Surgical Prophylaxis Guidelines

FHA Surgical Antibiotic Prophylaxis Guidelines Updated Jul 08 (2)

Surgical Prophylaxis Guidelines

Table 1: Procedure & Recommended Prophylaxis
Biliary Tract 1
High risk only: > 70 yrs old, biliary obstruction, common bile duct stones, acute cholecystitis, previous biliary surgery, non functioning gall bladder

Pre-operative Drug & Dose (Adults)5

Cefazolin 1-2 g IV X 1 dose

Alternatives for Cephalosporin Allergy5

Clindamycin 600 mg IV OR [Metronidazole 500 mg + Gentamicin 2 mg/Kg] X 1 dose Clindamycin 600 mg IV + Gentamicin 2 mg/Kg X 1 dose Clindamycin 600 mg IV + Gentamicin 2 mg/Kg X 1 dose TMP-SMX 1 tab DS X 1 dose (2-4 hours pre-op) Metronidazole 500 mg g IV + Gentamicin 2 mg/Kg X 1 dose Clindamycin 900 mg IV Clindamycin 900 mg IV Gentamicin 2 mg/Kg Vancomycin 1 g IV X 1 dose pre-op; maximum 1 additional dose Q12H post op o Vancomycin 1 g IV X 1 dose; Add Gentamicin 2 mg/kg x 1 dose if groin incision4

Bowel 1

Appendectomy1 Colorectal surgery for obstructions, fistulas, tumor mass High risk only: decreased gastric acidity or motility, obesity, gastric ulcer or malignancy, esophageal obstruction, hemorrhage

Cefazolin 1-2 g IV + Metronidazole 500 mg IV X 1 dose

Esophageal, Gastroduodenal (gastric resection, gastroplasty) 1

Cefazolin 1-2 g IV X 1 dose

Genitourinary 1

Prostatectomy & all other high risk: urine culture positive/unavailable, preoperative catheter, transrectal prostatic biopsy, placement of prosthesis. If culture results are available, modify therapy based on results. Vaginal, abdominal or laparoscopic hysterectomy

Ciprofloxacin 500 mg PO ( 2 - 4 hrs pre-op) or 400 mg IV (1-2 hrs pre-op) X 1 dose Cefazolin 1-2 g IV +/- Metronidazole 500 mg IV X 1 dose Cefazolin 2 g IV X 1 dose Cefazolin 2 g IV + Metronidazole 500 mg IV X 1 dose Cefazolin 1-2 g IV X 1 dose pre-op; maximum 2 additional doses Q8H post op o Cefazolin 12 g IV X 1 dose

Gynecology 1 Obstetrics 1

Cesarean section (elective & non elective) Cesarean section: High risk (consider factors such as active labor, prolonged rupture of membranes for over 6 hrs, maternal fever, failed instrument delivery)

Orthopedic,2,3
Elective total joint replacement (hip and knee arthroplasty) For emergency surgeries involving fractures, institute treatment rather than prophylaxis (cefazolin plus gentamicin +/- metronidazole if heavily soiled)

Peripheral Vascular,2,4

Abdominal aortic aneurism, prosthesis, groin incision4

NOTES:

1. 2. 3.

4. 5.

In presence of perforation, abscess, gangrene, peritonitis, cholangitis or presence of active infectious process, institute treatment rather than prophylaxis. Vancomycin may be used for vascular or orthopedic surgery if patient is colonized with MRSA or if there is a high local prevalence of MRSA in post-op wound infection. If a tourniquet is to be used in the procedure, the entire dose of antibiotic must be infused prior to its inflation. There is no evidence to suggest that use of prophylaxis regimen longer than 24 hours reduces infection rates, even in presence of drains or catheters. Prophylaxis is not recommended for surgery without implantation of prosthetic material, eg, arhroscopy, acromioplasty, skin and soft tissue repair with resorbable sutures. Vancomycin does not cover gram negative bacilli therefore add cefazolin (or gentamicin 2 mg/Kg if cephalosporin allergy) for groin incisions. Single pre-operative dose is superior to multiple peri-operative doses. Refer to Guidelines for timing of pre-op dose (prior to incision).

FHA Surgical Antibiotic Prophylaxis Guidelines Updated Jul 08 (2)

Surgical Prophylaxis Guidelines

FHA Surgical Antibiotic Prophylaxis Guidelines Updated Jul 08 (2)

Surgical Prophylaxis Guidelines

References

FHA Surgical Antibiotic Prophylaxis Guidelines Updated Jul 08 (2)