□ IR Prophylactic Antibiotics
All
No Antibiotics
High Risk
Biliary
Embolization
□ Ablation (Solid organ tumor)
▼
□ Recommended Antibiotic:
Cefazolin
Ceftriaxone if history of instrumented liver
Ceftriaxone if history of instrumented liver
⚠️ β-Lactam Allergy Alternative:
Clindamycin
Levofloxacin if history of instrumented liver
Levofloxacin if history of instrumented liver
❄️ Cryoablation (FAVA/soft tissue)
▼
□ Recommended Antibiotic:
None required
□ Abscess Drainage
▼
□ Recommended Antibiotic:
Abdomen: Zosyn OR Metronidazole + Ciprofloxacin
Chest: Ampicillin-Sulbactam (Unasyn)
Chest: Ampicillin-Sulbactam (Unasyn)
⚠️ β-Lactam Allergy Alternative:
Abdomen: Ciprofloxacin + Metronidazole
Chest: Levofloxacin + Metronidazole
Chest: Levofloxacin + Metronidazole
□ Angiography/Angioplasty/Stents
▼
□ Recommended Antibiotic:
None required
□ Biliary Procedures (Routine)
▼
□ Recommended Antibiotic:
Ceftriaxone
⚠️ β-Lactam Allergy Alternative:
Clindamycin + Ciprofloxacin
□ Biliary (Prior anastomosis/instrumentation)
▼
□ Recommended Antibiotic:
Zosyn (Piperacillin-Tazobactam)
⚠️ β-Lactam Allergy Alternative:
Levofloxacin
□ Biopsy
▼
□ Recommended Antibiotic:
None
Ciprofloxacin if prostate (transrectal approach)
Ciprofloxacin if prostate (transrectal approach)
⚠️ β-Lactam Allergy Alternative:
N/A
Ciprofloxacin for prostate
Ciprofloxacin for prostate
□ Bone (Ablation, sclerotherapy)
▼
□ Recommended Antibiotic:
None required
□ Catheter-directed thrombolysis
▼
□ Recommended Antibiotic:
None required
□ CO2 Laser
▼
□ Recommended Antibiotic:
None in most cases
Cefazolin if high risk patient* or treatment site
Cefazolin if high risk patient* or treatment site
⚠️ β-Lactam Allergy Alternative:
Clindamycin
□ Dialysis fistula/graft interventions
▼
□ Recommended Antibiotic:
None required
□ Embolization of artery or vein
▼
□ Recommended Antibiotic:
None required
□ Embolization/Chemoembolization (tumor/organ)
▼
□ Recommended Antibiotic:
Ampicillin-Sulbactam (Unasyn)
Ceftriaxone if renal or splenic
Ceftriaxone if renal or splenic
⚠️ β-Lactam Allergy Alternative:
Clindamycin + Ciprofloxacin +/- Metronidazole
□️ IVC Filter Placement
▼
□ Recommended Antibiotic:
None required
□ Lower extremity venous embolization/laser
▼
□ Recommended Antibiotic:
None required
□ Lower extremity venous ligation/phlebectomy
▼
□ Recommended Antibiotic:
None if low risk patient or treatment site
Cefazolin if high risk patient* or treatment site
Cefazolin if high risk patient* or treatment site
⚠️ β-Lactam Allergy Alternative:
N/A
Clindamycin if high risk
Clindamycin if high risk
□ Lymphangiography
▼
□ Recommended Antibiotic:
None required
□ Lymphangiography with embolization
▼
□ Recommended Antibiotic:
Cefazolin + Metronidazole
⚠️ β-Lactam Allergy Alternative:
Clindamycin + Ciprofloxacin
□ Nephrostogram/tube exchange
▼
□ Recommended Antibiotic:
None if low risk, asymptomatic patient
Ceftriaxone if high risk** or symptomatic patient
Ceftriaxone if high risk** or symptomatic patient
⚠️ β-Lactam Allergy Alternative:
Clindamycin + Ciprofloxacin
□ Nephrostomy/Ureteral Stent Placement
▼
□ Recommended Antibiotic:
Ceftriaxone
⚠️ β-Lactam Allergy Alternative:
Clindamycin + Ciprofloxacin
□ Paracentesis and Thoracentesis
▼
□ Recommended Antibiotic:
None required
□ Partial Splenic Embolization
▼
□ Recommended Antibiotic:
****See dedicated protocol****
⚠️ β-Lactam Allergy Alternative:
****See dedicated protocol****
□ Sclerotherapy
▼
□ Recommended Antibiotic:
None in most cases
Cefazolin if high risk patient* or treatment site
Cefazolin if high risk patient* or treatment site
⚠️ β-Lactam Allergy Alternative:
Clindamycin
□ Sclerotherapy (transoral)***
▼
□ Recommended Antibiotic:
Ampicillin-Sulbactam (Unasyn)
⚠️ β-Lactam Allergy Alternative:
Clindamycin + Ciprofloxacin
□ Venous Access (PICC)
▼
□ Recommended Antibiotic:
None required
□ Venous Access (Port, Tunneled CVC)
▼
□ Recommended Antibiotic:
None if immunocompetent
Cefazolin if immunocompromised
Cefazolin if immunocompromised
⚠️ β-Lactam Allergy Alternative:
Clindamycin
□ Venous Access (PICC/Port)
▼
□ Recommended Antibiotic:
None if immunocompetent
Cefazolin if immunocompromised (Port/CVC)
Cefazolin if immunocompromised (Port/CVC)
⚠️ β-Lactam Allergy Alternative:
Clindamycin
□ Complete Dosing Reference
Ampicillin
Dose:
50 mg/kg
Max dose:
2 g
Redose:
Every 4 hours
Ampicillin-Sulbactam (Unasyn)
Dose:
50 mg/kg
Max dose:
2 g (Ampicillin portion)
Redose:
Every 4 hours
Cefazolin
Dose:
25 mg/kg
Max dose:
2g (<120kg), 3g (≥120kg)
Redose:
Every 4 hours
Ceftriaxone
Dose:
50 mg/kg
Max dose:
2g (1g for SBE)
Redose:
None needed
Ciprofloxacin
Dose:
10 mg/kg
Max dose:
400 mg
Redose:
Every 8 hours
Clindamycin
Dose:
10 mg/kg (7.5 if ≤44wks PMA)
Max dose:
900 mg
Redose:
Every 6 hours
Levofloxacin
Dose:
10 mg/kg
Max dose:
500 mg
Redose:
8 hrs (<5yo); None (≥5yo)
Metronidazole
Dose:
15 mg/kg
Max dose:
500 mg
Redose:
None needed
Piperacillin-Tazobactam (Zosyn)
Dose:
75 mg/kg
Max dose:
3g (Piperacillin portion)
Redose:
Every 4 hours
Vancomycin
Dose:
15 mg/kg (10 if ≤44wks PMA)
Max dose:
1.5 g
Redose:
Every 8 hours
⚠️ Key Points
- Timing: Give within 1 hour of incision (2 hours for Vancomycin/Fluoroquinolones)
- Complete administration before procedure start
- *High Risk Patient (general): immunocompromised, advanced age, diabetes
- **High Risk Urology Patient: bladder dysfunction, indwelling catheter, early manipulation of tube, ureterointestinal anastomosis, bacteriuria, urinary stones
- ***Transoral procedures: Postprocedural Amoxicillin-Clavulanic acid (Augmentin) 250-500mg PO Q8 hrs for 7 days
- PMA: Post-menstrual age
- SBE: Subacute bacterial endocarditis prophylaxis