A specific treatment plan for management of perforated appendix in children, initiated at the Children's Hospitals in Boston, and later utilized at the Child Health Center in Galveston, has been applied to 143 patients by many surgical housestaff and faculty. The protocol consists of appendectomy, routine use of systemic gentamicin, ampicillin and clindamycin, antibiotic peritoneal irrigation, and transperitoneal drainage through the incision. The average age of the children in this series was 9.1 years (range 14 months to 21 years). The average length of hospitalization was 12.1 days. The use of this protocol resulted in only 11 patients (7.7%) developing significant complications. Complications related to infection occurred in only six of the eleven patients (4.2%). There were no deaths. This protocol of intensive primary therapy can significantly decrease the sequelae from perforated appendicitis in children.