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Perioperative Antimicrobial Prophylaxis Guidelinesfor Adult and Pediatric Patients

Drug Information CenterC-113 Chandler Medical Center, (859) 323-5320

A d u l t Antimicrobial Selection and Dosing

Surgical Category Antimicrobial Agent andAdult Dose

(See opposite side for pediatric doses)

Notes

Cardiac/Vascular/

Non-Cardiac Thoracic

Cefazolin 1g IV x1 Should be continued for no longer than 24hours.

GastrointestinalBiliary Tract,

Gastroduodenal,

Appendectomy (non-perf),

Colorectal

Ampicillin/Sulbactam 3g IV x1 For penicillin-allergic patients:

Clindamycin 900mg x1 +

Gentamicin 5mg/kg x1(max 400mg)

Orthopedic

With prosthetic material Cefazolin 1g IV x1 Most clean procedures without prosthetic

material do not require prophylaxis.

Head and Neck

With prosthetic material Cefazolin 1g IV x1 Most clean procedures without prosthetic

material do not require prophylaxis.

Clean-contaminated

oral or pharyngeal mucosa is

compromised)

Cefazolin 1g IV x1 +

metronidazole 500mg IV x1

For cephalosporin or severely penicillin-

allergic patients:

Clindamycin 900mg IV x1 +

Gentamicin 5mg/kg IV x1(max 400mg)

Neurosurgical Cefazolin 1g IV x1

OB/GYNCesarean delivery with active labor

or premature rupture of membranes

Cefazolin 1g IV x1 Prophylaxis should be given immediately

after the umbilical cord is clamped.

Hysterectomy Cefazolin 1g IV x1

Urologic

for patients with known bacteriuria

only)

Sulfamethoxazole/Trimethoprim 160mg

(TMP component) IV infusion over 60

minutes x1

Alternative agents may be necessary based

on results of prior urine cultures.

Doxycycline 100mg IV infusion over 60

minutes x1 may be given for patients with a

sulfa allergy.

otes:

or patients with known colonization with MRSA or previous MRSA infection, vancomycin 1gm IV x1 may be used for prophylaxis.Vancomycin must be given over 60 minutes to minimize the likelihood of Red Mans Syndrome.

or patients with cephalosporin allergies, or anaphylactic or other life-threatening allergies to penicillin agents, clindamycin 900mg IV x1should be used.

or patients weighing >100kg, cefazolin 2gm IV x1 should be used as an alternative to cefazolin 1gm IV x1.

or all procedures in which cefazolin is administered, a repeat dose should be given if the procedure lasts >4 hours.

or individuals with prosthetic heart valves, native valve abnormalities, or other conditions requiring endocarditis prophylaxis, consult the

American Heart Association Guidelines, available at JAMA 1997;277:1794-1801 OR The Sanford Guide to Antimicrobial Therapy

Approved by Medical Executive Committee 4/27/04, OR Subcommittee 4/30/04, and Pharmacy and Therapeutics Committee

4/15/04

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Ped i a t r i c Antimicrobial Selection and Dosing

Surgical Category Antimicrobial Agent andPediatric Dose

(See opposite side for adult doses)

Notes

Cardiac/Vascular/

Non-Cardiac Thoracic

Cefazolin 30mg/kg IV Should be continued for no longer than 24hours.

GastrointestinalBiliary Tract,

Gastroduodenal,Appendectomy (non-perf),

Colorectal

0-2yrs: Ampicillin 50mg/kg IV +

Gentamicin 2.5mg/kg IV +Clindamycin 15mg/kg IV

>2 yrs: Ampicillin/Sulbactam 50mg/kg

(ampicillin component)

For penicillin-allergic patients:

Clindamycin 15mg/kg x1 +Gentamicin 2.5mg/kg x1

Orthopedic

With prosthetic material Cefazolin 30mg/kg IV x1 Most clean procedures without prosthetic

material do not require prophylaxis.

Head and NeckWith prosthetic material Cefazolin 30mg/kg IV x1 Most clean procedures without prosthetic

material do not require prophylaxis.

Clean-contaminated

oral or pharyngeal mucosa iscompromised)

Cefazolin 30mg/kg IV x1 +

Clindamycin 15mg/kg IV x1

For penicillin-allergic patients:

Clindamycin 15mg/kg IV x1 +Gentamicin 2.5mg/kg IV x1

Neurosurgical Cefazolin 30mg/kg IV x1

Urologic

for patients with known bacteriuria

only)

0-2 yrs: Gentamicin 2.5mg/kg IV x1>2 yrs: Sulfamethoxazole/Trimethoprim

5mg/kg (trimethoprim component) IV

infusion over 60 minutes x1

Alternative agents may be necessary basedon results of prior urine cultures.

otes:or patients with known colonization with MRSA or previous MRSA infection, vancomycin 15mg/kg IVPB x1 may be used for prophylax

Vancomycin must be given over 60 minutes to minimize the likelihood of Red Mans Syndrome.

ulfamethoxazole/Trimethoprim and Doxycycline should be administered as an infusion over 60 minutes.

or all procedures in which cefazolin is administered, a repeat dose should be given if the procedure lasts >4 hours.

or individuals with prosthetic heart valves, native valve abnormalities, or other conditions requiring endocarditis prophylaxis, consult theAmerican Heart Association Guidelines, available at JAMA 1997;277:1794-1801 OR The Sanford Guide to Antimicrobial Therapy

References:

Medical Letter. Antimicrobial Prophylaxis in Surgery. Med Lett Drugs Ther. October 29, 2001;43(1116-1117):92-7.

IDSA (Infectious Diseases Society of America). Quality Standards Subcommittee of the Clinical Affairs Committee. Dellinger EP, Gross PA, Barrett TL, et

al. Quality standards for antimicrobial prophylaxis in surgical procedures. Released in 1994 (reviewed in 1998). Clin Infect Dis 1994 Mar;18(3):422-7.

ASHP (American Society of Health System Pharmacists). ASHP Commission on Therapeutics: ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis

in Surgery.Am J Health Syst Pharm 1999;56:1839-88.

Approved by Operating Room Subcommittee 4/30/04, Pharmacy and Therapeutics Committee 4/15/04, and Medical Executive

Committee 4/27/04

_________________________________________________________________________________________________________________

App roved b y P&T Co mmit tee: 4/04 | Posted on: 4/04 | For Internal University of Kentucky Chandler Medical Center Use Only