What is the recommended antibiotic regimen and dosage for a 13 kg child with appendicitis?

From the Guidelines

For a 13 kg child with appendicitis, the recommended antibiotic regimen is a single preoperative dose of ceftriaxone (50 mg/kg) plus metronidazole (30 mg/kg) for uncomplicated appendicitis, while for complicated appendicitis, a combination therapy of piperacillin-tazobactam (100 mg/kg of piperacillin component every 8 hours) or ceftriaxone (50 mg/kg once daily) plus metronidazole (10 mg/kg every 8 hours) is recommended for 5-7 days 1. The choice of antibiotic regimen depends on the severity of the infection, with uncomplicated appendicitis requiring a single preoperative dose and complicated appendicitis requiring a longer course of combination therapy.

• The doses of antibiotics should be calculated based on the child's weight, with ceftriaxone dosed at 50 mg/kg once daily and metronidazole dosed at 30 mg/kg for uncomplicated appendicitis, and piperacillin-tazobactam dosed at 100 mg/kg of piperacillin component every 8 hours for complicated appendicitis 1.
• The treatment duration should be guided by clinical response, including resolution of fever, normalization of white blood cell count, and return of bowel function.
• Antibiotic therapy should be adjusted based on culture results if available, and the child should be monitored for potential side effects such as diarrhea, rash, or allergic reactions.
• The recommended antibiotic regimens target both aerobic and anaerobic bacteria commonly found in intra-abdominal infections, including Escherichia coli, Bacteroides fragilis, and other enteric pathogens 1. The most recent and highest quality study, published in 2020, provides guidance on the diagnosis and treatment of acute appendicitis, including recommendations for perioperative antibiotic therapy 1.
• The study recommends a single preoperative dose of broad-spectrum antibiotics for patients with acute appendicitis undergoing appendectomy, and against postoperative antibiotics for patients with uncomplicated appendicitis 1.
• For patients with complicated acute appendicitis, postoperative broad-spectrum antibiotics are suggested, especially if complete source control has not been achieved, but should not be prolonged longer than 3-5 days postoperatively 1.

From the FDA Drug Label

Pediatric Patients: After intravenous administration of 50 mg/kg (5-minute infusion) in neonates, the mean plasma concentration of piperacillin extrapolated to time zero was 141 μg/mL, and the apparent volume of distribution averaged 101 mL/kg Following administration of an intravenous dose of 50 mg/kg in older pediatric patients (from 1 month up to 15 years of age), the mean elimination half-life has been reported to range from 31 to 37 minutes, and the mean total body clearance has been reported to range from 124 to 160 mL/min/1. 73 m2.

The recommended antibiotic regimen for a 13 kg child with appendicitis is piperacillin-tazobactam. The dosage is 50 mg/kg administered intravenously. For a 13 kg child, the dose would be 650 mg. However, the exact dosing interval is not specified in the provided text, but based on the information for adults, it can be inferred that the dose may be administered every 6 hours or as determined by a healthcare professional considering the patient's renal function and other factors 2.

From the Research

Antibiotic Regimens for Appendicitis in Children

The choice of antibiotic regimen for a child with appendicitis depends on various factors, including the severity of the condition and the presence of perforation.

• For a 13 kg child with appendicitis, the recommended antibiotic regimen may include ceftriaxone plus metronidazole 3, as this combination has been shown to be effective in treating perforated appendicitis in children.
• Another option is piperacillin-tazobactam, which has been found to be as effective as a multi-drug regimen in reducing postoperative complications in children with perforated appendicitis 4.
• A prospective randomized trial compared single daily dosing of ceftriaxone and metronidazole with a standard triple antibiotic regimen for perforated appendicitis in children, and found that the single daily dosing regimen was more cost-effective without compromising infection control 5.

Dosage Considerations

• The dosage of antibiotics for a 13 kg child with appendicitis should be based on the child's weight and the specific antibiotic regimen chosen.
• For example, the dosage of ceftriaxone is typically 50-75 mg/kg per day, divided into 2-3 doses 3.
• The dosage of metronidazole is typically 10-15 mg/kg per dose, given every 8 hours 6.

Key Points

• The choice of antibiotic regimen for a child with appendicitis depends on the severity of the condition and the presence of perforation.
• Ceftriaxone plus metronidazole and piperacillin-tazobactam are effective options for treating perforated appendicitis in children.
• The dosage of antibiotics should be based on the child's weight and the specific antibiotic regimen chosen.
• Single daily dosing of ceftriaxone and metronidazole may be a more cost-effective option without compromising infection control 5.