Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Table 1. GI Surgical Prophylaxis RegimensGastrointestinalGI:Cholecystectomy 3 Escherichia coli andKlebsiella . Streptococci andstaphylococci areoccasionally isolated.Anaerobic bacteria areuncommon, but Clostridiumis possible.GI: UpperMost common areGastroduodenal3 nasopharyn gealcommensals (streptococci,lactobacilli and diphtheroids)GI: Colorectal3 Enteric Gram - nega tivebacilli, anaerobes, with E.coli and Bacteroides fragilisthe most commonorganisms.GI: Appendectomy3 Anaerobic organisms(especially B fragilis) andGram - negative entericorganisms (predominantly Ecoli). Staph ylococcus,Enterococcus andPseudomonas species havealso been reported.LIKELY PAT HOGENS ANTIMICROBIAL REGIMEN OR REDOSING COMMENTS• Cefazolin 1 g IV 4 pre-op(2 g if > 80 kg)-op•( 2Cefazoling if > 80 4 kg)1 g IV pre----- or• Cefuroxime 1.5 g IV pre-opBowel prep (day before surgery):• Metoclopramide 10 mg PO 30 min. prior toGI lavage 1.5 L Q1H until clear(max. 4-6 L). When GI lavage is clear,start neomycin 1 g PO with erythromycin1 g PO at 1300, 1400, and 2300.• Unasyn® (ampicillin/sulbactam)1.5 g-3 g IV pre-op----- or• Cefoxitin 1-2 g IV pre-op(2 g if > 80 kg)----- or• Ciprofloxacin 400 mg IV pre-opplusMetronidazole 500-750 mg IV pre-op.----- or•Clindamycin 900 mg IVplusgentamicin 1.7 mg/kg IV 30 pre-opUncomplicated:• Cefoxitin 4 1 g IV pre-op(2 g if > 80 kg)Complicated (adult):• Unasyn® (ampicillin/sulbactam)1.5-3 g IV pre-opComplicated (children):• Unasyn® (ampicillin/sulbactam)12.5-25 mg/kg pre-op• Cefazolin every 4hours• Cefazolin every 4hours• Cefuroxime every 4hours• Unasyn® every 4hours• Cefoxitin every 3hours• Ciprofloxacin: none• Metronidazole every 6hours• Clindamycin every 6hours• Cefoxitin every 3hours• Unasyn® every 4hoursBacteria isolated from bile duringsurgery are those most likely to beassociated with wound infections.Prophylaxis indicated only for patientswith increased pH from the use of H2receptor blockers, proton pumpinhibitors, with gastric obstruction or GIhemorrhage. and with complexprocedures suche asa Whipple or a gastricbypass.Metronidazole 750 mg may besubstituted for erythromycin inerythromycin - sens itive patients.NOTE: 50% of trials evaluated dem -onstrated