Surgical Site Infections

Check MRSA status and contact microbiologist if positive.

**Ongoing management and duration of therapy to be discussed with Microbiology during working hours.

Antibiotic – 1st line

Co-amoxiclav IV 1.2g q8h

 

Penicillin allergy and high risk of MRSA

Teicoplanin IV 10mg/kg q12h for 3 doses then q24h (round to nearest 200mg or 400mg vial)
plus 
Metronidazole 500mg q8h IV
plus 
Gentamicin one stat dose (click here for full gentamicin policy) 
Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.

5mg/kg IV one stat dose  (max 500mg): if <70 years and CrCl≥30mL/min  or
3mg/Kg IV one stat dose  (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation.
If patient is obese ie. 20% over ideal body weight – use adjusted body weight

Duration of therapy 5 days (guided by clinical response)

Antibiotic – 1st line
Flucloxacillin 1g q6h IV (500mg q6h PO). Review IV antibiotics at 48 hours.

 

2nd Line
Clindamycin 600mg q6h IV/PO

Duration of therapy and the need for further gentamicin after 24 hours should be  guided by clinical response and discuss with microbiologist in working hours if necessary

Antibiotic – 1st line

Flucloxacillin 2g 6 hourly IV
plus 
Metronidazole 500mg q8h IV
plus 
Gentamicin one stat dose (click here for full gentamicin policy) 
Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.

5mg/kg IV one stat dose (max 500mg): if <70 years and CrCl≥30mL/min  or
3mg/Kg IV one stat dose (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation.
If patient is obese ie. 20% over ideal body weight – use adjusted body weight

 

2nd Line

Clindamycin 600mg IV/PO 6 hourly
plus 
Gentamicin  one stat dose (click here for full gentamicin policy) 
Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.

5mg/kg IV one stat dose (max 500mg): if <70 years and CrCl≥30mL/min  or
3mg/Kg IV one stat dose (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation.
If patient is obese ie. 20% over ideal body weight – use adjusted body weight

Comment
Gentamicin*: 5mg/ kg  but for elderly patients or with moderate/severe renal impairment(CrCl <30ml/min), may require 3mg/ kg or shorter duration treatment.

Duration of therapy to be discussed with Microbiology during working hours

Antibiotic – 1st line

Flucloxacilin 2g 6 hourly IV
plus 
Metronidazole 500mg q8h IV
plus 
Gentamicin (click here for full gentamicin policy) 
Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.

5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min  or
3mg/Kg IV q24h (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation.
If patient is obese ie. 20% over ideal body weight – use adjusted body weight

 

2nd Line
Cefuroxime 1.5g q8h IV plus Metronidazole 500mg  q8h IV.

Comment
Clindamycin, Co-amoxiclav and Piperacillin-tazobactam usually have sufficient anaerobic cover.  Addition of Metronidazole is only required for dirty trauma wounds at the discretion of the patient’s Consultant.