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OR Quinolone 1.5 mg/kg IV 1g IV 400 mg IV Laparoscopy (diagnostic, tubal sterilization, operative except for hysterectomy) None Abortion, surgical Doxycycline 100 mg orally one hour before procedure and 200 mg orally after procedure Hysterosalpingogram or chromotubation Doxycycline ◊ 100 mg orally twice daily for five days Other transcervical procedures: Hysteroscopy (diagnostic or operative, including hysteroscopic sterilization) Intrauterine device insertion Endometrial biopsy None IV: intravenous. * Common pathogens: enteric gram-negative bacilli, anaerobes, group B streptococcus, enterococci. • Parenteral prophylactic antimicrobials can be given as a single IV dose begun within 60 minutes before the procedure. Δ An alternative regimen should be used in women with history of immediate hypersensitivity to beta-lactam agents. If vancomycin or a fluoroquinolone is used, the infusion should be started within 60 to 120 minutes before the initial incision. Due to increasing resistance of E. coli to fluoroquinolones and ampicillin-sulbactam, local sensitivity profiles should be reviewed prior to use. Metronidazole (500 mg IV) is an acceptable alternative to clindamycin for anaerobic coverage. ◊ Prophylaxis is warranted for patients with history of pelvic inflammatory disease or if the procedure demonstrates dilated fallopian tubes. No prophylaxis is indicated for patients without dilated tubes. Adapted from: Treatment Guidelines from The Medical Letter, October 2012; Vol. 10 (122):73. www.medicalletter.org. ACOG Committee on Practice Bulletins--Gynecology. ACOG practice bulletin No. 104: antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113:1180. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.