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Bleeding risk
Bleeding risk
HIGH bleeding risk
HIGH bleeding risk
INR ≤ 1.8
Plt ≥ 50,000
CBC, INR/PT routinely recommended
Anticoagulant/Antiplatelet Agent
Anticoagulants
Antiplatelets
Antibiotics
Antibiotics
No antibiotic therapy required for low risk patients
High risk patient = colonized urothelium, ileal conduit, indwelling ureteral stent
Severe beta-lactam allergy = hives, anaphylaxis, or DRESS/SJS/TEN to any beta-lactam
High risk patient = Ceftriaxone
Ceftriaxone IV
Adult = 2 g
Peds = 50 mg/kg (max = 1 g)
High risk patient with severe beta-lactam allergy = Vancomycin AND Gentamicin
Vancomycin IV
Adult < 80 kg = 1000 mg
Adult > 80 kg = 1500 mg
Peds = 15 mg/kg (max = 1500 mg)
Gentamicin IV
Adult = 5 mg/kg
Peds = 2.5 mg/kg
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