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Transcript
Clean
orthopedic
procedures
(other)
Staphylococci
• Minor procedures - None
• Minor procedures - None
• Major procedures –
Cefazolin4 1 g IV pre-op, (2
g if > 80 kg)
• Major procedures –
Cefazolin 25mg/kg IV preop (Maximum of 1 g)
----- or
• Vancomycin 15mg/kg IV
pre-op (Maximum of 1 g) if
MRSA+
• Vancomycin 1 g IV preop if
patient is MRSA-positive
• Cefazolin every 4
hours
• Vancomycin none;
every 6 hours for
pediatric patients
Use vancomycin only for severe
penicillin allergy. Some clinicians
use clindamycin in penicillinallergic patients.
Genitourinary
LIKELY
PATHOGENS
ANTIMICROBIAL REGIMEN
(Adult)
ANTIMICROBIAL REGIMEN
(Pediatric)
OR REDOSING
COMMENTS
Transurethral
Resection of
Prostate3
E coli as well as other
Gram--negative bacilli
and enterococci
• Gentamicin 80 mg IV
(single dose) plus
Ampicillin 500 mg - 1 g IV
(single dose) pre-op
•
• None
If urine is sterile the role of
perioperative prophylaxis is
probably of marginal benefit.
Continuing antibiotic prophylaxis
post TURP is strongly
discouraged and will greatly
increase the risk of nosocomial
UTI with enterococci, resistant
Gram--negative bacilli, and
candida.
----- or
• Ciprofloxacin 500 mg PO
or
400 mg IV pre-op (single
dose)
Injury
Ruptured
viscus3
LIKELY
PATHOGENS
Enteric Gram--negative
bacilli, anaerobes
(Bacteroides fragilis)
and enterococci.
ANTIMICROBIAL REGIMEN
(Adult)
ANTIMICROBIAL REGIMEN
(Pediatric)
• Unasyn®
(ampicillin/sulbactam)
3 g IV pre-op
• Unasyn
(ampicillin/sulbactam)
37.5mg/kg (provides
25mg/kg of ampicillin) IV
(Maximum of 3 g) preop
• Unasyn every 4
hours
Use Unasyn® for communitybased peritonitis.
• Pip/Tazo every 4
hours
• Piperacillin/tazobactam
80mg/kg IV pre-op
(Maximum of 4.5 g)
• Clindamycin every
6 hours
Use piperacillin/tazobactam for
peritonitis that develops
secondarily in hospitalized
patients or patients with prior
antibiotic use at risk for resistant
bacteria such as Enterococcus
and Pseudomonas.
----- or
• Piperacillin/tazobactam
4.5 g IV pre-op
----- or
• Clindamycin 900 mg IV
plus gentamicin 1.7
mg/kg IV pre-op for
penicillin-allergic patients
• Clindamycin 10mg/kg IV
plus gentamicin 2mg/kg IV
(Maximum of 80mg) pre-op
for pencillin-allergic
patients
OR REDOSING
• Gentamicin every 8
hours
COMMENTS