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Antibiotic Therapy for Urodynamics Testing – Adult – Ambulatory [19]

Antibiotic Therapy for Urodynamics Testing – Adult – Ambulatory [19] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Ambulatory Delegation Protocols


01/20/2014 1

Delegation Protocol Number: 19

Protocol Title:
Antibiotic Therapy for Urodynamics Testing – Adult – Ambulatory
Delegation Protocol Applies To:
UWHC Urology Clinics, UW Health OB/Gyn Clinics

Target Patient Population:
Adult patients undergoing urology urodynamics testing.

Delegation Protocol Champion:
Wade Bushman, MD - Department of Medicine-Urology
Dobie Giles, MD – Department of Medicine - Gynecology

Delegation Protocol Workgroup:
Wade Bushman, MD - Department of Medicine-Urology
Zachary Lenhart, Administrative Fellow - Urology

Responsible Department:
Department of Medicine-Urology
Department of Obstetrics and Gynecology

Purpose Statement:
To delegate authority from the provider to Registered Nurses (RN) to order prophylactic antibiotics in
adult patients undergoing urodynamics testing.

Who May Carry Out This Delegation Protocol:
RNs trained in the use of this delegation protocol.

Guidelines for Implementation:
1. Patients requiring urodynamic testing will be screened at the time of scheduling using UWHC Form
#SR300047: Urodynamics Screening Sheet. Urodynamic screening done to determine appropriate
prophylactic therapy.
2. Any patient with a history of a joint replacement within the past two years will receive one of the
following:
2.1. First line treatment with ciprofloxacin 500 mg orally once one hour prior to procedure or
2.2. If allergic or resistant to ciprofloxacin, then cephalexin 500 mg orally once one hour prior to
procedure.
3. Any patient who has an indwelling catheter, performs intermittent self-catheterization, or used a
condom catheter and has not had recent urine cultures will need the following prophylactic antibiotic
therapy prior to testing:
3.1. First line treatment with ciprofloxacin 500 mg orally every 12 hours starting two days prior to the
procedure for a total of three days or
3.2. If allergic to ciprofloxacin, then trimethoprim/sulfamethoxazole 160/800 mg orally every 12
hours starting two days prior to the procedure for a total of three days or
3.3. If allergic to ciprofloxacin and trimethoprim/sulfamethoxazole then nitrofurantoin macrocrystals
ER 100 mg orally every 12 hours starting two days prior to the procedure for a total of three
days
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org

01/20/2014 2

3.4. If urine culture includes enterococcus (not VRE) and not allergic to penicillin, give amoxicillin
500mg TID starting two days prior to the procedure for a total of 3 days.(If allergic to penicillin
use nitrofurantoin alternative under 3.3)
3.5. If urine cultures have been done within the last 7-10 days, select antibiotic regimen appropriate
for cultures and sensitivity
4. For UW Health Urology Clinic Patients ONLY: Any patient who did not require pre-treatment due
to 2 or 3 above will receive one of the following antibiotics post-procedure:
4.1. First line treatment with ciprofloxacin 500 mg orally once
4.2. If allergic or resistant to ciprofloxacin, then cephalexin 500 orally once
5. Patient not meeting the above criteria will require consultation with provider to determine
appropriate antibiotic prophylaxis.
6. If a patient requiring pre-medication arrives for urodynamics testing without being premedicated,
testing will be rescheduled and the patient will be advised on proper preparation for the next
appointment. In selected cases, the Urology provider may elect to proceed with testing based on
his/her professional judgment.

Order Mode: Protocol/Policy without Cosign
References:
Best Practice Policy Statement on Urologic Surgery Antimicrobial Prophylaxis
(2008) http://www.auanet.org/education/guidelines/antimicrobial-prophylaxis.cfm
Collateral Documents/Tools: NA

Approved By:
UW Health Ambulatory Protocol Committee – November 2013; February 2015¹
Pharmacy and Therapeutics Committee – November 2013 (expedited process)
Medical Board – January 2014 (expedited process)
UW Health CAMO – January 2014 (expedited process)

Effective Date: January 2014

Scheduled for Review: January 2016

¹ Addition of UW Health OB/Gyn Clinics as delegates
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised:
 
11/2017CCKM@uwhealth.org