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
β-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.
11
