Surgical Prophylaxis - Hand Surgery

  

Soft tissue surgery of the hand

Antibiotic prophylaxis should be considered

 

Elective hand surgery involving insertion of either percutaneous K-wires or metal or silastic implants

FLUCLOXACILLIN 1g (NB: for patients >90kg give 2g). If CrCl < 10ml/min - maximum 4g in 24 hours.


plus

GENTAMICIN 3mg/kg (maximum dose 300mg)

(dose table for Ideal Body Weight)

If CrCl <21 maximum dose 180mg

 

If current / previous MRSA positive:

ADD

TEICOPLANIN

Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

}

 

IV single dose only at induction

OR

If penicillin allergy (explanatory notes), then use:
TEICOPLANIN 

Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

plus

GENTAMICIN 3mg/kg (maximum dose 300mg)

(dose table for Ideal Body Weight)

If CrCl <21 maximum dose 180mg

 

}

 

IV single dose only at induction

 

Clean open hand injuries if: 1) Open fracture, tendon or joint injury 2) More than 6 hours delay to definitive treatment 

FLUCLOXACILLIN 1g qds

If admitted, first dose given IV in ED, then oral until 5 days post op

If admission delayed, oral pre-op until 5 days post op, IV in theatre

(NB: For patients >90kg give 2g as the IV dose: maximum oral dose is 1g)

If current / previous MRSA positive: 

Add

TEICOPLANIN IV stat

Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

Given in ED or in theatre if admission delayed

  

OR

If penicillin allergy (explanatory notes), then use:

TEICOPLANIN IV stat

Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

Given in ED or in theatre if admission delayed

Plus

CLINDAMYCIN 450 mg qds po

Pre-op and until 5 days post-op

 

Contaminated open hand injuries

FLUCLOXACILLIN 1g qds IV (NB: for patients >90kg give 2g at induction, then continue with 1g six hourly. If CrCl <10ml/min - maximum of 4g in 24 hours)

plus

GENTAMICIN 3mg/kg (maximum dose 300mg)

(dose table for Ideal Body Weight)

If CrCl <21 maximum dose 180mg


plus

METRONIDAZOLE 400 mg tds po

 

 

If current / previous MRSA positive:

ADD

TEICOPLANIN IV at induction then further doses at 12 hourly intervals up to 48 hours post-surgery

Dose:

<50kg: 600mg

 50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

  

OR

If penicillin allergy (explanatory notes), then use:

TEICOPLANIN  IV at induction then further doses at 12 hourly intervals up to 48 hours post-surgery

Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

 

 

plus

GENTAMICIN 3mg/kg (maximum dose 300mg

(dose table for Ideal Body Weight)

If CrCl <21 maximum dose 180mg

plus

METRONIDAZOLE 400 mg tds po

IV regimes until 24-48 hours post-surgery then:

 

Po switch therapy

 

CO-AMOXICLAV 625 mg tds po

 

OR

If penicillin allergy (explanatory notes), then use:

CIPROFLOXACIN 500 mg bd po

plus

CLINDAMYCIN 450 mg qds po

 

OR

If current / previous MRSA positive: consult Microbiologist

 

Duration:- until 5 days post-surgery

Last reviewed: 20/09/17

For guidance on the administration of intravenous antibiotics click here
(GHNHSFT intranet)