Appendicitis — General Antibiotic Recommendations — Clinical Pathway: Inpatient

Appendicitis Clinical Pathway — Inpatient

General Antibiotic Recommendations

Antibiotic Recommendations for Appendicitis

  First-Line Therapy Allergy to First-Line β-Lactam
Assess Need for Alternative		 Comments
  • Appendicitis
    (including acute non-perforated, acute perforated, post-operative abscess, non-operative management of perforated appendicitis with abscess)
  • Ceftriaxone
  • Infants, Children, Adolescents, and Adults:
    • 75 mg/kg/day IV every 24 hours
    • Max dose 2000 mg
  • AND
  • Metronidazole
  • Infants PMA > 44 weeks Children, Adolescents, and Adults:
    • 7.5 mg/kg/dose IV every 6 hours
    • or
    • 10 mg/kg/dose IV every 8 hours
    • Max dose: 2000 mg/day
  • Ciprofloxacin
  • Children, Adolescents, and Adults:
    • 10 mg/kg/dose IV every 8 hours
    • Max dose: 400 mg/dose, 1,200 mg/day
  • AND
  • Metronidazole
  • Infants PMA > 44 weeks Children, Adolescents, and Adults:
    • 7.5 mg/kg/dose every 6 hours
    • or
    • 10 mg/kg/dose every 8 hours
    • Max dose: 2000 mg/day
  • Patients discharged on oral antibiotics:
  • Ciprofloxacin
    Children, Adolescents, and Adults:
    • 20 mg/kg/dose PO BID
    • Max dose: 750 mg/dose, 1500 mg/day
  • AND
  • Metronidazole
  • Infants PMA > 44 weeks Children, Adolescents, and Adults:
    • 7.5 mg/kg/dose PO QID
    • Max dose: 500 mg/dose
  • An alternative drug for children who do not tolerate metronidazole is difficult to identify. Amoxicillin/clavulanate may be adequate, but an IV regimen might need to be considered.
  • For perforated appendicitis patients receiving IV ceftriaxone/metronidazole who are still febrile and symptomatic on POD 3:
  • It is reasonable to consider switching to a different antibiotic regimen such as piperacillin/tazobactam
  • Consider ID Consult
  • Recent Hospitalization > 4 Days/Immunocompromised/Very Ill
  • Consult Infectious Disease
  • Piperacillin/Tazobactam
  • ≥ 2-9 months:
    • 80 mg piperacillin/kg/dose every 8 hours
  • Infants ≥ 9 months, Children, Adolescents ≤ 40 kg:
    • 100 mg piperacillin/kg/dose every 8 hours
    • Max dose: 3000 mg piperacillin/day
  • Children, Adolescents > 40 kg:
    • 3000 mg piperacillin every 6 hours