{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,26]],"date-time":"2026-07-26T03:35:14Z","timestamp":1785036914033,"version":"3.55.0"},"reference-count":28,"publisher":"Georg Thieme Verlag KG","issue":"03","license":[{"start":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T00:00:00Z","timestamp":1766534400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Postoperative antibiotic treatment of varying length is routinely used in perforated appendicitis to reduce the risk of complications. In the pediatric population, outcomes of shortened antibiotic regimens have not been specifically reviewed.<\/jats:p>\n                  <jats:p>Medline, Embase, the Cochrane Library, and CINAHL were searched (October 2023): P, patients: Children with perforated appendicitis; I, intervention and C, comparison: Antibiotic regimen below (I) and above (C) a defined number of days; O, outcomes, focus: Patient risks and benefits. For the main outcome (intra-abdominal abscess), non-inferiority was assessed.<\/jats:p>\n                  <jats:p>Three randomized controlled trials (RCTs; 215 children) and one non-randomized study (288 children) fulfilled the PICO criteria. Regarding intra-abdominal abscess, pooling data from two RCTs (&lt;5 vs. 5 days of intravenous antibiotics; 16 (17%) vs. 15 [15%] events) resulted in a wide 95% confidence interval (risk difference: \u22128 to 12 percentage points) not meeting the predefined non-inferiority margin of 7.5. One RCT (2 vs. 5 days of intravenous antibiotics) provided data regarding readmissions (9 vs. 7 events) and complications to antibiotic treatment (8 vs. 9 events). Two RCTs (&lt;5 vs. 5 days of intravenous antibiotics) reported significantly shorter length of stay in the intervention group.<\/jats:p>\n                  <jats:p>This systematic review shows neither non-inferiority nor an increased risk of intra-abdominal abscess with a shortened postoperative antibiotic regimen. There may be no difference regarding readmission rates and treatment-related complications. Shorter regimens probably offer the advantage of reduced hospital stay. Due to substantial uncertainties, further RCTs are needed to define the optimal duration of antibiotics in children.<\/jats:p>","DOI":"10.1055\/a-2761-5649","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T23:46:55Z","timestamp":1766620015000},"page":"210-216","source":"Crossref","is-referenced-by-count":2,"title":["Effectiveness and Safety of Shortened Postoperative Antibiotic Regimens in Children with Perforated Appendicitis: A Systematic Review and Meta-Analysis"],"prefix":"10.1055","volume":"36","author":[{"given":"Pia","family":"L\u00f6fgren","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias","family":"Berge","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth M.L.","family":"de Wijkerslooth","sequence":"additional","affiliation":[{"name":"Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lennart","family":"Jiveg\u00e5rd","sequence":"additional","affiliation":[{"name":"Center for Health Technology Assessment, Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1376-9092","authenticated-orcid":false,"given":"Sofia","family":"Sj\u00f6str\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden"},{"name":"Department of Paediatrics, Sahlgrenska Academy, University of Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7238-1680","authenticated-orcid":false,"given":"Susanna M.","family":"Wallerstedt","sequence":"additional","affiliation":[{"name":"Center for Health Technology Assessment, Sahlgrenska University Hospital, Region V\u00e4stra G\u00f6taland, Gothenburg, Sweden"},{"name":"Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2025,12,24]]},"reference":[{"issue":"03","key":"ref1","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s00383-016-3990-2","article-title":"Pediatric appendicitis: state of the art review","volume":"33","author":"R M Rentea","year":"2017","journal-title":"Pediatr Surg Int"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3109\/08941939.2015.1114690","article-title":"Predicting postoperative complications after pediatric perforated appendicitis","volume":"29","author":"G Frongia","year":"2016","journal-title":"J Invest Surg"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1001\/archsurg.142.3.236","article-title":"Risk factors for the development of abdominal abscess following operation for perforated appendicitis in children: A multicenter case-control study","volume":"142","author":"M C Henry","year":"2007","journal-title":"Arch Surg"},{"issue":"09","key":"ref4","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1089\/sur.2019.293","article-title":"Multi-center prospective study of restrictive post-operative antibiotic treatment of children with complicated appendicitis","volume":"21","author":"Q Liu","year":"2020","journal-title":"Surg Infect (Larchmt)"},{"issue":"12","key":"ref5","doi-asserted-by":"crossref","first-page":"3049","DOI":"10.1007\/s00268-010-0767-y","article-title":"Prolonged antibiotic treatment does not prevent intra-abdominal abscesses in perforated appendicitis","volume":"34","author":"K van Wijck","year":"2010","journal-title":"World J Surg"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1186\/s12887-019-1799-6","article-title":"Intravenous versus intravenous\/oral antibiotics for perforated appendicitis in pediatric patients: A systematic review and meta-analysis","volume":"19","author":"C Wang","year":"2019","journal-title":"BMC Pediatr"},{"issue":"08","key":"ref7","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1016\/j.jpedsurg.2016.01.016","article-title":"The contribution of practice variation to length of stay for children with perforated appendicitis","volume":"51","author":"T S Gross","year":"2016","journal-title":"J Pediatr Surg"},{"key":"ref8","first-page":"100173","article-title":"Is there a need for revised guidelines in the treatment of perforated appendicitis in children? 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