Jalava K, Sallinen V, Lampela H, Malmi H, Steinholt I, Augestad KM et al.
JAMA Surg 2025; 160: 745–754.
This multicenter trial included 1,797 adults with uncomplicated acute appendicitis undergoing surgery within 24h. Perforation rates were similar (8.3% antibiotics vs 8.9% controls, p=0.66). Surgical site infections were less frequent with antibiotics (1.6% vs 3.2%, p=0.03).
Comment: The only demonstrable difference was a very small reduction in SSIs which may not be worth the cost of the antibiotics. The trial does demonstrate that antibiotics do not prevent perforation.
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