Table 2.

Common Agents in Surgical Antibiotic Prophylaxis and Possible Alternatives for Consideration

Antibiotic	Antibiotic Class	Bacterial Coverage	Role in Surgical Antibiotic Prophylaxis
Common agents used in surgical antibiotic prophylaxis
Cefazolin	β-lactam	Gram-positive ++	Gram-positive and limited Gram-negative cover. Common for many surgical procedures
		Gram-negative +
		Anaerobes +
Clindamycin	Lincosamide	Gram-positive ++	Gram-positive cover, typically reserved for patients with immediate hypersensitivity to β-lactam antibiotics
		Gram-negative -
		Anaerobes ++
Gentamicin	Aminoglycoside	Gram-positive -	Gram-negative cover, commonly used in urological and gastrointestinal surgery
		Gram-negative +++
		Anaerobes -
Vancomycin	Glycopeptide	Gram-positive +++	Gram-positive cover, typically reserved for patients with immediate hypersensitivity to β-lactam antibiotics or patients with MRSA
		Gram-negative -
		Anaerobes ++
Alternative agents for consideration as surgical antibiotic prophylaxis in antibiotic resistance*
Meropenem/Ertapenem	Carbapenem	Gram-positive ++	Consider for ESBL producers and sensitivity to carbapenems. Avoid in suspected immediate hypersensitivity to β-lactams
		Gram-negative +++
		Anaerobes ++
Fosfomycin	Oxazolidinone	Gram-positive +	Consider for transrectal prostate biopsy in patients complicated with or suspected fluoroquinolone resistant bacteria (mostly E. coli)
		Gram-negative ++
		Anaerobes -
Daptomycin	Cyclic lipopeptide	Gram-positive +++	Consider for VRE. Could also be considered for MRSA where vancomycin or teicoplanin contraindicated
		Gram-negative -
		Anaerobes +
Linezolid	Oxazolidinone	Gram-positive +++	Consider for VRE. Could also be considered for MRSA where vancomycin or teicoplanin contraindicated
		Gram-negative -
		Anaerobes +
Tigecycline	Glycylcycline	Gram-positive ++	Consider for cover of VRE and MRSA where vancomycin, daptomycin and/or linezolid are contraindicated. Avoid in suspected hypersensitivity to tetracyclines
		Gram-negative ++
		Anaerobes ++

Notes: Table 2 shows examples of common agents used in surgical antibiotic prophylaxis and examples of alternatives that could be considered in resistant bacteria based on their underlying spectrum of activity. Definitions, +++Indicates high degree of antibiotic activity, ++Indicates moderate degree of antibiotic activity, +Indicates low degree of antibiotic activity, -Indicates minimal to no antibiotic activity, *There is limited evidence comparing the efficacy of surgical antibiotic prophylaxis with alternative agents for resistant bacteria, unnecessary use may potentiate resistance and judicious selection is recommended in conjunction with infectious diseases/medical microbiology guidance.

Abbreviations: MRSA, methicillin-resistant S. aureus; ESBL producers, extended-spectrum β-lactamase-producing bacteria; VRE, vancomycin-resistant Enterococcus.