Orthopaedic WH - Surgical Antibiotic Prophylaxis INDICATIONS: prosthetic large joint replacement other orthopaedic procedures involving insertion of prosthetic or transplant material internal fixation of fractures of large bones spinal surgery cephazolin 2 g IV (child: 30 mg/kg up to 2 g)  (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) If MRSA risk factors present or re-operation, ADD vancomycin 15 mg/kg IV (adult and child), (infused at 1gm/hour maximum, infusion ends just prior to incision) Administer antibiotic 30 minutes before skin incision (around time of induction) unless vancomycin used If tourniquet is used, allow 5 minutes between administration of antibiotic and application of a tourniquet Continuing prophylaxis postoperatively is not necessary MRSA risk factors (for vancomycin use) Known, suspected or previous MRSA colonisation & inpatients > 7 days Patients undergoing joint surgery if the procedure is a reoperation (return to theatre or revision). Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. This can be accessed from the desktop of all WH computers.

Plastics and Thoracics WH - Surgical Antibiotic Prophylaxis INDICATIONS: Plastics; Prophylaxis is not recommended for the majority of clean procedures unless the patient has risk factors for postoperative infection (eg implantation of prosthetic material, prior skin irradiation) Prophylaxis is recommended for clean–contaminated procedures cephazolin 2 g IV (child: 30 mg/kg up to 2 g)  (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) If MRSA risk factors present, ADD vancomycin 15 mg/kg IV (adult and child), (infused at 1gm/hour maximum, infusion ends just prior to incision) Administer antibiotic 30 minutes before skin incision (around time of induction) unless vancomycin used If tourniquet is used, allow 5 minutes between administration of antibiotic and application of a tourniquet Continuing prophylaxis postoperatively is not necessary MRSA risk factors (for vancomycin use) Known, suspected or previous MRSA colonisation Hospital inpatient > 7 days Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. This can be accessed from the desktop of all WH computers.

Vascular WH - Surgical Antibiotic Prophylaxis INDICATIONS: arterial reconstructive surgery involving the abdominal aorta and/or the lower limb groin incisions implantation of foreign material & AV fistula formations lower limb amputation cephazolin 2 g IV (child: 30 mg/kg up to 2 g)  (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) Amputation of ischemic limb; add Metronidazole 500mg IV If MRSA risk factors present, ADD vancomycin 15 mg/kg IV (adult and child), (infused at 1gm/hour maximum, infusion ends just prior to incision) Administer antibiotic 30 minutes before skin incision (around time of induction) unless vancomycin used Continue for 2 doses post operatively q8h. MRSA risk factors (for vancomycin use) Known, suspected or previous MRSA colonisation Hospital inpatient > 7 days Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. This can be accessed from the desktop of all WH computers.

Abdominal WH - Surgical Antibiotic Prophylaxis INDICATIONS; Upper Abdominal. Biliary tract procedures, including laparoscopic surgery Gastroduodenal or oesophageal procedures that enter the gastrointestinal tract lumen Small intestine surgery without obstruction, and hernia repair with mesh cephazolin 2 g IV (child: 30 mg/kg up to 2 g)  (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) INDICATIONS; Colorectal and appendicectomy, including small intestine surgery with obstruction Metronidazole 500 mg IV (child: 12.5 mg/kg up to 500mg) PLUS cephazolin 2 g IV (child: 30 mg/kg up to 2 g)  (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) Administer antibiotic 30 minutes before skin incision (around time of induction) Peritonitis or peritoneal soiling require ongoing therapy Colorectal surgery; consider screening for multidrug-resistant Gram-negative organisms; see OP-PS2.1.1, Standard and Transmission Based Precautions Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. This can be accessed from the desktop of all WH computers.

GI endoscopic procedures WH - Surgical Antibiotic Prophylaxis INDICATIONS: ERCP Endoscopic ultrasound guided FNA Gastrostomy (PEG) or jejunostomy (PEJ) tube insertion cephazolin 2 g IV (child: 30 mg/kg up to 2 g)  (or gentamicin 2mg/kg IV as a push over 3-5 mins) For FNA procedures, add Metronidazole 500 mg IV (child: 12.5 mg/kg up to 500mg) For PEG and PEJ, If MRSA risk factors present, add Vancomycin 15 mg/kg IV (adult and child), (infused at 1gm/hour maximum, infusions ends just prior to incision) Administer antibiotic 30 minutes before skin incision (around time of induction) unless vancomycin used ERCP for cholangitis needs separate treatment MRSA risk factors (for vancomycin use) Known, suspected or previous MRSA colonisation Inpatients > 7 days Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. This can be accessed from the desktop of all WH computers.

Head & Neck WH - Surgical Antibiotic Prophylaxis INDICATIONS: procedures that involve an incision through oral, nasal, pharyngeal or oesophageal mucosa including procedures that involve insertion of prosthetic material. Prophylaxis is not necessary in tonsillectomy, adenoidectomy, nasal septoplasty, endoscopic sinus surgery, or uncontaminated neck dissection cephazolin 2 g IV (child: 30 mg/kg up to 2 g)  (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) If incision through mucosal surfaces, ADD Metronidazole 500 mg IV (child: 12.5 mg/kg up to 500mg) Administer antibiotic 30 minutes before skin incision (around time of induction) Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. This can be accessed from the desktop of all WH computers.

Obstetric and Gynaecology WH - Surgical Antibiotic Prophylaxis INDICATIONS; C-section & abdominal hysterectomy cephazolin 2 g IV   (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) INDICATIONS; Vaginal Hysterectomy cephazolin 2 g IV   (IF PROCEDURE MORE THAN 4 hours REDOSE REQUIRED) PLUS Metronidazole 500 mg IV (child: 12.5 mg/kg up to 500mg) INDICATIONS; Surgical termination of pregnancy Doxycycline 400mg oral 2-4 hours prior to surgery  Administer antibiotic 30 minutes before skin incision (around time of induction) Western Health recommends prophylaxis per Therapeutic Guidelines Australia, October 2014. This can be accessed from the desktop of all WH computers.