BNF for Children 2011-2012

256 5.1 Antibacterial drugs BNFC 2011–20125 InfectionsResections of colon and rectum, and resections ininflammatory bowel disease, and appendicectomy 1Single dose 2 of i/v gentamicin + i/v metronidazole 3 ori/v cefuroxime + i/v metronidazole 3 or i/v co-amoxiclavaloneAdd i/v teicoplanin 4 if high risk of meticillin-resistant StaphylococcusaureusEndoscopic retrograde cholangiopancreatography 1Single dose of i/v gentamicin or oral or i/v ciprofloxacinProphylaxis recommended if pancreatic pseudocyst, immunocompromised,history of liver transplantation, or risk ofincomplete biliary drainage. For biliary complications followingliver transplantation, add i/v amoxicillin or i/vvancomycinPercutaneous endoscopic gastrostomy orjejunostomy 1Single dose of i/v co-amoxiclav or i/v cefuroximeUse single dose of i/v teicoplanin 4 if history of allergy topenicillins or cephalosporins, or if high risk of meticillinresistantStaphylococcus aureusPrevention of infection in orthopaedicsurgeryClosed fractures 1Single dose 2 of i/v cefuroxime or i/v flucloxacillinIf history of allergy to penicillins or to cephalosporins or ifhigh risk of meticillin-resistant Staphylococcus aureus, usesingle dose 2 of i/v teicoplanin 4Open fracturesi/v co-amoxiclav alone or i/v cefuroxime + i/v metronidazole(or i/v clindamycin alone if history of allergy topenicillins or to cephalosporins)Add i/v teicoplanin 4 if high risk of meticillin-resistant Staphylococcusaureus. Start prophylaxis within 3 hours ofinjury and continue until soft tissue closure (max. 72 hours).At first debridement also use a single dose of i/v cefuroxime+ i/v metronidazole + i/v gentamicin or i/v co-amoxiclav +i/v gentamicin (or i/v clindamycin + i/v gentamicin ifhistory of allergy to penicillins or to cephalosporins).At time of skeletal stabilisation and definitive soft tissueclosure 1 use a single dose of i/v gentamicin and i/vteicoplanin 4Prevention of infection in obstetric surgeryTermination of pregnancySingle dose 2 of oral metronidazoleIf genital chlamydial infection cannot be ruled out, givedoxycycline (section 5.1.3) postoperativelyPrevention of endocarditisNICE GuidanceAntimicrobial prophylaxis against infectiveendocarditis in children and adultsundergoing interventional procedures(March 2008)Antibacterial prophylaxis and chlorhexidinemouthwash are not recommended for the preventionof endocarditis in patients undergoing dentalprocedures.Antibacterial prophylaxis is not recommended forthe prevention of endocarditis in patients undergoingprocedures of the:. upper and lower respiratory tract (including ear,nose, and throat procedures and bronchoscopy);. genito-urinary tract (including urological,gynaecological, and obstetric procedures);. upper and lower gastro-intestinal tract.While these procedures can cause bacteraemia,there is no clear association with the developmentof infective endocarditis. Prophylaxis may exposepatients to the adverse effects of antimicrobialswhen the evidence of benefit has not been proven.Any infection in patients at risk of endocarditis 5should be investigated promptly and treated appropriatelyto reduce the risk of endocarditis.If patients at risk of endocarditis 5 are undergoing agastro-intestinal or genito-urinary tract procedure ata site where infection is suspected, they shouldreceive appropriate antibacterial therapy thatincludes cover against organisms that cause endocarditis.Patients at risk of endocarditis 5 should be:. advised to maintain good oral hygiene;. told how to recognise signs of infective endocarditis,and advised when to seek expertadvice.Dermatological proceduresAdvice of a Working Party of the British Society forAntimicrobial Chemotherapy is that patients whoundergo dermatological procedures 6 do not requireantibacterial prophylaxis against endocarditis.1. Intravenous antibacterial prophylaxis should be given up to30 minutes before the procedure2. Additional intra-operative or postoperative doses of antibacterialmay be given for prolonged procedures or if thereis major blood loss3. Metronidazole may alternatively be given by suppositorybut to allow adequate absorption, it should be given 2hours before surgery4. Where teicoplanin is suggested vancomycin may be used5. Patients at risk of endocarditis include those with valvereplacement, acquired valvular heart disease with stenosisor regurgitation, structural congenital heart disease (includingsurgically corrected or palliated structural conditions,but excluding isolated atrial septal defect, fullyrepaired ventricular septal defect, fully repaired patentductus arteriosus, and closure devices considered to beendothelialised), hypertrophic cardiomyopathy, or a previousepisode of infective endocarditis6. The British Association of Dermatologists Therapy Guidelinesand Audit Subcommittee advise that such dermatologicalprocedures include skin biopsies and excision ofmoles or of malignant lesions