Is there a real role of postoperative antibiotic administration for mild-moderate acute cholecystitis? A prospective randomized controlled trial

Background: In cases of acute cholecystitis (AC), postoperative antibiotic prophylaxis is generally used for the purpose of preventing subsequent infections. However, there is still no standardized guideline regarding antibiotic administration after cholecystectomy. Methods: A total of 200 patients at five participating hospitals who were admitted for cholecystectomy to treat grade I or II AC were enrolled and randomly allocated to a group given a placebo (group A) or a group given postoperative antibiotics (group B). Surgical outcomes and incidence of postoperative infectious morbidities were reviewed. Results: A total of 188 patients (95 patients in group A and 93 patients in group B) were finally analyzed. The incidence rate of infectious complications (7 cases, 7.4%, in group A and 8 cases, 8.6%, in group B, p=0.794) and overall non- infectious complications (7 cases, 7.4%, in group A and 6 cases, 6.5%, in group B, p=1.000) showed no significant difference between the two groups.Tabled 1FP19-12 Table [Analysis of postoperative infectious morbidities]CharacteristicsTotal (n=188)group A (No antibiotics, n=95)group B (Antibiotics, n=93)p-valueInfectious complications (%)15 (8)7 (7.4)8 (8.6)0.794Sustained fever after POD 2 (%)7 (3.7)3 (3.2)4 (4.3)0.719Surgical site infection (%)8 (4.3)4 (4.2)4 (4.3)1.000Superficial incisional SSI6 (3.2)3 (3.2)3 (3.2)1.000Deep incisional SSI1 (0.5)01 (1.1)0.495Organ/space SSI1 (0.5)1 (1.1)01.000 Open table in a new tab Conclusions: Absence of postoperative antibiotic administration did not lead to an increase in postoperative infections in cases of mild to moderate AC. Avoidance of unnecessary antibiotic use will reduce the adverse effects of antibiotics and also allow for a tailored treatment strategy according to the severity of cholecystitis.