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تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Antimicrobial prophylaxis for gynecologic and obstetric surgery in adults*

Antimicrobial prophylaxis for gynecologic and obstetric surgery in adults*
Procedure ACOG preferred regimen[1,2] Dose Alternative regimensΔ[3,4] Dose

Hysterectomy (abdominal, including supracervical, vaginal, laparoscopic, or robotic)

Pelvic reconstruction procedures, including colporrhaphy or those involving mesh or vaginal sling placement
Cefazolin, cefoxitin or cefotetan

Cefazolin:

<120 kg: 2 g IV

≥120 kg: 3 g IV


Cefoxitin or cefotetan:

2 g IV

Regimen:
Ampicillin-sulbactam 3 g IV
Regimen:
Clindamycin OR 900 mg IV
Vancomycin 15 mg/kg IV (not to exceed 2 g per dose)
PLUS one of the following:
Gentamicin OR 5 mg/kg IV (if overweight or obese, based on adjusted body weight)§
Aztreonam OR 2 g IV
Fluoroquinolone¥  
Regimen:
Metronidazole 500 mg IV
PLUS one of the following:
Gentamicin OR 5 mg/kg IV (if overweight or obese, based on adjusted body weight)§
Fluoroquinolone¥  
Cesarean delivery (intact membranes, not in labor) Cefazolin

<120 kg: 2 g IV

≥120 kg: 3 g IV
Clindamycin 900 mg IV
PLUS
Gentamicin 5 mg/kg IV (if overweight or obese, based on adjusted body weight)§
Cesarean delivery (in labor, ruptured membrane) Cefazolin

<120 kg: 2 g IV

>120 kg: 3 g IV
Clindamycin 900 mg IV
PLUS PLUS
Azithromycin 500 mg IV Gentamicin 5 mg/kg IV (if overweight, or obese, based on adjusted body weight)
PLUS
Azithromycin 500 mg IV
Uterine evacuation (including surgical abortion, suction D&C, and D&E) Doxycycline 200 mg orally    
Hysterosalpingogram, including chromotubation or saline infusion sonography Not recommended
Laparotomy without entry into bowel or vagina Consider cefazolin

<120 kg: 2 g IV

≥120 kg: 3 g IV
   

Laparoscopy (diagnostic, tubal sterilization, operative except for hysterectomy)

Other transcervical procedures:
  • Cystoscopy
  • Hysteroscopy (diagnostic or operative)
  • Intrauterine device insertion
  • Endometrial biopsy
  • Oocyte retrieval
  • D&C for non-pregnancy indication
  • Cervical tissue biopsy, including LEEP or endocervical curettage
Not recommended
ACOG: American College of Obstetricians and Gynecologists; IV: intravenous; D&C: dilation and curettage; D&E: dilation and evacuation; LEEP: loop electrosurgical excision procedure; IDSA: Infectious Diseases Society of America; ASHP: American Society of Health-System Pharmacists; HSG: hysterosalpingogram; PID: pelvic inflammatory disease.
* Common pathogens: Enteric gram-negative bacilli, anaerobes, group B Streptococcus, enterococci.
¶ Parenteral prophylactic antimicrobials can be given as a single IV dose begun within 60 minutes before the procedure. If vancomycin or a fluoroquinolone is used, the infusion should be given over 60 to 90 minutes and started within 60 to 120 minutes before the initial incision.
Δ An alternative regimen should be used in women with history of immediate hypersensitivity to beta-lactam agents. Due to increasing resistance of Escherichia coli to ampicillin-sulbactam and fluoroquinolones, local sensitivity profiles should be reviewed prior to use.
When clindamycin prophylaxis is warranted, UpToDate authors prefer a single dose of 900 mg based upon pharmacokinetic considerations according to 2013 IDSA/ASHP surgical antibiotic prophylaxis guidelines.[3] However, a 600 mg dose consistent with ACOG guidance may be sufficient.[1,2]
§ Gentamicin use for surgical antibiotic prophylaxis should be limited to a single dose given preoperatively. Based on evidence from colorectal procedures, a single dose of approximately 5 mg/kg gentamicin appears more effective for the prevention of surgical site infection than multiple doses of gentamicin 1.5 mg/kg every 8 hours.[4] For overweight and obese patients (ie, actual weight is >125% of ideal body weight), a dosing weight should be used. A calculator to determine ideal body weight and dosing weight is available in UpToDate.
¥ Ciprofloxacin 400 mg IV OR levofloxacin 500 mg IV OR moxifloxacin 400 mg IV. Fluoroquinolones are contraindicated in pregnancy and in women who are breastfeeding.
‡ Antimicrobial prophylaxis is recommended for women undergoing HSG or chromotubation with a history of PID or abnormal tubes noted on HSG or laparoscopy. For these women, an antibiotic prophylaxis regimen of doxycycline, 100 mg twice daily for 5 days, can be considered to reduce the incidence of post-procedural PID.[5,6] For women undergoing chromotubation, a single preoperative 2 gram dose of intravenous cefazolin is recommended, and the patient can be discharged on the same doxycycline regimen recommended for abnormal HSG.
† Most clinicians exclude urinary tract infection with a urinalysis before cystoscopy, with subsequent urine culture performed to confirm findings suggestive of infection. Patients with positive test results should be given antibiotic treatment.
References:
  1. ACOG practice bulletin No. 195: Prevention of infection after gynecologic procedures. Obstet Gynecol 2018; 131:e172.
  2. ACOG practice bulletin No. 199: Use of prophylactic antibiotics in labor and delivery. Obstet Gynecol 2018; 132:e103.
  3. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
  4. Zelenitsky SA, Silverman RE, Duckworth H, Harding GK. A prospective, randomized, double-blind study of single high dose versus multiple standard dose gentamicin both in combination with metronidazole for colorectal surgical prophylaxis. J Hosp Infect 2000; 46:135.
  5. Pittaway DE, Winfield AC, Maxson W, et al. Antibiotic prophylaxis for gynecologic procedures prior to and during the utilization of assisted reproductive technologies: a systematic review. Am J Obstet Gynecol 1983; 147:623.
  6. Pereira N, Hutchinson AP, Lekovich JP, et al. Antibiotic prophylaxis for gynecologic procedures prior to and during the utilization of assisted reproductive technologies: a systematic review. J Pathog 2016; 2016:4698314.
Adapted from: Antimicrobial prophylaxis for surgery. Med Lett Drugs Ther 2016; 58:63.
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