Template:Appendicitis Antibiotics: Difference between revisions

Latest revision as of 12:50, 20 March 2026

Coverage should extend to E. coli, Klebsiella, Proteus, and Bacteroides (an anaerobe)

Adult Simple Appendicitis

Antibiotic prophylaxis should be coordinated with surgical consult

Options:

Cefoxitin 2g IV q6 hours OR
Cefotetan 2g IV q12 hours OR
Moxifloxacin 400mg IV once daily OR
Ertapenem 1g IV once daily

Pediatric Simple Appendicitis

Options:

Cefoxitin 40mg/kg IV q6 hours
Cefotetan 40mg/kg IV q12 hours
Gentamicin 2.5mg/kg IV q8hrs +
- Metronidazole 7.5mg/kg IV q6hrs OR
- Clindamycin 10mg/kg IV q8hrs
Ertapenem 15mg/kg IV q12h (max 1g); >13 years: 1g IV daily

Adult Complicated Appendicitis

Defined as perforation, abscess, or phlegmon

Options:

Metronidazole 500mg IV q8hrs +
- Cefepime 2g IV q12hrs OR
- Ciprofloxacin 400mg IV q12hrs OR
- Levofloxacin 750mg IV q24hrs OR
- Aztreonam 2g IV q8hrs
Imipenem/Cilastatin 500mg IV q6hrs
Meropenem 1g IV q8hrs
Piperacillin/Tazobactam 4.5g IV q8hrs

Pediatric Complicated Appendicitis

Options:

Metronidazole 7.5mg/kg IV q6hrs +
- Cefepime 50mg/kg IV q12hrs (max 2g) OR
- Aztreonam 30mg/kg IV q8hrs
Imipenem/Cilastatin 25mg/kg IV q6hrs (max 500mg)
Meropenem 20mg/kg IV q8hrs (max 1g)
Piperacillin/Tazobactam 100mg/kg IV q8hrs (max 4.5g)

Cautious use should be applied to use of fluoroquinolones in complicated pediatric appendicitis due to the risk of tendon injury

@@ Line 19: / Line 19: @@
 **{{AntibioticDose|disease=Appendicitis|drug=Metronidazole|dose=7.5mg/kg IV q6hrs|context=Pediatric Simple|population=Pediatric}} OR
 **{{AntibioticDose|disease=Appendicitis|drug=Clindamycin|dose=10mg/kg IV q8hrs|context=Pediatric Simple|population=Pediatric}}
+*{{AntibioticDose|disease=Appendicitis|drug=Ertapenem|dose=15mg/kg IV q12h (max 1g); >13 years: 1g IV daily|context=Pediatric Simple|population=Pediatric}}
-====Complicated Appendicitis====
+====Adult Complicated Appendicitis====
 ''Defined as perforation, abscess, or phlegmon''
 '''Options:'''
-*{{AntibioticDose|disease=Appendicitis|drug=Metronidazole|dose=500 mg IV q8hrs|context=Complicated}} +
+*{{AntibioticDose|disease=Appendicitis|drug=Metronidazole|dose=500mg IV q8hrs|context=Adult Complicated}} +
-**{{AntibioticDose|disease=Appendicitis|drug=Cefepime|dose=50 mg/kg IV q12hrs|context=Complicated}} OR
+**{{AntibioticDose|disease=Appendicitis|drug=Cefepime|dose=2g IV q12hrs|context=Adult Complicated}} OR
-**{{AntibioticDose|disease=Appendicitis|drug=Ciprofloxacin|dose=400 mg IV q12hrs|context=Complicated}} OR
+**{{AntibioticDose|disease=Appendicitis|drug=Ciprofloxacin|dose=400mg IV q12hrs|context=Adult Complicated}} OR
-**{{AntibioticDose|disease=Appendicitis|drug=Levofloxacin|dose=750 mg IV q24hrs|context=Complicated}} OR
+**{{AntibioticDose|disease=Appendicitis|drug=Levofloxacin|dose=750mg IV q24hrs|context=Adult Complicated}} OR
-**{{AntibioticDose|disease=Appendicitis|drug=Aztreonam|dose=30 mg/kg IV q8hrs|context=Complicated}}
+**{{AntibioticDose|disease=Appendicitis|drug=Aztreonam|dose=2g IV q8hrs|context=Adult Complicated}}
-*{{AntibioticDose|disease=Appendicitis|drug=Imipenem/Cilastatin|dose=25 mg/kg IV q6hrs (max 500mg)|context=Complicated}}
+*{{AntibioticDose|disease=Appendicitis|drug=Imipenem/Cilastatin|dose=500mg IV q6hrs|context=Adult Complicated}}
-*{{AntibioticDose|disease=Appendicitis|drug=Meropenem|dose=20 mg/kg IV q8hrs (max 1g)|context=Complicated}}
+*{{AntibioticDose|disease=Appendicitis|drug=Meropenem|dose=1g IV q8hrs|context=Adult Complicated}}
-*{{AntibioticDose|disease=Appendicitis|drug=Piperacillin/Tazobactam|dose=100 mg/kg (max 4.5g) IV q8hrs|context=Complicated}}
+*{{AntibioticDose|disease=Appendicitis|drug=Piperacillin/Tazobactam|dose=4.5g IV q8hrs|context=Adult Complicated}}
+====Pediatric Complicated Appendicitis====
+'''Options:'''
+*{{AntibioticDose|disease=Appendicitis|drug=Metronidazole|dose=7.5mg/kg IV q6hrs|context=Pediatric Complicated|population=Pediatric}} +
+**{{AntibioticDose|disease=Appendicitis|drug=Cefepime|dose=50mg/kg IV q12hrs (max 2g)|context=Pediatric Complicated|population=Pediatric}} OR
+**{{AntibioticDose|disease=Appendicitis|drug=Aztreonam|dose=30mg/kg IV q8hrs|context=Pediatric Complicated|population=Pediatric}}
+*{{AntibioticDose|disease=Appendicitis|drug=Imipenem/Cilastatin|dose=25mg/kg IV q6hrs (max 500mg)|context=Pediatric Complicated|population=Pediatric}}
+*{{AntibioticDose|disease=Appendicitis|drug=Meropenem|dose=20mg/kg IV q8hrs (max 1g)|context=Pediatric Complicated|population=Pediatric}}
+*{{AntibioticDose|disease=Appendicitis|drug=Piperacillin/Tazobactam|dose=100mg/kg IV q8hrs (max 4.5g)|context=Pediatric Complicated|population=Pediatric}}
 ''Cautious use should be applied to use of [[fluoroquinolones|fluoroquinolones]] in complicated pediatric appendicitis due to the risk of tendon injury''