32. General Surgery

Procedure	Antibiotic	Dose	Route	Dose Interval	Comment
Colorectal surgery	Cefuroxime and metronidazole OR Co-amoxiclav	1.5g 500mg  1.2g	IV IV	Single single	Only post operative if severe peritonitis If history of penicillin anaphylaxis use ciprofloxacin 400mg IV
Appendectomy	Cefuroxime and metronidazole OR Co-amoxiclav	1.5g 500mg 1.2g	IV IV	Single Single	Only post operative if severe peritonitis If history of penicillin anaphylaxis use ciprofloxacin 400mg IV
Biliary surgery (open)	Cefuroxime OR Co-amoxiclav	750mg 1.2g	IV IV	Single Single	If history of penicillin anaphylaxis use ciprofloxacin 400mg IV. If previous cholecystitis in the elderly, the seriously ill or those who have bowel/bile duct anastomoses, consider adding metronidazole to cefuroxime.
Clean-contaminated procedures	Co-amoxiclav	1.2g	IV	Single	If penicillin allergic (rash) use cefuroxime and metronidazole. If history of penicillin anaphylaxis use ciprofloxacin 400mg IV
Endoscopic gastrostomy	Co-amoxiclav OR Cefotaxime	1.2g 2g	IV IV	Single Single	If penicillin allergic (rash) use cefuroxime and metronidazole IV OR If history of penicillin anaphylaxis use ciprofloxacin 400mg IV
Gastroduodenal surgery	Cefuroxime and metronidazole OR Co-amoxiclav	1.5g 500mg 1.2g	IV	Intra operatively and 48 hours post operation for perforated DU	If penicillin allergic (rash) use cefuroxime and metronidazole IV If history of penicillin anaphylaxis use ciprofloxacin 400mg IV
Oesophageal Surgery	Co-amoxiclav	1.2g	IV	Single	If penicillin allergic (rash) use cefuroxime and metronidazole IV If history of penicillin anaphylaxis use ciprofloxacin 400mg IV *(see note below)
Small bowel  surgery	Cefuroxime and metronidazole OR Co-amoxiclav	1.5g 500mg 1.2g	IV	Single	No post op doses
Laparoscopic or non-laparoscopic hernia repair with mesh	Cefuroxime OR	1.5mg 1.2g	IV	Single	For patients with a history of penicillin anaphylaxis use clarithromycin 500mg IV
Laparoscopic or non-laparoscopic hernia repair without mesh	PROPHYLAXIS IS NOT RECOMMENDED
Laparoscopic cholecystectomy	PROPHYLAXIS IS NOT RECOMMENDED

NOTE: If surgery is prolonged (>4 hours) give a second dose of antibiotic