Surgical Prophylaxis

Surgical Prophylaxis

Clinical Considerations

ALL prophylactic antimicrobials should be administered 15-60 minutes prior incision EXCEPT Vancomycin which should be given 60-120 minutes prior to incision  

  • If the entire dose of vancomycin cannot be infused prior to incision, infuse at least the first gram over 1 hour

Routine post incision closure antibiotics in clean and clean-contaminated procedures are NOT recommended

  • Post incision closure antibiotic prophylaxis are recommended at the present time in:
    • Cardiothoracic surgery x 24 hours (excludes EP procedures)
    • Transplant surgery
    • Joint arthroplasty
    • Breast implants x 24 hours
  • Additional prophylactic antimicrobial agent doses should NOT be administered after the surgical incision is closed for clean and clean-contaminated procedures, even in the presence of a drain
  • Contaminated or infected surgical wounds recommend antibiotic orders be added on by a ‘case by case’ basis
  • Post-procedure cefazolin should be started 6 hours from last preoperative or intraoperative dose

More Information

Bratzler et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. AJHP. 2013; 70:195-283.

Updated: 2/7/2022