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Guidelines for General Surgery Prophylaxis Upper Gastrointestinal/Biliary Surgery in patients at risk of endocarditis

Endocarditis and Surgical Prophylaxis Regimen:

Amoxicillin 1g IV plus Gentamicin 2mg/kg IV a single dose of each given on induction

If patient is allergic to penicillins:

Teicoplanin 400mg IV plus Gentamicin 2mg/kg IV a single dose of each given on induction

Notes

For best efficacy antibiotics should be given between 1 and 30 minutes before incision, for practicality, doses are usually given at induction,
If operation lasts more than 4 hours or patient has blood loss >1500ml additional intra-operative doses may need to be given.
Post-operative prophylactic antibiotics do not further reduce infection risk will further disturb normal microbiological flora and increase the risk of C.Diff: Only use post-operative antibiotics if specifically advised in the guideline or the patient requires treatment of infection (e.g. peritonitis post- perforated appendicitis).

The full guideline "Surgical Antibiotic Prophylaxis Guidelines Within General and Vascular Surgery for Adult Patients" is available here

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.