Antibiogram

Bacterial Endocarditis Prophylaxis

Recent guidelines from the American Heart Association & American College of Cardiology are suggesting antimicrobial prophylaxis only for patients having underlying cardiac conditions associated with the highest risk of adverse outcome from infective endocarditis:

  • Prosthetic heart valve
  • History of endocarditis

Congenital Heart Disease

  • Unrepaired cyanotic CHD, including palliative shunts or conduits
  • Completely repaired congenital heart defect with prosthetic material or device during the first six months after the procedure
  • Repaired CHD with residual effects at the site or adjacent to the site of a prosthetic patch or device
  • Cardiac transplant recipients with cardiac valvular disease.
Treatment
30-60 Min Pre-Procedure*
Adult Dose Pediatric Dose
Amoxicillin 2 g PO 50mg/kg
Ampicillin 2 g 111/11.1 50mg/kg
Clindamycin 600mg PO/III 20mg/kg
Cephalexin 2g PO 50mg/kg
Cettriaxone 1 g IV/N 50mg/kg
Cefazolin 1 g 111/IM 50mg/kg
Azithromycin 500mg PO 15mg/kg

*Dental, Oral, Respiratory Tract or Esophagel Procedures - Involving incision, biopsy, or respiratory tract or manipulation of gingival tissue, periapical region of teeth or perforation of oral mucosa (Viridans streptococci (alpha-hemolytic streptococci) most prevalent bacteria)

Infected Skin, Skin Structure or Musculoskeletal Tissue
  • Treat with agents active against staphylococci and beta-hemolytic streptococci: antistaphylococcal PCN (oxacillin) or cephalosporin (see above doses)
  • If MRSA suspected in wound/skin structure: (or intolerant of beta-lactam) Vancomycin 15.20mg/kg for adults up to 2 g or (15mg/kg to 1 g for children)
GI or Genitourinary Tract

Prophylaxis solely to prevent endocarditis NOT recommended.

IF: An enterococcal UTI present, treat before an elective GU procedure or include enterococcal coverage perioperatively for non-elective procedures.

IF: exisiting GI or GU infection or receiving perioperative antibiotics to prevent surgical site infection or sepsis, it is reasonable to include an agent with activity against enterococci.

Pre-Op Antibiotic Recommendations
General
Procedure Recommended Alternate if Allergic
Appendectomy for uncomplicated appendicitis cefoxitin or cefazolin + metronidazole clindamycin + AMG or aztreonam or FQ OR metronidazole + AMG or FQ
Biliary tract cefazolin or cefoxitin or ceftriaxone (if infected) clindamycin or vancomycin + AMG or aztreonam or FQ OR metronidazole + AMG or FQ
Cardiac device insetion (pacer) cefazolin clindamycin or vancomycin
Colorectal cefazolin + metronidazole OR cefoxitin OR ertapenem OR ceftriaxone + metronidazole clindamycin + AMG aztreonam or FQ OR metronidazole + AMG or FQ
Gastroduodenal cefazolin clindamycin or vancomycin + AMG or aztreonam or FQ
Head & Neck
Procedure Recommended Alternate if Allergic
Clean None None
Clean with prosthesis (excludes tympanostomy tubes) cefazolin or cefoxitin clindamycin
Clean-contaminated (except tonsillectomy and functional endoscopic sinus procedures cefazolin or cefoxitin + metronidazole clindamycin
Hernia Repair - Clean cefazolin clindamycin or vancomycin
C-Section cefazolin clindamycin + AMG
Hysterectomy (vaginal or abdominal) cefazolin or cefoxitin clindamycin + AMG or aztreonam or FQ OR metronidazole + AMG or FQ
Ophthalmic neomycin/ polymixin/ B-gramicidin or moxifloxacin or gatifloxacin
Orthopedic
Procedure Recommended Alternate if Allergic
Clean w/o Implant None None
Hip fracture, implant of internal fixation device, or total joint replacement cefazolin clindamycin or vancomycin
Plastics
Procedure Recommended Alternate if Allergic
Clean None None
Clean with risk factors or clean-contaminated cefazolin clindamycin or vancomycin
Small Intestines
Procedure Recommended Alternate if Allergic
Non-obstructed cefazolin clindamycin + AMG or aztreonam or FQ
Hip fracture, implant of internal fixation device, or total joint replacement cefazolin + metronidazole OR cefoxitin metronidazole + AMG or FQ
Urologic
Procedure Recommended Alternate if Allergic
Lower tract instrumentation with risk factors (includes transrectal prostate biopsy) FQ or TMP/SMX or cefazolin AMG +/- clindamycin
Clean w/o entry into tract cefazolin clindamycin or vancomycin
...with implanted prosthesis cefazolin +/- AMG or axtreonam clindamycin or vancomycin +/- AMG or aztreonam
Clean w/ entry into tract cefazolin FQ OR AMG +/- clindamycin
Clean-contaminated cefazolin + metronidazole OR cefoxitin FQ OR AMG + metronidazole or clindamycin
Vascular cefazolin clindamycin or vancomycin