Single dose, IV prophylaxis ≤ 60 minutes prior to skin incision/ intervention.
If >1.5L blood loss replace fluid and repeat antibiotic dose: flucloxacillin, metronidazole, clarithromycin, co-amoxiclav. Give half the original teicoplanin dose if ≥ 1.5L blood loss within the first hour of operation.
If surgery >4hrs repeat co-amoxiclav, flucloxacillin; >8hrs repeat, clarithromycin, co-amoxiclav, flucloxacillin, metronidazole. 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.
Weight > 80 Kg
Increase the dose of antibiotic as below:
|> 100 Kg|
|Co-amoxiclav||add 1g IV amoxicillin to 1.2g IV co-amoxiclav|
|> 80 Kg||> 160 Kg|
|Clindamycin||900 mg||1200 mg|
|Metronidazole||1000 mg||1500 mg|