The aim of surgical prophylaxis is to reduce surgical site infections. SIGN 104 outlines which surgical procedures require prophylaxis with antimicrobials, when they should be administered and for how long. This guideline states which antibiotics should be used for surgical procedures within NHS Forth Valley, taking into account national guidance on reducing the incidence of C.difficle by restricting certain antibiotics.
Points of note
- If anaphylaxis to penicillin – discuss with microbiology
- These regimes may be unsuitable for patients who have infections with ESBL organisms
- If concerns re choice of prophylaxis for selected patients or their renal function, please discuss with microbiology for alternative options.
- If patient already on antibiotics prior to surgery ensure the suitability of these as prophylaxis, discuss with microbiology if needed
- If antibiotics to be continued post operatively ensure their suitability by checking the microbiology culture results
- Teicoplanin can affect renal function and bone marrow
- Co-amoxiclav and cefuroxime are associated with C.difficile infection
Principles of Therapy
- Indication for prophylaxis should comply with SIGN 104.
- Timing – Optimum timing is ≤30 minutes prior to skin incision. (Suboptimal if > 1 hour prior to skin incision or post-skin incision).
- Prescribing / Recording of Administration – This should be recorded on HEPMA - this is preferable to recording on the anaesthetic chart. Where prophylaxis is to continue beyond a single dose, the reason for this along with the duration should be recorded in the medical notes.
- Choice of drug -
- Avoid cephalosporins,clindamycin,co-amoxiclav and quinolones where possible.
- Narrow spectrum agents should be used where possible
- Consider alternatives for beta-lactam allergy.
- Administration – frequency – Single dose is sufficient except in the following circumstances:
- >1.5 litre intra-operative blood loss. Re-dose following fluid replacement – see below for dosing guidance
- Operation prolonged
- Arthroplasty – up to 24 hours prophylaxis can be considered.