These are the 2005 recommendations for the empiric use of antibiotics  at NewYork-Presbyterian Hospital
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These are the 2005 recommendations for the empiric use of antibiotics at NewYork-Presbyterian Hospital

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NEW YORK-PRESBYTERIAN HOSPITAL ADULT RECOMMENDATIONS FOR SURGICAL PROPHYLAXIS These recommendations take into account the site of infection, most common organisms, hospital epidemiology and susceptibilities, expert opinion, and cost. The goals of these guidelines are to optimize antibiotic use and patient outcomes while limiting the emergence of resistant bacteria. These recommendations are modified from many sources including the Medical Letter 2006; Vol. 4 (Issue 52): 83-88 and Clin Infect Dis 2004; 38:1706-15. For endocarditis prophylaxis, consult the NYPH recommendations for the prevention of endocarditis based on the American Heart Association recommendations, Circulation 2007; 115. General Principles:• Choice of antimicrobial agent - Drug chosen should be active against the pathogens most commonly associated with wound infections following the specific procedure and against the pathogens endogenous to the region of the body being operated. - Selection of an appropriate agent for specific patients should take into account not only comparative efficacy but also adverse-effect profiles and patient drug allergies. - For most procedures, cefazolin 1 g or cefoxitin 2 g should be the agent of choice because of their relatively long duration of action, their effectiveness against the organisms most commonly encountered in surgery, and their relatively low cost. - Clindamycin or vancomycin should be used in penicillin-allergic patients. Clindamycin ...

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mg/kg (usually 1 Usual IV Dose 2 grams 3 grams 600 mg 1.5 mg/kg 2 grams 500 mg 1 – 2 grams 400 mg 600 mg 160 mg (TMP) grams gram) q8 hrs q8 hrs Redosing (highly dependent on (highly dependent frequency intra- q8 hrs q6 hrs No redose No redose q4 hrs q4 hrs q4 hrs q8 hrs No redose q4 hrs renal function – no on renal function – redose for patients no redose for operatively with ↑ SCr) patients with ↑ SCr) IV push IV push 60 minute infusion (3-5 min) (3-5 min) 30 minute 30 minute 30 minute 15-30 minute 30 minute 30 minute 2 hour 30 minute 60 minute (doses > 1 gram Administration OR OR infusion infusion infusion infusion require 90 minute infusion infusion infusion infusion infusion 30 minute 30 minute infusion) infusion infusion APPROVED BY THE ANTI-INFECTIVE SUBCOMMITTEE AND THE FORMULARY & THERAPEUTICS COMMITTEE NYPH: LAST UPDATED 7/16/08 • Adult Gentamicin Dosing for Surgical Prophylaxis Based on Weight (doses should be rounded to facilitate preparation, administration, and availability of gentamicin) Weight (kg) Gentamicin Dose to Administer (1.5 mg/kg/dose) 30-40 60 mg 41-50 70 51-60 90 61-70 100 71-100 120 > 100 kg Use alternative if appropriate: aztreonam 2 g PRIMARY ANTIBIOTIC PROPHYLAXIS DURATION OF NATURE OF OPERATION PATHOGENS ALTERNATIVE RECOMMENDED PROPHYLAXIS Coronary artery bypass, other For up to 24 Staphylococcus aureus, S. epidermidis cefazolin 1-2 grams IV q8h open-heart surgery vancomycin 1 gram IV q12h hours cefazolin 1-2 grams IV q8h vancomycin 1 gram IV q12h For up to 24 Prosthetic valve Staphylococcus aureus, S. epidermidis ± gentamicin 1.5 mg/kg IV x 1 ± gentamicin 1.5 mg/kg IV x 1 hours 1a 1a clindamycin 600 mg IV q8h For up to 48 Pacemaker, defibrillator Staphylococcus aureus, S. epidermidis cefazolin 1-2 grams IV q8h or vancomycin 1 g IV q12h hours (maximum) placement 1a May be switched post-op to oral cephalexin 500 mg PO q6h or cefadroxil 1 g PO q12h or clindamycin (for PCN-allergic patients) 450 mg PO q8h for a total duration not to exceed 48 hours. cefoxitin 2 grams IV or 2a Enteric gram-negative bacilli, gram-positive cefazolin 1-2 grams IV Esophageal, gastroduodenal clindamycin 600 mg IV + 1 Pre-op Dose cocci 2a gentamicin 1.5 mg/kg IV cefazolin 2-3 grams IV ± metronidazole Bariatric surgery Staphylococcus aureus, Streptococcus sp., clindamycin 900 mg IV 1 Pre-op Dose 500 mg IV cefoxitin 2 grams IV or 2b Enteric gram-negative bacilli, enterococci, cefazolin 1-2 grams IV Biliary tract clindamycin 600 mg IV + 1 Pre-op Dose clostridia 2b gentamicin 1.5 mg/kg IV Oral: neomycin + erythromycin base (after appropriate diet and catharsis); 1 gram of each at 1pm, 2pm and 11pm the day before an 8am operation (Adjust timing for Enteric gram-negative bacilli, anaerobes, clindamycin 600 mg IV + a later operative start) or Colorectal 1 Pre-op Dose enterococci gentamicin 1.5 mg/kg IV IV: cefazolin 1-2 grams IV + metronidazole 500 mg IV or cefoxitin 2 grams IV Enteric gram-negative bacilli, anaerobes, clindamycin 600 mg IV + Appendectomy, non-perforated cefoxitin 2 grams IV 1 Pre-op Dose enterococci gentamicin 1.5 mg/kg IV 2a High risk only (morbid obesity, esophageal obstruction, decreased gastric acidity or gastrointestinal motility) 2b High risk only (Age>70 yrs, biliary stent, non-functioning gall bladder, obstructive jaundice or common duct stones) APPROVED BY THE ANTI-INFECTIVE SUBCOMMITTEE AND THE FORMULARY & THERAPEUTICS COMMITTEE NYPH: LAST UPDATED 7/16/08 2. GASTRO-INTESTINAL 1. CARDIAC PRIMARY ANTIBIOTIC PROPHYLAXIS DURATION OF NATURE OF OPERATION PATHOGENS ALTERNATIVE RECOMMENDED PROPHYLAXIS ampicillin 2 grams IV 3a + gentamicin 1.5 mg/kg IV vancomycin 1 gram IV 1 Pre-op Dose Enteric gram-negative bacilli, enterococci or 3a + gentamicin 1.5 mg/kg IV 3a cefazolin 1-2 grams IV 3a High risk (urine culture positive or unavailable, pre-operative catheter, transrectal prostatic biopsy, placement of prosthetic material); transurethral resection of prostate cefoxitin 2 grams IV or Vaginal or abdominal Enteric gram-negative bacilli, anaerobes, cefazolin 1-2 grams IV clindamycin 600 mg IV + 1 Pre-op Dose hysterectomy Group B strep, enterococci gentamicin 1.5 mg/kg IV Enteric gram-negative bacilli, anaerobes, cefazolin 1 gram IV cefoxitin 2 grams IV 1 Pre-op Dose Cesarean section Group B strep, enterococci (after cord clamping) (after cord clamping) Anaerobes, enteric gram negative bacilli, S. clindamycin 600-900 mg IV + Incisions through oral or cefazolin 1-2 grams IV 1 Pre-op Dose aureus gentamicin 1.5 mg/kg IV pharyngeal mucosa Craniotomy S. aureus, S. epidermidis cefazolin 1-2 grams IV vancomycin 1 gram IV 1 Pre-op Dose APPROVED BY THE ANTI-INFECTIVE SUBCOMMITTEE AND THE FORMULARY & THERAPEUTICS COMMITTEE NYPH: LAST UPDATED 7/16/08 4. GYNECOLOGIC 3. 6. 5. HEAD AND AND OBS TETRIC GENIT O U RINARY NEUROSURGERY NECK PRIMARY ANTIBIOTIC PROPHYLAXIS DURATION OF NATURE OF OPERATION PATHOGENS ALTERNATIVE RECOMMENDED PROPHYLAXIS gentamicin, tobramycin, moxifloxacin, S. epidermidis, S. aureus, streptococci, gatifloxacin or neomycin-gramicidin- For up to 24 enteric gram-negative bacilli, Pseudomonas polymixin B; multiple drops topically over hours aeruginosa 2 to 24 hours Total joint replacement, For up to 24 cefazolin 1-2 grams IV q8h clindamycin 600 mg IV q8h or S.aureus, S. epidermidis internal fixation of fractures hours vancomycin 1 gram IV q12h cefazolin 1-2 grams IV vancomycin 1 gram IV S. aureus, S. epidermidis, streptococci, 1 Pre-op Dose enteric gram-negative bacilli APPROVED BY THE ANTI-INFECTIVE SUBCOMMITTEE AND THE FORMULARY & THERAPEUTICS COMMITTEE NYPH: LAST UPDATED 7/16/08 9. THORACIC 8. 7. OPHTHALMIC (NON-CARDIAC) O RTH O PEDI C PRIMARY ANTIBIOTIC PROPHYLAXIS DURATION OF NATURE OF OPERATION PATHOGENS ALTERNATIVE RECOMMENDED PROPHYLAXIS cefazolin 1-2 grams IV vancomycin 1 gram IV 1 Pre-op Dose Heart aztreonam 1 g IV q8h 10a ampicillin/sulbactam (Unasyn ®) 3 grams Lung For up to 5 days IV q6h + vancomycin 1 g IV q12h cefazolin 1-2 grams IV vancomycin 1 gram IV 1 Pre-op Dose Kidney aztreonam 1 g IV q8h ampicillin/sulbactam (Unasyn ®) 3 grams + metronidazole 500 mg IV For up to 24 Liver IV q6h q12h hours + vancomycin 1 g IV q12h rifampin 600 mg PO or IV x 1 rifampin 600 mg PO or IV x 1 + fluconazole 400 mg PO or + fluconazole 400 mg PO or IV x 1 For up to 48 LVAD IV x 1 + TMP/SMX 160 mg (TMP) IV q8h for up hours (CUMC) + vancomycin 1 g IV q12h for to 48 hrs up to 48 hrs clindamycin 600 mg IV q8h ampicillin/sulbactam (Unasyn ®) 3 grams + aztreonam 1 g IV q8h for up IV q6h for up to 24 hours For up to 24 - 48 to 24 hours Pancreas or kidney/pancreas hours + fluconazole 400 mg IV q24h for up to 48 + fluconazole 400 mg IV q24h hours for up to 48 hours 10a Antibiotics listed are for routine (“non-septic”) lung transplants. Modification of antibiotic regimens is necessary in cases where culture and susceptibility data from the donor and/or recipient are available. Arterial surgery involving a S. aureus, S. epidermidis, enteric gram- cefazolin 1-2 grams IV 1 Pre-op Dose prosthesis, the abdominal vancomycin 1 gram IV negative bacilli aorta, or a groin incision Lower extremity amputation for S. aureus, S. epidermidis, enteric gram- 1 Pre-op Dose cefazolin 1-2 grams IV vancomycin 1 gram IV ischemia negative bacilli, clostridia APPROVED BY THE ANTI-INFECTIVE SUBCOMMITTEE AND THE FORMULARY & THERAPEUTICS COMMITTEE NYPH: LAST UPDATED 7/16/08 11. VASCULAR 10. TRANSPL ANTS