Inpatient Clinical Pathway for Evaluation/Treatment
of Children with Appendicitis
Related Pathway
Appendicitis w/o
Known GI Disease
Appendicitis w/o
Known GI Disease
Diagnosis of Appendicitis
Consider Non-operative
Management of Acute Appendicitis
Inclusion, Exclusion Criteria
Clinical Care
General Antibiotic Recommendations
Criteria for Failure of Non-operative care
Discharge Instructions
Management of Acute Appendicitis
Inclusion, Exclusion Criteria
Clinical Care
General Antibiotic Recommendations
Criteria for Failure of Non-operative care
Discharge Instructions
Operative Management
Post-operative Management
- No post-operative antibiotics
- Oral Pain Medications
- Narcotics 2-3 days
- Advance diet as tolerated
- Encourage ambulation
- Post-operative antibiotics
- Ceftriaxone /Metronidazole until
- Normal VS, tolerating diet and ambulating
- Oral Pain Medications
- Narcotics 2-3 days
- IR Drainage as able
- Ceftriaxone /Metronidazole
- ID Consult as indicated
- Discharge to complete 7 days of PO:
- Ciprofloxacin + Metronidazole
- IR Drainage as able
- Ceftriaxone /Metronidazole
- ID Consult as indicated
- Discharge to complete 14 days of PO:
- Ciprofloxacin + Metronidazole
- Interval Appendectomy
- 4-6 weeks
No antibiotics after Discharge
Discharge Criteria
- Use Clinical Criteria Only
- Normal Vital Signs
- Abdominal Exam
- Soft, non-distended
- No significant tenderness
- Tolerating diet
- Ambulating
- Comfortable on PO pain medications
- Key Principles
- General Antibiotic Recommendations
Care of Patients with Appendectomy
- IVF, advance diet as tolerated
- Pain Management
- Ketorolac if no bleeding concerns
- PO Oxycodone once tolerating PO
Posted: June, 2011
Last Revised: October 2024
Authors: J. Gerber, MD; P. Mattei, MD; T. Metjian, PharmD; M. Hayes, PharmD; K. Chiotos, MD; K. Johanson, CRNP
Last Revised: October 2024
Authors: J. Gerber, MD; P. Mattei, MD; T. Metjian, PharmD; M. Hayes, PharmD; K. Chiotos, MD; K. Johanson, CRNP
Evidence
- Evidence Review: Antibiotic Management for Pediatric Appendicitis
- Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial
- Effect of Oral Moxifloxacin vs Intravenous Ertapenem Plus Oral Levofloxacin for Treatment of Uncomplicated Acute Appendicitis: The APPAC II Randomized Clinical Trial
- Association of Nonoperative Management Using Antibiotic Therapy vs Laparoscopic Appendectomy With Treatment Success and Disability Days in Children With Uncomplicated Appendicitis
- Efficacy and Safety of Nonoperative Treatment for Acute Appendicitis: A Meta-analysis
- Nonoperative Treatment With Antibiotics Versus Surgery for Acute Nonperforated Appendicitis in Children: A Pilot Randomized Controlled Trial
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