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 antibiotics 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.
The selection of antibiotics 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 guidelines.
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.
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