University of Maryland Medical Center

Perioperative Antibiotics for Surgical Prophylaxis

Guidelines for Use

1. The first dose of any antibiotic should be given within 2 hours of incision, preferably
30 minutes prior to incision [1].

2. There is no evidence that continuing prophylactic antibiotics post-operatively further

reduces the risk of infection.

The following practices are also recommended by the CDC [2] and the Surgical
Infection Society [3] to reduce the risk of surgical site infection (SSI). The evidence that
these measures reduce SSI’s is not as strong as the evidence for the guidelines above.

3. The therapeutic concentration of any antibiotic in the tissue needs to be maintained

intra-operatively. Hence perioperative antibiotics should be re-dosed every two to
three hours during the operative procedure (see table below).

4. In patients with obesity (women >80 kg; men > 100 kg), the dose of the antibiotics
should be increased.

5. If blood loss of >1500 cc occurs, the antibiotic should be redosed regardless of when
the last dose was previously given.

Intra-operative Dosing Guidelines

Antibiotic Dose Half-life Dosing Interval

Cefazolin 1 gm 90-150 min Every 2-3 hours
Ciprofloxacin 400 mg 4 hours Every 8 hours
Clindamycin 600 mg 3 hours Every 6 hours

References

1. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing
of prophylactic administration of antibiotics and the risk of surgical-wound infection
[see comments]. N Engl J Med 1992;326:281-6
2. CDC Draft Guideline for the Prevention of Surgical Site Infection. Federal Register
1998;63:33167-33192
3. Page CP, Bohnen JM, Fletcher JR, McManus AT, Solomkin JS, Wittmann DH.
Antimicrobial prophylaxis for surgical wounds. Guidelines for clinical care. Arch Surg
1993;128:79-88
4. Forse RA, Karam B, MacLean LD, Christou NV. Antibiotic prophylaxis for surgery in
morbidly obese patients. Surgery 1989;106:750-6; discussion 756-7
Updated 3/99