General Principles
- Give intravenous antibiotics within 60 mins (ideally 30- 60 minutes) PRIOR to skin incision.
- Prophylaxis is single dose, but in the event of major blood loss (requiring 3 or more units of blood transfusion) or significant fluid replacement, consider giving additional dose(s) of antibiotics.
- For patients already on treatment dose antibiotics, prophylaxis should still be given (usually cefazolin) unless advised not to by ID/Micro.
- Further intra-operative doses of antibiotic should be considered if procedure lasts more than 4 hours (see table below for redosing intervals).
- All antibiotic prescriptions should be recorded electronically in the patients record, on powerchart (or carevue)
Redosing table
If procedure lasts more than 4 hours, further doses should be administered. See table for re-dosing interval. e.g. for a 16 hour operation 4-5 doses of cefazolin are given.
These recommendations on re-dosing are for patients with normal renal and hepatic function unless otherwise stated.
|
Agent |
Redosing interval (h) |
Max dose in 24 hours (including pre-op dose) |
|
4 |
12g |
|
|
4 |
12g |
|
|
6-8* |
2 doses at 3mg/kg (max 240mg per dose) |
|
|
6 |
2700mg |
|
|
Do not redose |
Do not redose |
|
|
Do not redose |
Do not redose |
|
|
8 |
1500mg |
*Additional information regarding gentamicin: Only for patients with CrCl greater than 30mL/min. This guidance does not apply to patients receiving haemodialysis or haemofiltration.
Gentamicin
A gentamicin calculator has been developed which will launch automatically when gentamicin is prescribed on EPR for patients aged 18 years and over. This includes gentamicin prescribed using powerplans.
Prescribers are required to ensure:
- Dosing weight and height is accurate or best estimate.
- Dose provided by calculator is in the expected range.
For further information see gentamicin monograph
In the case of EPR downtime, use the following guideline (On OUH Intranet): EPR Downtime Guide