Timing. Antibiotics should be administered or infusion completed within 60 minutes before the procedure or skin incision.
Document doses in the “once only” section of the paper drug administration chart (the kardex) or as STAT orders on HEPMA.
A single dose of antibiotic is recommended. Exceptions are outlined in individual protocols.
No dose adjustment in renal or hepatic impairment is required unless indicated.
Repeat dosing may be required if the operation is prolonged (see table below for re‐dosing guidance for individual antibiotics):
The repeat dose is given at the recommended interval from the time the initial dose was administered.
Intra‐operative blood loss >1.5L. Re‐dose following fluid replacement/blood transfusion.
Discuss patients with consultant microbiologist at pre‐op assessment for complex issues including:
Carriage of, or previous infection with resistant organisms other than MRSA, e.g. gentamicin resistant coliforms
Where eGFR is <20ml/min for alternatives to gentamicin
Patients already being treated with antibiotics for urological infection
Gentamicin toxicity is associated with cumulative use; discuss possible need for alternatives in patients with previous gentamicin courses and procedures recommending more than a single dose
MRSA – See intranet for MRSA infection control policy on decolonisation prior to surgery
PROSTATE | ||
Procedure | Recommended | Penicillin allergy or MRSA |
Transrectal prostate biopsy (TRUS) | Ciprofloxacin 500mg oral; 1 hour prior to procedure and 12hrs post (2 doses total) If known quinolone/ciprofloxacin resistant organisms: Gentamicin IV (dose as per table) | MRSA Ciprofloxacin 500mg oral; 1 hour prior to procedure and 12hrs post (2 doses total) AND Teicoplanin IV 400mg |
If known quinolone/ciprofloxacin resistant organisms: Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg | ||
Transperineal prostate biopsy | Cefalexin oral 500mg 1hr before procedure | PENICILLIN ALLERGY Co‐trimoxazole 960mg oral; 1 hour before procedure MRSA ADD Teicoplanin 400mg IV |
Lap/robotic radical prostatectomy | Gentamicin IV (dose as per table) | MRSA Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg |
Transurethral resection of prostate (TURP)/ green light laser/bladder neck incision (BNI) | NON‐CATHETERISED Gentamicin IV (dose as per table) | NON‐CATHETERISED Gentamicin IV (dose as per table) |
MRSA Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg | ||
CATHETERISED PRE‐OP Gentamicin IV (dose as per table) AND Amoxicillin 1g IV | CATHETERISED PRE‐OP Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg | |
BLADDER | ||
Procedure | Recommended | Penicillin allergy or MRSA |
Trans urethral removal of bladder tumour | Gentamicin IV (dose as per table) | MRSA |
(TURBT)/biopsy | Gentamicin IV (dose as per table) | |
AND | ||
Teicoplanin IV 400mg | ||
Radical cystectomy and bladder | Gentamicin IV (dose as per table) | Gentamicin IV (dose as per table) |
augmentation/reconstruction/conduit | AND | AND |
Amoxicillin 1g IV | Teicoplanin 400mg IV | |
AND | AND | |
Metronidazole 500mg IV | Metronidazole 500mg IV | |
Sacral nerve stimulation (SNS) | Teicoplanin 400mg IV on induction (or if local anaesthetic Teicoplanin 400mg IM 60 minutes prior to implantation) | Teicoplanin 400mg IV on induction (or if local anaesthetic Teicoplanin 400mg IM 60 minutes prior to implantation) |
ANDROLOGY | ||
PENIS | ||
Procedure | Recommended | Penicillin allergy or MRSA |
Radical penectomy and perineal urostomy | Gentamicin IV (dose as per table) AND Co‐amoxiclav 1.2g IV | Teicoplanin 400mg IV AND Gentamicin IV (dose as per table) AND Metronidazole 500mg IV |
Partial penectomy without graft | Co‐amoxiclav 1.2g IV | Teicoplanin 400mg IV AND Gentamicin IV (dose as per table) AND Metronidazole 500mg IV |
Partial penectomy and skin graft | Co‐amoxiclav 1.2g IV every 8 hours for 3 doses ORAL STEP DOWN Co‐amoxiclav 625mg oral every 8 hours for 4 days | Teicoplanin 400mg IV every 12 hours for two doses AND Gentamicin IV (dose as per table) single dose only AND Metronidazole 500mg IV every 8 hours for 3 doses |
ORAL STEP DOWN PENICILLIN ALLERGY: Co‐trimoxazole oral 960mg every 12 hours (reduce dose if eGFR<30ml/min) AND Metronidazole 400mg oral every 8 hours for 4 days | ||
MRSA: Discuss with microbiology | ||
LYMPHADENECTOMY | ||
Procedure | Recommended | Penicillin allergy or MRSA |
Dynamic sentinel lymph node biopsy (DSLNB) | No prophylaxis | No prophylaxis |
Radical lymphadenectomy | Co‐amoxiclav 1.2g IV Continue orally post‐op until drains removed | Teicoplanin 400mg IV AND Gentamicin IV (dose as per table) AND Metronidazole 500mg IV Discuss oral options with microbiology |
Penile implant | Piperacillin‐tazobactam 4.5g IV every 8 hours for three doses AND Gentamicin IV (dose as per table) single dose only ORAL STEP DOWN Co‐amoxiclav 625mg oral every 8 hours for 7 days | Teicoplanin 400mg IV every 12 hours for two doses AND Gentamicin IV (dose as per table) single dose only AND Metronidazole 500mg IV every 8 hours for 3 doses |
ORAL STEP DOWN PENICILLIN ALLERGY: Co‐trimoxazole 960mg oral every 12 hours for 7 days (reduce dose if eGFR<30ml/min) | ||
MRSA: discuss oral options with microbiology | ||
Orchidectomy with prosthesis | Co‐amoxiclav 1.2g IV | Teicoplanin 400mg IV AND Gentamicin IV (dose as per table) AND Metronidazole 500mg IV |
Surgery with skin grafts | Co‐amoxiclav 1.2g IV every 8 hours for 3 doses ORAL STEP DOWN Co‐amoxiclav 625mg oral every 8 hours for 4 days | Teicoplanin 400mg IV every 12 hours for two doses AND Gentamicin IV (dose as per table) single dose only AND Metronidazole 500mg IV every 8 hours for 3 doses |
ORAL STEP DOWN PENICILLIN ALLERGY: Co‐trimoxazole oral 960mg every 12 hours (reduce dose if eGFR<30ml/min) AND Metronidazole 400mg oral every 8 hours for 4 days | ||
Oral step down MRSA: Discuss with microbiology | ||
KIDNEY | ||
Procedure | Recommended | Penicillin allergy or MRSA |
Lap/robotic radical or partial nephrectomy | No prophylaxis. If collecting system breached: Gentamicin IV (dose as per table) | No prophylaxis. If collecting system breached: Gentamicin IV (dose as per table) |
AND Amoxicillin 1g IV | AND Teicoplanin 400mg IV | |
Open radical/partial nephrectomy or nephroureterectomy | Gentamicin IV (dose as per table) AND Amoxicillin 1g IV | Gentamicin IV (dose as per table) AND Teicoplanin 400mg IV |
URETHRA | ||
Procedure | Recommended | Penicillin allergy or MRSA |
Optical urethrotomy/dilation | Gentamicin IV (dose as per table) | MRSA: Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg |
Urethroplasty | Gentamicin IV (dose as per table) AND Co‐amoxiclav 1.2g IV single dose ORAL STEP DOWN Co‐amoxiclav 625mg oral every 8 hours for 2 days | Gentamicin IV (dose as per table) AND Teicoplanin 400mg IV If oral mucosal graft: ADD Metronidazole 500mg IV ORAL STEP DOWN PENICILLIN ALLERGY: Co‐trimoxazole 960mg oral every 12 hours for 48 hours (reduce dose if eGFR<30ml/min) If oral mucosal graft: ADD Metronidazole 400mg oral every 8 hours for 48 hours to above MRSA: discuss oral treatment with microbiology. |
Artificial urinary sphincter | Gentamicin IV (dose as per table) AND Co‐amoxiclav 1.2g IV single dose | MRSA: See intranet for MRSA infection control policy on decolonization. |
ORAL STEP DOWN Co‐amoxiclav 625mg oral every 8 hours for 2 days | Teicoplanin 400mg IV AND Gentamicin IV (dose as per table) AND Metronidazole 500mg IV | |
ORAL STEP DOWN PENICILLIN ALLERGY: Co‐trimoxazole 960mg oral every 12 hours for 48 hours (reduce dose if eGFR<30ml/min) MRSA: discuss oral treatment with microbiology. | ||
ENDOUROLOGY | ||
Procedure | Recommended | Penicillin allergy or MRSA |
Extracorporeal shock wave lithotripsy (ESWL) | No prophylaxis. If recent UTI consider Gentamicin IV (dose as per table) if isolate susceptible. | |
Stent insertion/change | Gentamicin IV (dose as per table) | MRSA Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg |
Ureteroscopy (URS) +/‐ biopsy +/‐ stone laser | Gentamicin IV (dose as per table) | MRSA Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg |
Percutaneous nephrolithonomy (PCNL) | Gentamicin IV (dose as per table) If evidence of urinary tract infection and stones treat with antibiotics post‐op, based on cultures, for up to 7 days. | MRSA Gentamicin IV (dose as per table) AND Teicoplanin IV 400mg If evidence of urinary tract infection and stones treat with antibiotics post‐ op, based on cultures, for up to 7 days. |
Height is used to estimate ideal body weight, dosing equates to approximately 5mg/kg, capped at 400mg.
* When height <5 foot use actual body weight to calculate gentamicin dose.
Avoid gentamicin if eGFR<20mls/min, seek advice on an alternative from microbiology.
FEMALE | ||
Height (Feet/Inches) | Height (cm) | Gentamicin dose |
<5' | <152 | 5mg/kg* (max 400mg) |
5' ‐ 5'1'' | 152 ‐ 155 | 240mg |
>5'1'' ‐ 5'6'' | >155 ‐ 168 | 280 mg |
>5'6'' ‐ 5'10'' | >168 ‐ 178 | 320 mg |
>5'10'' ‐ 6'2'' | >178 ‐ 188 | 360 mg |
>6'2'' | >188 | 400mg |
MALE | ||
Height (Feet/Inches) | Height (cm) | Gentamicin dose |
<5' | <152 | 5mg/kg* (max 400mg) |
5' ‐ 5'4'' | 152 ‐ 163 | 280mg |
>5'4'' ‐ 5'8'' | >163 ‐ 173 | 320 mg |
>5'8'' ‐ 6'1'' | >173 ‐ 185 | 360 mg |
>6'1'' | >185 | 400mg |
Antibiotic | Administration | Re‐dosing advice: prolonged surgery | Re‐dosing advice: >1.5L blood loss |
Amoxicillin iv | Bolus over 3‐5 minutes | Repeat original dose (every) 4 hours | Repeat original dose |
Cefalexin oral | 60 minutes prior to procedure | Repeat dose after 4 hours | Repeat dose |
Ciprofloxacin oral | 60 minutes prior to procedure | Not relevant | Not relevant |
Ciprofloxacin iv | Infuse 400mg over 60 minutes | Not relevant | Not relevant |
Co‐amoxiclav iv | Bolus over 3‐5 minutes | Repeat dose after 4 hours | Repeat dose |
Co‐trimoxazole oral | 60 minutes prior to procedure | Re‐dosing not required | Not relevant |
Gentamicin iv | Bolus over 3‐5 minutes | Where 5mg/kg dosing has been used measure gentamicin level at 6 hours; if <2.0mg/L re‐dose with half original dose after 8 hours | Where 5mg/kg dosing has been used once bleeding controlled measure gentamicin level; if <2.0mg/L re‐dose with half original dose |
Metronidazole iv | Infuse over 20 minutes | Repeat dose after 8 hours | Repeat dose |
Piperacillin‐ tazobactam iv | Infuse over 30 minutes | Repeat original dose after (every) 4 hours | Repeat original dose |
Teicoplanin iv | Bolus over 3‐5 minutes | Re‐dosing not required | 200mg (50% original dose), if ≥ 1.5L blood loss within first hour of operation. |