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 (seven cases, 7.4%, in group A and eight cases, 8.6%, in group B, P = 0.794) and overall non-infectious complications (seven cases, 7.4%, in group A and six cases, 6.5%, in group B, P = 1.000) showed no significant difference between the two groups. 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.