GUIDELINES FOR PROPHYLACTIC ANTIBIOTICS IN ADULT PATIENTS
Revised June 1, 2009
NOTES:
·Always confirm with surgeons at the Time-Out or earlier; in some cases they may wish to delay antibiotics until after culture.
·Make sure dose is in before tourniquet goes up.
·Additional inter-operative doses should be given in circumstancesof significant blood loss.
EXTRADURAL ORTHO AND NEURO SPINE, CARDIOTHORACIC, VASCULAR SURGERY AND KIDNEY TRANSPLANTATION
|
Drug |
Dose |
Timing |
Additional dose |
|
Cefazolin |
<80 kg: 1 gm ≥80 kg: 2 gm |
<60 min before incision as a bolus over 3-5 min; with bolus dose, tissue levels are adequate in a few minutes |
Q 4 hours Exclude Kidney Tx |
|
For Significant Beta-lactam Allergy |
|||
|
Vancomycin or |
1 gm |
Start infusion on arrival in OR (once monitors are attached); infuse over 30-60 min |
Q 12 hours |
|
Clindamycin |
<100 kg: 600 mg ≥100 kg: 900 mg |
<60 min before incision as infusion over 10-15 min |
Q 6 hours |
PRIMARY/ REVISION HIP AND PRIMARY KNEE ARTHROPLASTY
|
Drug |
Dose |
Timing |
Additional dose |
|
Cefazolin |
<80 kg: 1 gm ≥80 kg: 2 gm |
60 min before incision as a bolus over 3-5 min |
1 additional dose 4 hours post-operatively |
|
For Significant Beta-lactam Allergy |
|||
|
Vancomycin |
< 80 kg: 1 gm ≥ 80 kg: 1.5 gm
|
Within 2 hrs prior to incision; start infusion in pre-op or on arrival in the OR; infuse over 60 minutes |
No additional doses to be given |
REVISION KNEE ARTHROPLASTY
|
Drug |
Dose |
Timing |
Additional dose |
|
Cefazolin
AND
Vancomycin
|
<80 kg: 1 gm ≥80 kg: 2 gm |
60 min before incision as a bolus over 3-5 min |
1 additional dose 4 hours post-operatively
|
|
< 80 kg: 1 gm ≥ 80 kg: 1.5 gm
|
Within 2 hrs prior to incision; start infusion in pre-op or on arrival in the OR; infuse over 60 minutes
|
No additional doses to be given | |
|
For Significant Beta-lactam Allergy |
|||
|
Vancomycin alone |
< 80 kg: 1 gm ≥ 80 kg: 1.5 gm
|
Within 2 hrs prior to incision; start infusion in pre-op or on arrival in the OR; infuse over 60 minutes |
No additional doses to be given |
|
For Significant Vancomycin Allergy |
|||
|
Clindamycin
AND Cefazolin |
<100 kg: 600 mg >100kg: 900 mg
|
<60 min before incision; infuse over 10-15 min |
1 additional dose 6 hours post-operatively |
|
< 80 kg: 1 gm ≥ 80 kg: 2 gm
|
60 min before incision; infuse over 3-5 min as a bolus |
1 additional dose 4 hours post-operatively |
|
NEUROSURGERY (CRANIAL AND INTRADURAL SPINE)
|
Drug |
Dose |
Timing |
Additional dose |
|
Ceftriaxone |
≥80 kg: 2 gm |
<60 min before incision as a bolus over 3-5 min |
Q 12 hours |
|
For Significant Beta-lactam Allergy |
|||
|
Vancomycin or |
1 gm |
Start infusion on arrival in OR (once monitors are attached); infuse over 30-60 min |
Q 12 hours |
|
Clindamycin |
<100 kg: 600 mg ≥100 kg: 900 mg |
<60 min before incision as infusion over 10-15 min |
Q 6 hours |
|
Drug |
Dose |
Timing |
|
|
Ceftriaxone |
<80 kg: 1 gm ≥80 kg: 2 gm |
<60 min before incision as a bolus over 3-5 min |
Q 12 hours |
|
For Significant Beta-lactam Allergy |
|||
|
Vancomycin or |
1 gm | Start infusion on arrival in OR (once monitors are attached); infuse over 30-60 min | Q 12 hours |
| Clindamycin |
<100 kg: 600 mg ≥100 kg: 900 mg |
<60 min before incision as infusion over 10-15 min | Q 6 hours |
|
Drug |
Dose |
Timing |
Additional dose |
|
Cefoxitin |
<80 kg: 1 gm ≥80 kg: 2 gm |
<60 min before incision as a bolus over 3-5 min |
Q 3 hours |
|
For Significant Beta-lactam Allergy |
|||
|
Ciprofloxacin and Metronidazole |
400mg
500 mg |
<60 min before incision as infusion over 30 min |
Q 6 hours |
VAGINAL AND ABDOMINAL HYSTERECTOMY
|
Drug |
Dose |
Timing |
Additional dose |
|
Cefazolin or Cefoxitin (if bowel involved) |
<80 kg: 1 gm ≥80 kg: 2 gm |
<60 min before incision as a bolus over 3-5 min |
Q 4 hours Q 3 hours |
|
For Significant Beta-lactam Allergy |
|||
|
Ciprofloxacin and Metronidazole or |
400mg
500 mg |
<60 min before incision as infusion over 30 min |
Q 6 hours |
|
Clindamycin and Gentamicin |
600 mg
1.5 mg/kg |
<60 min before incision as infusion over 10 – 15 min |
Q 6 hours |
Drug Dose
Cefazolin 20-30 mg/kg
Ceftriaxone 25 mg/kg
Cefoxitin 20-30 mg/kg
Cefuroxime 50 mg/kg
Vancomycin 15 mg/kg (as an infusion over 30-60 min)
Gentamicin 2 mg/kg
Clindamycin 15 mg/kg
Metronidazole 10 mg/kg
Ciprofloxacin Not recommended