Appendicitis Perforated/Peritoneal Spillage (Complicated)

Most likely pathogens

Duration of therapy

5-7 days

(if source control achieved and no abscess)

May switch to oral amoxicillin-clavulanate (if applicable) once afebrile, tolerating diet and normal WBC to complete therapy.

Gentamicin
7 mg/kg/dose IV q24h
Maximum: 400 mg/24h prior to levels

AND

Metronidazole 15 mg/kg/dose IV q12h
Maximum: 500 mg/dose

OR

Cefoxitin 80 -160 mg/kg/24h IV divided q6-8h
Maximum: 2 grams/dose

Ceftriaxone 50-75 mg/kg/dose IV q24h
Maximum: 1-2 gram/24h

AND

Metronidazole 15 mg/kg/dose IV q12h
Maximum: 500 mg/dose

OR

Dosing based on piperacillin component:
Piperacillin-tazobactam 240-300 mg/kg/24h IV divided q6-8h

Maximum: 4 grams/doseand 16 grams/24h

Gentamicin
7 mg/kg/dose IV q24h
Maximum: 400 mg/24h prior to levels

AND

Metronidazole 15 mg/kg/dose IV q12h
Maximum: 500 mg/dose

OR

Ceftriaxone 50-75 mg/kg/dose IV q24h
Maximum: 1-2 gram/24h

AND

Metronidazole 15 mg/kg/dose IV q12h
Maximum: 500 mg/dose