Thoracic, neurosurgery (no spinal hardware), orthopedic (not total join or spine), vascular (no graft) and other surgeries not listed below
|
Drug |
Dose |
Timing |
Infusion Duration |
Re-dose Intraop |
|
Cefazolin |
<120 kg: 2 gm ≥120 kg: 3 gm |
≤60 min before incision |
Bolus over 3-5 mins (with bolus, tissue levels adequate in a few mins) |
2 gm q 4 hours |
|
For Serious Beta-Lactam Allergy (i.e., Hives, Angioedema, Anaphylaxis) |
||||
|
Vancomycin OR |
1 gm |
≤120 min before incision |
Infuse over 60 mins in pre-op area |
1 gm q 8 hours |
|
Clindamycin |
900 mg |
≤60 min before incision |
Infuse over 30 mins (not to exceed 30 mg/min) |
900 mg q 6 hours |
Urologic Surgery
TURP, TURBT, URS, ureteral stents, percutaneous nephrolithotomy (for TRUS, see Intra-Abdominal Surgery)
|
Drug |
Dose |
Timing |
Infusion Duration |
Re-dose Intraop |
|
Cefazolin |
<120 kg: 2 gm ≥120 kg: 3 gm |
≤60 min before incision |
Bolus over 3-5 mins (with bolus, tissue levels adequate in a few mins) |
2 gm q 4 hours |
|
For Serious Beta-Lactam Allergy (i.e., Hives, Angioedema, Anaphylaxis) |
||||
|
Ciprofloxacin |
400 mg |
≤120 min before incision |
Infuse over 60 mins |
400 mg q 6 hours |
Intra-abdominal Surgery
Biliary, gastroduodenal, hernia repair
|
Drug |
Dose |
Timing |
Infusion Duration |
Re-dose Intraop |
|
Cefazolin |
<120 kg: 2 gm ≥120 kg: 3 gm |
≤60 min before incision |
Bolus over 3-5 mins (with bolus, tissue levels adequate in a few mins) |
2 gm q 4 hours |
|
For Serious Beta-Lactam Allergy (i.e., Hives, Angioedema, Anaphylaxis) |
||||
|
Vancomycin OR |
1 gm |
≤120 min before incision |
Infuse over 60 mins in pre-op area |
1 gm q 8 hours |
|
Clindamycin |
900 mg |
≤60 min before incision |
Infuse over 30 mins (not to exceed 30 mg/min) |
900 mg q 6 hours |
Intra-abdominal Surgery
Large and small bowel (including appendectomy), colon, transrectal ultrasound (TRUS)
|
Drug |
Dose |
Timing |
Infusion Duration |
Re-dose Intraop |
|
Ceftriaxone PLUS Metronidazole |
<40 kg: 1 gm ≥40 kg: 2 gm 500 mg |
≤60 min before incision ≤60 min before incision |
Bolus over 3-5 mins (with bolus, tissue levels adequate in a few mins) Infuse over 30 mins |
<40 kg: 1 gm q 12 hr ≥40 kg: 2 gm q 12 hr 500 mg q 6 hours |
|
For Serious Beta-Lactam Allergy (i.e., Hives, Angioedema, Anaphylaxis) |
||||
|
Ciprofloxacin PLUS |
400 mg |
≤120 min before incision |
Infuse over 60 mins |
400 mg q 6 hours |
|
Metronidazole |
500 mg |
≤60 min before incision |
Infuse over 30 mins |
500 mg q 6 hours |
Obstetrics/Gynecology
Cesarean delivery, hysterectomy, midurethral sling, vaginal prolapse (uterosacral suspension, sacrocolpopexy)
|
Drug |
Dose |
Timing |
Infusion Duration |
Re-dose Intraop |
|
Cefazolin |
<120 kg: 2 gm ≥120 kg: 3 gm |
≤60 min before incision |
Bolus over 3-5 mins (with bolus, tissue levels adequate in a few mins) |
2 gm q 4 hours |
|
For Serious Beta-Lactam Allergy (i.e., Hives, Angioedema, Anaphylaxis) |
||||
|
Clindamycin PLUS |
900 mg |
≤60 min before incision |
Infuse over 30 mins (not to exceed 30 mg/min) |
900 mg q 6 hours |
|
Gentamicin OR |
5 mg/kg** |
≤60 min before incision |
Infuse over 30 mins |
No need to re-dose |
|
**Secondary Alternative For Hysterectomy Only** |
||||
|
Ciprofloxacin PLUS |
400 mg |
≤120 min before incision |
Infuse over 60 mins |
400 mg q 6 hours |
|
Metronidazole |
500 mg |
≤60 min before incision |
Infuse over 30 mins |
500 mg q 6 hours |
Surgeries with Prosthetic Material
Hip & knee arthroplasty, spinal hardware procedures, placement of vascular graft
|
Drug |
Dose |
Timing |
Infusion Duration |
Re-dose Intraop |
|
Cefazolin PLUS |
<120 kg: 2 gm ≥120 kg: 3 gm |
≤60 min before incision |
Bolus over 3-5 mins (with bolus, tissue levels adequate in a few mins) |
2 gm q 4 hours |
|
Vancomycin |
1 gm |
≤120 min before incision |
Infuse over 60 mins in pre-op area |
1 gm q 8 hours |
|
For Serious Beta-Lactam Allergy (i.e., Hives, Angioedema, Anaphylaxis) |
||||
|
Vancomycin OR |
1 gm |
≤120 min before incision |
Infuse over 60 mins in pre-op area |
1 gm q 8 hours |
|
Clindamycin |
900 mg |
≤60 min before incision |
Infuse over 30 mins (not to exceed 30mg/min) |
900 mg q 6 hours |
Clean-contaminated head and neck surgery
|
Cefazolin PLUS |
<120 kg: 2 gm ≥120 kg: 3 gm |
≤60 min before incision |
Bolus over 3-5 mins (with bolus, tissue levels adequate in a few mins) |
2 gm q 4 hours |
|
Metronidazole OR |
500 mg |
≤60 min before incision |
Infuse over 30 mins |
500 mg q 6 hours |
|
Ampicillin-Sulbactam |
3 gm |
≤60 min before incision |
Infuse over 30 mins |
3 gm q 2 hours x 3 doses maximum; then q 6 hours |
|
For Serious Beta-Lactam Allergy (i.e., Hives, Angioedema, Anaphylaxis) |
||||
|
Clindamycin |
900 mg |
≤60 min before incision |
Infuse over 30 mins (not to exceed 30 mg/min) |
900 mg q 6 hours |
Pediatric Patients - Suggested Dosing*
|
Drug |
Dose |
|
Cefazolin |
25 mg/kg |
|
Vancomycin |
15 mg/kg (as an infusion over 30-60 min) |
|
Gentamicin |
2.5 mg/kg |
|
Clindamycin |
10 mg/kg |
|
Ceftriaxone |
50 mg/kg |
|
Metronidazole |
10 mg/kg |
|
Ampicillin-Sulbactam |
50 mg/kg of ampicillin component |
*All pediatric doses should not exceed adult dosing recommendations.
Notes:
In most instances, a single antibiotic dose prior to the procedure is sufficient for prophylaxis.
However:
Per protocol for clean-contaminated head and neck surgery, antibiotics should be continued for a maximum of 24 hours post surgery
Additional intra-operative doses should also be administered in circumstances of significant blood loss (Adults: ≥6 units or ≥1.5 L EBL or hemo dilution during surgery. Pediatrics ≥20-30 mL/kg).
With prolonged procedures, antibiotics may need to be re-dosed intraoperatively to ensure adequate levels until wound closure. Please refer to “Re-dose Intraop” column for information on specific antibiotics.
Prophylactic antibiotics should not be continued after wound closure
Always confirm with surgeons at the Time-Out or earlier before antibiotics are administered. In some cases they may wish to delay antibiotics until after cultures are obtained.
The entire antibiotic dose should be administered before the tourniquet is inflated