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
