Antimicrobial prescribing: NHS Lothian
|
Procedure |
Recommended |
Penicillin allergy or MRSA |
|
Colorectal surgery |
Gentamicin IV (dose as per table) |
Gentamicin IV (dose as per table) |
|
AND |
AND |
|
|
Metronidazole 500mg IV |
Metronidazole 500mg IV |
|
|
AND |
AND |
|
|
Amoxicillin 1g IV |
Teicoplanin 400mg IV |
Colorectal surgery
General Principles of Prescribing Antibiotics for Surgical Prophylaxis
- Timing. Antibiotics should be administered or infusion completed within 60 minutes before the procedure or skin incision
- Document doses in the "once only" section of the paper drug administration chart (the kardex) or as STAT orders on HEPMA
- A single dose of antibiotic is recommended. Exceptions are outlined in individual protocols
- No dose adjustment in renal or hepatic impairment is required unless indicated
- 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
- Discuss patients with consultant microbiologist pre-operatively for complex issues including:
- Carriage of or previous infection with resistant organisms, other than MRSA
- Where eGFR is <20ml/min
- MRSA. See intranet for MRSA infection control policy on decolonisation prior to surgery.
Height is used to estimate ideal body weight, dosing equates to approximately 3mg/kg capped at 300mg.
* When height <5 foot use actual body weight to calculate gentamicin dose.
|
FEMALE |
||
|
Height (Feet/Inches) |
Height (cm) |
Gentamicin dose |
|
<5’ |
<152 |
*3mg/kg (max 300mg) |
|
5' - 5'3'' |
152 - 163 |
160 mg |
|
>5'3'' - 5'8'' |
>163 - 175 |
200 mg |
|
>5'8'' - 6'1'' |
>175 - 188 |
240 mg |
|
>6'1'' - 6'4'' |
>188 - 193 |
280 mg |
|
>6’4'' |
>193 |
300mg |
|
MALE |
||
|
Height (Feet/Inches) |
Height (cm) |
Gentamicin dose |
|
<5’ |
<152 |
*3mg/kg (max 300mg) |
|
5' - 5'1'' |
152 - 155 |
160 mg |
|
>5'1'' - 5'6'' |
>155 - 168 |
200 mg |
|
>5'6'' - 5'11'' |
>168 - 180 |
240 mg |
|
>5'11'' - 6'4'' |
>180 - 193 |
280 mg |
|
>6'4'' |
>193 |
300mg |
|
Antibiotic |
Administration |
Re-dosing advice: prolonged surgery |
Re-dosing advice: >1.5L blood loss |
|
Amoxicillin IV |
Bolus over 3-5 minutes |
Repeat original dose (every) 4 hours |
Repeat original dose |
|
Gentamicin IV |
Bolus over 3-5 minutes |
Repeat half original dose 8 hours after initial dose if eGFR >60ml/min |
Repeat half original dose |
|
Metronidazole IV |
Infuse over 20 minutes |
Repeat original dose after 8 hours |
Repeat original dose |
|
Teicoplanin IV |
Bolus over 3-5 minutes |
No re-dosing required |
200mg (half original dose), if ≥ 1.5L blood loss within first hour of operation |