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Urology Surgical Antibiotic Prophylaxis Guidelines PRE-OPERATIVE CONSIDERATIONS Drug administration: Preoperative IV antibiotics – should be given 60 minutes (ideally 15 to 30 minutes) before skin incision. Administration after skin incision or > 60 minutes before incision reduces effectiveness Patients with structural urological problems and long term permanent IDCs (eg paraplegics etc) should have any infection treated prior to surgery, and antibiotics should be chosen according to susceptibility testing. Short courses should be chosen and given just prior to surgery. Oral antibiotics are generally satisfactory. Procedures Transrectal ultrasound (TRUS) guided prostate biopsy* PROPHYLAXIS REGIMEN First line regimen Alternative (Immediate type or severe penicillin or cephalosporin hypersensitivity or contraindication to first line agent(s)) Ciprofloxacin 750mg PO (single dose only), given 1-2 hours prior to procedure Gentamicin 3mg/kg IV (single dose only) bolus over 5 minutes prior to procedure *Seek Infectious Diseases advice for patients with recent overseas travel or recent exposure to fluoroquinolones Transurethral resection of the prostate (TURP) Gentamicin 3mg/kg IV (single dose only) bolus over 5 minutes prior to procedure Ciprofloxacin 750mg PO (single dose only), given 1-2 hours prior to procedure Retention TURP (ie catheter in place for a month) Gentamicin 3mg/kg IV (single dose only) bolus over 5 minutes prior to procedure PLUS Amoxycillin 2g IV (single dose only) bolus over 5 minutes prior to procedure Ciprofloxacin 750mg PO (single dose only), given 1-2 hours prior to procedure Urological endoscopy with biopsy, stent, stone treatment Cephazolin 2g IV (single dose only) bolus over 5 minutes prior to procedure Gentamicin 3mg/kg IV (single dose only) bolus over 5 minutes prior to procedure Clean incision with/without entry into urinary tract (including radical prostatectomy, nephrectomy) Cephazolin 2g IV (single dose only) bolus over 5 minutes before incision Teicoplanin 400mg IV (single dose only) (800mg IV for patients > 80 kg), inject slowly over 5 minutes before incision PLUS Gentamicin 3mg/kg IV (single dose only) bolus over 5 minutes before incision Clean with/without entry into urinary tract involving implanted prosthesis (e.g. artificial sphincter, penile prosthesis) Cephazolin 2g IV (single dose only) bolus over 5 minutes before incision PLUS Gentamicin 3mg/kg IV (single dose only) bolus over 5 minutes before incision Teicoplanin 400mg IV (single dose only) (800mg IV for patients > 80 kg), inject slowly over 5 minutes before incision PLUS Gentamicin 3mg/kg IV (single dose only) bolus over 5 minutes before incision Clean-contaminated (involving entry into bowel e.g. ileal conduit, bladder augmentation) Cephazolin 2g IV (single dose only) bolus over 5 minutes before incision PLUS Metronidazole 500mg IV (single dose only) infused over 20 minutes prior to procedure Teicoplanin 400mg IV (single dose only) (800mg IV for patients > 80 kg), inject slowly over 5 minutes before incision PLUS Metronidazole 500mg IV (single dose only) infused over 20 minutes prior to the procedure PLUS Gentamicin 3mg/kg IV (single dose only) bolus over 5 minutes before incision Cystoscopy with no intervention Nil recommended Nil recommended MRSA COLONISATION Patients with a recent history of MRSA colonisation or infection (not required for TRUS, TURP, urological endoscopy, or cystoscopy) ADD Teicoplanin 400mg IV (single dose only) (800mg IV for patients > 80 kg), inject slowly over 5 minutes before incision DURATION OF PROPHYLAXIS Prophylaxis should be no greater than 24 hours, and a single dose suffices in most cases. A second dose should be given if the procedure is longer than two half lives of the agent used (e.g. re-dose cephazolin after 4 hours). Continuing antibiotic administration is not appropriate unless infection is confirmed or suspected – modify antibiotic regimen appropriately according to treatment guidelines. Dr Simon Wood Director Urology Dr Stephen Lynch Chair Division of Surgery Version 3 Approval: December 2015 Review date: December 2017 Dr David Looke Chair Antimicrobial Sub-Committee Professor Peter Pillans Chair Drug and Therapeutics Committee
