Post-Discharge Oral Home Antibiotics Versus No Oral Home Antibiotics in Complicated Pediatric Appendicitis: A Systematic Review and Meta-Analysis

Background: The use of oral home antibiotics (OHA) after discharge in children undergoing surgery for complicated acute appendicitis (CAA) remains controversial. This systematic review and meta-analysis aimed to evaluate whether OHA reduces the risk of infectious complications or readmissions compared to patients discharged without antibiotics (NHA). Methods: This systematic review was prospectively registered in PROSPERO (CRD420251049919). We searched PubMed, Web of Science, Scopus, Ovid, and Cochrane CENTRAL from inception to March 2025. Two independent reviewers screened the studies, extracted the data, and assessed the methodological quality using the ROBINS-I tool. Four random-effects meta-analyses and four leave-one-out analyses were conducted for intra-abdominal abscesses (IAA), surgical site infections (SSI), organ/space infections (OSI), and hospital readmissions (RA). Three exploratory random-effects meta-regression models were performed for RA. Results: Fourteen studies comprising 26,174 pediatric patients with CAA were included. Meta-analyses showed no significant differences between intervention (IG) and comparator (CG) groups for IAA (RR 0.97; 95% CI: 0.38–2.47), SSI (RR 0.89; 95% CI: 0.58–1.38), OSI (RR 1.19; 95% CI: 0.73–1.93). or RA (RR 1.02; 95% CI: 0.73–1.41), with no evidence of publication bias. A sensitivity analysis restricted to studies reporting crude data for OHA vs. NHA revealed a significantly lower RA risk in NHA patients (RR 0.75; 95% CI: 0.62–0.90, P < 0.01). Meta-regression exploring differences in predischarge total leukocyte counts showed a non-significant trend toward increased RA in patients receiving OHA. Conclusions: OHA after discharge do not appear to reduce the risk of postoperative complications in children treated surgically for CAA. Given the lack of consistent benefit and potential for unnecessary harm, routine use of post-discharge OHA is not supported. A risk-adapted, stewardship-oriented approach is warranted.