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
• 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