| Indication | Prophylaxis | Timing | Duration |
| ECMO (cannulation, chest revision, reoperation on ECMO, decannulation) – if not on anitbiotics with both gramnegative and grampositive cover already | Cephazolin 50mg/kg up to 1g IV or (if cephazolin unavailable)Cephalothin 50mg/kg up to 2g IV | Optimal timing for Beta-Lactams: administer 30 – 60min before incision | 2nd dose 25mg/kg if operation > 3hrs, continue 25mg/kg 8hrly, remember to cease after 24hrs |
| Known MRSA infection or colonization, currently or in the past | Cephazolin 50mg/kg up to 1g IV plusVancomycin 25mg/kg up to 1.5g (child < 12yrs: 30mg/kg up to 1.5g) | Optimal timing for Beta-Lactams: administer 30 – 60min before incision; for Vancomycin: slow infusion, starting 60min before, and finishing immediately before incision, CVL not required | 2nd dose 25mg/kg if operation > 3hrs, continue 25mg/kg 8hrly, remember to cease after 24hrs; no further doses of Vancomycin required |
| Penicillin / Cephalosporin allergy | Vancomycin 25mg/kg up to 1.5g (child < 12yrs: 30mg/kg up to 1.5g) IV plusGentamicin 2mg/kg IV | Optimal timing for Beta-Lactams: administer 30 – 60min before incision; for Vancomycin: slow infusion, starting 60min before, and finishing immediately before incision, CVL not required | No further doses required |
| ECMO (cannulation, chest revision, reoperation on ECMO, decannulation) – if on anitbiotics with both gramnegative and grampositive cover already | No further prophylaxis required | n/a | n/a |
References:
[1] Therapeutic Guidelines: Antibiotic, 2006: Therapeutic Guidelines Ltd, Melbourne.
[2] Ann Thorac Surg 2006, 81:397-404: The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part 1: Duration.
[3] The Society of Thoracic Surgeons Practice Guideline Series: Antibiotic Prophylaxis in Cardiac Surgery, Part 2: Antibiotic Choice. Ann Thorac Surg 2007;83:1596-76.
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