The study matters because appendicitis remains one of the world’s most common surgical emergencies, while antimicrobial resistance continues to threaten healthcare systems globally. Inappropriate antibiotic use, whether unnecessary, excessive, or poorly targeted, can reduce treatment effectiveness and contribute to drug-resistant infections.
Published in the Asian Journal of Healthcare Analytics (AJHA), the research offers a close look at antibiotic stewardship in a regional Indonesian hospital and highlights where clinical practice aligns with, and departs from, international recommendations.
Acute appendicitis occurs when the appendix becomes inflamed, usually requiring prompt surgical removal to prevent serious complications such as perforation and peritonitis. Antibiotics play an important supporting role in treatment. In uncomplicated appendicitis, they are primarily used to prevent infection around surgery. In perforated or complicated cases, antibiotics become part of active infection management.
International guidelines issued by the American Society of Health-System Pharmacists (ASHP) and the Infectious Diseases Society of America (IDSA) outline how these medicines should be prescribed. However, implementing those standards consistently can be challenging, especially in regional healthcare facilities where treatment decisions may also depend on local protocols and available resources.
To evaluate prescribing quality, the UKI researchers conducted a retrospective observational study at RSUD Aeramo.
The team reviewed medical records from adult appendicitis patients treated between April 2024 and April 2025. Of 35 identified cases, only 25 records met the study’s inclusion requirements because they contained complete information about antibiotic type, dosage, route of administration, and timing.
Rather than using complex statistical modeling, the researchers relied on a clinical audit tool known as the Gyssens Method. This system evaluates whether antibiotics are prescribed appropriately by examining indications, drug selection, dosage, timing, and treatment duration. Prescriptions are grouped into categories ranging from Category 0, representing rational and appropriate use, to higher categories that signal problems such as ineffective drug choice or lack of medical indication.
The patient profile revealed several notable patterns.
Women accounted for most appendicitis cases in the study, representing 60 percent of patients, while men comprised 40 percent. Young adults aged 18 to 25 years formed the largest age group, accounting for 52 percent of all cases.
Researchers also found a slightly higher number of perforated appendicitis cases than non-perforated cases. Among the 25 patients, 13 patients (52 percent) experienced perforated appendicitis, while 12 patients (48 percent) had non-perforated disease.
This difference may reflect delayed treatment-seeking behavior.
According to the researchers, limited awareness of early symptoms, including lower-right abdominal pain, nausea, and digestive discomfort, may lead some patients to postpone medical care. Delayed diagnosis increases the likelihood of perforation, which often requires more intensive treatment and longer antibiotic exposure.
Antibiotic prescribing patterns at RSUD Aeramo showed a strong preference for cephalosporin-based regimens.
All patients received prophylactic antibiotics consisting of cefazolin combined with metronidazole before surgery. This combination is commonly used to prevent surgical site infections and broadly aligns with hospital policy.
For pre-operative treatment, cefotaxime dominated prescribing patterns, used in 76 percent of patients, while ceftriaxone accounted for 20 percent of cases. Post-operative treatment varied, including cefotaxime alone, ceftriaxone alone, and combinations with metronidazole. Almost every patient later received cefixime as oral take-home therapy.
The most important findings emerged when researchers assessed whether these prescriptions were medically justified.
Across the 25 patients, researchers documented 100 antibiotic administrations. Evaluation using the Gyssens method produced mixed results.
The study found:
- 53 percent of antibiotic use was classified as rational and appropriate (Category 0)
- 14 percent fell into Category IV A, meaning a more effective alternative was available
- 33 percent were categorized as Category V, indicating no clear medical indication
The largest source of inappropriate prescribing involved post-operative antibiotics in non-perforated appendicitis cases.
Under international recommendations, uncomplicated appendicitis generally requires only prophylactic antibiotics before surgery. Additional antibiotics after surgery are usually unnecessary unless complications develop. Despite this guidance, the study found that many patients with non-perforated appendicitis still received prolonged antibiotic treatment.
The use of cefotaxime and cefixime in uncomplicated cases contributed substantially to prescriptions categorized as lacking indication.
Drug selection also presented challenges.
Researchers found that some perforated cases received cefazolin, even though international guidance recommends broader empirical therapy such as ceftriaxone combined with metronidazole for complicated intra-abdominal infections. These prescribing choices placed several cases into the category where more effective alternatives were available.
Even so, the study did identify encouraging results.
Overall accuracy reached 67 percent when assessed by dosage, route of administration, and timing. This indicates that healthcare providers generally administered antibiotics correctly once treatment decisions had been made.
The remaining problems, however, centered on deciding when antibiotics were truly necessary and which agents were most appropriate.
Romauli Lumbantobing and colleagues argue that these findings reinforce the need for stronger Antimicrobial Stewardship Programs (ASP) within hospitals. Such programs are designed to monitor antibiotic prescribing, improve adherence to guidelines, and slow the development of antimicrobial resistance.
For hospitals like RSUD Aeramo, the research provides practical evidence that better compliance with updated antimicrobial protocols could improve care quality while protecting antibiotic effectiveness for future patients.
The implications extend beyond a single hospital.
As antimicrobial resistance continues to rise worldwide, studies like this highlight how everyday prescribing decisions can influence broader public health outcomes. Rational antibiotic use is no longer only a clinical issue it has become a long-term healthcare priority.
Author Profile
Dr. Romauli Lumbantobing is a lecturer and researcher in the Department of Pharmacology and Therapy, Faculty of Medicine, Universitas Kristen Indonesia. Her work focuses on pharmacology, rational drug use, and clinical therapy evaluation.
Lidwindy Morani Logo Ule is a clinical medical student at the Faculty of Medicine, Universitas Kristen Indonesia, with research interests in clinical practice and healthcare evaluation.
Nur Nunu Prihantini is affiliated with the Department of Biochemistry, Faculty of Medicine, Universitas Kristen Indonesia, specializing in biomedical and clinical sciences.
0 Komentar