Wounds requiring surgical management

For patients with wounds requiring surgical management, intravenous therapy is required. Use:

cefazolin 2 g (child: 50 mg/kg up to 2 g) intravenously, 8-hourly. For dosage adjustment in adults with kidney impairment, see cefazolin dosage adjustment. cefazolin cefazolin cefazolin

Additional anaerobic activity is recommended for heavily contaminated severe injuries, such as agricultural injuries; add metronidazole to cefazolin:

metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, 12-hourly. metronidazole metronidazole metronidazole

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, the above regimens are suitable.

For patients who have had a severe immediate¹ hypersensitivity reaction to a penicillin, the cefazolin containing regimens above can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For patients who have had a severe immediate¹ hypersensitivity reaction to a penicillin in whom cefazolin is not used, or for patients who have had a severe delayed² hypersensitivity reaction to a penicillin, use:

clindamycin 600 mg (child: 15 mg/kg up to 600 mg) intravenously, 8-hourly³. clindamycin clindamycin clindamycin

The regimens in this section provide an adequate spectrum for surgical antibiotic prophylaxis; however, adjust the timing of the dose to optimise plasma and tissue concentrations at the time of surgical incision, and for the duration of the procedure—for more information, see Timing of surgical antibiotic prophylaxis.

Duration of therapy: prophylaxis for nonsevere injuries can be discontinued at definitive wound closure. Do not continue prophylaxis for severe injuries for more than 24 hours after definitive wound closure. Regardless of injury severity, the total duration of prophylaxis should be no more than 72 hours, even if soft tissue coverage is not achievable.

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

² Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return

³ There are more clinical and microbiological data to support the use of clindamycin than lincomycin. Intravenous lincomycin can be used at the same dosage if clindamycin is unavailable or if a local protocol recommends its use.Return