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. MRSA – See intranet for MRSA infection control policy on decolonisation prior to surgery.

Antimicrobial recommendations

 

Procedure

Recommended

Penicillin allergy

Penicillin allergy + MRSA  

Renal Transplant

Piperacillin-tazobactam  4.5g IV

If MRSA then

ADD

Vancomycin 1g IV

 

Ciprofloxacin 400mg IV

AND 

Vancomycin 1g IV

 

IV antibiotic administration and re-dosing guidance

 

Antibiotic

Administration

Re-dosing advice prolonged surgery

>1.5 L blood loss

Piperacillin-tazobactam IV

Infuse 4.5g over 30 minutes

Repeat original dose every 4 hours

Repeat original dose

Ciprofloxacin IV

Infuse 400mg over 60 minutes

Not required

Not required

Vancomycin IV

Infuse 1g over 100-120 minutes

Repeat original dose after 12 hours

Repeat half original dose (e.g. 500mg)