Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
Important: Therapy
IV Amoxicillin
+ IV Metronidazole
+ IV Gentamicin
Notes:
Consider IV to oral switch when afebrile for 24 hours and inflammatory markers improving.
In absence of microbiology results use Co-amoxiclav for oral switch.
Appendicitis/Peritonitis
Warning
What's new / Latest updates
Updated duration guidance and treatment options.
Micro Organisms
Coliforms, anaerobes, Enterococci
Duration
Up to 7 days depending on degree of contamination and established infection. See notes below.
Simple appendicitis: No post-operative antibiotics.
Complex appendicitis (perforation/gangrenous/associated sepsis): Minimum of 72 hours post-operatively (48 hours IV). Consider stopping from 3 days post-surgery if apyrexial for over 24 hours and white cell count below 10. If white cell count remains over 10 on day 3, complete 7 days.
Conservatively managed appendicitis: Minimum 24 hours IV. 7 days total.
Oral switch may not be required depending on duration of IV therapy.
Longer courses may be necessary if source control is not achieved. Discuss with paediatric infectious diseases consultant or microbiology.
Important: Therapy
IV Ceftriaxone
+ IV Metronidazole
Notes:
Consider IV to oral switch when afebrile for 24 hours and inflammatory markers improving. For oral switch options seek specialist advice from paediatric infectious diseases consultant or microbiology.
Important: Therapy
IV Clindamycin
+ IV Gentamicin
Notes:
Consider IV to oral switch when afebrile for 24 hours and inflammatory markers improving. For oral switch options seek specialist advice from paediatric infectious diseases consultant or microbiology.
Important: Therapy
All cases must be discussed with Paediatric Renal Consultant on call at RHC, Glasgow.
Notes:
Important: Notes
For complicated intra-abdominal infection send blood for culture and intra-abdominal samples (ideally pus in a universal container) from theatre.
Please note: antibiotic surgical prophylaxis for appendectomy should be a single dose at induction, unless already on treatment.