Small intestinal surgery
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis) and the general principles of surgical antibiotic prophylaxis for abdominal surgery. See Small intestinal procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for small intestinal surgery.
If the patient is being treated with antibiotic therapy for acute intra-abdominal infection (eg peritonitis), it is not necessary to give additional antibiotic prophylaxis provided the regimen has activity against the organism(s) most likely to cause postoperative infection. However, adjust the timing of the treatment dose to achieve adequate plasma and tissue concentrations at the time of surgical incision and for the duration of the procedure. See Surgical antibiotic prophylaxis for patients receiving treatment for established infection.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
endoscopic small intestinal procedures |
NO |
|
nonendoscopic small intestinal procedures |
YES |
The choice of prophylaxis depends on whether the bowel lumen is obstructed.
For prophylaxis for nonendoscopic small intestinal procedures when the small intestine is not obstructed, use:
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, small intestinal cefazolin
If the small intestine is obstructed, the prophylactic regimen includes metronidazole for activity against anaerobes; use:
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed cefazolin
PLUS
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, small intestinal metronidazole
As an alternative when the small intestine is obstructed, cefoxitin may be used as a single drug; however, its activity against anaerobes is inferior to the regimen above. It also requires frequent redosing (every 2 hours). Use:
cefoxitin 2 g (child: 40 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, small intestinal cefoxitin
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, the above regimens are suitable. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins, whether or not the small intestine is obstructed, use:
gentamicin (adult and child) 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision12; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, small intestinal gentamicin
PLUS
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. metronidazole