Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

GastrointestinalLIKELYPATHOGENSANTIMICROBIAL REGIMEN(Adult)ANTIMICROBIAL REGIMEN(Pediatric)OR REDOSINGCOMMENTSGI:Cholecystectomy 3Escherichia coli andKlebsiella. Streptococciand staphylococci areoccasionally isolated.Anaerobic bacteria areuncommon, butClostridium is possible.• Cefazolin 1 g IV 4 pre-op(2 g if > 80 kg)• Cefazolin 25mg/kg IV preop(Maximum of 1 g)• Cefazolin every 4hoursBacteria isolated from bile duringsurgery are those most likely to beassociated with wound infections.GI: UpperGastroduodenal3Most common arenasopharyngealcommensals(streptococci, lactobacilliand diphtheroids)• Cefazolin 4 1 g IV pre-op(2 g if > 80 kg)----- or• Cefuroxime 1.5 g IV pre-op• Cefazolin 25mg/kg IV preop(Maximum of 1 g)----- or• Cefuroxime 30mg/kg IVpreop (Maximum of 1.5 g)• Cefazolin every 4hours• Cefuroxime every 4hoursProphylaxis indicated only forpatients with increased pH fromthe use of H2 receptor blockers,proton pump inhibitors, withgastric obstruction or GIhemorrhage and with complexupper GI procedures such as aWhipple or gastric bypass.GI: Colorectal 3Enteric Gram-negativebacilli, anaerobes, withE. coli and Bacteroidesfragilis the most commonorganisms.Bowel prep (day beforesurgery):• Metoclopramide 10 mg PO 30min. prior to GI lavage 1.5 LQ1H until clear(max. 4-6 L). When GIlavage is clear, startneomycin 1 g PO witherythromycin1 g PO at 1300, 1400, and2300.• Unasyn®(ampicillin/sulbactam)1.5 g-3 g IV pre-op----- or• Cefoxitin 1-2 g IV pre-op(2 g if > 80 kg)----- or• Ciprofloxacin 400 mg IV preopplusMetronidazole 500-750 mgIV pre-op.----- or• Clindamycin 900 mg IVplusgentamicin 1.7 mg/kg IV 30pre-opBowel prep (day beforesurgery):Metoclopramide 0.1mg/kg(Maximum of 10mg) PO 30min prior to GI lavage (seeorder set for weight baseddosing). Then give neomycin20mg/kg PO x3 doses(Maximum of 1 g) witherythromycin 20mg/kg x3doses• Unasyn(ampicillin/sulbactam)37.5mg/kg (provides25mg/kg of ampicillin) IV(Maximum of 3 g) preop---- or• Cefoxitin 30mg/kg IV(Maximum of 2 g) preop---- or• Clindamycin 10mg/kg IV(Maximum of 900mg) plusgentamicin 2mg/kg IVpreop (Maximum of 80mg)pre-op• Unasyn® every 4hours• Cefoxitin every 3hours• Ciprofloxacin: none• Metronidazole every6 hours• Clindamycin every 6hoursMetronidazole 750 mg may besubstituted for erythromycin inerythromycin-sensitive patients.NOTE: 50% of trials evaluateddemonstrated