Pediatric Guidelines: Intra-Abdominal Infections - Community Onset

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Appendicitis, other community-onset intra-abdominal infection

Enteric Gram negatives


Ceftriaxone 50mg/kg IV q24h (max 2g/dose)


Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose)

Beta lactam allergy:

Ciprofloxacin 15mg/kg/dose IV q12h (max 400mg/dose)


Metronidazole 10mg/kg/dose IV q8h (max 500mg/dose)

Duration: For uncomplicated appenditicitis, only perioperative prophylaxis is needed

For complicated appendicitis or other community-onset intra-abdominal infection, if adequate source control, treat until resolution of abdominal signs & symptoms, usually <= 7 days

Reference: Solomkin, JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of AmericaClin Infect Dis 2010;50:133-164. 

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).