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OR trimethoprim-sulfamethoxazole One 160/800 mg (double strength, DS) tablet orally Cystoscopy with manipulation or upper tract instrumentation ◊ Enteric gram-negative bacilli, enterococci Ciprofloxacin Δ 500 mg orally or 400 mg IV

OR trimethoprim-sulfamethoxazole One 160/800 mg (double strength, DS) tablet orally Open or laparoscopic surgery § Enteric gram-negative bacilli, enterococci Cefazolin ¥ <80 kg: 1 g IV ≥80 kg: 2 g IV * Parenteral prophylactic antimicrobials can be given as a single IV dose begun within 60 minutes before the procedure. For prolonged procedures (>3 hours) or those with major blood loss, or in patients with extensive burns, additional intraoperative doses should be given at intervals one to two times the half-life of the drug (ampicillin-sulbactam every 2 hours, cefazolin every 4 hours, cefuroxime every 4 hours, cefoxitin every 2 hours, clindamycin every 6 hours, vancomycin every 12 hours) for the duration of the procedure in patients with normal renal function. If vancomycin or a fluoroquinolone is used, the infusion should be started within 60 to 120 minutes before the initial incision to have adequate tissue levels at the time of incision and to minimize the possibility of an infusion reaction close to the time of induction of anesthesia. • Urine culture positive or unavailable, preoperative catheter, transrectal prostatic biopsy, or placement of prosthetic material. Δ Due to increasing resistance of E. coli to fluoroquinolones and ampicillin-sulbactam, local sensitivity profiles should be reviewed prior to use. ◊ Shock wave lithotripsy, ureteroscopy. § Including percutaneous renal surgery, procedures with entry into the urinary tract, and those involving implantation of a prosthesis. If manipulation of bowel is involved, prophylaxis is given according to colorectal guidelines. ¥ For patients allergic to penicillins and cephalosporins, clindamycin or vancomycin with either gentamicin, ciprofloxacin, levofloxacin, or aztreonam is a reasonable alternative. Fluoroquinolones should not be used for prophylaxis in cesarean section. Reprinted with special permission from: Treatment Guidelines from The Medical Letter, October 2012; Vol. 10 (122):73. www.medicalletter.org .