Patients | Antibiotics |
---|---|
All Patients | Flucloxacillin 1 g IV at induction followed by 1 g IV after bypass (e.g. at skin closure) and then 6, 12 and 18 h later and then STOP plus Gentamicin 5 mg/kg IV (maximum 480 mg) at induction only Note: The administration of a 2nd (or sometimes 3rd) intra-operative dose of flucloxacillin will depend on factors such as the length of operation and the type of bypass used and is therefore at the discretion of the anaesthetist/surgeon to be adjusted according to circumstances |
Penicillin allergy | Teicoplanin 400 mg IV (use 600 mg in those ≥90 kg) at induction with a subsequent dose at 12 h and then STOP plus Gentamicin 5 mg/kg IV (maximum 480 mg) at induction only |
Renal impairment | Flucloxacillin 1 g IV: No adjustment required Gentamicin: 2 mg/kg if GFR < 50 ml/min Teicoplanin 400 mg IV: No adjustments required for single dose and if GFR > 60 ml/min. If GFR ≤60 ml/min – A 2nd dose within 24 h is NOT required |