| Procedure | Recommended Antibiotics and Comments |
| Colorectal surgery |
Amoxicillin IV 1g + Metronidazole IV 500mg + Gentamicin IV as per Gentamicin prophylactic dosing table. If penicillin allergy: Teicoplanin IV 400mg + Metronidazole IV 500mg + Gentamicin IV as per Gentamicin prophylactic dosing table. |
| Oesophageal surgery, stomach and duodenal surgery, gastric bypass surgery, gall bladder surgery (open) and small intestine |
Gentamicin IV as per Gentamicin prophylactic dosing table. |
| Appendectomy, biliary tract surgery |
Metronidazole IV 500mg + Gentamicin IV as per Gentamicin prophylactic dosing table. |
| Gall bladder surgery (laparoscopic) |
Not routinely recommended. Consider if: cholangiogram, bile spillage, conversion to laparotomy, acute cholecystitis / pancreatitis, jaundice, immunosuppression, insertion of prosthetic devices. If required use Gentamicin IV as per Gentamicin prophylactic dosing table. |
|
Splenectomy **Refer to Splenectomy guidance for advice on vaccinations and long-term antimicrobial prophylaxis** |
Not routinely recommended. Consider if immunosuppression. If required use Gentamicin IV as per Gentamicin prophylactic dosing table. |
| Hernia repair +/- mesh, open or laparoscopic |
Not routinely recommended. Meta-analysis does not support routine prophylaxis. Consider in patients with mesh insertion if: obesity, diabetes or other risk factors for surgical site infection. If required use Gentamicin IV as per Gentamicin prophylactic dosing table. |
| Therapeutic Endoscopic Retrograde CholangioPancreatography (ERCP), Percutaneous endoscopic gastrostomy (PEG) tube insertion |
Not routinely recommended. Consider if: pancreatic pseudocyst, immunosuppression, incomplete biliary drainage (e.g. primary sclerosing cholangitis or cholangiocarcinoma). If required use Gentamicin IV as per Gentamicin prophylactic dosing table. |
| Variceal banding / injection (acute) |
Co-amoxiclav IV 1.2g If penicillin allergy: Clarithromycin IV 500mg. If antibiotic therapy not otherwise required, continue for 48 hours after cessation of bleeding (observe IV to oral switch). |
| Upper or lower diagnostic gastrointestinal endoscopy |
Not recommended |
| Endoscopic mucosal resection |
Not recommended |
| Breast surgery |
Co-amoxiclav IV 1.2g If penicillin allergy: Teicoplanin IV 400mg |
| Insertion of Tenckhoff catheter for CAPD |
Flucloxacillin IV 2g If penicillin allergy: Teicoplanin IV 400mg |
| Guideline reviewed | March 2024 |
| Page updated | September 2024 |