Permanent Pacemaker Insertion (or other cardiac implantable electronic device)

FLUCLOXACILLIN 1g              IV single dose only at induction
                                                    (n.b. give a 2nd IV dose during procedure if it lasts longer than 2 hours)
plus
GENTAMICIN 2mg/kg              IV single dose only at induction
(max. 240mg)
OR Local instillation, 80–160mg injected into pacemaker pocket once subcutaneous tissue closed

OR if penicillin allergy (explanatory notes)
OR if known MRSA positive
OR if at increased risk of resistant staphylococcal infection (see below*), then use:

TEICOPLANIN 600mg               IV single dose only at induction
plus
GENTAMICIN 2mg/kg                IV single dose only at induction
(max. 240mg)
OR Local instillation, 80–160mg injected into pacemaker pocket once subcutaneous tissue closed

*Patients at increased risk of resistant staphylococcal infection:

• MRSA screening results unknown
• Existing temporary pacing wires
• Repeat pacing procedure during same admission
• Received previous flucloxacillin in last 4 weeks