Adult and Pediatric Perioperative Antimicrobial Prophylaxis Guidelines

ADULT ive Antimicrobial Prophylaxis Guidelines
Antimi icrobial Selection and Dosing (dirty and infected cases excluded)
Surgical Category
Cardiac/Vascular/
Non-Cardiac Thoracic
Gastrointestinal
Biliary Tract,
Gastroduodenal,
Appendectomy (non-perf),
Colorectal
Antimicrobial Agent and Dose
Cefazolin 1-2g IV x1 *
Ampicillin/Sulbactam
3g IV x1
Notes
Should be continued for no longer than 24 hours.
If beta-lactam allergy, Clindamycin 900mg IV x1.
If beta-lactam allergy:
Clindamycin 900mg IV
x1 +
Gentamicin 2mg/kg IV
x1.
OR
Clindamycin 900mg IV
x1 +
Levofloxacin 500mg IV
x1^.
Orthopedic/Plastics/Hand
With mplant
Cefazolin 1-2g IV x1*
If beta-lactam allergy, Clindamycin 900mg IV x1.
Note: Most clean procedures without prosthetic material
do not require prophylaxis.
Head and
Neck/OMFS/Plastics
With implant
Cefazolin 1-2g IV x1*
If beta-lactam allergy, Clindamycin 900mg IV x1.
Note: Most clean procedures without prosthetic material
do not require prophylaxis.
Clean-contaminated
(oral or pharyngeal mucosa is
compromised)
Neurosurgical
OB/GYN
Cesarean delivery with active labor
or premature rupture of
membranes
Ampicillin/Sulbactam
3g IV x1
If contamination>4hrs, add q8h X 9
doses
Cefazolin 1-2g IV x1*
Cefazolin 1-2g IV x1 *
If beta-lactam # allergy, Clindamycin 900mg IV x1 +
Gentamicin 2mg/kg IV
x1.
If beta-lactam # allergy, Clindamycin 900mg IV x1.
Prophylaxis should be given immediately after the
umbilical cord is clamped.
If beta-lactam # allergy, Clindamycin 900mg IV x1.
Hysterectomy
Cefazolin 1-2g IV x1*
If beta-lactam allergy, Clindamycin 900mg IV x1 +
Levofloxacin 500mg IV
x1^.
Urologic
Levofloxacin 500mg Orally x1 Alternative agents may
be necessary based on results of
prior urine cultures and
susceptibilities.
Notes:
*Cefazolin dosing: 80kg: 2g
^ Intravenous Levofloxacin must be given at a rate no greater than 500mg/hour.
# Beta-Lactam allergy defined as any reported allergy to any penicillin, cephalosporin, or carbapenem.
-For patients with known colonization with MRSA or previous MRSA infection, vancomycin 1gm IV
x1 may be used for
prophylaxis. Vancomycin must be given over at least 60 minutes to minimize the likelihood of Red Man’s Syndrome.
-For all procedures in which cefazolin is administered, a repeat dose should be given iff the proceduree lasts >4 hours.
-For all procedures in which clindamycin is administered, a repeat dose should be given if the procedure lasts >6 hours.
-Recommendations should serve as a guideline, and should
not override clinical judgement.
Endocarditis Prophylaxis (highest risk patients only)
Prosthetic cardiac valve or prosthetic material used for cardiac valve repair
Previous endocarditis
Unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
Completely repaired congenital heart disease with prosthetic material during thee first 6 months after procedure
Repaired congenital heartt disease with residual defect a the site or adjacent to the site of a prosthetic patch or device
Cardiac
transplantation recipients who develop valvulopathy
Procedure
Dental, Oral, Respiratory Tract,
or Esophageal
Genitourinary/Gastrointestinal
(excluding esophageal)
Agent
Ampicillin 2g IV x1
None specifically for endocarditis.
General surgical prophylaxis
only.
Notes
Beta-lactam allergic patients:
Clindamycin 600mg IV x1
Beginning in 2007, The American Heart Association no longer
recommends prophylaxis solely
to prevent endocarditis in these
patients. For general surgical prophylaxis, refer to the proper
surgical category above.
Draft Update November 2010

PEDIA ATRIC
Perioperative Antimicrobial Prophylaxiss Guidelines
Antimicrobial Selection and Dosing (dirty and infected cases excluded)
Surgical
Category
Antimicrobial Agent andd Pediatric Dose
(See opposite side for adult doses)
Notes
Cardiac/Vascular/
Non-Cardiac Thoracicc
Gastrointestinal
Biliary Tract,
Gastroduodenal,
Appendectomy (non-perf),
Colorectal
Cefazolin 30mg/kg IV x1
0-6 months: Ampicillin 50mg/kg IV +
Gentamicin 2. .5mg/kg IV +
Clindamycin 10-15mg/kg IV
>6 months: Ampicillin/Sulbactam 50mg/kgg
For beta-lactam allergic patients:
Clindamycin 10mg/kgg x1
For beta-lactam allergic patients:
Clindamycin 15mg/kgg x1 +
Gentamicin 2.5mg/kgg x1
OR
Metronidazole 10mg/ /kg IV x1
(ampicillin component)
Orthopedic/Plastics/Hand
For beta-lactam allergic patients:
Clindamycin 10mg/kgg x1.
With implant
Cefazolin 30mg/kg IV x1
Most clean procedures without
prosthetic material do
not require
prophylaxis.
Head and
Neck/OMFS/Plastics
With implant
Cefazolin 30mg/kg IV x1
For beta-lactam allergic patients:
Clindamycin 10mg/kgg x1. Most clean
procedures without prosthetic material
do not require prophylaxis.
Clean-contaminated
(oral or pharyngeal mucosa is compromised)
Cefazolin 30mg/kg IV x1 +
Clindamycin 10-15mg/kg IV
x1
For beta-lactam allergic patients:
Clindamycin 10mg/kgg IV x1 +
Gentamicin 2.5mg/kgg IV x1
Neurosurgical
Cefazolin 30mg/kg IV x1
For beta-lactam allergic patients:
Clindamycin 10mg/kgg x1
Urologic
(for patients with knownn bacteriuria only)
0-2 yrs: Gentamicin 2.5mg/kg IV x1
>2 yrs: Sulfamethoxazole/Trimethoprim
5mg/kg (trimethoprim component) IV
Alternative agents may be necessaryy
based on results of prior urine cultures.
infusion over 60 minutes x1
Notes:
-For patients with known colonization with MRSA or previous MRSA infection, vancomycin 15mg/kg IVPB x1 may be used
for prophylaxis. Vancomycin must
be given over
60 minutes to minimize the likelihood of Red Man’s Syndrome.
-Sulfamethoxazole/Trimethoprim and Doxycycline should
be administered as an infusion over 60 minutes.
-For all procedures in which cefazolin is administered, a repeat dose should be given iff the proceduree lasts >4 hours.
-For all procedures in which clindamycin is administered, a repeat dose should be given if the procedure lasts >6 hours.
-Recommendations should serve as a guideline, and should
not override clinical judgement.
-Endocarditis
Prophylaxis:
Procedure
Agent
Notes
Dental,
Oral, Respiratory Tract, or Esophageal
Ampicillin
50mg/kg IV x1 or
Beta-lactam allergic patients:
Cefazolin 30mg/kg IV
x1
Clindamycin 10mg/kg IV x1
Genitourinary/Gastrointestinal (excluding
Ampicillin 50mg/kg IV x1, then
Beta-lactam allergic patients:
esophageal)
25mg/kg IV 6 hrs later +
Vancomycinn 20mg/kg IV infusion x1 +
Gentamicin 2.5mg/kg
gentamicin (dose at left)
(max 120mg) x1 on induction
OR
>6 months: Ampicillin/Sul
lbactam
50mg/kg (ampicillin component)
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, Grosss PA, Barrett TL, et al. Quality standards
for antimicrobial prophylaxis in
surgical procedures. Released in 1994 (reviewed in 1998). Clin Infectt Dis 1994 Mar;18(3):422-7.
-ASHP (American Society of Health System Pharmacists). ASHP Commission on Therapeutics: ASHPP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery. Am J
Health Syst Pharm 1999;56:1839-88.
-American Heart Association. Wilson W, Taubertt KA, Gewitz M,, et al. Prevention of Bacterial Endocarditis. Circulationn 2007;106.
Draft Update November 2010