From the FDA Drug Label
To prevent postoperative infection in contaminated or potentially contaminated surgery, recommended doses are: 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery. For lengthy operative procedures (e.g., 2 hours or more), 500 mg to 1 gram IV or IM during surgery (administration modified depending on the duration of the operative procedure). 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours postoperatively
Prophylactic Antibiotics for Abdominal Procedure after TAVR:
- The recommended dose of cefazolin for prophylactic use in abdominal procedures is 1 gram IV or IM administered 1/2 hour to 1 hour prior to the start of surgery.
- For lengthy operative procedures, an additional dose of 500 mg to 1 gram IV or IM may be administered during surgery.
- Postoperative doses of 500 mg to 1 gram IV or IM every 6 to 8 hours for 24 hours may be given to prevent infection 1.
From the Research
Prophylactic antibiotics are generally recommended for patients undergoing abdominal procedures after TAVR, with cefazolin being the preferred choice, even in patients with a reported beta-lactam allergy, as recent evidence suggests its safety and effectiveness in preventing surgical site infections. For most abdominal procedures following TAVR, a single dose of cefazolin 2g IV (or 3g for patients >120kg) administered within 60 minutes before the procedure is appropriate 2. The use of cefazolin in patients labeled as beta-lactam allergic is supported by a recent study that found fewer surgical site infections in the cefazolin group compared to those receiving clindamycin and/or vancomycin, without an increase in interoperative hypersensitivity reactions 2. Some key points to consider include:
- The timing of the abdominal procedure relative to TAVR, with antibiotic prophylaxis being more strongly considered if within 6 months of valve placement due to incomplete endothelialization of the prosthesis during this period.
- The importance of assessing the patient's allergy history and considering the use of cefazolin, as many reported beta-lactam allergies may not be true allergies 3.
- The potential for broader coverage with antibiotics such as piperacillin-tazobactam or cefoxitin for abdominal procedures with high risk of enteric contamination.
- The duration of antibiotic prophylaxis should be limited to the perioperative period, with additional doses only if the procedure exceeds two half-lives of the antibiotic or if significant blood loss occurs. Overall, the goal of prophylactic antibiotic use in this context is to prevent procedure-related infections and infective endocarditis, while minimizing the risk of adverse reactions and promoting the best possible outcomes for patients undergoing abdominal procedures after TAVR 4, 5.