Guidelines Document Title: Document ID: Document Name: Surgical antibiotic prophylaxis adult patients GD-CLN-900027 GD-CLN-900027 Version Number: 3.4 Revision Date: 30/08/2016 Key Words Antimicrobial stewardship, antibiotics, antibiotic, surgical, surgery, prophylaxis, medication Internal Use Only: The Material within this document has been developed solely for the internal business purposes of Mater Health Services. Disclosure of information of this classification may result in a breach of statutory or regulatory obligations by the Mater. NOTICE OF CURRENCY: If viewing a printed copy of this document, NEVER assume that the printed copy being viewed is current. Always check the online Mater Document Centre to confirm you are viewing the current version of this guideline. Our Mission Our Vision Our Values In the spirit of the Sisters of Mercy, Mater Health Services offer compassionate service to the sick and needy, promotes an holistic approach to healthcare in response to changing community needs and foster high standards in health-related education and research. Following the example of Christ the healer, we commit ourselves to offering these services without discrimination. In the Mercy tradition, Mater will be renowned as a leader in the delivery of exceptional healthcare and experienced by all as a community of compassion. Mercy Dignity Care Commitment Quality Affirmation This governance document is consistent with the Mater Values and supports the Mater s Mission and Vision by establishing and mandating appropriate controls to support the delivery of health care services. Copyright Mater Misericordiae Health Services Brisbane Limited. All Rights Reserved.
Table of Contents 1 Document Controls... 3 1.1 Document Revision History... 3 1.2 Document Review and Approval... 3 1.3 References... 3 2 Introduction... 4 2.1 Purpose... 4 2.2 Scope and Context... 4 3 Guidelines... 5 3.1 General Information... 5 4 Appendices... 6 4.1 Appendix 1: MHS Recommendations for Adult Surgical Antibiotic... 6 Abdominal surgery 6 Gastrointestinal endoscopic procedures..8 Breast surgery..9 Plastic Surgery.9 Head and neck surgery..9 Vascular surgery..10 Amputation lower limb..10 Neurosurgery. 11 Cardiac surgery. 11 Thoracic surgery..11 Obstetric and gynaecological surgery..12 Orthopaedic surgery. 12 Urological surgery..13 Copyright Mater Misericordiae Health Services Brisbane Limited. All Rights Reserved.
1 Document Controls 1.1 Document Revision History Version Date Description 1 08-Feb-2014 Version 1 published on the Mater Document Centre 2 23-Jun-2014 Version 2 published on the Mater Document Centre 3 24-Jun-2016 Version 3 published on the Mater Document Centre. 3.1 07-Jul-2016 Amendments requested by Anna Klusak (AMS Pharmacist): a. The words endocarditis prophylaxis have been added to Abdominal surgery, Gastrointestinal endoscopic procedures, Urological surgery, and notes under Vancomycin (page 16) b. Vascular surgery and Amputation of lower limb (for patients with MRSA), additional words consider repeating dose of vancomycin* 15 mg/kg after 12 hours. c. Orthopaedic surgery (for patients with open fractures and immediate ), dose is specified at 450 mg 8 hourly where it states Continue dosing 3.2 01-Aug-2016 Amendment requested by Nicola Townell (AMS Physician): Statement added to MHS recommendations for adult surgical antibiotic prophylaxis (top of page 6) about the timing of antibiotic administration (fifth dot point) 3.3 30-Aug-2016 Amendment requested by Anna Klusak(AMS Pharmacist): a. Tallman lettering added throughout the document b. New content added directly under heading Plastic surgery (two dot points) 3.4 02-Dec-2016 Amendment requested by Anna Klusak (AMS Pharmacist) to correct typo on page 16. Dosing for teicoplanin, second line, changed from greater than 80 kg to up to 80 kg. 1.2 Document Review and Approval Person Name / Committee Position (if applicable) Function (Owner Approve Review) Anna Klusak Antimicrobial Stewardship Pharmacist Document author Nicola Townell Infectious Diseases/AMS physician Document author Steve Parry-Jones Director of Pharmacy Document owner Antimicrobial Stewardship Working Party Clinical Policy Governance Committee Review/approve Endorse 1.3 References Internal Documents Document Type Document ID (with link) Document Title Governing PY-CLN-900018 Prescribing, administration and safe management of medications - adult patients Supporting PR-CLN-900060 Antimicrobial prescribing and management Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 3 of 17
PR-CLN-000016 Medication abbreviation plus Tallman Related GD-CLN-900009 Gentamicin dosing and monitoring guidelines for adult patients External Documents 1 : surgical [revised 2014 Oct] In: etg complete [Internet]. Melbourne: Therapeutic Guidelines Limited; 2015 July 2 Alfirevic Z, Gyte GML, Dou L. Different classes of antibiotics given to women routinely for preventing infection at caesarean section. Cochrane Database of Systematic Reviews 2010, Issue 10. Art. No: CD008726. DOI: 10.1002/14651858.CD008726. 3 Duguid M, Cruickshank M (eds). Antimicrobial Stewardship in Australian Hospitals. Australian Commission on Safety and Quality in Healthcare. 2011 [online] [accessed 02/06/2014] http://www.health.gov.au/internet/safety/publishing.nsf/content/ba31d58417a40e8cca2578620002ee1 B/$File/AMS-PRELIMS-EXEC%20SUMMARY.PDF 4 Centre for Healthcare Related Infection Surveillance and Prevention. Position Statement: Surgical Antibiotic. 2010. [online] [accessed 02/06/2014] http://www.health.qld.gov.au/chrisp/resources/antibio_proph.pdf 5 van Schalkwyk J, Van Eyk N, Council of the Society of Obstetricians and Gynaecologists of Canada (SOGC). Clinical Practice Guideline. Antibiotic in Obstetric Procedures. 2010, 247, September: 870-895. [online] [accessed 02/06/2014] http://www.sogc.org/guidelines/documents/gui247cpg1009e_000.pdf 6 Costantine MM, Rahman M, Ghulmiyah L, Byers BD, Longo M, Wen T, Hankins GDV, Saade MD. Timing of perioperative antibiotic for caesarean section: a metaanalysis. American Journal of Obstetrics and Gynecology, 2008, 199(3): 301.e1-301.e6. 7 Sullivan SA, Smith T, Chang E, Hulsey T, Vandorsten JP, Soper DA. Administration of Cephazolin prior to skin incision is superior to Cephazolin at cord clamping in preventing postcesarean infectious morbidity: A randomized, controlled trial. American Journal of Obstetrics and Gynaecology, 2007, 196(5):455.e1-455e-5. 8 Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, Napolitano LM, Sawyer RG, Slain D, Steinberg JP, Weinstein RA. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2011,70(1):195-283. 2 Introduction 2.1 Purpose This guideline is to provide a standardised approach to the appropriate use and prescribing of surgical antibiotic prophylaxis to minimise surgical site infections. The objective of this guideline is to minimise the selection of antibiotic-resistant organisms and promote safe and effective antibiotic prescribing. Inappropriate prescribing is wasteful and may endanger patient wellbeing. The primary basis for decision-making approval is the latest edition of the Therapeutic Guidelines. 1 2.2 Scope and Context This guideline applies to all staff working within the Mater Health Services relating to adult patients who require surgical antibiotic prophylaxis Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 4 of 17
3 Guidelines 3.1 General Information a. The process for administration of antibiotic prophylaxis should be standardised to ensure consistent, timely administration. There is evidence to suggest that optimal timing of antibiotic prophylaxis prior to surgery is within the period 15-30 minutes. Thus it is recommended that antibiotics be administered within this window. Antibiotics requiring longer infusion times should be administered such that the infusion is complete during this time. b. The guidelines for surgical antibiotic prophylaxis and the administration process should be reviewed regularly and in accordance with the published Therapeutic Guidelines. 1 c. The choice of antibiotic should be in accordance with the published Therapeutic Guidelines and be guided by previous microbiological results and known colonisations. For further advice please contact Infectious Diseases. d. Implementation of these recommendations will mean that the health service has taken responsible steps to respond to the legal duty to improve the quality of care provided with regard to the surgical antibiotic prophylaxis standard. e. The current Mater Health Services recommendations are available in all operating theatres and via the Intranet. f. Compliance with surgical antibiotic prophylaxis will be monitored via the Infection Control surgical site surveillance program and results reported to the Infection Control Committees and the Health Quality and Complaints Commission (HQCC). g. Antibiotic dose and timing must be clearly and accurately documented on the anaesthetic record. Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 5 of 17
4 Appendices 4.1 Appendix one: MHS Recommendations for adult surgical antibiotic prophylaxis MHS recommendations for adult surgical antibiotic prophylaxis If patient is known or suspected to be colonised with a resistant organism OR has a history of overseas travel (India, Asia, Southern Europe) in the last 12 months, or known contraindications to agents listed below, contact ID/Clinical Microbiology for advice Post-operative antibiotics are NOT indicated unless infection is confirmed or suspected, regardless of the presence of surgical drains or indwelling urinary catheters If infection is suspected, consider modification of antibiotic regimen according to clinical condition and microbiology results One dose of antibiotic is generally sufficient. Second dose is indicated if surgery delayed or prolonged beyond antibiotic re-dosing times- see Table A below. Antibiotics should be administered within an hour of surgical incision (ideally within 15-30 minutes ) Surgical indication Table A: Recommended antibiotic re- dosing times 8 Antibiotic Re-dosing interval cefazolin 4 hours clindamycin 4 hours gentamicin NA metronidazole 12 hours vancomycin* 8 hours Abdominal surgery Table B: Recommended rates for IV infusions Antibiotic Rate clindamycin 30 mg/minute. Dilute to 18 mg/ml or weaker prior to infusion. metronidazole 25 mg/minute vancomycin* 15 mg/minute (~1g/hr) Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 6 of 17 Endocarditis prophylaxis: Patients with specific cardiac conditions undergoing gastrointestinal tract procedures where antibiotic prophylaxis is routinely indicated require antibiotics for the prevention of infective endocarditis. See end of table ## a) Gastroduodenal /oesophageal procedures entering GIT lumen or for procedures NOT entering the lumen, only for patients with risk factors for postoperative infection e.g. obesity; immunocompromise; gastric outlet obstruction; reduced gastric acidity or motility; gastrointestinal bleeding, malignancy or perforation b) Biliary procedures for patients with risk factors or surgical risk factors for postoperative infection e.g. older than 70 years, diabetes, obstructive jaundice, common bile duct stones, acute cholecystitis or nonfunctioning gall bladder; and open cholecystectomy Exclusions: Low risk, uncomplicated elective biliary procedures, including laparoscopic surgery prior ideally gentamicin 5 mg/kg ideal body weight IV prior ADD
Surgical indication Abdominal surgery Endocarditis prophylaxis: Patients with specific cardiac conditions undergoing gastrointestinal tract procedures where antibiotic prophylaxis is routinely indicated require antibiotics for the prevention of infective endocarditis. See end of table ## c) Small intestine Exclusions: endoscopic procedures If obstruction is present, metronidazole 500 mg IV prior gentamicin 5 mg/kg ideal body weight IV ideally ADD If obstruction is present, metronidazole 500 mg IV d) Colorectal surgery and appendicectomy e) hernia repair with prosthetic material (mesh) Consider IF risk factors e.g. immunocompromise, advanced age, reoperation, prolonged duration of surgery, use of surgical drains. If entry in bowel lumen expected follow colorectal and appendicectomy advice see above Exclusions: hernia repair without prosthetic material. metronidazole 500 mg IV prior prior prior gentamicin 5 mg/kg ideal body weight IV metronidazole 500 mg IV ideally ideally ADD ADD Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 7 of 17
Surgical indication Gastrointestinal endoscopic procedures Endocarditis prophylaxis: Patients with specific cardiac conditions undergoing gastrointestinal tract procedures where antibiotic prophylaxis is routinely indicated require antibiotics for the prevention of infective endocarditis. See end of table ## a) Endoscopic retrograde cholangiopancreatography (ERCP) Evidence of biliary tract obstruction where it is suspected that complete biliary drainage may not be achieved e.g. primary sclerosing cholanigitis, hilar tumours Communicating pancreatic cysts, drainage of pseudocysts. Patients with acute cholangitis should be on treatment antibiotics 1. Additional single dose- ERCP prophylaxis is not recommended. The timing of the antibiotic dose should be adjusted to achieve adequate plasma and tissue concentrations at the time of surgical incision and for the duration of the procedure. b) Endoscopic ultrasound-guided (EUG) fine-needle aspiration Only if significant bowel contamination i.e. solid lesions adjacent to lower GIT and cystic lesions adjacent to the GIT only Exclusions: Solid lesions adjacent to the upper GIT c) Gastrostomy or jejunostomy tube insertion prior metronidazole 500 mg IV prior prior gentamicin 5 mg/kg ideal body weight IV prior gentamicin 5 mg/kg ideal body weight IV metronidazole 500 mg IV prior ideally Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 8 of 17
Surgical indication a) Breast cancer surgery including lymph node exploration, reduction mammoplasty, procedures involving prosthetic implantation or wire localisation and reoperations Exclusions: wound revision, diagnostic excisional biopsy, lumpectomy without wire localisation. Breast surgery within the period 15-30 minutes prior to first incision Plastic surgery ideally Continuation of antibiotic while waiting for non-infected skin graft or flaps to epithelise is not evidence based and is not recommended Application of topical antibiotics (e.g. chloramphenicol, mupirocin) to surgical infection site to prevent postoperative wound infection is not indicated a) Clean-contaminated procedures. Exclusions: clean procedures unless risk factors for postoperative infection e.g. implantation prosthetic material, prior skin irradiation or complex procedure such as TRAM within the period 15-30 minutes prior to first incision Head and neck surgery ideally Patients with specific cardiac conditions undergoing tonsillectomy or adenoidectomy require antibiotics for the prevention of infective endocarditis. See end of table ## a) Incision through oral, nasal, pharyngeal or oesophageal mucosa; stapedectomy or similar operations b) Procedures that involve insertion of prosthetic material Exclusions: tonsillectomy, adenoidectomy, thyroidectomy, nasal septoplasty, endoscopic sinus surgery or uncontaminated neck dissection (for incision through mucosal surfaces) metronidazole 500mg IV prior clindamycin 900mg IV over at least 30 minutes, to be completed within the period 15-30 minutes Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 9 of 17
Surgical indication Vascular surgery Reconstructive surgery involving the abdominal aorta or lower limbs and implantation foreign material Exclusions: Surgery on varicose veins where prosthetic material is NOT inserted within the period 15-30 minutes prior to first incision, then 8 hourly for up to 2 further doses Amputation lower limb vancomycin* 25mg/kg ideally Consider repeating dose of vancomycin* 15mg/kg after 12 hours IF there is a risk of infection with gram negative organisms gentamicin 5mg/kg ideal body weight^ IV To be Consider repeating dose of vancomycin* 15mg/kg after 12 hours Exclusions: receiving treatment for established infection. Dose and timing should be adjusted to ensure adequate tissue concentrations at time of incision. In these patients, antibiotic treatment can be stopped 2-5 days after amputation if infected bone and tissue removed within the period 15-30 minutes prior to first incision, then 8 hourly for up to 2 further doses IF limb is ischaemic ADD metronidazole 500mg IV to be Consider repeating dose of metronidazole after 12 hours vancomycin* 25mg/kg ideally Consider repeating dose of vancomycin* 15mg/kg after 12 hours gentamicin 5mg/kg ideal body weight^ IV IF limb is ischaemic ADD Consider repeating dose of vancomycin* 15mg/kg after 12 hours metronidazole 500mg IV Consider repeating dose after 12 hours. To be Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 10 of 17
Surgical indication a) Craniotomy when procedure is prolonged, reexplorations and microsurgery, insertion of prosthetic material Ventricular drains that remain in situ are not a justification to extend the duration of antibiotic prophylaxis beyond what is otherwise indicated for a specific procedure. a) Device insertions Insertion of implantable cardiac devices such as permanent pacemakers, cardioverterdefibrilators or cardiac resynchronisation devices a) Thoracic surgery including VATS procedure Neurosurgery Cardiac surgery Completed within the period 15-30 minutes prior. Thoracic surgery cefazolin 2 grams IV (3g if 120kg or greater) within the period 15-30 minutes prior to first incision ideally vancomycin* 25mg/kg gentamicin 5 mg/kg ideal body weight IV Completed within the period 15-30 minutes prior. ideally Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 11 of 17
Surgical indication a) Caesarean section Administered before skin incision (not after cord clamping) 7 Administer to all patients including those who are already on prophylaxis for Group B Streptococcus or pre-term premature rupture of membranes (PPROM) Obstetric and gynaecological surgery b) Hysterectomy a) Prosthetic large joint replacement, procedures involving insertion of prosthetic or transplant material; internal fixation of fractures, spinal surgery and arthroscopic procedures involving insertion of prosthetic material, avascular tissue, or patient is immunocompromised. metronidazole 500mg IV Infusion to be complete within the period 15-30 minutes Orthopaedic surgery. Exclusions: routine arthroscopic procedures a) Open fractures. Continue dosing 8 hourly for 24-72 hours if debridement has occurred within 8 hours of injury. If more than 8 hours after injury, give presumptive treatment for 7 days, even if there is no evidence of infection clindamycin 900mg IV over at least 30 minutes, to be completed within the period 15-30 minutes clindamycin 900mg IV over at least 30 minutes, to be completed within the period 15-30 minutes gentamicin 5mg/kg ideal body weight^ IV intravenously within the period 15-30 minutes ideally clindamycin 900mg IV over at least 30 minutes, completed within the period 15-30 minutes Continue dosing at 450 mg 8 hourly for 24-72 hours if debridement has occurred within 8 hours of injury. If more than 8 hours after injury, give presumptive treatment for 7 days, even if there is no evidence of infection. Switch to oral therapy when patient able to tolerate (450mg 8 hourly). Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 12 of 17
Surgical indication Urological surgery Preoperative urine cultures are recommended before elective urological procedures. Treatment is recommended for patients with significant bacteriuria even if they are asymptomatic due to increased risk of postoperative infection. Treat with a short course of antibiotics, as per recommendations for acute cystitis in adults and children in the Therapeutic Guidelines: Antibiotic 1 and guided by the results of cultures and susceptibility testing Endocarditis prophylaxis: Patients with specific cardiac conditions undergoing genitourinary tract procedures require antibiotics for the prevention of infective endocarditis. See end of table ## a) Endoscopic procedures Intrarenal and ureteric stone procedures (e.g. percutaneous nephrolithotomy, ureteroscopy or pyeloscopy for ureteric or renal stones) Specific risk for infection (e.g. resection of large or necrotic tumors, risk of bleeding, bladder outlet obstruction with incomplete bladder emptying) b) Transurethral resection of the prostate (TURP)* For recommendations for prophylaxis in radical prostatectomy, see open or laparoscopic urological procedures gentamicin 2 mg/kg IV ideal body weight^ (See table D in appendix for dosing) If gentamicin is contraindicated or relevant precautions preclude its use, REPLACE gentamicin with: gentamicin 2 mg/kg IV ideal body weight^ (See table D in appendix for dosing) gentamicin 2 mg/kg IV ideal body weight^ (See table D in appendix for dosing) If gentamicin is contraindicated or relevant precautions preclude its use, REPLACE gentamicin with: OR trimethoprim 300 mg orally, trimethoprim 300 mg orally, OR trimethoprim + sulfamethoxazole 160 + 800 mg orally OR trimethoprim + sulfamethoxazole 160 + 800 mg orally Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 13 of 17
Surgical indication c) Transrectal prostatic biopsy~ Urological surgery Ciprofloxacin~ 500 mg orally, as a single dose 1 to 2 hours before the procedure If procedure is delayed beyond 6 hours, repeat the dose d) Transperineal prostatic biopsy~ e) Open or laparoscopic urological procedures where the urinary tract is NOT entered* ~for patients at high risk of carriage of ciprofloxacin-resistant Enterobacteriaceae (e.g. quinolone therapy within the preceding 3 months, or travel to Asia or southern Europe within the preceding 6 months), Contact ID/Clinical microbiology for advice ideally ideally before first incision is NOT required for patients with sterile urine unless the patient has risk factors for post-operative infection or the procedure involves implantation of prosthetic devices. Consider prophylaxis where immediate operation is required and bacteriuria cannot be excluded. For implantation of prosthetic devices (e.g. penile prosthesis, artificial urinary sphincters) gentamicin 2 mg/kg ideal body weight^ IV (See table D in appendix for dosing) If gentamicin is contraindicated or relevant precautions preclude its use, REPLACE gentamicin with: REPLACE cephazolin with: ideally ideally before first incision trimethoprim 300 mg orally, OR trimethoprim + sulfamethoxazole 160 + 800 mg orally Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 14 of 17
Surgical indication f) Open or laparoscopic urological procedures where the urinary tract IS entered* For radical prostatectomy or implantation of prosthetic devices (e.g. mesh) gentamicin 2 mg/kg ideal body weight^ IV (See table D in appendix for dosing) Urological surgery ideally gentamicin 2 mg/kg ideal body weight^ IV (See table D in appendix for dosing) ideally before first incision If gentamicin is contraindicated or relevant precautions preclude its use, REPLACE gentamicin with: trimethoprim 300 mg orally, OR trimethoprim + sulfamethoxazole 160 + 800 mg orally IF there is a risk of entry in to the bowel lumen (e.g. ileal conduit, rectocele repair) metronidazole 500 mg IV Infusion to be completed within the period 15-30 minutes If gentamicin is contraindicated or relevant precautions preclude its use, REPLACE gentamicin with: trimethoprim 300 mg orally, OR 160 + 800 mg orally IF there is a risk of entry in to the bowel lumen (e.g. ileal conduit, rectocele repair) metronidazole 500mg IV Infusion to be completed within the period 15-30 minutes Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 15 of 17
Surgical indication a) Extracorporeal Shock Wave Lithotripsy (ESWL)* only required if unknown or high risk of infection ( e.g. previous infection even if urine currently sterile or if the procedure is required immediately and bacteriuria cannot be excluded) Urological surgery gentamicin 2 mg/kg IV ideal body weight^ (See table D in appendix for dosing) a) Other clean procedures generally NOT recommended *VANCOMYCIN Maximum dose 3g Rate of 15mg/min recommended to minimise the risk of red man syndrome. Rate may be increased as tolerated Vancomycin infusion to be started at least one hour before surgery and can be continued into the operative period provided more than 75% of the dose has been administered prior to incision. Vancomycin is the preferred glycopeptide, with greater evidence to support its use in surgical prophylaxis. Tecioplanin can be used as an alternative to vancomycin in the true emergency setting or if vancomycin infusion cannot be commenced an hour prior to incision time Dosing for teicoplanin Body weight (actual) Up to 80 kg Greater than 80 kg and less than 120 kg Greater then 120 kg Dose 400 mg IV 600 mg IV 800 mg IV ##ENDOCARDITIS PROPHYLAXIS: Antibiotic prophylaxis for endocarditis is recommended in patients with the following cardiac conditions: prosthetic cardiac valve or prosthetic material used for cardiac valve repair previous infective endocarditis congenital heart disease but only if it involves: o unrepaired cyanotic defects, including palliative shunts and conduits o completely repaired defects with prosthetic material or devices, whether placed by surgery or catheter intervention, during the first 6 months after the procedure (after which the prosthetic material is likely to have been endothelialised) o repaired defects with residual defects at or adjacent to the site of a prosthetic patch or device (which inhibit endothelialisation) rheumatic heart disease in high-risk patients (Indigenous Australians and those who are at significant socioeconomic disadvantage) AND undergoing the following procedures: Abdominal surgery and Gastrointestinal endoscopic procedures : all procedures listed above except for Gastrostomy or jejunostomy tube insertion Urological surgery: All procedures involving manipulation of the urinary tract Head and neck surgery: tonsillectomy or adenoidectomy Use the following antibiotics: Where the listed regimens above do not contain vancomycin, use: amoxy/ampicillin 2 g (child: 50 mg/kg up to 2 g) IV, within 15 to 30 minutes prior to skin incision If patient is allergic to penicillin, use vancomycin*25mg/kg up to 3g. ideally Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 16 of 17
Table C: Adult gentamicin dose reference table 5 mg/kg ideal body weight*^ FEMALE Height (cm) 152-159 160-168 169-178 179-186 187-195 196-200 Height (inches) 4 11-5 2 5 3-5 6 5 7-5 10 5 11-6 1 6 2-6 4 6 5-6 6 IBW (kg) 45-51 52-59 60-68 69-76 77-84 85-88 Dose (mg) 240 280 320 360 400 440 MALE Height (cm) 152-154 155-162 163-171 172-180 181-189 190-198 Height (inches) 4 11-5 0 5 1-5 4 5 5-5 7 5 8-5 10 5 11-6 2 6 3-6 6 IBW (kg) 50-52 53-59 60-67 68-75 76-83 84-91 Dose (mg) 240 280 320 360 400 440 Table D: Adult gentamicin dose reference table 2 mg/kg ideal body weight*^ FEMALE Height (cm) 152-162 163-173 174-184 185-195 196-200 Height (inches) 4 11-5 4 5 5-5 8 5 9-6 0 6 1-6 5 6 6-6 7 IBW (kg) 45-54 55-64 65-74 75-84 85-88 Dose (mg) 100 120 140 160 180 MALE Height (cm) 152-156 157-168 169-179 180-190 191-200 Height (inches) 4 11-5 1 5 2-5 6 5 7-5 10 5 11-6 3 6 4-6 7 IBW (kg) 50-54 55-64 65-74 75-84 85-93 Dose (mg) 100 120 140 160 180 *Adult Ideal Body Weight (IBW) = 0.9kg for each cm over 152cm + 50kg (for males) or 45kg (for females). If actual body weight (ABW) less than IBW, use ABW For patients weighing greater than 20% of IBW (excluding pregnancy) use the formula: dosing weight = (IBW + 0.3 x [ABW - IBW]) ^Round calculated dose to nearest 40mg and infuse over 30 minutes Document Title: Guidelines for Surgical antibiotic prophylaxis adult patients Page 17 of 17