Recommended Antimicrobial Prophylaxis for Urologic Procedures (AUA guidelines 2008)
| Procedure
|
Organisms
|
Prophylaxis Indicated
|
Antimicrobial(s) of Choice
|
Alternative Antimicrobial(s)
|
Duration of Therapy*
|
| Lower Tract Instrumentation
|
| Removal of external urinary catheter
|
GU tract†
|
If risk factors‡,§
|
|
- Aminoglycoside (Aztreonam￥) ± Ampicillin
- 1st/2nd gen. Cephalosporin
- Amoxacillin/Clavulanate
|
≤24hours
|
| Cystography, urodynamic study, or simple cystourethroscopy
|
GU tract
|
t If risk factors§
|
|
- Aminoglycoside (Aztreonam￥) ± Ampicillin
- 1st/2nd gen. Cephalosporin
- Amoxacillin/ Clavulanate
|
≤24hours
|
| Cystourethroscopy with manipulation
|
GU tract
|
All
|
|
- Aminoglycoside (Aztreonam￥) ± Ampicillin
- 1st/2nd gen. Cephalosporin
- Amoxacillin/ Clavulanate
|
≤24hours
|
| Prostate brachytherapy or cryotherapy
|
Skin
|
Uncertain
|
|
|
≤24hours
|
| Transrectal prostate biopsy
|
Intestine††
|
All
|
- Fluoroquinolone
- 1st/2nd/3rd gen. Cephalosporin
|
- Aminoglycoside (Aztreonam￥)+ Metronidazole or Clindamycin**
|
≤24hours
|
| Upper Tract Instrumentation
|
| Shock-wave lithotripsy
|
GU tract
|
All
|
|
- Aminoglycoside (Aztreonam￥) ± Ampicillin
- 1st/2nd gen. Cephalosporin
- Amoxacillin/ Clavulanate
|
≤24hours
|
| Percutaneous renal surgery
|
GU tract and skin‡‡
|
All
|
- 1st/2nd gen. Cephalosporin
- Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin
|
- Ampicillin/Sulbactam
- Fluoroquinolone
|
≤24hours
|
| Ureteroscopy
|
GU Tract
|
All
|
|
- Aminoglycoside (Aztreonam￥) ± Ampicillin
- 1st/2nd gen. Cephalosporin
- Amoxacillin/Clavulanate
|
≤24hours
|
| Open or Laparoscopic Surgery
|
| Vaginal surgery (includes urethral sling procedures)
|
GU tract, skin and Grp B Strep
|
All
|
- 1st/2nd gen. Cephalosporin
- Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin
|
- Ampicillin/Sulbactam
- Fluoroquinolone
|
≤24hours
|
| Without entering urinary tract
|
Skin
|
If risk actors
|
|
|
Single dose
|
| Involving entry into urinary tract
|
GU tract and skin
|
All
|
- 1st/2nd gen. Cephalosporin
- Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin
|
- Ampicillin/Sulbactam
- Fluoroquinolone
|
≤24hours
|
| Involving intestine §§
|
GU tract, skin and intestine
|
All
|
- 2nd/3rd gen. Cephalosporin
- Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin
|
- Ampicillin/Sulbactam
- Ticarcillin/Clavulanate
- Pipercillin/Tazobactam
- Fluoroquinolone
|
≤24hours
|
| Involving implanted prosthesis
|
GU tract and skin
|
All
|
- Aminoglycoside (Aztreonam ￥)+1st/2nd gen. Cephalosporin or Vancomycin
|
- Ampicillin/Sulbactam
- Ticarcillin/Clavulanate
- Pipercillin/Tazobactam
|
≤24hours
|
Order of agents in each column is not indicative of preference. The absence of an agent does not preclude its appropriate use depending on specific situations.
| Key: gen, generation; Grp, group; GU, genitourinary; TMPSMX, trimethoprimsulfamethoxazole. * Additional antimicrobial therapy may be recommended at the time of removal of an externalized urinary catheter. † GU tract: Common urinary tract organisms are E. coli, Proteus sp., Klebsiella sp., Enterococcus. ‡ See “Patientrelated factors affecting host respo ¶nse to surgical infections.” If urine culture shows no growth prior to the procedure, antimicrobial prophylaxis is not necessary.
|
Or full course of culture-directed antimicrobials for documented infection (which is treatment, not prophylaxis). ￥Aztreonam can be substituted for aminoglycosides in patients with renal insufficiency. _ Includes transurethral resection of bladder tumor and prostate, and any biopsy, resection, fulguration, foreign body removal, urethral dilation or urethrotomy, or ureteral instrumentation including catheterization or stent placement/removal. **Clindamycin, or aminoglycoside+ metronidazole or clindamycin, are general alternatives to penicillins and cephalosporins in patients with penicillin allergy, even when not specifically listed.
|
†† Intestine: Common intestinal organisms are E. coli, Klebsiella sp., Enterobacter, Serratia sp., Proteus sp., Enterococcus, and Anaerobes. ‡‡ Skin: Common skin organisms are S. aureus, coagulase negative Staph. sp., Group A Strep. sp. For surgery involving the colon, bowel preparation with oral neomycin plus either erythromycin base or metronidazole can be added to or substituted for systemic agents. Copyright ⓒ 2008 American Urological Association Education and Research, Inc.Ⓡ Revised July 31, 2008
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