Surgical Antibiotic Prophylaxis

<Management>

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Pre-operative

-  Abdominal

-  Cardiothoracic

-  Orthopaedic

-  Obs & Gynae

-  Urology

-  Vascular

-  Endocarditis

 

 

 

Abdominal Surgery

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-  Colorectal, appendicectomy, upper GI or biliary incl laparascopic Sx: cholecystectomy

-  Metronidazole 500mg IV end at induction

-   + Cephazolin 1g IV (Adult >80kg: 2g) OR

-   + Gentamicin 2mg/kg slow IV bolus at induction

-  Low risk Pts: omit Metronidazole

-   Upper GI Sx: normal gastric acidity & motility, no obstruction/bleeding/malignancy, nil prev. gastric Sx

-   Biliary Sx: < 60yrs, non-DM, elective cholecystectomy

-  Gastrostomy tube insertion

-  Vancomycin 25mg/kg (up to 2g) slow IV infusion end prior to procedure

-  Endoscopy

-  Biliary tract, sclerotherapy, oesophageal dilation, ERCP

-   Cephazolin 1g (Adult > 80kg 2g) IV OR

-   Gentamicin 2,g/kg slow IV bolus at induction

-  Routine upper GI endoscopy no Abx required

 

 

 

Cardiothoracic Surgery

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-  PPM or PPM Generator Change

-  Cephazolin 1g (Adult > 80kg 2g) IV OR

-  Gentamicin 2mg/kg slow IV bolus at induction

-   + Flucloxacillin 2g IV bolus at induction OR

-   + Vancomycin 25mg/kg (up to 2g) slow IV infusion end prior to procedure

 

 

 

Orthopaedic Surgery

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-  Major joint arthroplasty, internal fixation of fracture

-  Cephazolin 1g (Adult > 80kg 2g) IV 15-30min prior to first incision

-  Then 1g (Adult > 80kg 2g) IV 8/24 x2 doses

-  Revision of joint arthroplasty

-  Cephazolin 1g (Adult > 80kg 2g) IV after consult w surgeon

-  Allergy to penicillin or MRSA

-  Vancomycin 25mg/kg (up to 2g) slow IV infusion end prior to procedure

-  Compound fracture

-  Cephazolin 1g (Adult > 80kg 2g) IV 8/24 for 1-3/7 OR

-  If present after 8hrs give for 5-7/7

-  If wound soiled, tissue damage is severe or devitalized tissue

-   Timentin 3.1g IV 6/24

-   Then Augmentin DF 875/125mg BD

-  If major allergy to penicillin

-   Clindamycin 600mg IV 8/24

-   + Gentamicin 4-6mg/kg IV daily

 

 

 

Obs & Gynae Surgery

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-  Hysterectomy, TOP

-  Cephazolin 1g (Adult > 80kg 2g) IV at induction

-  + Metronidazole 500mg IV end at induction

-  Ceasarian section

-  Cephazolin 1g (Adult > 80kg 2g) IV after clamping cord

 

 

 

Urological Surgery

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-  Sterile urine pre-op, if not

-  Gentamicin 4-6mg/kg IV daily

-  Prostatectomy

-  Gentamicin 2mg/kg slow IV bolus at induction

-  Transrectal Prostatic Biopsy

-  Trimethoprim 300mg PO Stat 1hr prior to procedure

 

 

 

Vascular Surgery

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-  Aterial reconstructive Sx, AAA or lower limb

-  Cephazolin 1g (Adult > 80kg 2g) IV at induction, then 8/24 for 2/7 OR

-  Flucloxacillin 2g IV at induction then 6/24 for 2/7

-   + Gentamicin 4-6mg/kg IV at induction, with 2nd dose 24hrs later

-  Brachial & carotid a. no Abx prophylaxis

-  Lower Limb Amputation

-  Benzylpenicillin 1.2g IV at induction then 6/24 for 1/7 OR

-  Metronidazole 500mg IV end at induction, then 12/24 for 1/7

 

 

 

Pts at risk of Endocarditis

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-  Pts w: prosthetic vavles, prev endocarditis, cardiac transplant w valvulopathy, RHD, congenital heart disease

-  Who are undergoing

-  Dental extraction, periodontal procedures, root planting, implants, apicoectomy OR

-  Resp procedure: tonsillectomy, bronchoscopy w incision/biopsy, bronchial sinus/nasal/middle ear Sx

-   Amoxycillin 3g PO 30-60min prior OR

-   Cephalexin 2g PO 30-60min prior OR

-   Ceftriaxone 1gm IM/IV 30-60min prior OR

-   Clindamycin 600mg PO/IV 30-60min prior OR

-   Azithromycin 500mg PO/IV 30-60min prior

-  Genitourinary/GIT: lithotripsy, vag delivery w prolonged labour, any GIT proc in presence of intra-abdo infection, any genito proc in presence of urinary infection

-   Amoxycillin 3g PO 30-60min prior OR

-   Vancomycin 25mg/kg (up to 2g) slow IV infusion end prior to procedure