From the FDA Drug Label
The preoperative administration of a single 1 gram dose of Ceftriaxone for Injection may reduce the incidence of postoperative infections in patients undergoing surgical procedures classified as contaminated or potentially contaminated (e.g., vaginal or abdominal hysterectomy or cholecystectomy for chronic calculous cholecystitis in high-risk patients, such as those over 70 years of age, with acute cholecystitis not requiring therapeutic antimicrobials, obstructive jaundice or common duct bile stones)
The patient has already received Metronidazole (Flagyl), which is often used in combination with other antibiotics for the treatment of intra-abdominal infections. Given that the patient is undergoing surgery for acute cholecystitis, the use of Ceftriaxone as a preoperative antibiotic is supported by the label.
- The recommended dose for surgical prophylaxis is a single 1 gram dose of Ceftriaxone.
- This dose provides protection from most infections due to susceptible organisms throughout the course of the procedure 1.
From the Research
For a patient with acute cholecystitis who has already received ceftriaxone and metronidazole (Flagyl) on the day of surgery, no additional preoperative antibiotics are needed if the doses were administered within the appropriate timeframe (typically within 60 minutes before surgical incision). The combination of ceftriaxone and metronidazole provides adequate coverage against the common pathogens involved in biliary infections, including gram-negative organisms (especially Escherichia coli) and anaerobes, as supported by the most recent guidelines 2. If more than 24 hours have elapsed since the last dose, or if the surgical procedure is prolonged (>4 hours), consider redosing with ceftriaxone (1-2g IV) to maintain adequate tissue concentrations and prevent surgical site infections, as suggested by updates on antibiotic regimens in acute cholecystitis 3. Some key points to consider in the management of acute cholecystitis include:
- The use of empirical antibiotics to prevent infectious morbidities following cholecystectomy, with first-generation cephalosporins being a suitable option for mild-to-moderate cases 4
- The importance of achieving adequate tissue concentrations of antibiotics at the time of incision to prevent surgical site infections 2
- The need for a full therapeutic course of antibiotics (typically 4-7 days total) to treat the underlying infection, depending on the clinical response and source control achieved during surgery 3
- Alternative regimens for patients with beta-lactam allergies, such as fluoroquinolones plus metronidazole, or aztreonam plus metronidazole 5.