This is the conclusion of a study by the Erasmus MC Department of Surgery that was published in the scientific journal The Lancet. The researchers hope that the proven method will be followed internationally.
Big problem
“Antibiotic resistance is a major problem worldwide,” say the three principal researchers, Prof. Bas Wijnhoven, Elisabeth de Wijkerslooth and Anne Loes van den Boom. “We believe these findings may aid in more strategic use of antibiotics.”
Surgical treatment of appendicitis, also known as appendicitis, is the most commonly performed emergency surgical procedure worldwide. In the Netherlands, approximately 14,000 people develop appendicitis every year. A third of them get what is known as complex appendicitis, for example because an abscess develops or because the appendix ‘pops’. The standard treatment is surgery to remove the appendix. Followed by an infusion of antibiotics for 3 to 5 days to prevent a new infection.
APPIC-trial
There have been indications that such an infusion can be considerably shorter. But a good randomized trial had not yet been done. The APPIC trial, which was funded by ZonMw as part of its Good Medicines Use programme, represents three important steps forward.
Firstly, reducing antibiotic use helps in the fight against antibiotic resistance. Secondly, patients do not receive more antibiotics than necessary. After all, antibiotics can have side effects, such as diarrhea and nausea. Allergic reactions also occur. Finally, patients must be hospitalized during the administration of an antibiotic infusion. With a 2-day infusion, they can therefore go home earlier.
Efficient occupation
“The great thing about this study,” says study coordinator Van den Boom, “is that it was partly carried out during the corona period in fifteen different hospitals. That was an extremely difficult period. The fact that we managed to get so many patients to participate in the study, is very special. At the same time, Corona showed that efficient occupancy of hospital beds is essential. This study shows that patients spend 1 to 2 days less in hospital.”
The more than 1000 patients who participated were divided into two groups. One group received the more conservative treatment, surgery plus 5 days of antibiotics via an infusion, the other group received surgery and a 2-day infusion. The vast majority of patients underwent keyhole surgery.
Re-admission
The number of A&E visits and readmissions was higher in the 2-day group. “But those were readmissions due to complications with a mild aftermath. And if you count the days of readmission, the 2-day group was still shorter in hospital than the 5-day group,” explains De Wijkerslooth.
People in the 5-day group experienced more side effects from the antibiotics. And the incidence of abscesses and reinterventions was equal. “The advantages of 2-day administration together outweigh the disadvantages.”
By: National Care Guide
