30. Cardiothoracic Surgery

(This excludes transplant patients. Use prior microbiology results if available. Also consider renal/hepatic function in choice of antibiotic. Data based on local CICU microbiology data.)

Procedure

Antibiotic

Dose

Route

Dosing Interval

Comment

Pacemaker insertion

Flucloxacillin

1g

IV

At induction

4 doses of oral flucloxacillin 1g every 6 hours post procedure
If history of penicillin allergy use oral clindamycin 300mg QDS

Pulmonary resection

Cefuroxime

750mg-1.5g

IV

At induction

If history of penicillin anaphylaxis use clarithromycin 500mg

Cardio-thoracic surgery

(e.g. valves/bypass)

Flucloxacillin and

gentamicin

1g

3-5mg/kg per day in divided doses

IV

6 hourly

12 hourly for 3 doses

Flucloxacillin for 48 hours and gentamicin for 24 hours
OR
Cefuroxime 750mg tds. Review after 48 hours
If history of penicillin anaphylaxis use IV clarithromycin 500mg BD

Procedure	Antibiotic	Dose	Route	Dosing Interval	Comment
Pacemaker insertion	Flucloxacillin	1g	IV	At induction	4 doses of oral flucloxacillin 1g every 6 hours post procedure If history of penicillin allergy use oral clindamycin 300mg QDS
Pulmonary resection	Cefuroxime	750mg-1.5g	IV	At induction	If history of penicillin anaphylaxis use clarithromycin 500mg
Cardio-thoracic surgery (e.g. valves/bypass)	Flucloxacillin and gentamicin	1g 3-5mg/kg per day in divided doses	IV	6 hourly 12 hourly for 3 doses	Flucloxacillin for 48 hours and gentamicin for 24 hours OR Cefuroxime 750mg tds. Review after 48 hours If history of penicillin anaphylaxis use IV clarithromycin 500mg BD