PREOPERATIVE antibiotics may not be necessary for adults with uncomplicated acute appendicitis awaiting surgery, according to findings from the multinational PERFECT-Antibiotics trial.
The randomized trial included 1,774 adult patients diagnosed with presumed uncomplicated appendicitis across hospitals in Finland and Norway. Participants were assigned to either receive antibiotics while awaiting surgery or to wait without them. All patients underwent laparoscopic appendectomy within 24 hours.
Rates of perforated appendicitis were similar in both groups: 8.3% among those who received antibiotics compared with 8.9% in those who did not. The difference met the criteria for noninferiority, indicating that withholding antibiotics did not increase the risk of disease progression. While surgical site infections were slightly more common in the no-antibiotic group (3.2% versus 1.6%), overall outcomes remained favourable.
The study challenges the traditional assumption that antibiotics are essential for preventing complications during surgical delays. “Our findings suggest that routine preoperative antibiotics may be safely omitted in select patients with uncomplicated appendicitis,” the authors concluded.
These results may support more conservative antibiotic stewardship and streamline preoperative protocols in emergency surgical settings.
Reference
Jalava K et al. Role of Preoperative Antibiotic Treatment While Awaiting Appendectomy: The PERFECT-Antibiotics Randomized Clinical Trial. JAMA Surg. 2025;DOI: 10.1001/jamasurg.2025.1212
