Surgery Book

Dermatology

Infectious Disease

  • Surgical Antibiotic Prophylaxis

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Surgical Antibiotic ProphylaxisAka: Prophylactic Antibiotics in Surgery, Antibiotic Prophylaxis in Surgery

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  1. See Also
    1. SBE Prophylaxis
  2. Epidemiology
    1. Surgical-site infection Incidence
      1. Extra-abdominal surgery: 2-5%
      2. Intra-abdominal surgery: 20%
  3. Efficacy
    1. Antibiotics do not prevent infection in clean surgery
    2. Antibiotic prophylaxis not recommended in:
      1. Nosocomial Infection Surveillance (NNIS) Class 0 to 1
    3. Knight (2001) Am J Surg 182:682
  4. Extraabdominal Procedures
    1. Cardiothoracic surgery (duration 24-72 hours)
      1. No Beta-lactam allergy: Cefazolin or Cefuroxime
      2. Beta-lactam allergy: Vancomyin or Clindamycin
    2. Vascular surgery
      1. No Beta-lactam allergy: Cefazolin or Cefuroxime
      2. Beta-lactam allergy: Vancomyin or Clindamycin
    3. Orthopedic: Hip or Knee surgery
      1. Antibiotic infused before tourniquet inflated
      2. No Beta-lactam allergy: Cefazolin or Cefuroxime
      3. Beta-lactam allergy: Vancomyin or Clindamycin
      4. Continue for 24 hours post-surgery
  5. Abdominal Surgery: Colon
    1. Organisms
      1. Bowel Anaerobes (including Bacteroides)
    2. Combination protocol (oral with parenteral antibiotics)
      1. Oral (used with parenteral agent below)
        1. Neomycin with Erythromycin base or
        2. Metronidazole
      2. Parenteral: Anti-Anaerobe Cephalosporins
        1. Cefotetan (Cefotan) or
        2. Cefoxitin (Mefoxin) or
        3. Cefotaxime (with Metronidazole for appendectomy) or
        4. Ceftriaxone (may become preferred agent)
          1. Woodfield (2002) Am J Surg 185:45
  6. Gynecologic Surgery
    1. Ceserean Section
      1. Cefazolin 1 to 2 grams IV for single dose and
      2. Consider coverage for Ureaplasma urealyticum
        1. Azithromycin and
        2. Doxycycline
      3. Administer after clamping Umbilical Cord
      4. References
        1. Andrews (2003) Obstet Gynecol 101:1183
    2. Hysterectomy
      1. Cefazolin 1 to 2 grams IV for single dose or
      2. Cefoxitin 2 grams IV for single dose or
      3. Cefotetan 1 to 2 grams IV for single dose or
      4. Metronidazole 500 mg IV for single dose
    3. Hysterosalpingogram with dilated tubes
      1. Doxycycline 100 mg PO bid for 5 days
    4. Induced abortion or Dilation and Curettage
      1. Doxycycline 100 mg PO before procedure, then
      2. Doxycycline 200 mg PO after procedure, then
      3. Metronidazole 500 mg PO bid for 5 days
    5. Procedures not requiring antibiotics
      1. Laparoscopy
      2. Laparotomy
      3. Hysteroscopy
      4. IUD Insertion
      5. Endometrial Biopsy
      6. Urodynamics
  7. Dosing Technique
    1. Dose once immediately before procedure
    2. Second dose indications
      1. Long Surgery
      2. Large Estimated Blood Loss
  8. Precautions
    1. Avoid Third Generation Cephalosporins for prophylaxis
      1. Expensive
      2. Less active against Staphylococcus than Ancef
    2. Promotes emerging resistance
  9. References
    1. (2001) Obstet Gynecol 23:1
    2. Bratzler (2004) Clin Infect Dis 38:1706

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