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Antibiotics - surgical wound prophylaxis in neonates

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Drug Choice

The preferred antibiotic for wound prophylaxis for abdominal surgical procedures is Cefazolin / Cephazolin , a first generation cephalosporin with a short half life. It has a narrow range of activity and provides excellent cover against the pathogens most likely to cause surgical site infections in neonates:

  • Third generation cephalosporins should not be used due to cost and concern that extensive use may promote resistance. 
  • Amoxycillin/clavulanate is also not recommended because of the prevalence of amoxicillin/clavulanate resistance in E. coli. 

Timing

For perioperative prophylaxis a dose should be given 30 minutes to 1 hour prior to the start of surgery (data sheet). For lengthy operative procedures (e.g. 2 hours or longer) a further dose may be given during the surgery (data sheet). This guideline applies to all Nurses who care for babies with surgical anomalies in Newborn Services.

Dose

30 mg/kg Cefazolin / Cephazolin as a single dose. See NZFC for more information

Excretion

Cefazolin / Cephazolin is excreted unchanged in the urine primarily by glomerular filtration and, to a lesser degree, by tubular secretion.

References

  1. Cefazolin: Neofax online accessed 2-11-12

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Document Control

  • Date last published: 12 October 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years