Perioperative Antibiotics for GI Surgery Laprascopic Cholecystectomy Small Bowel Obstruction Appendectomy Diverticulitis

Open or Laprascopic Cholecystectomy for acute cholecystitis (Pre-Op) No antibiotics recommended if no cholecystitis expected (level A evidence) For Patients WITHOUT penicillin allergy Cefazolin 2 gm IVPB injection – to be given in OR by Anesthesiology <60 min before incision OR Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients WITH penicillin allergy Clindamycin 900 grams IV q8h AND Gentamicin 5 mg/kg IV q24h Aztreonam 2 grams IV q8h

Laprascopic Cholecystectomy for acute cholecystitis (Post-Op) For Patients WITHOUT penicillin allergy Ceftriaxone 2 grams IV q24h AND Metronidazole 500 mg IV q8h For Patients WITH penicillin allergy Clindamycin 900 grams IV q8h Gentamicin 5 mg/kg IV q24h OR Aztreonam 2 grams IV q8h

Small Bowel Obstruction Pre-Op For Patients WITHOUT penicillin allergy Cefazolin 2 gm IVPB injection – to be given in OR by Anesthesiology <60 min before incision And Metronidazole 500mg IVPB injection- to be given in OR by Anesthesiology <60 min before incision OR Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision Gentamicin 5 mg/kg IVPB to be given in the OR by anesthesiology <60min before incision Or Aztreonam 2 gm IVPB to be given in the OR by anesthesiology <60min before incision

Small Bowel Obstruction Post-Op (if evidence of infection) For Patients WITHOUT penicillin allergy Cefazolin 2 gm IVPB injection q8hr x 2 doses AND Metronidazole 500 mg IVBP injection q 8hr x 2 doses OR Cefoxitin 2 gm IVPB injection q 8 hrs x 2 doses For Patients with penicillin allergy Clindamycin 900 mg IVPB injection q8hr x 2 doses Aztreonam 2 gm IVPB q8hr x 2 doses (if aztreonam used pre-op)

Appendectomy Pre-Op (for acute appendicitis) For Patients WITHOUT penicillin allergy Cefazolin 2 gm IVPB AND Metronidazole 500 mg IVPB OR Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision Gentamicin 5mg/kg IVPB to be given in the OR by anesthesiology <60min before incision Aztreonam 2gm IVPB to be given in the OR by anesthesiology <60min before incision

Appendectomy Post-Op For Patients WITHOUT penicillin allergy Cefazolin 2 gm IVPB AND Metronidazole 500 mg IVPB OR Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision And Aztreonam 2 gm IVPB to be given in the OR by anesthesiology <60min before incision

Diverticulitis (Conservative/Non-Operative) For Patients WITHOUT penicillin allergy Piperacillin-Tazobactam 3.375 g IVPB q8h as a 4 hour infusion x 48 hours For Patients with penicillin allergy Levofloxacin 750 mg IVPB q24h x 48 hours Metronidazole 500 mg IV q8h x 48 hours

Diverticulitis Washout Pre-Op For Patients WITHOUT penicillin allergy Cefazolin 2 grams IVPB AND Metronidazole 500 mg IVPB OR Cefoxitin 2gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy Clindamycin 900mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision And Gentamicin 5 mg/kg IVPB to be given in the OR by anesthesiology <60min before incision Or Aztreonam 2 gm IVPB to be given in the OR by anesthesiology <60min before incision

Diverticulitis Washout Post-Op For Patients WITHOUT penicillin allergy Piperacillin-Tazobactam 3.375 gm IVPB injection q8 hrs as a 4 hours infusion x 5 days For Patients with penicillin allergy Levofloxacin 750mg IVPB injection q 24 hrs x 5 days And Metronidazole 500mg IVPB injection- q8 hrs x 5 days

Diverticulitis with stoma Pre-Op For Patients WITHOUT penicillin allergy Cefazolin 2 gm IVPB AND Metronidazole 500 mg IVPB OR Cefoxitin 2 gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision Gentamicin 5 mg/kg IVPB to be given in the OR by anesthesiology <60min before incision Aztreonam 2 gm IVPB to be given in the OR by anesthesiology <60min before incision

Diverticulitis with stoma Post-Op For Patients WITHOUT penicillin allergy Cefazolin 2 gm IVPB q8h x 2 doses AND Metronidazole 500 mg IVPB q8h x 2 doses OR Cefoxitin 2 gm IVPB IVPB q8h x 2 doses For Patients with penicillin allergy Clindamycin 900 mg IVPB q8h x 2 doses Aztreonam 2 gm IVPB q8h x 2 doses (ONLY if given pre-op)

Diverticulitis without stoma Pre-Op For Patients WITHOUT penicillin allergy Cefazolin 2 grams IVPB AND Metronidazole 500 mg IVPB OR Cefoxitin 2gm IVPB injection- to be given in OR by Anesthesiology <60min before incision For Patients with penicillin allergy Clindamycin 900 mg IVPB injection to be given in the OR by Anesthesiology <60 min before incision Gentamicin 5 mg/Kg IVPB to be given in the OR by anesthesiology <60min before incision Aztreonam 2gm IVPB to be given in the OR by anesthesiology <60min before incision

Diverticulitis without stoma Post-Op For Patients WITHOUT penicillin allergy Cefazolin 2 grams IVPB q8h x 2 doses AND Metronidazole 500 mg IVPB q8h x 2 doses OR Cefoxitin 2gm IVPB q8h x 2 doses For Patients with penicillin allergy Clindamycin 900 mg IVPB q8h x 2 doses Aztreonam 2gm IVPB q8h x 2 doses (only if given pre-op)