Surgical prophylaxis for spinal surgery

Consider the principles for appropriate prescribing of surgical antibiotic prophylaxis (see Principles for appropriate prescribing of surgical antibiotic prophylaxis). See Spinal surgery procedures and their requirement for surgical antibiotic prophylaxis for the recommendations for surgical prophylaxis for spinal surgery.

For a printable summary table of the indications and regimens for surgical antibiotic prophylaxis, see here.

Table 1. Spinal surgery procedures and their requirement for surgical antibiotic prophylaxis
Procedure	Is surgical antibiotic prophylaxis required?
spinal surgery	YES

For prophylaxis for spinal surgery, 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, spinal cefazolin

For patients colonised or infected with methicillin-resistant Staphylococcus aureus (MRSA), or at increased risk of being colonised or infected with MRSA (see Risk factors for infection with methicillin-resistant Staphylococcus aureus), add to cefazolin:

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, spinal vancomycin

For patients with immediate nonsevere or delayed nonsevere hypersensitivity to penicillins, use cefazolin, with or without vancomycin, as above. See also Surgical antibiotic prophylaxis for patients with a penicillin or cephalosporin allergy.

For patients with immediate severe or delayed severe hypersensitivity to penicillins, use vancomycin as monotherapy (see dosage above).

Small cohort studies suggest that topical vancomycin applied to the incision reduces infection rates in neurosurgical spinal procedures. However, high-quality data on the safety and efficacy of this practice are lacking, so it is not recommended.

¹ It is the consensus view of the Antibiotic Expert Groups that the vancomycin infusion should be started at least 15 minutes before surgical 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.Return