This lecture was presented at the July 2013 Centegra summer symposium. Continue reading
- The optimal for administration is now within 60 minutes prior to incision. This is more specific than the previous “induction of anesthesia” timing in the previous recommendations. Drugs like vancomycin should be administered within 120 minutes prior to incision.
- Increased dosing for obese patients is now recommended. Use 3gm of cefazolin (Ancef) for patients weighing >120kg
- Intraoperative redosing is recommended for procedures lasting more than two half lives of the drug. Redose cefazolin (Ancef) for procedures lasting greater than 4 hours (cefazolin half life is 2 hours). Time for re-administration should be measured from the first antibiotic dose and not the start of the procedure.
- Duration of prophylaxis should be less than 24 hours for most procedures.
- Routine use of vancomycin is not recommended for any procedure but should be considered for patients known to be colonized with MRSA or those at high risk for colonization is the absence of surveillance data.
- The guidelines now have details for many specific surgical procedures.
|Surgical procedure||Approved antibiotics|
|Cardiac or Vascular||Cefazolin, cefuroxime or vancomycin (see foot note) if allergy to beta lactam vancomycin or clindamycin|
|Hip or knee arthroplasty||Cefazolin, cefuroxime or vancomycin (see foot note) if allergy to beta lactam vancomycin or clindamycin|
|Colon||Cefotetan, Cefoxitin, Ampicillin/sulbactam OR [Cefazolin + Metronidazole], If β-lactam allergy: [Clindamycin + aminoglycoside], or [Clindamycin + Ciprofloxacin], or [Clindamycin + Aztreonam] or [Metronidazole with Gentamicin], or [Metronidazole + Ciprofloxacin]|
|Hysterectomy||Cefotetan, Cefazolin, Cefoxitin, Cefuroxime or Ampicillin/sulbactam OR Clindamycin + ciprofloxacin OR Clindamycin + Aztreonam OR Metronidazole + Gentamicin OR Metronidazole + ciprofloxacin (CIPRO)|
- Vancomycin is acceptable with a physician/APN/PA/pharmacist documentation justification for its use (allergy to penicillin known MRSA, hospitalized >24 hrs; Cardiac valve surgery)
- Levofloxacin 750mg may be substituted for Ciprofloxacin