CD Abx Decision Support

CD ANTIBIOTIC SCREENING QUESTIONS

Patient Weight

* must provide value

< 120 kg

≥ 120 kg

reset

Patient has severe penicillin allergy (i.e., anaphylaxis) and/or any allergy to cephalosporin antibiotics.

* must provide value

Yes

reset

Patient with known MRSA colonization.

* must provide value

Yes

reset

Clinical concern for chorioamnionitis?

* must provide value

Yes

reset

In labor and/or with ruptured membranes?

* must provide value

Yes

reset

Patient is GBS+ or unknown GBS status AND has been receiving prophylaxis?

* must provide value

Yes

reset

Antibiotic used for GBS prophylaxis

* must provide value

Ampicillin

Cefazolin

reset

Antibiotic used for GBS prophylaxis

* must provide value

Clindamycin

Vancomycin

reset

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Azithromycin 500 mg IV

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

Administer the following prior to skin incision:
Cefazolin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision cefazolin regardless of timing of last GBS prophylaxis dose

***GBS prophylaxis dose is smaller than standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Vancomycin

< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Azithromycin 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Azithromycin 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision cefazolin regardless of timing of last GBS prophylaxis dose

***GBS prophylaxis dose is smaller than standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin

< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision cefazolin regardless of timing of last GBS prophylaxis dose

***GBS prophylaxis dose is smaller than standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin

< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Vancomycin
< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Vancomycin
< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision cefazolin regardless of timing of last GBS prophylaxis dose

***GBS prophylaxis dose is smaller than standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin
< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin
< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision cefazolin regardless of timing of last GBS prophylaxis dose

***GBS prophylaxis does is smaller than standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1 g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 2 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Azithromycin 500 mg IV

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

Administer the following prior to skin incision:
Cefazolin 3 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 3 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision cefazolin regardless of timing of last GBS prophylaxis dose

***GBS prophylaxis dose is smaller than standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Vancomycin 2 g IV

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Azithromycin 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin 2g IV

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision cefazolin regardless of timing of last GBS prophylaxis dose

***GBS prophylaxis dose is smaller than standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin 2g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Azithromycin 500 mg IV

PLUS

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Cefazolin 3 g IV

PLUS

Metronidazole 500 mg IV

PLUS

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Azithromycin 500 mg IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision clindamycin only if it has been at least 6 hours after last dose

***GBS prophylaxis dose is same as standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:

Gentamicin 160 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Azithromycin 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision clindamycin only if it has been at least 6 hours after last dose

***GBS prophylaxis dose is same as standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Azithromycin 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision clindamycin only if it has been at least 6 hours after last dose

***GBS prophylaxis dose is same as standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision clindamycin only if it has been at least 6 hours after last dose

***GBS prophylaxis dose is same as standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 160 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin
< 80 kg: 1g IV
80 - 99 kg: 1.25 g IV
100 - < 120 kg: 1.5 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Azithromycin 500 mg IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.
Give pre-incision clindamycin only if it has been at least 6 hours after last dose

***GBS prophylaxis dose is same as standard pre-incision prophylaxis abx***

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

Note: Once receiving pre-incision antibiotics, GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Vancomycin 2 g IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Azithromycin 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin 2 g IV

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Administer the following prior to skin incision:
Clindamycin 900 mg IV

PLUS

Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Azithromycin 500 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

Administer the following prior to skin incision:
Gentamicin 240 mg IV

PLUS

Metronidazole 500 mg IV

PLUS

Vancomycin 2 g IV

Note: Once receiving pre-incision antibiotics GBS prophylaxis can be discontinued.

REDOSE cefazolin q4hr during procedure or if QBL >1500 mL
Azithromycin, metronidazole, and vancomycin (for pre-incision ppx) do not require redosing
For chorio patients: REDOSE antibiotics if due for chorio treatment while intra-op

REDOSE clindamycin q6hr during procedure or if QBL >1500 mL
Azithromycin, metronidazole, and vancomycin (for pre-incision ppx) do not require redosing
For chorio pts: REDOSE antibiotics if due for chorio treatment while intra-op

Full algorithm is available here:

Attachment:CD PPX Abx Algorithm_3.22.24.pdf

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