GIT & Biliary Surgery - Laparoscopic/Open Procedures

Laparoscopic UGI or HPB surgery

Low risk: Antibiotics NOT routinely required

High risk laparoscopic or open UGI or HPB surgery (excluding infected bile or bile spills)

Preferred (including for penicillin allergy (non-severe)): cefazolin  iv (see dosing table below)

For penicillin allergy (severe) or MRSA positive patients: gentamicin 3mg/kg iv 

High risk laparoscopic or open UGI or HPB surgery where suspected or confirmed infected bile associated with biliary obstruction/stents etc or bile spills 

Preferred (including for penicillin allergy (non-severe)):

cefazolin iv (see dosing table below) AND gentamicin 3mg/kg iv.

Re-dose with cefazolin 1g at 3, 6 and 9 hours of operation (Max 12g in 24 hours). Do not re-dose gentamicin.

For penicillin allergy (severe) or MRSA positive patients:  teicoplanin 800mg iv AND gentamicin 3mg/kg iv. Do not re-dose teicoplanin or gentamicin.

Laparoscopic or open colorectal and transanal surgery (including appendectomy)

Preferred (including for penicillin allergy (non-severe)): cefazolin iv (see dosing table below) AND metronidazole 500mg iv 

For penicillin allergy (severe) or MRSA positive patients: gentamicin 3mg/kg iv AND metronidazole 500mg iv 

For high risk transanal procedures (Transanal minimally invasive surgery (TAMIS) or transanal endoscopic microsurgery (TEMS)), post operative metronidazole 400mg tds po for 3 days may be indicated

Preferred (including for penicillin allergy (non-severe)): cefazolin iv (see dosing table below)

For penicillin allergy (severe) or MRSA positive patients: gentamicin 3mg/kg iv