Sandbox Jose2

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.