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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‡,§ |
|
|
≤24hours |
| Cystography, urodynamic study, or simple cystourethroscopy | GU tract | t If risk factors§ |
|
|
≤24hours |
| Cystourethroscopy with manipulation | GU tract | All |
|
|
≤24hours |
| Prostate brachytherapy or cryotherapy | Skin | Uncertain |
|
|
≤24hours |
| Transrectal prostate biopsy | Intestine†† | All |
|
|
≤24hours |
| Upper Tract Instrumentation | |||||
| Shock-wave lithotripsy | GU tract | All |
|
|
≤24hours |
| Percutaneous renal surgery | GU tract and skin‡‡ | All |
|
|
≤24hours |
| Ureteroscopy | GU Tract | All |
|
|
≤24hours |
| Open or Laparoscopic Surgery | |||||
| Vaginal surgery (includes urethral sling procedures) | GU tract, skin and Grp B Strep | All |
|
|
≤24hours |
| Without entering urinary tract | Skin | If risk actors |
|
|
Single dose |
| Involving entry into urinary tract | GU tract and skin | All |
|
|
≤24hours |
| Involving intestine §§ | GU tract, skin and intestine | All |
|
|
≤24hours |
| Involving implanted prosthesis | GU tract and skin | All |
|
|
≤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 |