UCSFMC Surgical Prophylaxis Guidelines

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GUIDELINES FOR PROPHYLACTIC ANTIBIOTICS IN ADULT PATIENTS TO REDUCE SURGICAL SITE INFECTION

 

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 circumstances of significant blood loss.

►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

For Significant Beta-lactam Allergy

Vancomycin

 

OR

Clindamycin

< 80 kg: 1 gm

≥ 80 kg: 1.5 gm

Infuse over 60 minutes in pre-op area; receive within 2 hrs prior to incision

Q 8 hours

<100 kg: 600 mg

≥100 kg: 900 mg

<60 min before incision as infusion over 20-30 min (not to exceed 30mg/min)

Q 6 hours

►HIP AND KNEE ARTHROPLASTY

Drug

Dose

Timing

Additional dose

Primary Hip or Knee Arthroplasty

Cefazolin

<80 kg: 1 gm

≥80 kg: 2 gm

60 min before incision as a bolus over 3-5 min

Q 4 hours

For Significant Beta-lactam Allergy

Vancomycin

< 80 kg: 1 gm

≥ 80 kg: 1.5 gm

Infuse over 60 minutes in pre-op area; receive within 2 hrs prior to incision

Q 8 hours

Revision Hip or Knee Arthroplasty

Cefazolin

PLUS

Vancomycin

 

<80 kg: 1 gm

≥80 kg: 2 gm

60 min before incision as a bolus over 3-5 min

Q 4 hours

< 80 kg: 1 gm

≥ 80 kg: 1.5 gm

Infuse over 60 minutes in pre-op area; receive within 2 hrs prior to incision

Q 8 hours

For Significant Beta-lactam Allergy   
 Vancomycin  

< 80 kg: 1 gm

≥ 80 kg: 1.5 gm

 Infuse over 60 minutes in pre-op area; receive within 2 hrs prior to incision  Q 8 hours
For Significant Vancomycin Allergy

Clindamycin

 

PLUS

Cefazolin

<100 kg: 600 mg

>100kg: 900 mg

<60 min before incision as infusion over 20-30 min (not to exceed 30mg/min) Q 6 hours

< 80 kg: 1 gm

≥ 80 kg: 2 gm

60 min before incision; infuse over 3-5 min as a bolus Q 4 hours

►NEUROSURGERY (CRANIAL, EXTRADURAL AND INTRADURAL ORTHO)

Drug

Dose

Timing

Additional dose

Cefazolin

<80 kg: 1 gm

≥80 kg: 2 gm

60 min before incision; infuse over 3-5 min as a bolus

Q 4 hours

For Significant Beta-lactam Allergy

Vancomycin

 

OR

Clindamycin

< 80 kg: 1 gm

≥ 80 kg: 1.5 gm

Infuse over 60 minutes in pre-op area; receive within 2 hrs prior to incision

Q 8 hours

<100 kg: 600 mg

≥100 kg: 900 mg

<60 min before incision as infusion over 20-30 min (not to exceed 30mg/min)

Q 6 hours

►NEUROSURGERY (SPINAL SURGERY)

Drug

Dose

Timing

Additional dose

Laminectomy or Primary Fusion

Cefazolin

<80 kg: 1 gm

≥80 kg: 2 gm

60 min before incision; infuse over 3-5 min as a bolus

Q 4 hours

Fusion (Revision)

Cefazolin

 

PLUS

Vancomycin

 

< 80 kg: 1 gm

≥ 80 kg: 2 gm

60 min before incision; infuse over 3-5 min as a bolus

Q 4 hours

< 80 kg: 1 gm

≥ 80 kg: 1.5 gm

Infuse over 60 minutes in pre-op area; receive within 2 hrs prior to incision

Q 8 hours

Fusion (Revision, involves sacrum)

Cefazolin

 

PLUS

Vancomycin

 

CONSIDER

Gentamicin

< 80 kg: 1 gm

≥ 80 kg: 2 gm

60 min before incision; infuse over 3-5 min as a bolus Q 4 hours

< 80 kg: 1 gm

≥ 80 kg: 1.5 gm

Infuse over 60 minutes in pre-op area; receive within 2 hrs prior to incision Q 8 hours
5mg/kg (based on ideal body weight) with maximum dose of 400mg -- contact ID pharmacy for dosing recommendations in renal failure 60 minutes before incision; infuse over 30 minutes One time dose only

Additional Recommendations:

1. For patients known to be colonized with MRSA, vancomycin can be added to cefazolin or used as an alternative agent.

2. The addition of vancomycin to cefazolin for revision fusion surgeries can be based on surgeon discretion taking into consideration MRSA colonization and use of topical vancomycin powder.

3. Discontinue antibiotics within 24 hours after surgery unless patient has a documented or suspected infection. Extended prophylaxis for 72 hours may be considered on a case by case basis for selected patients with high drain outputs.

4. In order to minimize risk of nephrotoxicity, gentamicin should be given only as a single preoperative dose.

 

►LIVER TRANSPLANTATION

Drug

Dose

Timing

Additional dose

Piperacillin/tazobactam

3.375 gm

<60 min before incision over 20-30 min

Q 2 hours

For Significant Beta-lactam Allergy

Vancomycin

 

AND

Aztreonam

< 80 kg: 1 gm

≥ 80 kg: 1.5 gm

Infuse over 60 minutes in pre-op area; receive within 2 hrs prior to incision

Q 8 hours

2 gm

<60 min before incision as infusion over 20-30 min

Q 4 hours

►COLON SURGERY

Drug

Dose

Timing

Additional dose

Ertapenem

 

OR

Cefoxitin

1 gm

<60 min before incision as a 30 minute infusion

No additional doses need to be given

<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

PLUS

Metronidazole

400mg

500 mg

<120 min before incision as infusion over 60 min

<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: ONE of the COMBINATIONS listed below:

Ciprofloxacin

PLUS

Metronidazole

400mg

500 mg

<120 min before incision as infusion over 60 min

<60 min before incision as infusion over 30 min

Q 6 hours

Clindamycin

 

 

PLUS

Gentamicin

600 mg

1.5 mg/kg

<60 min before incision as infusion over 20-30 min (not to exceed 30mg/min)

 

<60 min before incision as infusion over 30 min

Q 6 hours

 

 

Q 6 hours