Inpatient Pathway for the Evaluation/Treatment of the Child with Appendicitis
Admitted for Suspected Appendicitis
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Appendicitis Diagnosed
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Operative Management
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NPO, IVF, Pain Control
Antibiotics as Indicated
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Equivocal Appendicitis
Estimated LOS 1 Day
Non-Perforated
Estimated LOS 2 Days
Perforated
Estimated LOS 2-7 Days

General Antibiotic Recommendations

  • Non-Allergic Healthy Patients
  • Cetriaxione/Metronidazole
  • Cephalosporin/PCN Allergy
  • Ciprofloxacin/Metronidazole
  • If Non-perforated Appendicitis
  • Pre-operative - Ceftriaxone/Metronidazole
  • Post-operative - Metronidazole, single dose
  • Recent Hospitalization > 4 Days/Immunocompromised/Very Ill
  • ID Consult
  • Piperacillin/Tazobactam

Discharge Criteria

  • Normal VS
  • Abdomen
    • Soft, non-distended
    • No significant tenderness
  • Tolerating diet
  • Ambulating
  • Comfortable on oral pain medications
  • Schedule follow-up with Surgery 3 to 4 weeks

Pain Medications

  • Morphine/Nalbuphine IV until taking po
  • PO Oxycodone once tolerating po
  • Ketorolac IV post-op, if no bleeding concerns
Posted: June, 2011
Authors: J. Collins, MD, J. Lavelle, MD, J. Gerber, MD, K. Ross, CRNP, K. Barnaby, CRNP, C. Jacobstein, MD
Evidence Reviews