Hernia repair
Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis) and the general principles of surgical antibiotic prophylaxis for abdominal surgery. See Hernia repairs and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for hernia repairs.
For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.
|
Procedures |
Is surgical antibiotic prophylaxis indicated? |
|---|---|
|
hernia repair with or without prosthetic material (mesh) |
YES [NB1] |
Note:
NB1: Although surgical antibiotic prophylaxis may not be needed for repairs without prosthetic material, prophylaxis is recommended for all procedures because it may not be possible to determine preoperatively whether prosthetic material will be used. | |
The choice of prophylaxis depends on whether entry into the bowel lumen is expected and whether the patient is at increased risk of methicillin-resistant Staphylococcus aureus (MRSA) infection (see Risk factors for infection with methicillin-resistant Staphylococcus aureus).
For prophylaxis for hernia repairs in which entry into the bowel lumen is not expected, use:
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, hernia repair cefazolin
For hernia repairs in which entry into the bowel lumen is expected, the prophylactic regimen includes metronidazole for activity against anaerobes; use:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed surgical prophylaxis, hernia repair metronidazole
PLUS
cefazolin 2 g (child: 30 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. cefazolin
As an alternative when entry into the bowel lumen is expected, cefoxitin may be used as a single drug; however, its activity against anaerobes is inferior to the regimen above. It also requires frequent redosing (every 2 hours). Use:
cefoxitin 2 g (child: 40 mg/kg up to 2 g) intravenously, within the 60 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, hernia repair cefoxitin
For patients colonised or infected with MRSA, or at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), add vancomycin to the above regimens:
vancomycin (adult and child) 15 mg/kg up to 2 g intravenously, started within the 120 minutes before surgical incision (recommended rate 10 mg/minute)1; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, hernia repair vancomycin
For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, the above regimens are suitable. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.
For patients with immediate severe or delayed severe hypersensitivity to penicillins undergoing hernia repair in which entry into the bowel lumen is not expected, use vancomycin as monotherapy (see dosage above).
For patients with immediate severe or delayed severe hypersensitivity to penicillins undergoing hernia repair in which entry into the bowel lumen is expected, use:
metronidazole 500 mg (child: 12.5 mg/kg up to 500 mg) intravenously, within the 120 minutes before surgical incision; intraoperative redosing may be required (see here ). Do not give additional doses once the procedure is completed metronidazole
PLUS
gentamicin (adult and child) 2 mg/kg up to 180 mg intravenously over 3 to 5 minutes, within the 120 minutes before surgical incision23; intraoperative redosing is unlikely to be required (see here ). Do not give additional doses once the procedure is completed. surgical prophylaxis, hernia repair gentamicin
Vancomycin (see dosage above) should be added to metronidazole and gentamicin if the patient is colonised or infected with MRSA, or at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus).