What Antibiotic to use?
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The choice and duration of peri-operative antibiotic prophylaxis is multifactorial:
Patient factors (i.e. Duration of hospitalisation pre-op, MRSA status, Drug allergies)
Type of Surgical Procedure (Clean, Contaminated etc)
Timing of prophylactic antibiotic:
The Scottist Intercollegiate Guidelines Network (SIGN) develops evidence based clinical practice guidelines for the NHS in Scotland. SIGN guidelines are derived from a systematic review of the scientific literature. SIGN published "Antibiotic Prophylaxis in Surgery" guidelines in 2008.
They suggest that antibiotics should be given <30mins pre incision
With intra-operative blood loss >1,500ml, and additional dose of antibiotics should be given after fluid replacement
Additional doses may be required if the procedure is prolonged where the antibiotic in question has a short half life, e.g. a cephalosporin or a penicillin. Vancomycin, teiocplanin and generally gentamicin would not usually require a second dose