Guidelines for the use of prophylactic antibiotics in surgery in Chi-Shan Hospital
Recommendations for use of prophylactic antibiotics in surgery by specific site or procedure
site/ procedure likely pathogen(s) Recommebded antibiotics Alternative Duration
Large skin(clean) S.aureus,CoNS Cefazolin 1gmIV at IA Clidamycin600mg 1 DOSE
Streptococci
Head and neck(clean) S.aureus,CoNS Cefazolin 2gmIV at IA Clidamycin600mg <1day
Head and neck(clean- S.aureus,CoNS Cefazolin 2gm Clidamycin600mg+Gentamicin <1day
contaminated) Streptococci + 2mg/kg
Enteric GNB Metronidazole500mg
Ear(clean- contamin- S.aureus
ated) Streptococci Cefazolin 2gmIV at IA Clidamycin600mg <1day
Nose and sinus(clean- S.aureus
contaminated) Enteric GNB Cefazolin 1gmIV at IA Clidamycin600mg <1day
Anaerobes
Tonsil(clean- S.aureus Cefazolin 1gmIV at IA Clidamycin600mg+Gentamicin <1day
contaminated) Enteric GNB 2mg/kg
Anaerobes
Lung(clean- contam S.aureus Cefazolin 2gmIV at IA Vancomycinª1gm IV on call
inated) CoNS then 1gm q8h to OR or
Pulmonary resection Streptococci Clidamycin600mg+Gentamicin <2day
(Iobectomy and pneu- 2mg/kg or 2°cephalosporins 1-2gm
monectomy)
Esophagus(clean- con- S.aureus Cefazolin 1-2gm IV at IA Vancomycinª1gm IV on call <2day
taminated) CoNS then 1gm q8h to OR or
Enteric GNB Clidamycin600mg+Gentamicin
2mg/kg or 2°cephalosporins 1-2gm
Total hip arthroplasty S.aureus Cefazolin 1-2gm IV at IA Vancomycinª1gm IV on call <2day
(clean) CoNS then 1gm q8h to OR or Cefuroxime 1.5gm
Total knee arthroplasty S.aureus Cefazolin 1-2gm IV at IA Vancomycinª1gm IV on call <2day
(clean) CoNS then 1gm q8h to OR
Internal fixation for S.aureus Cefazolin 1-2gm IV at IA Vancomycinª1gm IV on call <1day
close reduction(clean) CoNS then 1gm q8h to OR
Spine(clean) S.aureus Cefazolin 1-2gm IV at IA Vancomycinª1gm IV on call <2day
CoNS then 1gm q8h to OR
Orther selective,non- S.aureus Cefazolin 1-2gm IV at IA Vancomycinª1gm IV on call <1day
prosthesis bone proced- CoNS then 1gm q8h to OR
ures(clean)
Craniotomy(clean) S.aureus Cefazolin 1-2gm IV Oxacillin 2gm IV at IA <1day
CoNS or
Vancomycinª1gm IV on call
to OR
Ventriculo-peritoneal S.aureus Cefazolin 1-2gm IV Oxacillin 2gm IV at IA <2day
shunting(clean) CoNS or
Vancomycinª1gm IV on call
to OR
Colorectum(clean- con Enteric GNB Cefazolin 2gm+metronidazole Cefoxitin 1-2gm IV or <1day
taminated) Anaerobes 500mg IV Augment 1.2gm IV or
Unasyn 3gm IV
Clidamycin600mg+Gentamicin
2mg/kg
Non-complicated
Appendectomy(infected) Enteric GNB Cefuroxime 1.5gm IV+ Cefoxitin 1-2gm IV or <1day
Anaerobes metronidazole 500mg IV Augment 1.2gm IV or
Unasyn 3gm IV
Clidamycin600mg+Gentamicin
2mg/kg
Open biliary(clean- con Enteric GNB Cefazolin 1gm at IA Cefuroxime 1.5gm IV or <1day
taminated) Clidamycin600mg+Gentamicin
2mg/kg
Open cholecystectomy Enteric GNB Cefazolin 1gm at IA Cefuroxime 1.5gm IV or <1day
(clean- contaminated) Clidamycin600mg+Gentamicin
2mg/kg
Laparoscopic Enteric GNB Cefazolin 1gm IV at IA Clidamycin600mg+Gentamicin <1day
Cholecystectomy 2mg/kg
(clean- contaminated)
Gastroduodenal Gram-positive cocci Cefazolin 2gm IV at IA Clidamycin600mg+Gentamicin <1day
(clean- contaminated) Enteric GNB 2mg/kg
Intestinal Gram-positive cocci Cefazolin 2gm IV at IA Clidamycin600mg+Gentamicin <1day
(clean- contaminated) Enteric GNB 2mg/kg
Laparoscopic or non- S.aureus Cefazolin 1gm IV at IA Clidamycin600mg IV at IA 1 dose
Laparoscopic CoNS
Herniorrhaphy with
mesh
Laparoscopic or non- S.aureus Nil or Cefazolin 1gm IV at IA Clidamycin600mg IV at IA 1 dose
Laparoscopic
Herniorrhaphy without
mesh
Breast(clean) S.aureus Nil or Cefazolin 1gm IV Clidamycin600mg IV at IA 1 dose
CoNS
Thyroid S.aureus Nil or Cefazolin 1gm IV Clidamycin600mg IV at IA 1 dose
CoNS
Transrectal prostate Enteric GNB Cefazolin 1gm IV at IA Ciprofloxacin 400mg IV on 1 dose
biopsy(clean- conta call to OR
minate)
Transurethral prostate Enteric GNB Cefazolin 1gm IV at IA Ciprofloxacin 400mg IV on <1day
biopsy(clean- conta call to OR
minate)
Transurethral bladder Enteric GNB Cefazolin 1gm IV at IA Ciprofloxacin 400mg IV on <1day
tumor resection(clean- call to OR
contaminate)
Hysterectomy,abdominal Enteric GNB
or vaginal(clean- conta Group B streptococcus Cefuroxime 1.5gm IV Clidamycin600mg+Gentamicin <1day
minate) Anaerobes 2mg/kg
Ceserean section(clean- Enteric GNB
minate) Group B streptococcus Cefazolin2gm IV Clidamycin600mg+Gentamicin
Anaerobes immediately after cord 2mg/kg <1day
Clamping
IA= induction of anesthesia;ª=indications for vancomycin:1)penicillin allergy;2)high rate of MRSA in the hospital
Reference:1.J Microbiol Immunol Infect 2004;37:71-74 2.The Sanford Guid to antimicrobial therapy 2010.
3.臨床使用抗生素手冊(第三版)