Surgical Prophylaxis - Hand Surgery

Elective hand surgery involving insertion of either percutaneous K-wires or metal or silastic implants

FLUCLOXACILLIN 1g

plus

GENTAMICIN 2mg/kg

(up to a maximum of 240mg)

 

If current / previous MRSA positive:

ADD

TEICOPLANIN 600mg

 

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IV single dose only at induction

OR

If penicillin allergy (explanatory notes), then use:
TEICOPLANIN 600mg  

plus

GENTAMICIN 2mg/kg

(up to a maximum of 240mg)

  

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IV single dose only at induction

  

Clean open hand injuries if: 1) Open fracture, tendon or joint injury 2) More than 6 hours delay to definitive treatment

FLUCLOXACILLIN 1g qds

If admitted, first dose given IV in ED, then oral until 5 days post op

If admission delayed, oral pre-op until 5 days post op, IV in theatre

 

If current / previous MRSA positive: 

Add

TEICOPLANIN 600mg

Given in ED or in theatre if admission delayed
  

OR

If penicillin allergy (explanatory notes), then use:

TEICOPLANIN 600mg IV stat

Given in ED or in theatre if admission delayed

Plus

CLINDAMYCIN 450 mg qds po

Pre-op and until 5 days post-op

 

Contaminated open hand injuries

FLUCLOXACILLIN 1g qds IV

plus

GENTAMICIN 2mg/kg  IV once daily

(up to a maximum of 240mg)

plus

METRONIDAZOLE 400 mg tds po

 

 

If current / previous MRSA positive:

ADD

TEICOPLANIN 600mg
  

OR

If penicillin allergy (explanatory notes), then use:

TEICOPLANIN 600mg od IV (after 3 loading doses 12 hourly of 400 mg)

plus

GENTAMICIN 2mg/kg  IV once daily

(up to a maximum of 240mg)

plus

METRONIDAZOLE 400 mg tds po
IV regimes until 24-48 hours post-surgery then:

 

Po switch therapy

 

CO-AMOXICLAV 625 mg tds po

 

OR

If penicillin allergy (explanatory notes), then use:

CIPROFLOXACIN 500 mg bd po

plus

CLINDAMYCIN 450 mg qds po

 

OR

If current / previous MRSA positive: consult Microbiologist

 

Duration:- until 5 days post-surgery

 

For guidance on the administration of intravenous antibiotics click here
(GHNHSFT intranet)