Antimicrobial Prophylaxis in Surgery (paid)

Table 3. Recommended Doses and Redosing Intervals for Commonly Used Antimicrobials for Surgical Prophylaxis Recommendations Pediatric Dose Levofloxacinf (Levaquin®) 500 mg 10 mg/kg NA 6-8 Metronidazole (Flagyl ®, generic) 500 mg 15 mg/kg: Neonates   <1200 g should receive a single   7.5 mg/kg dose NA 6-8 Moxifloxacin (Avelox®) 400 mg 10 mg/kg NA 8-15 Infants 2-9 mos of age: 80 mg/kg   of the piperacillin component Children >9 mos of age and ≤40 kg:   100 mg/kg   of the piperacillin component 2 hrs 0.7-1.2 NA 4-8 Antimicrobial Piperacillin3.375 g tazobactam (Zosyn®) b Vancomycin (generic) 15 mg/kg 15 mg/kg Redosing Intervalc,d Adult Half-Life in Normal Renal Function (hrs)d Adult Dosea Oral Antibiotics for Colorectal Surgery Prophylaxish Erythromycin base (generic) 1g 20 mg/kg NA NA Metronidazole (Flagyl ®, generic) 1g 15 mg/kg NA NA Neomycini,j (generic) 1 g 15 mg/kg NA NA NA NA Topical Mupirocin Bactroban® Apply to nares bid Adult doses are obtained from studies cited in the full text guideline. When doses differed between studies, expert opinion used the most-often recommended dose. b The maximum pediatric dose should NOT exceed the usual adult dose. c From initiation of the preoperative dose. d For antimicrobials with a short half-life (eg, cefazolin, cefoxitin) used before long procedures, redosing in the operating room is recommended at an interval of approximately two times the half-life of the agent in patients with normal renal function. Recommended redosing intervals marked as "not applicable" (NA) are based on typical case length; for unusually long procedures, redosing may be needed. e Although FDA-approved package insert labeling indicates 1 g, experts recommend 2 g for obese patients. f While fluoroquinolones have been associated with an increased risk of tendinitis/tendon rupture in all ages, use of these agents for single-dose prophylaxis is generally safe. g In general, gentamicin for surgical antibiotic prophylaxis should be limited to a single dose given preoperatively. Dosing is based on the patient's actual body weight. If the patient's actual weight is more than 20% above ideal body weight (IBW), the dosing weight (DW) can be determined as follows: DW = IBW + 0.4 (actual weight − IBW). h ALWAYS neomycin with EITHER metronidazole OR erythromycin base used in conjunction with a mechanical bowel preparation and given as three doses over approximately 10 hours the afternoon and evening before the operation and after the mechanical bowel prep. i 3% absorbed under normal gastrointestinal conditions. j When used as a single dose in combination with metronidazole or erythromycin base for colorectal procedures. 7 a

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