Neurosurgical surgery

General Principles of Prescribing Antibiotics for Surgical Prophylaxis 

1. 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 consultant microbiologist at pre-op assessment for complex issues including:
   • Carriage of, or previous infection with resistant organisms other than MRSA
   • Where eGFR is <20ml/min for alternatives to gentamicin.
7. MRSA – See intranet for MRSA infection control policy on de-colonization prior to surgery
8. Teicoplanin and gentamicin are incompatible when mixed directly, therefore always flush between administrations