Perioperative Antibiotics for GI Surgery

1. Perioperative Antibiotics forGI Surgery • LaprascopicCholecystectomy • Small Bowel Obstruction • Appendectomy • Diverticulitis

2. Open or LaprascopicCholecystectomyfor acute cholecystitis (Pre-Op) No antibiotics recommended if no cholecystitis expected (level A evidence) For Patients WITHOUT penicillin allergy Cefazolin2 gm IVPB injection – to be given in OR by Anesthesiology <60 min before incision OR Cefoxitin2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients WITH penicillin allergy Clindamycin 900 grams IV q8h AND Gentamicin 5 mg/kg IV q24h OR Aztreonam 2 grams IV q8h

3. LaprascopicCholecystectomyfor acute cholecystitis (Post-Op) For Patients WITHOUT penicillin allergy Ceftriaxone 2 grams IV q24h AND Metronidazole 500 mg IV q8h For Patients WITH penicillin allergy Clindamycin 900 grams IV q8h AND Gentamicin 5 mg/kg IV q24h OR Aztreonam 2 grams IV q8h

4. Small Bowel ObstructionPre-Op For Patients WITHOUT penicillin allergy • Cefazolin 2 gm IVPB injection – to be given in OR by Anesthesiology <60 min before incision • And • Metronidazole 500mg IVPB injection- to be given in OR by Anesthesiology <60 min before incision • OR • Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy • Clindamycin900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision • And • Gentamicin5 mg/kg IVPB to be given in the OR by anesthesiology <60min before incision • Or • Aztreonam2 gm IVPB to be given in the OR by anesthesiology <60min before incision

5. Small Bowel ObstructionPost-Op (if evidence of infection) For Patients WITHOUT penicillin allergy • Cefazolin 2 gm IVPB injection q8hr x 2 doses • AND • Metronidazole500 mg IVBP injection q 8hr x 2 doses • OR • Cefoxitin 2 gm IVPB injection q 8 hrs x 2 doses For Patients with penicillin allergy • Clindamycin900 mg IVPB injection q8hr x 2 doses • AND • Aztreonam 2 gm IVPB q8hr x 2 doses (if aztreonam used pre-op)

6. AppendectomyPre-Op (for acute appendicitis) For Patients WITHOUT penicillin allergy • Cefazolin 2 gm IVPB • AND • Metronidazole 500 mg IVPB • OR • Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy • Clindamycin900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision • AND • Gentamicin 5mg/kg IVPB to be given in the OR by anesthesiology <60min before incision • OR • Aztreonam2gm IVPB to be given in the OR by anesthesiology <60min before incision

7. AppendectomyPost-Op For Patients WITHOUT penicillin allergy • Cefazolin 2 gm IVPB • AND • Metronidazole 500 mg IVPB • OR • Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy • Clindamycin900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision • And • Aztreonam 2 gm IVPB to be given in the OR by anesthesiology <60min before incision

8. Diverticulitis(Conservative/Non-Operative) For Patients WITHOUT penicillin allergy • Piperacillin-Tazobactam 3.375 g IVPB q8h as a 4 hour infusion x 48 hours For Patients with penicillin allergy • Levofloxacin 750 mg IVPB q24h x 48 hours • Metronidazole 500 mg IV q8h x 48 hours

9. Diverticulitis WashoutPre-Op For Patients WITHOUT penicillin allergy • Cefazolin 2 grams IVPB • AND • Metronidazole 500 mg IVPB • OR • Cefoxitin2gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy • Clindamycin 900mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision • And • Gentamicin 5 mg/kg IVPB to be given in the OR by anesthesiology <60min before incision • Or • Aztreonam2 gm IVPB to be given in the OR by anesthesiology <60min before incision

10. Diverticulitis WashoutPost-Op For Patients WITHOUT penicillin allergy • Piperacillin-Tazobactam 3.375 gm IVPB injection q8 hrs as a 4 hours infusion x 5 days For Patients with penicillin allergy • Levofloxacin 750mg IVPB injection q 24 hrs x 5 days • And • Metronidazole 500mg IVPB injection- q8 hrs x 5 days

11. Diverticulitis with stomaPre-Op For Patients WITHOUT penicillin allergy • Cefazolin 2 gm IVPB AND • Metronidazole 500 mg IVPB OR • Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy • Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision AND • Gentamicin 5 mg/kg IVPB to be given in the OR by anesthesiology <60min before incision OR • Aztreonam2 gm IVPB to be given in the OR by anesthesiology <60min before incision

12. Diverticulitis with stomaPost-Op For Patients WITHOUT penicillin allergy • Cefazolin 2 gm IVPB q8h x 2 doses AND • Metronidazole 500 mg IVPB q8h x 2 doses OR • Cefoxitin 2 gm IVPB IVPB q8h x 2 doses For Patients with penicillin allergy • Clindamycin 900 mg IVPB q8h x 2 doses AND • Aztreonam 2 gm IVPB q8h x 2 doses (ONLY if given pre-op)

13. Diverticulitis without stomaPre-Op For Patients WITHOUT penicillin allergy • Cefazolin 2 grams IVPB AND • Metronidazole 500 mg IVPB OR • Cefoxitin2gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy • Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision AND • Gentamicin 5 mg/Kg IVPB to be given in the OR by anesthesiology <60min before incision OR • Aztreonam2gm IVPB to be given in the OR by anesthesiology <60min before incision

14. Diverticulitis without stomaPost-Op For Patients WITHOUT penicillin allergy • Cefazolin 2 grams IVPB q8h x 2 doses AND • Metronidazole 500 mg IVPB q8h x 2 doses OR • Cefoxitin 2gm IVPB q8h x 2 doses For Patients with penicillin allergy • Clindamycin 900 mg IVPB q8h x 2 doses AND • Aztreonam 2gm IVPB q8h x 2 doses (only if given pre-op)