Penetrating intracranial injury / gunshot (= contaminated neurosurgery)
Link to General Principles of Surgical Prophylaxis including redosing table and renal dosing for cefazolin.
Give antibiotics for 5 days post-op.
Preferred
metronidazole 30mg/kg (Max 500mg) iv
AND
cefazolin iv see dosing table below
| Weight | cefazolin iv dose |
| Weight less than 120kg | 30mg/kg (maximum 2g) |
| Weight 120kg or more | 3g |
For post-op doses: co-amoxiclav 30mg/kg (Max 1.2g) iv TDS (BD for patients 1-2 months old). Duration of 5 days post-op.
Alternative
For penicillin allergy (non-severe)
metronidazole 30mg/kg (Max 500mg) iv
AND
cefazolin iv see dosing table below
| Weight | cefazolin iv dose |
| Weight less than 120kg | 30mg/kg (maximum 2g) |
| Weight 120kg or more | 3g |
For post-op doses: ceftriaxone 80mg/kg iv (Max 4g) OD AND metronidazole 7.5mg/kg iv (Max 500mg) TDS. Duration of 5 days post-op.
For penicillin allergy (severe) or MRSA positive
teicoplanin 10 mg/kg (Max 800 mg) iv BD for 3 doses then 10 mg/kg (Max 800 mg) iv OD. Duration of 5 days post-op.
AND
metronidazole 30mg/kg iv (Max 500mg) in theatre then continue metronidazole at 7.5mg/kg (Max 500mg) iv TDS. Duration of 5 days post-op.