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.
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.
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