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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
