Pediatric Appendicitis Empiric Therapy 

Updated: Aug 09, 2017
  • Author: Henry C Lin, MD; Chief Editor: Thomas E Herchline, MD  more...
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Empiric Therapy

Preoperative antibiotic prophylaxis should be given in conjunction with surgery for suspected appendicitis. Antibiotics are typically stopped after surgery in patients without perforation. In children with perforated appendicitis, triple antibiotic therapy with ampicillin, gentamicin, and clindamycin or metronidazole is often used. [1, 2, 3]

In patients with suspected appendicitis who do not undergo surgery, antimicrobial therapy should be administered for at least 3 days, until clinical symptoms and signs of infection resolve. [4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14]

Acute Appendicitis

Treatment options are as follows:

  • Ampicillin-sulbactam 200 mg/kg/day (based on ampicillin component) IV/IM divided q6h or
  • Piperacillin-tazobactam 200-300 mg/kg/day (based on piperacillin component) IV divided q6-8h or
  • Ticarcillin-clavulanate 200-300 mg/kg/day (based on ticarcillin component) IV divided q4-6h or
  • Cefoxitin 80-160 mg/kg/day IV divided q6-8h or
  • Ampicillin 200 mg/kg/day IV divided q6h plus  gentamicin 3-7.5 mg/kg/day IV/IM divided q8h plus  clindamycin 20-40 mg/kg/day IV q6-8h or
  • Ampicillin 200 mg/kg/day IV divided q6h plus  gentamicin 3-7.5 mg/kg/day IV/IM divided q8h plus  metronidazole 30-40 mg/kg/day IV divided q8h

Complicated Appendicitis

Treatment options are as follows:

  • Piperacillin-tazobactam 200-300 mg/kg/day (based on piperacillin component) IV divided q6-8h or
  • Meropenem 60 mg/kg/day IV divided q8h or
  • Cefepime 100 mg/kg/day IV q12h plus  metronidazole 30-40 mg/kg/day IV divided q8h or
  • Aztreonam 90-120 mg/kg/day IV divided q6-8h plus  metronidazole 30-40 mg/kg/day IV divided q8h or
  • Imipenem-cilastin 60-100 mg/kg/day IV divided q6h