adult surgical antibiotic prophylaxis protocol patient id label

Comments

Transcription

adult surgical antibiotic prophylaxis protocol patient id label
Form 6702 (03/17) Page 1 of 4
AUTHORIZATION IS GRANTED TO DISPENSE AND ADMINISTER AN ALTERNATE DRUG PRODUCT ACCEPTABLE TO THE MEDICAL STAFF’S PHARMACY COMMITTEE UNLESS THE
DRUG PRODUCT IS SPECIFICALLY CIRCLED.
 This protocol is used when provider orders surgical antibiotic prophylaxis per protocol.
 If history of severe or life-threatening allergic reaction to penicillin, amoxicillin or related cephalosporins, then give alternative antibiotic
 Timing of the first dose: Initial antibiotic dose for all drugs must be started within one hour prior to incision except Vancomycin AND Fluoroquinolones, which must be
started within 2 hours prior to incision because of the prolonged infusion time required for these drugs.
 The National Surgical Infection Prevention (SIP) project mandates that prophylactic antibiotics not be extended beyond 24 hours of the end of the operation. (Cardiothoracic
surgery can be extended to 48 hours)
 Cefazolin 3 gm is used for weight > 120 kg.
 Vancomycin maximum dose is 2.5 gm
 See Pharmacy Website for Pediatric and Interventional Radiology Pre-Op/Pre-Procedure Antibiotic Dosing Protocol
 For patients with prosthetic joints in which the procedure listed below states “no antibiotic required”, the surgeon may wish to consider antibiotic prophylaxis based on
AAOS recommendations and individual patient risk factors. In these cases the surgeon should order the specific antibiotic desired.
Type of Procedure
Preferred First Line
Interop Redosing
Post-Op Antibiotic
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Clindamycin
900mg IVPB
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Not
Recommended
Vancomycin
15mg/kg IVPB
Pre-OP
Alternative if allergy to preferred antibiotic
Pre-OP
Interop Redosing
Post-Op Antibiotic
Cardiac / Thoracic:
 Any open-heart surgery including
mediastinal re-exploration
 Collis Nissen
 Non Cardiac Thoracotomy
Procedures (Lobectomy / biopsy)
 TAVR or TAVI
 Esophagectomy
 Pacemaker or defibrillator
implant
 EP studies (afib ablation, ASD
closures, perivalvular leak
closures)
Vancomycin
15mg/kg IVPB &
Gentamicin
5mg/kg IVPB
Not
Recommended
Vancomycin
15mg/kg IVPB
q 12 hrs x 2 doses
Clindamycin
900mg IVPB
q 6 hrs
Not
Recommended
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
Not
Recommended
Clindamycin
900mg IVPB
q 6 hrs
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
No antibiotics required
Vascular:
 Any AAA Procedure
 Arterial surgery involving a
prosthesis
 Any procedure with a groin
incision
 Any LE Bypass procedure or
amputation
 AV fistula – any surgical or
radiologic manipulation
 Dialysis Cath removal
 Carotid endarterectomy
 Any Angiography procedure
including stenting
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Clindamycin
900mg IVPB
No antibiotics required
Gastrointestinal / Intra-Abdominal / General Surgery:
Colorectal / Appendectomy
Examples include:
 Colostomy
 Right/left colectomy
 Low anterior resection,
 Rectopex
 I&D Perirectal abscess
ERCP With Obstruction
Cefazolin 2 gm IVP
& Metronidazole
500mg IVPB
Cefazolin 2 gm IVP
q 4 hrs
Ciprofloxacin
400mg IVPB
Not
Recommended
Not Recommended
Metronidazole
500mg IVPB &
Gentamicin
5mg/kg IVPB
Not
Recommended
Not Recommended
Not Recommended
Vancomycin
15mg/kg IVPB &
Gentamicin
5mg/kg IVPB
Not
Recommended
Not Recommended
ADULT SURGICAL ANTIBIOTIC PROPHYLAXIS PROTOCOL
PATIENT ID LABEL
Type of Procedure
Pre-OP
Preferred First Line
Interop Redosing
Post-Op Antibiotic
Open Chole/Nissen Fundoplication
Examples include:
 Common Bile Duct
 Exploration
Lap
chole/splenectomy/adrenalectomy
Examples include:
 Laparoscopic Nissen
Small Bowel Surgery – no
Obstruction
Small Bowel Surgery – with
Obstruction
 Includes both open and
laparoscopic
General Surgery – All other
Surgeries
Examples include:
 Esophageal procedure
 Gastroduodenal procedures
 Hernia, Laparotomy
 Enterolysis
 Lysis of Adhesions
 Percutaneous G-tube placement
 Mastectomy, Sentinal Node
Biopsy
 Bariatric (Banding, bypass,
sleeve gastrectomy)
 Open splenectomy
 Pancrease resection (distal,
Whipple Pseudocyst)
Form # 6702 (03/17) Page 2 of 4
Alternative if allergy to preferred antibiotic
Pre-OP
Interop Redosing
Post-Op Antibiotic
Not Recommended
Clindamycin
900mg IVPB +
Gentamicin
5mg/kg IVPB
Clindamycin
900mg IVPB
q 6 hrs
Not Recommended
Not Recommended
Clindamycin
900mg IVPB +
Gentamicin
5mg/kg IVPB
Clindamycin
900mg IVPB
q 6 hrs
Not Recommended
Not Recommended
Clindamycin
900mg IVPB +
Gentamicin
5mg/kg IVPB
Clindamycin
900mg IVPB
q 6 hrs
Not Recommended
Cefazolin 2 gm IVP
q 4 hrs
Not Recommended
Metronidazole
500mg IVPB &
Gentamicin
5mg/kg IVPB
Not
Recommended
Not Recommended
Cefazolin 2 gm IVP
q 4 hrs
Not Recommended
Clindamycin
900mg IVPB
Clindamycin
900mg IVPB
q 6 hrs
Not Recommended
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
& Metronidazole
500mg IVPB
Cefazolin 2 gm
IVP
General Surgery – ABX Not Required
Examples Include:
 ERCP without obstruction
 Laparoscopy (diagnostic,
operative)
 Parathyroidectomy
 Thyroidectomy
 Wire Loc Breast Biopsy
 Lumpectomy
 Partial Mastectomy
No Antibiotics Required
Genitourinary:
 Laparoscopic Procedures
o Robotic Prostatectomy
o Nephroureterectomy
 Perineal Prostatectomy
 Procedures involving bowel
 Cystectomy
 Prosthetic implants (penile,
sphincter, etc.)
 Percutaneous nephrostomy
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
& Metronidazole
500mg IVPB
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Ciprofloxacin
400mg IVPB
Not
Recommended
Ciprofloxacin 500mg
PO or 400mg IVPB
q 12 hrs x 1 dose
Cefazolin 2 gm IVP
q 8 hrs x 2 doses &
Metronidazole
500mg IVPB q 8 hrs
x 2 doses
Metronidazole
500mg IVPB &
Gentamicin
5mg/kg IVPB
Not
Recommended
Metronidazole
500mg IVPB
q 8 hrs x 2 doses
Not
Recommended
Vancomycin 15mg/kg
IVPB
q 12 hrs x 1 dose
Clindamycin
900mg IVPB
q 6 hrs
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
Cefazolin 2 gm IVP
& Gentamicin
5mg/kg IVPB
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Ampicillin 2 gm
IVPB +
Gentamicin
5mg/kg
Ampicillin 2 gm
q 2 hrs
Ampicillin 2 gm
q 6 hrs x 3 doses
Vancomycin
15mg/kg IVPB &
Gentamicin
5mg/kg IVPB
Clindamycin
900mg IVPB &
Gentamicin
5mg/kg IVPB
ADULT SURGICAL ANTIBIOTIC PROPHYLAXIS PROTOCOL
PATIENT ID LABEL
Type of Procedure
Post-Op Antibiotic
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Clindamycin
900mg IVPB
Clindamycin
900mg IVPB
q 6 hrs
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
Ciprofloxacin
400mg IVPB
Not
Recommended
Ciprofloxacin
500mg PO or
400mg IVPB
q 12 hrs x 1 dose
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Ciprofloxacin
500mg PO
Not
Recommended
Not
Recommended
Ceftriaxone 2 gm
IVP
Not
Recommended
Not
Recommended
Clindamycin
900mg IVPB
q 6 hrs
Not
Recommended
Clindamycin
900mg IVPB
q 6 hrs
Clindamycin
900mg IVPB
q 6 hrs
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
Pre-OP
 Nephrostolithotomy
 Nephrectomy
 Brachytherapy
 Scrotal procedures
o Hydrocele
o Spermatocele
o Variocele
o Epididymal cystectomy
o Vasectomy
 Penile procedures
 Cystoscopy
 Bladder Biopsy
 Retrograde pyelogram
 Hydrodistension
 TURP, TURBT
 Prostate Vaporization
 Ureteroscopy
 Lithotripsy
 Transrectal Biopsy
Form # 6702 (03/17) Page 3 of 4
Alternative if allergy to preferred antibiotic
Pre-OP
Interop Redosing
Post-Op Antibiotic
Clindamycin
Clindamycin
Clindamycin 900mg
900mg IVPB &
900mg IVPB
IVPB
Gentamicin
q 6 hrs
q 12 hrs x 1 dose
5mg/kg IVPB
Preferred First Line
Interop Redosing
 Bladder sling – see under
Gynecologic AND Obstetric
See under Gynecologic / Obstetric
Gynecologic / Obstetric:









Abortion: Any stage
Suction D & C
Hysterectomy, Myomectomy
Colporrhaphy
C-Section
Bladder sling
Tubal ligation (any)
Cervical Cone Procedures
Laparoscopy (diagnostic,
operative, tubal sterilization)
 Laparotomy (unless vagina or GI
tract is entered)
 Hysteroscopy (diagnostic,
operative, essure, endometrial
ablation)
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Not
Recommended
Clindamycin
900mg IVPB &
Gentamicin
5mg/kg IVPB
No antibiotics required
Head / Neck Surgery:
 Incisions through oral or
pharyngeal mucosa
 Placement of prosthetic material
 Oral Surgery
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Clindamycin
900mg IVPB
Unasyn 3 gm IVPB
Unasyn 3 gm IVPB
q 2 hrs
Unasyn 3 gm IVPB
q 6 hrs x 3 doses
Clindamycin
900mg IVPB
 Head and neck procedures
including : blepharoplasties,
Mohs flap reconstruction, lymph
node biopsies, rhinoplasties,
tympanoplasties, tonsillectomy /
adenoidectomy
No antibiotics required
Neurosurgery:
 Cranial / Spinal / CSF shunt
procedures
 Pain pump implant or spinal cord
stimulator
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Vancomycin
15mg/kg IVPB
Not
Recommended
Cefazolin 2 gm IVP
Not Applicable
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Clindamycin
900mg IVPB
Not Applicable
Vancomycin 15mg/kg
IVPB
q 12 hrs x 1 dose
Clindamycin 900mg
IVPB
ADULT SURGICAL ANTIBIOTIC PROPHYLAXIS PROTOCOL
PATIENT ID LABEL
Type of Procedure
 Discogram / Kyphoplasty
Pre-OP
Preferred First Line
Interop Redosing
Cefazolin 2 gm IVP
Not Applicable
Form # 6702 (03/17) Page 4 of 4
Alternative if allergy to preferred antibiotic
Pre-OP
Interop Redosing
Post-Op Antibiotic
q 12 hrs x 1 dose
Clindamycin
Not
Not Applicable
900mg IVPB
Recommended
Post-Op Antibiotic
Not
Recommended
Orthopedic:
 Hardware Removal
 If surveillance culture is positive
for MRSA, disregard all other
bullet points in this section
 Hip, knee, & long bone
procedures
 Hand & Foot procedures
 Orthopedic procedures not using
implanted device
 Arthroscopic Procedures
 Shoulder procedures
Follow recommendation for specific joint as below
Vancomycin
15mg/kg IVPB q 12
Vancomycin
hrs x 1 dose &
15mg/kg IVPB &
Not
Cefazolin 2 gm IVP
Gentamicin
Recommended
x 2 doses
5mg/kg IVPB
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Clindamycin
Clindamycin
Cefazolin 2 gm IVP
900mg IVPB &
900mg IVPB q
q 8 hrs x 2 doses
Gentamicin
6 hrs
5mg/kg IVPB
Clindamycin
Cefazolin 2 gm IVP
Clindamycin
900mg IVPB q
q 8 hrs x 2 doses
900mg IVPB
6 hrs
Clindamycin
Vancomycin
Not
900mg IVPB
15mg/kg IVPB
Recommended
q 12 hrs x 1 dose
No antibiotics required
Vancomycin
15mg/kg IVPB &
Cefazolin 2 gm IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Clindamycin
900mg IVPB
Clindamycin
900mg IVPB
q 6 hrs
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 2 doses
Clindamycin
900mg IVPB
Cefazolin 2 gm
IVP
Cefazolin 2 gm IVP
q 4 hrs
Cefazolin 2 gm IVP
q 8 hrs x 5 doses
Clindamycin
900mg IVPB
Not
Recommended
Clindamycin
900mg IVPB
 Peripheral Nerve Transposition
Vancomycin 15mg/kg
IVPB
q 12 hrs x 1 dose
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
Vancomycin 15mg/kg
IVPB
q 12 hrs x 1 dose
Plastic Surgery:
 All plastic surgery procedures
 Breast Reconstruction Surgery
with implants
Clindamycin
900mg IVPB q
6 hrs
Clindamycin
900mg IVPB q
6 hrs
Clindamycin 900mg
IVPB
q 12 hrs x 1 dose
Clindamycin 900mg
IVPB
q 12 hrs x 3 doses
Clindamycin
900mg IVPB
q 6 hrs
Not
Recommended
Subacute Bacterial Endocarditis (SBE) Prophylaxis, Prosthetic Joint Prophylaxis:
Dental Procedures: Infective
endocarditis prophylaxis is
reasonable only for patients with
underlying cardiac conditions
associated with the highest risk of
adverse outcomes from infective
endocarditis (e.g. prosthetic cardiac
valves or prosthetic material used
for cardiac valve repair, previous
infective endocarditis, congenital
heart disease, cardiac transplant
recipients with valve regurgitation
due to structurally abnormal valve)
GI/GU Procedures
Ampicillin 2 gm
IVPB
Ampicillin 2 gm
IVPB
q 2 hrs
SBE prophylaxis no longer required
The physician’s full signature is to follow the orderAbbreviations for names are not acceptable.
Signature
Date
Time
ADULT SURGICAL ANTIBIOTIC PROPHYLAXIS PROTOCOL
PATIENT ID LABEL
PROTOCOL

Similar documents