Surgical Prophylaxis (scroll down for guidelines)

Antimicrobial prophylaxis prior to surgery in ADULTS

CLEAN

  • Elective procedures where there is no sign of infection or inflammation.
  • There is no breach of aseptic technique.
  • The respiratory, alimentary, genital or urinary tracts are not penetrated.

NO PROPHYLAXIS REQUIRED

INSERTION OF IMPLANTS

  • For orthopaedic and vascular surgery click on speciality (see below).

PROPHYLAXIS REQUIRED

CLEAN CONTAMINATED

  • Non traumatic but respiratory, alimentary, genital or urinary tracts are penetrated.
  • Minor spillage or only a minor breach in aseptic technique.

PROPHYLAXIS REQUIRED

CONTAMINATED

  • Major break in aseptic technique.
  • Major spillage from hollow viscus that may include non purulent material
  • Dirty, traumatic wound, faecal contamination, foreign body, de-vitalised viscus.
  • Pus encountered from any source during surgery.

TREATMENT REQUIRED

(as per Trust antibiotic guidelines)

 

Prophylaxis

Timing

  • The prophylactic antibiotic should be administered pre-operatively (typically during induction of anaesthesia) and should be given within 60 minutes before incision (ideally between 15 and 45 minutes, and not less than 15 minutes). Exceptions will include some types of orthopaedic surgery. See orthopaedic guideline for further information. Note: The complete dose should be given prior to any tourniquet inflation or other procedure which significantly reduces blood flow to the surgical site.”

Re-Dosing

  • Additional dose of prophylactic agent is not indicated unless there is a blood loss of greater then 1500ml during surgery, haemodilution of greater than 15ml/kg or prolonged surgery.  Exceptions will include some types of orthopaedic surgery (>5hours).
  • Note that additional gentamicin dosing is not required in prolonged surgery.  Additional gentamicin dosing may be considered after fluid replacement if there is blood loss of greater than 1500ml during surgery and in the absence of significant renal impairment. 
  • 

Allergy

  • Anaphylactic Penicillin allergy includes reactions to Cephalosporins, Carbapenems and any other Beta Lactams. Individuals with a DEFINITE history of ANAPHYLAXIS or URTICARIAL RASH immediately after being given a Penicillin, Cephalosporin or any other Beta Lactam antibiotic SHOULD NOT receive any of these antibiotics. If in doubt consult Microbiology or Pharmacy Medicines Information Department.
  • NON URTICARIAL RASH allergy to Penicillins is unlikely to be associated with a serious cross reaction to Cephalosporins or Carbapenems. PENICILLINS should be avoided (further information)

Gentamicin

  • Gentamicin doses must be calculated using ideal body weight (IBW) (dose table for IBW poster).  For patients >120% of IBW then use obese dose body weight (ODBW). 

 

  • In the event of failed prophylaxis refer to TREATMENT guidelines for appropriate choice of antibiotics.

 Last reviewed: 10/11/16

Procedures:

 

Arthroplasty Patients with Urethral Catheters – role of antibiotics for prophylaxis and treatment

Biliary Surgery

Breast Surgery

Gastrointestinal Surgery

Hand Surgery

Intrathecal Catheter Insertion

Obstetric & Gynaecological Surgery

Orthopaedic Surgery

Splenectomy local guidelines 

Urological Surgery

Vascular Surgery