Early postoperative infection
In patients with early postoperative arthroplasty device infection, broad-spectrum empirical therapy is required to treat the likely organisms (see Classification and aetiology of arthroplasty device infections). The choice of cefepime, ciprofloxacin or gentamicin (or for patients with immediate severe or delayed severe hypersensitivity to penicillins, the choice of ciprofloxacin or gentamicin) for empirical treatment of Gram-negative organisms should be determined by local epidemiology (if known), local antimicrobial stewardship policy and drug availability.
Modify therapy based on culture and susceptibility results from intraoperative sampling (see Directed antibiotic therapy for arthroplasty device infections). If the results of culture or susceptibility testing are not available by 72 hours or if the culture results are negative, seek expert advice on rationalising therapy.
For empirical therapy in patients with early postoperative arthroplasty device infection, after intraoperative samples have been taken and while awaiting infectious diseases or clinical microbiology advice, use:
vancomycin intravenously; see Intermittent vancomycin dosing in noncritically ill adults for initial dosingvancomycin vancomycin vancomycin
PLUS one of the following
1cefepime 2 g intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefepime dosage adjustment cefepime cefepime cefepime
OR
1ciprofloxacin 750 mg orally, 12-hourly1. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment ciprofloxacin ciprofloxacin ciprofloxacin
OR
1gentamicin intravenously; see Gentamicin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing. gentamicin gentamicin gentamicin
For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, after intraoperative samples have been taken and while awaiting infectious diseases or clinical microbiology advice, use vancomycin plus cefepime, ciprofloxacin or gentamicin (see dosages above).
For empirical therapy in patients who have had a severe (immediate or delayed) hypersensitivity reaction to a penicillin, after intraoperative samples have been taken and while awaiting infectious diseases or clinical microbiology advice, use:
vancomycin intravenously; see Intermittent vancomycin dosing in noncritically ill adults for initial dosing vancomycin vancomycin vancomycin
PLUS EITHER
1ciprofloxacin 750 mg orally, 12-hourly1. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment ciprofloxacin ciprofloxacin ciprofloxacin
OR
1gentamicin intravenously; see Gentamicin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing.gentamicingentamicin gentamicin