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Remarks:
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AUG has very good activities on anaerobes. There is no need to add MET when these drugs are being used
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"3 doses" mean 1 dose during induction followed by 2 more doses postoperatively, i.e. 3 doses in total
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iv CLIN 900mg q8h is required for cases with toxic shock syndrome
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Give Cefazolin 2g for patients with body weight greater than 80kg
5
For hospitals or units with high incidence of postoperative wound infections by MRSA or MRSE, screening and additional preoperative measures for MRSA may
be indicated and / or use Vancomycin as preoperative prophylaxis
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KWC Antibiotic Guideline for Surgical Prophylaxis
General principle:
1) Timing:
Antibiotics must be given so that good tissue levels are present at the time of procedure and for the first 3-4 hours after surgical
incision. Therefore, the first dose of IV antibiotics should be given within 30 - 60 minutes before surgical incision is made, i.e.
with induction of anesthesia. For those antibiotics requiring infusion (Ciprofloxacin, Clindamycin, Metronidazole, Vancomycin),
infusion should be completed 10 minutes before incision.
2) Duration:
Single dose antibiotic given during induction provides adequate tissue level for most surgical procedures. For procedure lasting
for several hours, repeated doses of antibiotics may be necessary intraoperatively to maintain adequate tissue level.
High Risk:
-Age > 70
-Acute Cholecystitis 6 / Pancreatitis
-Obstructive Jaundice
-Common Bile Duct Stones iv Cefuroxime 1.5g +/- iv MET 500mg
Hepatobiliary System
-Morbid obesity OR
-Intraoperative cholangiogram iv GEN 120mg (1 dose)
Laparoscopic Gall Bladder iv AUG1 1.2g
-Bile spillage
Surgery
-Pregnancy (1 dose)8
-Immunosuppression
-Insertion of prosthetic devices
-Laparoscopic converts to
laparotomy
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KWC Antibiotic Regimen
Alternative
Type of operation Indication Recommendation (for patients with
beta-lactam allergy)
iv Cefuroxime 1.5g (1 dose) followed by
750mg (2 doses) + iv MET 500mg (3
doses2)8 iv GEN 120mg + iv MET 500mg (q8h
Appendectomy
OR for 3 doses 2)8
iv AUG1 1.2g
(3 doses in total 2)8
Parenteral
iv Cefuroxime 1.5g (1 dose) followed by
Lower GI 750mg (2 doses) + iv MET 500mg (3
doses2)8
Colorectal surgery OR
iv GEN 120mg + iv MET 500mg
- Most procedures require iv AUG11.2g
(3 doses in total 2)8
parenteral +/- oral prophylaxis (3 doses in total 2)8
Oral
po Neomycin and Erythromycin base 1g
each three times a day the day before
operation
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Abbreviations for anti-infective agents
AG= Aminoglycoside; AMK= Amikacin; AMOX= Amoxicillin; AMP= Ampicillin; AUG= Augmentin
(Amoxicillin&Clavulanic acid); CIP= Ciprofloxacin; CLIN= Clindamycin; CLR= Clarithromycin;
CLOX= Cloxacillin, ERY= Erythromycin; EMB= Ethambutol; FQ= Fluoroquinolone;
GEN= Gentamicin; INH= Isoniazid; LIN= Linezolid; LVX= Levofloxacin; MER= Meropenem;
MET= Metronidazole; NIT= Nitrofurantoin; PEN=Penicillin; PIP= Piperacillin; PZA= Pyrazinamide;
RIF= Rifampicin; SUL= Sulperazon, SXT= Septrin(Cotrimoxazole); TEIC= Teicoplanin;
TIEN= Tienam; TIM= Timentin (ticarcillin - clavulanate); TZC= Tazocin(piperacillin -tazobactam);
UNA = Unasyn (Ampicillin- sulbactam); VAN= Vancomycin
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