제 6장. 비뇨기계 항생제 사용법 편집하기 (부분)

=예방적 항생제의 사용=

Recommended Antimicrobial Prophylaxis for Urologic Procedures (AUA guidelines 2008)
{| class="wikitable"
!Procedure
!Organisms
!Prophylaxis Indicated
!Antimicrobial(s) of Choice
!Alternative Antimicrobial(s)
!Duration of Therapy*
|-
| colspan="6" |Lower Tract Instrumentation
|-
|Removal of external urinary catheter
|GU tract† 
|If risk factors‡,§
|
* Fluoroquinolone 
* TMP-SMX
|
* Aminoglycoside (Aztreonam￥) ± Ampicillin 
* 1st/2nd gen. Cephalosporin 
* Amoxacillin/Clavulanate
|≤24hours
|-
|Cystography, urodynamic study, or simple cystourethroscopy
|GU tract
|t If risk factors§
|
* Fluoroquinolone 
* TMP-SMX
|
* Aminoglycoside (Aztreonam￥) ± Ampicillin 
* 1st/2nd gen. Cephalosporin 
* Amoxacillin/ Clavulanate
|≤24hours
|-
|Cystourethroscopy with manipulation 
|GU tract
|All
|
* Fluoroquinolone
* TMP-SMX
|
* Aminoglycoside (Aztreonam￥) ± Ampicillin
* 1st/2nd gen. Cephalosporin
* Amoxacillin/ Clavulanate
|≤24hours
|-
|Prostate brachytherapy or cryotherapy
|Skin
|Uncertain
|
* 1st gen. Cephalosporin
|
* Clindamycin**
|≤24hours
|-
|Transrectal prostate biopsy
|Intestine†† 
|All
|
* Fluoroquinolone 
* 1st/2nd/3rd gen. Cephalosporin
|
* Aminoglycoside (Aztreonam￥)+ Metronidazole or Clindamycin**
|≤24hours
|-
| colspan="6" |'''Upper Tract Instrumentation'''
|-
|Shock-wave lithotripsy
|GU tract 
|All
|
* Fluoroquinolone 
* TMP-SMX 
|
* Aminoglycoside (Aztreonam￥) ± Ampicillin 
* 1st/2nd gen. Cephalosporin 
* Amoxacillin/ Clavulanate
|≤24hours
|-
|Percutaneous renal surgery
|GU tract and skin‡‡ 
|All 
|
* 1st/2nd gen. Cephalosporin
* Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin
|
* Ampicillin/Sulbactam 
* Fluoroquinolone
|≤24hours
|-
|Ureteroscopy
|GU Tract
|All
|
* Fluoroquinolone
* TMP-SMX 
|
* Aminoglycoside (Aztreonam￥) ± Ampicillin 
* 1st/2nd gen. Cephalosporin 
* Amoxacillin/Clavulanate
|≤24hours
|-
| colspan="6" |'''Open or Laparoscopic Surgery'''
|-
|Vaginal surgery (includes urethral sling procedures)
|GU tract, skin and Grp B Strep
|All
|
* 1st/2nd gen. Cephalosporin
* Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin
|
* Ampicillin/Sulbactam
* Fluoroquinolone
|≤24hours
|-
|Without entering urinary tract
|Skin
|If risk actors
|
* 1st gen. Cephalosporin
|
* Clindamycin
|Single dose
|-
|Involving entry into urinary tract
|GU tract and skin 
|All
|
* 1st/2nd gen. Cephalosporin
* Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin
|
* Ampicillin/Sulbactam
* Fluoroquinolone
|≤24hours
|-
|Involving intestine §§
|GU tract, skin and intestine
|All
|
* 2nd/3rd gen. Cephalosporin 
* Aminoglycoside (Aztreonam￥) + Metronidazole or Clindamycin
|
* Ampicillin/Sulbactam 
* Ticarcillin/Clavulanate 
* Pipercillin/Tazobactam
* Fluoroquinolone
|≤24hours
|-
|Involving implanted prosthesis
|GU tract and skin
|All
|
* Aminoglycoside (Aztreonam ￥)+1st/2nd gen. Cephalosporin or Vancomycin
|
* Ampicillin/Sulbactam
* Ticarcillin/Clavulanate 
* Pipercillin/Tazobactam
|≤24hours
|}
Order of agents in each column is not indicative of preference. The absence of an agent does not preclude its appropriate use depending on specific situations.
{| class="wikitable"
|Key: gen, generation; Grp, group; GU, genitourinary; TMPSMX, trimethoprimsulfamethoxazole. * Additional antimicrobial therapy may be recommended at the time of removal of an externalized urinary catheter. † GU tract: Common urinary tract organisms are E. coli, Proteus sp., Klebsiella sp., Enterococcus. ‡ See “Patientrelated factors affecting host respo ¶nse to surgical infections.” If urine culture shows no growth prior to the procedure, antimicrobial prophylaxis is not necessary.
|Or full course of culture-directed antimicrobials for documented infection (which is treatment, not prophylaxis). ￥Aztreonam can be substituted for aminoglycosides in patients with renal insufficiency. _ Includes transurethral resection of bladder tumor and prostate, and any biopsy, resection, fulguration, foreign body removal, urethral dilation or urethrotomy, or ureteral instrumentation including catheterization or stent placement/removal. **Clindamycin, or aminoglycoside+ metronidazole or clindamycin, are general alternatives to penicillins and cephalosporins in patients with penicillin allergy, even when not specifically listed.
|†† Intestine: Common intestinal organisms are E. coli, Klebsiella sp., Enterobacter, Serratia sp., Proteus sp., Enterococcus, and Anaerobes. ‡‡ Skin: Common skin organisms are S. aureus, coagulase negative Staph. sp., Group A Strep. sp. For surgery involving the colon, bowel preparation with oral neomycin plus either erythromycin base or metronidazole can be added to or substituted for systemic agents. Copyright ⓒ 2008 American Urological Association Education and Research, Inc.Ⓡ Revised July 31, 2008
|}