Surgical antimicrobial prophylaxis

All IV single doses unless stated STARSHIP OR

QUESTIONS CLEAN SURGERY CLEAN-CONTAMINATED SURGERY CONTAMINATED/DIRTY/COMPLEX SURGERY
Antibiotic and dose Antibiotic and dose Antibiotic and dose
1. How clean is the surgery?
Neurosurgery ORL:
2. What surgical antimicrobial prophylaxis Craniotomy and CSF shunt cephazolin 30mg/kg 1. Adenoidectomy
do I need to give? insertion (2g max) 2. Tonsillectomy None required
3. When will I need to redose? Myelomenigocele 3. Tympanostomy
4. L & Bs
Head and neck surgery None required cephazolin 30mg/kg
Do not adjust dose for renal/hepatic 5. FESS/cleft palate Other complex
Thyroglossal cysts (2g max) and
impairment 6. Repair CSF leaks procedures
Thyroid surgery cephazolin 30mg/kg metronidazole 7.5mg/kg
7. Mastoidectomy above the diaphragm
cephazolin 30mg/kg (2g max) (500mg max)
Continue current antimicrobial treatment Hearing Implants (2g max) 8. Septoplasty,
regimens as scheduled peri-operatively myringoplasty

Cardiac surgery Dental Surgery None required

Standard surgical prophylaxis should be
1. Congenital repair Unit specific guideline
administered in addition to any current
2. Valve replacement
therapy Trauma: Trauma: cephazolin 30mg/kg
cephazolin 30mg/kg
3. Thoracotomy Compound fractures Compound fractures (2g max) and
cephazolin 30mg/kg (2g max)
4. Implantable cardiac device grade 1 - 2 grade 3 gentamicin 5mg/kg
MRSA infected (2g max) (360mg max)
Add vancomycin 15mg/kg (ABW) (Max 2g) to
regimen Orthopaedics
Neonatal GI Surgery cephazolin 30mg/kg
1. Osteotomy/
cephazolin 30mg/kg (2g max)
ESBL colonised/infected Dysplasia/lengthening
(2g max) then
Seek advice from Paediatric Infectious 2. Spinal surgery –
15mg/kg q8h for up to 3 Upper GI
Diseases congenital/idiopathic cephazolin 30mg/kg Peritonitis
doses 1. Congenital surgery
3. Open reduction int fixation (2g max) Abscess drainage
2. Jejunostomy tube
Severe penicillin allergy - anaphylaxis 5. Revision surgery Bowel anastomotic
Placement cefuroxime 50mg/kg
Intra-abdominal replace cephazolin with cephazolin 30mg/kg repair
6. Biopsy None required (1.5g max) and
gentamicin 5mg/kg (LBW) (Max 360mg) (2g max) and Fistula repair
3. Small bowel surgery metronidazole 7.5mg/kg
cephazolin 30mg/kg (2g metronidazole 7.5mg/kg Reversal of stoma
7. Spinal surgery - complex 4. Biliary surgery (500mg max)
All others replace cephazolin with max) and gentamicin (500mg max) Urinary procedure that
vancomycin 15mg/kg (ABW) (Max 2g) results in entry into the
General surgery
or clindamycin 10mg/kg (Max 600mg) bowel
1. . High risk abdominal Colorectal cephazolin 30mg/kg
Antimicrobial Stewardship Committee

laparoscopic surgery cephazolin 30mg/kg 1. Appendicectomy (2g max) ±

When to give 2. . High risk central lines (2g max) 2. Colectomy metronidazole 7.5mg/kg
0-60 mins before knife to skin for all antibiotics 3. . Thoracoscopy 3. Trauma (500mg max)
except vancomycin which should be completed
within 30 minutes of incision
Urology
When to redose (the same dose) with General surgery 1. Nephrectomy
extensive blood loss or surgery >4 hours: 1. Herniotomy 2. Cystoscopy
None required
November 2015

Cephazolin every 4 hours 2 Orchidopexy/hydroceles 3. Renal stent

cephazolin 30mg/kg
Cefuroxime every 4 hours 3 Elective skin procedures placement
(2g max)
Clindamycin every 6 hours 4. Any procedure that
Metronidazole every 7 hours results in entry into the
Vancomycin every 8 hours urinary tract (e.g.
Solid organ transplantation Unit -specific guidelines hypospadias)
Gentamicin not required
References:
1. Bratzler DW, Dellinger EP, Olsen KM et al Clinical practice guidelines for antimicrobial. Am J Hosp Sys Pharm 2013; 70: 195-283.
2. Peter Mac Surgical Antibiotic Prophylaxis-Flowchart and Decision Support Poster. Antimicrobial Stewardship Committee & therapeutic Drug Committee, August 2011 Peter MacCullum Hospital, Melbourne, Vic, Australia
3. Therapeutic Guidelines Antibiotic v 15, 2014. Therapeutic Guidelines Limited, Melbourne.
 Surgical antimicrobial prophylaxis PAEDIATRIC
All IV single doses unless stated CARDIOTHORACIC
QUESTIONS CLEAN SURGERY CHEST REOPENING/RETURN TO THEATRE CONTAMINATED/DIRTY/COMPLEX SURGERY
Antibiotic and dose Antibiotic and dose Antibiotic and dose

Do not adjust dose for renal/hepatic

impairment

Continue current antimicrobial treatment Primary cardiac cefazolin 30mg/kg

regimens as scheduled peri-operatively surgery Valve replacement in a (2g max)
cefazolin 30mg/kg patient with active
1. Prior to skin incision cefazolin 30mg/kg (2g max) Return to theatre or and current treatment for
(2g max) endocarditis
Standard surgical prophylaxis should be 2. Going onto bypass cefazolin 30mg/kg (1g max) into chest opening in endocarditis
then
administered in addition to any current bypass pump PICU within 24
30mg/kg (1g max) q8h
3. Every four hours cefazolin 30mg/kg (2g max) hours of primary NB: Treatment for
therapy for 2 doses
during the procedure then operation endocarditis (e.g.
postoperatively
AND at the 30mg/kg (1g max) q8h for 2 doses streptococcal) may not
MRSA infected completion of surgery postoperatively provide adequate
Add vancomycin 15mg/kg (ABW) (Max 2g) to coverage for S.aureus.
regimen

ESBL colonised/infected
Seek advice from Paediatric Infectious
Diseases
Antibiotics may be
Complex medical or surgical issues cefazolin 30mg/kg (2g max) Delayed chest deferred until after
Re-exploration of wound
Seek advice from Paediatric Infectious Non-bypass cardiac then closure >24 hours cefazolin 30mg/kg sampling then
because of suspected
Diseases surgery 30mg/kg (1g max) q8h for 2 doses after primary (2g max) cefazolin 30mg/kg
infection
postoperatively procedure (2g max)
Severe penicillin allergy - anaphylaxis and current treatment
Replace cefazolin with per prescribed timing
vancomycin 15mg/kg (ABW) (Max 2g)
or clindamycin 10mg/kg (Max 600mg)
If 2 post-operative doses required use
Antimicrobial Stewardship Committee

standard treatment regimens without taking

levels
Continue current
antimicrobial treatment
When to give and ask surgeon if
0-60 mins before knife to skin for all antibiotics cefazolin 30mg/kg (2g max)
antibiotics should be
except vancomycin which should be then Washout and
Implantable cardiac deferred until after
completed within 30 minutes of incision 30mg/kg (1g max) q8h for 2 doses debridement for proven
devices sampling then
postoperatively infection
cefazolin 30mg/kg
(2g max)
August 2016

When to redose (the same dose) with and current treatment as

Blood loss >1500mL or surgery >4 hours: per prescribed timing
Cefazolin every 4 hours
Clindamycin every 6 hours
Vancomycin every 8 hours

References:
Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR. The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic prophylaxis in cardiac surgery, Part I: duration. Ann Thorac Surg 2006; 81: 397-404
Edwards R, Shahian D, Shemin R, Guy ST, Bratzler D, Edwards F, Jacobs M, Fernando H, Bridges C. The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic prophylaxis in cardiac surgery, Part II: antibiotic choice. Ann Thorac Surg 2007; 83: 1569-76.
Lador A, Nasir H, Mansur N, Sharoni E, Biderman P, Leibovici L, Paul M. Antibiotic prophylaxis in cardiac surgery: systemic review and meta-analysis. J Antimicrob Chemother. 2012; 67: 541-50
Kappeler R, Gillham M, Brown NM. Antibiotic prophylaxis for cardiac surgery. . J Antimicrob Chemother. 2012; 67: 521-2.