OGCO-E14 Antibiotic prophylaxis for surgery in general gynaecology

Question 1

antibiotic prophylaxis for suction evacuation for 1st trimester TOP under LA with consious sedation or GA?

Answer 1

Azithromycin 1g orally and metronidazole 800mg orally after assessment by doctor in the morning

If sensitive to azithromycin: doxycycline 100mg twice daily for 7 days, starting on TOP and metronidazole 800mg orally after morning doctor assessment

Question 2

Antibiotic prophylaxis for hysterectomy?

Answer 2

Cefazolin 1g single dose IV at induction in OT (give cefazolin 2g for patients with body weight over 80kg)

If sensitive to penicillin (metronidazole 500mg +gentamicin 1.5mg/kg or ciprofloxacin 400mg IV)

Patients known to have bacterial vaginosis should be treated with metronidazole for at least 4 days beginning just before surgery

Question 3

Antibiotic prophylaxis for open/laparoscopic operations for patients at high risk of bowel injury

Answer 3

Cefuroxime 1.5g and metronidazole 500mg IV to be given at induction in OT. Antibiotics can be continued as case of contamination for 2-7 days, initially as cefuroxime 750mg q8h and metronidazole 500mg q8h IV, then cefuroxime 500mg bd and metronidazole 400mg tds orally.