Pediatric Appendicitis Organism-Specific Therapy
- Author: Kara E Hennelly, MD; Chief Editor: Thomas E Herchline, MD more...
Organism-Specific Therapy
Organism-specific therapeutic regimens for appendicitis in children are outlined below, including those for anaerobic organisms (including Bacteroides fragilis, Clostridium species [spp], and Prevotella spp), aerobic gram-negative bacilli (including Escherichia coli, Klebsiella spp, and Proteus mirabilis), Pseudomonas aeruginosa, streptococci, enterococci, and mixtures of aerobes and anaerobes.[1, 2, 3, 4, 5, 6]
Anaerobic organisms (including Bacteroides fragilis, Clostridium spp, Prevotella spp)
- Clindamycin 20-40 mg/kg/day IV divided q6-8h or
- Metronidazole 30-40 mg/kg/day IV divided q8h or
- Ampicillin-sulbactam 200 mg/kg/day (based on ampicillin component) IV/IM divided q6h or
- Ticarcillin-clavulanate 200-300 mg/kg/day (based on ticarcillin component) IV divided q4-6h
Aerobic gram-negative bacilli (including Escherichia coli, Klebsiella spp, Proteus mirabilis)
- Aztreonam 90-120 mg/kg/day IV divided q6-8h or
- Ampicillin 200 mg/kg/day IV divided q12h or
- Cefoxitin 80-160 mg/kg/day IV divided q4-6h or
- Cefotetan 40-80 mg/kg/day IV divided q12h or
- Cefotaxime 150-200 mg/kg/day IV divided q6-8h or
- Ceftriaxone 50-75 mg/kg IV q24h
Pseudomonas aeruginosa
- Aztreonam 90-120 mg/kg/day IV divided q6-8h or
- Piperacillin-tazobactam 200-300 mg/kg/day (based on piperacillin component) IV divided q6h or
- Imipenem-cilastin 60-100 mg/kg/day IV divided q6h or
- Meropenem 60 mg/kg/day IV divided q8h
Streptococci and enterococci
- Ampicillin-sulbactam 200 mg/kg/day (based on ampicillin component) IV/IM divided q6h or
- Ticarcillin-clavulanate 200-300 mg/kg/day (based on ticarcillin component) IV divided q4-6h or
- Piperacillin-tazobactam 200-300 mg/kg/day (based on piperacillin component) IV divided q6-8h or
- Imipenem-cilastin 60-100 mg/kg/day IV divided q6h or
- Meropenem 60 mg/kg/day IV divided q8h
Mixtures of aerobes and anaerobes
- Cefoxitin 80-160 mg/kg/day IV divided q4-6h or
- Cefotetan 40-80 mg/kg/day IV divided q12h or
- Ticarcillin-clavulanate 200-300 mg/kg/day (based on ticarcillin component) IV divided q4-6h or
- Piperacillin-tazobactam 200-300 mg/kg/day (based on piperacillin component) IV divided q6-8h or
- Ampicillin-sulbactam 200 mg/kg/day (based on ampicillin component) IV/IM divided q6h or
- Imipenem-cilastin 60-100 mg/kg/day IV divided q6h or
- Meropenem 60 mg/kg/day IV divided q8h
Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis?. JAMA. 2007;298(4):438-451.
Hernanz-Schulman M. CT and US in the diagnosis of appendicitis: an argument for CT. Radiology. 2010;255(1):3-7.
Katz MS, Freitas MS, Tucker JR, Glick P. Appendicitis. Medscape Reference. WebMD. Updated January 9, 2009. Available at http://emedicine.medscape.con/article/926795-overview.
Kharbanda AB, Taylor GA, Fishman SJ, Bachur RG. A clinical decision rule to identify children at low risk for appendicitis. Pediatrics. 2005;116(3):709-716.
Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:133-164.
Tsao K, St Peter SD, Valusek PA, et al. Management of pediatric acute appendicitis in the computed tomographic era. J Surg Res. 2008;147(2):221-224.
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