General Principles
• 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- and intra-operative antibiotics For patients NOT currently on antibiotics:
• Pre-operative dose should be completed within 60 minutes prior to the incision.
• Patients who screen positive for MRSA should be given a singly 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.
For patients currently ON antibiotics:
• If treatment antibiotics appropriate for perioperative antimicrobial prophylaxis (AMP), continue schedule/follow intraoperative redosing table for timing of next dose.
• If treatment is not appropriate for perioperative AMP, consider routine pre-op prophylaxis in addition to concurrent therapy.
• Patients who screen positive for MRSA should be given a singly pre-operative dose of vancomycin in addition to routine prophylaxis
Post-operative continuation
• 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.
• Operative guidance table does not apply to post-op dosing or intervals.
