OBJECTIVE: To compare the efficacy of short-course versus longcourse antibiotic therapy among patients undergoing appendectomy for complicated appendicitis. METHODS: The authors conducted an electronic search of PubMed, Cochrane Library, and EBSCOHost for studies from 2000 to January, 2000 to September, 2018 comparing short-course versus long-course antibiotic therapy in adults undergoing appendectomy for complicated appendicitis. The outcomes considered were the incidence of superficial surgical site infection and intra-abdominal abscess, and duration of hospital stay. Meta-analysis was performed using Review Manager software. RESULTS: A total of 360 patients in two studies were analyzed. Superficial surgical site infection was identified in 5 out of 123 patients in the short-course antibiotic group (4%), and 5 out of 237 patients in the long-course antibiotic group (2.1%) (95% CI 0.38, 5.51, p=0.58). There was a decrease in the incidence of intra-abdominal abscess in the short-course antibiotic group (6.5%), but the difference was not statistically significant (95% CI 0.32, 1.77, p=0.52). The duration of hospital stay was significantly less in the short-course antibiotic group (3.95 days) compared to the long-course antibiotic group (4.6 days) (95% CI -0.66, -0.21; p<0.001). CONCLUSION No difference between the <5-day and ≥5-day antibiotic course in terms of surgical site infection and intra-abdominal abscess was detected. However, the hospital stay of the <5-day group was shorter.
Appendectomy

INTRODUCTION: Antibiotics have been used customarily in the treatment of uncomplicated diverticulitis since their introduction and have become the standard of care. The aim of this study is to compare the effectiveness of antibiotic therapy versus no antibiotic therapy in the treatment of uncomplicated sigmoid diverticulitis. METHODS: An electronic search for randomized controlled trials comparing antibiotics versus no antibiotic therapy for uncomplicated diverticulitis was conducted. The outcomes considered were associated morbidity (abscess formation and sigmoid perforation); need for sigmoid colon resection, and recurrence of diverticulitis. The included studies were evaluated for risk of bias. Meta-analysis with Forest plot was performed using Review Manager Version 5.3. RESULTS: Two trials, consisting of 1,151 subjects, were included in the meta-analysis. There was no difference in the risk of sigmoid perforation (RR 1.02, 95% CI 0.30, 3.49). Abscess formation and incidence of sigmoid resection were lower in the antibiotics groups (RR 2.24, 95% CI 0.51, 9.95 and RR 1.59, 95% CI 0.75, 3.36, respectively) but the differences were not significant. There was no difference in the recurrence of diverticulitis (RR 1.05, 95% CI 0.74, 1.78) between the two groups. CONCLUSION There is no definite advantage in giving antibiotics to patients with uncomplicated diverticulitis. Not giving antibiotics may be an acceptable treatment option for patients with acute uncomplicated sigmoid diverticulitis.