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APPENDIX B: UWHC SURGICAL ANTIMICROBIAL PROPHYLAXIS GUIDELINES Principles of prophylaxis 1) Use antimicrobials for surgical procedures where prophylactic antimicrobials have been found to be beneficial. 2) Time antimicrobial administration so that the agent is present in the potentially contaminated tissue before the bacteria enter the site (i.e. at the time of surgical incision and persisting in tissues throughout the period of potential contamination). Antimicrobials vary in their distribution pharmacokinetics. The goal is begin delivery of the antimicrobial 30-60 minutes before incision to ensure infusion is complete prior to incision. Vancomycin and ciprofloxacin, which must be infused over 60 minutes, may be begun 120 minutes prior to incision). 3) For longer cases, appropriate antibiotics should be redosed according to their t Â½ lives. 4) Appropriate antibiotics should be redosed after significant blood loss (4 units or 1000 ml). 5) Limit the duration of antimicrobial prophylaxis. Studies document that postoperative antimicrobial administration is not necessary for many surgeries. 6) Plan the route of antimicrobial administration, for example, use oral antimicrobials for gut decontamination 7) Select an antimicrobial which is active against the most common surgical wound pathogens. Head and Neck3 Basic Case Major head and neck surgical cases where mouth or pharynx is entered3 LIKELY PATHOGENS ANTIMICROBIAL REGIMEN (Adult) Normal flora of the mouth, various streptococci (including aerobic and anaerobic species), Staph aureus, Peptostreptococcus, Neisseria and numerous anaerobic Gramnegative bacteria including Porphyromonas (Bacteroides), Prevotella (Bacteroides), Fusobacterium and Veillonella. Nasal flora includes Staphylococcus, Streptococcus pyogenes, Strep pneumoniae, Moraxella and Haemophilus species. â¢ Cefuroxime5 1.5 g IV preop â¢ Cefuroxime 30mg/kg IV preop (Maximum of 1.5 g) â¢ Cefuroxime every 4 hours â¢ Clindamycin 900 mg IV plus gentamicin 1.7 mg/kg IV preop â¢ Clindamycin 10mg/kg IV (Maximum of 900mg) plus gentamicin 1.5mg/kg IV (Maximum of 80mg) preop â¢ Clindamycin every 6 hours ----- or ---- or â¢ UnasynÂ® (ampicillin/sulbactam) 1.5 g-3 g IV preop â¢ Unasyn (ampicillin/sulbactam) 37.5mg/kg (provides 25mg/kg of ampicillin) IV (Maximum of 3 g) preop â¢ Cefuroxime 1.5 g IV plus Metronidazole 500 mg IV pre-op â¢ Cefuroxime 30mg/kg IV preop (Maximum of 1.5 g) plus Metronidazole 7.5mg/kg IV (Maximum of 500mg) preop ----- or â¢ Cefoxitin4 1 g IV preop (2 g if > 80 kg) ANTIMICROBIAL REGIMEN (Pediatric) ----- or â¢ Cefoxitin 25mg/kg IV (Maximum of 1 g) preop OR REDOSING â¢ UnasynÂ® every 4 hours â¢ Cefuroxime every 4 hours â¢ Metronidazole every 6 hours â¢ Cefoxitin every 3 hours COMMENTS Risk is high for mixed infections of anaerobes, staphylococci and some Gram-negative rods. Risk is high for mixed infections of anaerobes and staphylococci but not Pseudomonas.