Initial Management

The standard approaches for the management of appendicitis are listed below:


Resuscitate patient if they are dehydrated or any signs of sepsis:

  • Oxygen (high flow, non-rebreather mask)
  • Intravenous access x2
  • IV normal saline 1-2 L, then reassess
  • Give immediate antibiotics if patient has signs of sepsis or generalised peritonitis (cephalosporin and metronidazole or tazobactam)


Morphine IV titrated to effect with IV anti-emetic if vomiting or nauseated.

A Cochrane review states that there is no evidence that opiates mask the signs of peritonism or lead to a delay in diagnosis. Analgesia should never be withheld until ‘the patient has seen the surgeon’ [15].

Keep nil by mouth

Patients with suspected appendicitis should be fasted as theatre may well be required.

Involve surgical team

The decision to administer antibiotics is based on the decision to take to theatre. Evidence suggests a single dose of antibiotic within a 60minute window prior to surgical incision can prevent the formation of wound infection or abscess.