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OTOLOGY ANTIBIOTIC ADMINISTRATION GUIDELINES

last modified on: Tue, 04/09/2024 - 09:28

return to: Otology - Neurotology

Note: last updated before 2010

Canal Wall Reconstruction Tympanomastoidectomy

  • Adults
    • Zosyn and cipro IV before incision and for 48 hours postoperatively.
    • Discharge on Levaquin or Cipro PO X 2 wk.
  • Children
    • Zosyn IV before incision and for 48 hours postoperatively.
    • Discharge on Augmentin PO X 2 wk.
  • Penicillin allergic adults
    • Clindamycin and cipro IV before incision and for 48 hours postoperatively.
    • Discharge on Levaquin or Cipro PO X 2wk.
  • Penicillin allergic children
    • Clindamycin IV before incision and for 48 hours postoperatively.
    • Discharge on Zithromax PO X 2wk.
  • Antibiotic drops (MH-Ciprodex, BG-Floxin) used BID starting after packing/suture removal at one week in ROD clinic and continuing until follow-up visit with attending at one month.
  • Bacitracin to incision BID starting after dressing removed.

All Other Otology/Neurotology Procedures in Main OR

  • Perioperative
    • Adults and children- Cefazolin IV and Decadron before incision.
    • Penicillin allergic - Clindamycin IV and Decadron before incision.
  • Postoperative
    • Cochlear implant and BAHA patients
    • Keflex PO for one week postoperatively.
    • Clindamycin PO if penicillin allergic.
  • All other otology procedures aside from CWR, CI and BAHA
    • No postoperative oral antibiotics – (this includes skull base procedures).
  • Stapes and any cases with inner ear fistula
    • fluoroquinolone drops BID until follow-up appointment with attending at one month.
  • Transcanal procedures
    • antibiotic drops (fluoroquinolone) BID until follow-up appointment with attending at one month.
  • Endaural and Canal Wall Down procedures
    • packing/suture removal in ROD clinic at one week then antibiotic drops (fluoroquinolone) BID until follow-up appointment with attending at one month.
    • Bacitracin to endaural and postauricular incisions BID starting after dressing removal.

Typical Dosages-assuming normal renal function

  • Amoxicillin/Clavulanate (Augmentin)
    • Adults: 875 mg PO BID
    • Pediatric: 45 mg/kg/day divided BID in children
  • Cefazolin (Ancef)
    • Adults: 2 g OCTOR, then 1g IV Q 8h
    • Pediatric: 30 mg/kg OCTOR then 10-15 mg/kg/dose IVQ 8h
  • Cephalexin (Keflex)
    • Adults: 500 mg PO QID
    • Pediatric 25-50 mg/kg/day PO divided TID/QID
  • Clindamycin (Cleocin)
    • Adult: 900 mg IV OCTOR, then 300 mg IV/PO Q 6h
    • Pediatric: 2-5 mg/kg/dose PO Q 6h
  • Dexamethasone (Decadron)
    • Adult: 10 mg OCTOR
    • Pediatric: 0.25 mg/kg OCTOR
  • Levofloxacin (Levaquin)
    • Adult: 500 mg IV/PO Q day
    • not for use in children
  • Pipercillin/Tazobactam (Zosyn)
    • Adult: 3.375g IV OCTOR and then q 6h
    • Pediatric: 80mg/kg/dose IV OCTOR and then q6-8h
  • Ciprofloxacin
    • 400 mg IV OCTOR and BID
    • 500 mg PO BID
    • Not for use in children

Protocol compiled 3/4/2007 – SG. Reviewed, approved by MH, BG 3/7/07. Revised 5/22/07-SG, 12/30/09-EW