Page 26 - HPP ANTIMICROBIAL GUIDELINE 2018
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Suggested Treatment
                           Infection/ Condition                                                                                       Comments
                                                                     Preferred                        Alternative

                 ORTHOPAEDIC SURGERY


                 Internal fixation of all closed fracture   Amoxicillin/clavulanate 1.2gm IV   Cefuroxime 1.5gm IV          Recommend to screen nasal
                 Total Joint Replacement                                                                                    MRSA carrier status
                 Arthroscopy
                                                                                                                            Intranasal mupirocin if MRSA
                                                                                                                            colonizer for 5 days


                 Spine surgery
                 Simple (laminectomy and discectomy )     Cefazolin 2gm IV                 Amoxicillin/clavulanate 1.2gm IV   Known MRSA colonization: add
                                                                                                                            IV Vancomycin  15 mg/Kg once
                 Complicated procedure :
                 Placement of prosthetic material


                 Gun shot and other penetrating wounds    Amoxicillin/clavulanate 1.2gm IV   Cefuroxime 1.5gm IV            Thorough surgical debridement

                                                                                           PLUS                             If gross contamination is seen, or
                                                                                           Metronidazole 500mg IV           fracture with major soft tissue
                                                                                                                            injury, 5 days duration is
                                                                                                                            recommended


                    References:
                    1.  Del Pozo JL.  NEJM.2009 361(8): 787
                    2.  IDSA guidelines, Clinical Infectious Diseases ; 2012 ; 54 : 132 -173 2012
                    3.  Michealis et al.. EFORT Open Rev 2016;1:128
                    4.  Nayagam S. et al.  British Orthopaedic Association Standards for Trauma .2009








               HPP AMG                                                       Chemoprophylaxis                                                             8
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