Surgical Antibiotic Prophylaxis
The policy is based on SIGN 104 (July 2008) which outlines those surgical procedures requiring prophylactic antibiotics and how and when they should be administered.
Refer to surgical speciality guidelines on NHSGGC StaffNet / Clinical Info / Clinical Guidelines Directory and search in 'Infections - Secondary Care Adult Prophylaxis' section of the directory for specific agent(s) and regimens, including gentamicin prophylaxis guideline.
General antibiotic prophylaxis prescribing guidance
- Check whether indication is appropriate. For indication and choice see tables on NHSGGC StaffNet / Clinical Info / Clinical Guidelines Directory and search in 'Infections - Secondary Care Adult Prophylaxis' section of the directory. Always discuss any complex individual prophylaxis issues with microbiology pre-operatively.
- Record antibiotic in the "once only" section of the drug prescription form, ideally it should also be recorded on the anaesthetic record.
- Administer a single dose of antibiotic(s). Optimum time is ≤60 minutes prior to skin incision (usually in anaesthetic room at induction of anaesthesia). If >1 hour has elapsed, cover will be sub-optimal.
- In some circumstances a second dose may be required. If so, always document the reason which may be:
- >1.5 litre intra-operative blood loss in which case following fluid replacement, re-dose giving same dose for all agents except gentamicin (give only half the recommended prophylaxis dose) and teicoplanin (do not re-dose).
- If surgery is prolonged then re-dose as per specific prophylaxis guideline
- MRSA: decolonise prior to procedure as per NHSGGC infection control guidelines and discuss with microbiology regarding antibiotic choice.
- Prophylactic gentamicin dosing is based on patient's height and approximates to 3mg/kg/ideal body weight, capped at 300 mg ( for dosing table see NHSGGC StaffNet / Clinical Info / Clinical Guidelines Directory and search in 'Infections - Secondary Care Adult Prophylaxis' section of the directory). This allows bolus administration in anaesthetic room. Avoid prophylactic gentamicin if eGFR <20ml/minute/1.73m2 and in renal transplant patients. Seek advice on an alternative from microbiology or the renal team.
Post-operative intra-abdominal infection
If antibiotic therapy for post-operative intra-abdominal infection is required, contact microbiology for advice. In the meantime empirical antibiotic regimens for intra-abdominal infection can be found here. If antibiotic therapy for post-operative infection is required, treat empirically as per anatomical source and review cultures.
Content last updated December 2018