1. 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.

2. 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.

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.