General Surgery

Colorectal/ appendicectomy

• Likely pathogens: Anaerobic bacteria, streptococci, aerobic Gram-negative bacilli, Enterococcus faecalis

cefazolin HMLSchedNZFPMLnoids Cefazolin F: n/a Half life: 2 hours Elimination: renal fe: 0.9

IV 2 g (IV 3 g in patients ≥ 120 kg body weight)

AND

metronidazole HMLSchedNZFPMLnoids Metronidazole F: 1 Half life: 8 hours Elimination: oxidation, glucuronidation fe: 0.1

IV 500 mg

Severe penicillin allergy

gentamicin HMLSchedNZFPMLnoids Gentamicin F: n/a Half life: 3 hours Elimination: renal fe: 0.9 Additional points: TDM.

IV 5 mg/kg ideal body weight

AND

Upper GI and Biliary Tract

• Likely pathogens: As above. Anaerobic organisms if biliary obstruction is present.

Severe penicillin allergy

• If biliary obstruction present, add metronidazole IV 500 mg to cefazolin or gentamicin (as above).

Pancreatoduodenectomy

• Likely pathogens: aerobic Gram-negative bacilli, enterococci. Anaerobic organisms if biliary obstruction is present.

piperacillin+tazobactam HMLNZFPMLnoids Piperacillin+Tazobactam F: n/a Half life: 1 hour Elimination: renal fe: 0.8/0.6

IV 4.5 g

Mild penicillin allergy

cefuroxime HMLSchedNZFPMLnoids Cefuroxime F: 0.4 Half life: 2 hours Elimination: renal fe: 0.9

IV 1.5 g

AND

Topic Code: 99272

must be prescribed or recommended by a consultant.