37. Urology

Choice and duration of antibiotics may need to be modified depending on recent urine culture results i.e. treatment may need to be initiated before surgery if an infection is present.

Procedure	Antibiotic	Antibiotic	Route	Dosing Interval	Comment
Catherisation	Gentamicin	160mg	IV	STAT
TRUS Biopsy	Ciprofloxacin	500mg	po	ONE hour before	Continue TWICE daily for 3 days
TURP (no infection present)	Gentamicin	3-5mg/kg/day	IV	STAT	Dose dependent on renal function
TURP (infection, bacteriuria or catheter present)*	Cefuroxime and gentamicin	750mg 5mg/kg	IV	24 hours before surgery	Review 1st day post-op. Continue for max. 48 hours
Nephrectomy	Cefuroxime or flucloxacillin	1.5g 1g	IV	STAT (3 doses if clinically needed)	For patients with a history of penicillin anaphylaxis use clarithromycin
Pyeloplasty	Cefuroxime	1.5g	IV	STAT
Percutaneous nephrolithotomy*	Cefuroxime and gentamicin	1.5g 5mg/kg/day	IV	At 24 hours before surgery	Review 1 day post op. Continue for maximum 48 hours
Nephrostomy	Gentamicin	3-5mg/kg	IV	STAT	Treat according to cultures
Cystectomy (no infection present)	Cefuroxime and metronidazole	1.5g 500mg	IV IV	STAT at induction	Then cefuroxime 750mg IV tds plus metronidazole IV 500mg tds for 3 doses
Cystectomy (infection, bacteriuria or catheter present)	Gentamicin, cefuroxime and metronidazole	5mg/kg 750mg 500mg	IV	24 hours before surgery	Review 1 day post operation. Continue for maximum 48 hours
Radical prostatectomy*	Cefuroxime or gentamicin	1.5g 3-5mg/kg/day	IV	STAT
Cystoplasty, ileal conduit	Gentamicin and metronidazole	3-5mg/kg/day 1g	IV	STAT
Colposuspension	Cefuroxime and metronidazole	1.5g 500mg	IV	STAT
Urethrectomy	Cefuroxime and gentamicin	1.5g 5mg/kg/day	IV	24 hours before  surgery	Review 1 day post operation. Continue for maximum 48 hours
Ureteroscopy - diagnostic	Cefuroxime and gentamicin	750mg 160mg	IV	STAT
Ureteroscopy - with stent or nephrostomy tube (infection, bacteriuria or catheter present)	Cefuroxime and gentamicin	750mg 160mg	IV	TDS OD 24 hours before surgery

*Ciprofloxacin 200mg IV BD should only be used if the patient has a proven penicillin or cephalosporin allergy, or has impaired renal function.