Pyloromyotomy Surgery in Children - Antimicrobial prophylaxis Guideline for

Publication: 31/12/2010  
Next review: 27/09/2026  
Clinical Guideline
ID: 2374 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2023  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Antimicrobial prophylaxis Guideline for Pyloromyotomy Surgery in Children

1. Summary table of routine recommendations



Evidence level

Aim of prophylaxis


Antimicrobial dose/route
Give <1 hours before procedure


MRAS risk* or true penicillin allergy




Prevention of surgical site infection


None recommended

None recommended

*MRSA risk = previous MRSA infection or known colonisation.

2. Background information

The continued presence of Meticillin-resistant Staphylococcus aureus (MRSA) in the Trust, ongoing problems with Clostridium difficile infection and the drive to reduce Health care associated infections. have prompted a review of surgical prophylaxis in children.

The aim of antimicrobial prophylaxis when used in gastrointestinal surgery is a reduction in surgical site infection (SSI) or intra-abdominal collections. Pyloromyotomy is considered a clean operation that can be approached either laparoscopically or as open surgery without and entry into the viscus.


Antibiotic guidelines for pyloromyotomy note differences in practice.  Mullassery et al. (1) carried out a survey of 94 members of the British Association of Paediatric Surgeons.  They found that prophylactic antibiotics were used by 70% of the surgeons exclusively performing umbilical pyloromyotomy. Six surgeons using other operative techniques (RUQ or laparoscopy) also found this policy beneficial. However, more than 50% of pediatric surgeons responding to the study questionnaire do not routinely prescribe antibiotics.

A survey of 9 consultant paediatric surgeons currently performing this procedure in the Leeds Teaching Hospitals Trust was performed. All 9 responded.  Only three of 9 surgeons (33%) stated that they use a single dose of flucloxacillin as prophylaxis against infection following pyloromyotomy. The remaining six surgeons do not use antibiotic prophylaxis. In comparison to a previous survey within our department with 6 consultants providing this surgery, 50% used antibiotics and this information was used to inform the previous guideline in recommending antibiotic prophylaxis at that time owing to lack of other evidence.

A literature review was performed. Saunders and Williams (2) studied one hundred and twenty-nine infants with infantile hypertrophic pyloric stenosis that were referred to one consultant surgeon over a 13-year period for whom antibiotics were not given. They found that wound infections developed in 3% of cases. The authors’ interpretation was that that prophylactic antibiotic treatment is not indicated.

Recent publication by Griffin et al (3) studied a large cohort of infants undergoing pyloromyotomy surgery from a national database involving 47 hospitals across United States. In 14,247 patients who underwent pyloromyotomy, there was no difference in complication rates whether or not patients received antibiotics. These results suggest antibiotic prophylaxis is unnecessary for pyloromyotomy.

Another recent consensus article published by Bianchini et al (4) representing the Peri-Operative prophylaxis in Neonatal and Paediatric Age (POP-NeoPed) Study Group describes the use of preoperative antibiotic prophylaxis in neonates and children that are undergoing abdominal surgery and has the purpose of providing guidance to healthcare professionals who take care of children to avoid unnecessary and dangerous use of antibiotics in these patients. This risk of surgical site infection in this group lies between 1 - 3% ony and pyloromyotomy does not involve breaching the lumen. The consensus was that antibiotic prophylaxis in this setting in not recommended.

Finally, antibiotic prophylaxis has been shown not to significantly alter the rate of wound infection in adult National Nosocomial Infection Surveillance classifications with clean or clean-contaminated wounds.(5)  Parallel data do not exist for pediatric populations and neonates who are by definition immunocompromised,

Our previous guideline suggested auditing our practice. We have retrospectively audited 2 years of our data from 2021 to 2023, We had 44 infants during this time period, only 9 (20%) received prophylactic antibiotic at induction. There were no readmissions within 30 days related to SSI. We can safely conclude from our data that antibiotic prophylaxis can be discontinued for pyloromyotomy surgery. There may still be an indication for antibiotic if any accidental breach occurred to the mucosa.

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Record: 2374
Clinical condition:

Pyloromyotomy Surgery

Target patient group: Children
Target professional group(s): Secondary Care Doctors
Adapted from:

Evidence base


  1. Mullassery D, Perry D, Goyal A et al., “Surgical practice for infantile hypertrophic pyloric stenosis in the United Kingdom and Ireland--a survey of members of the British Association of Paediatric Surgeons”, J Pediatr Surg, 2008, 43, 6, pp 1227-9.
  2. Saunders MP, Williams CR, “Infantile hypertrophic pyloric stenosis: experience in a district general hospital”, J R Coll Surg Edinb, 1990, 35, 1, pp 36-8
  3. Griffin KL, Beyene TJ, Kenney B. Questioning Prophylactic Antibiotic Use for Pyloromyotomy: Analysis of the Pediatric Health Information System Database. J Pediatr Surg. 2023 Jun;58(6):1123-1127.
  4. Bianchini S, Rigotti E, Monaco S, et al. The Peri-Operative Prophylaxis In Neonatal And Paediatric Age Pop-NeoPed Study Group. Surgical Antimicrobial Prophylaxis in Abdominal Surgery for Neonates and Paediatrics: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel). 2022 Feb 21;11(2):279.
  5. Knight R, Charbonneau P, Ratzer E et al., “Prophylactic antibiotics are not indicated in clean general surgery cases”, Am J Surg, 2001, 182, 6, pp 682-6

Evidence Levels

A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. LTHT Consensus (no national guidelines exist, guidelines from different learned bodies contradict each other, or no evidence exists)

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Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Special antimicrobial prophylaxis recommendations
Not applicable

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