Re‐Dosing Guidelines for Complex cases Cases Longer than 4 hours The following are re‐dosing guidelines based on patients with normal renal function: Antibiotics Re-dosing Interval Cefazolin 4 hours Cefoxitin 4 hours Ciprofloxacin 8 hours Clindamycin 6 hours Ertapenem 24 hours Gentamicin 8 hours* Metronidazole 8 hours Vancomycin 12 hours** * = Renal insufficiency (CrCl <50ml/min): 12 hours (CrCl <30ml/min, HD/CRRT): 24 hours ** = Renal insufficiency (CrCl <30ml/min, HD/CRRT): 24 hours First dose of antibiotic Should be within 1 hr prior to Incision time

ABx

At time of 1st Dose document/mark on Anesthesia Record the time for re‐dosing Document antibiotic, re‐dose and time Updated 2/21/2011 Page 1 of 2 Antibiotics Subcommittee The Antibiotic Surgical Care Improvement Project (SCIP) measures include the following: Antibiotic Proppyhylaxis: 1. Antibiotic received within one hour prior to surgical incision, 2. Antibiotic selection for surgical patients, and 3. Antibiotics discontinued within 24 hours after surgery end time. (48 hrs for cardiac surgery) Type of Surg ery Antimicrobial Recommendations Preferred: Cefazolin 1-2 gm IV. Cardiac or Vascular If B-lactam allergy: Clindamycin 600-900 mg IV or Vancomycin 1 g IV. If known history of MRSA: Vancomycin 1 g IV

Colon Preferred: Cefoxitin 1-2 g IV, or Ertapenem 1 g IV. If ß-Lactam Allergy: Metronidazole 500 mg IV and Ciprofloxacin 400 mg IV

General Surgery Preferred: Cefoxitin 1-2 g IV. (gastroduodenal, hepatobiliary) If ß-Lactam Allergy: Metronidazole 500 mg IV and Ciprofloxacin 400 mg IV

Preferred: Cefazolin 1-2 g IV. Other General Surgical Procedures If ß-Lactam Allergy: Clindamycin 600-900 mg IV or Vancomycin 1 g IV. (e.g. hernia repair, breast) If known history of MRSA: Vancomycin 1 g IV

Preferred: Cefoxitin 1-2 g IV. Gynecological Procedures If B-lactam allergy: Metronidazole 500 mg IV and Gentamicin 1.5mg/kg IV or Metronidazole 500 mg IV (e. g. hysterectomy, C -section) and Ciprofloxacin 400 mg IV

Preferred: Cefazolin 1-2 gm IV. Neurosurgery If ß-Lactam Allergy: Clindamycin 600-900 mg IV or Vancomycin 1 g IV. If known history of MRSA: Vancomycin 1 g IV

Orthopedic: Hip/Knee Arthroplasty Preferred: Cefazolin 1-2 gm IV. (infuse completely before tourniquet If ß-lactam allergy: Clindamycin 600-900 mg IV or Vancomycin 1 g IV. inflation) If known history of MRSA: Vancomycin 1 g IV

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