Surgical Prophylaxis - Orthopaedic Surgery

Routine aseptic procedures such a joint aspiration, arthroscopy and short 'clean' non-implants do not require antibiotic prophylaxis

 If microbiological sampling of e.g. a prosthetic joint is to be undertaken the administration of the prophylactic antibiotics should be deferred until the sampling has been performed. 

 

For guidance on Arthroplasty Patients with Urethral Catheters – role of antibiotics for prophylaxis and treatment (Click here)

Joint Arthroplasty, Closed Fracture Fixation, Hip Fracture Repair, Spinal Surgery

FLUCLOXACILLIN 1g IV at induction then 1g six hourly for a further 3 doses (NB: for patients >90kg give 2g at induction, then 1g six hourly for a further 3 doses. If CrCl < 10ml/min - maximum of 4g in 24 hours)

plus

GENTAMICIN 3mg/kg (maximum dose 300mg) IV single dose only at induction

(dose tables for Ideal Body Weight)

If CrCl <21 maximum dose 180mg 

    

  

If current / previous MRSA positive

OR

If penicillin allergy (explanatory notes), then use:

 

TEICOPLANIN  IV at induction then further doses at 12 and 24 hours after surgery
  Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

 

plus

GENTAMICIN 3mg/kg (maximum dose 300mg) IV single dose only at induction

(dose tables for Ideal Body Weight)

If CrCl <21 maximum dose 180mg 

 

 

  

 Open fractures

Adequate prophylaxis includes all 3 steps below:

Adequate prophylaxis includes all 3 steps below:

 Penicillin allergy (see explanatory notes)

1. Start prophylaxis as soon as possible after injury and certainly within 3 hours.

 CO-AMOXICLAV 1.2g iv every 8 hours until first debridement

 If current / previous MRSA positive:


ADD


TEICOPLANIN  iv every 12 hours for 4 doses  then  iv once daily
until first debridement 
Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

 

1. Start prophylaxis as soon as possible after injury and certainly within 3 hours. 

CLINDAMYCIN 600mg iv every 6 hours until first debridement (NB: for patients >90kg give 1.2g)

 If current / previous MRSA positive:

ADD

 
TEICOPLANIN iv every 12 hours for 4 doses  then iv once daily
until first debridement
Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

2. At time of first debridement:

 CO-AMOXICLAV 1.2g iv

plus

GENTAMICIN 3mg/kg (maximum dose 300mg) IV single dose only at induction

(dose tables for Ideal Body Weight)

If CrCl <21 maximum dose 180mg 

 If current / previous MRSA positive:

ADD

TEICOPLANIN  iv
Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg

Note: patients should not receive more than 2400mg of teicoplanin in less than 24 hours.

 Continue co-amoxiclav +/- teicoplanin as in 1. until definitive soft tissue closure or for up to 72 hours, whichever is sooner. 

 

2. At time of first debridement:

 CLINDAMYCIN 600mg iv (NB: for patients >90kg give 1.2g)

plus

GENTAMICIN 3mg/kg (maximum dose 300mg) IV single dose only at induction

(dose tables for Ideal Body Weight)

If CrCl <21 maximum dose 180mg 

 If current / previous MRSA positive:

ADD

TEICOPLANIN  iv
Dose:

<50kg: 600mg

50-74kg: 800mg

75-100kg: 1000mg

>100kg: 1200mg
Note: patients should not receive more than 2400mg of teicoplanin in less than 24 hours.

 Continue clindamycin +/- teicoplanin as in 1. until definitive soft tissue closure or for up to 72 hours, whichever is sooner.

3. At time of skeletal stabilisation and definitive soft tissue closure:

GENTAMICIN 3mg/kg (maximum dose 300mg) IV single dose only at induction

(dose tables for Ideal Body Weight)

If CrCl <21 maximum dose 180mg 

plus

TEICOPLANIN iv
Dose:
<50kg: 600mg
50-74kg: 800mg
75-100kg: 1000mg
>100kg: 1200mg

 Note: patients should not receive more than 2400mg of teicoplanin in less than 24 hours.

 Single dose, do not continue post-operatively.

 

3. At time of skeletal stabilisation and definitive soft tissue closure:

 

GENTAMICIN 3mg/kg (maximum dose 300mg) IV single dose only at induction

(dose tables for Ideal Body Weight)

If CrCl <21 maximum dose 180mg 

plus

TEICOPLANIN iv
Dose:
<50kg: 600mg
50-74kg: 800mg
75-100kg: 1000mg
>100kg: 1200mg

Note: patients should not receive more than 2400mg of teicoplanin in less than 24 hours.

 Single dose, do not continue post-operatively.

  

Last reviewed: 20/09/17 

Urinary catheterisation – adequate antimicrobial cover is provided by the prophylaxis if the catheter is inserted at induction or during the immediate post operative period (within 6 hours of induction).

 

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