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HOSPITAL OF THE UNIVERSITY OF PENNSYLVANIA

PERI-OPERATIVE ANTIBIOTIC PROPHYLAXIS

***Please note that the Surgical and Anesthesiology Teams MUST discuss prophylaxis for procedures not listed below, as well as for patients currently receiving antibiotics for active infections.***

Cardiothoracic Surgery

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
Median sternotomy	cefazolin + vancomycin	vancomycin + gentamicin	Pre-op Post-op
Heart transplant, VAD placement	cefazolin + vancomycin	vancomycin + levofloxacin	Pre-op Post-op
Lung transplant (non-infected)	vancomycin + cefepime	vancomycin + levofloxacin	Pre-op Post-op

Electrophysiology

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
AICD and pacemaker placement	cefazolin	vancomycin	Pre-op Post-op

Vascular

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
All procedures	cefazolin	vancomycin	Pre-op Post-op

Orthopaedics

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
Insertion of prosthetic joints, open operations	cefazolin	vancomycin	Pre-op Post-op
Other	cefazolin	vancomycin	Pre-op Post-op

Head and Neck

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
Operations involving the mucous membranes and deep tissues	cefazolin + metronidazole	clindamycin + gentamicin	Pre-op Post-op

Thoracic Surgery

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
General thoracic: pulmonary and esophageal	cefazolin	vancomycin + gentamicin	Pre-op Post-op

Neurosurgery

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
All procedures	cefazolin	vancomycin	Pre-op Post-op

General Surgery

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
Gastroduodenal: procedures involving entry into lumen of gastrointestinal tract	cefazolin +/- metronidazole	vancomycin + gentamicin +/- metronidazole	Pre-op Post-op
Cholecystectomy (open or laparoscopic)	cefazolin +/- metronidazole	vancomycin + gentamicin +/- metronidazole	Pre-op Post-op
Biliary tract surgeries: all open and laparoscopic procedures, chronically intubated biliary tract	cefazolin +/- metronidazole	vancomycin + gentamicin +/- metronidazole	Pre-op Post-op
Bariatric surgery	cefazolin	vancomycin + gentamicin	Pre-op Post-op
Hernia repair without MESH	cefazolin	vancomycin	Pre-op Post-op
Hernia repair with MESH	cefazolin	vancomycin	Pre-op Post-op
Gastrostomy or jejunostomy (open or endoscopic) tube placement	cefazolin	vancomycin + gentamicin	Pre-op Post-op
Appendectomy: simple appendicitis (antibiotics are empiric or definitive for complicated appendicitis)	cefazolin + metronidazole	vancomycin + gentamicin + metronidazole	Pre-op Post-op
Abdominal trauma	ampicillin/sulbactam	clindamycin + gentamicin	Pre-op Post-op
Colorectal: operations that open the colon and/or rectum	cefazolin + metronidazole	vancomycin + gentamicin + metronidazole	Pre-op Post-op
Breast augmentation	cefazolin	vancomycin	Pre-op Post-op
Mastectomy with tissue expanders	cefazolin	vancomycin	Pre-op Post-op
Tunneled central venous catheter placement (Hickman, Port-a-cath, Medcomp)	cefazolin	vancomycin	Pre-op Post-op
Liver transplant	ampicillin/sulbactam	levofloxacin +/- metronidazole	Pre-op Post-op

Gynecologic Surgery

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
Cesarean section	cefazolin	vancomycin + gentamicin	Pre-op Post-op
Hysterectomy	cefazolin	vancomycin + gentamicin	Pre-op Post-op

Urologic Surgery

Procedure	Antimicrobial Agent(s)	Alternative in β-lactam Allergic Patient	Dosing (click on pre-op or post-op)
Transrectal prostate biopsy	trimethoprim/sulfamethoxazole 160 mg/800 mg or levofloxacin	trimethoprim/sulfamethoxazole 160 mg/800 mg or levofloxacin	Pre-op Post-op
Radical prostatectomy	cefazolin	trimethoprim/sulfamethoxazole 160 mg/800 mg or levofloxacin	Pre-op Post-op
Transurethral resection of prostate (TURP): pre-procedure urine infected	trimethoprim/sulfamethoxazole 160 mg/800 mg or levofloxacin	trimethoprim/sulfamethoxazole 160 mg/800 mg or levofloxacin	Pre-op Post-op
Transurethral resection of prostate (TURP): pre-procedure urine NOT infected	none	none	none
Cystoscopy	cefazolin	trimethoprim/sulfamethoxazole 160 mg/800 mg or levofloxacin	Pre-op Post-op