Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Cleanorthopedicprocedures(other)Staphylococci• Minor procedures - None• Major procedures –Cefazolin 4 1 g IV pre-op, (2g if > 80 kg)----- or• Vancomycin 1 g IV preop ifpatient is MRSA-positive• Minor procedures - None• Major procedures –Cefazolin 25mg/kg IV preop(Maximum of 1 g)• Vancomycin 15mg/kg IVpre-op (Maximum of 1 g) ifMRSA+• Cefazolin every 4hours• Vancomycin none;every 6 hours forpediatric patientsUse vancomycin only for severepenicillin allergy. Some cliniciansuse clindamycin in penicillinallergicpatients.GenitourinaryLIKELYPATHOGENSANTIMICROBIAL REGIMEN(Adult)ANTIMICROBIAL REGIMEN(Pediatric)OR REDOSINGCOMMENTSTransurethralResection ofProstate 3E coli as well as otherGram--negative bacilliand enterococci• Gentamicin 80 mg IV(single dose) plusAmpicillin 500 mg - 1 g IV(single dose) pre-op----- or• Ciprofloxacin 500 mg POor400 mg IV pre-op (singledose)• • None If urine is sterile the role ofperioperative prophylaxis isprobably of marginal benefit.Continuing antibiotic prophylaxispost TURP is stronglydiscouraged and will greatlyincrease the risk of nosocomialUTI with enterococci, resistantGram--negative bacilli, andcandida.InjuryLIKELYPATHOGENSANTIMICROBIAL REGIMEN(Adult)ANTIMICROBIAL REGIMEN(Pediatric)OR REDOSINGCOMMENTSRupturedviscus 3Enteric Gram--negativebacilli, anaerobes(Bacteroides fragilis)and enterococci.• Unasyn ®(ampicillin/sulbactam)3 g IV pre-op----- or• Piperacillin/tazobactam4.5 g IV pre-op----- or• Clindamycin 900 mg IVplus gentamicin 1.7mg/kg IV pre-op forpenicillin-allergic patients• Unasyn(ampicillin/sulbactam)37.5mg/kg (provides25mg/kg of ampicillin) IV(Maximum of 3 g) preop• Piperacillin/tazobactam80mg/kg IV pre-op(Maximum of 4.5 g)• Clindamycin 10mg/kg IVplus gentamicin 2mg/kg IV(Maximum of 80mg) pre-opfor pencillin-allergicpatients• Unasyn every 4hours• Pip/Tazo every 4hours• Clindamycin every6 hours• Gentamicin every 8hoursUse Unasyn ® for communitybasedperitonitis.Use piperacillin/tazobactam forperitonitis that developssecondarily in hospitalizedpatients or patients with priorantibiotic use at risk for resistantbacteria such as Enterococcusand Pseudomonas.