Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ GYN SURGERY: PREOPERATIVE CONSIDERATIONS +++ Antibiotic Prophylaxis for Gynecologic Procedures ++ Antimicrobial Prophylactic Regimens by Procedure (Table 2-1) ++Table Graphic Jump LocationTABLE 2-1ANTIMICROBIAL PROPHYLACTIC REGIMENS BY PROCEDUREView Table||Download (.pdf)TABLE 2-1ANTIMICROBIAL PROPHYLACTIC REGIMENS BY PROCEDURE Procedure Antibiotic Dose Hysterectomy Urogynecology procedures, including those involving mesh Cefazolin1 (preferred) If PCN allergic: Clindamycin2 plus Gentamicin3 (preferred for PCN allergic) OR Metronidazole2 plus Gentamicin3 (alternative for PCN allergic) Weight <120 kg: 2 g IV Weight ≥120 kg: 3 g IV 600 mg IV 5 mg/kg IV4 500 mg IV 5 mg/kg IV4 Laparoscopy Diagnostic/Operative Tubal sterilization None Laparotomy None Hysteroscopy Diagnostic/Operative Endometrial ablation Essure None Hysterosalpingogram or chromotubation Doxycycline5 100 mg orally twice daily for 5 days IUD insertion None Endometrial biopsy None Induced abortion/D&C Doxycycline 100 mg orally 1 hour before procedure and 200 mg orally after the procedure Metronidazole 500 mg orally twice daily for 5 days Urodynamics None 1Acceptable alternatives: Cefotetan, cefoxitin, cefuroxime, ampicillin-sulbactam.2Antimicrobial agents of choice if history of immediate hypersensitivity to penicillin (PCN). Combination of drugs recommended to broaden coverage.3Quinolones (cipro-, levo-, moxi-floxacin) or aztreonam (1 g IV) can be alternatives to gentamicin.4Gentamicin is recommended as a single dose preoperatively based on actual body weight (ABW) unless ABW is >20% above ideal body weight (IBW); in this case, calculate weight for dose by IBW + 0.4 (ABW-IBW).5If history of PID or dilated fallopian tubes. No prophylaxis is indicated for a study without dilated tubes. Data from ACOG Practice Bulletin No. 104, May 2009, Reaffirmed 2011; Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health-Syst Pharm. 2013;70:195–283. +++ Key Points to Remember ++ Antibiotics must be given within 1 hour prior to skin incision. Anesthesia induction is a convenient time Give repeat dose of antibiotic if Long procedure (over one to two times antibiotics half-life; ex: re-dose cefazolin at 3 hours) EBL over 1500 cc Neither treatment for several days before a procedure nor subsequent doses after procedure are indicated for prophylaxis Prophylactic antibiotics are recommended for induced abortion/dilation and curettage (D&C) even if negative gonorrhea/chlamydia (GC/CT) testing +++ Endocarditis Prophylaxis ++ Cardiac conditions associated with the highest risk of adverse outcomes from endocarditis that require antibiotic prophylaxis are shown in Table 2-2. Suggested antibiotics are listed in Table 2-3 ++Table Graphic Jump LocationTABLE 2-2CARDIAC CONDITIONS REQUIRING ENDOCARDITIS PROPHYLAXISView Table||Download (.pdf)TABLE 2-2CARDIAC CONDITIONS REQUIRING ENDOCARDITIS PROPHYLAXIS Prosthetic cardiac valve or prosthetic material used for cardiac valve repair Previous infective endocarditis Congenital heart disease (CHD)* Unrepaired cyanotic CHD, including palliative shunts and conduits Completely repaired CHD with prosthetic material or ... Your Access profile is currently affiliated with [InstitutionA] and is in the process of switching affiliations to [InstitutionB]. Please select how you would like to proceed. Keep the current affiliation with [InstitutionA] and continue with the Access profile sign in process Switch affiliation to [InstitutionB] and continue with the Access profile sign in process Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Error: Incorrect UserName or Password Username Error: Please enter User Name Password Error: Please enter Password Sign in Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free profile for additional features.