Endoscopic ultrasound
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 gastrointestinal endoscopic procedures. See Endoscopic ultrasound procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for endoscopic ultrasound procedures.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
diagnostic EUS EUS-FNA of solid lesions |
NO |
|
EUS-FNA of cystic lesions |
YES |
Note:
EUS = endoscopic ultrasound; EUS-FNA= endoscopic ultrasound-guided fine-needle aspiration | |
If prophylaxis is indicated for endoscopic ultrasound procedures, use:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before the procedure; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, endoscopic ultrasound metronidazole
PLUS EITHER
1 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, endoscopic ultrasound cefazolin
OR
2 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, endoscopic ultrasound gentamicin
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 the procedure; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, endoscopic ultrasound 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, use metronidazole plus gentamicin (as above).