SURGICAL PROPHYLAXIS ANTIBIOTICS
Surgery- Pediatric
Cardiac
Colorectal or Appendectomy
GI esophageal and gastroduodenal
(for high risk patients)
GI (ruptured viscus)
GU
Head and Neck (thru oral mucosa)
Head and Neck (skin incision)
Neurosurgery
Orthopedic
Thoracic (Cardiac)
Thoracic (Non-Cardiac)
Traumatic Wound
Traumatic Wound (bite)
Antibiotic*
3
4 or [6 and 7 (+/- 1)]
3
4 or ( 6 and 7)
1 plus 7
6 plus 7
3
3 or 5 or 6
3
3
3
3
2
Surgery- Pediatric (cont.)
Surgery- Neonates
Antibiotic*
1 plus 8
Surgery-Adult
Vaginal or Abdominal
Antibiotic
Adult Dose
3
or 4
1 to 2 gm
1 to 2 gm
Endocarditis (SBE) Prophylaxis
See SBE Order Set
MRSA Suspected or Confirmed*
Beta-Lactam (Penicillin) Allergy
9
9 or 6
* Vancomycin (usually in addition to other antibiotics such as cefazolin) should be considered in patients known to be previously colonized or infected
with MRSA. It is used (without cefazolin) in those allergic to penicillins or cephalosporins.
Prophylactic Antibiotic Choices
1 Ampicillin
2 Ampicillin/Sulbactam
3 Cefazolin
4 Cefoxitin
5 Ceftriaxone
6 Clindamycin
7 Gentamicin†‡
8 Gentamicin†§
9
Vancomycin†‡ **
Neonates§ >2 kg
50 mg/kg/dose IV
50 mg/kg/dose IV
25 mg/kg/dose IV
40 mg/kg/dose IV
50 mg/kg/dose IV
10 mg/kg/dose IV
2 mg/kg/dose IV
3 mg/kg/dose IV
10 mg/kg/dose IV
10 mg/kg/dose IV
repeat intraoperatively in 4 hours
repeat intraoperatively in 4 hrs
repeat intraoperatively in 4 hrs
repeat intraoperatively in 4 hrs
repeat intraoperatively in 12 hrs
repeat intraoperatively in 6 hrs
repeat intraoperatively in 8 hrs
NO second dose is recommended
repeat intraoperatively in 8 hrs
repeat intraoperatively in 12 hrs
†
Max 2000 mg
Max 2000 mg
Max 2000 mg
Max 2000 mg
Max 2000 mg
Max 900 mg
Max 120 mg
Max 120 mg
Max 1000 mg
If patient has renal impairment, please call pharmacy for appropriate dose and frequency.
Do not give gentamicin or vancomycin pre-op if patient received a dose within 8 hours of surgery.
§
Do not give gentamicin or vancomycin pre-op if patient received a dose within 12 hrs of surgery for premature neonate, or within 8 hrs if term neonate.
**
Be aware that infusion of vancomycin (even over 60 minutes) may cause hypotension, especially during induction of anesthesia; further slowing of the
infusion and/or treatment with diphenhydramine may be necessary.
‡
Notes:




Doses above are for patients with normal renal function
Always confirm that antibiotics have been given, with surgeons at the time-out or earlier
Additional intra-operative doses should also be given in circumstances of significant blood loss
Please note time of last dose of antibiotic(s) given
For questions contact __________________________________
Infection Control Department
SURGICAL PROPHYLAXIS ANTIBIOTICS
Prophylaxis for Prevention of Endocarditis in Patients with Underlying Cardiac Conditions
(Adapted from AAP Recommendations- 2003 Redbook)
High Risk
Moderate Risk
Not Recommended
1. Prosthetic cardiac valves, including
1. Most other congenital heart
1. Isolated secundum ASD
bioprosthetic and homograft valves
malformations
2. Surgical repair of ASD, VSD or PDA
2. Previous bacterial endocarditis
2. Acquired valvular dysfunction (e.g.
(without residua and beyond 6 mo of age)
3. Complex cyanotic congenital heart
ARF)
3 .Previous coronary artery bypass surgery
disease
3. Hypertrophic cardiomyopathy
4. Mitral valve prolapse with no dysfunction
4. Surgically constructed systemic
4. Mitral valve prolapse with valvular
5. Previous ARF with no valve dysfunction
pulmonary shunts or conduits
regurgitation or thickened leaflets
6. Cardiac pacemakers and implanted
defibrillators
Infection Control Department