Paediatric
General Principles of Surgical Prophylaxis
- The surgical prophylaxis guidelines are for patients aged over 1 month.
- Give intravenous antibiotics within 30-60 minutes PRIOR to skin incision.
- Prophylaxis is single dose, but in the event of major blood loss (more than 1.5L or 25ml/kg of blood loss) 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).
Redosing table
***This table should NOT be used in neonatal patients***
If procedure lasts more than 4 hours, further doses should be administered. See table for redosing interval.
| Agent | Redosing interval (h) | Max dose in 24h (including pre-op dose) |
| flucloxacillin | 4 | 8g |
| cefazolin | 4 * | 6g |
| gentamicin | Do not redose | Do not redose |
| clindamycin | 6 | 2.4g |
| teicoplanin | Do not redose | Do not redose |
| vancomycin | Do not redose | Do not redose |
| metronidazole | Do not redose | Do not redose |
*for cefazolin, the re-dosing interval should be amended according to renal function (see table below). The dose stays the same.
| Recommended re-dosing interval for cefazolin | ||||
| CrCl over 50mL/min | CrCl 30 to 50 mL/min | CrCl 10 to 29 mL/min | CrCl less than 10mL/min | |
|
Interval |
4hours | 8hours | 12hours | Do not redose |
Reference
Reference: The University of Texas MD Anderson Cancer Center. Surgical Antibiotic Prophylaxis - Pediatric: Version 6 [Internet]. 2023 Available from: Link [accessed 10th July 2023]