AnTibiotic Prophylaxis for Gynecologic Procedures Flashcards
Class I/Clean Wound
Uninfected operative wound with no inflammation and the alimentary, genital, and uninfected urinary tract are not entered
- Primarily closed and drained with closed drainage
Class II/Clean-Contaminated
Operative wound where the alimentary, genital or non-infected urinary tract are entered under controlled conditions without unusual contamination and no signs of infection (appendix and vagina)
Class III/Contaminated
Operations with major breaks in sterile technique or gross-spillage from the GI tract, or signs of acute, non-purulent inflammation
Class IV/ Dirty-infected
Operative sites involving infected sites or perforated viscera
When should antibiotics be given
At the time or shortly before when the bacteria are innoculated; typically when anesthesia is administered
- Re-dosing can be used for lengthier procedures, give at one to two times the half-length of the drug, also can be given with blood loss >1500 mL
Cefazolin
Dosing: 1g, Half-life: 1.8 hrs
Morbidly obese dosing (>35 BMI): 2 g
Antibiotics for hysterectomy
cefazolin 1-2g IV
Antibiotics for urogynecology procedures, including those involving meshwork
Clindamycin + gentamicin 600 mg IV, 1.5 mg/kg IV
or quinolone 400 mg IV
or aztreonam 1g IV
or metronidazole + gentamicin 500 mg IV, 1.5 mg/kg IV
Antibiotics for Laparoscopy (diagnostic, operative, tubal ligation)
None
Antibiotics for laparotomy
None
Antibiotics for Hysteroscopy (diagnostic, operative, endometrial ablation, Essure)
None
Antibiotics for hysterosalpingogram or chromotubation
Doxycycline 100 mg orally twice daily for 5 days (if dilated tubes are found)
Antibiotics for IUD insertion
None
Antibiotics for endometrial biopsy
None
Antibiotics for induced abortion/ D&E
Doxycycline 100 mg orally 1 hour before procedure and 200 mg orally after the procedure
or Metronidazole 500 mg orally twice daily for 5 days
