Table 4: These are the preventive antibiotic choices that are currently recommended by the Surgical Care Improvement Project. The advantages and disadvantages are the authors opinion.

Drug choice (dose)AdvantagesDisadvantages

Cefoxitin (1 g)Low toxicity cephalosporin with many years of use for prophylaxis; aerobic and anaerobic coverage.Short biological elimination half-life (45 min); concerns about gram negative resistance.
Cefotetan (1 g)Low toxicity cephalosporin with many years of use for prophylaxis; aerobic and anaerobic coverage. Long biological elimination half-life (4 hr)Concerns about gram negative resistance.
Ampicillin/sulbactam
(1.5–3.0 g)
Extensively used penicillin with a beta-lactamase inhibitor; good anaerobic coverage.Short biological elimination half-life (1 hr); emerging E. coli resistance in up to 40% of isolates.
Ertapenem (1 g)Extended gram negative coverage (not Pseudomonas spp.); long biological elimination half-life (3.5 hr).Expense.
Cefazolin (1 g) and metronidazole (500 mg)Good bacteriological coverage of anticipated pathogens Limited clinical data to show effectiveness in elective colon surgery
Cefuroxime (500 mg) and metronidazole (500 mg)Good bacteriological coverage of anticipated pathogensLimited clinical data to show effectiveness in elective colon surgery
Aminoglycoside (gentamicin or tobramycin; 1 mg/kg) and clindamycin (300–600 mg)A good choice for patients needing extended gram negative coverage (e.g., nursing home patients)Unpredictable aminoglycoside pharmacology.
Quinolone (ciprofloxacin; 500–750 mg, or levofloxacin; 500–750 mg) and clindamycin (300–600 mg)Comprehensive antimicrobial coverage of anticipated pathogens.Limited data to validate use for prophylaxis in elective colon surgery
Aztreonam (1 g) and clindamycin (300–600 mg)Good antimicrobial coverage of anticipated pathogens. Aztreonam has no gram positive coverage and should not be used with metronidazole
Aminoglycoside (gentamicin or tobramycin; 1 mg/kg) and metronidazole (500 mg)A good choice for patients needing extended gram negative coverage (e.g., nursing home patients)Unpredictable aminoglycoside pharmacology.
Quinolone (ciprofloxacin; 500–750 mg, or levofloxacin; 500–750 mg) and metronidazole (500 mg)