Surgical site infection, clean-contaminated, contaminated and infected procedures
For surgical wound classification see: Surgical site infection, definitions and classification
Treat for 5 days (review IV daily and convert to oral within 48 hours or when clinical condition allows).
For patients with penicillin allergy label consider penicillin allergy assessment and delabelling
Initial oral therapy or oral switch options
Choose from one of the following when initiating or switching to oral therapy:
co-trimoxazole 960mg po bd
doxycycline 100mg po bd
cefalexin 1g po tds
For contaminated or infected procedures or for any procedure involving the gastrointestinal or urogenital tracts:
ADD metronidazole 400mg po tds
Preferred initial IV therapy (if required)
amoxicillin 500mg po tds (or 1g iv tds) PLUS gentamicin* 5mg/kg iv (for maximum of 3 days).
*Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval. See gentamicin monograph for dosing (including renal dosing) and monitoring.
For contaminated or infected procedures or for any procedure involving the gastrointestinal or urogenital tracts:
ADD metronidazole 400mg po tds (or 500mg iv tds if NBM)
Alternative initial IV therapy (if required)
For penicillin allergy (non-severe or severe) or MRSA positive patients:
co-trimoxazole 960mg bd po (or iv if NBM)
For contaminated or infected procedures or for any procedure involving the gastrointestinal or urogenital tracts:
ADD metronidazole 400mg po tds (or 500mg iv tds)