Antimicrobial Therapy for Children with Appendicitis
Key Points
Key Points
- Appendicitis affects approximately 300,000 patients/year and consumes over 1 million hospital days in the US. Lifetime risk is 8.6% for males and 6.7% for females. In 2005, patients with abdominal pain composed 6.8%
of 115 million annual emergency department visits. - Appendicitis typically begins with luminal obstruction from inspissated fecal matter or lymphoid hyperplasia and progresses to perforation at a rate of approximately 5-10%/24 hours after the first 24 hours.
- In young, preverbal toddlers, the risk of perforation at the time of appendicitis diagnosis is high. In children younger than 4 years, appendiceal perforation occurs in the vast majority of cases, with rates reported as high as 80% to 100%. In contrast, appendicitis in children aged 10 to 17 years is more common, but the perforation rate is much lower (10%-20%).
- Appendicitis is generally diagnosed by a constellation of history and physical exam findings and limited laboratory evaluations.
- Diagnostic imaging is used to confirm the diagnosis in most women and children, and frequently in men as well.
- Most patients with acute appendicitis can be safely managed with laparoscopic or open appendectomy.
- Selected patients with periappendiceal abscess or phlegmon, and selected patients with acute, nonperforated appendicitis can be safely managed nonoperatively with antimicrobial therapy alone.
- Antimicrobial therapy is important in preventing the complications of acute appendicitis, including both surgical site infections and deep organ space abscesses.
- Antimicrobial therapy should be initiated preoperatively in all patients undergoing operative appendectomy. Antimicrobial therapy should be discontinued within 24 hours in patients with acute, nonperforated appendicitis.
- Patients with perforated appendicitis and patients being managed nonoperatively should receive antimicrobial therapy according to the general principles outlined for management of patients with complicated intra-abdominal infection.
Assessment and Diagnosis
...ssment and Diagno...
...s for appendicitis obtained from t...
Table 1. The Alvarado Score (Mnemonic for the diagnostic score of acute appendicitis: MANTRELS)
...he Alvarado Score (Mnemonic for the diagnostic s...
...cted Appendiciti...
Imaging
...aging
...d upon the patient’s age, history and p...
...is the initial imaging modality of choice for...
...es should undergo diagnostic imaging. Those...
If these studies do not define the pathology prese...
...ing of all children (particularly those...
...ients with negative imaging studies for suspected...
For patients with suspected appendicitis that...
Antimicrobial Therapy
...microbial Therapy
...bial therapy should be administered to all patien...
...ropriate antimicrobial therapy includes agents eff...
...rapy should be started when the diagnosis of ap...
...ppendicitis without evidence of per...
...with suspected appendicitis whose diagno...
Microbiology
...crobiology
...help define the presence of yeast. (C, III)686...
...patients, aerobic and anaerobic cultures sho...
...appears clinically toxic or is severely immunocom...
...bility testing for Pseudomonas, Pro...
...is significant resistance (greater than 10-20%)...
Table 2. Initial Intravenous Adult and Child Doses of Antibiotics for Empiric Treatment of Complicated Intra-Abdominal Infections
...al Intravenous Adult and Child Doses...
Outpatient Antimicrobial Therapy
...atient Antimicrobial Therap...
For children and adults whose signs and symptom...
...or adults recovering from intra-abdominal inf...
...e and susceptibility testing identify organisms su...
...outpatient parenteral antibiotic managemen...
...wn therapy in children, intra-abdominal cultures...