Surgical Prophylaxis - Orthopaedic Surgery

Routine aseptic procedures such a joint aspiration, arthroscopy and short 'clean' non-implants do not require antibiotic prophylaxis

 

Total Hip Replacement, Prosthetic Knee Replacement, Closed Fracture Fixation, Hip Fracture Repair, Spinal Surgery

FLUCLOXACILLIN 1g IV at induction then 1g six hourly for a further 3 doses

plus

GENTAMICIN 2mg/kg (up to a maximum of 240mg) IV single dose only at induction

 


If current / previous MRSA positive:
ADD

TEICOPLANIN 600mg IV single dose at induction then 400mg at 12 and 24 hours after surgery

   
  

OR

If penicillin allergy (explanatory notes), then use:

 

TEICOPLANIN 600mg IV single dose at induction then 400mg at 12 and 24 hours after surgery

plus

GENTAMICIN 2mg/kg (up to a maximum of 240mg) IV single dose only at induction 

 

 

Open Fracture (compound wounds)

FLUCLOXACILLIN 1g

 

If current / previous MRSA positive:

Add

TEICOPLANIN 600mg

  

IV at induction then 1g six hourly for a further 3 doses

 

 

IV single dose at induction then 400mg at 12 and 24 hours after surgery
  

OR

If penicillin allergy (explanatory notes), then use:

 

TEICOPLANIN 600mg

 

  

  

 

IV single dose at induction then 400mg at 12 and 24 hours after surgery

 

 

 

 

Type 2 or 3 Open Fractures and Dirty Farmyard Injury
(see comments below)

FLUCLOXACILLIN 1g

 Plus

GENTAMICIN 2mg/kg

(up to a maximum of 240mg)

Plus

METRONIDAZOLE 500mg

 

If current / previous MRSA positive:

Add

TEICOPLANIN 600mg

IV at induction then 1g six hourly for a further 3 doses

 

IV single dose only at induction

 

IV at induction then 500mg eight hourly for a further 2 doses

 

IV single dose at induction then 400mg at 12 and 24 hours after surgery
  

OR

If penicillin allergy (explanatory notes), then use:

 

TEICOPLANIN 600mg

Plus

GENTAMICIN 2mg/kg 

(up to a maximum of 240mg)

Plus

METRONIDAZOLE 500mg

IV single dose at induction then 400mg at 12 and 24 hours after surgery

 

IV single dose only at induction

 

IV at induction then 500mg eight hourly for a further 2 doses

 

In type 2 or 3 open fracture & dirty farmyard injury flucloxacillin is often supplemented with an aminoglycoside plus metronidazole although there is no hard evidence to support this policy (ref: Antibacterial prophylaxis for orthopaedic surgery - Drug and Therapeutics Bulletin 2001;39:43-6).

 

Urinary catheterisation – adequate antimicrobial cover is provided by the prophylaxis if the catheter is inserted at induction or during the immediate post operative period (within 6 hours of induction).

 

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