Dosing Table for Operative Antibiotic Prophylaxis
Guideline · Feb 2019 · 1 min read
In brief
In brief
Clinical reference guide for perioperative antibiotic prophylaxis dosing in surgical patients. Covers timing of preoperative administration, intraoperative redosing intervals, MRSA-positive patient management, and principles for patients already on antibiotic therapy.
- Pre-operative antibiotics must be completed within 60 minutes before incision; redose based on drug half-life or if excessive blood loss occurs.
- MRSA-positive patients require single pre-operative vancomycin dose in addition to standard surgical prophylaxis regardless of current antibiotic therapy.
- Routine prophylactic antibiotics should be discontinued once incision is closed; post-operative continuation is not indicated for standard cases.
- Patients already on antibiotics may continue if appropriate for prophylaxis, otherwise add routine pre-op prophylaxis to concurrent therapy.
- Consult infectious disease and pharmacy for patients with renal/hepatic dysfunction, multiple allergies, or complex infection history before dosing.
Written by the GCMD Library team from the guideline.
General Principles for Antibiotic Prophylaxis
All dosing recommendations assume normal renal and hepatic function. Consultation with infectious disease and pharmacy is recommended for patients with multiple allergies, complex infection history, organ dysfunction, or ongoing antibiotic therapy.
Pre-operative and Intra-operative Antibiotics for Patients NOT on Antibiotics
Pre-operative antibiotics must be administered within 60 minutes before incision. MRSA-positive patients require a single dose of vancomycin in addition to standard prophylaxis, and redosing should follow protocol timing or occur with excessive blood loss.
Pre-operative and Intra-operative Antibiotics for Patients Currently ON Antibiotics
If current treatment antibiotics are appropriate for perioperative prophylaxis, continue the existing schedule and follow intraoperative redosing intervals. If treatment antibiotics are not appropriate, add routine prophylaxis while continuing concurrent therapy, with vancomycin added for MRSA-positive patients.
Post-operative Antibiotic Continuation
Routine prophylactic antibiotics should be discontinued after incision closure and not continued postoperatively. Redosing in the operating room before closure should be considered if closure will occur within 30 minutes of the scheduled redosing time, with subsequent timing based on the last pre-closure dose.
Statements in this guideline
All dosing recommendations are for patients with normal renal and/or hepatic function.
Consider consultation with ID and pharmacy in cases of multiple allergies, complex infection history, hepatic or renal dysfunction, and with ongoing pre-operative antibiotic therapy.
Pre-operative dose should be completed within 60 minutes prior to the incision.
Patients who screen positive for MRSA should be given a single pre-operative dose of vancomycin in addition to routine prophylaxis.
Re-dose prophylactic antibiotic according to times in the table or if the patient has experienced excessive blood loss.
If treatment antibiotics appropriate for perioperative antimicrobial prophylaxis, continue schedule and follow intraoperative redosing table for timing of next dose.
If treatment is not appropriate for perioperative antimicrobial prophylaxis, consider routine pre-op prophylaxis in addition to concurrent therapy.
For routine prophylaxis, antibiotics should not be continued after the incision is closed.
Redosing in the OR prior to closure should be considered if closure is anticipated within 30 minutes of the usual redosing time.
The first post-operative dose is timed off of last dose given prior to incision closure.