Template:Appendicitis Antibiotics

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

Complicated Appendicitis

Defined as perforation, abscess, or phlegmon

Options:

• Metronidazole 500 mg IV q8hrs +
  • Cefepime 50 mg/kg IV q12hrs OR
  • Ciprofloxacin 400 mg IV q12hrs OR
  • Levofloxacin 750 mg IV q24hrs OR
  • Aztreonam 30 mg/kg IV q8hrs
• Imipenem/Cilastatin 25 mg/kg IV q6hrs (max 500mg)
• Meropenem 20 mg/kg IV q8hrs (max 1g)
• Piperacillin/Tazobactam 100 mg/kg (max 4.5g) IV q8hrs

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