Version May 2024
| Nature of operation | Common pathogens | Recommended antimicrobials | Usual adult dose* | Redose interval¶ |
| Gastroduodenal surgery | ||||
| Procedures involving entry into lumen of gastrointestinal tract | Enteric gram-negative bacilli, gram-positive cocci | CefazolinΔ | <120 kg: 2 g IV ≥120 kg: 3 g IV | 4 hours |
| Procedures not involving entry into lumen of gastrointestinal tract (selective vagotomy, antireflux) | Enteric gram-negative bacilli, gram-positive cocci | High risk◊ only: cefazolinΔ | <120 kg: 2 g IV ≥120 kg: 3 g IV | 4 hours |
| Biliary tract surgery (including pancreatic procedures) | ||||
| Open procedure or laparoscopic procedure (high risk)§ | Enteric gram-negative bacilli, enterococci, clostridia | CefazolinΔ¥ (preferred) | <120 kg: 2 g IV ≥120 kg: 3 g IV | 4 hours |
| OR cefotetan | 2 g IV | 6 hours | ||
| Laparoscopic procedure (low risk) | N/A | None | None | None |
| Appendectomy‡ | ||||
| Enteric gram-negative bacilli, anaerobes, enterococci | CefazolinΔ PLUS metronidazole (preferred) | For cefazolin:
For metronidazole:
| For cefazolin:
For metronidazole:
| |
| OR cefotetanΔ | 2 g IV | 6 hours | ||
| Small intestine surgery | ||||
| Nonobstructed | Enteric gram-negative bacilli, gram-positive cocci | CefazolinΔ | <120 kg: 2 g IV ≥120 kg: 3 g IV | 4 hours |
| Obstructed | Enteric gram-negative bacilli, anaerobes, enterococci | CefazolinΔ PLUS metronidazole (preferred) | For cefazolin:
For metronidazole:
| For cefazolin:
For metronidazole:
|
| OR cefotetanΔ | 2 g IV | 6 hours | ||
| Hernia repair | ||||
| Aerobic gram-positive organisms | CefazolinΔ | <120 kg: 2 g IV ≥120 kg: 3 g IV | 4 hours | |
| Colorectal surgery† | ||||
| Enteric gram-negative bacilli, anaerobes, enterococci | Parenteral: | |||
| CefazolinΔ PLUS metronidazole (preferred) | For cefazolin:
For metronidazole:
| For cefazolin:
For metronidazole:
| ||
| OR cefotetanΔ | 2 g IV | 6 hours | ||
| Oral (used in conjunction with mechanical bowel preparation): | ||||
| Neomycin PLUS erythromycin base or metronidazole | ** | ** | ||
IV: intravenous.
* Parenteral prophylactic antimicrobials can be given as a single IV dose begun within 60 minutes before the procedure. If vancomycin or a fluoroquinolone is used, the infusion should be started within 60 to 120 minutes before the initial incision to have adequate tissue levels at the time of incision and to minimize the possibility of an infusion reaction close to the time of induction of anesthesia.
¶ For prolonged procedures (>3 hours) or those with major blood loss or in patients with extensive burns, additional intraoperative doses should be given at intervals one to two times the half-life of the drug.
Δ For patients allergic to penicillins and cephalosporins, clindamycin (900 mg) or vancomycin (15 mg/kg IV; not to exceed 2 g) with either gentamicin (5 mg/kg IV), ciprofloxacin (400 mg IV), levofloxacin (500 mg IV), or aztreonam (2 g IV) is a reasonable alternative. Metronidazole (500 mg IV) plus an aminoglycoside or fluoroquinolone is also an acceptable alternative regimen, although metronidazole plus aztreonam should not be used, since this regimen does not have aerobic gram-positive activity.
◊ Severe obesity, gastrointestinal (GI) obstruction, decreased gastric acidity or GI motility, gastric bleeding, malignancy or perforation, or immunosuppression.
§ Factors that indicate high risk may include age >70 years, pregnancy, acute cholecystitis, nonfunctioning gallbladder, obstructive jaundice, common bile duct stones, immunosuppression.
¥ Cefotetan, cefoxitin, and ampicillin-sulbactam are reasonable alternatives.
‡ For a ruptured viscus, therapy is often continued for approximately 5 days.
† Use of ertapenem or other carbapenems not recommended due to concerns of resistance.
** In addition to mechanical bowel preparation, the following oral antibiotic regimen is administered: neomycin (1 g) plus erythromycin base (1 g) OR neomycin (1 g) plus metronidazole (1 g). The oral regimen should be given as 3 doses over approximately 10 hours the afternoon and evening before the operation. Issues related to mechanical bowel preparation are discussed further separately; refer to the UpToDate topic on overview of colon resection.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
