Firstline - Clinical Decisions

Guidelines

Vascular

First Line Prophylaxis

Cefazolin 2 g

If >120 kg: 3 g
Re-dosing intra-op: q4h
Dosing post-op: q8h

OR

Vancomycin

If allergy

Dose:
- 50-69 kg: 1 g
- 70-100 kg: 1.5 g
- 101-135 kg: 2 g
- 136-165 kg: 2.5 g
Re-dosing intra-op: q12h (ask Pharmacy to dose if renal disease or elderly)
Dosing post-op: q12h (ask Pharmacy to dose if renal disease or elderly)

MRSA Colonization or Involving Implants

Vancomycin

Dose:
- 50-69 kg: 1 g
- 70-100 kg: 1.5 g
- 101-135 kg: 2 g
- 136-165 kg: 2.5 g
Re-dosing intra-op: q12h (ask Pharmacy to dose if renal disease or elderly)
Dosing post-op: q12h (ask Pharmacy to dose if renal disease or elderly)

PLUS

Cefazolin 2 g

If >120 kg: 3 g
Re-dosing intra-op: q4h
Dosing post-op: q8h

OR

Vancomycin

If allergy

Dose:
- 50-69 kg: 1 g
- 70-100 kg: 1.5 g
- 101-135 kg: 2 g
- 136-165 kg: 2.5 g
Re-dosing intra-op: q12h (ask Pharmacy to dose if renal disease or elderly)
Dosing post-op: q12h (ask Pharmacy to dose if renal disease or elderly)

Duration

Usually continued for 24 hours post-op; some authorities suggest only pre-op and intra-op doses are of benefit

Max duration 24 hours post-op (except cardiac surgery 48 hours post-op based on expert opinion/STS consensus statement)