Royal Alexandra Children’s Hospital, Brighton and Sussex University Hospitals NHS Trust

Surgical Treatment Algorithm for Acute Appendicitis

Diagnosis of acute appendicitis

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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

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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

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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