2013-14 iv antibiotic regimens for pre-operative surgical prophylaxis

PENNSYLVANIA HOSPITAL
& THE SURGERY CENTER
2013-14 IV ANTIBIOTIC REGIMENS FOR
PRE-OPERATIVE SURGICAL PROPHYLAXIS – PH-DG3
(Note: All IV therapy unless otherwise stated) Continue no longer than 24 hours unless otherwise stated *** Surgical and anesthesiology teams should consult ID to discuss prophylaxis regimens not listed below, as well as for patients currently receiving antibiotics for active infection *** n.b. In the instance that a patient’s surgery is delayed after receiving the initial pre-op dose OR the patient has standing orders for antibiotics prior to the procedure, please call the pharmacy for dosing recommendations. Refer to PAH policy RE-DOSING OF IV ANTIBIOTICS DURING SURGICAL PROCEDURES PH-DG24 for patients undergoing prolonged procedures and/or who experience greater than 1500 cc of blood loss. If SEVERE beta-lactam allergy see definition
(Must be documented)
SEVERE beta-lactam allergy= evidence of anaphylaxis, urticaria, angioedema, swelling, shortness of breath, acute interstitial nephritis (AIN)
or acute kidney injury, history of pancytopenia or Steven’s Johnson Syndrome/toxic epidermal necrolysis that developed while on beta-lactam therapy Coronary bypass, valve surgery, thoracotomy, lobectomy, pneumonectomy, lung resection, VATS, Operations involving the mucous membranes and cefazolin 2 grams + metronidazole 500 mg deep tissues, clean-contaminated surgery All other clean head and neck procedures Otorhinolaryngology Sinus, nasal, otologic, pharyngeal surgery All procedures including CSF shunting, craniotomy, If pre-existing implanted orthopedic prosthesis present, spinal surgery, laminectomy, implantation of If pre-existing implanted orthopedic prosthesis present, i.e. TKA, THA use cefazolin + clindamycin 900 mg Orthopedic/Podiatry All procedures including insertion of prosthetic joints, open operations, ACL repair, foot and ankle Vascular All procedures including peripheral vascular surgery, abdominal aorta, carotid surgery, legs cefazolin 2 grams + metronidazole 500 mg Gastroduodenal procedures with or without entry If pre-existing implanted orthopedic prosthesis If pre-existing implanted orthopedic prosthesis present i.e. TKA, THA = use same regimen present i.e. TKA, THA = use same regimen cefazolin 2 grams + metronidazole 500 mg Biliary tract surgeries-- open or laproscopic cefazolin 2 grams + metronidazole 500 mg cefazolin 2 grams + metronidazole 500 mg vancomycin 1 gram + gentamicinA 5 mg/kg x ONCE Hernia repair with or without MESH
2013-14 IV Antibiotic Regimens for Pre-Operative Surgical Prophylaxis (Continued) If SEVERE beta-lactam allergy see definition
(Must be documented)
unless significant patient comorbidities unless significant patient comorbidities Tunneled central venous catheter placement cefazolin 1-2 grams; if greater than 100 kg OR BMI clindamycin 900 mg + gentamicinA 1.5 mg/kg cefazolin 1-2 grams; if greater than 100 kg OR BMI clindamycin 900 mg + gentamicinA 1.5 mg/kg Urogynecologic procedures including sling, cefazolin 1-2 grams; if greater than 100 kg OR BMI clindamycin 900 mg + gentamicinA 1.5 mg/kg cefazolin 2 grams + metronidazole 500 mg Clindamycin 900 mg + gentamicinA 1.5 mg/kg Hysterosalpingogram (HSG) or chromotubation in patients with history of PID or procedure doxycycline 100 mg pre-operatively THEN 200 mg doxycycline 100 mg pre-operatively THEN 200 mg cefazolin 2 grams q8h + metronidazole 500 mg clindamycin 900 mg + gentamicinA 5 mg/kg/DAY Inpatient
Inpatient
Lower tract instrumentation
If renal insufficiency; CrCl less than 45 ml/min use: Cystography, urodynamic study, or simple Outpatient
Outpatient
PO: cefuroxime 500 mg x 1 tab given 2 hours prior PO Option: TMP/SMX 1 DS tab x 1 hour prior to If sulfa allergy use ciprofloxacin 500 mg x 1 tab gentamicinA 5 mg/kg ONCE + clindamycin 900 mg If renal insufficiency; CrCl less than 45 ml/min use: Upper Tract Instrumentation
If the patient has renal insufficiency; CrCl less than gentamicinA 5 mg/kg ONCE + metronidazole 500 mg If renal insufficiency; CrCl less than 45 ml/min use: Open/ Laparoscopic Surgery
gentamicinA 5 mg/kg ONCE + metronidazole 500 mg If renal insufficiency; CrCl less than 45 ml/min use: cefazolin 2 grams + metronidazole 500 mg gentamicinA 5 mg/kg ONCE + metronidazole 500 mg If renal insufficiency; CrCl less than 45 ml/min use: • Urology procedures involving implanted prosthesis (i.e. penile prosthesis); including gentamicinA 5 mg/kg ONCE + vancomycin 1 gram gentamicinA 5 mg/kg ONCE + vancomycin 1 gram patient with pre-existing orthopedic prosthetics AGentamicin dosing-- Use ideal body weight (IBW); IBW= 45.5women (use 50 for men) + (2.3 x # inches greater than 60) OR
if BMI > 30 use adjusted body weight (AdjBW) = ActualBW - IBW (0.4) + Actual BW)

Revised February 2008, Reviewed December 2008, Revised August 2011, Revised October 2011, Revised August 2012, Revised
October 2012, Revised March 2013
\DrugLists\PreOp Abx Surg Prophylaxis PH-DG 03.13.docx

Source: https://www.shacqa.cc/library/PAHantibiotics.pdf