SAGES 2026 Annual Meeting Emerging Technology Session

Background

•Taylor’s method is a common nonoperative approach (NOM) for hemodynamically stable PPU patients.

•Optimal antibiotic choice and treatment duration remain unclear — evidence-based guidance is needed.

Methods

•Retrospective multicenter cohort: 2,553 adults with nonoperatively managed PPU (2016–2024)

•Regimens grouped: single-agent, multiple sequential, or multiple simultaneous

•Duration classified: 1–3, 4–6, or ≥7 days

•Multivariable regression: sepsis, abdominal infection, hemorrhage, LOS, 30-day mortality, readmission

Results

•Single-agent therapy (41.6%) was associated with lower sepsis, abdominal infection, 30-day mortality, and shorter LOS than multi-agent regimens.

•Zosyn was the most commonly used single-agent antibiotic (81.1%).

•Zosyn use for ≤3 days was associated with reduced morbidity in NOM of PPU (OR <1, p< 0.05).

•Zosyn use for 4–6 days was associated with reduced mortality (OR <1, p< 0.05).

•Antifungal use was associated with higher infection and mortality rates (OR <1, p< 0.05).

•Pantoprazole use was associated with nearly 6-fold higher risk of perforation hemorrhage (OR >1, p< 0.05).

•Increasing age was associated with worse sepsis, hemorrhage, LOS, and 30-day mortality (OR <1, p< 0.05).

Conclusion

•Findings support evidence-based protocols using short-course single-agent antibiotics (Zosyn) to improve recovery and reduce harm in NOM of PPU.

•PPI and Antifungals may be associated with worse patient outcomes.

Single-Agent and Short-Course Antibiotic Result in Optimal Outcomes for the Nonoperative Management of Perforated Peptic Ulcer