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
Colorectalj
Cefazolin
+
metronidazole
Clindamycin
+
aminoglycosidec
or aztreonam or
fluoroquinoloned-f
Cefoxitin
Cefotetan
Ampicillin���sulbactamd
A
Ertapenem
k
Ceftriaxone
+
metronidazole
Metronidazole
+
aminoglycosidec or
fluoroquinoloned-f
Gastroduodenall
Procedures involving entry
into lumen of gastrointestinal
tract, or gastric bypass
procedures
Cefazolin
Procedures without entry
into the gastrointestinal tract
(antireflux, highly selective
vagotomy) for high risk
patients
Cefazolin
A
Clindamycin or
vancomycin
+
aminoglycosidec
or aztreonam or
fluoroquinoloned-f
Clindamycin or
vancomycin
Head and Neck
Clean
With placement of
prosthesism
Clean-contaminated cancer
surgery
Other clean-contaminated
procedures with the
exception of tonsillectomy
and functional endoscopic
sinus procedures
None
B
Cefazolin
Cefuroxime
C
Cefazolin
+
metronidazole
Cefuroxime
+
metronidazole
Ampicillin���sulbactamd
Cefazolin
+
metronidazole
Cefuroxime
+
metronidazole
Ampicillin���sulbactamd
None
Clindamycini
Clindamycini
A
Clindamycini
B
Hernia Repair Procedures
Clean
Cefazolin
A
Clindamycin
Vancomycin
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