Preoperative Antibiotics
Page updated Winter 2021.
Disclaimer: Medicine is an ever-changing science. We have been witnessing changes in diagnostic and therapeutic modalities and guidelines during last several years. We have used sources believe to be reliable for purpose of this website including AUA guidelines, EAU guidelines, NCCN guidelines, Campbell-Walsh-Wein Urology, UpToDate, Merck Manual, Lexi-Comp, FDA website, and other reputable sources. However, due to possibility of human error or changes in medicine, readers are required to confirm the information provided in this website with other sources. Readers are specially required to read all parts of the product information sheet included in the package of each drug they plan to administer and follow those instructions. Readers are also needed to follow instructions of FDA and other regulatory bodies and their own department in this regard. Authors can cite information provided in our textbooks or they need to cite the original sources. This website serves as a general framework. We and other users would adjust the approach per departments policies and patients situation. Forms can be used by other health care professionals.
Open, Laparoscopic or Robotic Surgery
None- Circumcision/ Penile biopsy
Cefazolin (Ancef)- Single dose
Inguinal and scrotal cases
Penile surgery/ Urethroplasty
Renal surgery/ Partial cystectomy/ Prostatectomy
Involving small intestine
Unasyn or Cefoxitin or Cefotetan -Single dose
Involving large bowel
Vaginal surgery/ Urethral sling procedures
Radical Cystectomy- Agent as above guidelines, for 24 hours
Implanted prosthetic devices
Unasyn <24 hours
Inflatable Penile Prosthesis
Urinary Sphincter/ Sacral Neuromodulator
Bowel Prep
No bowel prep is needed for small intestine surgeries.
Bowel prep is given for large intestine surgeries.
Mechanical Bowel Prep combined with preoperative oral antibiotics is typically recommended for elective colorectal resections.
GoLYTELY
Reconstitute GoLYTELY powder with water before its use.
Drink at a rate of 240 mL (8 oz.) every 10 minutes, until 1 gallon is consumed or rectal effluent is clear.
For nasogastric tube, rate is 1.2 to 1.8 liters per hour
Antibiotic prep
The oral antimicrobial should be given as three doses over approximately 10 hours the afternoon and evening before the operation and after the mechanical bowel prep.
The following oral antibiotic prep prior to colon surgery has been well studied and found to be effective and well tolerated:
Neomycin: 1 g oral given at 2 pm, 3 pm, and 10 pm
Erythromycin base:1 g given at 2 pm, 3 pm, and 10 pm
Metronidazole: 500 mg may be substituted for erythromycin for better tolerability
IV prophylaxis
As mentioned on antibiotic prophylaxis section.
Endoscopic Procedures
None
Antimicrobial prophylaxis is not recommended for routine cystoscopy or for urodynamic studies in healthy adults in the absence of infectious signs and symptoms.
Augmentin
Single dose
Cystoscopy
Cefazolin
Percutaneous renal surgery <24 hours
Ureteroscopy- Single dose
TURP, TURBT, laser enucleative and ablative procedures- Single dose
Percutaneous Procedures
Cefazolin
Single dose
Prostate brachytherapy or cryotherapy
Ciprofloxacin (Cipro)
Single dose
Transrectal prostate biopsy
Shock Wave Lithotripsy
None
Shock wave lithotripsy does not require antimicrobial prophylaxis if the pre-procedural urine microscopy is negative for infection.
Cefazolin
Single dose
Lengthy procedure
Antimicrobial prophylaxis should be stopped after wound closure and case completion, even in the presence of a drain.
Catheter Removal
Fluoroquinolone
Antimicrobial prophylaxis for about 24 hours may be considered at the time of clinical procedures such as trials of voiding, or removal of catheter or drain tubing, or stent or nephrostomy tube, especially when other patient and procedural risk factors are present.
Antibiotic Prophylaxis- Indwelling Orthopedic Hardware
None
Total joint inserted >2 yr ago
Pins, plates, screws
Ampi + Genta
Ampicillin 2 g IV /gentamicin- 1.5 mg/kg IV
Total joint inserted <2 yr ago
Aberrant host factor(s)
Endocarditis Prophylaxis
GU and GI procedures- Not recommended
Respiratory tract or infected skin
Reasonable only for patients with prosthetic cardiac valve, previous IE, congenital heart disease, cardiac transplantation.
Options: Cover Enterococci with:
Ampicillin 2 g IM or IV
Vancomycin - If Ampi is not an option
Asymptomatic Funguria
None
Urinary catheter, nephrostomy or stent placement or exchange.
Prior to a low-risk urologic surgical procedure in otherwise low-risk patient.
Single-dose antifungal prophylaxis
Prior to endoscopic, robotic, or open surgery on the urinary tract.
Longer course of periprocedural antifungal treatment: Neutropenic patients
Symptomatic Fungal Urinary Tract Infections
Needs Antifungal treatment.
Refer to Urinary Tract Infection for policies.
Refer to other medications for doses.
Fungus Ball
Needs periprocedural antifungal treatment based on sensitivities.
Five to seven days before and after the procedure.
A shorter duration may be reasonable in cases of an immunocompetent host where the obstruction has been completely relieved.
A longer course may be considered if part of fungus ball persists, and/or if repeated procedures are needed.