Orthopaedic WH Surgical Antibiotic Prophylaxis INDICATIONS prosthetic large

Orthopaedic WH - Surgical Antibiotic Prophylaxis INDICATIONS: • prosthetic large joint replacement • other orthopaedic procedures involving insertion of prosthetic or transplant material • internal fixation of fractures of large bones • spinal surgery cephazolin 2 g IV (child: 30 mg/kg up to 2 g) (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) If MRSA risk factors present or re-operation, ADD vancomycin 15 mg/kg IV (adult and child), (infused at 1 gm/hour maximum, infusion ends just prior to incision) • Administer antibiotic 30 minutes before skin incision (around time of induction) unless vancomycin used • If tourniquet is used, allow 5 minutes between administration of antibiotic and application of a tourniquet MRSA risk factors (for vancomycin use) is not necessary • Continuing prophylaxis postoperatively • Known, suspected or previous MRSA colonisation & inpatients > 7 days • Patients undergoing joint surgery if the procedure is a reoperation (return to theatre or revision). Footer Text Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. 1 This can be accessed from the desktop of all WH computers.

Plastics and Thoracics WH - Surgical Antibiotic Prophylaxis INDICATIONS: • Plastics; Prophylaxis is not recommended for the majority of clean procedures unless the patient has risk factors for postoperative infection (eg implantation of prosthetic material, prior skin irradiation) • Prophylaxis is recommended for clean–contaminated procedures cephazolin 2 g IV (child: 30 mg/kg up to 2 g) (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) If MRSA risk factors present, ADD vancomycin 15 mg/kg IV (adult and child), (infused at 1 gm/hour maximum, infusion ends just prior to incision) • Administer antibiotic 30 minutes before skin incision (around time of induction) unless vancomycin used • If tourniquet is used, allow 5 minutes between administration of antibiotic and application of a tourniquet risk factors (for vancomycin use)is not necessary • MRSA Continuing prophylaxis postoperatively • Known, suspected or previous MRSA colonisation • Hospital inpatient > 7 days Footer Text Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. 2 This can be accessed from the desktop of all WH computers.

Vascular WH - Surgical Antibiotic Prophylaxis INDICATIONS: • arterial reconstructive surgery involving the abdominal aorta and/or the lower limb • groin incisions • implantation of foreign material & AV fistula formations • lower limb amputation cephazolin 2 g IV (child: 30 mg/kg up to 2 g) (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) Amputation of ischemic limb; add Metronidazole 500 mg IV If MRSA risk factors present, ADD vancomycin 15 mg/kg IV (adult and child), (infused at 1 gm/hour maximum, infusion ends just prior to incision) • Administer antibiotic 30 minutes before skin incision (around time of induction) unless vancomycin used • MRSA Continue 2 doses operatively q 8 h. riskfor factors (forpost vancomycin use) • Known, suspected or previous MRSA colonisation • Hospital inpatient > 7 days Footer Text Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. 3 This can be accessed from the desktop of all WH computers.

Abdominal WH - Surgical Antibiotic Prophylaxis INDICATIONS; Upper Abdominal. • Biliary tract procedures, including laparoscopic surgery • Gastroduodenal or oesophageal procedures that enter the gastrointestinal tract lumen • Small intestine surgery without obstruction, and hernia repair with mesh cephazolin 2 g IV (child: 30 mg/kg up to 2 g) (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) INDICATIONS; Colorectal and appendicectomy, including small intestine surgery with obstruction Metronidazole 500 mg IV (child: 12. 5 mg/kg up to 500 mg) PLUS cephazolin 2 g IV (child: 30 mg/kg up to 2 g) (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) • Administer antibiotic 30 minutes before skin incision (around time of induction) • Peritonitis or peritoneal soiling require ongoing therapy • Colorectal surgery; consider screening for multidrug-resistant Gram-negative organisms; see OPPS 2. 1. 1, Standard and Transmission Based Precautions Footer Text Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. 4 This can be accessed from the desktop of all WH computers.

GI endoscopic procedures WH - Surgical Antibiotic Prophylaxis INDICATIONS: • ERCP • Endoscopic ultrasound guided FNA • Gastrostomy (PEG) or jejunostomy (PEJ) tube insertion cephazolin 2 g IV (child: 30 mg/kg up to 2 g) (or gentamicin 2 mg/kg IV as a push over 3 -5 mins) For FNA procedures, add Metronidazole 500 mg IV (child: 12. 5 mg/kg up to 500 mg) For PEG and PEJ, If MRSA risk factors present, add Vancomycin 15 mg/kg IV (adult and child), (infused at 1 gm/hour maximum, infusions ends just prior to incision) • Administer antibiotic 30 minutes before skin incision (around time of induction) unless vancomycin used • ERCP for cholangitis needs separate treatment MRSA risk factors (for vancomycin use) • Known, suspected or previous MRSA colonisation • Inpatients > 7 days Footer Text Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. 5 This can be accessed from the desktop of all WH computers.

Head & Neck WH - Surgical Antibiotic Prophylaxis INDICATIONS: • procedures that involve an incision through oral, nasal, pharyngeal or oesophageal mucosa including procedures that involve insertion of prosthetic material. • Prophylaxis is not necessary in tonsillectomy, adenoidectomy, nasal septoplasty, endoscopic sinus surgery, or uncontaminated neck dissection cephazolin 2 g IV (child: 30 mg/kg up to 2 g) (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) If incision through mucosal surfaces, ADD Metronidazole 500 mg IV (child: 12. 5 mg/kg up to 500 mg) • Administer antibiotic 30 minutes before skin incision (around time of induction) Footer Text Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. 6 This can be accessed from the desktop of all WH computers.

Obstetric and Gynaecology WH - Surgical Antibiotic Prophylaxis INDICATIONS; C-section & abdominal hysterectomy cephazolin 2 g IV (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) INDICATIONS; Vaginal Hysterectomy cephazolin 2 g IV (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) PLUS Metronidazole 500 mg IV (child: 12. 5 mg/kg up to 500 mg) INDICATIONS; Surgical termination of pregnancy Doxycycline 400 mg oral 2 -4 hours prior to surgery • Administer antibiotic 30 minutes before skin incision (around time of induction) Footer Text Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. 7 This can be accessed from the desktop of all WH computers.