Suspected appendicitis
This guideline is for the management of suspected appendicitis prior to surgical intervention. The decision to start treating as a suspected appendicitis should be made by a registrar or consultant.
Preferred
co-amoxiclav iv:
1 month to 2 months: 30 mg/kg iv BD
3 months to 17 years: 30 mg/kg (Max 1.2g) iv TDS
AND
Consider adding gentamicin if severity score is 4 or more (see table below). gentamicin 7mg/kg (max 560mg) iv OD
For MRSA positive patients: Add vancomycin iv
Alternative: For penicillin allergy (non-severe)
ceftriaxone 80mg/kg (Max 4g) iv OD
AND
metronidazole:
1 month up to 2 months: Loading dose 15mg/kg (Max 500mg) iv, then (after 8 hours) 7.5mg/kg (Max 500mg) iv TDS
2 months to 17 years: 7.5mg/kg (max 500mg) iv TDS
Alternative: For penicillin allergy (severe)
clindamycin 10mg/kg (max 600mg) iv QDS
AND
Consider adding gentamicin if severity score is 4 or more (see table below). gentamicin 7mg/kg (Max 560mg) iv OD
For MRSA positive patients: Add vancomycin iv