Guidelines for the Use of Prophylaxis

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)