Surgical Antibiotic Prophylaxis Guidelines Heatherwood and Wexham Park Hospitals

NHS Foundation Trust

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Infection 1st Line Antibiotics Penicillin Allergy Comments Infection 1st Line Antibiotics Penicillin Allergy Comments
Antibiotics must be administered within 60 minutes prior Plastics and Ear Nose & Throat General Surgery

to incision. Head and Neck Upper GI IV Gentamicin 3mg/kg (max 180mg)

Single dose
Gastro-duodenal surgery plus
See Adult Surgical Antibiotic Prophylaxis Guidelines for guidance Clean, benign
Clean ear surgery
Not recommended Gastric Bypass Surgery IV Clindamycin 600mg
on administration Contaminated/clean- Lower GI and
Single dose.
Single dose. Hepatobiliary
contaminated (e.g. oral IV Gentamicin 3mg/kg (max 180mg) Use of antibiotics
IV Gentamicin 3mg/kg Small bowel
lesions) plus post surgery only if
Documentation of antibiotic prophylaxis must be made Oncology/Skin cancer
IV Co-amoxiclav 1.2g (max 180mg)
plus Ear surgery:
Colorectal surgery
IV Metronidazole 500mg clinical evidence of
surgery Appendicectomy
in the drug chart and Anaesthetic Record Sheet, including Ear surgery with
IV Clindamycin 600mg If implant, continue po Bile duct surgery
infection, discuss with
antibiotics for 5 days Microbiology/ID
the time of infusion and the time of incision prosthesis Gall bladder surgery
IV Flucloxacillin Abdomen
Single dose.
Septorhinoplasty 2g qds 24 hour cover. Laparoscopic or non-
IV Clindamycin IV Gentamicin 3mg/kg (max 180mg) Prophylaxis not
+/- implant plus If implant, continue po laparoscopic hernia
600mg tds plus recommended for
MRSA colonisation or ADD IV Metronidazole antibiotics for 5 days repair with mesh
IV Metronidazole 500mg laparoscopic hernia
infection IV Teicoplanin 400mg Single dose 500mg bd Splenectomy
repair without mesh
(All operations) if not previously indicated (immunosupression)
Hand, Upper and Lower extremity
IV Flucloxacillin 2g IV Teicoplanin 400mg Single dose.
Elective surgery using plus plus Followed by:
Single dose IV Ertapenem 1g
K-wires or implants IV Gentamicin 3mg/ IV Gentamicin 3mg/kg IV Ertapenem 1g od for
All procedures when: Severe penicillin allergy:
Infection 1st Line Antibiotics Penicillin Allergy Comments kg (max 180mg) (max 180mg) 3-5 days.
Suspected or confirmed IV Teicoplanin 400mg
Severe Penicillin
Urology IV Ertapenem 1g od ruptured viscus/ plus
Allergy: IV Teicoplanin
Severe penicillin peritoneal contamination IV Metronidazole 500mg plus
Single dose. * 400mg bd plus
IV Co-amoxiclav 1.2g allergy: IV Ciprofloxacin 400mg
Endoscopic *Use pre-op assessment Continue until soft IV Ciprofloxacin 400mg
IV Ertapenem 1g Emergency surgery, 3 doses 8 hourly IV Teicoplanin 400mg
Procedures urine C&S if available tissue closure or 3 days bd plus IV Metronidazole
Severe penicillin allergy: IV Gentamicin dirty wounds and open plus bd plus
TURP to help guide choice of if no active infection 500mg for 3-5 days
3mg/kg (max 180mg) fractures IV Gentamicin 3mg/kg IV Metronidazole
TURBT antibiotic prophylaxis in whichever is sooner
urological surgery (max 180mg) stat 500mg tds plus Vascular Surgery
IV Ciprofloxacin
Open Surgery for Clean IV Ertapenem 1g
IV Ertapenem 1g 400mg bd
Cases IV Co-amoxiclav 1.2g Severe penicillin
Severe penicillin allergy: IV Gentamicin Single dose IV Flucloxacillin 2g IV Teicoplanin 400mg Aortic Aneurysm 3 doses 8 hourly allergy:
e.g. nephrectomy for Skin Grafting
3 mg/kg (max 180mg) plus plus Femoral-Popliteal by-pass plus IV Teicoplanin 400mg
Carcinoma Revascularisation Single dose 24 hour cover only
IV Gentamicin 3mg/kg IV Gentamicin 3mg/kg graft IV Gentamicin 3mg/kg bd
Percutaneous Free flaps
(max 180mg) (max 180mg) Amputation (max 180mg) stat plus
nephrolithotomy. IV Ertapenem 1g IV Gentamicin 3mg/kg
Stent change. Severe penicillin allergy: IV Gentamicin Single dose (max 180mg) stat
Nephrostomy, including 3mg/kg (max 180mg) Infection 1st Line Antibiotics Penicillin Allergy Comments
nephrostomy changes
Obstetrics and Gynaecology Infection 1st Line Antibiotics Penicillin Allergy Comments
IV Ertapenem 1g
plus Orthopaedics
IV Cefuroxime 1.5g
Gentamicin 3mg/kg (max 180mg) plus IV Teicoplanin 400mg 2 doses
Or/if Severe penicillin allergy: IV Metronidazole 12 hours apart
IV Gentamicin 3mg/kg (max 180mg) 500mg Joint replacement plus 24 hour cover only
TRUS biopsy plus Single dose Severe penicillin IV stat Gentamicin 3mg/kg
PO Ciprofloxacin 750mg Abdominal or Vaginal IV Co-amoxiclav 1.2g
allergy: Single dose (max 180mg)
plus either Hysterectomy
IV Gentamicin 3mg/kg Arthroscopy: Without No prophylaxis required
PR Metronidazole 1g or (max 180 mg) Single dose
use of metal implant
PO Metronidazole 400mg or plus
IV Metronidazole 500mg IV Teicoplanin 400mg
IV Metronidazole Arthroscopy: With metal
plus Single dose
Open Surgery for IV Ertapenem 1g Single dose. 500mg implant/screws
IV Gentamicin 3mg/kg (max 180mg)
Infected Cases Severe penicillin allergy: If already on antibiotics
IV Teicoplanin 400mg 2 doses
e.g. pyelonephritis IV Gentamicin 3mg/kg (max 180mg) maintain current regime IV Cefuroxime 1.5g
12 hours apart
plus Revision arthroplasty
IV Ertapenem 1g plus 24 hour cover only
IV Metronidazole (no infection suspected)
Severe penicillin allergy: IV stat Gentamicin 3mg/kg
Procedures involving 500mg
IV Gentamicin 3mg/kg (max 180mg) Single dose (max 180mg)
the Bowel Severe penicillin
plus Manual Evacuation of IV Co-amoxiclav 1.2g
allergy: Single dose IV Teicoplanin 400mg
IV Metronidazole 500mg Placenta
IV Gentamicin 3mg/kg Spinal surgery plus Single dose
(max 180mg) IV Gentamicin 3mg/kg (max 180 mg)
Infection 1st Line Antibiotics Penicillin Allergy 24 hour cover only plus
IV Metronidazole IV Ertapenem 1g od
Breast Surgery Severe penicillin
500mg
allergy:
Mastectomy, Breast IV Co-amoxiclav 1.2g
Doxycycline 100mg bd IV Teicoplanin Continue until soft
Cancer surgery, breast IV Co-amoxiclav 1.2g IV Teicoplanin 400mg Single dose IV Metronidazole 400mg 3 doses 8 hourly
for 7 days should be 400mg bd tissue closure or 3 days
reduction, duct excision or Open fracture plus
Induced Abortions considered post op due plus if no active infection
IV Metronidazole 1g rectally 2 hours before IV Gentamicin 3mg/kg
to the risk of ascending IV Metronidazole whichever is sooner
IV Teicoplanin 400mg 2 doses procedure (max 180mg) stat
chlamydial infections 500mg tds plus
Reconstructive Breast 12 hours apart IV Ciprofloxacin
surgery with implant or plus 24 hour cover IV Cefuroxime 1.5g
400mg bd
tissue expander IV Gentamicin 3mg/kg Severe penicillin allergy: Single dose 30 - 60
Caesarean Section Closed fracture requiring IV Teicoplanin 400mg
(max 180mg) stat IV Clindamycin 900mg minutes before skin
(Elective & Emergency) open surgery plus plus Single dose
Add IV Gentamicin 3mg/kg (max 180mg) if incision
pyrexia in labour metalwork IV Gentamicin 3mg/kg (max 180mg)
Antimicrobial Stewardship Group April 2012