Open or laparoscopic 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 open or laparoscopic urological procedures.
Patients undergoing open or laparoscopic urological 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.
The choice of prophylaxis for open or laparoscopic urological procedures depends on whether the bowel lumen is entered.
If prophylaxis is indicated for an open or laparoscopic urological procedure in which entry into the bowel lumen is not expected, 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, urological: open or laparoscopic cefazolin
PLUS
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, urological: open or laparoscopic gentamicin
If gentamicin is contraindicated (see Contraindications and precautions to gentamicin for surgical prophylaxis), seek expert advice for choice of prophylaxis.
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins who are undergoing procedures in which entry into the bowel lumen is not expected, use cefazolin plus gentamicin as above. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins who are undergoing procedures in which entry into the bowel lumen is not expected, 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 gentamicin
PLUS EITHER
1 vancomycin (adult and child) 15 mg/kg up to 2 g intravenously, started within the 120 minutes before surgical incision (recommended rate 10 mg/minute)3; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, urological: open or laparoscopic vancomycin
OR
2 clindamycin 600 mg (child: 15 mg/kg up to 600 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, urological: open or laparoscopic clindamycin
In cases of inadvertent rectal injury, administer an immediate dose of metronidazole. Add to the above regimens:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, as a single dose. surgical prophylaxis, urological: open or laparoscopic metronidazole
For prophylaxis for open or laparoscopic urological procedures in which entry into the bowel lumen is expected (eg ileal conduit, rectocele repair), 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. metronidazole
As an alternative, 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, urological: open or laparoscopic cefoxitin
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, the above regimens are suitable.
For patients with immediate severe or delayed severe hypersensitivity to penicillins, 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 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