Antibiotics for surgical site infection prevention [Neurosurgery Wiki]

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====== Antibiotics for surgical site infection prevention ======

Prevention of a [[wound infection]] depends on adequate primary surgical treatment of a [[wound]]. Treatment is aimed at suppressing the development of [[infection]] through administration of [[antibiotic]]s and other antimicrobial preparations and at strengthening the defensive mechanisms of the afflicted individual; an adequate [[diet]], transfusions of blood and protein preparations, and the administration of specific serums, toxoids, autovaccines, and gamma globulin serve the latter purpose.

see [[Antibiotic prophylaxis]].

The selection of [[antibiotic]]s for [[surgical site infection prevention]] is based on the specific procedure, the potential pathogens involved, and local resistance patterns. Commonly used antibiotics for neurosurgical prophylaxis may include [[cefazolin]] or [[vancomycin]], depending on the patient's risk factors and the institution's [[guideline]]s.

Avoid cephalosporins, clindamycin, quinolones, and co-amoxiclav wherever possible

Use narrow-spectrum agents when possible e.g. avoid carbapenems, piperacillin/tazobactam

Take into account local resistance patterns e.g. >95% of MRSA isolated in Tayside are sensitive to gentamicin

Provision of alternatives for beta-lactam allergy

De-colonisation therapy before surgery when MRSA is positive when recommended in Infection Control Policies

Complex individual prophylaxis issues should be discussed with Microbiology or Infectious Diseases pre-operatively and recorded in medical records

Compliance with local policy is required. Any deviation from policy must be recorded in the appropriate medical records.
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[[Cefuroxime]] 1.5 g Bolus over 3-5 minutes Redose 1.5g after 4 hours 1.5g

[[Flucloxacillin]] 2g Bolus over 3-5 minutes Repeat 2g dose after 4 hours 2g

[[Teicoplanin]] 800mg
(400mg if <40kg)
Bolus over 3-5 minutes Not required Give half the original dose if 1500ml or more
blood loss within the first hour of operation

[[Metronidazole]] 500mg Infusion over 20 minutes Redose 500mg after 8 hours 500mg