{ "schema_version": 1, "kind": "condition", "id": "acute-appendicitis", "name": "Acute Appendicitis (Emergency Referral)", "category": "emergency", "sources": "Appendicitis - StatPearls, Lotfollahzadeh, Lopez & Deppen, updated 12 February 2024 - https://www.ncbi.nlm.nih.gov/books/NBK493193/ · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, p306) · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) - general adult dosage 1 to 2 g intravenously or intramuscularly once daily or divided twice daily, maximum 4 g daily, with community-acquired intra-abdominal infection among the named indications. · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, p306) - intra-abdominal infection, oral or intravenous 500 mg every 8 hours as part of an appropriate combination regimen, for 4 to 7 days following adequate source control.", "review_status": "reviewed", "verified_against": "Appendicitis - StatPearls, Lotfollahzadeh, Lopez & Deppen, updated 12 February 2024 - https://www.ncbi.nlm.nih.gov/books/NBK493193/ · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, p306) · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) - general adult dosage 1 to 2 g intravenously or intramuscularly once daily or divided twice daily, maximum 4 g daily, with community-acquired intra-abdominal infection among the named indications. · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, p306) - intra-abdominal infection, oral or intravenous 500 mg every 8 hours as part of an appropriate combination regimen, for 4 to 7 days following adequate source control.", "verified_date": "2026-08", "treatments": [ { "id": 32, "generic": "Ceftriaxone", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 1000.0, "adult_dose": "1 to 2 g intravenously or intramuscularly once daily, or the same total split into two doses. Maximum 4 g daily.", "adult_duration": "Until appendicectomy - this is cover for the operation, not a course", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, p255) - general adult dosage 1 to 2 g intravenously or intramuscularly once daily or divided twice daily, maximum 4 g daily, with community-acquired intra-abdominal infection among the named indications.", "rationale": "The appendicitis article's antibiotic cover targets aerobes and anaerobes together, and names a third-generation cephalosporin such as ceftriaxone for the aerobic gram-negative half. It also says antibiotics are given intravenously as directed by the surgical care team while the patient is kept nil by mouth and hydrated with crystalloid. Eight ceftriaxone 1 g products are marketed in Egypt.", "cautions": [ "GIVEN WITH METRONIDAZOLE, NOT ALONE. Ceftriaxone covers the aerobic gram-negatives; the anaerobic half of the regimen is the other drug.", "The referral comes first. This is the regimen the patient is being sent for - the article is explicit that antibiotics are given as the surgical team directs, and that appendicectomy, not antibiotics, remains the standard treatment. Starting an antibiotic in the clinic and reviewing tomorrow is how an appendix perforates.", "Contraindicated in penicillin or cephalosporin hypersensitivity.", "Contraindicated in the neonate given calcium-containing intravenous fluids.", "Where renal and hepatic impairment coexist, the formulary caps the daily dose at 2 g.", "The article notes that local resistance patterns, allergy and previous antibiotic exposure change the choice; the pairing above is the article's default, not an invariant rule." ], "peds_mgkg_low": 50.0, "peds_mgkg_high": 75.0, "peds_max_mg": 1000.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "Infants, children and adolescents, mild to moderate infection: 50 to 75 mg/kg per dose intramuscularly or intravenously once daily, maximum 1,000 mg per day. Because it is given once daily, that daily maximum is also the per-dose ceiling shown above. Severe infection is dosed differently, at 100 mg/kg/day divided every 12 to 24 hours. Appendicitis is the commonest abdominal surgical emergency of childhood, and the dose is given by the surgical team.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 500, "high_mg": 750, "capped": false }, { "weight_kg": 20, "low_mg": 1000, "high_mg": 1000, "capped": true }, { "weight_kg": 30, "low_mg": 1000, "high_mg": 1000, "capped": true }, { "weight_kg": 40, "low_mg": 1000, "high_mg": 1000, "capped": true } ], "brands": [ { "trade_name": "ZOXIDEL 1 GM PD. FOR I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 22.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOXIDEL 1 GM PD. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINTRIAXONE 1 GM PD. FOR I.V INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOTRIAXONE 1 GM I.M VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OFRAMAX 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > SUN PHARMA EGYPT LIMITED", "price_egp": 71.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.V VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-appendicitis" }, { "id": 33, "generic": "Metronidazole", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 500.0, "adult_dose": "500 mg intravenously or orally every 8 hours, as part of a combination", "adult_duration": "Until appendicectomy - this is cover for the operation, not a course", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph, p306) - intra-abdominal infection, oral or intravenous 500 mg every 8 hours as part of an appropriate combination regimen, for 4 to 7 days following adequate source control.", "rationale": "The appendicitis article pairs the cephalosporin with an anaerobic agent. Metronidazole is the drug the Egyptian formulary doses for intra-abdominal infection, and it is stocked as a ready-to-use 500 mg in 100 mL infusion, which is what a district hospital will have.", "cautions": [ "GIVEN WITH CEFTRIAXONE, NOT ALONE. It covers anaerobes only.", "The referral comes first; this is what the receiving team gives.", "No alcohol during treatment or for 3 days after it, and not within 2 weeks of disulfiram - the formulary contraindicates all three.", "Contraindicated in the first trimester when the indication is trichomoniasis, and in active neurological disorders, blood dyscrasia, hypothyroidism and hypoadrenalism.", "Halve the dose in severe hepatic impairment (Child-Pugh C).", "The article offers clindamycin as the alternative anaerobic agent to metronidazole. Only one of the two is given, alongside the cephalosporin.", "How long it runs after the operation is a separate question, and the two documents differ: the article gives no antibiotic at all after an uncomplicated appendicectomy and a 4-day course where the appendix was complicated, while the formulary's intra-abdominal figure is 4 to 7 days following adequate source control. Both are recorded; the operating team decides which applies.", "The article records that uncomplicated appendicectomy needs no antibiotic afterwards, while complicated disease is scheduled for a 4-day course, and that a periappendiceal abscess may need percutaneous drainage with broad-spectrum antibiotics for several weeks before an interval appendicectomy." ], "peds_mgkg_low": 22.5, "peds_mgkg_high": 40.0, "peds_max_mg": 4000.0, "peds_basis": "day", "peds_unit": "mg", "peds_note": "Infants, children and adolescents, intravenous: 22.5 to 40 mg/kg/day in 3 or 4 divided doses, maximum 4,000 mg per day. By mouth the formulary gives a different band - 15 to 50 mg/kg/day in 3 divided doses, maximum 2,250 mg per day - so the route decides which applies. The grid above is the intravenous one, because that is the route used before appendicectomy.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 225, "high_mg": 400, "capped": false }, { "weight_kg": 20, "low_mg": 450, "high_mg": 800, "capped": false }, { "weight_kg": 30, "low_mg": 675, "high_mg": 1200, "capped": false }, { "weight_kg": 40, "low_mg": 900, "high_mg": 1600, "capped": false } ], "brands": [ { "trade_name": "METRONIDAZOLE-OTSUKA 500MG /100ML I.V. INF. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "OTSUKA", "price_egp": 20.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FLAZOL 500MG/100ML I.V.INFUSION", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 31.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AMRIZOLE 500 MG VIAL 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMRIYA", "price_egp": 47.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "METROFLAG 500MG/100ML VIAL FOR I.V. INF.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ARABCOMED-EGYPT", "price_egp": 47.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "acute-appendicitis" }, { "id": 34, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Same-day surgical referral. Pain that begins diffuse or around the umbilicus and then localises to the right lower quadrant is the classic course; fever is present in about 40%. Do NOT start antibiotics in the clinic and review tomorrow, and do NOT let a normal temperature or a soft abdomen early on reassure you - the appendix can perforate while the patient is still walking. Analgesia does not mask the diagnosis and should not be withheld.", "adult_duration": "Refer, with advice", "dose_source": "No dose - referral pathway, no medicine given in primary care", "rationale": null, "cautions": [ "SURGICAL EMERGENCY. StatPearls puts rupture at roughly 2% of cases by about 36 hours from when symptoms begin, and has that figure climbing a further 5% or so with each 12 hours that go by without proper medical treatment.", "The primary treatment remains surgical - StatPearls has surgery as the first option for acute appendicitis still, and antibiotics alone are a hospital decision, not a primary-care one.", "An Alvarado score of 7 or more is significantly associated with appendicitis, but a LOW score does not exclude it and must not be used to send someone home.", "Pregnancy, the elderly and the immunosuppressed present atypically and are the ones who perforate." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Children present less typically and perforate sooner. A child with abdominal pain, vomiting and any right-sided tenderness goes to hospital the same day, not to a review appointment.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "acute-appendicitis" } ] }