Gastrointestinal and General Procedures

Procedure

Recommended Antibiotics and comments

Gastrointestinal and general procedures

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

Oesophageal surgery, stomach and duodenal surgery, gastric bypass surgery, gall bladder surgery (open) and small intestine

Gentamicin IV as per table

Appendectomy, biliary tract surgery

Metronidazole 500mg IV + Gentamicin IV as per table

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

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.  

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.

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

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).

Upper or lower diagnostic gastrointestinal endoscopy

Not recommended

Endoscopic mucosal resection

Not recommended

Breast surgery

Co-amoxiclav 1.2g IV

If penicillin allergy: Teicoplanin 400mg IV