Appendicular abscess medical therapy

Abscess Main Page
Appendicular abscess Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Appendicular abscess from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
Abdominal X Ray
CT
MRI
Echocardiography or Ultrasound
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Appendicular abscess medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Appendicular abscess medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Appendicular abscess medical therapy
CDC on Appendicular abscess medical therapy
Appendicular abscess medical therapy in the news
Blogs on Appendicular abscess medical therapy
Directions to Hospitals Treating Blastomycosis
Risk calculators and risk factors for Appendicular abscess medical therapy

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.

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.

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.

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

Percutaneous drainage

• Percutaneous drainage can be performed under ultrasound or CT guidance, using either the Seldinger or trocar technique.
• Ultrasound is limited if the abscess is small, obscured by other structures, or if precise placement is required because of nearby vessels or organs. In these cases, CT is the optimal imaging modality.
• When an abscess is deep in the pelvis, depending on the specific location of the fluid collection, access may be obtained via transgluteal, transvaginal, or transrectal approaches.
• If the fluid collection is sterile, a transgluteal approach is preferred because it allows for sterile technique.
• Depending on the location of abscess,patient is placed in prone or supine position on the CT table
• Localization scan using CT allows in selecting a safe window of access into the collection.
• A coaxial micropuncture introducer set is advanced into the abscess under CT guidance.
• An Amplatz guidewire is advanced through the sheath and coiled within the abscess.
• After serial dilatation of the tract with a dilator, an pigtail drain is advanced over the guidewire and deployed.