Treatment
����The antimicrobial agent should be started within 60 minutes
prior to surgical incision (up to 120 minutes for vancomycin or
fluoroquinolones). Vancomycin should NOT be used for routine
perioperative prophylaxis and is less effective for methicillin-sensitive
S. aureus (MSSA) than cefazolin.
Weight-Based Dosing
����In theory, using the ideal body weight as the basis for dosing a
lipophilic drug (eg, vancomycin) could result in subtherapeutic serum
and tissue concentrations, and the use of actual body weight for
dosing a hydrophilic drug (eg, an aminoglycoside) could result in
excessive serum and tissue concentrations.
Note: Body fat percentage is a more sensitive and precise measurement of SSI risk
than body mass index.
Duration of Prophylaxis
����If an agent with a short half-life is used (eg, cefazolin, cefoxitin),
it should be readministered if the procedure duration exceeds the
recommended redosing interval (from the time of initiation of the
preoperative dose [see Table 3]).
����Readministration may also be warranted if prolonged or excessive
bleeding occurs, or if there are other factors that may shorten the
half-life of the prophylactic agent (eg, extensive burns).
����If antibiotic prophylaxis is continued postoperatively, the duration
should be <24 hours regardless of the presence of intravascular
catheters or indwelling drains.
Note: Limiting the duration of antimicrobial prophylaxis to a single preoperative dose
can reduce the risk of Clostridium difficile disease.
����When given as a single preoperative dose before incision, antibiotic
prophylaxis often does not need to be modified for patients with renal
or hepatic dysfunction.
Pediatrics
����In most cases, the data in pediatric patients are limited and
have been extrapolated from adult data. Therefore, all pediatric
recommendations are based on expert opinion.
������ Fluoroquinolones should NOT be routinely used for surgical prophylaxis in
pediatric patients because of the potential for toxicity in this population.
����With few exceptions (eg, aminoglycoside dosages), pediatric dosages
should NOT exceed the maximum adult recommended dosages.
Note: Generally, if a dosage calculated on a milligram-per-kilogram basis for children
weighing >40 kg exceeds the maximum recommended dosage for adults, adult dosages
should be used.
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