Treatment
Table 4. Antimicrobial Recommendations for Surgical
Prophylaxis Stratified by Type of Procedure
Type of Procedure
Recommended
Agentsa,b
Strength of Alternative in
Evidence
β-Lactam Allergy
Appendectomy for uncomplicated appendicitis
Cefoxitin
Cefotetan
Cefazolin +
metronidazole
A
Clindamycin
+
aminoglycosidec or aztreonam or
fluoroquinoloned-f
Metronidazole
+
aminoglycosidec or
fluoroquinoloned-f
Biliary tract
Open procedure
Cefazolin
Cefoxitin
Cefotetan
Ceftriaxoneg
Ampicillin–sulbactamd
A
Clindamycin or vancomycin
+
aminoglycosidea or aztreonam
or fluoroquinoloned-f
Metronidazole
+
aminoglycosidec or
fluoroquinoloned-f
Laparoscopic procedure
Elective, low-riskh
None
Elective, high-riskh
Cefazolin
Cefoxitin
Cefotetan
Ceftriaxoneg
Ampicillin–sulbactamd
A
A
None
Clindamycin or vancomycin
+
aminoglycosidec or aztreonam or
fluoroquinoloned-f
Metronidazole
+
aminoglycosidec or
fluoroquinoloned-f
Cardiac
Coronary artery bypass
Cardiac device insertion
procedures (eg,
pacemaker implantation)
Cefazolin
Cefuroxime
A
Ventricular assist devices
8
Cefazolin
Cefuroxime
Cefazolin
Cefuroxime
C
A
Clindamycini
Vancomycini
Clindamycini
Vancomycini
Clindamycini
Vancomycini
