Iowa Head and Neck Protocols

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Heartland Regional Chapter of SOHN

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The Department of Otolaryngology and the University of Iowa wish to acknowledge the support of those who share our goal in improving the care of patients we serve. The University of Iowa appreciates that supporting benefactors recognize the University of Iowa's need for autonomy in the development of the content of the Iowa Head and Neck Protocols.

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 OTOLOGY ANTIBIOTIC ADMINISTRATION GUIDELINES

return to: Otology - Neurotology

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