Liver transplant surgery

General Principles of Prescribing Antibiotics for Surgical Prophylaxis

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.

6. MRSA – See intranet for MRSA infection control policy on de-colonization prior to surgery.

Antimicrobial Recommendations

Procedure

Recommended

Penicillin allergy

Penicillin allergy + MRSA

Liver Transplant

At induction:

amoxicillin 1g IV

and

gentamicin IV dosing (as per chart below)

and

metronidazole 500 mg IV

At induction:

ciprofloxacin 400 mg IV

and

vancomycin 1g IV

and

metronidazole 500 mg IV

Gentamicin dosing Height is used to estimate ideal body weight, dosing equates to approximately 3mg/kg capped at 300mg.

* When height <5-foot or <152cm use actual body weight to calculate gentamicin dose.

Antibiotic	Administration	Re-dosing advice prolonged surgery	>1.5 L blood loss (After giving fluids replacements)
Amoxicillin IV	Infuse 1g over 30 minutes	Repeat original dose after 4 hours and if needed after 8 hours (again) after initial dose	Repeat original dose
Ciprofloxacin IV	Infuse 400mg over 60 minutes	Repeat original dose at 12 hours after initial dose	Not required
Gentamicin IV	Bolus over 3 to 5 minutes	Repeat original dose 8 hours after initial dose if eGFR > 60ml/min	Give 50% original dose
Metronidazole IV	Infuse over 20minutes	Repeat original dose 8 hours after initial dose	Repeat original dose
Vancomycin IV	Infuse 1g over 100-120 minutes	Repeat original dose 12 hours after initial dose	Repeat half original dose (e.g. 500mg)