3rd/4th Degree Tear | Right Decisions

Right Decisions
Antimicrobial prescribing: NHS Forth Valley
Surgical Prophylaxis Guidance
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Obstetrics
3rd/4th Degree Tear

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Prophylaxis

Important: Therapy

Co-amoxiclav 1.2g IV

If weight >100kg give additional dose of Amoxicillin 1g IV

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

Notes:

Continue Co-amoxiclav 625mg PO 8 hourly for 5 days post-op

Prophylaxis - Penicillin Allergy

Important: Therapy

Clindamycin 600mg IV AND Gentamicin IV (refer to Drug Dosing Table)

Weight >80kg: increase Clindamycin dose to 900mg IV

Weight >160kg: increase Clindamycin dose to 1200mg IV

Notes:

Continue Clindamycin 600mg PO 8 hourly for 5 days post-op

Prophylaxis - MRSA Positive Patient

Important: Therapy

ADD Teicoplanin to above prophylaxis (refer to Drug Dosing Table)

Notes:

Discuss ongoing oral antibiotic post-op with consultant microbiologist

(Teicoplanin will provide 24hr of MRSA cover so doesn't need to be urgent discussion e.g. if OOH)