Vascular surgery | Right Decisions

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 medical microbiology at pre-op assessment for complex issues including:
- Carriage of, or previous infection with resistant organisms, other than MRSA.
- Where eGFR is <20ml/min

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

Antimicrobial recommendations

Procedure

Recommended

Penicillin allergy or MRSA

Lower limb amputation

Flucloxacillin 1g IV

AND

Gentamicin*3mg/kg IV

AND

Metronidazole 500 mg IV

Teicoplanin 800 mg IV

(600mg IV if patient weight<60Kg)

AND

Gentamicin*3mg/kg IV

AND

Metronidazole 500mg IV

Vascular Surgery (abdominal and lower limb arterial reconstruction)

Flucloxacillin 1g IV

AND

Gentamicin*3mg/kg IV

Teicoplanin 800 mg IV

(600mg IV if patient weight<60Kg)

AND

Gentamicin*3mg/kg IV

*Higher dose of gentamicin (5mg/kg) could be considered if operation is of known infected site and treatment dose is needed rather than prophylaxis

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.

*Higher dose of gentamicin (5mg/kg) could be considered if operation is of known infected site and treatment dose is needed rather than prophylaxis

Height is used to estimate ideal body weight, dosing equates to approximately 5mg/kg, capped at 400mg.

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

Avoid gentamicin if eGFR<20mls/min, seek advice on an alternative from microbiology

Antibiotic	Administration	During the procedure		>1.5L blood loss
Antibiotic	Administration	After 4 hours	After 8 hours	>1.5L blood loss
Flucloxacillin IV	Bolus over 3-5 minutes	Repeat original dose	Repeat original dose	Repeat original dose
Gentamicin 5mg/kg IV	Bolus over 3-5 minutes	Not required	Not required	Give half original dose
Gentamicin 3mg/kg IV	Bolus over 3-5 minutes	Not required	Give half original dose if eGFR >60ml/min	Give half original dose
Metronidazole IV	Infuse over 20 minutes	Not required	Repeat original dose	Repeat original dose
Teicoplanin IV	Bolus over 3-5 minutes	Not required	Not required	Half original dose original dose), if >1.5L blood loss within first hour of operation