Cefoxitin IV 40mg/kg (up to 2g max) as a single dose peri-operatively at induction.

No further antibiotics usually required.

Immediate type penicillin/cephalosporin hypersensitivity,

Substitute with single dose of Metronidazole IV 7.5 mg/kg (maximum 500 mg)

PLUS Gentamicin 5 mg/kg IV

(1 month to 10 years old: maximum 320 mg)

(More than 10 years old: maximum 560 mg)

IV antibiotics are not usually required for postoperative treatment of uncomplicated appendicitis.
If required a short course (e.g. 72 hours) is usually sufficient:


Ampicillin IV ( or Amoxycillin IV)

If more than 1 month of age: 50mg/kg/dose IV every 6 hours (Max 2gram/dose)

Plus Gentamicin IV

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 560mg/day)

Plus Metronidazole IV

If more than 1 month of age: 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

If IV antibiotics required for more than 72 hours, direct treatment based on microbiology results and seek ID advice.

For delayed type hypersensitivity (eg. rash) to penicillins,If more than 1 month of age: use Ceftriaxone IV 50mg/kg once daily (Max 2gram/day)

PLUS Metronidazole IV 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins,

If more than 1 month of age: use Gentamicin IV plus Lincomycin IV 15mg/kg/dose (Max 1.2gram/dose) every 8 hours

EMPIRICAL ANTIBIOTICS FOR FIRST 72 HOURS, CHOOSE EITHER OPTION 1 OR OPTION 2 :

OPTION 1:

Ampicillin IV ( or Amoxycillin IV)

Neonates: Refer to Ampicillin/Amoxycillin neonatal dosing section

If more than 1 month of age: 50mg/kg/dose IV every 6 hours (Max 2gram/dose)

Plus Gentamicin IV

Neonates: Refer to Gentamicin neonatal dosing section

If more than 1 month and less than 10 years of age: 7.5mg/kg IV once daily (max initial dose of 320mg/day)

If more than 10 years of age: 6mg/kg IV once daily (max initial dose of 560mg/day)

Plus Metronidazole IV

Neonates: Refer to Metronidazole neonatal dosing section

If more than 1 month of age: 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

OPTION 2:

Piperacillin/ Tazobactam IV

Neonates: 100mg/kg/dose every 8 hours (dose based on Piperacillin component).

If more than 1 month of age: 100mg/kg/dose every 6 hours (maximum 4 g/dose Piperacillin component).

Piperacillin/ Tazobactam IV 100mg/kg/dose every 6 hours (maximum 4 g/dose Piperacillin component).

IF ANTIBIOTICS REQUIRED BEYOND 72 HOURS, CHANGE TO EITHER OPTION 3 OR OPTION 4:

OPTION 3:

IV Amoxicillin-Clavulanic acid (for up to 4 days)

Neonates and Infants (0 to 3 months)

• If <4kg: 25mg/kg/dose (amoxicillin component) every 12 hours
• If >4kg: 25mg/kg/dose (amoxicillin component) every 8 hours

Infants and children (>3 months)

Severe infection: 25mg/kg/dose (amoxicillin component) every 6 hourly (Max 1000mg/dose Amoxicillin component)

Adolescents >12 years (and >40kg):

Severe infection: 25mg/kg/dose (amoxicillin component) every 6 hourly (Max 2000mg/dose Amoxicillin component)

OPTION 4:

Piperacillin/ Tazobactam IV (for up to 4 days)

Neonates: 100mg/kg/dose every 8 hours (dose expressed as Piperacillin component).

1 month of age and older: 100mg/kg/dose every 6 hours (maximum 4 g/dose Piperacillin component).

For delayed type hypersensitivity (eg. rash) to penicillins,

If more than 1 month of age: use Ceftriaxone IV 50mg/kg once daily (Max 2gram/day)

PLUS Metronidazole IV 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

If associated sepsis, in patients with delayed type hypersensitivity (eg. rash) to penicillins,

If more than 1 month of age: use Ceftriaxone IV 50mg/kg (Max 2gram/dose) every 12 hours

PLUS Metronidazole IV 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins,

If more than 1 month of age: use Gentamicin IV plus Lincomycin IV 15mg/kg/dose (Max 1.2gram/dose) every 8 hours

INTRAVENOUS TO ORAL SWITCH:

Oral option to complete course: Amoxicillin/ Clavulanic acid 22.5 mg/kg/dose orally twice daily (maximum 875 mg/dose Amoxicillin component). Early oral switch can take place if patient clinically improving.

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins, seek ID advice.

If poor clinical response, antibiotic regimens may be modified based upon the results of cultures of blood, peritoneal fluid, or surgical specimens – seek ID advice. Antibiotic therapy is generally required for 4 to 7 days, the duration may need to be further prolonged if there are deep undrained collections.

Comments:

More information, refer to PICU Empirical Antibiotic Guidelines.

Cefotaxime IV

Neonates: Refer to Cefotaxime neonatal dosing section

If more than one month old: 50mg/kg/dose every 6 hours (Max 2gram/dose)

Plus Metronidazole IV

Neonates: Refer to Metronidazole neonatal dosing section

If more than one month old: 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

Seek ID advice within 72hours

OR

If more than one month old:

Ceftriaxone IV 50mg/kg once daily (Max 2gram/day)

Plus Metronidazole IV 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

Seek ID advice within 72hours

If associated sepsis,

If more than one month old:

Ceftriaxone IV 100mg/kg once daily (Max 4gram/day)

Plus Metronidazole IV 7.5mg/kg/dose IV every 8 hours (Max 500mg/dose)

Seek ID advice within 72hours

Comments:
For more information, refer to CHQ-GDL-01202 Paediatric Antibiocard: Empirical Antibiotic Guidelines.

Infants and Children < 1 year of age: Mebendazole oral 50mg as a single dose

Children >1 year of age: Mebendazole oral 100mg as a single dose

Note: Treat all family members.

Infants and Children: Metronidazole oral 30mg/kg once daily (Max 2gram/dose) for 3 days.