Table 2.

Surgical antimicrobial prophylaxis for patients of neonatal and pediatric age undergoing orthopedic and hand surgery.

Clinical Scenario	Recommendation
Bloodless fracture reduction	Peri-operative antibiotic prophylaxis is not recommended in pediatric patients undergoing bloodless fracture reduction.
Reduction of unexposed fracture and grade I and II exposed fracture	In the pediatric patient undergoing emergency surgery for reduction of an unexposed fracture with an open approach and emergency surgery for reduction of grade I and II exposed fracture, peri-operative antibiotic prophylaxis with cefazolin with a single dose of 30 mg/Kg (maximum dose 2 g) EV is recommended within 30 min before surgery and repeatable in case of surgery lasting more than 4 h.
Reduction of grade III exposed fracture or traumatic amputation	In the pediatric patient undergoing emergency surgery for reduction of an exposed grade III fracture or traumatic amputation, peri-operative prophylaxis with cefazolin at a dose of 30 mg/Kg (maximum dose 2 g) IV is recommended within 30 min before surgery, repeatable in case of surgery lasting more than 4 h, except in cases where broad-spectrum antibiotic therapy is already in progress.
Non-traumatic amputation	In the pediatric patient undergoing elective amputation surgery, peri-operative prophylaxis with cefazolin at a dose of 30 mg/Kg (maximum dose 2 g) IV is recommended to be administered within 30 min before surgery, repeatable if the surgery lasts longer than 4 h. In case of intractable limb infection, the latter prophylaxis should be added to the antibiotic treatment already in place.
Emergency intact skin trauma surgery and elective surgery without synthetic media placement	No antibiotic prophylaxis is recommended in neonatal and pediatric patients undergoing emergency intact skin soft tissue trauma surgery and elective orthopedic surgery without placement of synthetic media.
Elective orthopedic surgery with prosthetic and/or synthetic media placement and spinal surgery	In neonatal and pediatric patients undergoing elective orthopedic surgery with prosthesis placement, orthopedic surgery with synthesis device placement, and elective orthopedic spine surgery with synthesis device placement, peri-operative antibiotic prophylaxis with cefazolin at a dose of 30 mg/Kg (maximum dose 2 g) IV is recommended within 30 min before surgery, repeatable in case of surgery lasting more than 4 h.
Clean elective hand surgeries with and without bone involvement, without synthetic means	No antibiotic prophylaxis is recommended in neonatal and pediatric patients undergoing elective clean soft-tissue hand surgery in the absence of bone involvement and elective hand surgery with bone involvement without the use of synthetic means.
Surgery of the hand on an elective basis with bone involvement and/or with the use of synthetic means.	In pediatric patients undergoing elective hand surgery with bone involvement using synthetic means and clean elective hand surgery lasting more than 4 h, peri-operative antibiotic prophylaxis with cefazolin at a dose of 30 mg/Kg (maximum dose 2 g) IV is recommended within 30 min before surgery, repeatable in case of surgery lasting more than 4 h, and to be administered every 8 h for 24 h.