Cardiac and Thoracic Surgery
Link to General Principles, including redosing table.
Cardiac Surgery
Including re-sternotomy within 48 hours and TAVI (Transcatheter aortic valve implementation)
Preferred, including penicillin allergy (non-severe): cefazolin iv (see dosing table below) AND gentamicin 3mg/kg iv
| cefazolin iv dose | |
| Weight under 50kg | 1g |
| Weight 50kg to less than 120kg | 2g |
| Weight 120kg or more | 3g |
| Creatinine clearance less than 10ml/min or patient receiving haemodialysis | 1g |
Note: Prophylaxis for Sternotomy and Coronary Artery Bypass Graft (CABG) patients on CTCCU: cefazolin may be continued for up to 24 hours from start of operation (max dose 12g in 24 hours). Do not re-dose gentamicin.
- For practical advice about timings and dosing for pre-operative antibiotics and intra-operative doses of cefazolin see CTCCU Perioperative antimicrobial prophylaxis for cardiac surgical patients document
Penicillin allergy (severe) or MRSA positive patients or if re-sternotomy after 48 hours: teicoplanin 800mg iv AND gentamicin 3mg/kg iv. Do not re-dose teicoplanin or gentamicin
Permanent Cardiac Device
Includes permanent pacemaker, implanted defibrillator.
Preferred: flucloxacillin 1g iv
For penicillin allergy (non-severe and severe) or for MRSA positive patients: teicoplanin 800mg iv
Thoracic Surgery
Including VATs, thymectomy, mediastinoscopy, mediastinotomy, thoracotomy, chest wall resection, rib fixation and thoracoscopy (including under local anaesthetic)
Preferred (including for penicillin allergy (non-severe)): cefazolin iv (see dosing table below)
| cefazolin iv dose | |
| Weight under 50kg | 1g |
| Weight 50kg to less than 120kg | 2g |
| Weight 120kg or more | 3g |
| Creatinine clearance less than 10ml/min or patient receiving haemodialysis |
1g |
For penicillin allergy (severe) or MRSA positive patients: teicoplanin 800mg iv AND gentamicin 3mg/kg iv
Endobronchial valve (EBV) insertion
- Bronchoalveolar lavage (BAL) culture should be sent prior to insertion of endobronchial valve.
- Post-operative antibiotic should be started post EBV insertion.
- Review the BAL culture result and post-op antibiotic for prophylaxis according to culture and sensitivity where possible. Discuss with Micro/ID if necessary.
Preferred (including for penicillin allergy (non-severe)) : cefazolin iv (see dosing table below)
| cefazolin iv dose | |
| Weight under 50kg | 1g |
| Weight 50kg to less than 120kg | 2g |
| Weight 120kg or more | 3g |
| Creatinine clearance less than 10ml/min or patient receiving haemodialysis | 1g |
For penicillin allergy (severe) or MRSA positive patients: teicoplanin 800mg iv AND gentamicin 3mg/kg iv
Post-operative (empirical): doxycycline 100mg po bd for 5 days in total