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Appendicitis Organism-Specific Therapy

Organism-Specific Therapeutic Regimens

Organism-specific therapeutic regimens for appendicitis in adults are outlined below, including those for anaerobic organisms (including Bacteroides fragilis, Clostridium 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.

See Appendicitis: Avoiding Pitfalls in Diagnosis, a Critical Images slideshow, to help make an accurate diagnosis.

Anaerobic organisms (including Bacteroides fragilis, Clostridium spp, Prevotella spp)

See the list below:

Clindamycin 600 mg IV q8h or

Metronidazole 500 mg IV q8h or

Ertapenem 1 g IV daily or

Ampicillin-sulbactam 3 g IV q6h or

Ticarcillin-clavulanate 3.1 g IV q4-6h or

Ceftolozane/tazobactam 1.5 g IV q8h plus metronidazole 500 mg IV q8h

Aerobic gram-negative bacilli (including Escherichia coli, Klebsiella spp, Proteus mirabilis)

See the list below:

Aztreonam 1-2 g IV q8h or

Ampicillin 2 g IV q4h for or

Ciprofloxacin 400 mg IV q12h or

Ertapenem 1 g IV daily or

Levofloxacin 750 mg IV q24h or

Gentamicin 5-7 mg/kg IV q24h or

Cefoxitin 2g IV q8h or

Cefotetan 2 g IV q12h or

Cefotaxime 1-2 g IV q6-8h or

Ceftriaxone 1-2g IV q24h or

Ceftolozane/tazobactam 1.5 g IV q8h plus metronidazole 500 mg IV q8h

Pseudomonas aeruginosa

See the list below:

Aztreonam 1-2 g IV q8h or

Ciprofloxacin 400 mg IV q12h or

Piperacillin-tazobactam 4.5 g IV q6h or

Doripenem 500 mg IV q8h or

Imipenem-cilastatin 500 mg IV q6h or

Meropenem 1 g IV q8h or

Ceftolozane/tazobactam 1.5 g IV q8h plus metronidazole 500 mg IV q8h

Streptococci and enterococci

See the list below:

Ampicillin-sulbactam 3 g IV q6h or

Ticarcillin-clavulanate 3.1 g IV q4-6h or

Piperacillin-tazobactam 3.375-4.5 g IV q6-8h or

Doripenem 500 mg IV q8h or

Imipenem-cilastatin 500 mg IV q6h or

Meropenem 1 g IV q8h or

Ceftolozane/tazobactam 1.5 g IV q8h plus metronidazole 500 mg IV q8h

Mixture of aerobes and anaerobes

See the list below:

Cefoxitin 2g IV q8h or

Cefotetan 2 g IV q12h or

Ticarcillin-clavulanate 3.1 g IV q4-6h or

Piperacillin-tazobactam 3.375-4.5 g IV q6-8h or

Ampicillin-sulbactam 3 g IV q6h or

Doripenem 500 mg IV q8h or

Imipenem-cilastatin 500 mg IV q6h or

Meropenem 1 g IV q8h or

Ertapenem 1 g IV daily or

Moxifloxacin 400 mg IV q24h

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