Therapeutic Handbook - GGC Prescribing

Surgical Antibiotic ProphylaxisThe policy is based on SIGN 104 (July 2008) which outlines those surgical procedures requiringprophylactic antibiotics and how and when they should be administered.Refer to surgical speciality guidelines at StaffNet, Clinical Guideline Electronic Resource Directoryand search in 'Infections' section for specific agent(s) and regimens, including gentamicin prophylaxisguideline.General antibiotic prophylaxis prescribing guidance• Check whether indication is appropriate. See tables on StaffNet for indication and antibioticchoice. Always discuss any complex individual prophylaxis issues with microbiology preoperatively.• Record antibiotic in the “once only” section of drug prescription form, not in the anaestheticrecord.• Administer a single dose of antibiotic(s). Optimum time is < 60 minutes prior to skin incision(usually in anaesthetic room at induction of anaesthesia). If > 1 hour has elapsed, cover will besub-optimal.• In some circumstances a second dose may be required. If so always document the reason whichmay be:- >1.5 litre intra-operative blood loss in which case following fluid replacement, re-dose givingsame dose for all agents except gentamicin (give only half the recommended prophylaxisdose) and teicoplanin (do not redose).- If surgery is prolonged then re-dose as per specific prophylaxis guideline• MRSA: decolonise prior to procedure as per NHSGGC infection control guidelines and discusswith microbiology regarding antibiotic choice.• Prophylactic gentamicin dosing is based on patient height and approximates to 3 mg/kg/idealbody weight, capped at 300 mg (see StaffNet for dosing table). This allows bolus administrationin anaesthetic room. Avoid prophylactic gentamicin if eGFR < 10ml/minute/1.73m 2 : seek adviceon an alternative from microbiology.Post-operative intra-abdominal infection managementInfection present prior to and following surgery: When intra-abdominal surgery has beenperformed as part of the management of an infection episode (e.g. laparotomy for peritonitis),antibiotic therapy as per infection management guidelines should be followed.No infection suspected prior to surgery: For suspected intra-abdominal sepsis followingintra-abdominal surgery / laparoscopy (e.g. following routine or “cold” colorectal surgery) wheregentamicin has been used within the prophylactic regime, give piperacillin and tazobactam, seepage 237. If true penicillin / beta-lactam allergy discuss treatment options with microbiology.For any other post-operative infection, seek advice from microbiology or the infectious diseasesunit.InfectionsPage 259