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Perioperative Antibiotics for GI Surgery

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PerioperativeAntibiotics forGI Surgery
LaprascopicCholecystectomySmall Bowel ObstructionAppendectomyDiverticulitis
Noantibiotics recommended if nocholecystitisexpected(level A evidence)ForPatients WITHOUT penicillinallergyCefazolin2 gm IVPB injection – to be given in OR by Anesthesiology <60 min before incisionORCefoxitin2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incisionForPatients WITH penicillin allergyClindamycin900 grams IV q8hANDGentamicin5 mg/kg IV q24hORAztreonam2 grams IV q8h
Open orLaprascopicCholecystectomyfor acutecholecystitis(Pre-Op)
LaprascopicCholecystectomyfor acutecholecystitis(Post-Op)
For Patients WITHOUT penicillin allergyCeftriaxone2 grams IV q24hANDMetronidazole500 mg IV q8hFor Patients WITH penicillin allergyClindamycin900 grams IV q8hANDGentamicin5 mg/kg IV q24hORAztreonam2 grams IV q8h
Small Bowel ObstructionPre-Op
For Patients WITHOUT penicillin allergyCefazolin2 gmIVPB injection – to be given in OR by Anesthesiology <60 min before incisionAndMetronidazole500mgIVPBinjection- to be given in OR by Anesthesiology <60 min beforeincisionORCefoxitin2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incisionForPatients with penicillin allergyClindamycin900 mgIVPB injection to be given in the OR by Anesthesiology <60 min before incisionAndGentamicin5 mg/kgIVPB to be given in the OR by anesthesiology <60min before incisionOrAztreonam2 gmIVPB to be given in the OR by anesthesiology <60min before incision
Small Bowel ObstructionPost-Op (if evidence of infection)
For Patients WITHOUT penicillin allergyCefazolin2 gmIVPB injectionq8hr x 2 dosesANDMetronidazole500 mgIVBP injection q8hrx2 dosesORCefoxitin2 gm IVPB injection q 8 hrs x 2 dosesForPatients with penicillin allergyClindamycin900 mgIVPB injection q8hr x2 dosesANDAztreonam2 gmIVPB q8hr x2 doses (ifaztreonamused pre-op)
AppendectomyPre-Op (for acute appendicitis)
For Patients WITHOUT penicillin allergyCefazolin2 gm IVPBANDMetronidazole500 mg IVPBORCefoxitin2 gmIVPB injection- to be given in OR by Anesthesiology <60min beforeincisionForPatients with penicillinallergyClindamycin900 mgIVPB injection to be given in the OR by Anesthesiology <60 min before incisionANDGentamicin5mg/kgIVPB to be given in the OR by anesthesiology <60min before incisionORAztreonam2gmIVPB to be given in the OR by anesthesiology <60min before incision
AppendectomyPost-Op
For Patients WITHOUT penicillin allergyCefazolin2 gm IVPBANDMetronidazole500 mg IVPBORCefoxitin2 gmIVPB injection- to be given in OR by Anesthesiology <60min beforeincisionForPatients with penicillinallergyClindamycin900 mgIVPB injection to be given in the OR by Anesthesiology <60 min before incisionAndAztreonam2 gmIVPB to be given in the OR by anesthesiology <60min before incision
Diverticulitis(Conservative/Non-Operative)
For Patients WITHOUT penicillin allergyPiperacillin-Tazobactam3.375g IVPB q8has a 4 hour infusion x48hoursForPatients with penicillinallergyLevofloxacin750 mg IVPB q24h x 48 hoursMetronidazole500 mg IV q8h x 48 hours
Diverticulitis WashoutPre-Op
For Patients WITHOUT penicillin allergyCefazolin2 grams IVPBANDMetronidazole500 mg IVPBORCefoxitin2gm IVPB injection- to be given in OR by Anesthesiology <60min beforeincisionForPatients with penicillinallergyClindamycin900mg IVPB injection to be given in the OR by Anesthesiology <60 min before incisionAndGentamicin5 mg/kgIVPB to be given in the OR by anesthesiology <60min before incisionOrAztreonam2 gmIVPB to be given in the OR by anesthesiology <60min before incision
Diverticulitis WashoutPost-Op
For Patients WITHOUT penicillin allergyPiperacillin-Tazobactam3.375 gmIVPB injectionq8hrsas a 4 hours infusion x5daysForPatients with penicillin allergyLevofloxacin750mgIVPB injection q 24 hrs x 5 daysAndMetronidazole500mg IVPB injection- q8 hrs x 5 days
Diverticulitis with stomaPre-Op
For Patients WITHOUT penicillin allergyCefazolin2 gm IVPBANDMetronidazole500 mg IVPBORCefoxitin2 gmIVPB injection- to be given in OR by Anesthesiology <60min beforeincisionForPatients with penicillin allergyClindamycin900 mgIVPB injection to be given in the OR by Anesthesiology <60 min before incisionANDGentamicin5 mg/kgIVPB to be given in the OR by anesthesiology <60min before incisionORAztreonam2 gmIVPB to be given in the OR by anesthesiology <60min before incision
Diverticulitis with stomaPost-Op
For Patients WITHOUT penicillin allergyCefazolin2 gm IVPB q8h x 2 dosesANDMetronidazole500 mg IVPB q8h x 2 dosesORCefoxitin2 gm IVPBIVPBq8hx 2 dosesFor Patients with penicillin allergyClindamycin900 mg IVPBq8h x 2 dosesANDAztreonam2 gm IVPB q8h x 2 doses (ONLY if given pre-op)
Diverticulitis without stomaPre-Op
For Patients WITHOUT penicillin allergyCefazolin2 grams IVPBANDMetronidazole500 mg IVPBORCefoxitin2gm IVPB injection- to be given in OR by Anesthesiology <60min beforeincisionForPatients with penicillin allergyClindamycin900 mgIVPB injection to be given in the OR by Anesthesiology <60 min beforeincisionANDGentamicin5 mg/KgIVPB to be given in the OR by anesthesiology <60min beforeincisionORAztreonam2gmIVPB to be given in the OR by anesthesiology <60min before incision
Diverticulitis without stomaPost-Op
For Patients WITHOUT penicillin allergyCefazolin2 grams IVPB q8h x 2 dosesANDMetronidazole500 mg IVPB q8h x 2 dosesORCefoxitin2gm IVPB q8h x 2 dosesFor Patients with penicillin allergyClindamycin900 mg IVPB q8h x 2 dosesANDAztreonam2gm IVPB q8h x 2 doses (only if given pre-op)

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Perioperative Antibiotics for GI Surgery