Inpatient Clinical Pathway for Evaluation/Treatment
of Children with Appendicitis

Diagnosis of Appendicitis
Operative Management
Post-operative Management
  • No post-operative antibiotics
  • Oral Pain Medications
    • Narcotics 2-3 days
  • Advance diet as tolerated
  • Encourage ambulation
  • Post-operative antibiotics
  • Ceftriaxone /Metronidazole until
    • Normal VS, tolerating diet and ambulating
  • Oral Pain Medications
    • Narcotics 2-3 days
  • IR Drainage as able
  • Ceftriaxone /Metronidazole
  • ID Consult as indicated
  • Discharge to complete 7 days of PO:
    • Ciprofloxacin + Metronidazole
  • IR Drainage as able
  • Ceftriaxone /Metronidazole
  • ID Consult as indicated
  • Discharge to complete 14 days of PO:
    • Ciprofloxacin + Metronidazole
  • Interval Appendectomy
    • 4-6 weeks
No antibiotics after Discharge
Discharge Criteria
  • Use Clinical Criteria Only
  • Normal Vital Signs
  • Abdominal Exam
    • Soft, non-distended
    • No significant tenderness
  • Tolerating diet
  • Ambulating
  • Comfortable on PO pain medications
  • IVF, advance diet as tolerated
  • Pain Management
    • Ketorolac if no bleeding concerns
    • PO Oxycodone once tolerating PO
Posted: June, 2011
Revised: June, 2015, March, 2016, November 2016, January 2017, January 2019, March 2021, May 2021,
November 2021
Authors: J. Gerber, MD; P. Mattei, MD; T. Metjian, PharmD; M. Hayes, PharmD; K. Chiotos, MD; K. Johanson, CRNP