Antibiotic Prophylaxis

TYPE OF SURGERY ANTIBIOTIC RECOMMENDED
Cefazolin, IV Cefazolin, IV:
PLUS
Orthopaedic surgery Primary total hip or total
knee replacement; internal
fixation of hip; spinal
procedures; open reduction
and internal fixation of
fractures; insertion of
prostheses, screws, plates,
etc.
Gastrointestinal surgery Gastric/ duodenal/ oesophageal
hernia repair. 		Billiary, colorectal,
manipulation of
viscera, appendicectomy,
division of adhesions,
exploratory laparotomy:
ADD
Metronidazole, IV.
Thoracic surgery specialist Pneumonectomy/
lobectomy:
ADD
Metronidazole, IV.
Cardiac surgery specialist Coronary artery bypass surgery/
routine cardiac valve surgery
(continue cefazolin, IV, 8 hourly
for 24 hours); cardiac device
insertion (pacemaker implantation).
Vascular surgery
(Prophylaxis is not
recommended for
other clean procedures). 		Vascular reconstruction:
abdominal aorta, groin incision
(continue 8 hourly for 24 hours);
AV fistula formation; and
ligation of varicose veins. 		Lower limb
amputation:
ADD
Metronidazole, IV.
Urology Clean procedures Clean contaminated
procedures:
ADD
Metronidazole, IV.
Plastic and reconstructive
surgery (Prophylaxis is
not recommended for clean
bone or soft tissue surgery). 		Craniotomy procedures.
Otorhinolaryngology/ head
and neck surgery
(Prophylaxis is not
recommended for other
procedures such as
tonsillectomy, sinus
procedures, etc.). 		No incision through the
oropharyngeal mucosa. 		With incision through
the oropharyngeal
mucosa:
ADD
Metronidazole, IV.
Obstetrics/ gynaecology
(Prophylaxis is not
recommended for early
suction termination). 		Caesarean section. Hysterectomy,
laparotoy procedures,
vaginal repair:
ADD
Metronidazole, IV.

Caesarean delivery:
ADD
Metronidazole, IV.
Neurosurgery
(Prophylaxis is not recommended for other minor clean procedures). 		Craniotomy; CSF shunt/drain; laminectomy.
Endoscopic
gastrointestinal procedures
(Prophylaxis is not
recommended for all other
procedures, with or
without biopsy). 		Percutaneous endoscopic
Gastrostomy insertion/
revision.
General Surgery
(Prophylaxis is not
recommended for
uncomplicated clean
procedures clean excision
procedures i.e. wound
revision, excision of scar
tissue, etc.). 		Clean contaminated
procedures (mastectomy,
node biopsy, etc.),
splenectomy.

LoEI [14]

Beta lactam allergies

Avoid beta-lactam antimicrobials in patients with a history of anaphylaxis, bronchospasm, urticaria, or angioedema after exposure to one of these agents.

  • Clindamycin, IV.

AND

  • Gentamicin, IV for the procedures listed below:
  • See Appendix II for guidance on prescribing.
    • Gastrointestinal surgery, urology procedures (clean-contaminated), and obstetric/gynaecological surgery (hysterectomy, laparotomy procedures, vaginal repair).

NOTE

Clindamycin has good coverage against Gram positive organisms and anaerobes, so the addition of metronidazole is unnecessary.

LoEIII [15]

Ophthalmic surgery

  • Chloramphenicol 0.5% ophthalmic drops, instil 1 drop 2–4 hourly for 24 hours prior to surgery.