Version June 2024
| Nature of operation | Common pathogens | Patient-population | Recommended antimicrobials | Usual adult dose* | Redose interval¶ |
| – | – | None | – | – |
| Staphylococcus aureus, Staphylococcus epidermidis and other coagulase-negative staphylococci | No known MRSA colonization, and no history of IgE-mediated or other severe beta-lactam allergy◊ | Cefazolin§ | <120 kg: 2 g IV ≥120 kg: 3 g IV | 4 hours |
| Known MRSA colonization¥ | Cefazolin | <120 kg: 2 g IV ≥120 kg: 3 g IV | 4 hours | ||
| plus | |||||
| Vancomycin¥ | 15 mg/kg IV (max 2 g) | N/A | |||
| IgE-mediated or other severe beta-lactam allergy◊ | Vancomycin§¥ | 15 mg/kg IV (max 2 g) | N/A | ||
IV: intravenous; N/A: not applicable; MRSA: methicillin-resistant Staphylococcus aureus.
* Parenteral prophylactic antimicrobials can be given as a single IV dose begun within 60 minutes before the procedure. If vancomycin is used, the infusion should be started within 60 to 120 minutes before the initial incision to have adequate tissue levels at the time of incision and to minimize the possibility of an infusion reaction close to the time of induction of anesthesia.
¶ For prolonged procedures (>3 hours), procedures with major blood loss, and patients with extensive burns, additional intraoperative doses should be given at intervals one to two times the half-life of the drug for the duration of the procedure in patients with normal renal function.
Δ The role of antimicrobial prophylaxis prior to removal of orthopedic hardware used for treatment of lower extremity factures is controversial. According to the guidelines issued by the United States Centers for Disease Control and Prevention, this is considered a "clean" surgical procedure (ie, without skin contamination or local infection), for which preoperative antibiotic prophylaxis is not routinely recommended. However, relatively high rates of surgical site infection have been reported for this procedure; therefore, we favor administration of preoperative antimicrobial prophylaxis. Refer to the text for further discussion.
◊ Many patients with reported beta-lactam allergies do not have IgE-mediated or other severe allergies and can tolerate cephalosporins. Because of lower efficacy of vancomycin, patients with reported beta-lactam allergies should be evaluated prior to surgery to determine the level of risk from cefazolin. Refer to UpToDate content for further details.
§ If a tourniquet is to be used in the procedure, the entire dose of antibiotic must be infused prior to its inflation.
¥ The addition of vancomycin to cefazolin is also appropriate in hospitals with unacceptably high rates of postoperative MRSA prosthetic joint infections. Rapid IV administration of vancomycin may cause hypotension, which could be especially dangerous during induction of anesthesia. Even when the drug is given over 60 minutes, hypotension may occur; treatment with diphenhydramine and further slowing of the infusion rate may be helpful. Some experts would give 15 mg/kg of vancomycin to patients weighing more than 75 kg, up to a maximum of 1.5 g, with a slower infusion rate (90 minutes for 1.5 g).آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
