Gastrostomy or jejunostomy tube insertion

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 Percutaneous gastrostomy or jejunostomy tube insertion procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for percutaneous gastrostomy or jejunostomy tube insertion.

For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.

Table 1. Percutaneous gastrostomy or jejunostomy tube insertion procedures and their requirement for surgical antibiotic prophylaxis

Procedures

Is surgical antibiotic prophylaxis indicated?

PEG or PEJ tube insertion

YES

PRG or PRJ tube insertion

YES

Note:

PEG = percutaneous endoscopic gastrostomy; PEJ = percutaneous endoscopic jejunostomy; PRG = percutaneous radiologic gastrostomy; PRJ = percutaneous radiologic jejunostomy

For prophylaxis for percutaneous gastrostomy or jejunostomy tube insertion, 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, gastrostomy or jejunostomy tube insertion cefazolin    

For patients colonised or infected with methicillin-resistant Staphylococcus aureus (MRSA), or at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), add to cefazolin:

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)1; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, gastrostomy or jejunostomy tube insertion vancomycin    

For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use cefazolin, with or without vancomycin, 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, use vancomycin as monotherapy (see dosage above).

1 It is the consensus view of the Antibiotic Expert Groups that the vancomycin infusion should be started at least 15 minutes before surgical incision to ensure adequate blood and tissue concentrations at the time of incision and allow potential infusion-related toxicity to be recognised before induction of anaesthesia.Return