Antimicrobial prophylaxis for genitourinary surgery in adults

Nature of operation	Common pathogens	Recommended antimicrobials	Usual adult dose*^[1]	Redose interval^{¶ [2]}
Cystoscopy alone	Enteric gram-negative bacilli, enterococci	High-risk^Δ only: ciprofloxacin^◊	500 mg orally or 400 mg IV	N/A
Cystoscopy alone	Enteric gram-negative bacilli, enterococci	OR trimethoprim-sulfamethoxazole	One 160/800 mg (double strength, DS) tablet orally	N/A
Cystoscopy with manipulation (eg, transrectal prostate biopsy) or upper tract instrumentation (eg, ureteroscopy, shock wave lithotripsy)	Enteric gram-negative bacilli, enterococci	Ciprofloxacin^◊	500 mg orally or 400 mg IV	N/A
	Enteric gram-negative bacilli, enterococci	OR trimethoprim-sulfamethoxazole	One 160/800 mg (double strength, DS) tablet orally	N/A
Open or laparoscopic surgery^§	Enteric gram-negative bacilli, enterococci	Cefazolin^¥	<120 kg: 2 g IV ≥120 kg: 3 g IV	4 hours

IV: intravenous.
* Parenteral prophylactic antimicrobials can be given as a single IV dose begun within 60 minutes before the procedure. If 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 for the duration of the procedure in patients with normal renal function.
Δ Urine culture positive or unavailable, preoperative catheter, or placement of prosthetic material.
◊ Due to increasing resistance of Escherichia coli to fluoroquinolones and ampicillin-sulbactam, local sensitivity profiles should be reviewed prior to use.
§ Including percutaneous renal surgery, procedures with entry into the urinary tract, and those involving implantation of a prosthesis. If manipulation of bowel is involved, prophylaxis is given according to colorectal guidelines.
¥ For patients allergic to penicillins and cephalosporins, clindamycin (900 mg IV) 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.

Reprinted with special permission from: Treatment Guidelines from The Medical Letter, October 2012; Vol. 10 (122):73. www.medicalletter.org.
Additional information from:

Antimicrobial prophylaxis for surgery. Med Lett Drugs Ther 2016; 58:63.
Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Surg Infect (Larchmt) 2013; 14:73.

Graphic 87199 Version 13.0

خرید پکیج

Antimicrobial prophylaxis for genitourinary surgery in adults