Appendicitis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
In combination with surgery, antibiotics are given intravenously to help kill bacteria and thus reduce the spread of infection in the abdomen and postoperative complications in the abdomen or wound.
Appendicitis Medical Therapy
Acute appendicitis is primary treated with surgery, either without rupture or with perforation and secondary peritonitis. Patients should be resuscitated with intravenous fluids, especially with septic shock.[1]
Pre-operative antibiotics used in acute appendicitis include cefuroxime and metronidazole. Equivocal cases may become more difficult to assess with antibiotic treatment and benefit from serial examinations.[2]
As blood cultures do not provide any additional clinical information for community-acquired intra-abdominal infection, they are not routinely recommended for such patients.[1]
Nonsurgical treatment may be used if:[3]
- Surgery is not available
- If a person is not well enough to undergo surgery
- If the diagnosis is unclear
The duration of post-operative treatment with intravenous antibiotics ranges from 5 to 10 days, until fever resolves, white blood cell count normalizes, and bowel function returns.
Some research suggests that appendicitis can get better without surgery. Nonsurgical treatment includes antibiotics to treat infection and a liquid or soft diet until the infection subsides. A soft diet is low in fiber and easily breaks down in the gastrointestinal tract.[4][5]
Timing of Antibiotic Therapy
Once the patient is diagnosed with appendicitis, antibiotics should be started immediately.[1]
Initial Empiric Treatment Recommendations
References
- ↑ 1.0 1.1 1.2 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.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 978-0-443-06839-3.
- ↑ Kirshenbaum M, Mishra V, Kuo D, Kaplan G (2003). "Resolving appendicitis: role of CT". Abdom Imaging. 28 (2): 276–9. doi:10.1007/s00261-002-0025-3. PMID 12592478.
- ↑ Cobben LP, de Van Otterloo AM, Puylaert JB (2000). "Spontaneously resolving appendicitis: frequency and natural history in 60 patients". Radiology. 215 (2): 349–52. doi:10.1148/radiology.215.2.r00ma08349. PMID 10796906.