Vancomycin Use in TURP Surgery

Primary Antibiotic Recommendations

The Canadian Urological Association recommends prophylaxis before TURP with an antibiotic chosen based on local epidemiology among uropathogens 1
Cefazolin, cefamandole, or cefuroxime are the first-choice antibiotics for prophylaxis in urological procedures including TURP, based on local uropathogen epidemiology 1, 2
Antibiotic prophylaxis should be limited to the operative period, sometimes 24 hours and exceptionally to 48 hours 3

Vancomycin should be used in patients with life-threatening allergies to beta-lactam antibiotics 4, 5, 6
Vancomycin should be used at institutions with high rates of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-resistant S. epidermidis 4, 5, 7
Vancomycin should be used in cases of known or suspected colonization with MRSA 3
Vancomycin should be used in cases of recent antibiotic therapy that may increase risk of resistant organisms 3
Vancomycin should be used in cases of reoperation in a patient hospitalized in a unit with MRSA ecology 3

Vancomycin should be administered at a dose of 30 mg/kg over 120 minutes 3
Infusion should be completed before the beginning of the procedure, ideally 30 minutes before incision 3
A single dose is sufficient unless the procedure lasts longer than 6 hours, in which case the dose should be repeated 4, 5
Prophylaxis should be discontinued after a maximum of two doses 4, 5

Routine use of vancomycin for surgical prophylaxis is discouraged due to concerns about promoting vancomycin resistance 4, 5, 6