Antibiotic prophylaxis - Urological Surgery
General Principles of Prescribing Antibiotics for Surgical Prophylaxis
1. Timing. Antibiotics should be administered or infusion completed within 60 minutes before the procedure or skin incision.
2. Document doses in the "once only" section of the paper drug administration chart (the kardex) or as STAT orders on HEPMA.
3. A single dose of antibiotic is recommended. Exceptions are outlined in individual protocols.
4. No dose adjustment in renal or hepatic impairment is required unless indicated.
5. Repeat dosing may be required if the operation is prolonged.
6. Discuss patients with consultant microbiologist pre-operatively for complex issues including:
• Carriage of or previous infection with resistant organisms, other than MRSA.
• Where eGFR is <20ml/min.
ENDOUROLOGY:
| Procedure | Recommended | MRSA |
| Extracrporeal shockwave lithotripsy (ESWL) | No prohlylaxis. If recent UTI consider Gentamicin IV (dose as per table) if isolate susceptible | |
| Stent insertion / change | Gentamicin IV (dose as per table) | Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg |
| Ureteroscopy (URS) +/- biopsy +/- lasertripsy |
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| Percutaneous nephrolithotomy (PCNL) | Gentamicin IV (dose as per table) If evidence of UTI and stones, treat with antibiotics post-op, based on cultures for upto 7 days |
Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg If evidence of UTI and stones, treat with antibiotics post-op, based on cultures for upto 7 days |
Gentamicin surgical prophylaxis dosing table:
Height is used to estimate ideal bosy weight, dosing equates to approximately 5mg/kg capped at 400mg
*When height <5 feet, use actual body weight to calculate gentamicin dose.
| FEMALE | ||
| Height (Feet /Inches) | Height (cm) | Gentamicin dose (mg) |
| <5' | <152cm | *5mg/kg(max 400mg) |
| 5' - 5'1'' | 152 - 155 | 240 |
| >5'1'' - 5'6'' | >155 - 168 | 280 |
| >5'6'' - 5'10'' | >168 - 178 | 320 |
| >5'10'' - 6'2' | >178 - 188 | 360 |
| >6'2'' | > 188 | 400 |
| MALE | ||
| Height (Feet /Inches) | Height (cm) | Gentamicin dose (mg) |
| <5' | <152cm | *3mg/kg(max 300mg) |
| 5' - 5'4'' | 152 - 163 | 280 |
| >5'4'' - 5'8'' | >163 - 173 | 320 |
| >5'8'' - 6'1'' | >173 - 185 | 360 |
| >6'1 | >185 | 400 |