Antimicrobial Prophylaxis in Surgery GUIDELINES App brought to you courtesy of Guideline Central. Enjoy!
Issue link: https://eguideline.guidelinecentral.com/i/109326
Treatment Table 4. Antimicrobial Recommendations for Surgical Prophylaxis Stratified by Type of Procedure (cont'd) Type of Procedure Recommended Agentsa,b Strength of Alternative in Evidence ��-Lactam Allergy Urologic Lower tract instrumentation with risk factors for infectiont Fluoroquinoloned-f Trimethoprim��� sulfamethoxazole A Aminoglycosidec +/clindamycin Cefazolin Clean without entry into urinary tractu Involving implanted prosthesis Cefazolin A Cefazolin +/aminoglycoside Cefazolin +/aztreonam A Ampicillin-sulbactam Clean with entry into urinary tractu Clean-contaminated Cefazolin Cefoxitin Vancomycini Clindamycin +/aminoglycoside or aztreonam Vancomycini +/aminoglycoside or aztreonam Fluoroquinoloned-f A Cefazolin + metronidazole Clindamycini Aminoglycosidec +/clindamycin Fluoroquinoloned-f A Aminoglycosidec + metronidazole or clindamycin Vascularv Cefazolin A Clindamycini Vancomycini The antimicrobial agent should be started within 60 minutes prior to surgical incision (120 minutes for vancomycin or fluoroquinolones). While single-dose prophylaxis is usually sufficient, the duration of prophylaxis for all procedures should be <24 hours. If an agent with a short half-life is used (eg, cefazolin, cefoxitin), it should be readministered if the procedure duration exceeds the recommended redosing interval (from the time of initiation of the preoperative dose [see Table 2]). Readministration may also be warranted if prolonged or excessive bleeding occurs, or if there are other factors that may shorten the half-life of the prophylactic agent (eg, extensive burns). Readministration may not be warranted in patients in whom the half-life of the agent may be prolonged (eg, patients with renal insufficiency or failure). b For patients known to be colonized with methicillin-resistant S. aureus, it is reasonable to add a single preoperative dose of vancomycin to the recommended agent(s). c Gentamicin or tobramycin. d Due to increasing resistance of E. coli to fluoroquinolones and ampicillin-sulbactam, local population susceptibility profiles should be reviewed prior to use. e Ciprofloxacin or levofloxacin. f Fluoroquinolones are associated with an increased risk of tendonitis and tendon rupture in all ages. However, this risk would be expected to be quite small with single-dose antibiotic prophylaxis. Although the use of fluoroquinolones may be necessary for surgical antibiotic prophylaxis in some children, they are not drugs of first choice in the pediatric population due to an increased incidence of adverse events as compared with controls in some clinical trials. g Ceftriaxone use should be limited to patients requiring antimicrobial treatment for acute cholecystitis or acute biliary tract infections which may not be determined prior to incision, not patients undergoing cholecystectomy for noninfected biliary conditions, including biliary colic or dyskinesia without infection. 12 a