Antibiotic guidelines in surgery, especially antibiotic prophylaxis. Prophylactic antibiotics in general surgery, cardiothoracic, vascular, orthopedic,neurosurgery, Classification of wounds. Guidelines of prophylactic antibiotics By doctor Saleem https://www.saleemplasticsurgeon.com/

1. Guidelines for antibiotic use By Doctor Saleem Holy Family Hospital Rawalpindi

11. CLINDAMYCIN, VANCOMYCIN CEFAZOLIN, CEFAMANDOLE,CEFUROXIME CEPHRADINE Clindmycin Cephradine Cefazolin, Cefuroxime Staph, Enterococcus,gram-ve baccili Vascular Surgery STAPH AUREUS,STAPH,EPSTREPT, GRAM –VE BACCILI CARDIO-THORACIC Alternative Available Recommended drug Likely Organisms Procedure

12. Ciprofloxacin, Gentamycin Ciprofloxacin Cefazolin Gram-ve bacilli Enterococus Urology surgery (high risk Only) Diabetic, Catheterized Altrnate Cephazolin+Metronidazole Available Include metrnidazole + Cephradine Clindamycin is recomended Organism Are Anerobes, Staph Aureus, Gram-ve Head and Neck Surgery

13. Clindamycin Cephradine Cefazolin Staph aureus, Staph epi 1)Closed fracture Clindamycin+ Gentacin Cephradin+Gentacin Cefazolin+Gentcin Staph, Strept, Gram-ve Baccili, Anearobes 2) Open fracture 2 nd line Available 1 st line Common Organims Orthopedic surgery

14. 2 nd line Clindamycin+ Gentacin Available Cephradin, Augmentin+Gentacin 1 st line Cephazolin Organism Enteric Gram-ve Bacilli, Gram +ve cocci General Surgery Gastoduodenal,Esophagial (High risk only) Augmentin+ Gentacin+Metronidazole Metronidazole+ Gentacin+Flucoxacilin ClostridiaGram –ve Bacili, Gram+ve Other anerobes Amputations

15. Cefoxitin Cephradin+Metronidazole Cefazolin+Metronidazole 03doses in non perforated,5days in perforated Enteric Gram-ve bacilli Appendicectomy Cefotaxime Cefotaxime single dose, Cefazolin Enteric Gram-ve Bacilli, Biliary Tract Surgery

16. Oral neomycin+metronidazole I/v Ampicilin+Gentacin+Metronidazole I/v Cefotaxime+ metronidazole One dose or gentacin+metronidazole Oral Prophylaxis Oral neomycin+erothrocin base 1g Each at1300,1400,2100hrs preop I/V Cefazolin+metronidazole Enteric Gram-ve Bacilli, Enterococcus, Anaerobes Colon Surgery (Elective)

17. No antibiotic prophlaxis required Laproscopic Cholecystectomy Cefoxitin 1g preop+ 3 postop doses 8 hrly Non elective

18. Cefotaxime+metronidazole Cefoxitin 1g 8hrly Anerobic and Gram-ve Bacilli Strangulated Hernia Cephradin Cefazolin Single dose Repair with mesh No prophylaxis required Herial repair without mesh

19. Augmentin Breast Surgery Metronidazole+gentacin Metronidazole+Cefotaxime Cefazolin+metronidazole Enteric Gram-ve bacilli Enterococcus, Anaerobes Penetrating abdominal trauma

20. Cefotaxime Cefuroxime Imipenum Acute Pancreatitus(low risk) High Risk Ciprofloxacin 500mg BD+Metronidazole 400mg TDS Gram –ve Bacilli+Anerobes Acute Cholecystitus