Orthopaedic Procedures

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Procedure

Recommended Antibiotics and comments

Orthopaedic procedures

Arthroplasty* and any surgery involving insertion of implant

Cefuroxime 1.5g IV

or

Flucloxacillin 1g IV + Gentamicin IV as per table

If penicillin allergy: Teicoplanin 400mg IV + Gentamicin IV as per table

*Include antibiotic impregnated cement.

Surgery without implant (clean)

Not recommended

Soft tissue surgery of hand

Not recommended

Arthroscopy

Not routinely recommended. If previous implant e.g. anterior cruciate ligament reconstruction, prophylaxis as per arthroplasty.

Open fracture

Open reduction

Internal fixation

Hemiarthroplasty*

Flucloxacillin 1g IV + Gentamicin IV as per table

or

Cefuroxime 1.5g IV

If penicillin allergy: Teicoplanin 400mg IV + Gentamicin IV as per table

*Include antibiotic impregnated cement.

Contaminated hand trauma (without bite) Incision and drainage**

Flucloxacillin 2g IV four times daily

If penicillin allergy: Vancomycin IV (as per treatment guidelines)

**Treatment NOT prophylaxis. Assess severity and follow NHS Ayrshire and Arran infection management guidelines  Remember appropriate IV to oral switch and minimum 7 days in total

** Contaminated hand trauma (with human or animal bite) Incision and drainage

 

Co-amoxiclav 1.2g IV three times daily

If penicillin allergy: Metronidazole 500mg IV three times daily / 400mg oral and Doxycycline 200mg oral on day 1, 100mg oral twice daily thereafter.

**Treatment NOT prophylaxis. Assess severity and follow NHS Ayrshire and Arran infection management guidelines  Remember appropriate IV to oral switch and minimum 7 days in total