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

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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

8. Diverticulitis (Conservative/Non-Operative)
For Patients WITHOUT penicillin allergy
Piperacillin-Tazobactam 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

9. 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

10. Diverticulitis Washout Post-Op
For Patients WITHOUT penicillin allergy
Piperacillin-Tazobactam 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

11. 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

12. 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)

13. 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

14. 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)