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 β-Lactam Allergy
Neurosurgery
Elective craniotomy and
cerebrospinal fluid-shunting
procedures
Cefazolin
Implantation of intrathecal
pumps
Cefazolin
A
C
Clindamycini
Vancomycini
Clindamycini
Vancomycini
Obstetrics-Gynecology
Cesarean delivery
Cefazolin
Hysterectomy (vaginal or
abdominal)
Cefazolin
A
Cefotetan
A
Cefoxitin
Clindamycin
+
aminoglycosidec
Clindamycin or
vancomycin
+
aminoglycosidec
or aztreonam or
fluoroquinoloned-f
Metronidazole
+
aminoglycosidec or
fluoroquinoloned-f
Ampicillin–sulbactamd
Ophthalmic (Addition of cefazolin 100 mg by subconjunctival injection or intracameral cefazolin
1-2.5 mg or cefuroxime 1 mg at the end of the procedure is optional.)
Topical neomycin–
polymyxin
B-gramicidin or
4th-generation topical
fluoroquinolones
(gatifloxacin or
moxifloxacin) given as
one drop every 5-15
minutes for five dosesn
B
Orthopedic
Clean procedures involving
hand, knee, or foot, not
involving implantation of
foreign materials
None
Spinal procedures with and
without instrumentation
Cefazolin
Hip fracture repair
Cefazolin
Implantation of internal
fixation deviceso
Cefazolin
Total joint replacement
Cefazolin
10
None
C
A
A
C
A
Clindamycini
Vancomycini
Clindamycini
Vancomycini
Clindamycini
Vancomycini
Clindamycini
Vancomycini
