Endoscopic urological procedures
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 urological surgery. See Urological procedures and their requirement for surgical antibiotic prophylaxis for the indications for surgical prophylaxis for endoscopic urological procedures.
Patients undergoing endoscopic urological procedures, with the exception of uncomplicated cystoscopic diagnostic procedures, should be screened for bacteriuria preoperatively (see Screening for preoperative bacteriuria). For patients treated for bacteriuria preoperatively, modify the choice of surgical antibiotic prophylaxis based on the results of culture and susceptibility testing.
If prophylaxis is indicated for endoscopic urological procedures, in the absence of culture and susceptibility test results, use:
gentamicin (adult and child) 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before the procedure12; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, urological: endoscopic gentamicin
If gentamicin is contraindicated (see Contraindications and precautions to gentamicin for surgical prophylaxis), use:
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before the procedure; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, urological: endoscopic cefazolin
Gentamicin is preferred to cefazolin for prophylaxis for endoscopic urological procedures because it is likely to have activity against a greater percentage of the bacteria associated with postoperative infection. The risk of gentamicin toxicity is very low when it is given as a single dose for prophylaxis.