Cardiothoracic, including pacemaker insertion surgery

Antimicrobial prescribing: NHS Lothian
NHS Lothian

General Principles of Prescribing Antibiotics for Surgical Prophylaxis

 

  1. Timing. Antibiotics should be administered, or infusion completed within 60 minutes before the procedure or skin incision.
  2. Document doses in the “once only” section of the paper drug administration chart (the kardex) or as STAT orders on HEPMA.
  3. A single dose of antibiotic is recommended. Exceptions are outlined in individual protocols.
  4. No dose adjustment in renal or hepatic impairment is required unless indicated.
  5. Repeat dosing may be required if the operation is prolonged (see table below for re-dosing guidance for individual antibiotics):
    • The repeat dose is given at the recommended interval from the time the initial dose was administered.
    • Intra-operative blood loss >1.5L. Re-dose following fluid replacement/blood transfusion.
  6. Discuss patients with medical microbiology at pre-op assessment for complex issues including carriage of, or previous infection with resistant organisms other than MRSA. For patients with multidrug resistant pseudomonas please review antibiotic susceptibilities in microbiology report and discuss with medical microbiology, Ceftazidime 2g IV may be a suitable alternative.
  7. MRSA – See intranet for MRSA infection control policy on de-colonisation prior to surgery.
  8. Surgery for Aspergillus lung disease e.g. aspergilloma. These are complex patients some of whom have antifungal resistant strains. Please discuss antifungal prophylaxis on a case-by-case basis at the time the patient at pre-op assessment. Do not wait until day of operation.

Antimicrobial recommendations

Cardiac Surgery

Procedure

Recommended

Penicillin allergy or MRSA

CABG

Cefuroxime 1.5g IV

Teicoplanin 800mg IV (600mg if <60kg)

CABG (off pump)

Cefuroxime 1.5g IV

Teicoplanin 800mg IV (600mg if <60kg)

Prosthetic Valve Surgery

 

Cefuroxime 1.5g IV followed by 1.5g IV at 8 hour intervals (three doses in total)

 

Teicoplanin 800mg IV (600mg if <60kg)

 

TAVI

Cefuroxime 1.5g IV

Teicoplanin 800mg IV (600mg if <60kg)

Urgent re-opening

Teicoplanin 800mg IV (600mg if <60kg)

Teicoplanin 800mg IV (600mg if <60kg)

Thoracic Surgery

Procedure

Recommended

Penicillin allergy or MRSA

Pulmonary resection

Co-amoxiclav 1.2g IV followed by 1.2g at 6 hour intervals (two doses in total) 

If high risk of pseudomonas infection (e.g., bronchiectasis)*

Use piperacillin/tazobactam  4.5g followed by 4.5g at 6 hour intervals (two doses in total)

Teicoplanin 800mg (600mg if <60kg) 

If high risk of pseudomonas infection (e.g., bronchiectasis)*

 ADD

 Ciprofloxacin 750mg oral (60 mins prior to procedure)

Pacemaker/other device prophylaxis

Procedure

Recommended

Penicillin allergy or MRSA

Pacemaker implantation

Flucloxacillin 1g IV

Teicoplanin 400mg IV 

IV antibiotic administration and re-dosing guidance

 

Antibiotic

Administration

Re-dosing advice: prolonged surgery

Re-dosing advice: >1.5L blood loss

IV Cefuroxime

Bolus over 3-5 minutes

Repeat original dose every 4 hours

Repeat original dose

IV Co-amoxiclav

Bolus over 3-5 minutes

Repeat original dose after 6 hours

Repeat original dose

IV Teicoplanin

Bolus over 3-5 minutes

Not required

Half original dose original dose if > 1.5L blood loss within first hour of operation

IV Flucloxacillin

Bolus over 3-5 minutes

Repeat original dose every 4 hours

Repeat original dose

Oral Ciprofloxacin

60 mins prior to procedure

Not required

Not required

IV Ceftazidime

Bolus over 3-5 minutes

Not required

Repeat original dose

IV Piperacillin

/Tazobactam

IV infusion over 30 minutes

Repeat original dose after 6 hours

Repeat original dose