SURGICAL PROPHYLAXIS ANTIBIOTICS

Surgery- Pediatric / Antibiotic* / Surgery- Pediatric (cont.) / Antibiotic*
Cardiac / 3 / Surgery- Neonates / 1 plus 8
Colorectal or Appendectomy / 4 or [6 and 7 (+/- 1)]
GI esophageal and gastroduodenal (for high risk patients) / 3
GI (ruptured viscus) / 4 or ( 6 and 7)
GU / 1 plus 7 / Surgery-Adult / Antibiotic / Adult Dose
Head and Neck (thru oral mucosa) / 6 plus 7 / Vaginal or Abdominal / 3 / 1 to 2 gm
Head and Neck (skin incision) / 3 / or 4 / 1 to 2 gm
Neurosurgery / 3 or 5 or 6
Orthopedic / 3 / Endocarditis (SBE) Prophylaxis / See SBE Order Set
Thoracic (Cardiac) / 3
Thoracic (Non-Cardiac) / 3
Traumatic Wound / 3 / MRSA Suspected or Confirmed* / 9
Traumatic Wound (bite) / 2 / Beta-Lactam (Penicillin) Allergy / 9 or 6

*Vancomycin (usually in addition to other antibiotics such as cefazolin) should be considered in patients known to be previously colonized or infected

with MRSA. It is used (without cefazolin) in those allergic to penicillins or cephalosporins.

Prophylactic Antibiotic Choices

1 / Ampicillin / 50 mg/kg/doseIV / repeat intraoperatively in 4 hours / Max 2000 mg
2 / Ampicillin/Sulbactam / 50 mg/kg/doseIV / repeat intraoperatively in 4 hrs / Max 2000 mg
3 / Cefazolin / 25 mg/kg/doseIV / repeat intraoperatively in 4 hrs / Max 2000 mg
4 / Cefoxitin / 40 mg/kg/doseIV / repeat intraoperatively in 4 hrs / Max 2000 mg
5 / Ceftriaxone / 50 mg/kg/doseIV / repeat intraoperatively in12 hrs / Max 2000 mg
6 / Clindamycin / 10 mg/kg/doseIV / repeat intraoperatively in 6 hrs / Max 900 mg
7 / Gentamicin†‡ / 2 mg/kg/doseIV / repeat intraoperatively in 8 hrs / Max 120 mg
8 / Gentamicin†§ / 3 mg/kg/dose IV / NO second dose is recommended / Max 120 mg
9 / Vancomycin†‡** / 10 mg/kg/dose IV / repeat intraoperatively in 8 hrs / Max 1000 mg
Neonates§ >2 kg / 10 mg/kg/dose IV / repeat intraoperatively in 12 hrs

†If patient has renal impairment, please call pharmacy for appropriate dose and frequency.

‡Do not give gentamicin or vancomycin pre-op if patient received a dose within 8 hours of surgery.

§Do not give gentamicin or vancomycin pre-op if patient received a dose within 12 hrs of surgery for premature neonate, or within 8 hrs if term neonate.

**Be aware that infusion of vancomycin (even over 60 minutes) may cause hypotension, especially during induction of anesthesia; further slowing of the

infusion and/or treatment with diphenhydramine may be necessary.

Notes: Doses above are for patients with normal renal function

  • Always confirm that antibiotics have been given, with surgeons at the time-out or earlier
  • Additional intra-operative doses should also be given in circumstances of significant blood loss
  • Please note time of last dose of antibiotic(s) given
  • For questions contact ______

Prophylaxis for Prevention of Endocarditis in Patients with Underlying Cardiac Conditions

(Adapted from AAP Recommendations- 2003 Redbook)

High Risk / Moderate Risk / Not Recommended
1. Prosthetic cardiac valves, including
bioprosthetic and homograft valves
2. Previous bacterial endocarditis
3. Complex cyanotic congenital heart disease
4. Surgically constructed systemic pulmonary shunts or conduits
/ 1. Most othercongenital heart malformations
2. Acquired valvular dysfunction(e.g. ARF)
3. Hypertrophic cardiomyopathy
4. Mitral valve prolapse with valvular
regurgitation or thickened leaflets
/ 1. Isolated secundum ASD
2. Surgical repair of ASD, VSD or PDA (without residua and beyond 6 mo of age)
3 .Previous coronary artery bypass surgery
4. Mitral valve prolapse with no dysfunction
5. Previous ARF with no valve dysfunction
6. Cardiac pacemakers and implanted defibrillators

Infection Control Department