High risk
- Head and neck cancer
- Radical/bilateral neck dissection
- Reconstructive surgery with myocutaneoous flaps or microvascular free flaps
- Mandibular surgery if tobacco/alcohol/illicit drug use
Common Pathogens
S. aureus
Streptococcus spp
Oral anaerobes
Enterobacteriaceae
| Regimen(s) of Choice See General Principles and Pre-Op Antibiotic Administration and Intraoperative Antibiotic Administration | ||
|---|---|---|
| [Cefazolin | 2g IV | x 1 pre-op dose |
| + | ||
| Metronidazole] | 500mg IV | x 1 pre-op dose |
| +/- | ||
| [Cefazolin | 2g IV q8h | x 24h post-op |
| + | ||
| Metronidazole] | 500mg IV q12h | x 24h post-op |
| Alternative Regimens if allergy to cefazolin, or severe non-IgE-mediated reaction to any β-lactam (interstitial nephritis, hepatitis, hemolytic anemia, serum sickness, severe cutaneous reactions [e.g. SJS, TEN, DRESS]) | ||
|---|---|---|
Note: Limited evidence for this regimen; recommendation based on poor outcomes with clindamycin prophylaxis. | ||
| [Levofloxacin | 500mg IV | x 1 pre-op dose |
| + | ||
| Metronidazole] | 500mg IV | x 1 pre-op dose |
| +/- | ||
| [Levofloxacin | 500mg IV | once post-op |
| + | ||
| Metronidazole] | 500mg IV q12h | x 24h post-op |