Antibiotic Prophylaxis For Gynaecologic Procedures

Clinical description

Antibiotic prophylaxis is antibiotic use for the purpose of preventing, not treating, infection.

For abdominal or vaginal procedures in which prophylaxis is indicated, pre-operative antibiotics should be given 30- 60 minutes prior to skin incision to decrease bacterial load of gram-positive skin flora or vaginal flora.

Post-operatively, only selectpatients at high risk (bowel injury, uncontrolled diabetic etc) or in whom there was evidence of pre-existing infection should be given broad spectrum antibiotics.

Signs and symptoms

History/Exam/Investigations Document need for pre-operative antibiotics clearly in pre-operative orders. After surgery, document in operative note whether or not antibiotic prophylaxis was given and write for post-operative antibiotic regimen as needed.

Treatment

Scenario Pre-operative (give 30-60 Post-operative minutes before skin incision) Surgical management of Nonea,b,c None unless concern for Induced miscarriage(Dilation and Abortion (see Miscarriage sharp curettage, or Manual section) Vacuum Aspiration) Hysterosalpingogram or None Doxycycline 100 mg PO BD x 5 chromotubation days(only if patient has history of PID or dilated fallopian tubes on HSG; otherwise, prophylaxis is not needed)a,b Laparoscopy None None Vaginal hysterectomy 1) Metronidazole 500 mg IV None, unless evidence of and/or Urogynaecology x 1 plus Gentamicin 1.5 infection during surgery (see procedures mg/kg IV below) Abdominal hysterectomy For Gram Positive skin None, unless evidence of (elective) flora: infection during surgery (see

• Cefazolin 1-2 g IV, or below)
• Ampicillin 2 g IV x 1

plus Gentamicin 1.5 mg/kg IV, or

• X-Penicillin 3 MU IV x 1

plus Gentamicin 1.5 mg/kg IV Other Laparotomy None, unless suspicion for None, unless evidence of intra-abdominal infection: infection during surgery:

• Cefazolin 1-2 g IV, or 1) For Gram-Negative pelvic
• Ampicillin 2 g IV x 1, or flora: Ceftriaxone 2g IV (or)
• X-Penicillin 3 MU IV x 1 Gentamicin 240 mg IV x 1 day

(or until patient is tolerating PO,

Clinical description

then Amoxicillin 500 mg PO TDS x to complete a 5-day course.

• For Anaerobic pelvic flora:

Metronidazole 500 mg IV TDS or Clindamycin 600 mg IV q6h x 1 day (or until patient is tolerating PO), then Metronidazole 400 mg PO TDS to complete a 5-day course.

References aAmerican College of Obstetricians & Gynecologists. Antibiotic prophylaxis for gynecologic procedures. ACOG Practice Bulletin #104. Obstetrics & Gynecology 2009;113:1180-9.

hPittaway DE, Winfield AC, Maxson W, Daniell J, Herbert C, Wentz AC. Prevention of acute pelvic inflammatory disease after hysterosalpingography: efficacy of doxycycline prophylaxis. Am J Obstet Gynecol. 1983 Nov 15;147(6):623-6.