Table 4. Antimicrobial Recommendations for Surgical
Prophylaxis Stratified by Type of Procedure (cont'd)
Type of Procedure
Recommended
Agentsa,b
Strength of
Evidence
Alternative in
��-Lactam Allergy
Plastics
Clean with risk factors or
clean-contaminated
Cefazolin
Ampicillin���
sulbactamb
C
Clindamycini
Vancomycini
Small Intestine
Non-obstructed
Cefazolin
C
Obstructed
Cefazolin +
metronidazole
Cefoxitin
Cefotetan
Clindamycin
+
aminoglycosidec
or aztreonam or
fluoroquinoloned-f
C
Metronidazole
+
aminoglycosidec or
fluoroquinoloned-f
Thoracic
Noncardiac procedures,
including lobectomy,
pneumonectomy, lung
resection, and thoracotomy
Cefazolin
Ampicillin���
sulbactamd
Video-assisted thoracoscopic
surgery
Cefazolin
Ampicillin���sulbactamd
Clindamycini
A
C
Vancomycini
Clindamycini
Vancomycini
Transplantation
p
Heartp
Cefazolin
Lung and heart���lung
Cefazolin
Livers
A (based
on cardiac
procedures)
Clindamycini
A (based
on cardiac
procedures)
Clindamycini
Piperacillin���
tazobactam
q,r
Vancomycini
Vancomycini
Pancreas and pancreas���kidney
Kidney
B
A
Cefotaxime +
Ampicillin
Clindamycin or
vancomycin
+
aminoglycosidec
or aztreonam or
fluoroquinoloned-f
Clindamycin or
vancomycin
+
aminoglycosidec
or aztreonam or
fluoroquinoloned-f
A
Clindamycin or
vancomycin
+
aminoglycosidec
or aztreonam or
fluoroquinoloned-f
Cefazolin
Cefazolin
Continued on next page.
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