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Guidelines
Surgical Prophylaxis

Surgical Prophylaxis

Background

Refers to the prevention of an infection and is the basis for this document

A necessary component in the standard of care for certain surgical procedures and can reduce the risk of post-operative infection

Clinical Considerations

  • Routine weight-based dosage adjustment will be done on all preoperative antibiotic orders for β-lactams, vancomycin, and aminoglycosides
  • Maximum single-dose for vancomycin IV is 2gm to be infused over 2 hours
  • Doses should be rounded to the nearest 250mg
  • Based on recent data, cefazolin has no like side chains to other beta-lactams and has low risk for cross allergy
    • This position has been supported by local Central Florida Division and corporate AdventHealth committees
  • For cefazolin allergic patients, vancomycin is the agent of choice

Clindamycin should not be routinely used for MRSA coverage due to high local rates of resistance

  • Patients receiving systemic antibiotic therapy prior to surgery should still receive standard pre-operative prophylaxis with appropriate timing of administration
  • In patients receiving routine IV vancomycin prior to surgery and need IV vancomycin during surgery, please notify pharmacy to inquire about rescheduling vancomycin doses to prevent the risk of nephrotoxicity

More Information

Updated: 10.25.2021

The recommendations provided serves as a guide and is not intended to replace sound clinical judgement in the delivery of healthcare

These surgical prophylaxis guidelines are adapted from:

  • The current version of the American Society for Health Systems Pharmacist (ASHP)
  • Infectious Diseases Society of America (IDSA)
  • The Surgical Infection Society (SIS)
  • The Society for Healthcare Epidemiology of America (SHEA) published in Clinical Infectious Diseases in 2013

For specific surgical procedures not included in these guidelines, additional resources were utilized to determine preferred and alternative regimens:

  • Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013 Feb 1;70(3):195-283. 
  • Inpatient Core Measure Specs 4.2b 1-1-13 to 12-31-13, Measure Set: Surgical Care Improvement Project (SCIP), Set Measure ID: SCIP-Inf-2 SCIP-2-5 to 2-6. 
  • Adventist Health System. Cephalosporin Use in Penicillin Allergic Patients Position Statement. 2015.
  • Berrios-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guidelines for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017; 152(8);784-791.