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

No further antibiotics usually required.

UNCOMPLICATED (e.g. no perforation) and COMPLICATED Appendicitis (e.g perforation, appendiceal collection/ abscess present)

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, use Ceftriaxone IV and Metronidazole IV.

For immediate type hypersensitivity (eg. anaphylaxis) to penicillins/cephalosporins, use Gentamicin IV plus Lincomycin IV.

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)

Seek ID specialist review if continued for more than 72 hours.

Comments:

Seek pharmacist/ID advice on appropriate therapeutic drug monitoring (TDM) and appropriate dosing for patients in renal failure.

Paediatric Tobramycin/Gentamicin Therapeutic drug monitoring

For more information, refer to CHQ Paediatric Antibiocard: Empirical Antibiotic Guidelines

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 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 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.