Sandbox Jose2: Difference between revisions
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| [[Cefazolin]] {{or}} [[Cefoxitin]] {{or}} [[Cefotetan]] | | [[Cefazolin]] {{or}} [[Cefoxitin]] {{or}} [[Cefotetan]] | ||
| 1-2 g IV | | 1-2 g IV | ||
| The recommended dose of cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | | The recommended dose of cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. For patients allergic to penicillins and cephalosporins, [[Clindamycin]] {{or}} [[Vancomycin]] with either [[Gentamicin]], [[Ciprofloxacin]], [[Levofloxacin]] or [[Aztreonam]] is a reasonable alternative. Fluoroquinolones should not be used for prophylaxis in cesarean section. Due to increasing resistance of E. coli to fluoroquinolones and [[Ampicillin/Sulbactam]], local sensitivity profiles should be reviewed prior to use. | ||
|- | |- | ||
| | | | ||
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| [[Cefazolin]] | | [[Cefazolin]] | ||
| 1-2 g IV | | 1-2 g IV | ||
| The recommended dose of [[Cefazolin]] is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | | The recommended dose of [[Cefazolin]] is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. For patients allergic to penicillins and cephalosporins, [[Clindamycin]] {{or}} [[Vancomycin]] with either [[Gentamicin]], [[Ciprofloxacin]], [[Levofloxacin]] or [[Aztreonam]] is a reasonable alternative. Fluoroquinolones should not be used for prophylaxis in cesarean section. Due to increasing resistance of E. coli to fluoroquinolones and [[Ampicillin/Sulbactam]], local sensitivity profiles should be reviewed prior to use. | ||
|- | |- | ||
| Abortion, surgical | | Abortion, surgical | ||
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| | | | ||
| S. aureus, S. epidermidis, enteric gram-negative bacilli, streptococci | | S. aureus, S. epidermidis, enteric gram-negative bacilli, streptococci | ||
| Cefazolin | | [[Cefazolin]] | ||
| 1-2 g IV | | 1-2 g IV | ||
| The recommended dose of [[Cefazolin]] is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | | The recommended dose of [[Cefazolin]] is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | ||
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| 3 g IV | | 3 g IV | ||
| Due to increasing resistance of E. coli to fluoroquinolones and [[Ampicillin/Sulbactam]], local sensitivity profiles should be reviewed prior to use. | | Due to increasing resistance of E. coli to fluoroquinolones and [[Ampicillin/Sulbactam]], local sensitivity profiles should be reviewed prior to use. | ||
|- | |||
| colspan=5 | Vascular | |||
|- | |- | ||
| | | Arterial surgery involving· a prosthesis, the abdominal aorta, or a groin incision | ||
| | | S. aureus, S. epidermidis, enteric gram-negative bacilli | ||
| Cefazolin | | [[Cefazolin]] | ||
| 1-2 g IV | | 1-2 g IV | ||
| | | The recommended dose of [[Cefazolin]] is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | ||
||- | |||
| | |||
| | |||
| {{or}} [[Vancomycin]] | |||
| 1 g IV | |||
| [[Vancomycin]] can be used in hospitals in which methicillin-resistant S. aureus and S. epidermidis are a frequent cause of postoperative wound infection, in patients previously colonized with MRSA, or for those who are allergic to penicillins or cephalosporins. Rapid IV administration may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with [[Diphenhydramine]] (Benadryl, and others) and further slowing of the infusion rate may be helpful. Some experts would give 15 mg/kg of [[Vancomycin]] to patients weighing more than 751<g, up to a maximum of 1.5 g, with a slower infusion rate (90 minutes for 1.5 g). For procedures in which enteric gram-negative bacilli are common pathogens, many experts would add another drug such as an aminoglycoside ([[Gentamicin]], [[Tobramycin]] or [[Amikacin]]), [[Aztreonam]] or a fluoroquinolone. | |||
|- | |- | ||
| | | Lower extremity amputation for ischemia | ||
| | | S. aureus, S. epidermidis, enteric gram-negative bacilli, clostridia | ||
| Cefazolin | | Cefazolin | ||
| 1-2 g IV | | 1-2 g IV | ||
| | | The recommended dose of [[Cefazolin]] is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | ||
||- | |||
| | |||
| | |||
| {{or}} [[Vancomycin]] | |||
| 1 g IV | |||
| | | [[Vancomycin]] can be used in hospitals in which methicillin-resistant S. aureus and S. epidermidis are a frequent cause of postoperative wound infection, in patients previously colonized with MRSA, or for those who are allergic to penicillins or cephalosporins. Rapid IV administration may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with [[Diphenhydramine]] (Benadryl, and others) and further slowing of the infusion rate may be helpful. Some experts would give 15 mg/kg of [[Vancomycin]] to patients weighing more than 751<g, up to a maximum of 1.5 g, with a slower infusion rate (90 minutes for 1.5 g). For procedures in which enteric gram-negative bacilli are common pathogens, many experts would add another drug such as an aminoglycoside ([[Gentamicin]], [[Tobramycin]] or [[Amikacin]]), [[Aztreonam]] or a fluoroquinolone. | ||
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Revision as of 15:38, 28 July 2015
Procedure | Causative etiologies | Recommended antimicrobials | Usual adult dosage | Comments | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Cardiovascular | ||||||||||
Staphylococcus aureus, Staphylococcus epidermidis | Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. Some experts recommend an additional dose when patients are removed from bypass during open-heart surgery. | |||||||
Cefuroxime | 1.5 g IV | Some experts recommend an additional dose when patients are removed from bypass during open-heart surgery. | ||||||||
Vancomycin | 1 g IV | |||||||||
Gastrointestinal | ||||||||||
Esophageal, gastroduodenal | Enteric gram-negative bacilli, gram-positive cocci | High-risk only: Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | ||||||
Biliary tract | Enteric gram-negative bacilli, enterococci, clostridia | High-risk only: Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | ||||||
Colorectal | Enteric gram-negative bacilli, anaerobes, enterococci | Oral: Neomycin PLUS Erythromycin bases OR Metronidazole | In addition to mechanical bowel preparation, 1 g of Neomycin PLUS 1 g of Erythromycin at 1 PM, 2 PM and 11 PM or 2 g of Neomycin PLUS 2 g of Metronidazole at 7 PM and 11 PM the day before an 8 AM operation. | |||||||
Parenteral: Cefoxitin or Cefotetan | 1-2 g IV | |||||||||
OR Cefazolin | 1-2 g IV | The recommended dose of cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | ||||||||
PLUS Metronidazole | 0.5 g IV | |||||||||
OR Ampicillin/Sulbactam | 3 g IV | |||||||||
Appendectomy, non-perforated | Same as for colorectal | Cefoxitin OR Cefotetan | 1-2 g IV | For patients allergic to penicillins and cephalosporins, Clindamycin OR Vancomycin with either Gentamicin, Ciprofloxacin, Levofloxacin or Aztreonam is a reasonable alternative. Fluoroquinolones should not be used for prophylaxis in cesarean section. | ||||||
OR Cefazolin | 1-2 g IV | |||||||||
PLUS Metronidazole | 0.5 g IV | |||||||||
Genitourinary | ||||||||||
Cystoscopy alone | Enteric gram-negative bacilli, enterococci | High-risk only: Ciprofloxacin | 500 mg PO OR 400 mg IV | Due to increasing resistance of E. coli to fluoroquinolones and Ampicillin/Sulbactam, local sensitivity profiles should be reviewed prior to use. | ||||||
OR Trimethoprim-Sulfamethoxazole | 1 DS tablet | |||||||||
Cystoscopy with manipulation or upper tract instrumentation | Enteric gram-negative bacilli, enterococci | Ciprofloxacin | 500 mg PO OR 400 mg IV | Due to increasing resistance of E. coli to fluoroquinolones and Ampicillin/Sulbactam, local sensitivity profiles should be reviewed prior to use. | ||||||
OR Trimethoprim-Sulfamethoxazole | 1 DS tablet | |||||||||
Open or laparoscopic surgery | Enteric gram-negative bacilli, enterococci | Cefazolin | 1-2 g IV | The recommended dose of cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | ||||||
Gynecologic and Obstetric | ||||||||||
Vaginal, abdominal or laparoscopic hysterectomy | Enteric gram-negative bacilli, anaerobes, Gp B strep, enterococci | Cefazolin OR Cefoxitin OR Cefotetan | 1-2 g IV | The recommended dose of cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. For patients allergic to penicillins and cephalosporins, Clindamycin OR Vancomycin with either Gentamicin, Ciprofloxacin, Levofloxacin or Aztreonam is a reasonable alternative. Fluoroquinolones should not be used for prophylaxis in cesarean section. Due to increasing resistance of E. coli to fluoroquinolones and Ampicillin/Sulbactam, local sensitivity profiles should be reviewed prior to use. | ||||||
OR Ampicillin/Sulbactam | 3 g IV | For patients allergic to penicillins and cephalosporins, Clindamycin OR Vancomycin with either Gentamicin, Ciprofloxacin, Levofloxacin or Aztreonam is a reasonable alternative. Fluoroquinolones should not be used for prophylaxis in cesarean section. Due to increasing resistance of E. coli to fluoroquinolones and Ampicillin/Sulbactam, local sensitivity profiles should be reviewed prior to use. | ||||||||
Cesarean section | same as for hysterectomy | Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. For patients allergic to penicillins and cephalosporins, Clindamycin OR Vancomycin with either Gentamicin, Ciprofloxacin, Levofloxacin or Aztreonam is a reasonable alternative. Fluoroquinolones should not be used for prophylaxis in cesarean section. Due to increasing resistance of E. coli to fluoroquinolones and Ampicillin/Sulbactam, local sensitivity profiles should be reviewed prior to use. | ||||||
Abortion, surgical | same as for hysterectomy | Doxycycline | 300 mg PO | Divided into 100 mg before the procedure and 200 mg after. | ||||||
Head and Neck Surgery | ||||||||||
Incisions through oral or pharyngeal mucosa | Anaerobes, enteric gram-negative bacilli, S. aureus | Clindamycin | 600 mg - 900 mg IV | |||||||
OR Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | ||||||||
Metronidazole | 0.5 g IV | |||||||||
OR Ampicillin/Sulbactam | 3 g IV | |||||||||
Neurosurgery | ||||||||||
S. aureus, S. epidermidis | Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | |||||||
OR Vancomycin | 1 g IV | Vancomycin can be used in hospitals in which methicillin-resistant S. aureus and S. epidermidis are a frequent cause of postoperative wound infection, in patients previously colonized with MRSA, or for those who are allergic to penicillins or cephalosporins. Rapid IV administration may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with Diphenhydramine (Benadryl, and others) and further slowing of the infusion rate may be helpful. Some experts would give 15 mg/kg of Vancomycin to patients weighing more than 751<g, up to a maximum of 1.5 g, with a slower infusion rate (90 minutes for 1.5 g). For procedures in which enteric gram-negative bacilli are common pathogens, many experts would add another drug such as an aminoglycoside (Gentamicin, Tobramycin or Amikacin), Aztreonam or a fluoroquinolone. | ||||||||
Ophthalmic | ||||||||||
S. aureus, S. epidermidis, streptococci, enteric gram-negative bacilli, Pseudomonas spp. | Gentamicin, Tobramycin, Ciprofloxacin, Gatifloxacin, Levofloxacin, Moxifloxacin, Ofloxacin OR Neomycin-gramicidin-polymyxin B | Multiple drops topically over 2 to 24 hours | ||||||||
OR Cefazolin | 100 mg subconjunctivally | |||||||||
Orthopedic | ||||||||||
S. aureus, S. epidermidis | Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | |||||||
OR Vancomycin | 1 g IV | Vancomycin can be used in hospitals in which methicillin-resistant S. aureus and S. epidermidis are a frequent cause of postoperative wound infection, in patients previously colonized with MRSA, or for those who are allergic to penicillins or cephalosporins. Rapid IV administration may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with Diphenhydramine (Benadryl, and others) and further slowing of the infusion rate may be helpful. Some experts would give 15 mg/kg of Vancomycin to patients weighing more than 751<g, up to a maximum of 1.5 g, with a slower infusion rate (90 minutes for 1.5 g). For procedures in which enteric gram-negative bacilli are common pathogens, many experts would add another drug such as an aminoglycoside (Gentamicin, Tobramycin or Amikacin), Aztreonam or a fluoroquinolone. If a tourniquet is to be used in the procedure, the entire dose of antibiotic must be infused prior to its inflation. | ||||||||
Thoracic (non-cardiac) | ||||||||||
S. aureus, S. epidermidis, enteric gram-negative bacilli, streptococci | Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | |||||||
OR Vancomycin | 1 g IV | Vancomycin can be used in hospitals in which methicillin-resistant S. aureus and S. epidermidis are a frequent cause of postoperative wound infection, in patients previously colonized with MRSA, or for those who are allergic to penicillins or cephalosporins. Rapid IV administration may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with Diphenhydramine (Benadryl, and others) and further slowing of the infusion rate may be helpful. Some experts would give 15 mg/kg of Vancomycin to patients weighing more than 751<g, up to a maximum of 1.5 g, with a slower infusion rate (90 minutes for 1.5 g). For procedures in which enteric gram-negative bacilli are common pathogens, many experts would add another drug such as an aminoglycoside (Gentamicin, Tobramycin or Amikacin), Aztreonam or a fluoroquinolone. | ||||||||
OR Ampicillin/Sulbactam | 3 g IV | Due to increasing resistance of E. coli to fluoroquinolones and Ampicillin/Sulbactam, local sensitivity profiles should be reviewed prior to use. | ||||||||
Vascular | ||||||||||
Arterial surgery involving· a prosthesis, the abdominal aorta, or a groin incision | S. aureus, S. epidermidis, enteric gram-negative bacilli | Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | - | OR Vancomycin | 1 g IV | Vancomycin can be used in hospitals in which methicillin-resistant S. aureus and S. epidermidis are a frequent cause of postoperative wound infection, in patients previously colonized with MRSA, or for those who are allergic to penicillins or cephalosporins. Rapid IV administration may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with Diphenhydramine (Benadryl, and others) and further slowing of the infusion rate may be helpful. Some experts would give 15 mg/kg of Vancomycin to patients weighing more than 751<g, up to a maximum of 1.5 g, with a slower infusion rate (90 minutes for 1.5 g). For procedures in which enteric gram-negative bacilli are common pathogens, many experts would add another drug such as an aminoglycoside (Gentamicin, Tobramycin or Amikacin), Aztreonam or a fluoroquinolone. | ||
Lower extremity amputation for ischemia | S. aureus, S. epidermidis, enteric gram-negative bacilli, clostridia | Cefazolin | 1-2 g IV | The recommended dose of Cefazolin is 1 g for patients who weigh <80 kg and 2 g for those ~80 kg. Morbidly obese patients may need higher doses. | - | OR Vancomycin | 1 g IV | Vancomycin can be used in hospitals in which methicillin-resistant S. aureus and S. epidermidis are a frequent cause of postoperative wound infection, in patients previously colonized with MRSA, or for those who are allergic to penicillins or cephalosporins. Rapid IV administration may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with Diphenhydramine (Benadryl, and others) and further slowing of the infusion rate may be helpful. Some experts would give 15 mg/kg of Vancomycin to patients weighing more than 751<g, up to a maximum of 1.5 g, with a slower infusion rate (90 minutes for 1.5 g). For procedures in which enteric gram-negative bacilli are common pathogens, many experts would add another drug such as an aminoglycoside (Gentamicin, Tobramycin or Amikacin), Aztreonam or a fluoroquinolone. |