Open sternum, skin open in OR or sternum opened in CCU Cefazolin 30 mg/kg/dose IV (max: 2 g) induction and every 8 hours of anesthesia + Cefazolin 30 mg/250 mL pump priming solution THEN Cefazolin 30 mg/kg IV (max: 2 g) post-op q8h x 72h, starting 8 hours after previous dose + Gentamicin 2.5 mg/kg/dose (max: 120 mg) IV q12h initially** x 72h **adjust dose according to TDM Vancomycin (preferred)* 15 mg/kg (max: 1 g) IV q12h initially** x 72h OR Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia then q8h x 72h + Gentamicin 2.5 mg/kg/dose (max: 120 mg) IV q12h initially** x 72h *25% S. aureus are resistant to clindamycin **adjust dose according to TDM Cefazolin Age ≤7 days: 30 mg/kg/dose IV q12h x 72h Age >7 days: 30 mg/kg/dose IV q8h x 72h + Cefazolin 30 mg/250 mL pump priming solution + Tobramycin 3 mg/kg/dose IV q24h initially** x 72h OR (if beta-lactam allergy) Vancomycin (preferred)* 15 mg/kg IV q24h initially** x 72h OR Clindamycin 7.5 mg/kg IV at induction of anesthesia then q8h x 72h + Tobramycin 3 mg/kg/dose IV q24h initially** x 72h *25% S. aureus are resistant to clindamycin **adjust dose according to TDM Thoracic (noncardiac) Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia Cefazolin 30 mg/kg IV at induction of anesthesia OR (if beta-lactam allergy) Clindamycin 7.5 mg/kg IV at induction of anesthesia
Spinal surgery with instrumentation Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia Vancomycin (preferred)* 15 mg/kg IV (max: 1 g) at induction of anesthesia OR Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia *25% S. aureus are resistant to clindamycin n/a Spinal surgery with instrumentation in incontinent patient or patient with neuromuscular disease Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia + Gentamicin 2.5 mg/kg IV (max: 120 mg) at induction of anesthesia + Metronidazole 10 mg/kg IV (max: 500 mg) at induction of anesthesia Vancomycin (preferred)* 15 mg/kg IV (max: 1 g) at induction of anesthesia OR Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia + Gentamicin 2.5 mg/kg IV (max: 120 mg) at induction of anesthesia + Metronidazole 10 mg/kg IV (max: 500 mg) at induction of anesthesia *25% S. aureus are resistant to clindamycin n/a Plastics Clean None None None Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia ± Gentamicin 2.5 mg/kg IV (max: 120 mg) at induction of anesthesia Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia OR (if beta-lactam allergy) Clindamycin 7.5 mg/kg IV at induction of anesthesia ± Tobramycin 3 mg/kg IV at induction of anesthesia
With placement of prosthesis (if surgery involves traversing mucous membranes, use regimen for clean contaminated as above) Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia OR Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia Vancomycin (preferred)* 15 mg/kg IV (max: 1 g) at induction of anesthesia OR Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia *25% S. aureus are resistant to clindamycin Cefazolin 30 mg/kg IV at induction of anesthesia OR (if beta-lactam allergy) Vancomycin (preferred)* 15 mg/kg IV at induction of anesthesia OR Clindamycin 7.5 mg/kg IV at induction of anesthesia *25% S. aureus are resistant to clindamycin Insertion of tissue expander Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia OR if near oral cavity Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia OR If near oral cavity Clindamycin 7.5 mg/kg IV at induction of anesthesia OR (if beta-lactam allergy) Vancomycin (preferred)* 15 mg/kg IV at induction of anesthesia OR Clindamycin 7.5 mg/kg IV at induction of anesthesia (If near oral cavity, Clindamycin 7.5 mg/kg IV at induction of anesthesia) *25% S. aureus are resistant to clindamycin Pectus excavatum Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia Vancomycin (preferred)* 15 mg/kg IV at induction of anesthesia OR Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia *25% S. aureus are resistant to clindamycin n/a