Guidelines
Surgical Prophylaxis in Pediatrics

Surgical Prophylaxis in Pediatrics

Prophylaxis Information

Please confirm antibiotic preference with surgeon prior to surgery

Preference is for antibiotic to be given as patient is wheeled back by anesthesia

  • Recommendations are for empiric coverage in surgical procedures that require perioperative antibiotics
  • Patients with a history of colonization or infection with an organism not covered by these recommendations (i.e. MRSA, multi-drug resistant organism) should receive targeted prophylaxis
  • Contact ASP/ID for recommendations

The patient should receive the appropriate pre-operative dose of antibiotics for surgical prophylaxis within 60 minutes prior to incision (120 min for vancomycin and fluoroquinolones)

  • If the patient is already receiving vancomycin or an aminoglycoside, and the same antibiotic will be used for prophylaxis, call pharmacy to discuss timing of pre-operative dosing
  • If the patient is receiving ceftriaxone and metronidazole and these will be used for surgical prophylaxis, give another dose within 1 hour of incision time if it has been >6 hours since the last dose. If it has been <6 hours you do not need to redose
  • For all other antibiotics, if the antibiotic appropriate for surgical prophylaxis has been given >1 hour prior to incision time (or >2 hours for drugs with prolonged infusion time like vancomycin and ciprofloxacin), administer the standard pre-operative dose
  • Recommended duration of antibiotics should not exceed the time listed
  • Time starts with the last dose given intra-operatively
  • Severe β-lactam allergy=Type II-IV (anaphylaxis, hives, shortness of breath, wheezing, edema, or recommended antibiotic resulted in serum sickness, DRESS, SJS, etc.)
  • Cefazolin has a unique side chain not shared with other penicillins and cephalosporins and may be considered for most beta lactam allergies

The patient has a history of MRSA please opt for vancomycin over clindamycin when given the option

Additional Information

  1. Baltimore RS, Gewitz M, et. Al. Infective Endocarditis in Childhood: 2015 Update, A Scientific Statement from the American Heart Association. Circulation. 2015:132:1487-1515.

  2. Berrios-Torres SI, Umscheid CA, et. Al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-79.

  3. Tunkel AR, Hasbun R, et. Al. 2017 Infectiuos Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. 2017;64:e34-e65).

  4. Fried HI, Nathan BR, et. Al. The Insertion and Management of External Ventricular Drains: An Evidence-Based Consensus Statement, A Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2016;24:61-81.