<prompt> Answer this question truthfullyWhat medical treatment is recommended for appendicitis?  <response>: <reason> The mainstay of therapy of appendicitis with or without rupture is surgery. Patients should be routinely resuscitated with intravenous fluids, especially with those with suspected sepsis. Nonsurgical treatment is not recommended and should be reserved for cases where: Surgery is not available Patient is not a candidate for surgical intervention The diagnosis is uncertainOnce the patient is diagnosed with appendicitis, antibiotics should be started immediately. Preoperative antibiotics have been associated with lower rates of wound and intra-abdominal infections. The duration of post-operative treatment with intravenous antibiotics ranges from 5 to 10 days, until fever resolves, white blood cell count normalizes, and bowel function returns.1. Community-acquired infection in adults 1.1. Mild-to-moderate severity perforated or abscessed appendicitis and other infections of mild-to-moderate severity: 1.1.1. Single agent: Preferred regimen 1: Cefoxitin 2 g IV q6h Preferred regimen 2: Ertapenem 1 g IV q24h Preferred regimen 3: Moxifloxacin 400 mg IV q24h Preferred regimen 4: Tigecycline 100 mg initial dose, THEN 50 mg IV q12h Preferred regimen 5: Ticarcillin - clavulanic acid 3.1 g IV q6h; FDA labeling indicates 200 mgkgday in divided doses every 6 h for moderate infection1.1.2. Combination: Preferred regimen 1: Cefazolin 12 g IV q8h AND Metronidazole 500 mg IV q812 h OR 1500 mg q24h Preferred regimen 2: Cefuroxime 1.5 g IV q8h AND Metronidazole 500 mg IV q812 h OR 1500 mg q24h Preferred regimen 3: Ceftriaxone 12 g IV q1224 h AND Metronidazole 500 mg IV q812 h OR 1500 mg q24h Preferred regimen 4: Cefotaxime 12 g IV q68 h AND Metronidazole 500 mg IV q812 h OR 1500 mg q24h Preferred regimen 5: Ciprofloxacin 400 mg IV q12h AND Metronidazole 500 mg IV q812 h OR 1500 mg q24h Preferred regimen 6: Levofloxacin 750 mg IV q24h AND Metronidazole 500 mg IV q812 h OR 1500 mg q24h1.2. High risk or severity severe physiologic disturbance, advanced age, or immunocompromised state: 1.2.1. Single agent: Preferred regimen 1: Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h Preferred regimen 2: Meropenem 1 g IV q8h Preferred regimen 3: Doripenem 500 mg IV q8h Preferred regimen 4: Piperacillin-tazobactam 3.375 g IV q6h1.2.2. Combination: Preferred regimen 1: Cefepime 2 g q812 h AND Metronidazole 500 mg IV q812 h or 1500 mg q24h Preferred regimen 2: Ceftazidime 2 g q8h AND Metronidazole 500 mg IV q812 h or 1500 mg q24h Preferred regimen 3: Ciprofloxacin 400 mg q12h AND Metronidazole 500 mg IV q812 h or 1500 mg q24h Preferred regimen 4: Levofloxacin 750 mg q24h AND Metronidazole 500 mg IV q812 h or 1500 mg q24h Note: Antimicrobial therapy of established infection should be limited to 47 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.2. Health CareAssociated Complicated Intra-abdominal Infection 2.1. Less than 20 Resistant Pseudomonas aeruginosa, Extended-spectrum B-lactamase-producing Enterobacteriaceae, Acinetobacter, or other multidrug resistant gram-negative bacilli: Preferred regimen 1: Meropenem 1 g IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Ceftazidime 2 g IV q8h AND Metronidazole 500 mg q812 h or 1500 mg q24h Preferred regimen 2: Imipenem-cilastatin 500 mg IV 6 h OR 1 g q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Ceftazidime 2 g IV q8h AND Metronidazole 500 mg IV q812 h or 1500 mg q24h Preferred regimen 3: Doripenem 500 mg IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Ceftazidime 2 g IV q8h AND Metronidazole 500 mg IV every 812 h or 1500 mg q24h Preferred regimen 4: Meropenem 1 g IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Cefepime 2 g IV q812 h AND Metronidazole 500 mg q812 h or 1500 mg q24h Preferred regimen 5: Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Cefepime 2 g IV q812 h AND Metronidazole 500 mg IV q812 h or 1500 mg q24h Preferred regimen 6: Doripenem 500 mg IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Cefepime 2 g IV q812 h AND Metronidazole 500 mg IV q812 h or 1500 mg q24h2.2. Extended-spectrum B-lactamase-producing Enterobacteriaceae: Preferred regimen 1: Meropenem 1 g IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Gentamicin 57 mgkg IV q24h Preferred regimen 2: Meropenem 1 g IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Tobramycin 57 mgkg IV q24h Preferred regimen 3: Meropenem 1 g IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Amikacin 1520 mgkg IV q24h Preferred regimen 4: Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Gentamicin 57 mgkg IV q24h Preferred regimen 5: Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Tobramycin 57 mgkg IV q24h Preferred regimen 6: Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Amikacin 1520 mgkg IV q24h Preferred regimen 7: Doripenem 500 mg IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Gentamicin 57 mgkg IV q24h Preferred regimen 8: Doripenem 500 mg IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Tobramycin 57 mgkg IV q24h Preferred regimen 9: Doripenem 500 mg IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Amikacin 1520 mgkg IV q24h2.3. Pseudomonas aeruginosa with more than 20 resistant to ceftazidime: Preferred regimen 1: Meropenem 1 g IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Gentamicin 57 mgkg IV q24h Preferred regimen 2: Meropenem 1 g IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Tobramycin 57 mgkg IV q24h Preferred regimen 3: Meropenem 1 g IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Amikacin 1520 mgkg IV q24h Preferred regimen 4: Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Gentamicin 57 mgkg IV q24h Preferred regimen 5: Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Tobramycin 57 mgkg IV q24h Preferred regimen 6: Imipenem-cilastatin 500 mg IV q6h OR 1 g q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Amikacin 1520 mgkg IV q24h Preferred regimen 7: Doripenem 500 mg IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Gentamicin 57 mgkg IV q24h Preferred regimen 8: Doripenem 500 mg IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Tobramycin 57 mgkg IV q24h Preferred regimen 9: Doripenem 500 mg IV q8h AND Piperacillin-tazobactam 3.375 g IV q6h AND Amikacin 1520 mgkg IV q24h2.4.Methicillin-resistant Staphylococcus aureus MRSA: Preferred regimen: Vancomycin 1520 mgkg IV q812 h Note: Antimicrobial therapy of established infection should be limited to 47 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome.3. Community-acquired infection in pediatric patients3.1. Single agent: Preferred regimen 1: Ertapenem 3 months to 12 years 15 mgkg bid not to exceed 1 gday Every 12 h, older than 13 years 1 gday Every 24 h OR Preferred regimen 2: Meropenem 60 mgkgday q8h Preferred regimen 3: Imipenem-cilastatin 60100 mgkgday IV q6h Preferred regimen 4: Ticarcillin-clavulanate 200300 mgkgday IV of Ticarcillin component q46 h Preferred regimen 5: Piperacillin-tazobactam 200300 mgkgday IV of Piperacillin component q68 h3.2.Combination: Preferred regimen 1: Ceftriaxone 5075 mgkgday q1224 h, AND Metronidazole 3040 mgkgday q8h Preferred regimen 2: Cefotaxime 150200 mgkgday q68 h, AND Metronidazole 3040 mgkgday q8h Preferred regimen 3: Cefepime 100 mgkgday q12h, AND Metronidazole 3040 mgkgday q8h Preferred regimen 4: Ceftazidime 150 mgkgday q8 h, AND Metronidazole 3040 mgkgday q8h Preferred regimen 5: Gentamicin 37.5 mgkgday q24 h, AND Metronidazole 3040 mgkgday q8h Ampicillin 200 mgkgday q6h Preferred regimen 6: Gentamicin 37.5 mgkgday q24 h, AND Clindamycin 2040 mgkgday q68 h Ampicillin 200 mgkgday q6h Preferred regimen 7: Tobramycin 3.07.5 mgkgday q824 h, AND Metronidazole 3040 mgkgday q8h Ampicillin 200 mgkgday q6h Preferred regimen 8: Tobramycin 3.07.5 mgkgday q824 h, AND Clindamycin 2040 mgkgday q68 h Ampicillin 200 mgkgday q6h Note: Antimicrobial therapy of established infection should be limited to 47 days, unless it is difficult to achieve adequate source control. Longer durations of therapy have not been associated with improved outcome. 