What is the role of medications 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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Answer

Administer 1 dose of preoperative antibiotics to children with suspected appendicitis. Antibiotics can be discontinued after surgery if no perforation is noted.

Antibiotics are selected to provide coverage for aerobic and anaerobic organisms. The most widely used regimen is the combination of ampicillin, clindamycin (or metronidazole), and gentamicin. Alternative regimens include the following:

  • Ampicillin/sulbactam

  • Cefoxitin

  • Cefotetan

  • Piperacillin/tazobactam

  • Ticarcillin/clavulanate

  • Imipenem/cilastatin

Resistant organisms develop in 15% of patients with a ruptured appendix. Antibiotic substitutions are made for patient allergies, poor clinical improvement or deterioration on current regimen, or culture-proven antibiotic resistance.

Patients with appendicitis also require medication for pain control. Antiemetic and antipyretic agents may also be indicated.

Antibiotic regimens should cover the most commonly encountered organisms, including Escherichia coli and Bacteroides, Klebsiella, Enterococcus, and Pseudomonas species.


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