- Single dose, IV prophylaxis up to 60 minutes prior to skin incision/ intervention.
- Single dose, oral ciprofloxacin 1 hour prior to procedure.
See table below for choice of antibiotic
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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.
Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.
If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.
See table below for choice of antibiotic
decolonise prior to procedure as per NHS GGC infection control guidelines and discuss with microbiology re antibiotic choice.
If identified as Carbapenamase producing Enterobacterales carriers contact microbiology.
see BNF warning re the restrictions and precautions for use, due to very rare reports of disabling and potentially long-lasting or irreversible side effects of quinolones. If high C. difficile risk (e.g. previous C. difficile infection, Age >65 AND ≥ 1 of: frailty, severe underlying disease, prolonged hospital stay, extensive prior antibiotic exposure) avoid ciprofloxacin and discuss alternative with microbiology.
ALWAYS review previous microbiology results- Ensure that prophylaxis covers recent urinary tract isolates etc.
If patient colonised or infected with resistant pathogens please contact on-call Microbiologist for further guidance.
Procedure | Recommended antibiotic/comment |
Endo-Urological procedure: Endoscopic ureteric stone fragmentation/ removal Ureteric Stent insertion/change TURP |
IV Gentamicin*# OR ^Ciprofloxacin 750mg orally 1 hr prior to procedure |
TURBT Cystoscopy, Urodynamic examination Cystoscopic Stent removal Urethral Catheter Change |
Not routinely recommended For TURBT if patient is considered high risk (based on burden of tumour, i.e. size, necrosis) consider IV Gentamicin*# |
Percutaneous procedure: Percutaneous nephrolithotomy (PCNL) Extracorporeal shock wave lithotripsy (ESWL) Removal of |
IV Gentamicin*# OR ^Ciprofloxacin 750 mg orally 1 hr prior to procedure |
Open, laparoscopic & robotic assisted operations): Open operation or laparoscopic surgery involving opening the urinary tract with bowel segments: Prostatectomy Cystectomy |
IV Amoxicillin 1 g + IV Metronidazole 500 mg + IV Gentamicin*# If true penicillin/ beta-lactam allergy Replace IV Amoxicillin with IV Teicoplanin~ 800 mg |
Clean, open operation or laparoscopic surgery: Nephrectomy/Partial Neprectomy Retroperitoneal lymph node dissection Nephroureterectomy Pyleoplasty |
IV Cefuroxime 1.5 g If true penicillin/ beta-lactam allergy or MRSA risk: IV Teicoplanin 800 mg |
Other procedures: Urethroplasty (with or without free flap, buccal mucosal graft) |
IV Co-amoxiclav 1.2 g + IV Gentamicin*# If true penicillin/ beta-lactam allergy or high MRSA risk replace IV Co-amoxiclav with IV Teicoplanin 800 mg + IV Metronidazole 500 mg |
Other procedures: Implantation of prosthetic device Penile amputation/glans resurfacing with or without lymph node dissection |
IV Flucloxacillin 2 g + IV Gentamicin*# If true penicillin/ beta-lactam allergy or high MRSA risk Replace IV Flucloxacillin with IV Teicoplanin 800 mg |
Transrectal prostate biopsy | IV Gentamicin*# OR ^Ciprofloxacin 750 mg orally 1 hr prior to procedure |