Open sternum, skin Cefazolin Vancomycin (preferred)* Cefazolin open in OR or sternum 30 mg/kg/dose IV (max: 2 g) 15 mg/kg (max: 1 g) Age days: 30 mg/kg/dose IV q12h x 72h ≤7 opened in CCU induction and every 8 hours of IV q12h initially** x 72h Age >7 days: 30 mg/kg/dose IV q8h x 72h anesthesia OR + Cefazolin + Cefazolin Clindamycin 30 mg/250 mL pump priming solution 30 mg/250 mL pump priming 15 mg/kg IV (max: 600 mg) at + Tobramycin solution induction of anesthesia then q8h x 3 mg/kg/dose IV q24h initially** x 72h THEN 72h OR (if beta-lactam allergy) + Cefazolin Gentamicin Vancomycin (preferred)* 30 mg/kg IV (max: 2 g) post-op 2.5 mg/kg/dose (max: 120 mg) IV 15 mg/kg IV q24h initially** x 72h q8h x 72h, starting 8 hours after q12h initially** x 72h OR previous dose *25% S. aureus are resistant to Clindamycin + Gentamicin clindamycin 7.5 mg/kg IV at induction of anesthesia then 2.5 mg/kg/dose (max: 120 mg) IV **adjust dose according to TDM q8h x 72h q12h initially** x 72h + Tobramycin **adjust dose according to TDM 3 mg/kg/dose IV q24h initially** x 72h *25% S. aureus are resistant to clindamycin **adjust dose according to TDM Thoracic (noncardiac) Cefazolin Clindamycin Cefazolin 30 mg/kg IV (max: 2 g) at 15 mg/kg IV (max: 600 mg) at 30 mg/kg IV at induction of anesthesia induction of anesthesia induction of anesthesia OR (if beta-lactam allergy) Clindamycin 7.5 mg/kg IV at induction of anesthesia
Open sternum, skin open in OR or sternum opened in CCU Cefazolin 30 mg/kg/dose IV (max: 2 g) induction and every 8 hours of anesthesia + Cefazolin 30 mg/250 mL pump priming solution THEN Cefazolin 30 mg/kg IV (max: 2 g) post-op q8h x 72h, starting 8 hours after previous dose + Gentamicin 2.5 mg/kg/dose (max: 120 mg) IV q12h initially** x 72h **adjust dose according to TDM Vancomycin (preferred)* 15 mg/kg (max: 1 g) IV q12h initially** x 72h OR Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia then q8h x 72h + Gentamicin 2.5 mg/kg/dose (max: 120 mg) IV q12h initially** x 72h *25% S. aureus are resistant to clindamycin **adjust dose according to TDM Cefazolin Age ≤7 days: 30 mg/kg/dose IV q12h x 72h Age >7 days: 30 mg/kg/dose IV q8h x 72h + Cefazolin 30 mg/250 mL pump priming solution + Tobramycin 3 mg/kg/dose IV q24h initially** x 72h OR (if beta-lactam allergy) Vancomycin (preferred)* 15 mg/kg IV q24h initially** x 72h OR Clindamycin 7.5 mg/kg IV at induction of anesthesia then q8h x 72h + Tobramycin 3 mg/kg/dose IV q24h initially** x 72h *25% S. aureus are resistant to clindamycin **adjust dose according to TDM Thoracic (noncardiac) Cefazolin 30 mg/kg IV (max: 2 g) at induction of anesthesia Clindamycin 15 mg/kg IV (max: 600 mg) at induction of anesthesia Cefazolin 30 mg/kg IV at induction of anesthesia OR (if beta-lactam allergy) Clindamycin 7.5 mg/kg IV at induction of anesthesia
SLA_2014_08_19_SO_1400863_SDC1.docx