GENTAMICIN 2mg/kg

(up to a maximum of 240mg)

plus

METRONIDAZOLE 500mg

with or without

AMOXICILLIN 1g

Amoxicillin not usually required for colorectal surgery

Avoid amoxicillin in penicillin allergy (explanatory notes). If amoxicillin indicated, use alternative of:

TEICOPLANIN 600mg

with gentamicin and metronidazole as above

If current / previous MRSA positive

ADD

TEICOPLANIN 600mg

}

IV single dose 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 chlongiocarcinoma

CIPROFLOXACIN 750mg

If current / previous MRSA positive:

ADD

TEICOPLANIN 600mg

}

Oral - 1 to 2 hours before procedure

OR

If CIPROFLOXACIN contraindicated, use:

GENTAMICIN 2mg/kg

(up to a maximum of 240mg)

If current / previous MRSA positive:

ADD

TEICOPLANIN 600mg

GENTAMICIN 2mg/kg

(up to a maximum of 240mg)

plus

METRONIDAZOLE 500mg

plus

AMOXICILLIN 1g

If current / previous MRSA positive:

ADD

TEICOPLANIN 600mg

}

IV single dose only at induction

OR

If penicillin allergy (explanatory notes), use:

CLINDAMYCIN 600mg

plus

GENTAMICIN 2mg/kg

(up to a maximum of 240mg)

If current / previous MRSA positive:

ADD

TEICOPLANIN 600mg

CO-AMOXICLAV 1.2g

}

IV single dose only at induction

OR

If penicillin allergy (explanatory notes) or if current / previous MRSA positive, use:

TEICOPLANIN 600mg

plus

GENTAMICIN 2mg/kg

(up to a maximum of 240mg)