. World Journal of Pediatrics. DOI: 10.1007/s12519-025-01008-z. https://link.springer.com/article/10.1007/s12519-025-01008-z
