< 24 hours duration
| Procedure | Antibiotic | Alternative |
| Lower tract | ||
| Simple cysto or UDS (if risk factors) |
Fluoroquinolone TMP-SMX |
Aminoglycoside ± ampicillin 1st/2nd gen cephalosporin Augmentin |
| Cystoscopy with manipulation (stents, etc.) | ||
| Prostate biopsy |
Fluoroquinolone 1st/2nd/3rd gen cephalosporin |
TMP-SMX Aminoglycoside |
| Brachytherapy |
1st gen cephalosporin |
Clindamycin |
| Vaginal or urinary tract incision (eg sling) |
1st/2nd gen cephalosporin Aminoglycoside + flagyl/clinda |
Unasyn Fluoroquinolone |
| Upper tract | ||
| ESWL (if risk factors) |
Fluoroquinolone TMP-SMX
|
Aminoglycoside ± ampicillin 1st/2nd gen cephalosporin Augmentin
|
| Ureteroscopy | ||
| PCN (percutaneous) |
1st/2nd gen cephalosporin Aminoglycoside + flagyl/clinda |
Unasyn Fluoroquinolone |
| Other | ||
| Not entering urinary tract (eg skin coverage only) | Ancef | Clinda |
| Prosthesis (e.g. IPP) | Aminoglycoside + vanc or 1st/2nd gen cephalosporin | Zosyn |
| Involving intestine |
2nd/3rd gen cephalosporin Aminoglycoside + flagyl/clinda |
Zosyn Fluoroquinolone |
Uncomplicated URS: Ancef OK
Indwelling stent or other risk factors: probably amp/gent
urine culture pending: look at past cultures and treat appropriately
Penicillin allergy: vanc or clinda
- PCN/cephalosporin cross-reactivity is based on side chain, not presence of b-lactam ring. Cefazolin has a different side chain than PCNs so it should not cross-react; there is only a 1-3% rate of hypersensitivity to cefazolin with PCN allergy
Asymptomatic funguria: IDSA guidelines - several days of antifungal (fluconazole) before and after procedure, if undergoing surgery on urinary tract (eg 3d before and 3d after)
Hx joint replacement in last 2 years: cipro
Dosing
| Fluoroquinolone |
Levofloxacin 500 mg x1 Ciprofloxacin 500 mg q12h |
| TMP-SMX | Bactrim DS BID |
| Cephalosporin |
1st: Ancef 2-3g IV q8 (depending on weight) 2nd: Keflex 500 mg BID 3rd: Cefoxitin 1-2g IV q8 Ceftriaxone 1g q24h |
| Aminoglycoside | Gentamicin 5 mg/kg (generally 240 or 320 mg) |
| Ampicillin | Ampicillin 1-2 g q6h |
|
Augmentin 875-125 mg BID Clinda 600 mg q8h |
|
| Antifungal |
Fluconazole 400 mg daily |
- AUA guidelines on preoperative antibiotics
- Hinman's - pg. 7
- GU procedure prophylaxis in patients with artificial joints