Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

APPENDIX B: UWHC SURGICAL ANTIMICROBIAL PROPHYLAXIS GUIDELINESPrinciples of prophylaxis1) Use antimicrobials for surgical procedures where prophylactic antimicrobials have been found to be beneficial.2) Time antimicrobial administration so that the agent is present in the potentially contaminated tissue before the bacteria enter the site (i.e. at the time ofsurgical incision and persisting in tissues throughout the period of potential contamination). Antimicrobials vary in their distribution pharmacokinetics. Thegoal is begin delivery of the antimicrobial 30-60 minutes before incision to ensure infusion is complete prior to incision. Vancomycin and ciprofloxacin, whichmust be infused over 60 minutes, may be begun 120 minutes prior to incision).3) For longer cases, appropriate antibiotics should be redosed according to their t ½ lives.4) Appropriate antibiotics should be redosed after significant blood loss (4 units or 1000 ml).5) Limit the duration of antimicrobial prophylaxis. Studies document that postoperative antimicrobial administration is not necessary for many surgeries.6) Plan the route of antimicrobial administration, for example, use oral antimicrobials for gut decontamination7) Select an antimicrobial which is active against the most common surgical wound pathogens.Head andNeck 3LIKELYPATHOGENSANTIMICROBIAL REGIMEN(Adult)ANTIMICROBIAL REGIMEN(Pediatric)Basic Case Normal flora of the • Cefuroxime 5 1.5 g IV preop • Cefuroxime 30mg/kg IVmouth, variouspreop (Maximum of 1.5 g)streptococci (includingaerobic and anaerobicspecies), Staph aureus, • Clindamycin 900 mg IV • Clindamycin 10mg/kg IVPeptostreptococcus, plus(Maximum of 900mg) plusNeisseria and numerous gentamicin 1.7 mg/kg IV gentamicin 1.5mg/kg IVanaerobic Gram- preop(Maximum of 80mg) preopnegative bacteriaincluding Porphyromonas----- or---- or• Unasyn®(Bacteroides), Prevotella• Unasyn(ampicillin/sulbactam) (ampicillin/sulbactam)Major head (Bacteroides),1.5 g-3 g IV preop37.5mg/kg (providesand neck Fusobacterium andVeillonella. Nasal flora25mg/kg of ampicillin) IVsurgical casesincludes(Maximum of 3 g) preopwhere mouthStaphylococcus,or pharynx isentered 3 Streptococcus• Cefuroxime 1.5 g IV plus • Cefuroxime 30mg/kg IVpyogenes, StrepMetronidazole 500 mg IV preop (Maximum of 1.5 g)pneumoniae, Moraxellaand Haemophiluspre-opplus Metronidazolespecies.7.5mg/kg IV (Maximum of----- or500mg) preop• Cefoxitin 4 1 g IV preop(2 g if > 80 kg)----- or• Cefoxitin 25mg/kg IV(Maximum of 1 g) preopOR REDOSING• Cefuroxime every 4hours• Clindamycin every 6hours• Unasyn® every 4hours• Cefuroxime every 4hours• Metronidazole every6 hours• Cefoxitin every 3hoursCOMMENTSRisk is high for mixed infections ofanaerobes, staphylococci andsome Gram-negative rods.Risk is high for mixed infections ofanaerobes and staphylococci butnot Pseudomonas.