Comparison of Short-Course versus Conventional Antimicrobial Duration in Mild and Moderate Complicated Intra-Abdominal Infections

Objectives: Studies have shown the feasibility of short-course antimicrobials in complicated intra-abdominal infection (CIAI) following source control procedure (SCP). This study was carried out to compare post-operative complication rates in short-course (5 days) and conventional (7–10 days) duration groups after antimicrobial therapy. Methods: This was a single-centre, open-labelled. randomised control trial conducted from July 2017 to December 2019 upon patients with CIAI. Patients who were haemodynamically unstable, pregnant and had non-perforated, non-gangrenous appendicitis or cholecystitis were excluded. Primary endpoints were surgical site infection (SSI), recurrent intra-abdominal infection (IAI) and mortality. Secondary endpoints included time till occurrence of composite primary outcomes, duration of antimicrobial therapy, the length of hospital stays, antimicrobial-free interval, hospital-free days at 30 days’ interval and the presence of extra-abdominal infections. Results: Overall, 140 patients were included whose demographic and clinico-pathological details were comparable in both groups. There was no difference in SSI (37% vs. 35.6%) and recurrent IAI (5.7% vs. 2.8%; P = 0.76), and no mortality was observed in either groups. The composite primary outcome (37% vs. 35.7%) was also similar in both groups. Secondary outcomes included the duration of antimicrobial therapy (5 vs. 8 days; P < 0.001) and length of hospitalisation (5 days vs. 7 days; P = 0.014) were significant. Times till occurrence of SSI and recurrent IAI, incidence of extra-abdominal infection and resistant pathogens were comparable. Conclusion: Short-course antimicrobial therapy for 5 days following SCP for mild and moderate CIAI was comparable to conventional duration antimicrobial therapy, indicating similar efficacy. Keywords: Abdominal Abscess; Antibiotic Prophylaxis; Antimicrobial Stewardship; Appendicitis, Perforated; Drug Resistance, Microbial; Intra-abdominal Infection; Peritonitis; Surgical Wound Infection.