Antibiotic Prophylaxis

Administer IV not more than 2 hours preoperatively. Repeat administration in cases longer than 3 hours. Substitute Erythromycin for Penicillin or Cefuroxime in cases of Penicillin allergy.

Following are doses for 70 kg adult - adjust for children

Upper GI Surgery

Co-amoxiclav 1.2 g or (Cefuroxime 750 millegrammes & Metronidazole 500 millegrammes)

Biliary Surgery

Co-amoxiclav 1.2 g or (Cefuroxime 750 millegrammes & Metronidazole 500 millegrammes) or (Ampicillin 500 millegrammes) or Tazocin (Piperacillin+Tazobactam) 4.5 g if biliary obstruction

ERCP

Ciprofloxacin - 750 millegrammes orally 60-90 mins before ERCP or Gentamycin 120 millegrammes IV just before the procedure

Colonic Surgery

Gentamycin 4 millegrammes/kg & Ampicillin 500 millegrammes & Metronidazole 500 millegrammes or (Cefuroxime & Metronidazole) given in theater at induction

Appendicectomy

Co-amoxiclav 1.2 g, or (Cefuroxime 750 millegrammes & Metronidazole 500 millegrammes).

Vascular Surgery

Co-amoxiclav 1.2 g at induction. It may be necessary, at the - discretion of the consultant or SR to continue this prophylactic regime post-operatively as therapy.

Amputation for ischaemia

Co-amoxiclav or (Cefuroxime & Metronidazole)

Peripheral Trauma

Co-amoxiclav & Tetanus toxoid +/- Humotet

Abdominal Trauma

as for colonic surgery

Splenic threat/injury

• Haemophilus Influenza type B (HIB)
• Pneumovax (23 polyvalent streptococcus pneumoniae vaccine)
• Neisseria Meningitidus A,C
• Pre-operative Penicillin and lifelong Penicillin

All trauma patients

should receive Tetanus toxoid +/- Humotet

Any Cardiac lesion

Amoxycillin & Gentamycin