Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

NeurosurgicalLIKELYPATHOGENS• ANTIMICROBIALREGIMEN (Adult)ANTIMICROBIAL REGIMEN(Pediatric)OR REDOSINGCOMMENTSCraniotomyCerebrospinalfluidshuntStaphylococcus aureus,coagulase-negativestaphylococciStaphylococci accountfor 75-80% of woundinfections following shuntprocedures; Gram--negative bacteria 1-20%.• Cefazolin 4 1 g IV pre-op(2 g if > 80 kg)• Cefuroxime 4,5 1.5 g IV preop----- or• Vancomycin 1 g IV as asingle dose• Cefazolin 25mg/kg IV preop(Maximum of 1 g)• Cefuroxime 30mg/kg IV(Maximum of 1.5g) pre-op---- Or• Vancomycin 15mg/kg IV(Maximum of 1 g) pre-op• Cefazolin every 4hours• Cefuroxime every 4hours• Vancomycin none;every 6 hours forpediatric patientsOrganisms listed represent >85%of post-op infectionsIF incidence of infections withMRSA >10% in an institution,vancomycin is recommended,otherwise it is optional(IF incidence of infections with MRSA>10% in an institution, vancomycin isrecommended, otherwise it isoptional)OrthopedicsLIKELYPATHOGENSANTIMICROBIAL REGIMEN(Adult)ANTIMICROBIAL REGIMEN(Pediatric)OR REDOSINGCOMMENTSTotal jointreplacementStaphylococcus aureusand Staphylococcusepidermidis and variousstreptococci cause>66% of woundinfections.• Cefazolin 1,4 1 g IV preop(2 g if > 80 kg)----- or• Cefuroxime 5 1.5 g IV preop----- or• Vancomycin (15 mg/kg), upto 1 g IVpre-op if MRSA+• Cefazolin 25mg/kg IV preop(Maximum of 1 g)---- Or• Cefuroxime 30mg/kg IVpreop (Maximum of 1.5 g)---- Or• Vancomycin 15mg/kg IV(Maximum of 1 g) preop ifMRSA+• Cefazolin every 4hours• Cefuroxime every 4hours• Vancomycin none;every 6 hours forpediatric patientsCefuroxime has enhanced activityagainst coagulase-negativestaphylococciUse vancomycin only for severepenicillin allergy or if MRSA+.Some clinicians use clindamycinin penicillin-allergic patientsHip fracturerepairStaphylococci• Cefazolin 1,4 1 g IV pre-op(2 g if > 80 kg)----- or• Cefuroxime 5 1.5 g IV preop----- or• Vancomycin (15 mg/kg) upto 1 g IV if MRSA+• Cefazolin 25mg/kg IV preop(Maximum of 1 g)---- Or• Cefuroxime 30mg/kg IVpreop (Maximum of 1.5 g)---- Or• Vancomycin 15mg/kg IV(Maximum of 1 g) preop ifMRSA+• Cefazolin every 4hours• Cefuroxime every 4hours• Vancomycin none;every 6 hours forpediatric patientsUse vancomycin only for severepenicillin allergy or MRSA+.Some clinicians use clindamycinin penicillin-allergic patients