Pharmacology for Anaesthesia and Intensive Care

Table 22.1.Guidelines for antibacterial prophylaxis.
Type of
Prevention aim Type of surgery anaesthesia Patient details Options for prophylaxis (NB adult doses)
Endocarditisin patients with Dental Local/none No recent penicillin Amoxycillin(3gp.o.)1hpre-op

• Valve lesion


• Prosthetic valve


• Septal defect


• PDA

Penicillin allergic or recent

penicillin

Clindamycin(600 mg p.o.)1hpre-op

Previous endocarditis Amoxycillin(1 g i.v.) andgentamicin (120 mg i.v.)

thenamoxycillin(500 mg p.o.)6hlater

General Nospecial risk Amoxycillin(1 g i.v.) at induction, thenamoxycillin

(500 mg p.o.)6hlater

Amoxycillin(3gp.o.)4hpre-op, thenamoxycillin

(3 g p.o.) asap post-op

Special risk Amoxycillin(1 g i.v.) andgentamicin(120 mg i.v.) at

induction, thenamoxycillin(500 mg p.o.)6hlater

Penicillin allergic or

recent penicillin

Vancomycin(1 g i.v.) pre-op andgentamicin

(120 mg i.v.) at induction

Teicoplanin(400 mg i.v.) andgentamicin

(120 mg i.v.) at induction

Upper

respiratory

tract

Any As for Dental

Genito-urinary Any As for Dental/GA/ Special risk. NB if urine infected,

ensure prophylaxis covers infecting organism

Obstetrics,

Gynaecology

and GI

procedures

Any As for Genito-urinary (but prophylaxis only required

for those atspecial risk)

Meningococcal meningitis N/A N/A Rifampicin(600 mg p.o.) bd for 2 days
Ciprofloxacin(500 mg p.o.) single dose
Ceftriaxone(250 mg i.m.) single dose
Pneumococcal infection(in
asplenia/sickle cell
disease)

N/A Any Penicillin V(500 mg bd)

Infection in abdominal
surgery

Upper GI

surgery

Any Gentamicin(120 mg i.v.) at induction

Cefuroxime(1.5 g i.v.)2hpre-op

Lower GI

surgery

Any Gentamicinandmetronidazole
Cefuroximeandmetronidazole
Hysterectomy Any Metronidazole at induction
Special risk=prosthetic valve or previous endocarditis. Recent pencillin=within the previous month