Royal Alexandra Children’s Hospital, Brighton and Sussex University Hospitals NHS Trust Surgical Treatment Algorithm for Acute Appendicitis Diagnosis of acute appendicitis Initial Assessment by surgical team Author: J.Sheth, R. Hallows, B.Narayanaswamy, D Annandale. Publication date: 05/2019 Review date: 05/2021 Normal appendix 1. IV Cefuroxime (See BNF) 2. IV Metronidazole 7.5mg/kg (max. 500mg) TDS For a total of 24 hours No antibiotics required upon discharge Upon discharge Gangrenous/perforated appendix 1. IV Cefuroxime (Doses as per operative findings) 2. IV Metronidazole 7.5mg/kg (max. 500mg) TDS 3. IV Gentamicin 7mg/kg OD Review and revise according to sensitivities For a total of 5 days If clinically well, no need for further antibiotics. In some cases e.g. resolving collection, discharge home on: 5 days of PO Co-Amoxiclav or alternative antibiotic according to sensitivities – consultant decision Severe penicillin allergy: discuss with Micro team Inflamed, non- perforated appendix 1. IV Cefuroxime (see BNF) 2. IV Metronidazole 7.5mg/kg (max. 500mg) TDS For a total of 48 hours Following Theatre No antibiotics required upon discharge • All patients with perforated or gangrenous appendicitis must have intra- operative peritoneal fluid or pus samples sent for microscopy, culture, and sensitivity. • Rationalise antibiotics as per sensitivities of intra-operative peritoneal fluid or pus cultures. • This algorithm is to assist in the decision-making process for children presenting with a diagnosis of acute appendicitis. Treatment of each individual case is at the discretion of the consultant surgeon. IV Cefuroxime TDS (Consider increased doses as per BNF in severe infection) and IV Metronidazole 7.5mg/kg (max. 500mg) TDS Consider IV Gentamicin 7mg/kg OD (check renal function) Severe penicillin allergy: IV Gentamicin 7mg/kg OD and IV Metronidazole 7.5mg/kg (max 500 mg) TDS