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Appendicitis, Suspected

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Algorithm for suspected appendicitis

flow chart

* Monitor as per Starship Clinical Guideline on Aminoglycosides, including measurement of renal function with serum creatinine.
**Peritoneal fluid culture results: antibiotics do not need to be changed on the basis of culture results if improving13



Prophylactic antibiotics should be administered before appendicectomy [Andersen et al 2004], in a single dose (secondary doses are only required to maintain tissue levels in long procedures, thus not needed in appendicectomy). For post-operative treatment of complicated appendicitis, an abbreviated regime is as effective as traditional fixed-term regimes [Fraser et al 2010, Yu et al 2013].

Appendiceal Mass

Most papers advocate conservative management with broad spectrum antibiotics and interval appendicectomy [Gillick, Velayudham, Puri 2001]. Incidence of ~16-40% will fail conservative management and require drainage or operation earlier than the booked interval appendicectomy. 

Overnight delay

Studies show no significant morbidity or complications from waiting overnight for appendicectomy [Rajendra, Quinn, Puri 1993].


  • Andersen BR, Kallehave FL, Andersen HK. Antibiotics versus placebo for prevention of postoperative infection after appendicectomy.. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD001439. DOI: 10.1002/14651858.CD001439.pub2.
  • Fraser J, Aguayo P, Leys C. M, Keckler S. J, St. Peter S. D, et al: A complete course of intravenous antibiotics vs. a combination of intravenous and oral antibiotics for perforated appendicitis in children: a prospective, randomized trial. J Pediatr Surg. 2010, 45: 1198-1202
  • Gillick J, Velayudham M, Puri P. Conservative management of appendix mass in children. BJS 2001;88(11):1539-42.
  • Rajendra S, Quinn F, Puri P. Is it necessary to perform appendicectomy in the middle of the night in children? BMJ 1993;306(6886):1168-1169.
  • Sauerland S, Jaschinski T, Neugebauer EAM. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No.: CD001546. DOI: 10.1002/14651858.CD001546.pub3.
  • Yu T, Hamill J, Evans S, Hill A, et al: Duration of Postoperative Intravenous Antibiotics in Childhood Complicated Appendicitis: A Propensity Score-Matched Comparison Study. European Journal of Pediatric Surgery 2013 June, 24(4) 

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Document Control

  • Date last published: 19 September 2016
  • Document type: Clinical Guideline
  • Services responsible: Paediatric Surgery
  • Author(s): James Hamill, Annabel Dekker
  • Owner: James Hamill
  • Editor: Greg Williams
  • Review frequency: 2 years

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