Gastrointestinal and General Procedures
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Procedure |
Recommended Antibiotics and comments |
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Gastrointestinal and general procedures |
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Colorectal surgery |
Amoxicillin 1g IV + Metronidazole 500mg IV + Gentamicin IV as per table If penicillin allergy: Teicoplanin 400mg IV + Metronidazole 500mg IV + Gentamicin IV as per table |
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Oesophageal surgery, stomach and duodenal surgery, gastric bypass surgery, gall bladder surgery (open) and small intestine |
Gentamicin IV as per table |
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Appendectomy, biliary tract surgery |
Metronidazole 500mg IV + Gentamicin IV as per table |
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Gall bladder surgery (laparoscopic) |
Not routinely recommended Consider if: cholangiogram, bile spillage, conversion to laparotomy, acute cholecystitis / pancreatitis, jaundice, immunosuppression, insertion of prosthetic devices. If required use Gentamicin IV as per table |
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Splenectomy ***Refer to Splenectomy section (Hospital guidance, under "other guidelines") for advice on vaccinations and long-term antimicrobial prophylaxis. *** |
Not routinely recommended Consider if immunosuppression If required use Gentamicin IV as per table. |
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Hernia repair +/- mesh, open or laparoscopic |
Not routinely recommended Meta-analysis does not support routine prophylaxis. Consider in patients with mesh insertion if: obesity, diabetes or other risk factors for surgical site infection If required use Gentamicin IV as per table. |
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Therapeutic Endoscopic Retrograde CholangioPancreatography (ERCP), Percutaneous endoscopic gastrostomy (PEG) tube insertion |
Not routinely recommended Consider if: pancreatic pseudocyst, immunosuppression, incomplete biliary drainage (e.g. primary sclerosing cholangitis or cholangiocarcinoma) If required use Gentamicin IV as per table |
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Variceal banding/ injection (acute) |
Co-amoxiclav 1.2g IV If penicillin allergy: Clarithromycin 500mg IV. If antibiotic therapy not otherwise required, continue for 48 hours after cessation of bleeding (observe IV to oral switch). |
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Upper or lower diagnostic gastrointestinal endoscopy |
Not recommended |
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Endoscopic mucosal resection |
Not recommended |
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Breast surgery |
Co-amoxiclav 1.2g IV If penicillin allergy: Teicoplanin 400mg IV |
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Insertion of Tenckhoff catheter for CAPD |
Flucloxacillin 2g IV If penicillin allergy: Teicoplanin 400mg IV |