Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

TraumaticwoundStaphylococcus aureus,Group A streptococci,clostridia• Cefazolin 4 1 g IV pre-op(2 g if > 80 kg)----- or• Cefuroxime 4,5 1.5 g IVplus or minus gentamicin80 mg(or tobramycin 3.3 mg/kg)IV pre-op• Cefazolin 25mg/kg IV preop(Maximum of 1 g)---- Or• Cefuroxime 30mg/kg IV(Maximum of 1.5 g) plus orminus gentamicin 2mg/kgIV (Maximum of 80mg) preop• Cefazolin every 4hours• Cefuroxime every4 hoursOrganisms may vary dependingon source of injury.If wound has been massivelycontaminated by soil, manure ordirty water, a regimen withactivity against P. aeruginosa, S.aureus, and other Gram--negative bacilli is recommended.• Add vancomycin 1g IV ifMRSA+---- Or• Add vancomycin 15mg/kgIV (Maximum of 1 g) ifMRSA+Footnotes:1. This population is usually elderly and doses should be adjusted accordingly based on renal function.2. Patients receiving vancomycin preoperatively may be given diphenhydramine 50 mg IV just before the vancomycin to reduce the risk of hypotension secondary tohistamine release3. Add endocarditis prophylaxis in patients at risk (ampicillin 2 g IV given 30 min prior to incision or vancomycin 1 g IV over 1 hour, completing infusion within 30min of starting procedure).4. Use clindamycin 600 mg 30 min pre-op for penicillin-allergic patients where the reaction is severe enough (i.e.: hives, angioedema, anaphylaxis) to warrantavoiding cephalosporins5. Use cefazolin 1-2 g IV if cefuroxime is not available.References:1. Clinical Infectious Diseases 2004;38:1706-152. Arch Surg 1993; 128: 79-883. Infect Control Hosp Epidemiol 1999; 20: 250-784. Clin Pharm 1992; 11: 483-5135. Medical Letter 2004; 2: 27-326. ASHP Therapeutic Guidelines on Antimicrobial Prophylaxis in Surgery April 21, 1999