Management of Acute Diarrhea in Postoperative Appendectomy Patients Receiving Ampicillin-Sulbactam

Evaluation and Management

The World Health Organization recommends testing for Clostridioides difficile using an immunoassay enzyme (EIA) for toxins A and B, which has a specificity of 93-100% but variable sensitivity of 63-99%, and PCR testing has higher sensitivity and is FDA-approved 1
The American College of Surgeons suggests evaluating for signs of alarm such as persistent fever, leucocytosis, and severe abdominal pain, which may indicate intra-abdominal complications 2, 3
The Infectious Diseases Society of America recommends against prolonging antibiotics more than 3-5 days in complicated appendicitis with adequate source control, as longer courses do not provide additional benefit and increase the risk of complications (Strong Recommendation 1A) 2, 3, 7
The Society of Surgical Oncology states that a fixed duration of therapy (approximately 4 days) had similar outcomes to longer courses (approximately 8 days) in the STOP-IT trial 2, 3, 6
The World Journal of Emergency Surgery suggests that suspension of antibiotics after 24 hours is safe and associated with shorter hospital stays without increasing complications 2, 3, 4

The American College of Surgeons recommends that for uncomplicated appendicitis, no postoperative antibiotics are needed, and a single preoperative dose of broad-spectrum antibiotics (0-60 minutes before incision) is sufficient 4, 5, 6
For complicated appendicitis, a period of 3-5 days is generally sufficient when adequate source control has been achieved 2, 3, 7, 8

If C. difficile is positive, the Infectious Diseases Society of America recommends initiating targeted treatment against C. difficile and managing fluids and electrolytes appropriately 1
If C. difficile is negative, the American College of Surgeons suggests evaluating whether the patient has complicated or uncomplicated appendicitis to determine if antibiotics are still indicated 2, 3

The World Health Organization recommends that suspension of antibiotics should be based on clinical and laboratory criteria, including absence of fever, normalization of leucocytosis, and evident clinical improvement 2, 3, 8