Surgical Prophylaxis - Biliary Surgery

Open/Laparoscopic Cholecystectomy

Antibiotic prophylaxis may not be required in low risk patients* undergoing laparoscopic biliary surgery but should still be considered.

*Low risk patient if all the following criteria apply:

  • ASA 1-2
  • Out-patient care prior to surgery
  • No previous biliary intervention
  • No history of common bile duct stones
  • No cholangiogram planned
  • No recent infection

All other patients undergoing laparoscopic biliary surgery who are not categorised as low risk should be offered antibiotic prophylaxis as for open biliary surgery.

 

Antibiotics should be given as soon as possible if:

  • Conversion from laparoscopic cholecystectomy (and no pre-operative antibiotic prophylaxis was given)
  • Intraoperative findings indicate a high risk procedure (and no pre-operative antibiotic prophylaxis was given)

GENTAMICIN 3mg/kg (maximum dose 300mg) (dose table for Ideal Body Weight)

If CrCl <21 then maximum dose 180mg

plus

METRONIDAZOLE 500mg

plus

AMOXICILLIN 1g

 

 

 

}

 

 

 

 

 

IV single dose only at induction

  

 

If current / previous MRSA positive:

OR

If penicillin allergy (explanatory notes) use:

 

GENTAMICIN 3mg/kg (maximum dose 300mg) (dose table for Ideal Body Weight

If CrCl <21 then maximum dose 180mg

plus

METRONIDAZOLE 500mg

plus

TEICOPLANIN

Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

} IV single dose only at induction

 

ERCP/Biliary Cannulation

If ongoing biliary sepsis see treatment section.

Note: routine prophylaxis not indicated provided adequate biliary decompression can be achieved.

 

Prophylaxis indications:

  • profound immunosuppression
  • pancreatic pseudocyst
  • certain biliary disorders e.g. primary sclerosing cholangitis, hilar cholangiocarcinoma

CIPROFLOXACIN 750mg

 

If current / previous MRSA positive:

ADD
TEICOPLANIN

Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

 

 

 

}

 

 

 

 

Oral - 1 to 2 hours before procedure

 

 

 

IV single dose only at induction

 

 

 

 

 

OR

If CIPROFLOXACIN contraindicated, use:

 

GENTAMICIN 3mg/kg (maximum dose 300mg) (dose table for Ideal Body Weight)

If CrCl <21 then maximum dose 180mg

 

If current / previous MRSA positive:

ADD

TEICOPLANIN

Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

 } IV single dose only at induction

 Last reviewed 31/11/16

For guidance on the administration of intravenous antibiotics click here
(GHNHSFT intranet)