Prophylactic Antibiotic Regimen Selection - NYSPFP · surgical procedure approved antibiotics...
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SURGICAL PROCEDURE APPROVED ANTIBIOTICS BETA-LACTAM ALLERGY SURGICAL PROCEDURE SUGGESTED ANTIBIOTICS BETA-LACTAM ALLERGY SCIP Cefazolin (Ancef) OR Vancomycin Vancomycin OR Clindamycin HEAD AND NECK Cefazolin (Ancef) Clindamycin (Cleocin) + Gentamicin VASCULAR NEURO SURGERY Cefazolin (Ancef) Clindamycin (Cleocin) ORAL DENTAL Dental and ENT SBE only SBE only SCIP NOTE: If patient has a history of ulti-drug Resistant Bacteria nd/or extensive prior ntibiotic exposure, onsult with an Infectious iseases attending physician for ntibiotic selection. m a a c D a Cefoxitin (Mefoxin) OR Ampicillin/Sulbactam (Unasyn) OR Metronidazole (Flagyl) + Cefazolin Clindamycin (Cleocin) + Gentamicin OR Clindamycin (Cleocin) + Cipro OR Metronidazole (Flagyl) + Gentamicin OR Metronidazole (Flagyl) + Cipro RESPIRATORY Infected Respiratory SBE only SBE only COLON BREAST Cefazolin (Ancef) Clindamycin (Cleocin) PACEMAKER AICD Cefazolin (Ancef) Clindamycin (Cleocin) SCIP NOTE: If patient has a history of ulti-drug Resistant Bacteria nd/or extensive prior ntibiotic exposure, onsult with an Infectious iseases attending physician for ntibiotic selection. m a a c D a Cefazolin (Ancef) OR Cefoxitin (Mefoxin) OR Ampicillin / Sulbactam (Unasyn) Clindamycin (Cleocin) + Gentamicin OR Clindamycin (Cleocin) + Cipro OR Metronidazole (Flagyl) + Gentamicin OR Metronidazole (Flagyl) + Cipro THORACIC Cefazolin (Ancef) Vancomycin OR Clindamycin (Cleocin) HYSTERECTOMY HYSTERECTOMY WITH COLON Infected GI GASTRO DUODENAL BILIARY TRACT Cefazolin (Ancef) Clindamycin (Cleocin) INGUINAL VENTRAL HERNIA Cefazolin (Ancef) Clindamycin (Cleocin) SCIP Cefazolin (Ancef) OR Vancomycin Vancomycin OR Clindamycin ( Cleocin ) GENITOURINARY Infected GU Cefazolin (Ancef) Clindamycin (Cleocin) OR Clindamycin (Cleocin) + Gentamicin HIP KNEE ARTHROPLASTY GENERAL ORTHOPEDIC SPINE SURGERY Cefazolin (Ancef) Vancomycin OR Clindamycin ( Cleocin ) GENERAL OBSTETRICS Cefoxitin (Mefoxin) Gentamicin + Clindamycin ( Cleocin ) Or Metronidazole (Flagyl) + Gentamicin TRAUMA Cefazolin (Ancef) Clindamycin (Cleocin) S B E PROPHYLAXIS Ampicillin OR Cefazolin Clindamycin ( Cleocin ) PROCESS FOR ALL CASES REQUIRING ANTIBIOTIC PROPHYLAXIS REDOSING INTERVAL ANTIMICROBIAL AGENT RECOMMENDED DOSES ADULTS PEDIATRICS Cefazolin (Ancef) - Wt 120 kg = 2 grams IV - Wt 120 kg = 3 grams IV Ampicillin /Sulbactam (Unasyn) 3 grams IV Cefoxitin (Mefoxin) 2 grams IV Cefazolin (Ancef) 30 mg/kg IV - Maximum dose = 1 gram IV Ampicillin/Sulbactam Ampicillin component = 50 mg/kg IV - Maximum dose = 2 grams of ampicillin Cefoxitin (Mefoxin) 40 mg/kg IV - Maximum dose = 1 gram IV Clindamycin (Cleocin) 900 mg IV Cipro 400 mg IV Metronidazole (Flagyl) 500 mg IV Clindamycin (Cleocin) 10 mg/kg IV - Maximum dose = 600 mg IV Cipro – NOT ROUTINELY USED Vancomycin 15 mg/kg IV based on actual body weight - Maximum dose = 1500 mg IV* Gentamicin 5 mg/kg IV ** SINGLE DOSE BASED ON IDEAL BODY WEIGHT Vancomycin 15 mg/kg IV based on actual body weight - Maximum dose = 1000 mg IV Gentamicin 2.5 mg/kg IV ** SINGLE DOSE BASED ON IDEAL BODY WEIGHT Prophylactic Antibiotic Regimen Selection NO REDOSING REFERENCES: SCIP Specifications Manual for National Hospital Inpatient Quality Measures American Society of Heath-System Pharmacist. ASHP clinical practice guidelines for antimicrobial prophylaxis in surgery, Am J Health-Syst Pharm-Vol 70 Feb 1, 2013 Tschudy MM, Arcara KM., eds. The Harriet lane handbook: a manual for pediatric house officers. Philadelphia, PA: Mosby Elsevier, 2012. LEXICOMP online website.http://online.lexi.com.cwplib.proxy.liu.edu/lco/action/home/switch. Accessed May 22, 2013. Prophylactic Antibiotic Selection Antibiotic selection per SCIP protocol Antibiotic selection by surgeon – consider suggested antibiotics - Consider INFECTIOUS DISEASE CONSULTATION for infected cases Prophylactic Antibiotic Selection - Antibiotic to be administered by Anesthesiology - Doses are weight based - Prophylaxis administered within 60 min. prior to incision EXCEPTION - VANCOMYCIN & CIPRO - administered within 120 min. - Confirm administration at “TIME OUT” - Start 3 or 6 hour timer – confirmed by R.N. at TIME OUT - Redose as per “REDOSING INTERVAL” Other Considerations - Vancomycin should be added for Ortho. cases institutionalized for over 1 week & for patients with a history of MRSA colonization - *Vancomycin doses of 1500 mg IV must be infused over 2.5 hours to avoid infusion-related reaction - ** Gentamicin – check renal function prior to administration - Open Fractures – Consider adding Gentamicin - Open Fractures with soil / fecal exposure– Consider adding Gentamicin + Penicillin Endocarditis Prophylaxis for High Risk patients having high risk procedures including Dental, ENT, infected GI, infected GU, or infected Respiratory procedures GREEN YELLOW SBE HIGH RISK PATIENTS Prosthetic Heart Valve Congenital Heart Defect History of Endocarditis Cardiac Transplant with Valvulopathy Metronidazole (Flagyl) 15 mg/kg IV - Maximum dose = 500mg IV - For neonates weighing less than 1200 grams, give dose of 7.5mg/kg IV
Transcript of Prophylactic Antibiotic Regimen Selection - NYSPFP · surgical procedure approved antibiotics...
SURGICAL PROCEDURE APPROVED ANTIBIOTICS BETA-LACTAM ALLERGY SURGICAL PROCEDURE SUGGESTED
ANTIBIOTICS BETA-LACTAM
ALLERGY
SCIP
Cefazolin (Ancef) OR
Vancomycin
Vancomycin OR
Clindamycin
HE
AD
A
ND
N
EC
K
Cefazolin (Ancef) Clindamycin (Cleocin)
+ Gentamicin
VA
SC
ULA
R
NE
UR
O
SU
RG
ER
Y
Cefazolin (Ancef) Clindamycin (Cleocin)
OR
AL
DE
NT
AL
Dental and ENT
SBE only
SBE only
SCIP NOTE: If patient has a history of
ulti-drug Resistant Bacteria nd/or extensive prior ntibiotic exposure, onsult with an Infectious iseases attending physician for ntibiotic selection.
maacDa
Cefoxitin (Mefoxin)
OR Ampicillin/Sulbactam
(Unasyn)
OR Metronidazole (Flagyl)
+ Cefazolin
Clindamycin (Cleocin) + Gentamicin
OR Clindamycin (Cleocin)
+ Cipro OR
Metronidazole (Flagyl) + Gentamicin
OR
Metronidazole (Flagyl) + Cipro
RE
SP
IRA
TO
RY
Infected Respiratory
SBE only
SBE only
CO
LON
BR
EA
ST
Cefazolin (Ancef)
Clindamycin (Cleocin)
PA
CE
MA
KE
R
AIC
D
Cefazolin (Ancef) Clindamycin (Cleocin)
SCIP
NOTE: If patient has a history ofulti-drug Resistant Bacteria
nd/or extensive prior ntibiotic exposure, onsult with an Infectious iseases attending physician forntibiotic selection.
maacD a
Cefazolin (Ancef)
OR Cefoxitin (Mefoxin)
OR Ampicillin / Sulbactam
(Unasyn)
Clindamycin (Cleocin)
+ Gentamicin OR
Clindamycin (Cleocin) + Cipro
OR Metronidazole (Flagyl)
+ Gentamicin
OR Metronidazole (Flagyl)
+ Cipro
TH
OR
AC
IC
Cefazolin (Ancef)
Vancomycin OR
Clindamycin (Cleocin)
HY
ST
ER
EC
TO
MY
H
YS
TE
RE
CT
OM
Y W
ITH
CO
LON
Infected GI
GA
ST
RO
D
UO
DE
NA
L B
ILIA
RY
TR
AC
T
Cefazolin (Ancef) Clindamycin (Cleocin)
ING
UIN
AL
V
EN
TR
AL
HE
RN
IA
Cefazolin (Ancef) Clindamycin (Cleocin)
SCIP
Cefazolin (Ancef) OR
Vancomycin
Vancomycin OR
Clindamycin ( Cleocin )
GE
NIT
OU
RIN
AR
Y
Infected GU
Cefazolin (Ancef)
Clindamycin (Cleocin) OR
Clindamycin (Cleocin) + Gentamicin
HIP
KN
EE
A
RT
HR
OP
LAS
TY
GE
NE
RA
L O
RT
HO
PE
DIC
S
PIN
E S
UR
GE
RY
Cefazolin (Ancef)
Vancomycin OR
Clindamycin ( Cleocin )
GE
NE
RA
L
OB
ST
ET
RIC
S
Cefoxitin (Mefoxin)
Gentamicin + Clindamycin ( Cleocin )
Or Metronidazole (Flagyl)
+ Gentamicin
TR
AU
MA
Cefazolin (Ancef) Clindamycin (Cleocin)
S B
E
PR
OP
HY
LAX
IS
Ampicillin OR
Cefazolin Clindamycin ( Cleocin )
PROCESS FOR ALL CASES REQUIRING ANTIBIOTIC PROPHYLAXIS
REDOSING INTERVAL ANTIMICROBIAL AGENT RECOMMENDED DOSES
ADULTS PEDIATRICS
Cefazolin (Ancef) - Wt 120 kg = 2 grams IV - Wt 120 kg = 3 grams IV Ampicillin /Sulbactam (Unasyn)
3 grams IV Cefoxitin (Mefoxin) 2 grams IV
Cefazolin (Ancef) 30 mg/kg IV - Maximum dose = 1 gram IV Ampicillin/Sulbactam
Ampicillin component = 50 mg/kg IV - Maximum dose = 2 grams of ampicillin Cefoxitin (Mefoxin) 40 mg/kg IV
- Maximum dose = 1 gram IV
Clindamycin (Cleocin) 900 mg IV Cipro 400 mg IV
Metronidazole (Flagyl) 500 mg IV
Clindamycin (Cleocin) 10 mg/kg IV - Maximum dose = 600 mg IV Cipro – NOT ROUTINELY USED
Vancomycin 15 mg/kg IV based on actual body weight
- Maximum dose = 1500 mg IV* Gentamicin 5 mg/kg IV **
SINGLE DOSE BASED ON IDEALBODY WEIGHT
Vancomycin 15 mg/kg IV based on actual body weight
- Maximum dose = 1000 mg IV Gentamicin 2.5 mg/kg IV **
SINGLE DOSE BASED ON IDEAL BODY WEIGHT
Prophylactic Antibiotic Regimen Selection
NO REDOSING
REFERENCES: SCIP Specifications Manual for National Hospital Inpatient Quality Measures American Society of Heath-System Pharmacist. ASHP clinical practice guidelines for antimicrobial prophylaxis in surgery, Am J Health-Syst Pharm-Vol 70 Feb 1, 2013 Tschudy MM, Arcara KM., eds. The Harriet lane handbook: a manual for pediatric house officers. Philadelphia, PA: Mosby Elsevier, 2012. LEXICOMP online website.http://online.lexi.com.cwplib.proxy.liu.edu/lco/action/home/switch. Accessed May 22, 2013.
Prophylactic Antibiotic Selection Antibiotic selection per SCIP protocol Antibiotic selection by surgeon – consider suggested antibiotics - Consider INFECTIOUS DISEASE CONSULTATION for infected cases Prophylactic Antibiotic Selection - Antibiotic to be administered by Anesthesiology - Doses are weight based - Prophylaxis administered within 60 min. prior to incision EXCEPTION - VANCOMYCIN & CIPRO - administered within 120 min. - Con�rm administration at “TIME OUT” - Start 3 or 6 hour timer – con�rmed by R.N. at TIME OUT - Redose as per “REDOSING INTERVAL” Other Considerations - Vancomycin should be added for Ortho. cases institutionalized for over 1 week & for patients with a history of MRSA colonization - *Vancomycin doses of 1500 mg IV must be infused over 2.5 hours to avoid infusion-related reaction - ** Gentamicin – check renal function prior to administration - Open Fractures – Consider adding Gentamicin - Open Fractures with soil / fecal exposure– Consider adding Gentamicin + Penicillin Endocarditis Prophylaxis for High Risk patients having high risk procedures including Dental, ENT, infected GI, infected GU, or infected Respiratory procedures
GREENYELLOW
SBE
HIGH RISK PATIENTSProsthetic Heart ValveCongenital Heart DefectHistory of Endocarditis Cardiac Transplant with Valvulopathy
Metronidazole (Flagyl) 15 mg/kg IV- Maximum dose = 500mg IV- For neonates weighing less than 1200 grams, give dose of 7.5mg/kg IV
