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