Thanks to Dr Kiran

January 17, 2008

Hi

On behalf of NetRUM I extend heartfelt thanks to Dr Kiran Chaudhari for moderating the discussion on Pharmacogenomics and RUM. Thanks Kiran for all your efforts and sorry that you got some brickbats. I apologise on behalf of NetRUM.

Do retrun as moderator on NetRUM.

Vijay

Groupie

>> I am thankful to the very less number of respondents for their participation.> > I believe that the future lays in our GENES and off course the use of drugs as per our Genetic Make up. > > The era of amplichip is today.> > Tomorrow it will be the time for "GENECHIP" or we can call it the "GENECARD".> > Very personal, very unique to each one.> > And hence the most rational tool for therapy…leading to the most rational way of therapy..> > I would like to thank the contributors of discussion who had done valuable inputs to our discussion "The Role of PGNX in RUM".> > Dr Swapnil for providing us the > > definition of RUM that is given by WHO as, "Patients receive medications appropriate to their clinical needs, in doses that meet their OWN INDIVIDUAL REQUIREMENTS, for adequate period of time, and at the lowest cost to them and their community."> > Dr Mangesh for giving us very comprehensive view on Pharmacogenomics as follows,> > "According to a famous ancient quote "what is medicine to some may be the fierce poison to others." The same drug and in the same dosage may produce beneficial effects in many patients but can produce adverse effects in few. We already have data regarding the number of hospital admissions and deaths due to adverse drug reactions. We also know that the most important factor for such variable response to medicines is the genetic differences between the individuals. > Pharmacogenomics is the new field that is bridging the gap between pharmacology, drug treatment and the patients. Pharmacogenomics associates individual's genetic make up with drug metabolism and treatment response. It takes into consideration all the causes of differences in the drug response which includes genes controlling the drug metabolizing enzymes, transporter proteins, signaling and cellular response pathways and cellular targets. Pharmacogenomcis holds the promise to use the current drugs more rationally, finding of the new drug targets, and development of new drugs. Now, how the knowledge of the molecular action of drug and genetic determinants of the drug response is to going to achieve the goal of giving the right drug at the right dose to the right patient and at the right time (RUM)? > By looking at the genetic profile of the patients, the genes responding to a given drug by over-expression, down-regulation or no response at all can be easily identified. So by this we can tell which are the genes involved in the drug response and expected side effects of the drug. > Treatment strategies based on the population's genetic profiles can be developed so that we can predict which are responders, non-responders and poor responders, also the patients who are prone to side effects. In conclusion, pharmacogenomics will be very helpful for the RUM:> By looking at the genetic profile, best drug for the patient can be selected.> Dosage adjustment can be made according to person's genetics so avoiding the risk of adverse effects.> Early selection of the optimal therapy will definitely increase the patient's compliance to therapy."> > And also about the ethical aspects in PGNX as follows,> Though the development of personalized medicine is scientifically and clinically seems very useful to mankind, there are few ethical concerns:> The pharmacogenomic data of the population may be utilized for the exclusion of the patients which are either adverse drug reaction prone or not responding to research medicine, thus neglecting these patients from the clinical trial.> As vast amount of the pharmacogenomic data will be available, maintenance of the confidentiality of it will be the most challenging task. Genetic profile of the patient will disclose the disease predisposition of that person, family members or entire ethnic group and abuse of such data can harm patient as well as entire population.> Also, if the patient's profile discloses any rare genetic disorder for which no treatment is available, then that may be the worst scenario for the patient.> > Further I would like to mention the contribution of Dr. S. Ziaur Rahman regarding > > 1. Pharmacogenetics is generally regarded as the study of genetic variation that gives rise to differing response to drugs, while pharmacogenomics is the broader application of genomic technologies to new drug discovery and further characterization of older drugs.> > 2. History as In the early 1950s, two interesting findings – prolonged muscle relaxation after curarization with suxamethonium in patients with congenital cholinesterase deficiency and acute hemolysis induced by antimalarial drugs (like primaquine) in patients with low G-6 PD activity set the stage for new developments. By the end of 1980s and 1990s, the causal genes coding for debrisoquine hydroxylase, or CYP2D6 had been cloned and characterized, inaugurating a new field of Pharmacogenetics and Pharmacogenomic> > 3. the role of PGNX in RUM would greatly enhance our approach to unanticipated drug toxicity and would narrow the risk/benefit margin of drug therapy. Such an integrative strategy is a key element directed towards the promotion of optimal drug therapy. The concept of PGNX is not only a rational (RUM) but also profitable during drug discovery process (can earn 5 billion USD/year). The risk like 1 out of 10 pass clinical trials to market and 1 out of 20 recover development costs may maximally be minimized. > Researches in this direction are being done in many places of clinical pharmacology. I know few scientists who are involved directly in this field such as Dr. Gaidgek (of USA who first time worked in gene deletion that explains slow metabolism), Professor Leif Bertilsson (of Clinical Pharmacology Dept, Karolinska Inst, Huddinge University Hospital, Sweden), Dr. Collen Masimirembwa (He has now started his own lab in Nairobi, Kenya. Earlier he was in AstraZeneca) , Professor Olavi Pelkonen (of Dept of Pharmacology and Toxicology, University of Oulu). > With the passage of time, we may take the advantage of this novel drug targeted PGNX; if not now, then our successors will definitely devour its fruits. PGNX as a part of RUM will improve human health. It will be helpful in both infectious diseases and noninfectious diseases, microbial drug resistance, where there is treatment failure, and in non-responders (30-60% of patients do not respond to treatment by available drugs). It will also help in drug intellectual property. > > Dr. Shilpa Jadav> > For providing an important article on > The concept of personal drugs in the undergraduate pharmacology practical curriculum. Indian J Pharmacol 2007;39:165- 7> > Dr Surendiran for enlightening us regarding funding agencies as> > There are enough agencies to fund research projects on genomics, which are remaining unutilized. These depot of resources like DBT, DST, ICMR, CEFIPRA etc are to be utilized by various institutions all over the country and set up pharmacogenetic labs with personnel. This has a long way to go, with the current rate of progress in research.> > Dr. Buch> > For adding the link of following article from NEJM As > > http://content. nejm.org/ cgi/content/ full/358/ 2/105?query= TOC> > Volume 358:105-107 January 10, 2008 Number 2> Letting the Genome out of the Bottle — Will We Get Our Wish?> > And lastly, the group owner Dr Vijay Thawani for giving me the apportunity to moderate on this forum.> > Thanks to all readers too.> > Regards,> Dr Kiran Chaudhari> Lecturer, Pharmacology,> GMC, Nagpur.> > > > ---------------------------------> Chat on a cool, new interface. No download required. Click here.>

January 18, 2008

hi netrum, i want to know about surgical prophylaxis mean which antibiotics is rational for use as prophylaxis in all surgery departments like ENT, general surgery, gynecology and orthopedic? and also about time and duration of administration Vijay <drvijaythawani@...> wrote: Hi On behalf of NetRUM I extend heartfelt thanks to Dr Kiran Chaudhari for moderating the discussion

on Pharmacogenomics and RUM. Thanks Kiran for all your efforts and sorry that you got some brickbats. I apologise on behalf of NetRUM. Do retrun as moderator on NetRUM. Vijay Groupie >> I am thankful to the very less number of respondents for their participation.> > I believe that the future lays in our GENES and off course the use of drugs as per our Genetic Make up. > > The era of amplichip is today.> > Tomorrow it will be the time for "GENECHIP" or we can call it the "GENECARD".> > Very personal, very unique to each one.> > And hence the

most rational tool for therapy…leading to the most rational way of therapy..> > I would like to thank the contributors of discussion who had done valuable inputs to our discussion "The Role of PGNX in RUM".> > Dr Swapnil for providing us the > > definition of RUM that is given by WHO as, "Patients receive medications appropriate to their clinical needs, in doses that meet their OWN INDIVIDUAL REQUIREMENTS, for adequate period of time, and at the lowest cost to them and their community."> > Dr Mangesh for giving us very comprehensive view on Pharmacogenomics as follows,> > "According to a famous ancient quote "what is medicine to some may be the fierce poison to others." The same drug and in the same dosage may produce beneficial effects in many patients but can produce adverse effects in few. We already have data regarding the number of hospital admissions and deaths due to adverse drug reactions. We

also know that the most important factor for such variable response to medicines is the genetic differences between the individuals. > Pharmacogenomics is the new field that is bridging the gap between pharmacology, drug treatment and the patients. Pharmacogenomics associates individual's genetic make up with drug metabolism and treatment response. It takes into consideration all the causes of differences in the drug response which includes genes controlling the drug metabolizing enzymes, transporter proteins, signaling and cellular response pathways and cellular targets. Pharmacogenomcis holds the promise to use the current drugs more rationally, finding of the new drug targets, and development of new drugs. Now, how the knowledge of the molecular action of drug and genetic determinants of the drug response is to going to achieve the goal of giving the right drug at the right dose to the right patient and at the right time (RUM)? > By looking at the genetic

profile of the patients, the genes responding to a given drug by over-expression, down-regulation or no response at all can be easily identified. So by this we can tell which are the genes involved in the drug response and expected side effects of the drug. > Treatment strategies based on the population's genetic profiles can be developed so that we can predict which are responders, non-responders and poor responders, also the patients who are prone to side effects. In conclusion, pharmacogenomics will be very helpful for the RUM:> By looking at the genetic profile, best drug for the patient can be selected.> Dosage adjustment can be made according to person's genetics so avoiding the risk of adverse effects.> Early selection of the optimal therapy will definitely increase the patient's compliance to therapy."> > And also about the ethical aspects in PGNX as follows,> Though the development of personalized medicine is

scientifically and clinically seems very useful to mankind, there are few ethical concerns:> The pharmacogenomic data of the population may be utilized for the exclusion of the patients which are either adverse drug reaction prone or not responding to research medicine, thus neglecting these patients from the clinical trial.> As vast amount of the pharmacogenomic data will be available, maintenance of the confidentiality of it will be the most challenging task. Genetic profile of the patient will disclose the disease predisposition of that person, family members or entire ethnic group and abuse of such data can harm patient as well as entire population.> Also, if the patient's profile discloses any rare genetic disorder for which no treatment is available, then that may be the worst scenario for the patient.> > Further I would like to mention the contribution of Dr. S. Ziaur Rahman regarding > > 1. Pharmacogenetics is

generally regarded as the study of genetic variation that gives rise to differing response to drugs, while pharmacogenomics is the broader application of genomic technologies to new drug discovery and further characterization of older drugs.> > 2. History as In the early 1950s, two interesting findings – prolonged muscle relaxation after curarization with suxamethonium in patients with congenital cholinesterase deficiency and acute hemolysis induced by antimalarial drugs (like primaquine) in patients with low G-6 PD activity set the stage for new developments. By the end of 1980s and 1990s, the causal genes coding for debrisoquine hydroxylase, or CYP2D6 had been cloned and characterized, inaugurating a new field of Pharmacogenetics and Pharmacogenomic> > 3. the role of PGNX in RUM would greatly enhance our approach to unanticipated drug toxicity and would narrow the risk/benefit margin of drug therapy. Such an integrative strategy is a key

element directed towards the promotion of optimal drug therapy. The concept of PGNX is not only a rational (RUM) but also profitable during drug discovery process (can earn 5 billion USD/year). The risk like 1 out of 10 pass clinical trials to market and 1 out of 20 recover development costs may maximally be minimized. > Researches in this direction are being done in many places of clinical pharmacology. I know few scientists who are involved directly in this field such as Dr. Gaidgek (of USA who first time worked in gene deletion that explains slow metabolism), Professor Leif Bertilsson (of Clinical Pharmacology Dept, Karolinska Inst, Huddinge University Hospital, Sweden), Dr. Collen Masimirembwa (He has now started his own lab in Nairobi, Kenya. Earlier he was in AstraZeneca) , Professor Olavi Pelkonen (of Dept of Pharmacology and Toxicology, University of Oulu). > With the passage of time, we may take the advantage of this novel drug targeted PGNX;

if not now, then our successors will definitely devour its fruits. PGNX as a part of RUM will improve human health. It will be helpful in both infectious diseases and noninfectious diseases, microbial drug resistance, where there is treatment failure, and in non-responders (30-60% of patients do not respond to treatment by available drugs). It will also help in drug intellectual property. > > Dr. Shilpa Jadav> > For providing an important article on > The concept of personal drugs in the undergraduate pharmacology practical curriculum. Indian J Pharmacol 2007;39:165- 7> > Dr Surendiran for enlightening us regarding funding agencies as> > There are enough agencies to fund research projects on genomics, which are remaining unutilized. These depot of resources like DBT, DST, ICMR, CEFIPRA etc are to be utilized by various institutions all over the country and set up pharmacogenetic labs with personnel. This has a

long way to go, with the current rate of progress in research.> > Dr. Buch> > For adding the link of following article from NEJM As > > http://content. nejm.org/ cgi/content/ full/358/ 2/105?query= TOC> > Volume 358:105-107 January 10, 2008 Number 2> Letting the Genome out of the Bottle — Will We Get Our Wish?> > And lastly, the group owner Dr Vijay Thawani for giving me the apportunity to moderate on this forum.> > Thanks to all readers too.> > Regards,> Dr Kiran Chaudhari> Lecturer, Pharmacology,> GMC, Nagpur.> > > > ---------------------------------> Chat on a cool, new interface. No download required. Click here.>

Unlimited freedom, unlimited storage. Get it now

January 18, 2008

Hello Sir,

Surgical antibiotic prophylaxis (SAP) is defined as judicious antimicrobial use prior to the surgical intervention as to prevent infection at the site of operated wound.

SAP varies according to the:

Ã˜ Type of wound to be operated

Ã˜ Suspected microorganism flora in the operative field

Ã˜ Local antimicrobial susceptibility pattern

Ã˜ Patient condition (Liver function, Kidney function, CVS status, CNS status)

Ã˜ Antimicrobial agent pk/pd status

There are separate guidelines for SAP in each of the field asked like ENT, gynecology, orthopedic, etc.

Kindly find the attachment which gives the broader idea about it.

Sir, I request you to mention your details at the end of post while airing it on NetRUM as this is the basic rule for everyone who makes the post on NetRUM.

Regards,

Dr. Smita Mali,

JRII, GMC,

Nagpur.

Hi

On behalf of NetRUM I extend heartfelt thanks to Dr Kiran Chaudhari for moderating the discussion on Pharmacogenomics and RUM. Thanks Kiran for all your efforts and sorry that you got some brickbats. I apologise on behalf of NetRUM.

Do retrun as moderator on NetRUM.

Vijay

Groupie

>> I am thankful to the very less number of respondents for their participation.> > I believe that the future lays in our GENES and off course the use of drugs as per our Genetic Make up. > > The era of amplichip is today.> > Tomorrow it will be the time for "GENECHIP" or we can call it the "GENECARD".> > Very personal, very unique to each one.> > And hence the most rational tool for therapyâ€¦leading to the most rational way of therapy..> > I would like to thank the contributors of discussion who had done valuable inputs to our discussion "The Role of PGNX in RUM".> > Dr Swapnil for providing us the > > definition of RUM that is given by WHO as, "Patients receive medications appropriate to their clinical needs, in doses that meet their OWN

INDIVIDUAL REQUIREMENTS, for adequate period of time, and at the lowest cost to them and their community."> > Dr Mangesh for giving us very comprehensive view on Pharmacogenomics as follows,> > "According to a famous ancient quote "what is medicine to some may be the fierce poison to others." The same drug and in the same dosage may produce beneficial effects in many patients but can produce adverse effects in few. We already have data regarding the number of hospital admissions and deaths due to adverse drug reactions. We also know that the most important factor for such variable response to medicines is the genetic differences between the individuals. > Pharmacogenomics is the new field that is bridging the gap between pharmacology, drug treatment and the patients. Pharmacogenomics associates individual's genetic make up with drug metabolism and treatment response. It takes into consideration all the causes of

differences in the drug response which includes genes controlling the drug metabolizing enzymes, transporter proteins, signaling and cellular response pathways and cellular targets. Pharmacogenomcis holds the promise to use the current drugs more rationally, finding of the new drug targets, and development of new drugs. Now, how the knowledge of the molecular action of drug and genetic determinants of the drug response is to going to achieve the goal of giving the right drug at the right dose to the right patient and at the right time (RUM)? > By looking at the genetic profile of the patients, the genes responding to a given drug by over-expression, down-regulation or no response at all can be easily identified. So by this we can tell which are the genes involved in the drug response and expected side effects of the drug. > Treatment strategies based on the population's genetic profiles can be developed so that we can predict which are

responders, non-responders and poor responders, also the patients who are prone to side effects. In conclusion, pharmacogenomics will be very helpful for the RUM:> By looking at the genetic profile, best drug for the patient can be selected.> Dosage adjustment can be made according to person's genetics so avoiding the risk of adverse effects.> Early selection of the optimal therapy will definitely increase the patient's compliance to therapy."> > And also about the ethical aspects in PGNX as follows,> Though the development of personalized medicine is scientifically and clinically seems very useful to mankind, there are few ethical concerns:> The pharmacogenomic data of the population may be utilized for the exclusion of the patients which are either adverse drug reaction prone or not responding to research medicine, thus neglecting these patients from the clinical trial.> As vast amount of the

pharmacogenomic data will be available, maintenance of the confidentiality of it will be the most challenging task. Genetic profile of the patient will disclose the disease predisposition of that person, family members or entire ethnic group and abuse of such data can harm patient as well as entire population.> Also, if the patient's profile discloses any rare genetic disorder for which no treatment is available, then that may be the worst scenario for the patient.> > Further I would like to mention the contribution of Dr. S. Ziaur Rahman regarding > > 1. Pharmacogenetics is generally regarded as the study of genetic variation that gives rise to differing response to drugs, while pharmacogenomics is the broader application of genomic technologies to new drug discovery and further characterization of older drugs.> > 2. History as In the early 1950s, two interesting findings â€“ prolonged muscle relaxation

after curarization with suxamethonium in patients with congenital cholinesterase deficiency and acute hemolysis induced by antimalarial drugs (like primaquine) in patients with low G-6 PD activity set the stage for new developments. By the end of 1980s and 1990s, the causal genes coding for debrisoquine hydroxylase, or CYP2D6 had been cloned and characterized, inaugurating a new field of Pharmacogenetics and Pharmacogenomic> > 3. the role of PGNX in RUM would greatly enhance our approach to unanticipated drug toxicity and would narrow the risk/benefit margin of drug therapy. Such an integrative strategy is a key element directed towards the promotion of optimal drug therapy. The concept of PGNX is not only a rational (RUM) but also profitable during drug discovery process (can earn 5 billion USD/year). The risk like 1 out of 10 pass clinical trials to market and 1 out of 20 recover development costs may maximally be minimized. >

Researches in this direction are being done in many places of clinical pharmacology. I know few scientists who are involved directly in this field such as Dr. Gaidgek (of USA who first time worked in gene deletion that explains slow metabolism), Professor Leif Bertilsson (of Clinical Pharmacology Dept, Karolinska Inst, Huddinge University Hospital, Sweden), Dr. Collen Masimirembwa (He has now started his own lab in Nairobi, Kenya. Earlier he was in AstraZeneca) , Professor Olavi Pelkonen (of Dept of Pharmacology and Toxicology, University of Oulu). > With the passage of time, we may take the advantage of this novel drug targeted PGNX; if not now, then our successors will definitely devour its fruits. PGNX as a part of RUM will improve human health. It will be helpful in both infectious diseases and noninfectious diseases, microbial drug resistance, where there is treatment failure, and in non-responders (30-60% of patients do not respond

to treatment by available drugs). It will also help in drug intellectual property. > > Dr. Shilpa Jadav> > For providing an important article on > The concept of personal drugs in the undergraduate pharmacology practical curriculum. Indian J Pharmacol 2007;39:165- 7> > Dr Surendiran for enlightening us regarding funding agencies as> > There are enough agencies to fund research projects on genomics, which are remaining unutilized. These depot of resources like DBT, DST, ICMR, CEFIPRA etc are to be utilized by various institutions all over the country and set up pharmacogenetic labs with personnel. This has a long way to go, with the current rate of progress in research.> > Dr. Buch> > For adding the link of following article from NEJM As > > http://content. nejm.org/ cgi/content/ full/358/ 2/105?query= TOC> > Volume 358:105-107 January

10, 2008 Number 2> Letting the Genome out of the Bottle â€” Will We Get Our Wish?> > And lastly, the group owner Dr Vijay Thawani for giving me the apportunity to moderate on this forum.> > Thanks to all readers too.> > Regards,> Dr Kiran Chaudhari> Lecturer, Pharmacology,> GMC, Nagpur.> > > > ------------ --------- --------- ---> Chat on a cool, new interface. No download required. Click here.>

Unlimited freedom, unlimited storage. Get it now

Forgot the famous last words? Access your message archive online. Click here.

<html>

<head>

<title>Chapter 6 - Antibiotic Prophylaxis in Surgery</title>

</head>

<body>

<h1><span

style= " mso-bookmark:_Toc469752611 " ><a

name= " Chaptert6 " >Antibiotic Prophylaxis In

Surgery</a></h1>

<hr>

<h2><a name= " fundamental " >Fundamental</a> principles

of <a

name= " SurgicalProphylaxis " >Surgical Prophylaxis</a></h2>

<p class= " MsoNormal "

style= " margin-left:21.3pt;text-align:justify;text-indent:

-18.0pt;mso-list:l29 level1 lfo21 " ><font

face= " Century Gothic " ><span style= " font-family:

& quot;Courier New & quot; " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; The

antibiotic must be in the tissue before the bacteria are introduced i.e.

antibiotic must

be given intravenously shortly before surgery to ensure high blood / tissue

levels.<span

style= " mso-spacerun:

yes " > & nbsp; Prophylaxis failure may be due to antibiotics

given too late or more often, given too early.<span style= " mso-spacerun:

yes " > & nbsp; The

half-life of the particular antibiotic is therefore important.

<p class= " MsoNormal "

style= " margin-left:21.3pt;text-align:justify;text-indent:

-18.0pt;mso-list:l29 level1 lfo21 " ><font

face= " Century Gothic " ><span style= " font-family:

& quot;Courier New & quot; " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; There

is no data to support more than a single dose.<span style= " mso-spacerun:

yes " > & nbsp; Further

doses generally constitute treatment. & nbsp;

Note

the waste of resources, the in-creased risk of complications and the fact that

multiple

doses are not associated with increased efficiency.

<p class= " MsoNormal "

style= " margin-left:21.3pt;text-align:justify;text-indent:

-18.0pt;mso-list:l29 level1 lfo21 " ><font

face= " Century Gothic " ><span style= " font-family:

& quot;Courier New & quot; " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; The

chosen antibiotics must be active against the most common ex-pected

pathogens.

<p class= " MsoNormal "

style= " margin-left:21.3pt;text-align:justify;text-indent:

-18.0pt;mso-list:l29 level1 lfo21 " ><font

face= " Century Gothic " ><span style= " font-family:

& quot;Courier New & quot; " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Deviations

from these guidelines may be warranted in certain situations, e.g. MRSA outbreak

in an

individual hospital.

<p class= " MsoNormal "

style= " margin-left:21.3pt;text-align:justify;text-indent:

-18.0pt;mso-list:l29 level1 lfo21 " ><font

face= " Century Gothic " ><span style= " font-family:

& quot;Courier New & quot; " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; High

risk patients, e.g. patients with jaundice or diabetics, or patients who undergo

any

procedures to insert prosthetic devices, generally warrant antibiotic

prophylaxis.

<font face= " Century

Gothic " >N.B.<span

style= " mso-tab-count:

1 " > & nbsp; & nbsp; & nbsp; & nbsp; There are no convincing

statistical differences in efficacy between the 1st, 2nd or 3rd generation

cephalosporins,

therefore a 1st generation cephalosporin MUST be the preferred

option.

& nbsp;

<h2><a name= " forwhich " >For which type of

operations?</a></h2>

Antibiotic prophylaxis is

generally

indicated for patients undergoing the following types of operations:<span

style= " mso-spacerun: yes " > & nbsp;

<p class= " MsoNormal "

style= " margin-left:21.3pt;text-align:justify;text-indent:

-18.0pt;mso-list:l0 level1 lfo22 " ><font

face= " Century Gothic " ><span style= " font-family:

& quot;Courier New & quot; " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; All

clean-contaminated procedures; these include penetration of the gastrointestinal

tract,

whether by penetrating trauma or related to a pathological organ event (e.g.

ruptured

appendix, perforated colonic diverticulum) prior to the development of clinical

peritonitis.

<p class= " MsoNormal "

style= " margin-left:21.3pt;text-align:justify;text-indent:

-18.0pt;mso-list:l0 level1 lfo22 " ><font

face= " Century Gothic " ><span style= " font-family:

& quot;Courier New & quot; " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Clean

operations with foreign body implant (e.g. vascular, cardiac and orthopaedic

operations),

and those without foreign body implants especially hernia repair, breast

surgery, median

sternotomy, vascular surgery involving the aorta and the lower extremities, and

craniotomy.

The use of antibiotics in

operations

classified as contaminated or dirty/infected should be considered as therapeutic

and is

clearly not prophylactic i.e. treatment should be given for a longer

duration.<span

style= " mso-spacerun: yes " > & nbsp; Operations for acute cholecystitis,

empyema of the

gallbladder, ascending cholangitis or liver abscess require antibiotic treatment

rather

than prophylaxis (see under gastrointestinal infections).<span

style= " mso-spacerun: yes " >

& nbsp; The same applies to operations for a perforated appendix with

evidence of

local or generalised peritonitis and/or intraabdominal abscess, and penetrating

abdominal

trauma where significant gastrointestinal leakage with peritoneal soiling is

identified at

the time of the operation.

<h2><a name= " timing " >Timing of antibiotic

prophylaxis</a></h2>

Current recommendations are

that the

parenteral antibiotics used in prophylaxis should be given in sufficient dosage

within 30

minutes preceding incision. & nbsp; This

results in

near maximum drug levels in the wound and the surrounding tissues during the

operation.<span

style= " mso-spacerun: yes " > & nbsp; This can be facilitated by having the

anaesthetist

administer the antibiotic in the operating room when the intravenous lines are

inserted

shortly before operative incision. & nbsp;

A single

preoperative dose of antibiotic has the same efficacy as multiple doses and the

current

recommendation is to administer a second dose only if the operation lasts for

longer than

2 - 3 hours. & nbsp; With the oral

preoperative

antibiotic preparation commonly used before elective colonic resection, the

chosen agents

should be given during the 24 hours before the operation in order to attain

significant

intraluminal (local) and serum (systemic) levels.

<h2><a name= " route " >Route of administration of

prophylactic

antibiotics</a></h2>

Intravenous administration

of the

prophylactic antibiotic is preferred for most patients undergoing an operative

procedure.<span

style= " mso-spacerun: yes " > & nbsp; Oral antibiotics currently play a major

role only

in the preparation of patients before elective colon surgery.

<h2 style= " text-align:justify " ><a name= " antibiotic " ><font face= " Century

Gothic " >Antibiotic

prophylaxis for common surgical operations</a></h2>

<font face= " Century

Gothic " >1.<span

style= " mso-tab-count:

1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; CARDIAC,

THORACIC AND VASCULAR SURGERY

<p class= " MsoNormal " style= " margin-left:36.0pt;text-align:justify;text-indent:

-36.0pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Antibiotic prophylaxis in cardiovascular surgery has proven beneficial

only in the

following procedures :

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l46 level1 lfo1 " ><font

face= " Century Gothic " >·<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

Reconstruction

of the abdominal aorta

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l46 level1 lfo1 " ><font

face= " Century Gothic " >·<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Procedures

on the leg which involve a groin incision

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l46 level1 lfo1 " ><font

face= " Century Gothic " >·<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Any

vascular procedure with insertion of a prosthesis / foreign body

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l46 level1 lfo1 " ><font

face= " Century Gothic " >·<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Lower

extremity amputation for ischaemia

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-align:justify;text-indent:

-18.0pt;mso-list:l46 level1 lfo1 " ><font

face= " Century Gothic " ><span style= " font-family:

Symbol " >·<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Cardiac

surgery

<p class= " MsoNormal " style= " margin-left:36.0pt;text-align:justify;text-indent:

-36.0pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Cardiac: & nbsp; prosthetic

valve

insertion, coronary artery bypass graft, other open heart surgery, pacemaker

implant,

median sternotomy.

<font face= " Century

Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

a. & nbsp; 1st generation

cephalosporins e.g.

cefazolin 1 - 2 g pre-induction

<font face= " Century

Gothic " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;\

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

OR

<font face= " Century

Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

b. & nbsp; 2nd generation

cephalosporins e.g.

cefuroxime 1.5 g IV

<p class= " MsoNormal "

style= " margin-left:120.5pt;text-align:justify;text-indent:

-120.5pt;tab-stops:35.45pt 92.15pt 120.5pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Note: (i)<span

style= " mso-tab-count:1 " > During

prolonged operations, additional intraoperative doses every 4 - 8 hours are

indicated.

<p class= " MsoNormal "

style= " margin-left:120.5pt;text-indent:-1.0cm;mso-list:l19 level1 lfo23;

tab-stops:35.45pt 92.15pt 120.5pt " ><font

face= " Century Gothic " >(ii)<span style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; Some

authors recommend continuing the antibiotic for up to 48 hours after the

procedure (e.g. 1

- 2 g 8 hrly).

<p class= " MsoNormal "

style= " margin-left:120.5pt;text-indent:-1.0cm;mso-list:l19 level1 lfo23;

tab-stops:35.45pt 92.15pt 120.5pt list 199.15pt " ><font

face= " Century Gothic " >(iii)

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Vancomycin, only if

there is a

high rate of documented MRSA infections in the unit.

<p class= " MsoNormal " style= " margin-left:36.0pt;text-align:justify;text-indent:

-36.0pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Non-cardiac vascular: e.g. aortic resection, prosthesis, groin

incision,

lower extremity amputation.

<font face= " Century

Gothic " ><span

style= " mso-tab-count:

1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

a. Cefazolin 1 g pre-induction.<span

style= " mso-spacerun: yes " > & nbsp; Additional intraoperative doses at 4 - 8

hour

intervals during prolonged operations

<font

face= " Century Gothic " >OR

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

b.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

Vancomycin, for

MRSA outbreaks only

<p class= " MsoNormal "

style= " margin-left:120.5pt;text-align:justify;text-indent:

-120.5pt;tab-stops:35.45pt 92.15pt 120.5pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Note: (i)<span

style= " mso-tab-count:1 " > The

value of antibiotics in carotid or brachial artery surgery has not been

established,

unless prosthetic material is used.

<p class= " MsoNormal "

style= " margin-left:120.5pt;text-align:justify;text-indent:

-120.5pt;tab-stops:35.45pt 92.15pt 120.5pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

(ii) To cover for Gram-negative

coliform

bacteria during groin incisions, a 2nd generation cephalosporin can be

considered, only if

high resistance rates to cefazolin are present in a specific

community.

2.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; GENERAL THORACIC: PULMONARY,

OESOPHAGEAL<o:p></o:p>

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

a.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; 1st

generation

cephalosporins & nbsp; e.g. cefazolin 1 - 2

g

pre-induction

<font

face= " Century Gothic " >OR

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

b.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; 2nd

generation

cephalosporins e.g. cefuroxime 1,5 g IV.

<p class= " MsoNormal " style= " margin-left:36.0pt;text-align:justify;text-indent:

-36.0pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Note: Some authors recommend continuing the antibiotic for up to 48 hrs

after the

procedure to prevent empyema or pneumonia.

3.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; ORTHOPAEDIC

SURGERY<o:p></o:p>

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Arthroplasty of joints, and/or joint replacement.

<p class= " MsoNormal " style= " margin-left:36.0pt;text-align:justify;text-indent:

-36.0pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

1st generation cephalosporins eg. cefazolin 1 - 2 g pre-operatively.<span

style= " mso-spacerun:

yes " > & nbsp; If the operation is longer than 3 hours, give a

second dose. & nbsp; Some authors recommend

continuing the antibiotic for up to 48 hours after the procedure (e.g. cefazolin

1 - 2 g 8

hrly).

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Open reduction of fracture<o:p></o:p>

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

1st generation cephalosporin eg. cefazolin 1 - 2 g IV pre-op.

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Laminectomy, spinal fusion<o:p></o:p>

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Prophylactic antibiotics have not been proved to be

beneficial.

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Lower limb amputation<o:p></o:p>

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

a.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; 1st

generation

cephalosporins & nbsp; eg. cefazolin 1 - 2

g IV.

<font

face= " Century Gothic " >OR

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

b.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

cefoxitin 2 g

IV.

& nbsp;<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:127.6pt;text-align:justify;text-indent:

-127.6pt;tab-stops:35.45pt 92.15pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Note: & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

(i)<span

style= " mso-tab-count:1 " > & nbsp; The use of a 2nd generation cephalosporin

may be

considered in cases of possible Gram-negative bacterial contamination (e.g. hip

surgery),

but is dictated by high incidence of resistance to the 1st generation

cephalosporins.

<p class= " MsoNormal "

style= " margin-left:128.25pt;text-align:justify;text-indent:

-36.0pt;mso-list:l44 level1 lfo24;tab-stops:35.45pt 92.15pt list 128.25pt " ><font

face= " Century Gothic " >(ii)<span style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; Data

regarding prophylactic antibiotics in arthroscopic surgery is not

available.

<p class= " MsoNormal "

style= " margin-left:128.25pt;text-align:justify;text-indent:

-36.0pt;mso-list:l44 level1 lfo24;tab-stops:35.45pt 92.15pt list 128.25pt " ><font

face= " Century Gothic " >(iii)

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

Compound

(open) fractures are considered contaminated, so antibiotics are essentially

therapeutic

in such situations.

4.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; GASTRODUODENAL

SURGERY<o:p></o:p>

<font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Antibiotics are indicated in high risk patients only, i.e. patients with

bleeding

ulcer, obstructive duodenal ulcer, gastric ulcer, low gastric acidity, decreased

GI

motility, malignancy or morbid obesity.

<p class= " MsoNormal "

style= " margin-left:72.0pt;text-indent:-36.0pt;mso-list:l25 level1 lfo4;

tab-stops:list 72.0pt " ><font

face= " Century Gothic " >a.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

1st generation cephalosporins e.g. cefazolin 1 g IV pre-op.

<p class= " MsoNormal "

style= " margin-left:72.0pt;text-align:justify;text-indent:

-36.0pt;mso-list:l25 level1 lfo4;tab-stops:list 72.0pt " ><font

face= " Century Gothic " >b.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

For beta-lactam allergy, gentamicin 120 mg plus clindamicin 600 mg IV

preop.

5.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; BILIARY TRACT

SURGERY<o:p></o:p>

<p class= " MsoNormal " style= " margin-left:36.0pt;text-align:justify;text-indent:

-36.0pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Most studies show that achieving adequate drainage will prevent

post-procedural

cholangitis or sepsis and there is no further benefit from prophylactic

antibiotics.<span

style= " mso-spacerun: yes " > & nbsp; With inadequate drainage, antibiotics

may be of

value. & nbsp; The American Society for GI

Endoscopy

recommends prophylaxis for known or suspected biliary obstruction.<span

style= " mso-spacerun: yes " > & nbsp; The value of prophylaxis for ERCP is

controversial.

<p class= " MsoNormal " style= " margin-left:36.0pt;text-align:justify;text-indent:

-36.0pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Note that cephalosporins are not active against the enterococci, yet are

clinically

effective as prophylaxis in biliary surgery.<span style= " mso-spacerun:

yes " > & nbsp; With

cholangitis, treat as infection, not prophylaxis.<span style= " mso-spacerun:

yes " > & nbsp; High

risk patients include those & gt;70 years of age, acute cholecystitis,

non-functioning

gall-bladder, obstructive jaundice or common duct stones.

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

a.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; 1st

generation

cephalosporins e.g. cefazolin 2 g pre-op as a single dose

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbs\

p;

OR

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

b.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

cefoxitin 2 g

pre-op as a single dose.

6.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; INGUINAL HERNIA

REPAIR<o:p></o:p>

<font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Available data is limited, routine use is not recommended.<span

style= " mso-spacerun: yes " > & nbsp; For a mesh implant, give prophylaxis

e.g. 1st

generation cephalosporin as a single dose.

7.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; COLON

SURGERY<o:p></o:p>

<p class= " MsoNormal " style= " margin-left:36.0pt;text-align:justify;text-indent:

-36.0pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Recommended approach for preoperative preparation before elective colon

surgery and

terminal ileal surgery:

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Second day prior to surgery (at home)<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l2 level1 lfo25;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Dietary

restriction - low residue or liquid diet.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-align:justify;text-indent:

-18.0pt;mso-list:l2 level1 lfo25;tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Magnesium

sulphate, 30 ml of a 50% solution (15 g) orally at 10h00, 14h00 and

18h00.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l2 level1 lfo25;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; In

the evening, enemas until clear.

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Day of hospitalisation (preoperative day)<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l12 level1 lfo26;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Admit

in the morning.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l12 level1 lfo26;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Clear

liquid diet, IV fluids as needed.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l12 level1 lfo26;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Magnesium

sulphate in dosage as above at 10h00 and 14h00.

<p class= " MsoNormal " align= " center "

style= " text-align:center;tab-stops:35.45pt " ><font

face= " Century Gothic " >OR

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-align:justify;text-indent:

-18.0pt;mso-list:l14 level1 lfo27;tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Whole-gut

lavage with polyethylene glycol electrolyte solution 1L/h for 2 - 4 hours, or

10% mannitol

until diarrhoea effluent is clear.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-align:justify;text-indent:

-18.0pt;mso-list:l14 level1 lfo27;tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Neomycin

and erythromycin base, 1 g each orally at 13h00, 14h00 and 23h00.<span

style= " mso-spacerun: yes " > & nbsp; Alternative oral antibiotics include

metronidazole

plus kanamycin or neomycin.

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Day of surgery<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l26 level1 lfo28;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Cefoxitin

2 g pre-op and every 6 hours for 3 doses OR

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l26 level1 lfo28;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Metronidazole

500 mg IV pre-op single dose OR

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l26 level1 lfo28;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Ampicillin

plus metronidazole plus aminoglycoside all as single doses

<p class= " MsoNormal " align= " center "

style= " margin-left:20.7pt;text-align:center " ><font

face= " Century Gothic " >OR

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l34 level1 lfo29;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; 3rd

generation cephalosporin plus metronidazole as a single dose

<p class= " MsoNormal " align= " center "

style= " margin-left:20.7pt;text-align:center " ><font

face= " Century Gothic " >OR

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l34 level1 lfo29;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; for

patients with beta-lactam allergy, give metronidazole 500 mg IV and gentamicin 3

mg/kg IV

pre-operatively, both as single doses.

<font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

For non-elective colorectal surgery, give cefoxitin 1 g IV

pre-operatively

and then 1 g 8 hourly for 3 doses.

8.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

APPENDICECTOMY<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l34 level1 lfo29;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Cefoxitin

2 g IV pre-op and for up to 3 doses. & nbsp;

If

perforated, continue for 3 - 5 days.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l34 level1 lfo29;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; For

patients with beta-lactam allergy, give metronidazole 500 mg IV pre-operatively

or use

metronidazole in form of suppository.

9.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; PENETRATING ABDOMINAL

TRAUMA<o:p></o:p>

<font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Any antibiotic cover can be considered as treatment and not as

prophylaxis.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l42 level1 lfo30;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Cefoxitin

2 g IV on admission, continue q.i.d. for 2 - 5 days for intestinal perforation

<font

face= " Century Gothic " >OR

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l42 level1 lfo30;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Metronidazole

500 mg IV and gentamicin 1.7 mg/kg IV.

10.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; ABDOMINAL SURGERY NOT INVOLVING A

VISCUS<o:p></o:p>

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

Data to support recommendations for prophylaxis not available.

11.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; OBSTETRICS AND

GYNAECOLOGY<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l42 level1 lfo30;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Vaginal

hysterectomy and emergency caesarian section

1st generation cephalosporin eg. cefazolin 1 - 2 g IV, as a single

dose.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-align:justify;text-indent:

-18.0pt;mso-list:l42 level1 lfo30;tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Abdominal

hysterectomy, cervical cerclage after 18 weeks, induced abortion with risk

factors,

(e.g. history of previous PID, multiple partners, young, known gonococcal or

chlamydia

infections) - antibiotic is probably indicated. 1st generation cephalosporin eg.

cefazolin

1 - 2 g IV.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l42 level1 lfo30;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Elective

caesarian section

Prophylactic antibiotics are not indicated.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l42 level1 lfo30;

tab-stops:list 2.0cm " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Insertion

of IUCD

Prophylactic antibiotics are not indicated.

12.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

UROLOGICAL

SURGERY<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:57.8pt;text-indent:-18.0pt;mso-list:l4 level1 lfo31;

tab-stops:list 57.8pt " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

Prostatectomy

Prophylaxis only in high risk patients viz. uraemia, diabetes, neurological

bladder,

large residual volume, cardiac disease or previous UTI.

<p class= " MsoNormal "

style= " margin-left:57.8pt;text-indent:-18.0pt;mso-list:l4 level1 lfo31;

tab-stops:list 57.8pt " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; quinolones

as a single oral pre-operative dose e.g. ciprofloxacin 500 mg PO stat

or

<p class= " MsoNormal "

style= " margin-left:57.8pt;text-indent:-18.0pt;mso-list:l4 level1 lfo31;

tab-stops:list 57.8pt " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; aminoglycosides

as a single IV pre-operative dose.

<p class= " MsoNormal "

style= " margin-left:57.8pt;text-indent:-18.0pt;mso-list:l4 level1 lfo31;

tab-stops:list 57.8pt " ><font

face= " Century Gothic " ><span

style= " font-family: & quot;Courier New & quot;;

mso-bidi-font-weight:bold " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Transrectal

prostate biopsy<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-2.0cm;tab-stops:2.0cm " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

The quinolones have been shown to reduce bacteraemia from 37% to

7%.

<p class= " MsoNormal "

style= " margin-left:148.85pt;text-align:justify;text-indent:

-148.85pt;tab-stops:2.0cm 4.0cm 148.85pt " ><font

face= " Century Gothic " ><span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

Note: (i) Dilatation of urethra,

endoscopic

diagnostic procedures, needle biopsy or lithotripsy with sterile urine:

prophylactic

antibiotics are not indicated.

<p class= " MsoNormal "

style= " margin-left:149.25pt;text-align:justify;text-indent:

-36.0pt;mso-list:l32 level1 lfo32;tab-stops:2.0cm 4.0cm list 149.25pt " ><font

face= " Century Gothic " >(ii)

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

Antimicrobials

are not recommended prior to urological procedures in patients with sterile

urine.

<p class= " MsoNormal "

style= " margin-left:149.25pt;text-align:justify;text-indent:

-36.0pt;mso-list:l32 level1 lfo32;tab-stops:2.0cm 4.0cm 148.85pt " ><font

face= " Century Gothic " >(iii)

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Prophylaxis is

supported if

catheter has been present for & gt; 24 hours.

<p class= " MsoNormal "

style= " margin-left:149.25pt;text-align:justify;text-indent:

-36.0pt;mso-list:l32 level1 lfo32;tab-stops:2.0cm 4.0cm 148.85pt " ><font

face= " Century Gothic " >(iv)

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Ideally the catheter should be

inserted

two hours or less, prior to surgery.

<p class= " MsoNormal "

style= " margin-left:149.25pt;text-align:justify;text-indent:

-36.0pt;mso-list:l32 level1 lfo32;tab-stops:2.0cm 4.0cm 148.85pt " ><font

face= " Century Gothic " >(v)

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; If the urine is

infected, it

is preferable to sterilize it before beginning an elective procedure.

13.<span

style= " mso-tab-count:1 " >

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; HEAD AND NECK

SURGERY<o:p></o:p>

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l32 level2 lfo32 " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Tonsillectomy

with/without adenoidectomy

Data regarding prophylaxis are not available.

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l32 level2 lfo32 " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; Major

head, neck and oral surgery

If incision is through oral or oropharyngeal mucosa:

<font face= " Century

Gothic " ><span

style= " mso-tab-count:

1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp\

; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

a.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp; & nbsp; & nbsp; & nbsp;

Cefazolin 2 g IV as single dose

<span

style= " mso-tab-count:2 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbs\

p;

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

OR

<font face= " Century

Gothic " ><span

style= " mso-tab-count:

1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp\

; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

b.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp; & nbsp; & nbsp; & nbsp;

amoxycillin-clavulanate IV 1,2 g as single dose

<span

style= " mso-tab-count:2 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbs\

p;

<span

style= " mso-tab-count:1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp;

OR

<font face= " Century

Gothic " ><span

style= " mso-tab-count:

1 " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp\

; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

c.

& nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & n\

bsp; & nbsp; & nbsp; & nbsp; & nbsp;

gentamicin 80mg PLUS clindamycin 600mg IV as single doses

<p class= " MsoNormal "

style= " margin-left:2.0cm;text-indent:-18.0pt;mso-list:l15 level1 lfo33 " ><font

face= " Century Gothic " >o<span

style= " font:7.0pt & quot;Times New

Roman & quot; " > & nbsp; & nbsp; & nbsp; & nbsp; & nbsp; & nbsp;

Rhinoplasty

Prophylactic antibiotics have not proved effective.

& nbsp;<o:p></o:p>

Infecting microorganisms

usually

associated with certain operative procedures and the prophylactic antibiotic

recommendation.

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 20 "

bgcolor= " #C0C0C0 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Surgical

procedure<o:p></o:p></td>

<td width= " 27% " valign= " top " align= " left " height= " 20 "

bgcolor= " #C0C0C0 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Predominant

infecting microorganism(s)<o:p></o:p></td>

<td width= " 25% " valign= " top " align= " left " height= " 20 "

bgcolor= " #C0C0C0 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Recommended

agent<o:p></o:p></td>

<td width= " 14% " valign= " top " align= " left " height= " 20 "

bgcolor= " #C0C0C0 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Dose</td>

<td width= " 12% " valign= " top " align= " left " height= " 20 "

bgcolor= " #C0C0C0 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Route</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 73 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Cardiothoracic</td>

<td width= " 27% " valign= " top " align= " left " height= " 73 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Staphylococci</td>

<td width= " 25% " valign= " top " align= " left " height= " 73 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Cefazolin

OR Cefuroxime

OR Vancomycin<o:p></o:p>

<span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >(see

text)<o:p></o:p></td>

<td width= " 14% " valign= " top " align= " left " height= " 73 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >1

- 2 g<o:p></o:p>

1.5 g<o:p></o:p></td>

<td width= " 12% " valign= " top " align= " left " height= " 73 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >IV

IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Non-cardiac

vascular surgery</td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Staphylococci</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Cefazolin<span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >

or

<span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Cefuroxime</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >1

- 2 g

1.5 g<o:p></o:p></td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >IV

IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><p class= " MsoNormal "

style= " margin-top:1.0pt;margin-right:0cm;margin-bottom:

0cm;margin-left:9.0pt;margin-bottom:.0001pt;text-indent:-9.0pt;mso-list:l0

level1 lfo1 " ><span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Courier

New & quot; " >o<span

style= " font:7.0pt & quot;Times New Roman & quot; " > & nbsp; <span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Arthroplasty

of joints, joint replacement <o:p></o:p>

<p class= " MsoNormal "

style= " margin-top:1.0pt;margin-right:0cm;margin-bottom:

0cm;margin-left:9.0pt;margin-bottom:.0001pt;text-indent:-9.0pt;mso-list:l0

level1 lfo1 " ><span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Courier

New & quot; " >o<span

style= " font:7.0pt & quot;Times New Roman & quot; " > & nbsp; <span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Open

reduction of fractures & nbsp;

<o:p></o:p>

<p class= " MsoNormal "

style= " margin-top:1.0pt;margin-right:0cm;margin-bottom:

0cm;margin-left:9.0pt;margin-bottom:.0001pt;text-indent:-9.0pt;mso-list:l0

level1 lfo1 " ><span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Courier

New & quot; " >o<span

style= " font:7.0pt & quot;Times New Roman & quot; " > & nbsp; <span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Lower

limb amputation<o:p></o:p></td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Staphylococci</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font

face= " Century Gothic " ><span

style= " font-size:10.0pt;mso-bidi-font-size:

12.0pt " >Cefazolin</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >1-

2 g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Gastroduodenal</td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Streptococci,

coliforms, anaerobic bacteria incl. Bacteroides spp.</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font

face= " Century Gothic " ><span

style= " font-size:10.0pt;mso-bidi-font-size:

12.0pt " >Cefazolin</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >1g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Biliary

tract

For high risk only:

& gt; 70 years

Obstructive jaundice

Acute cholecystits

Acute cholangitis

Common duct stone

Low risk:<o:p></o:p></td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Coliforms,

enterococci, anaerobic bacteria incl. Bacteroides, clostridia<font

face= " Century Gothic " >

</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font face= " Century

Gothic " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Cefazolin

or

Cefoxitin & nbsp;

& nbsp;

<span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >

No prophylaxis</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >2

g

2 g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >IV

IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Colon/small

bowel<o:p></o:p></td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Coliforms,

anaerobic bacteria incl. Bacteroides fragilis</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font face= " Century

Gothic " >Cefoxitin

see text for<span

style= " font-weight:

normal " >

alteratives.<o:p></o:p></td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >2g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Appendectomy</td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Coliforms,

anaerobic bacteria incl. Bacteroides fragilis</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font

face= " Century Gothic " >Cefoxitin</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >2

g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Penetrating

abdominal trauma</td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Coliforms,

anaerobic bacteria incl. Clostridia, Bacteroides fragilis</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font

face= " Century Gothic " >Cefoxitin</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >2

g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Vaginal

or abdominal hysterectomy</td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Coliforms,

enterococci group B streptococci<o:p></o:p></td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font

face= " Century Gothic " >Cefazolin</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >2

g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Caesarian

section with high risk e.g. premature rupture of membranes<span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >Low

risk - elective<o:p></o:p></td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >as

for hysterectomy<o:p></o:p></td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font face= " Century

Gothic " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Cefazolin<span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >

or

<span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Cefoxitin

No prophylaxis<o:p></o:p></td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >1

g

2 g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >IV

IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Abortion</td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >as

for hysterectomy</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font face= " Century

Gothic " >Cefazolin</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >1

g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Prostatectomy</td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Coliforms</td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font face= " Century

Gothic " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Ciprofloxacin<span

style= " font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >

or

gentamicin</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >500

mg

1,5 mg/kg</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >PO

IV</td>

</tr>

<tr>

<td width= " 22% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >CNS

shunts <o:p></o:p></td>

<td width= " 27% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >Staphylococci<o:p></o:p></td>

<td width= " 25% " valign= " top " align= " left " height= " 19 " ><font face= " Century

Gothic " >Cefazolin</td>

<td width= " 14% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century Gothic & quot; " >1

g</td>

<td width= " 12% " valign= " top " align= " left " height= " 19 " ><span

style= " font-size:10.0pt;

mso-bidi-font-size:12.0pt;font-family: & quot;Century

Gothic & quot; " >IV</td>

</tr>

</table>

</center></div>

</body>

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