Firstline - Clinical Decisions

Note

Infusion of the first dose of antimicrobials should be carefully timed to ensure that tissue concentrations are maximal prior to the first skin incision.
For typical antimicrobials (eg. ceFAZolin), infusion must begin WITHIN 60 minutes of the surgical incision.
Vancomycin, however, should be administered 1-2 hours prior to incision as it needs to be infused over a minimum of one hour (dose dependent) with completion of the infusion prior to skin incision.

No antimicrobials are routinely required post-operatively unless in exceptional circumstances or if being used for treatment purposes

Prior history of allergy to penicillin or ampicillin/amoxicillin

Since the side chain of cefazolin is different than penicillin or amoxicillin, patients who report an allergy to penicillin can safely be given cefazolin.
Exceptions are past history or SJS, DRESS, toxic epidermal necrolysis, acute generalized pustulosis, skin desquamation, hepatitis, nephritis, hemolytic anemia or serum sickness or prior reaction to cefazolin itself..

Prolonged operations require re-administration of IV antimicrobials to maintain therapeutic levels at the site of wound closure if the operation lasts twice the half life of the antibiotic, if there is excessive blood loss or extended use of cardiopulmonary bypass.

Doses quoted are for the intravenous route and for patients with normal renal function. Do not exceed the maximum adult dose.

Surgical Prophylaxis: Pediatrics

Note

Prior history of allergy to penicillin or ampicillin/amoxicillin

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