Acute appendicitis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

uncomplicated acute appendicitis

1st line – appendectomy + supportive care

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1st line –

appendectomy + supportive care

Once the diagnosis of acute appendicitis is made, patients should be given nothing by mouth.

Intravenous fluids should be started.[101] Give patients adequate analgesia.[12][45] Refer to local guidelines for choice of suitable analgesic and dose.

Appendectomy should be performed without delay, as early appendectomy reduces the chances of perforation and intra-abdominal abscess.[7]

There are two operative options for appendectomy: open and laparoscopic. In adults, the choice of appendectomy generally depends upon the experience of the surgeon.

Studies have shown laparoscopic appendectomy to have better cosmetic results, shorter length of hospital stay, reduced postoperative pain, and reduced risk of wound infection when compared with open appendectomy.[121][122] [ ] [Evidence B]

Laparoscopic appendectomy is recommended for uncomplicated appendicitis.[123] It is also considered the safest approach in obese patients.[125]

Laparoscopic appendectomy decreases the incidence of overall postoperative complications, including wound infection and duration of total hospital stay.[118][121][126][127][128][129][136]

Some patients with uncomplicated appendicitis may be discharged safely after laparoscopic appendectomy without hospitalization, provided that an ambulatory pathway with well-defined ERAS (Enhanced Recovery After Surgery) protocols and patient information/consent are locally established.[7][134] ERAS implementation after laparoscopic appendectomy carries similar rates of morbidity and readmissions compared with conventional care.[135] Its potential benefits include earlier recovery after surgery and lower hospital and social costs.[7]

In pregnant patients, laparoscopic appendectomy should be preferred to open appendectomy when surgery is indicated and where expertize of laparoscopy is available.[130][131] It is safe in terms of risk of fetal loss and preterm delivery.[130][131] Compared with open surgery during pregnancy, laparoscopic appendectomy is associated with shorter length of hospital stay and lower incidence of surgical site infection.[131] Laparoscopy is technically safe and feasible during pregnancy.[7][130][131][132] Pregnant patients with acute appendicitis should be managed with obstetric support.[100]

In children, nonoperative management is feasible, safe, and effective as initial treatment unless an appendicolith is present.[2][7] However, in the US the usual standard of care for the management of uncomplicated appendicitis in children continues to be operative.[50]

Patients with higher APACHE (Acute Physiology and Chronic Health Evaluation) scores seem to be at higher risk of development of postoperative complications. [ APACHE II scoring system Opens in new window ]

Consider – preoperative intravenous antibiotic therapy

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Consider –

preoperative intravenous antibiotic therapy

Treatment recommended for SOME patients in selected patient group

A single preoperative dose of broad-spectrum antibiotic should be given to patients with uncomplicated appendicitis undergoing appendicectomy at the time of surgery.

In adults, examples for suitable regimens include ceftriaxone, cefotaxime, or cefotetan plus metronidazole.[7][89][102] In patients with beta-lactam allergy, options include ciprofloxacin or levofloxacin plus metronidazole.[7][89][102] Cefotetan is a less desirable option because of the increasing resistance of anaerobic bacteria to this agent and possible decreased efficacy.[7][89][102] See your local drug information source for guidance on antibiotic selection for pregnant patients.

In children, examples of suitable regimens include ceftriaxone plus metronidazole, piperacillin/tazobactam, or ciprofloxacin plus metronidazole.[7][89][102]

Postoperative antibiotics are not indicated for these patients.[7][89][102]

Primary options

Adults

ceftriaxone: 2 g intravenously as a single dose

cefotaxime: 1-2 g intravenously as a single dose

cefotetan: 2 g intravenously as a single dose

-- AND --

metronidazole: 500 mg intravenously as a single dose

Children

ceftriaxone: 50-75 mg/kg intravenously as a single dose, maximum 2000 mg/dose

and

metronidazole: 15 mg/kg intravenously as a single dose, maximum 500 mg/dose

Children

piperacillin/tazobactam: 80-100 mg/kg intravenously as a single dose, maximum 3000 mg/dose

Adults

ciprofloxacin: 400 mg intravenously as a single dose

levofloxacin: 500 mg intravenously as a single dose

-- AND --

metronidazole: 500 mg intravenously as a single dose

Children

ciprofloxacin: 10 mg/kg intravenously as a single dose, maximum 400 mg/dose

and

metronidazole: 15 mg/kg intravenously as a single dose, maximum 500 mg/dose

2nd line – antibiotic-only therapy

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2nd line –

antibiotic-only therapy

Antibiotics alone for the treatment of uncomplicated appendicitis can be successful in selected patients who wish to avoid surgery, and who accept the risk of up to 39% recurrence.[86] In such cases, it is recommended that the diagnosis of uncomplicated appendicitis be confirmed by imaging, and that patient expectations be managed via a shared decision-making process.[7][87][88][89]

The evidence supporting nonoperative management of appendicitis continues to be conflicting, and further research is warranted.[90][91][92][93] There is more evidence to support a nonoperative approach in children than in adults.[7][87][88][94][95][96][97][98][99]

In adults, initial antibiotic therapy should be with a broad-spectrum antibiotic such as ceftriaxone, cefotaxime, cefepime, or ceftazidime plus metronidazole (or ciprofloxacin or levofloxacin plus metronidazole where beta-lactams are contraindicated).[7][89][102] Piperacillin/tazobactam is also an option. In patients at risk of infection by antimicrobial resistant organisms, antibiotic options include ertapenem, imipenem/cilastatin, meropenem, or aztreonam plus vancomycin and metronidazole.[7][89][102] After clinical improvement in 1 to 3 days, antibiotics can be swapped to an oral regimen, to complete a total duration of 7 to 10 days. Oral options include ciprofloxacin or levofloxacin plus metronidazole, or amoxicillin/clavulanate (if local rates of Escherichia coli resistance are <10%).[7][89][102]

In children, initial antibiotic therapy should be with a broad-spectrum antibiotic regimen such as ceftriaxone or cefotaxime plus metronidazole.[7][89][102] Piperacillin/tazobactam is also an option.[89][102] Ciprofloxacin plus metronidazole may be used if beta-lactams are contraindicated.[89][102] In patients at risk of infection by antimicrobial resistant organisms, antibiotic options include ertapenem, imipenem/cilastatin, or meropenem.[7][89][102] After clinical improvement in 1 to 2 days, antibiotics can be swapped to an oral regimen to complete a total duration of 7 to 10 days. Oral options include amoxicillin/clavulanate, or ciprofloxacin plus metronidazole.[7][89][102]

An antibiotic-only approach is not recommended if an appendicolith is present since nonoperative management carries a significant failure rate.[2][7][103]

An antibiotic-only approach is not recommended in pregnant patients.[7]

Primary options

Adults: initial therapy

ceftriaxone: 1-2 g intravenously every 24 hours

cefotaxime: 2 g intravenously every 8 hours

cefepime: 2 g intravenously every 8-12 hours

ceftazidime sodium: 2 g intravenously every 8 hours

-- AND --

metronidazole: 500 mg intravenously every 8 hours

Adults: initial therapy

piperacillin/tazobactam: 3.375 to 4.5 g intravenously every 6 hours

Children: initial therapy

ceftriaxone: 50-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 2000 mg/day

cefotaxime: 150-200 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 2000 mg/day

-- AND --

metronidazole: 30-40 mg/kg/day intravenously given in divided doses every 8 hours, maximum 1500 mg/day; or 30 mg/kg intravenously every 24 hours, maximum 1000 mg/dose (body weight <80 kg) or 1500 mg/dose (body weight ≥80 kg)

Children: initial therapy

piperacillin/tazobactam: 240-400 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 4000 mg/dose

Adults: initial therapy

ciprofloxacin: 400 mg intravenously every 12 hours

levofloxacin: 750 mg intravenously every 24 hours

-- AND --

metronidazole: 500 mg intravenously every 8 hours

Adults: initial therapy

ertapenem: 1 g intravenously every 24 hours

Adults: initial therapy

imipenem/cilastatin: 500 mg intravenously every 6 hours, or 1000 mg every 8 hours

Adults: initial therapy

meropenem: 1 g intravenously every 8 hours

Adults: initial therapy

aztreonam: 1-2 g intravenously every 8 hours

and

vancomycin: 15-20 mg/kg intravenously every 8-12 hours

and

metronidazole: 500 mg intravenously every 8 hours

Children: initial therapy

ciprofloxacin: 10-15 mg/kg intravenously every 12 hours, maximum 400 mg/dose

and

Tertiary options

Adults: step-down therapy

ciprofloxacin: 500 mg orally twice daily

levofloxacin: 750 mg orally once daily

-- AND --

metronidazole: 500 mg orally three times daily

Adults: step-down therapy

amoxicillin/clavulanate: 875 mg orally two to three times daily

Children: step-down therapy

ciprofloxacin: 10-15 mg/kg orally twice daily, maximum 500 mg/dose

and

metronidazole: 30 mg/kg/day orally given in 4 divided doses, maximum 4000 mg/day

Children: step-down therapy

amoxicillin/clavulanate: children <3 months of age and <40 kg body weight: 30 mg/kg/day orally given in 2 divided doses; children ≥3 months of age and <40 kg body weight: 25-45 mg/kg/day orally given in 2 divided doses, or 20-40 mg/kg/day given in 3 divided doses

Primary options

Adults: initial therapy

ceftriaxone: 1-2 g intravenously every 24 hours

cefotaxime: 2 g intravenously every 8 hours

cefepime: 2 g intravenously every 8-12 hours

ceftazidime sodium: 2 g intravenously every 8 hours

-- AND --

metronidazole: 500 mg intravenously every 8 hours

Adults: initial therapy

piperacillin/tazobactam: 3.375 to 4.5 g intravenously every 6 hours

Children: initial therapy

ceftriaxone: 50-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 2000 mg/day

cefotaxime: 150-200 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 2000 mg/day

-- AND --

Children: initial therapy

piperacillin/tazobactam: 240-400 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 4000 mg/dose

Adults: initial therapy

ciprofloxacin: 400 mg intravenously every 12 hours

levofloxacin: 750 mg intravenously every 24 hours

-- AND --

metronidazole: 500 mg intravenously every 8 hours

Adults: initial therapy

ertapenem: 1 g intravenously every 24 hours

Adults: initial therapy

imipenem/cilastatin: 500 mg intravenously every 6 hours, or 1000 mg every 8 hours

Adults: initial therapy

meropenem: 1 g intravenously every 8 hours

Adults: initial therapy

aztreonam: 1-2 g intravenously every 8 hours

and

vancomycin: 15-20 mg/kg intravenously every 8-12 hours

and

metronidazole: 500 mg intravenously every 8 hours

Children: initial therapy

ciprofloxacin: 10-15 mg/kg intravenously every 12 hours, maximum 400 mg/dose

and

Tertiary options

Adults: step-down therapy

ciprofloxacin: 500 mg orally twice daily

levofloxacin: 750 mg orally once daily

-- AND --

metronidazole: 500 mg orally three times daily

Adults: step-down therapy

amoxicillin/clavulanate: 875 mg orally two to three times daily

Children: step-down therapy

ciprofloxacin: 10-15 mg/kg orally twice daily, maximum 500 mg/dose

and

metronidazole: 30 mg/kg/day orally given in 4 divided doses, maximum 4000 mg/day

Children: step-down therapy

Back to drug information with added comorbidities

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Show drug information for a patient with no comorbidities

Primary options

Adults: initial therapy

ceftriaxone

cefotaxime

cefepime

ceftazidime sodium

-- AND --

metronidazole

Adults: initial therapy

piperacillin/tazobactam

Children: initial therapy

ceftriaxone

cefotaxime

-- AND --

metronidazole

Children: initial therapy

piperacillin/tazobactam

Secondary options

Adults: initial therapy

ciprofloxacin

levofloxacin

-- AND --

metronidazole

Adults: initial therapy

ertapenem

Adults: initial therapy

imipenem/cilastatin

Adults: initial therapy

meropenem

Adults: initial therapy

aztreonam

and

vancomycin

and

metronidazole

Children: initial therapy

ciprofloxacin

and

metronidazole

Tertiary options

Adults: step-down therapy

ciprofloxacin

levofloxacin

-- AND --

metronidazole

Adults: step-down therapy

amoxicillin/clavulanate

Children: step-down therapy

ciprofloxacin

and

metronidazole

Children: step-down therapy

amoxicillin/clavulanate

ill with perforation or abscess

1st line – intravenous antibiotic therapy + supportive care

Back

1st line –

intravenous antibiotic therapy + supportive care

These patients have evidence of perforation, mass, or abscess.

Initial management includes keeping the patient nothing by mouth and starting intravenous fluids.[101] Patients who are in shock should be given a bolus of intravenous fluid to help maintain a stable pulse rate and blood pressure.[105] See Shock.

Following on, maintenance intravenous fluids should be given until the condition of the patient improves and an oral diet can be tolerated.

Intravenous antibiotics should be started immediately.[101] Give patients adequate analgesia.[12][45] Refer to local guidelines for choice of suitable analgesic and dose.

Pregnant patients with acute appendicitis should be managed with obstetric support.[100]

In adults, options include: ceftriaxone, cefotaxime, cefepime, ceftazidime, ciprofloxacin, or levofloxacin plus metronidazole; or piperacillin/tazobactam. For more severe infections, patients who are at risk of infection with antimicrobial resistant organisms, or who have healthcare associated infections, antibiotic options include ertapenem, imipenem/cilastatin, meropenem, or aztreonam plus vancomycin and metronidazole.[7][89][102]

See your local drug information source for guidance on antibiotic selection for pregnant patients.

In children, antibiotic options include ceftriaxone or cefotaxime plus metronidazole, or piperacillin/tazobactam. In patients with beta-lactam allergy or other contraindications to the preceding regimens, ciprofloxacin plus metronidazole can be used.[7][89][102]

Combination antibiotic regimens may also be used based on local sensitivities and protocols.[21]

Antibiotics should be continued until the patient becomes afebrile and leukocytosis is corrected.[7]

Patients may be switched from intravenous to oral antibiotics (step-down therapy) when appropriate after clinical improvement. Antibiotics should be considered postoperatively in children and adults who undergo appendectomy.

Short-term postoperative broad-spectrum antibiotics should be considered for adults who have undergone appendectomy for complicated appendicitis, especially if complete source control has not been achieved.[7][50] Options for oral regimens include amoxicillin/clavulanate, or metronidazole plus levofloxacin or ciprofloxacin.[102][115]

Postoperative antibiotics are also recommended for children. Postoperative antibiotics for less than 7 days seems to be safe and is not associated with an increased risk of complications.[89] These can be switched from intravenous to oral form after 48 hours in children with complicated appendicitis, if there is clinical improvement and white cell count has normalized, with an overall length of therapy shorter than 7 days.[7][89][102] Options for oral regimens include amoxicillin/clavulanate, or ciprofloxacin plus metronidazole.[7][89][102]

Patients with higher APACHE (Acute Physiology and Chronic Health Evaluation) scores seem to be at higher risk of development of postoperative complication. [ APACHE II scoring system Opens in new window ]

Primary options

Adults: initial therapy

ceftriaxone: 1-2 g intravenously every 24 hours

cefotaxime: 2 g intravenously every 8 hours

cefepime: 2 g intravenously every 8-12 hours

ceftazidime sodium: 2 g intravenously every 8 hours

-- AND --

metronidazole: 500 mg intravenously every 8 hours

Adults: initial therapy

piperacillin/tazobactam: 3.375 to 4.5 g intravenously every 6 hours

Children: initial therapy

ceftriaxone: 50-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 2000 mg/day

cefotaxime: 150-200 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 2000 mg/day

-- AND --

Children: initial therapy

piperacillin/tazobactam: 240-400 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 4000 mg/dose

Adults: initial therapy

ciprofloxacin: 400 mg intravenously every 12 hours

levofloxacin: 750 mg intravenously every 24 hours

-- AND --

metronidazole: 500 mg intravenously every 8 hours

Adults: initial therapy

ertapenem: 1 g intravenously every 24 hours

Adults: initial therapy

imipenem/cilastatin: 500 mg intravenously every 6 hours, or 1000 mg every 8 hours

Adults: initial therapy

meropenem: 1 g intravenously every 8 hours

Adults: initial therapy

aztreonam: 1-2 g intravenously every 8 hours

and

vancomycin: 15-20 mg/kg intravenously every 8-12 hours

and

metronidazole: 500 mg intravenously every 8 hours

Children: initial therapy

ciprofloxacin: 10-15 mg/kg intravenously every 12 hours, maximum 400 mg/dose

and

Tertiary options

Adults: step-down therapy

ciprofloxacin: 500 mg orally twice daily

levofloxacin: 750 mg orally once daily

-- AND --

metronidazole: 500 mg orally three times daily

Adults: step-down therapy

amoxicillin/clavulanate: 875 mg orally two to three times daily

Children: step-down therapy

ciprofloxacin: 10-15 mg/kg orally twice daily, maximum 500 mg/dose

and

metronidazole: 30 mg/kg/day orally given in 4 divided doses, maximum 4000 mg/day

Children: step-down therapy

Primary options

Adults: initial therapy

ceftriaxone: 1-2 g intravenously every 24 hours

cefotaxime: 2 g intravenously every 8 hours

cefepime: 2 g intravenously every 8-12 hours

ceftazidime sodium: 2 g intravenously every 8 hours

-- AND --

metronidazole: 500 mg intravenously every 8 hours

Adults: initial therapy

piperacillin/tazobactam: 3.375 to 4.5 g intravenously every 6 hours

Children: initial therapy

ceftriaxone: 50-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 2000 mg/day

cefotaxime: 150-200 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 2000 mg/day

-- AND --

Children: initial therapy

piperacillin/tazobactam: 240-400 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 4000 mg/dose

Adults: initial therapy

ciprofloxacin: 400 mg intravenously every 12 hours

levofloxacin: 750 mg intravenously every 24 hours

-- AND --

metronidazole: 500 mg intravenously every 8 hours

Adults: initial therapy

ertapenem: 1 g intravenously every 24 hours

Adults: initial therapy

imipenem/cilastatin: 500 mg intravenously every 6 hours, or 1000 mg every 8 hours

Adults: initial therapy

meropenem: 1 g intravenously every 8 hours

Adults: initial therapy

aztreonam: 1-2 g intravenously every 8 hours

and

vancomycin: 15-20 mg/kg intravenously every 8-12 hours

and

metronidazole: 500 mg intravenously every 8 hours

Children: initial therapy

ciprofloxacin: 10-15 mg/kg intravenously every 12 hours, maximum 400 mg/dose

and

Tertiary options

Adults: step-down therapy

ciprofloxacin: 500 mg orally twice daily

levofloxacin: 750 mg orally once daily

-- AND --

metronidazole: 500 mg orally three times daily

Adults: step-down therapy

amoxicillin/clavulanate: 875 mg orally two to three times daily

Children: step-down therapy

ciprofloxacin: 10-15 mg/kg orally twice daily, maximum 500 mg/dose

and

metronidazole: 30 mg/kg/day orally given in 4 divided doses, maximum 4000 mg/day

Children: step-down therapy

Back to drug information with added comorbidities

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Show drug information for a patient with no comorbidities

Primary options

Adults: initial therapy

ceftriaxone

cefotaxime

cefepime

ceftazidime sodium

-- AND --

metronidazole

Adults: initial therapy

piperacillin/tazobactam

Children: initial therapy

ceftriaxone

cefotaxime

-- AND --

metronidazole

Children: initial therapy

piperacillin/tazobactam

Secondary options

Adults: initial therapy

ciprofloxacin

levofloxacin

-- AND --

metronidazole

Adults: initial therapy

ertapenem

Adults: initial therapy

imipenem/cilastatin

Adults: initial therapy

meropenem

Adults: initial therapy

aztreonam

and

vancomycin

and

metronidazole

Children: initial therapy

ciprofloxacin

and

metronidazole

Tertiary options

Adults: step-down therapy

ciprofloxacin

levofloxacin

-- AND --

metronidazole

Adults: step-down therapy

amoxicillin/clavulanate

Children: step-down therapy

ciprofloxacin

and

metronidazole

Children: step-down therapy

amoxicillin/clavulanate

perforation

Plus – appendectomy

Back

Plus –

appendectomy

Treatment recommended for ALL patients in selected patient group

There are two operative options for appendectomy: open and laparoscopic. In adults, the choice of appendectomy generally depends upon the experience of the surgeon.

Studies have shown laparoscopic appendectomy to have better cosmetic results, shorter length of hospital stay, reduced postoperative pain, and reduced risk of wound infection, when compared with open appendectomy.[121] [ ] [Evidence B]

Laparoscopic appendectomy is recommended for complicated and perforated appendicitis.[123][124] It is also considered the safest approach in obese patients.[125]

In pregnant patients, laparoscopic appendectomy should be preferred to open appendectomy when surgery is indicated and where expertize of laparoscopy is available.[130][131] It is technically feasible and is safe in terms of risk of fetal loss and preterm delivery.[130][131] Compared with open surgery during pregnancy, laparoscopic appendectomy is associated with shorter length of hospital stay and lower incidence of surgical site infection.[7][132][137] Pregnant patients with acute appendicitis should be managed with obstetric support.[100]

In children, laparoscopic appendectomy decreases the incidence of overall postoperative complications, including wound infection and duration of total hospital stay.[118][121][126][127][128][129][136]

abscess

Plus – drainage ± interval appendectomy

Back

Plus –

drainage ± interval appendectomy

Treatment recommended for ALL patients in selected patient group

Abscess usually occurs as a progression of the disease process, particularly after perforation.

Presents with tender right lower quadrant mass, swinging fever, and leukocytosis. Ultrasonography or computed tomography (CT) scan will show the abscess.

Initial treatment in both adults and children includes intravenous antibiotics and CT-guided or operative drainage of the abscess.

If there is clinical improvement and the signs and symptoms are completely resolved, interval appendectomy may be unnecessary.[7][106][107][108][109] Interval appendectomy should be performed if the symptoms do not completely resolve and/or symptoms recur.[7][13] Interval appendectomy is also recommended in all patients over 30 years old with complicated appendicitis initially treated nonoperatively; in addition any patient ages ≥40 years with uncomplicated appendicitis who has conservative management without interval appendectomy should undergo screening with colonoscopy and interval full-dose contrast-enhanced CT scan since the incidence of appendicular neoplasms is high.[7][110] Interval appendectomy can also be used to identify patients who have underlying appendiceal neoplasm; interval appendectomy may reduce the future risk of appendiceal neoplasm, particularly in the context of complicated appendicitis.[111][112] The risk of appendiceal neoplasm in patients treated with nonoperative management of complicated appendicitis is 11%, increasing to 16% in patients ages 50 years and older and 43% in patients ages over 80 years.[110][113][114]

For patients with phlegmon or abscess, management remains subject to debate. Latest evidence suggests that laparoscopic appendectomy is associated with fewer readmissions and fewer additional interventions than conservative management, provided advanced laparoscopic expertize is available.[7][116] However, nonoperative management with antibiotics and, if available, percutaneous image-guided drainage is a reasonable alternative if the patient is stable and laparoscopic appendectomy is unavailable, although there is a lack of evidence for its use on a routine basis.[7] Pregnant patients with acute appendicitis should be managed with obstetric support.[100]

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Acute appendicitis

Treatment algorithm

uncomplicated acute appendicitis

appendectomy + supportive care

preoperative intravenous antibiotic therapy

Primary options

Adults

Children

Children

Secondary options

Adults

Children

These drug options and doses relate to a patient with no comorbidities.

Primary options

Adults

Children

Children

Secondary options

Adults

Children

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Adults

Children

Children

Secondary options

Adults

Children

antibiotic-only therapy

Primary options

Adults: initial therapy

Adults: initial therapy

Children: initial therapy

Children: initial therapy

Secondary options

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Children: initial therapy

Tertiary options

Adults: step-down therapy

Adults: step-down therapy

Children: step-down therapy

Children: step-down therapy

These drug options and doses relate to a patient with no comorbidities.

Primary options

Adults: initial therapy

Adults: initial therapy

Children: initial therapy

Children: initial therapy

Secondary options

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Children: initial therapy

Tertiary options

Adults: step-down therapy

Adults: step-down therapy

Children: step-down therapy

Children: step-down therapy

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

Adults: initial therapy

Adults: initial therapy

Children: initial therapy

Children: initial therapy

Secondary options

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Adults: initial therapy

Children: initial therapy

Tertiary options

Adults: step-down therapy

Adults: step-down therapy