High risk
open cholecystectomy
emergency laparoscopic cholecyst-ectomy
insertion of prosthetic device
acute cholecystitis
biliary colic within 30 days
biliary spillage
biliary obstruction
obstructive jaundice or common bile duct stones
non-functioning gallbladder
recent (within 1 month) biliary surgery
> 65 yrs old
diabetes
pregnancy
obesity
immunosuppression
Common Pathogens
Enterobacteriaceae
Enterococcus spp
Clostridium spp
Streptococcus spp
Staphylococcus spp
| Regimen(s) of Choice See General Principles and Pre-Op Antibiotic Administration and Intraoperative Antibiotic Administration | ||
|---|---|---|
| Cefazolin | 2g IV | x 1 pre-op dose |
| Alternative Regimens if allergy to cefazolin, or severe non-IgE-mediated reaction to any β-lactam (interstitial nephritis, hepatitis, hemolytic anemia, serum sickness, severe cutaneous reactions [e.g. SJS, TEN, DRESS]) | ||
|---|---|---|
| [Gentamicin | 1.5mg/kg IV | x 1 pre-op dose |
| + | ||
| Clindamycin] | 600mg IV | x 1 pre-op dose |
| or | ||
| [Gentamicin | 1.5mg/kg IV | x 1 pre-op dose |
| + | ||
| Metronidazole] | 500mg IV | x 1 pre-op dose |