Table 1.

Surgical antibiotic institutional prophylaxis protocol for orthopaedic surgery

Protocol features	Recommendation
Antibiotic prescription choice	Cefazolin is the drug of choice due to its broad coverage of microorganisms and its relatively low cost. Vancomycin should be prescribed as an alternative in patients with β-lactam allergy and added to cefazolin in patients with prior isolates of methicillin-resistant strains of S aureus (MRSA).
Pre-surgical administration: dose and timing	A single dose of 2 g cefazolin should be administered in the operating room 15–60 min before surgical incision (alternatively or additionally, 1 g vancomycin should be administered 60 min before incision, starting the administration 120 min before incision in the orthopaedic ward)
Intraoperative redosing	If surgery exceeded 4 hours or blood loss >1 L, a new cefazolin dose should be administered
Antibiotic duration	Postoperative antibiotic administration should not exceed 24 hours following surgery (a total of three doses of cefazolin every 8 hours and two doses of vancomycin every 12 hours)
Postoperative dosage adequate for patient weight and renal function	Doses should be adjusted to renal function (if the glomerular filtration rate is <50 mL/min) and patient body weight (cefazolin 1 g if <70 kg and 2 g if >70 kg, vancomycin 1 g if <95 kg and 1.5 g if >95 kg, respectively)