Appendix D
All Patients with Appendicitis
COMPLICATED
UNCOMPLICATED
ALL other patients with appendicitis
1. Continued on Ceftriaxone/Flagyl
2. Dose timing as an extension of preoperative dose(s) of those antibiotics
1. Viable appendix
2. No evidence of gangrene
3. No evidence of perforation
4. Fluid can be clear or cloudy but not thick or
with fibrinous exudate
Discharge Criteria
1. Afebrile (febrile =temp>38.5)
2. Normal heart rate for age (PALS)
3. Normal blood pressure for age (PALS)
4. Surgical site(s) are clean, dry, and intact
5. Pain well controlled with IV or oral pain medication
6. Tolerating PO well (PO fluids > IV maintenance rate
7. Pain controlled with oral pain medication (pain score ≤ 3)
8. Patient is ambulating well
9. Parents are ready for the patient to go home
10. The patient has no supplemental oxygen requirement
11. Foley is out and able to urinate
12. No nausea or vomiting
When all criteria are met Patient Tracker sends a page to NP/Resident
indicating patient has met discharge criteria
Discharge Criteria
Same as uncomplicated appendicitis except patient must be afebrile for 24 hours
No CT abdomen/pelvis until POD 10
No PICC/TPN until POD 5
No change in antibiotics without a culture demonstrating resistance or ID consult
When all criteria are met Patient Tracker sends a page to NP/Resident indicating patient has met
discharge criteria
NORMAL WBC
Stop Antibiotics
Home
Follow-up in 1 week
Obtain pre-clinic CBC
Home
Follow-up in 2-3 weeks
Home
Follow-up in 1 week
Obtain pre-clinic CBC
Check WBC
Either absolute WBC for age or differential
ABNORMAL WBC
Switch to Oral Antibiotics
Cefdinir
14 mg/kg PO 1X/day ≥ 13 years of age
7 mg/kg PO 2X/day for 6months to 12 years of age
Flagyl
10mg/kg PO 3X /day ≥ 13 years of age
7.5 mg/kg PO 4X/day for 6 months to 12 years of age
Duration to cover until first clinic visit