Surgical Use
Prophylactic antibiotics are not indicated for:
- Clean surgical procedures including many orthopaedic procedures
- Dental procedures including tooth extractions
- Postoperative use for ANY procedure unless treating known infection
Prophylactic & Perioperative Use Antibiotics
are Indicated for:
- For prolonged clean surgery (anticipated >90 minutes)
- For surgery involving an implant (e.g. pin, screw, plate or stent)
- For surgery involving entry into a hollow viscus (e.g. gastrointestinal tract, urinary tract) or where a joint capsule is penetrated
- For debilitated or immunosuppressed patients (ASA score 3 or above)
Antibiotics for Use
Administer 30–60 minutes before the first incision
- Cefuroxime 20 mg/kg IV
- Cefazolin 22 mg/kg IV
- Amoxicillin/clavulanate 20 mg/kg IV
Then every 90 (amoxicillin/clavulanate) or 120 (cefuroxime, cefazolin) minutes until the
end of surgery
Where anaerobic involvement is highly likely (e.g. colonic surgery)
- ADD metronidazole 10 mg/kg IV
Do not continue antibiotics beyond the day of surgery, unless there is a
therapeutic indication
Therapeutic Antibiotics
ARE Indicated for:
- To treat a KNOWN bacterial infection (e.g. septic peritonitis) or if there is pre-existing remote infection
- Where there is an obvious major break in asepsis causing significant contamination of the surgical site
- For 2–3 days postoperatively for open fractures
- Until source control has been achieved AND sufficient clinical improvement documented for dirty procedures
