Appendicular abscess medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
No universal standard treatment exists for appendicitis complicated by abscess. The mainstay of treatment includes abscess drainage along with empiric antibiotics. It resolves most of the abscess. Once the abscess is resolved, it is followed by appendectomy 8-12 weeks after the pharmacological treatment.
Treatment
The preferred treatment includes non-operative management such as drainage and broad spectrum IV antibiotics along with IV fluids followed by surgery which includes interval laparoscopic appendectomy. It has proved to have a high success rates up to 97% and low incidences of complications.[1][2][3][4]
Medical Therapy
Antibiotics should be started immediately once the diagnosis of abscess is made. Preoperative antibiotics have been associated with lower rates of wound and intra-abdominal infections.[5][6]
Duration
The duration of treatment with intravenous antibiotics ranges from 5 to 10 days, until fever resolves, white blood cell count normalizes, and bowel function returns.[6]
Empiric therapy
Monotherapy with a beta-lactam/beta-lactamase inhibitor:
- Preferred regimen (1):Ampicillin-sulbactam 3 g IV q6h
- Preferred regimen (2):Ticarcillin-clavulanate 3 g IV q4h
- Preferred regimen (3):Piperacillin-tazobactam 3 g or 4.5 g IV q6h
Combination third generation cephalosporins PLUS metronidazole
- Preferred regimen (1): Ceftriaxone 1 g IV q24h AND Metronidazole 500 mg IV q8h OR 1500 mg q24h.
- Preferred regimen (2): Cefazolin 1–2 g IV q8h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
- Preferred regimen (3): Cefuroxime 1.5 g IV q8h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
- Preferred regimen (4): Cefotaxime 1–2 g IV q6–8 h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
Alternative empiric regimens
Combination fluoroquinolone PLUS metronidazole:
- Preferred regimen (1): Ciprofloxacin 400 mg IV q12h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
- Preferred regimen (2): Levofloxacin 750 mg IV q24h AND Metronidazole 500 mg IV q8–12 h OR 1500 mg q24h
Monotherapy with a carbapenem
- Preferred regimen (1): Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h
- Preferred regimen (2): Meropenem 1 g IV q8h
- Preferred regimen (3): Doripenem 500 mg IV q8h
- Preferred regimen (4): Ertapenem 1 g IV q24h
References
- ↑ Samuel M, Hosie G, Holmes K (2002). "Prospective evaluation of nonsurgical versus surgical management of appendiceal mass". J. Pediatr. Surg. 37 (6): 882–6. PMID 12037755.
- ↑ Kaminski A, Liu IL, Applebaum H, Lee SL, Haigh PI (2005). "Routine interval appendectomy is not justified after initial nonoperative treatment of acute appendicitis". Arch Surg. 140 (9): 897–901. PMID 16175691.
- ↑ Ansaloni L, Catena F, Coccolini F, Ercolani G, Gazzotti F, Pasqualini E, Pinna AD (2011). "Surgery versus conservative antibiotic treatment in acute appendicitis: a systematic review and meta-analysis of randomized controlled trials". Dig Surg. 28 (3): 210–21. doi:10.1159/000324595. PMID 21540609.
- ↑ Meshikhes AW (2008). "Management of appendiceal mass: controversial issues revisited". J. Gastrointest. Surg. 12 (4): 767–75. doi:10.1007/s11605-007-0399-1. PMID 17999120.
- ↑ Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.
- ↑ 6.0 6.1 Sartelli, Massimo; Viale, Pierluigi; Catena, Fausto; Ansaloni, Luca; Moore, Ernest; Malangoni, Mark; Moore, Frederick A; Velmahos, George; Coimbra, Raul; Ivatury, Rao; Peitzman, Andrew; Koike, Kaoru; Leppaniemi, Ari; Biffl, Walter; Burlew, Clay Cothren; Balogh, Zsolt J; Boffard, Ken; Bendinelli, Cino; Gupta, Sanjay; Kluger, Yoram; Agresta, Ferdinando; Di Saverio, Salomone; Wani, Imtiaz; Escalona, Alex; Ordonez, Carlos; Fraga, Gustavo P; Junior, Gerson Alves Pereira; Bala, Miklosh; Cui, Yunfeng; Marwah, Sanjay; Sakakushev, Boris; Kong, Victor; Naidoo, Noel; Ahmed, Adamu; Abbas, Ashraf; Guercioni, Gianluca; Vettoretto, Nereo; Díaz-Nieto, Rafael; Gerych, Ihor; Tranà, Cristian; Faro, Mario Paulo; Yuan, Kuo-Ching; Kok, Kenneth Yuh Yen; Mefire, Alain Chichom; Lee, Jae Gil; Hong, Suk-Kyung; Ghnnam, Wagih; Siribumrungwong, Boonying; Sato, Norio; Murata, Kiyoshi; Irahara, Takayuki; Coccolini, Federico; Lohse, Helmut A Segovia; Verni, Alfredo; Shoko, Tomohisa (2013). "2013 WSES guidelines for management of intra-abdominal infections". World Journal of Emergency Surgery. 8 (1): 3. doi:10.1186/1749-7922-8-3. ISSN 1749-7922.