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