Antibiotic prophylaxis for paediatric surgery

This advice represents the consensus view from each specialty as well as pharmacy, microbiology and infectious disease clinicians on the anti-microbial management team, based on local resistance data. It aims to help you in making the most appropriate choice of antimicrobial in order to improve stewardship and keep antibiotics working.

Try to keep to the guidance when prescribing. There will be occasions when you may have to prescribe an alternate antimicrobial to that advised in the guidance, but you will be expected to be able to justify your choice if this occurs. Advice can be obtained from Infectious Disease or Microbiology.

General Principles for prescribing:

• Administer the pre-operative IV prophylaxis dose within the 60 minutes prior to skin incision/intervention.
• If severe blood loss repeat antibiotic dose for: cefuroxime, flucloxacillin, clarithromycin, co-amoxiclav (all at full prophylactic dose) and gentamicin (at half prophylaxis dose). Do not redose metronidazole or teicoplanin.
• To reduce the risk of post-operative drug errors, prescribe antibiotics on the ‘Once Only’ section of the drug kardex and also on the anaesthetic record.
• Check previous microbiology and seek opinion for patients on existing antimicrobial therapy or with complex microbiological problems.
• Follow paediatric monographs for drug reconstitution and administration.