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Transcript
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 ½ 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.
• Cefuroxime5 1.5 g IV preop
• Cefuroxime 30mg/kg IV
preop (Maximum of 1.5 g)
• Cefuroxime every 4
hours
• Clindamycin 900 mg IV
plus
gentamicin 1.7 mg/kg IV
preop
• Clindamycin 10mg/kg IV
(Maximum of 900mg) plus
gentamicin 1.5mg/kg IV
(Maximum of 80mg) preop
• Clindamycin every 6
hours
----- or
---- or
• Unasyn®
(ampicillin/sulbactam)
1.5 g-3 g IV preop
• Unasyn
(ampicillin/sulbactam)
37.5mg/kg (provides
25mg/kg of ampicillin) IV
(Maximum of 3 g) preop
• Cefuroxime 1.5 g IV plus
Metronidazole 500 mg IV
pre-op
• Cefuroxime 30mg/kg IV
preop (Maximum of 1.5 g)
plus Metronidazole
7.5mg/kg IV (Maximum of
500mg) preop
----- or
• Cefoxitin4 1 g IV preop
(2 g if > 80 kg)
ANTIMICROBIAL REGIMEN
(Pediatric)
----- or
• Cefoxitin 25mg/kg IV
(Maximum of 1 g) preop
OR REDOSING
• Unasyn® every 4
hours
• Cefuroxime every 4
hours
• Metronidazole every
6 hours
• 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.