MedBalans

Complicated appendicitis

Adults · verify locally

Inpatient

First line

  • Ceftriaxone + metronidazole · i.v.

    Ceftriaxone 1–2 g IV daily + metro 500 mg IV tid

Alternatives

  • Piperacillin/tazobactam · i.v.

    4.5 g IV q6–8h

  • Ertapenem · i.v.

    1 g IV daily

  • Ciprofloxacin + metronidazole · i.v.

    Cipro 400 mg IV bid + metro 500 mg IV tid

Duration

≤24 h after uncomplicated appendectomy; ~4 days after adequate source control if complicated (STOP-IT style)

Notes

  • Source control is primary; short post-op course if drainage/resection adequate.
  • Uncomplicated appendectomy: perioperative antibiotics only.

Blood cultures if septic; intraoperative/drain cultures for abscess.

  • • SIS / WSES appendicitis; STOP-IT trial (2015)