| Procedure | First choice | Alternate | Allergic Alternate |
|---|---|---|---|
| Biliary Drainage | Zosyn 4.5 gm IVPB | Unasyn 3 gm IVP | PCN allergy: Clinamycin 600mg IVPB Aztreonam 1gm IVPB |
| Percutaneous cholangiogram | Zosyn 4.5 gm IVPB | ||
| Liver Biopsy in transplant | Zosyn 4.5 gm IVPB | Unasyn 3 gm IVP | |
| Nephrostomy (PCN) | Levaquin 500 mg IVPB | ||
| Abscess Drain | Based on clinical picture | ||
| Gastrostomy | Cefazolin 1 gm IVPB | PCN allergy: Clinamycin 600mg IVPB | |
| Jejunostomy | Cefazolin 1 gm IVPB |
ANTIBIOTIC PROPHYLAXIS: VASCULAR PERCUTANEOUS INTERVENTION
| Procedure | First Choice | Alternate | Allergic Alternate |
|---|---|---|---|
| Stent: Arterial or Venous | None | ||
| Angioplasty: Arterial or Venous | None | ||
| Embolization: Liver, Spleen, Colon, small bowel | Zosyn 4.5 gm IVPB
(Pippercillin/Tazobactam)if risk factors for Gram(-) resistance |
Unasyn 3 gm IVPB | Clinamycin 6oomg IVPB
Aztreonam 1 gm IVPB |
| Embolization: Uterine Fibroid | Clinamycin 6oomg IVPB
Gentamycin 80 mg IVPB |
Unasyn 3 gm IVPB | Clinamycin 6oomg IVPB
Aztreonam 1 gm IVPB |
| Embolization: Kidney | Depends on presence of UTI. UTI treat with Levaquin 500 mg IVPB | ||
| Embolization: pelvis, external carotid, bronchial artery | None | ||
| Thrombectomy: dialysis Graft | None | ||
| Prolonged TPA infusion/lysis | None | ||
| Vein Ablation | None | ||
| Venous Access: Port, Tunneled Catheter (Permacath, hickman, trifusion). Tunneled PICC | Cefazolin 1 gm IVPB | PCN allergy: Vancomycin 1 GM IVPB | |
| TIPS | Unasyn 3 gm IVPB | Zosyn 4.5 gm IVPB | PCN allergy: Levaquin 500mg IVPB |
| PICC | None |
Frequently Asked Questions
What is the first-choice antibiotic for biliary drainage procedures?
The first-choice antibiotic for biliary drainage procedures is Zosyn, administered at 4.5 grams intravenously. Zosyn is a combination of piperacillin and tazobactam, which is effective against a broad range of bacteria, including those commonly found in the biliary tract.
What alternatives are available for patients with penicillin allergies during liver biopsy in transplant procedures?
For patients with penicillin allergies undergoing a liver biopsy in transplant procedures, Clindamycin 600 mg intravenously or Aztreonam 1 gm intravenously can be used as alternatives. These antibiotics provide coverage against common bacteria while avoiding penicillin-related allergic reactions.
Are antibiotics required for arterial or venous stent procedures?
Antibiotics are generally not required for arterial or venous stent procedures unless specific clinical conditions necessitate their use. The risk of infection is considered low, and prophylactic antibiotics are not routinely recommended in these cases.
What is the recommended antibiotic for gastrostomy procedures in patients with penicillin allergies?
For patients with penicillin allergies undergoing gastrostomy procedures, Clindamycin 600 mg intravenously is recommended. Clindamycin provides adequate coverage for the bacteria that might be encountered during the procedure.
When is Levaquin used in interventional procedures?
Levaquin, at 500 mg intravenously, is used in cases where there's a urinary tract infection (UTI) before kidney embolization procedures or as an alternative for patients with penicillin allergies undergoing procedures like nephrostomy. It's an effective antibiotic for treating Gram-negative infections.
Why is no antibiotic prophylaxis recommended for some percutaneous interventions?
For certain percutaneous interventions, such as angioplasty and thrombectomy, the risk of infection is minimal, and thus, antibiotic prophylaxis is not routinely recommended. This approach helps prevent unnecessary antibiotic use and reduces the risk of antibiotic resistance.
What antibiotics are used for embolization procedures with risk factors for Gram-negative resistance?
For embolization procedures where there's a risk of Gram-negative bacterial resistance, Zosyn 4.5 gm intravenously is recommended. This antibiotic provides broad-spectrum coverage, which is crucial in managing infections resistant to standard treatments.