Timing of surgical antibiotic prophylaxis

Large trials show that appropriately timed antibiotic prophylaxis is crucial.

Surgical antibiotic prophylaxis must be administered before surgical incision to achieve effective plasma and tissue concentrations at the time of incision. For short-acting antibiotics, such as cefazolin, the dose should be administered no more than 60 minutes before surgical incision. For antibiotics that are not short acting, the dose should be administered no more than 120 minutes before surgical incision.

Vancomycin requires a slow infusion, at a rate not exceeding 10 mg/minute. Shorter infusion times can be used if tolerated, but should not be less than 60 minutes for a 1 g dose, 90 minutes for a 1.5 g dose or 120 minutes for a 2 g dose. Start the vancomycin infusion within the 120 minutes before surgical incision. It is the consensus view of the Antibiotic Expert Groups that the infusion should be started at least 15 minutes before incision to ensure adequate blood and tissue concentrations at the time of incision and allow potential infusion-related toxicity to be recognised before induction of anaesthesia. The infusion can be completed after surgical incision.