Sections View Full Chapter Figures Tables Videos 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 MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. 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 Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth