Single dose, IV prophylaxis ≤ 60mins prior to skin incision/ intervention.
If >1.5L blood loss: replace fluid and repeat antibiotic dose intra-operatively: co-amoxiclav, flucloxacillin. Amikacin should be re-dosed at half prophylaxis dose. Give half the original teicoplanin dose if ≥ 1.5L blood loss within the first hour of operation.
If surgery prolonged >4hrs post first antibiotic dose: repeat co-amoxiclav, flucloxacillin, >8hrs post first antibiotic dose – repeat co-amoxiclav, flucloxacillin, and if eGFR > 60mls/min/ 1.73m2 amikacin (full prophylactic dose). No repeat dosing of teicoplanin if surgery prolonged.
MRSA: decolonise prior to procedure as per NHS GGC infection control guidelines and discuss with microbiology re antibiotic choice.
CPE carriers: For those patients who have been identified as CPE (carbapenemase producing enterobacteriaceae) carriers, contact microbiology.
- Give 400mg teicoplanin by slow intravenous injection over 3-5 minutes
- Teicoplanin and amikacin are incompatible when mixed directly and must not be mixed before injection.