Hysterectomy, and gynaecological–oncological, other laparotomy, pelvic organ prolapse or synthetic mid-urethral sling procedures

For prophylaxis for hysterectomy, and gynaecological–oncological, other laparotomy, pelvic organ prolapse or synthetic mid-urethral sling procedures, use:

cefazolin 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, gynaecological cefazolin

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metronidazole 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, gynaecological metronidazole

For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, the above regimen is 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:

clindamycin 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, gynaecological clindamycin

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gentamicin 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision¹ ²; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, gynaecological gentamicin

For premenopausal women with abnormal vaginal flora (including bacterial vaginosis) who did not receive surgical antibiotic prophylaxis, perioperative treatment with rectal metronidazole reduced the rate of vaginal cuff infection following abdominal hysterectomy. However, these results have not been replicated in patient cohorts who received surgical antibiotic prophylaxis with metronidazole. Consequently, routine bacterial vaginosis screening before hysterectomy cannot be recommended.

¹ If the patient is obese (body mass index 30 kg/m² or more), use adjusted body weight (see ../Aminoglycoside-use-in-special-patient-groups/c_ABG_Aminoglycoside-use-in-special-patient-groups_topic_5.html#c_ABG_Aminoglycoside-use-in-special-patient-groups_topic_5__fig-504) to calculate the dose.Return

² Do not use gentamicin for surgical prophylaxis in adults with a CrCl less than 20 mL/min; seek expert advice. For children with kidney impairment, seek expert advice on gentamicin use.Return