Title : Antibiotics use for acute appendicitis
Abstract:
Aims: There was anecdotal evidence of inconsistent antibiotic prescriptions for patients with acute appendicitis as there was only one existing antibiotics trust guideline that covers all intraabdominal infections. This audit aimed to investigate the compliance to the current guideline, with the introduction of new antibiotics guidelines focused on acute appendicitis, followed by a second loop audit to investigate the compliance to the new guideline.
Method: The first loop audit included all patients (N=122) admitted with acute appendicitis from June to September 2024. The audit findings was presented in the clinical governance meeting in February 2025, alongside with the proposed new guideline on acute appendicitis by the microbiology team. The new guideline was published in June 2025 after being approved by the general surgery, anaesthetics, microbiology and paediatrics team. The second loop audit included all patients (N=64) admitted with acute appendicitis from June to July 2025.
Results: In the first loop audit, the compliance rate to the existing abdominal infection guideline was 3% with mean duration 3.3 days and 7.3 days for uncomplicated and complicated appendicitis respectively. The rate of readmission and surgical site infections were 9% and 3.3% respectively. After the introduction of the new trust guideline on appendicitis use, the compliance was 77% in the second loop audit, with mean duration of 3.2 days and 7.4 days for both uncomplicated and complicated appendicitis respectively. The rate of readmission and surgical site infections were 7.8% and 4.7% respectively.
Conclusions: The second-loop audit revealed a major improvement in the compliance rate (3% to 77%) after the introduction of the new trust guideline on antibiotics for acute appendicitis, with a slight reduction in the readmission rate. SSI rates remained low in both audits. Further intervention and audit should be conducted to review the compliance rate.
