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Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
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Preferred Treatment |
Alternative Treatment |
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Staphylococcus epidermidis, Staphylococcus aureus, Corynebacterium spp., Enteric Gram-negative bacilli |
Cefazolin 30mg/kg IV; max. 2gm |
β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg |
If known to have MRSA/ MRSE colonization, use Vancomycin 15mg/kg IV |
CHEMOPROPHYLAXIS: SURGICAL
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Timing:
Administration of antimicrobial agent is recommended within 60 minutes before surgical incision to ensure adequate tissue concentration at the start of the procedure. Agents that require longer administration time such as Vancomycin should be given within 120 minutes before surgery begins.
Adequate antimicrobial concentration should be maintained throughout the surgical procedures and in most instances, single dose of antimicrobial agent is sufficient and the duration of prophylaxis after any procedure should not exceed 24 hours.
- Intra-operative dosing is required if the duration of the procedure is greater than two times the half-life of the antimicrobial agent or if there is excessive blood loss.
- Re-dosing timings are calculated from the initiation of pre-operative dose.
|
Antimicrobial |
Recommended Re-dosing Interval in Adults with Normal Renal Function (From Initiation of Preoperative Dose in hours) |
|
Cefazolin |
4 |
|
Cefuroxime |
4 |
|
Ampicillin-sulbactam |
2 |
|
Flucloxacillin |
4 |
|
Clindamycin |
6 |
|
Cefotaxime |
3 |
|
Gentamicin |
NA |
|
Amoxicillin-clavulanate |
4 |
|
Infection/Condition and Likely Organism |
Suggested Treatment |
|
|
Preferred Treatment |
Alternative Treatment |
|
|
Non-cardiac including lobectomy, pneumonectomy, lung resection and thoracotomy |
Cefazolin 30mg/kg IV; max. 2gm |
Ampicillin-sulbactam 50mg/kg (of Ampicillin component) IV Re-dosing : every 2 hours β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg
|
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Infection/Condition and Likely Organism |
Suggested Treatment |
|
|
Preferred Treatment |
Alternative Treatment |
|
|
Gastroduodenal |
Cefazolin 30mg/kg IV; max. 2gm |
Ampicillin-sulbactam 50mg/kg (of Ampicillin component) IV β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg AND Gentamicin 2.5mg/kg IV |
|
Biliary tract (Open procedure/ Laparoscopic procedure/ Appendectomy/Small intestine/Hernia repair (hernioplasty and herniorrhaphy) / Colorectal) |
Cefazolin 30mg/kg IV; max. 2gm OR Ampicillin-sulbactam 50mg/kg (of Ampicillin component) IV |
Ceftriaxone 50-75mg/kg IV; max. 2gm OR Cefotaxime 50mg/kg; max. 1gm PLUS Metronidazole 15mg/kg IV (For neonates less than 1200gm, to give 7.5mg/ kg) β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg PLUS Gentamicin 2.5mg/kg IV |
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Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
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Clean (tonsillectomy, adenoidectomy, tracheostomy, thyroglossal cyst excision, preauricular sinus, dermoid cyst, brachial anomaly, thyroidectomy, parotidectomy, lymph node biopsy etc.) |
No antibiotic routinely |
|
|
|
Clean with placement of prosthesis (excludes tympanostomy tubes) |
Cefazolin 30mg/kg IV; max. 2gm |
Ampicillin-sulbactam 50mg/kg (of Ampicillin component) IV OR Cefuroxime 50mg/kg IV; max. 1.5gm β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg |
|
|
Clean-contaminated procedures with the exception of tonsillectomy and functional endoscopic sinus procedure |
Cefazolin 30mg/kg IV; max. 2gm PLUS Metronidazole 15mg/kg IV |
Ampicillin-sulbactam 50mg/kg (of Ampicillin component) IV OR Cefuroxime 50mg/kg IV; max. 1.5gm PLUS Metronidazole 15mg/kg IV β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg |
|
|
Clean-contaminated cancer surgery |
Cefazolin 30mg/kg IV; max. 2gm PLUS Metronidazole 15mg/kg IV |
Ampicillin-sulbactam 50mg/kg (of Ampicillin component) IV OR Cefuroxime 50mg/kg IV; max. 1.5gm PLUS Metronidazole 15mg/kg IV β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg |
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|
Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
|
Neurosurgery |
|||
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Elective craniotomy and cerebrospinal fluid-shunting procedures |
Cefazolin 30mg/kg IV; max. 2gm |
β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg |
If known to have MRSA/ MRSE colonization, use Vancomycin 15mg/kg IV. |
|
Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
|
Clean operations involving hand, knee, or foot and not involving implantation of foreign materials |
None |
|
|
|
Spinal procedure with or without instrumentation / hip surgery / Implantation of internal fixation devices (e.g. nails, screws, plates, wires) |
Cefazolin 30mg/kg IV; max. 2gm |
β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg |
|
|
Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
|
Low tract instrumentation with risk factors for infections |
Trimethoprim 2mg/kg PO; max. 150mg |
Cefazolin 30mg/kg IV; max. 2gm β-lactam Allergy: Gentamicin 2.5mg/kg IV |
|
|
Clean without entry into urinary tract/clean with entry into urinary tract (e.g. hypospadias surgery) |
Cefazolin 30mg/kg IV; max. 2gm |
Amoxicillin-clavulanate 30mg/kg IV; max 1.2gm |
UTI should be treated before procedure when possible. |
|
Clean-contaminated (entering gastrointestinal tract) |
Cefazolin 30mg/kg IV; max. 2gm PLUS Metronidazole 15mg/kg IV |
Amoxicillin-clavulanate 30mg/kg IV; max 1.2gm β-lactam Allergy: Gentamicin 2.5mg/kg IV |
|
|
Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
|
Elective soft tissue surgery |
No prophylaxis unless complete prolonged procedure If complex, Flucloxacillin 25mg/kg IV; max 1gm |
|
|
|
Elective hand or foot surgery involving bone |
Flucloxacillin 25mg/kg IV; max 1gm |
β-lactam Allergy: Clindamycin 10mg/kg IV; max 900mg |
|
|
Cleft lip and palate surgery |
Amoxicillin-clavulanate 30mg/kg; max. 1.2gm |
||
|
Excision and grafting surgery |
Amoxicillin-clavulanate 30mg/kg; max. 1.2gm |
||
|
Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
|
Percutaneous endoscopic gastrostomy (PEG) or jejunostomy (PEJ) or nephrostomy tube placement |
Cefazolin 30mg/kg IV; max. 2gm |
Amoxicillin-clavulanate 30mg/kg; max. 1.2gm |
|
|
Micturating cystourethrogram (MCUG) |
Trimethoprim 2mg/kg PO; max. 150mg (if patient is already on existing antibiotic UTI prophylaxis, increase antibiotic to therapeutic dose for a single dose prior procedure) |
|
|
|
Tenkhoff peritoneal dialysis catheter insertion |
Cefazolin 30mg/kg IV; max. 2gm |
Amoxicillin-clavulanate 30mg/kg; max. 1.2gm |
|
|
Burns |
No prophylaxis required |
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