Drug Dosing, Administration and Redosing

Antibiotic Prophylaxis in Surgery - Drug Dosing, Administration and Redosing

ANTIBIOTIC	DOSE	ADMINISTRATION	REDOSE IN PROLONGED PROCEDURE	REDOSE AFTER >1.5L BLOOD LOSS - (REDOSE AFTER FLUID REPLACEMENT)
Amoxicillin	1g IV	Bolus over 3-4 minutes	After 4 hours: 1g IV After 8 hours: 1g IV	1g IV
Cefuroxime	1.5g IV	Bolus over 3-4 minutes	After 4 hours: 1.5g IV After 8 hours: 1.5g IV	1.5g IV
Ciprofloxacin	1000mg PO	1hr pre-procedure	N/A	N/A
Co-amoxiclav	1.2g IV	Bolus over 3-4 minutes	After 4 hours: 1.2g IV After 8 hours: 1.2g IV	1.2g IV
Clindamycin	600mg IV	Infuse over 10-60 mins	After 4 hours: 600mg IV After 8 hours: 600mg IV	600mg IV
Flucloxacillin	1g IV	Bolus over 3-4 minutes	After 4 hours: 1g IV dose After 8 hours: 1g IV dose	1g IV
Gentamicin	3mg/kg IV Use ideal body weight (IBW) if >20% overweight - see below Do not repeat dose unless >1.5L blood loss or surgery > 8 hours (half dose)	Bolus over 2-3 minutes. Can also be given as short infusion	After 4 hours: NOT REQUIRED After 8 hours: Half original pre-op dose if no renal impairment (i.e. CrCl > 60mL/min)	Half original pre-op dose
Metronidazole	500mg IV	Infuse over 20 minutes	After 4 hours: NOT REQUIRED After 8 hours: 500mg IV	500mg IV
Teicoplanin	<65kg: 400mg 66-99kg: 600mg 100-130kg: 800mg 131-166kg: 1000mg	Infuse over 3-4 minutes	After 4 hours: NOT REQUIRED After 8 hours: NOT REQUIRED	Half original pre-op dose if ≥ 1.5 litre blood loss occurs in 1st hour of procedure

*IBW= Male: 50kg / Female 45.5kg +0.9kg for every cm>150cm

WEIGHT-BASED DOSING:

Weight >100kg

Co-Amoxiclav

Add Amoxicillin 1g IV to Co-amoxiclav 1.2g IV

(i.e. total dose = 2g Amoxicillin and 200mg clavulanic acid)

NB:-

Redosing antibiotics for surgical prophylaxis to maintain antibiotic concentrations during prolonged surgical
procedures can significantly reduce the rate of surgical site infections (SSI).

For procedures lasting more than 4 hours, redosing (where indicated) after 4 or 8 hours promotes safe and
effective surgical prophylaxis. Decisions around redosing should be made on an individual patient basis
taking account of the risks and benefits of repeat dosing. Patients with complex management requirements
should be discussed with microbiology colleagues in advance to ensure redosing is safe and appropriate.
These recommendations include redosing advice where there is intraoperative blood loss of 1,500 mL or
more.

It is not recommended to give a repeat dose of antibiotics after every subsequent 1,500 mL blood
loss and specialist advice is needed where blood loss exceeds 3,000 mL.

(Reference: Good practice recommendations for redosing antibiotics for surgical prophylaxis in adults Oct 22)