General Surgery (GI) and Breast Surgery Antibiotic Prophylaxis in Adults (51)

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Recommendations for Antibiotic Prophylaxis in General Surgery and Breast Surgery

Single dose, IV prophylaxis ≤ 60mins prior to skin incision/ intervention. 

For gentamicin#

  • See appendix 1 for prophylactic dosing
  • Doses of up to 400mg gentamicin can be given by slow IV injection over 3 – 5 minutes
  • If subsequent treatment using gentamicin is required, measure gentamicin concentration 6-14 hours post theatre gentamicin dose, and follow GGC guidance on staffnet for gentamicin dosing. Calculate the gentamicin dose using the online calculator. Discuss with pharmacy if further advice is required ( or if out of hours, the on call pharmacist)
  • Teicoplanin and gentamicin are incompatible when mixed directly and must not be mixed before injection.
  • See below for intra-operative gentamicin dosing advice.

If >1.5L blood loss

  • replace fluid and repeat antibiotic dose: amoxicillin, metronidazole
  • once bleeding is controlled, measure gentamicin concentration. If the gentamicin concentration is < 2.0mg/L re-dose with half the original gentamicin dose.
  • Give half the original teicoplanin dose if ≥ 1.5L blood loss within the first hour of operation.

If surgery

>4hrs redose amoxicillin;

>8hrs redose amoxicillin, metronidazole,

If surgery is expected to continue for > 8hours from first gentamicin dose,

  • Measure the gentamicin concentration at 6 hours. If the gentamicin concentration is < 2.0 mg/L re-dose with half the original gentamicin dose.

No repeat dosing of teicoplanin if surgery prolonged.

If surgery continues for > 8hours from first antibiotic dose and > 1.5L blood loss

  • Once bleeding is controlled, measure the gentamicin concentration. If the gentamicin concentration is < 2.0mg/L re-dose with half the original gentamicin dose.

If MRSA: decolonise prior to procedure as per NHS GGC infection control guidelines and discuss with microbiology antibiotic choice.

CPE carriers: If identified as Carbapenamase producing Enterobacterales carriers contact microbiology.

Weight > 80 Kg

Increase the dose of antibiotic as below:

  >80 Kg >160 Kg
Metronidazole 1000 mg 1500 mg

Table: Procedure, Comments, Antibiotic

Table

Last reviewed: 23 March 2021

Next review: 29 February 2024

Author(s): Ysobel Gourlay

Version: 6

Author Email(s): [email protected]

Approved By: Antimicrobial Utilisation Committee

Document Id: 51