Inpatient Pathway for the Evaluation/Treatment of the Child with Appendicitis

Perforated Appendicitis

Diet/IVF NPO
Clear, advance diet as tolerated
IV heplock when tolerating po fluid
Activity out of bed as tolerated
Pain Control Ketorolac unless contraindicated
Morphine or Nalbuphine
Transition to po Oxycodone when able
Antibiotics Ceftriaxone and Metronidazole
Consider transition to oral Ciprofloxacin and
Metronidazole once clinically improved and
afebrile for 24 hours
Total antibiotic course 14 days
Drains Daily assess need for drain if present
Discharge Teaching Standard nursing post-op teaching
Evaluate for Abscess
Consider US or CT
CBC, CRP
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No Collection
Evaluate other
causes of fever

Failure to Improve After IV Antibiotics 7 Days

Abscess
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Off Pathway
Follow
Drainable Collection Pathway