CT: computed tomography; ED: emergency department.
* Nonperforated appendicitis, also referred to as simple appendicitis or uncomplicated appendicitis, refers to acute appendicitis that presents without CT signs of perforation (eg, inflammatory mass, phlegmon, or abscess).
¶ Nonoperative management has not been sufficiently studied in these patients, as they have been excluded from the trials.
Δ Antibiotic choices are not standardized. Refer to Table 2 for sample choices. Refer to UpToDate content on the management of appendicitis for other appropriate antibiotic regimens.
◊ Antibiotic response may be delayed in patients who are 45 years of age or older; in those who have appendicoliths, extraluminal fluid or air, fever, or elevated inflammatory markers; and in those who have had symptoms for more than 48 hours, all of which are associated with appendiceal abscess. A longer period of observation and intravenous antibiotics may be required for these patients.
§ The lower percentage has been reported by trials excluding patients with appendicolith; the higher percentage has been reported by trials including patients with appendicolith.
¥ These are sample choices for low- to moderate-risk community-acquired infections. For the full complement of suitable regimens, refer to the appropriate UpToDate content on management of appendicitis. Doses shown are for patients with normal kidney function; some agents require adjustment for kidney impairment; refer to Lexicomp drug monograph(s).
‡ Amoxicillin-clavulanate is a reasonable option if the community rate of Escherichia coli resistance to the agent is not >10%.