Transcript For Patients WITH penicillin allergy

Perioperative Antibiotics for
GI Surgery
•
•
•
•
Laprascopic Cholecystectomy
Small Bowel Obstruction
Appendectomy
Diverticulitis
Open or Laprascopic Cholecystectomy
for acute cholecystitis (Pre-Op)
No antibiotics recommended if no cholecystitis expected (level A evidence)
For Patients WITHOUT penicillin allergy
Cefazolin 2 gm IVPB injection – to be given in OR by Anesthesiology <60
min before incision
OR
Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min
before incision
For Patients WITH penicillin allergy
Clindamycin 900 grams IV q8h
AND
Gentamicin 5 mg/kg IV q24h
OR
Aztreonam 2 grams IV q8h
Laprascopic Cholecystectomy
for acute cholecystitis (Post-Op)
For Patients WITHOUT penicillin allergy
Ceftriaxone 2 grams IV q24h
AND
Metronidazole 500 mg IV q8h
For Patients WITH penicillin allergy
Clindamycin 900 grams IV q8h
AND
Gentamicin 5 mg/kg IV q24h
OR
Aztreonam 2 grams IV q8h
Small Bowel Obstruction
Pre-Op
For Patients WITHOUT penicillin allergy
• Cefazolin 2 gm IVPB injection – to be given in OR by Anesthesiology <60
min before incision
•
•
And
Metronidazole 500mg IVPB injection- to be given in OR by Anesthesiology
<60 min before incision
•
OR
•
Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min
before incision
For Patients with penicillin allergy
• Clindamycin 900 mg IVPB injection to be given in the OR by
Anesthesiology <60 min before incision
•
•
Gentamicin 5 mg/kg IVPB to be given in the OR by anesthesiology <60min
before incision
•
•
And
Or
Aztreonam 2 gm IVPB to be given in the OR by anesthesiology <60min
before incision
Small Bowel Obstruction
Post-Op (if evidence of infection)
For Patients WITHOUT penicillin allergy
• Cefazolin 2 gm IVPB injection q8hr x 2 doses
» AND
• Metronidazole 500 mg IVBP injection q 8hr x 2 doses
» OR
• Cefoxitin 2 gm IVPB injection q 8 hrs x 2 doses
For Patients with penicillin allergy
• Clindamycin 900 mg IVPB injection q8hr x 2 doses
» AND
• Aztreonam 2 gm IVPB q8hr x 2 doses (if aztreonam used pre-op)
Appendectomy
Pre-Op (for acute appendicitis)
For Patients WITHOUT penicillin allergy
• Cefazolin 2 gm IVPB
» AND
• Metronidazole 500 mg IVPB
» OR
• Cefoxitin 2 gm IVPB injection- to be given in OR by
Anesthesiology <60min before incision
For Patients with penicillin allergy
• Clindamycin 900 mg IVPB injection to be given in the OR by
Anesthesiology <60 min before incision
» AND
• Gentamicin 5mg/kg IVPB to be given in the OR by
anesthesiology <60min before incision
» OR
• Aztreonam 2gm IVPB to be given in the OR by
anesthesiology <60min before incision
Appendectomy
Post-Op
For Patients WITHOUT penicillin allergy
• Cefazolin 2 gm IVPB
» AND
• Metronidazole 500 mg IVPB
» OR
• Cefoxitin 2 gm IVPB injection- to be given in OR by
Anesthesiology <60min before incision
For Patients with penicillin allergy
• Clindamycin 900 mg IVPB injection to be given in the OR by
Anesthesiology <60 min before incision
» And
• Aztreonam 2 gm IVPB to be given in the OR by
anesthesiology <60min before incision
Diverticulitis
(Conservative/Non-Operative)
For Patients WITHOUT penicillin allergy
– Piperacillin-Tazobactam 3.375 g IVPB q8h as a 4 hour infusion x 48
hours
For Patients with penicillin allergy
– Levofloxacin 750 mg IVPB q24h x 48 hours
– Metronidazole 500 mg IV q8h x 48 hours
Diverticulitis Washout
Pre-Op
For Patients WITHOUT penicillin allergy
• Cefazolin 2 grams IVPB
–
•
AND
Metronidazole 500 mg IVPB
–
OR
•
Cefoxitin 2gm IVPB injection- to be given in OR by Anesthesiology <60min
before incision
For Patients with penicillin allergy
• Clindamycin 900mg IVPB injection to be given in the OR by Anesthesiology
<60 min before incision
•
•
Gentamicin 5 mg/kg IVPB to be given in the OR by anesthesiology <60min
before incision
•
•
And
Or
Aztreonam 2 gm IVPB to be given in the OR by anesthesiology <60min
before incision
Diverticulitis Washout
Post-Op
For Patients WITHOUT penicillin allergy
• Piperacillin-Tazobactam 3.375 gm IVPB
injection q8 hrs as a 4 hours infusion x 5 days
For Patients with penicillin allergy
• Levofloxacin 750mg IVPB injection q 24 hrs x 5
days
» And
• Metronidazole 500mg IVPB injection- q8 hrs x
5 days
Diverticulitis with stoma
Pre-Op
For Patients WITHOUT penicillin allergy
• Cefazolin 2 gm IVPB
AND
• Metronidazole 500 mg IVPB
OR
• Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min
before incision
For Patients with penicillin allergy
• Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology
<60 min before incision
AND
•
Gentamicin 5 mg/kg IVPB to be given in the OR by anesthesiology <60min
before incision
OR
•
Aztreonam 2 gm IVPB to be given in the OR by anesthesiology <60min before
incision
Diverticulitis with stoma
Post-Op
For Patients WITHOUT penicillin allergy
• Cefazolin 2 gm IVPB q8h x 2 doses
AND
• Metronidazole 500 mg IVPB q8h x 2 doses
OR
• Cefoxitin 2 gm IVPB IVPB q8h x 2 doses
For Patients with penicillin allergy
• Clindamycin 900 mg IVPB q8h x 2 doses
AND
• Aztreonam 2 gm IVPB q8h x 2 doses (ONLY if given pre-op)
Diverticulitis without stoma
Pre-Op
For Patients WITHOUT penicillin allergy
• Cefazolin 2 grams IVPB
AND
•
Metronidazole 500 mg IVPB
OR
•
Cefoxitin 2gm IVPB injection- to be given in OR by Anesthesiology <60min
before incision
For Patients with penicillin allergy
• Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology
<60 min before incision
AND
• Gentamicin 5 mg/Kg IVPB to be given in the OR by anesthesiology <60min
before incision
OR
•
Aztreonam 2gm IVPB to be given in the OR by anesthesiology <60min before
incision
Diverticulitis without stoma
Post-Op
For Patients WITHOUT penicillin allergy
• Cefazolin 2 grams IVPB q8h x 2 doses
AND
• Metronidazole 500 mg IVPB q8h x 2 doses
OR
• Cefoxitin 2gm IVPB q8h x 2 doses
For Patients with penicillin allergy
• Clindamycin 900 mg IVPB q8h x 2 doses
AND
• Aztreonam 2gm IVPB q8h x 2 doses (only if given pre-op)