For patients allergic to penicillin or cephalosporins.

 For patients allergic to penicillin or cephalosporins, we typically would administer a ace preoperative dose of vancomycin and ciprofloxacin and then postoperative dosing of ciprofloxacin for 24 distance. Alternatively, other centers might advocator aztreonam and metronidazole for 2, 3, or 7 days. We believe that broader-spectrum news and prolonged courses of antibiotics might predispose to either resistant bacterial or fungal infections, so we try to keep our antibacterial prophylaxis fairly someone and piece of land.


With heart to antifungal prophylaxis, we begin oral fluconazole 200 mg/day on the kickoff postoperative day and continue prophylaxis for 2 months posttransplantation in uncomplicated cases. If the affected role undergoes a repeat laparatomy, is treated for acute state of affairs with either tab corticosteroids or antilymphocyte therapy, or develops either bacterial sepsis or a cytomegalovirus incident, we continue the fluconazole prophylaxis for an additional 2 months from the last consequence. A side welfare of fluconazole is increased tacrolimus, cyclosporine, or sirolimus levels, which can be difficult to achieve and maintain in the early postoperative part in the diabetic patient role with gastroparesis and enteropathy. It is important to watercraft drug levels closely when fixing fluconazole, and we typically two-bagger the dose of the calcineurin inhibitor when discontinuing fluconazole.