From the Guidelines
Following a laparoscopic cholecystectomy (lap chole), no antibiotics are routinely prescribed unless there are specific indications such as infection or high risk of infection. Prophylactic antibiotics are typically given only as a single dose before surgery to prevent surgical site infections. According to the most recent and highest quality study 1, the first-choice antibiotics recommended for most procedures were cefazolin (with or without metronidazole) and cefuroxime. However, for laparoscopic cholecystectomy without risk factors, the guidelines suggest no antibiotic prophylaxis (ABP) is needed 1. Post-operative antibiotics are generally unnecessary for uncomplicated laparoscopic cholecystectomy since it is considered a clean-contaminated procedure with low infection risk. Some key points to consider include:
- The type of surgical procedure and probable causative pathogens and their resistance patterns
- Selecting the right antibiotic
- The standard practice follows antimicrobial stewardship principles to prevent antibiotic resistance while ensuring appropriate coverage when genuinely needed
- Antibiotics would only be continued after surgery if complications occur such as bile spillage, conversion to open procedure, or signs of infection. In cases of known or highly suspected allergies, alternative antibiotics such as vancomycin, clindamycin, or the combination of an aminoglycoside (gentamicin) plus clindamycin may be considered 1.
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 surgical prophylactic use, to prevent postoperative infection in contaminated or potentially contaminated colorectal surgery, the recommended dosage schedule for adults is: a 15 mg/kg infused over 30 to 60 minutes and completed approximately one hour before surgery
- Cefazolin and metronidazole were prescribed following lap chole, as they can be used for perioperative prophylactic use to prevent postoperative infection in contaminated or potentially contaminated surgery, such as laparoscopic cholecystectomy (lap chole) 2 3.
From the Research
Antibiotics Prescribed Following Lap Chole
- Cefazolin was prescribed in several studies, including 4, 5, and 6, as a prophylactic antibiotic to reduce surgical site infection in laparoscopic cholecystectomies.
- A second generation cephalosporin and metronidazole were administered in study 7 to high risk patients undergoing laparoscopic cholecystectomy.
- Cephalexin was used as an alternative antibiotic prophylaxis in study 8 during periods of limited cefazolin supply.
- Cefuroxime was compared to cefazolin in study 6 as a prophylactic therapy for high-risk cholecystectomy, with a single 1.5 gram dose of cefuroxime being a potential cost-effective alternative to multiple doses of cefazolin.
Specific Antibiotic Regimens
- 1 g of cefazolin was administered preoperatively in studies 4 and 5.
- A single dose of antibiotics (second generation cephalosporin and metronidazole) was administered on induction to patients with a risk factor present in study 7.
- 0.5 g of cephalexin was administered orally within 2 hours prior to laparoscopic cholecystectomy in study 8.
- A single 1.5 gram dose of cefuroxime was compared to four 1 gram doses of cefazolin in study 6.