appendicitis medication_ penicillins, cephalosporins, aminoglycosides, carbapenems,...

8/18/2019 Appendicitis Medication_ Penicillins, Cephalosporins, Aminoglycosides, Carbapenems, Fluoroquinolones, Anti-Infecti…

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4/25/2016 Appendici tis Medication: Penici ll ins, Cephalosporins, Aminoglycosides, Carbapenems, Fluoroquinolones, Anti-infective Agents, Analgesics

http://emedicine.medscape.com/article/773895-medication#showall 1/5

Appendicitis Medication

Author: Sandy Craig, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP more...

Updated: Dec 27, 2015

Medication Summary

The goals of therapy are to eradicate the infection and to prevent complications.Thus, antibiotics have an important role in the treatment of appendicitis, and all

such. Agents under consideration must offer full aerobic and anaerobic coverage.The duration of the administration is closely related to the stage of appendicitis at

he time of the diagnosis.

Antibiotic agents are effective in decreasing the rate of postoperative woundinfection and in improving outcome in patients with appendiceal abscess or

septicemia. The Surgical Infection Society recommends starting prophylacticantibiotics before surgery, using appropriate spectrum agents for less than 24 hours

for nonperforated appendicitis and for less than 5 days for perforated appendicitis.Regimens are of approximately equal efficacy, so consideration should be given tofeatures such as medication allergy, pregnancy category (if applicable), toxicity, and

cost.

Penicillins

Class Summary

The penicillins are bactericidal antibiotics that work against sensitive organisms at

adequate concentrations and inhibit the biosynthesis of cell wall mucopeptide.

View full drug information

Piperacillin and tazobactam sodium (Zosyn)

This agent is a drug combination of beta-lactamase inhibitor with piperacillin. It has

activity against some gram-positive organisms, gram-negative organisms, andanaerobic bacteria. When used as a single agent, it inhibits biosynthesis of cell wallmucopeptide and is effective during active multiplication stages.


Ampicillin and sulbactam (Unasyn)

This agent is a drug combination of beta-lactamase inhibitor with ampicillin. It isused as a single agent and interferes with bacterial cell wall synthesis during active

replication, causing bactericidal activity against susceptible organisms. Ampicillin/sulbactam also has activity against some gram-positive organisms, gram-

negative organisms (nonpseudomonal species), and anaerobic bacteria.


Ticarcillin/clavulanate (Timentin)

Ticarcillin/clavulanate inhibits biosynthesis of cell wall mucopeptide and is effective

during the stage of active growth. It is an antipseudomonal penicillin plus beta-lactamase inhibitor that provides coverage against most gram-positive organisms,

most gram-negative organisms, and most anaerobic organisms.

Cephalosporins

Class Summary

Cephalosporins are structurally and pharmacologically related to penicillins. Theyinhibit bacterial cell wall synthesis, resulting in bactericidal activity.


Cefotetan (Cefotan)

Cefotetan is a second-generation cephalosporin that is used as single-drug therapyfor broad gram-negative and anaerobic coverage. Administer cefotetan with

cefoxitin to achieve the effectiveness of single dose. Its half-life is 3.5 hours.


Cefoxitin (Mefoxin)

This drug is also a second-generation cephalosporin that is indicated as single agent

for the management of infections caused by susceptible gram-positive cocci andgram-negative rods. It has a half-life of 0.8 hours.


Cefepime

Cefepime is a fourth-generation cephalosporin. It has gram-negative coverage

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comparable to ceftazidime but has better gram-positive coverage. Cefepime is a

zwitter ion that rapidly penetrates gram-negative cells.

Aminoglycosides

Class Summary

Aminoglycosides have concentration-dependent bactericidal activity. These agentswork by binding to the 30S ribosome, inhibiting bacterial protein synthesis.


Gentamicin (Gentacidin, Garamycin)

Gentamicin is an aminoglycoside antibiotic used for gram-negative coverage, aswell as in combination with an agent against gram-positive organisms and another

one against anaerobes. Gentamicin is not the drug of choice, but consider using thisdrug if penicillins or other less toxic drugs are contraindicated, when it is clinically

indicated, and in mixed infections caused by susceptible staphylococci and gram-negative organisms. This agent may be administered intravenously or

intramuscularly and has numerous regimens; the dose must be adjusted for creatinine clearance and changes in volume of distribution.

Carbapenems

Class Summary

Carbapenems are structurally related to penicillins and have broad-spectrum

bactericidal activity. The carbapenems exert their effect by inhibiting cell wallsynthesis, which leads to cell death. They are active against gram-negative, gram-positive, and anaerobic organisms.


Meropenem (Merrem)

Meropenem is a bactericidal broad-spectrum carbapenem antibiotic that inhibits cellwall synthesis. It is used as a single agent and is effective against most gram-

positive and gram-negative bacteria.


Ertapenem

Ertapenem has bactericidal activity that results from the inhibition of cell wall

synthesis and is mediated through ertapenem binding to penicillin-binding proteins.It is stable against hydrolysis by a variety of beta-lactamases, including

penicillinase, cephalosporinase, and extended-spectrum beta-lactamases.

Fluoroquinolones

Class Summary

These agents can be used to relieve acute undifferentiated abdominal pain in

patients presenting to the ED.


Ciprofloxacin (Cipro)

Ciprofloxacin is a fluoroquinolone that inhibits bacterial DNA synthesis and,

consequently, growth, by inhibiting DNA gyrase and topoisomerase, which arerequired for replication, transcription, and translation of genetic material. Quinoloneshave broad activity against gram-positive and gram-negative aerobic organisms.


Levofloxacin (Levaquin)

Levofloxacin is used for infections caused by various gram-negative organisms,antipseudomonal infections due to multidrug resistant gram-negative organisms.


Moxifloxacin (Avelox)

Moxifloxacin is a fluoroquinolone that inhibits A subunits of DNA gyrase, inhibitingbacterial DNA replication and transcription.

Anti-infective Agents

Class Summary

Anti-infectives such as metronidazole and tigecycline are effective against manyypes of bacteria that have become resistant to other antibiotics.


Metronidazole (Flagyl)

Metronidazole has broad gram-negative and anaerobic coverage and is used incombination with aminoglycosides (eg, gentamicin). This agent appears to be

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absorbed into cells; intermediate metabolized compounds bind DNA and inhibit

protein synthesis, causing cell death.


Tigecycline (Tygacil)

Tigecycline is a glycylcycline antibiotic that is structurally similar to tetracycline

antibiotics. It inhibits bacterial protein translation by binding to the 30S ribosomalsubunit, and it blocks entry of amino-acyl tRNA molecules into the ribosome A site.

Analgesics

Class Summary

These agents can be used to relieve acute undifferentiated abdominal pain in

patients presenting to the ED.


Morphine sulfate (Astramorph, Duramorph, MS Contin, MSIR,Oramorph)

Morphine sulfate is the drug of choice for analgesia because of its reliable andpredictable effects, safety profile, and ease of reversibility with naloxone. Various

intravenous doses are used; morphine sulfate is commonly titrated to the desiredeffect.

Contributor Information and Disclosures

Author

Sandy Craig, MD Residency Program Director, Carolinas Medical Center; Associate Professor, Department of Emergency Medicine, University of North Carolina at Chapel Hill School of Medicine

Sandy Craig, MD is a member of the following medical societies: Alpha Omega Alpha, Society for Academic

Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program

Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve UniversitySchool of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha,

American Heart A ssociation, American Thoracic S ociety, Arkansas M edical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest P hysicians, American College of Emergency Physicians,

American College of Physicians


Acknowledgements

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of EmergencyMedicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine,Martin Luther King Jr/Drew Medical Center


William Lober, MD, MS Associate Professor, Health Informatics and Global Health, Schools of Medicine,

Nursing, and Public Health, University of Washington


Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College

of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

1. Polites SF, Mohamed MI, Habermann EB, et al. A simple algorithm reduces computed tomography use in

the diagnosis of appendicitis in children. Surgery . 2014 Jun 19. [Medline].

2. Douglas D. Algorithm cuts pediatric CT use in suspected appendicitis. Reuters Health Information. July 10,2014. [Full Text].

3. Yeh B. Evidence-based emergency medicine/rational clinical examination abstract. Does this adult patienthave appendicitis?. Ann Emerg Med . 2008 Sep. 52(3):301-3. [Medline].

4. Markle GB 4th. Heel-drop jarring test for appendicitis. Arch S urg . 1985 Feb. 120(2):243. [Medline].

5. Thimsen DA, Tong GK, Gruenberg JC. Prospective evaluation of C-reactive protein in patients suspectedto have acute appendicitis. Am Surg . 1989 Jul. 55(7):466-8. [Medline].

6. de Carvalho BR, Diogo-Filho A, Fernandes C, Barra CB. [Leukocyte count, C reactive protein, alpha-1 acid

glycoprotein and erythrocyte sedimentation rate in acute appendicitis]. Arq Gastroenterol . 2003 Jan-Mar.40(1):25-30. [Medline].

7. Albu E, Miller BM, Choi Y, et al. Diagnostic value of C-reactive protein in acute appendicitis. Dis ColonRectum. 1994 Jan. 37(1):49-51. [Medline].

8. Bolandparvaz S, Vasei M, Owji AA, Ata-Ee N, Amin A, Daneshbod Y, et al. Urinary 5-hydroxy indole aceticacid as a test for early diagnosis of acute appendicitis. Clin Biochem. 2004 Nov. 37(11):985-9. [Medline].

http://reference.medscape.com/medline/abstract/15498526http://reference.medscape.com/medline/abstract/8287747http://reference.medscape.com/medline/abstract/14534661http://reference.medscape.com/medline/abstract/2742230http://reference.medscape.com/medline/abstract/3977592http://reference.medscape.com/medline/abstract/18763359http://www.medscape.com/viewarticle/828027http://reference.medscape.com/medline/abstract/24953265http://www.acponline.org/http://www.acep.org/http://www.chestnet.org/http://www.aaem.org/http://www.saem.org/http://www.nyas.org/http://www.nyam.org/http://www.arkmed.org/http://www.thoracic.org/http://www.heart.org/http://www.alphaomegaalpha.org/http://www.saem.org/http://www.alphaomegaalpha.org/http://reference.medscape.com/drug/ms-contin-astramorph-morphine-343319http://reference.medscape.com/drug/ms-contin-astramorph-morphine-343319http://reference.medscape.com/drug/tygacil-tigecycline-342527http://reference.medscape.com/drug/tygacil-tigecycline-342527


4/5



9. Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, et al. Low-dose abdominal CT for evaluating suspected

appendicitis. N Engl J Med . 2012 Apr 26. 366(17):1596-605. [Medline].

10. Howell JM, Eddy OL, Lukens TW, Thiessen ME, Weingart SD, Decker WW. Clinical policy: Critical issuesin the evaluation and management of emergency department patients with suspected appendicitis. Ann

Emerg Med . 2010 Jan. 55(1):71-116. [Medline].

11. [Guideline] National Guideline Clearinghouse (NGC). Guideline summary: Clinical policy: critical issues in

the evaluation and management of emergency department patients with suspected appendicitis. NationalGuideline Clearinghouse (NGC), Rockville (MD). Available at http://guideline.gov/content.aspx?id=15598.

Accessed: November 18, 2013.

12. Barloon TJ, Brown BP, Abu-Yousef MM, Warnock N, Berbaum KS. Sonography of acute appendicitis inpregnancy. Abdom Imaging . 1995 Mar-Apr. 20(2):149-51. [Medline].

13. Manterola C, Vial M, Moraga J, Astudillo P. Analgesia in patients with acute abdominal pain. CochraneDatabase Syst Rev . 2011 Jan 19. 1:CD005660. [Medline].

14. Karamanakos SN, Sdralis E, Panagiotopoulos S, Kehagias I. Laparoscopy in the emergency setting: a

retrospective review of 540 patients with acute abdominal pain. Surg Laparosc Endosc Percutan Tech.2010 Apr. 20(2):119-24. [Medline].

15. Niwa H, Hiramatsu T. A rare presentation of appendiceal diverticulitis associated with pelvic pseudocyst.World J Gastroenterol . 2008 Feb 28. 14(8):1293-5. [Medline]. [Full Text].

16. Place RC. Acute urinary retention in a 9-year-old child: an atypical presentation of acute appendicitis. J Emerg Med . 2006 Aug. 31(2):173-5. [Medline].

17. Oto A, Ernst RD, Mileski WJ, Nishino TK, Le O, Wolfe GC, et al. Localization of appendix with MDCT and

influence of findings on choice of appendectomy incision. AJR Am J Roentgenol . 2006 Oct. 187(4):987-90.[Medline].

18. Sedlak M, Wagner OJ, Wild B, Papagrigoriades S, Exadaktylos AK. Is there still a role for rectalexamination in suspected appendicitis in adults?. Am J E merg M ed . 2008 Mar. 26(3):359-60. [Medline].

19. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med . 1986 May.

15(5):557-64. [Medline].

20. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospective

pediatric cohort. Ann Emerg Med . 2007 Jun. 49(6):778-84, 784.e1. [Medline].

21. Schneider C, Kharbanda A, Bachur R. Evaluating appendicitis scoring systems using a prospectivepediatric cohort. Ann Emerg Med . 2007 Jun. 49(6):778-84, 784.e1. [Medline].

22. Migraine S, Atri M, Bret PM, Lough JO, Hinchey JE. Spontaneously resolving acute appendicitis: clinicaland sonographic documentation. Radiology . 1997 Oct. 205(1):55-8. [Medline].

23. Cobben LP, de Van Otterloo AM, Puylaert JB. Spontaneously resolving appendicitis: frequency and naturalhistory in 60 patients. Radiology . 2000 May. 215(2):349-52. [Medline].

24. Dueholm S, Bagi P, Bud M. Laboratory aid in the diagnosis of acute appendicitis. A blinded, prospective

trial concerning diagnostic value of leukocyte count, neutrophil differential count, and C-reactive protein. DisColon Rectum. 1989 Oct. 32(10):855-9. [Medline].

25. Gurleyik E, Gurleyik G, Unalmiser S. Accuracy of serum C-reactive protein measurements in diagnosis of acute appendicitis compared with surgeon's clinical impression. Dis Colon Rectum. 1995 Dec. 38(12):1270-4. [Medline].

26. Shakhatreh HS. The accuracy of C-reactive protein in the diagnosis of acute appendicitis compared withthat of clinical diagnosis. Med Arh. 2000. 54(2):109-10. [Medline].

27. Asfar S, Safar H, Khoursheed M, Dashti H, al-Bader A. Would measurement of C-reactive protein reducethe rate of negative exploration for acute appendicitis?. J R Coll Surg Edinb. 2000 Feb. 45(1):21-4.[Medline].

28. Erkasap S, Ates E, Ustuner Z, Sahin A, Yilmaz S, Yasar B, et al. Diagnostic value of interleukin-6 and C-reactive protein in acute appendicitis. Swiss Surg . 2000. 6(4):169-72. [Medline].

29. Gronroos JM, Gronroos P. Leucocyte count and C-reactive protein in the diagnosis of acute appendicitis. Br J Surg . 1999 Apr. 86(4):501-4. [Medline].

30. Ortega-Deballon P, Ruiz de Adana-Belbel JC, Hernandez-Matias A, Garcia-Septiem J, Moreno-Azcoita M.

Usefulness of laboratory data in the management of right iliac fossa pain in adults. Dis Colon Rectum.2008 Jul. 51(7):1093-9. [Medline].

31. Gronroos JM. Is there a role for leukocyte and CRP measurements in the diagnosis of acute appendicitis inthe elderly?. Maturitas. 1999 Mar 15. 31(3):255-8. [Medline].

32. Yang HR, Wang YC, Chung PK, et al. Role of leukocyte count, neutrophil percentage, and C-reactive

protein in the diagnosis of acute appendicitis in the elderly. Am Surg . 2005 Apr. 71(4):344-7. [Medline].

33. Gronroos JM. Do normal leucocyte count and C-reactive protein value exclude acute appendicitis in

children?. Acta Paediatr . 2001 Jun. 90(6):649-51. [Medline].

34. Stefanutti G, Ghirardo V, Gamba P. Inflammatory markers for acute appendicitis in children: are theyhelpful?. J Pediatr Surg . 2007 May. 42(5):773-6. [Medline].

35. Mohammed AA, Daghman NA, Aboud SM, Oshibi HO. The diagnostic value of C-reactive protein, whiteblood cell count and neutrophil percentage in childhood appendicitis. Saudi Med J . 2004 Sep. 25(9):1212-

5. [Medline].

36. Yang HR, Wang YC, Chung PK, Chen WK, Jeng LB, Chen RJ. Laboratory tests in patients with acute

appendicitis. ANZ J S urg . 2006 Jan-Feb. 76(1-2):71-4. [Medline].

37. Tundidor Bermudez AM, Amado Dieguez JA, Montes de Oca Mastrapa JL. [Urological manifestations of acute appendicitis]. Arch E sp Urol . 2005 Apr. 58(3):207-12. [Medline].

38. Rao PM, Rhea JT, Rattner DW, et al. Introduction of appendiceal CT: impact on negative appendectomyand appendiceal perforation rates. Ann Surg . 1999 Mar. 229(3):344-9. [Medline].

39. McGory ML, Zingmond DS, Nanayakkara D, Maggard MA, Ko CY. Negative appendectomy rate: influence

http://reference.medscape.com/medline/abstract/10077046http://reference.medscape.com/medline/abstract/15906614http://reference.medscape.com/medline/abstract/16483301http://reference.medscape.com/medline/abstract/15448768http://reference.medscape.com/medline/abstract/17502181http://reference.medscape.com/medline/abstract/11440098http://reference.medscape.com/medline/abstract/15943411http://reference.medscape.com/medline/abstract/10340286http://reference.medscape.com/medline/abstract/18484138http://reference.medscape.com/medline/abstract/10215824http://reference.medscape.com/medline/abstract/10967943http://reference.medscape.com/medline/abstract/10815376http://reference.medscape.com/medline/abstract/10934841http://reference.medscape.com/medline/abstract/7497838http://reference.medscape.com/medline/abstract/2676422http://reference.medscape.com/medline/abstract/10796906http://reference.medscape.com/medline/abstract/9314962http://reference.medscape.com/medline/abstract/17383771http://reference.medscape.com/medline/abstract/17383771http://reference.medscape.com/medline/abstract/3963537http://reference.medscape.com/medline/abstract/18358949http://reference.medscape.com/medline/abstract/16985147http://reference.medscape.com/medline/abstract/17044580http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690682/http://reference.medscape.com/medline/abstract/18300360http://reference.medscape.com/medline/abstract/20393340http://reference.medscape.com/medline/abstract/21249672http://reference.medscape.com/medline/abstract/7787719http://guideline.gov/content.aspx?id=15598http://reference.medscape.com/medline/abstract/20116016http://reference.medscape.com/medline/abstract/22533576


5/5



Medscape Reference © 2011 WebMD, LLC

of CT scans. Am Surg . 2005 Oct. 71(10):803-8. [Medline].

40. Harswick C, Uyenishi AA, Kordick MF, Chan SB. Clinical guidelines, computed tomography scan, andnegative appendectomies: a case series. Am J E merg Med . 2006 Jan. 24(1):68-72. [Medline].

41. Frei SP, Bond WF, Bazuro RK, Richardson DM, Sierzega GM, Reed JF. Appendicitis outcomes with

increasing computed tomographic scanning. Am J E merg Med . 2008 Jan. 26(1):39-44. [Medline].

42. Pickhardt PJ, Lawrence EM, Pooler BD, Bruce RJ. Diagnostic performance of multidetector computed

tomography for suspected acute appendicitis. Ann Intern Med . 2011 Jun 21. 154(12):789-96. [Medline].

43. Kepner AM, Bacasnot JV, Stahlman BA. Intravenous contrast alone vs intravenous and oral contrastcomputed tomography for the diagnosis of appendicitis in adult ED patients. Am J E merg M ed . 2012 May

23. [Medline].

44. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med .2007 Nov 29. 357(22):2277-84. [Medline].

45. Zilbert NR, Stamell EF, Ezon I, Schlager A, Ginsburg HB, Nadler EP. Management and outcomes for children with acute appendicitis differ by hospital type: areas for improvement at public hospitals. Clin

Pediatr (Phila). 2009 Jun. 48(5):499-504. [Medline].

46. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, et al. US or CT for Diagnosis

of Appendicitis in Children and Adults? A Meta-Analysis. Radiology . 2006 Oct. 241(1):83-94. [Medline].

47. Boggs W. Ultrasound/MRI Strategy Diagnoses Appendicitis in Kids Without Radiation. Medscape MedicalNews. Available at http://www.medscape.com/viewarticle/821332. Accessed: March 12, 2014.

48. Aspelund G, Fingeret A, Gross E, Kessler D, Keung C, Thirumoorthi A, et al. Ultrasonography/MRI VersusCT for Diagnosing Appendicitis. Pediatrics. 2014 Mar 3. [Medline].

49. Cobben LP, Groot I, Haans L, Blickman JG, Puylaert J. MRI for clinically suspected appendicitis duringpregnancy. AJR Am J Roentgenol . 2004 Sep. 183(3):671-5. [Medline].

50. Repplinger MD, Levy JF, Peethumnongsin E, et al. Systematic review and meta-analysis of the accuracy of MRI to diagnose appendicitis in the general population. J Magn Reson Imaging . 2015 Dec 22. [Medline].

51. Thieme ME, Leeuwenburgh MM, Valdehueza ZD, Bouman DE, de Bruin IG, Schreurs WH, et al.

Diagnostic accuracy and patient acceptance of MRI in children with suspected appendicitis. Eur Radiol .2013 Oct 19. [Medline].

52. Singer DD, Thode HC Jr, Singer AJ. Effects of pain severity and CT imaging on analgesia prescription in

acute appendicitis. Am J E merg M ed . 2016 Jan. 34 (1):36-9. [Medline].

53. Eriksson S, Granström L. Randomized controlled trial of appendicectomy versus antibiotic therapy for acute

appendicitis. Br J Surg . 1995 Feb. 82(2):166-9. [Medline].

54. Salminen P, Paajanen H, Rautio T, et al. Antibiotic Therapy vs Appendectomy for Treatment of Uncomplicated Acute Appendicitis: The APPAC Randomized Clinical Trial. JAMA. 2015 Jun 16. 313

(23):2340-8. [Medline].

55. Bonadio W, Rebillot K, Ukwuoma O, Saracino C, Iskhakov A. Management of pediatric perforated

appendicitis: comparing outcomes using early appendectomy vs solely medical management. Pediatr Infect

Dis J . 2015 Dec 14. [Medline].

56. Bickell NA, Aufses AH Jr, Rojas M, Bodian C. How time affects the risk of rupture in appendicitis. J A mColl Surg . 2006 Mar. 202(3):401-6. [Medline].

57. Abou-Nukta F, Bakhos C, Arroyo K, Koo Y, Martin J, Reinhold R, et al. Effects of delaying appendectomy

for acute appendicitis for 12 to 24 hours. Arch S urg . 2006 May. 141(5):504-6; discussion 506-7. [Medline].

58. Fair BA, Kubasiak JC, Janssen I, et al. The impact of operative timing on outcomes of appendicitis: a

National Surgical Quality Improvement Project analysis. Am J S urg . 2015 Mar. 209 (3):498-502. [Medline].

59. Boomer LA, Cooper JN, Anandalwar S, et al. Delaying appendectomy does not lead to higher rates of surgical site infections: a multi-institutional analysis of children with appendicitis. Ann Surg . 2015 Dec 16.

[Medline].

60. [Guideline] Korndorffer JR Jr, Fellinger E, Reed W. SAGES guideline for laparoscopic appendectomy. Surg

Endosc . 2010 Apr. 24(4):757-61. [Medline]. [Full Text].

61. Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg .

2012 Nov. 99(11):1470-8. [Medline].

62. Liang MK, Lo HG, Marks JL. Stump appendicitis: a comprehensive review of literature. Am Surg . 2006

Feb. 72(2):162-6. [Medline].

63. Barclay L. Ultrasound, CT Comparable to Detect Appendicitis in Children. Medscape Medical News. Available at http://www.medscape.com/viewarticle/817370. Accessed: December 9, 2013.

64. Le J, Kurian J, Cohen HW, Weinberg G, Scheinfeld MH. Do clinical outcomes suffer during transition to anultrasound-first paradigm for the evaluation of acute appendicitis in children?. AJR Am J Roentgenol . 2013

Dec. 201(6):1348-52. [Medline].

65. Hurst AL, Olson D, Somme S, et al. Once-daily ceftriaxone plus metronidazole versus ertapenem and/or cefoxitin for pediatric appendicitis. J Pediatric Infect Dis Soc . 2015 Dec 24. [Medline].
http://reference.medscape.com/medline/abstract/26703242http://reference.medscape.com/medline/abstract/24261376http://www.medscape.com/viewarticle/817370http://reference.medscape.com/medline/abstract/16536249http://reference.medscape.com/medline/abstract/23001791http://www.sages.org/publication/id/05/http://reference.medscape.com/medline/abstract/19787402http://reference.medscape.com/medline/abstract/26692077http://reference.medscape.com/medline/abstract/25557970http://reference.medscape.com/medline/abstract/16702523http://reference.medscape.com/medline/abstract/16500243http://reference.medscape.com/medline/abstract/26669739http://reference.medscape.com/medline/abstract/26080338http://reference.medscape.com/medline/abstract/7749676http://reference.medscape.com/medline/abstract/26458534http://reference.medscape.com/medline/abstract/24135892http://reference.medscape.com/medline/abstract/26691590http://reference.medscape.com/medline/abstract/15333354http://reference.medscape.com/medline/abstract/24590746http://www.medscape.com/viewarticle/821332http://reference.medscape.com/medline/abstract/16928974http://reference.medscape.com/medline/abstract/19252102http://reference.medscape.com/medline/abstract/18046031http://reference.medscape.com/medline/abstract/22633722http://reference.medscape.com/medline/abstract/21690593http://reference.medscape.com/medline/abstract/18082779http://reference.medscape.com/medline/abstract/16338513http://reference.medscape.com/medline/abstract/16468523https://adclick.g.doubleclick.net/aclk%253Fsa%253DL%2526ai%253DBWuK87iceV6nOM5WqoAOs-IOgA7q9hNoHAAAAEAEgADgAWMKGo7y7AmDpgoCA5A2CARdjYS1wdWItMzEwMDg3ODU2NDA4MDcxNLIBFmVtZWRpY2luZS5tZWRzY2FwZS5jb226AQlnZnBfaW1hZ2XIAQnaATdodHRwOi8vZW1lZGljaW5lLm1lZHNjYXBlLmNvbS9hcnRpY2xlLzc3Mzg5NS1tZWRpY2F0aW9uwAIC4AIA6gIjLzQzMTI0MzQvcHJvZnByb21vL21lZHNjcHJlZmRlc2t0b3D4Av7RHpADsAmYA-ADqAMB0ASQTuAEAdIFBRDqnIUbkAYBoAYf2AcA4AcL%2526num%253D0%2526cid%253DCAASEuRoiKnOEyaazu78c5UQRjCqbQ%2526sig%253DAOD64_2R5-T3GNYNsv5v4Y5ycA2uSl0ntw%2526client%253Dca-pub-3100878564080714%2526adurl%253Dhttp://www.medscape.com/invitation/viewTracker.do?src=house_6

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