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AppendicitisMedication
Updated:Dec27,2015
Author:SandyCraig,MDChiefEditor:BarryEBrenner,MD,PhD,FACEPmore...

MEDICATION

MedicationSummary
Thegoalsoftherapyaretoeradicatetheinfectionandtopreventcomplications.Thus,antibiotics
haveanimportantroleinthetreatmentofappendicitis,andallsuch.Agentsunderconsiderationmust
offerfullaerobicandanaerobiccoverage.Thedurationoftheadministrationiscloselyrelatedtothe
stageofappendicitisatthetimeofthediagnosis.
Antibioticagentsareeffectiveindecreasingtherateofpostoperativewoundinfectionandinimproving
outcomeinpatientswithappendicealabscessorsepticemia.TheSurgicalInfectionSociety
recommendsstartingprophylacticantibioticsbeforesurgery,usingappropriatespectrumagentsfor
lessthan24hoursfornonperforatedappendicitisandforlessthan5daysforperforatedappendicitis.
Regimensareofapproximatelyequalefficacy,soconsiderationshouldbegiventofeaturessuchas
medicationallergy,pregnancycategory(ifapplicable),toxicity,andcost.

Penicillins
ClassSummary
Thepenicillinsarebactericidalantibioticsthatworkagainstsensitiveorganismsatadequate
concentrationsandinhibitthebiosynthesisofcellwallmucopeptide.

Piperacillinandtazobactamsodium(Zosyn)
Viewfulldruginformation
Thisagentisadrugcombinationofbetalactamaseinhibitorwithpiperacillin.Ithasactivityagainst
somegrampositiveorganisms,gramnegativeorganisms,andanaerobicbacteria.Whenusedasa
singleagent,itinhibitsbiosynthesisofcellwallmucopeptideandiseffectiveduringactive
multiplicationstages.

Ampicillinandsulbactam(Unasyn)
Viewfulldruginformation
Thisagentisadrugcombinationofbetalactamaseinhibitorwithampicillin.Itisusedasasingle
agentandinterfereswithbacterialcellwallsynthesisduringactivereplication,causingbactericidal
activityagainstsusceptibleorganisms.Ampicillin/sulbactamalsohasactivityagainstsomegram
positiveorganisms,gramnegativeorganisms(nonpseudomonalspecies),andanaerobicbacteria.

Ticarcillin/clavulanate(Timentin)
Viewfulldruginformation
Ticarcillin/clavulanateinhibitsbiosynthesisofcellwallmucopeptideandiseffectiveduringthestageof
activegrowth.Itisanantipseudomonalpenicillinplusbetalactamaseinhibitorthatprovidescoverage
againstmostgrampositiveorganisms,mostgramnegativeorganisms,andmostanaerobic
organisms.

Cephalosporins
ClassSummary
Cephalosporinsarestructurallyandpharmacologicallyrelatedtopenicillins.Theyinhibitbacterialcell
wallsynthesis,resultinginbactericidalactivity.

Cefotetan(Cefotan)
Viewfulldruginformation
Cefotetanisasecondgenerationcephalosporinthatisusedassingledrugtherapyforbroadgram
negativeandanaerobiccoverage.Administercefotetanwithcefoxitintoachievetheeffectivenessof
singledose.Itshalflifeis3.5hours.

Cefoxitin(Mefoxin)
Viewfulldruginformation
Thisdrugisalsoasecondgenerationcephalosporinthatisindicatedassingleagentforthe
managementofinfectionscausedbysusceptiblegrampositivecocciandgramnegativerods.Ithasa
halflifeof0.8hours.

Cefepime
Viewfulldruginformation
Cefepimeisafourthgenerationcephalosporin.Ithasgramnegativecoveragecomparableto
ceftazidimebuthasbettergrampositivecoverage.Cefepimeisazwitterionthatrapidlypenetrates
gramnegativecells.

Aminoglycosides
ClassSummary
Aminoglycosideshaveconcentrationdependentbactericidalactivity.Theseagentsworkbybindingto
the30Sribosome,inhibitingbacterialproteinsynthesis.

Gentamicin(Gentacidin,Garamycin)
Viewfulldruginformation

Gentamicinisanaminoglycosideantibioticusedforgramnegativecoverage,aswellasin
combinationwithanagentagainstgrampositiveorganismsandanotheroneagainstanaerobes.
Gentamicinisnotthedrugofchoice,butconsiderusingthisdrugifpenicillinsorotherlesstoxicdrugs
arecontraindicated,whenitisclinicallyindicated,andinmixedinfectionscausedbysusceptible
staphylococciandgramnegativeorganisms.Thisagentmaybeadministeredintravenouslyor
intramuscularlyandhasnumerousregimensthedosemustbeadjustedforcreatinineclearanceand
changesinvolumeofdistribution.

Carbapenems
ClassSummary
Carbapenemsarestructurallyrelatedtopenicillinsandhavebroadspectrumbactericidalactivity.The
carbapenemsexerttheireffectbyinhibitingcellwallsynthesis,whichleadstocelldeath.Theyare
activeagainstgramnegative,grampositive,andanaerobicorganisms.

Meropenem(Merrem)
Viewfulldruginformation
Meropenemisabactericidalbroadspectrumcarbapenemantibioticthatinhibitscellwallsynthesis.It
isusedasasingleagentandiseffectiveagainstmostgrampositiveandgramnegativebacteria.

Ertapenem
Viewfulldruginformation
Ertapenemhasbactericidalactivitythatresultsfromtheinhibitionofcellwallsynthesisandis
mediatedthroughertapenembindingtopenicillinbindingproteins.Itisstableagainsthydrolysisbya
varietyofbetalactamases,includingpenicillinase,cephalosporinase,andextendedspectrumbeta
lactamases.

Fluoroquinolones
ClassSummary
Theseagentscanbeusedtorelieveacuteundifferentiatedabdominalpaininpatientspresentingto
theED.

Ciprofloxacin(Cipro)
Viewfulldruginformation
CiprofloxacinisafluoroquinolonethatinhibitsbacterialDNAsynthesisand,consequently,growth,by
inhibitingDNAgyraseandtopoisomerase,whicharerequiredforreplication,transcription,and
translationofgeneticmaterial.Quinoloneshavebroadactivityagainstgrampositiveandgram
negativeaerobicorganisms.

Levofloxacin(Levaquin)
Viewfulldruginformation

Levofloxacinisusedforinfectionscausedbyvariousgramnegativeorganisms,antipseudomonal
infectionsduetomultidrugresistantgramnegativeorganisms.

Moxifloxacin(Avelox)
Viewfulldruginformation
MoxifloxacinisafluoroquinolonethatinhibitsAsubunitsofDNAgyrase,inhibitingbacterialDNA
replicationandtranscription.

AntiinfectiveAgents
ClassSummary
Antiinfectivessuchasmetronidazoleandtigecyclineareeffectiveagainstmanytypesofbacteriathat
havebecomeresistanttootherantibiotics.

Metronidazole(Flagyl)
Viewfulldruginformation
Metronidazolehasbroadgramnegativeandanaerobiccoverageandisusedincombinationwith
aminoglycosides(eg,gentamicin).Thisagentappearstobeabsorbedintocellsintermediate
metabolizedcompoundsbindDNAandinhibitproteinsynthesis,causingcelldeath.

Tigecycline(Tygacil)
Viewfulldruginformation
Tigecyclineisaglycylcyclineantibioticthatisstructurallysimilartotetracyclineantibiotics.Itinhibits
bacterialproteintranslationbybindingtothe30Sribosomalsubunit,anditblocksentryofaminoacyl
tRNAmoleculesintotheribosomeAsite.

Analgesics
ClassSummary
Theseagentscanbeusedtorelieveacuteundifferentiatedabdominalpaininpatientspresentingto
theED.

Morphinesulfate(Astramorph,Duramorph,MSContin,MSIR,Oramorph)
Viewfulldruginformation
Morphinesulfateisthedrugofchoiceforanalgesiabecauseofitsreliableandpredictableeffects,
safetyprofile,andeaseofreversibilitywithnaloxone.Variousintravenousdosesareusedmorphine
sulfateiscommonlytitratedtothedesiredeffect.
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