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This conservative, non-surgical treatment protocol was developed by Karolinska University Hospital for the management of acute appendicitis, particularly in pediatric populations. The regimen serves as an alternative to laparoscopic appendectomy and consists of a sequential antibiotic course. It typically begins with intravenous administration of meropenem and metronidazole, followed by a transition to oral ciprofloxacin and metronidazole. Meropenem is a broad-spectrum carbapenem that inhibits bacterial cell wall synthesis, metronidazole targets anaerobic bacteria by disrupting DNA, and ciprofloxacin is a fluoroquinolone that inhibits DNA gyrase and topoisomerase IV. The protocol was evaluated in the CONSAPP Pilot trial to assess feasibility and outcomes compared to standard surgical intervention.
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