What is the role of antibiotics in the treatment of pediatric appendicitis?

Updated: Oct 25, 2018
  • Author: Adam C Alder, MD; Chief Editor: Carmen Cuffari, MD  more...
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Antibiotic therapy is an important aspect of the treatment of ruptured appendicitis. Intravenous antibiotics should be started once the diagnosis of acute appendicitis is confirmed. Antibiotic therapy should be directed against gram-negative and anaerobic organisms such as Escherichia coli and Bacteroides species.

If the appendix is not gangrenous or perforated, no postoperative antibiotics are indicated. A gangrenous appendix warrants antibiotics for 24-72 hours, depending on clinical improvement and/or Gram stain, if one was obtained during surgery.

Antibiotic therapy for ruptured appendicitis is continued for a minimum of 7-10 days, but a longer course may be needed. Intravenous antibiotics are used during the hospitalization. Oral antibiotics may be used to complete therapy if a child is well enough for discharge.

While appendectomy remains the definitive treatment for appendicitis, many patients with perforated appendicitis are now treated with intravenous antibiotics alone with drainage of the abscess if needed. Additionally, some advocate nonoperative treatment with antibiotics only for early appendicitis, especially when the diagnosis is vague.

A study by Kronman et al compared the effectiveness of extended-spectrum versus narrower-spectrum antibiotics for children with appendicitis. The study found that extended-spectrum antibiotics seem to offer no advantage over narrower-spectrum agents for children with surgically managed acute uncomplicated or complicated appendicitis. [18]

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