From: Logan Whitfield
To: Pharmacy Department
Sent: Friday, January 4, 2019 8:38:54 AM
Subject: Cefazolin and post-op surgery orders

Good Morning Pharmacy Department,

Below is the email that you received when cefazolin once again was available. I needed to make a clarification regarding the exceptions for discontinuation of post-operative antibiotics. Note subsection b. of #3 below:

ANCEF (Cefazolin) is once again available. However, continued supply will remain uncertain for the coming months.  As of this morning, all pre-op/pre-procedural areas should have their Pyxis stations restocked.

1. Patients can once again receive cefazolin as the preferred pre-op prophylaxis in those without beta –lactam allergies.
2. For any active infections cefazolin can again be ordered for treatment.

The following changes not related to the supply of cefazolin will REMAIN in effect based on the consensus of the Medical Executive Committee and Pharmacy and Therapeutics Committee:

3. For all clean/clean-contaminated procedures where cefazolin, clindamycin, or vancomycin are listed on current pre/post-op orders, all post-op antibiotic orders will automatically be discontinued due to no supportive literature/guidelines. Exceptions where no automatic change will be made include:
4. Post-op orders with 'until drain removed' in neurosurgery patients
5. For CV surgery post-op orders ≤ 48 hours
6. Joint replacement post-op orders ≤ 24 hours
7. Colorectal surgery post-op orders
8. Post-op orders for Implantation of spinal cord stimulator, generator, and lead wires ≤ 24 hours
9. Post-op orders for breast implantation 4. The surgery department will not utilize vancomycin or cefazolin in irrigation solutions.
10. Pre-op antibiotic orders for cefazolin, vancomycin, or clindamycin will be automatically discontinued for percutaneous procedures involving venous puncture (e.g., tunneled lines, drain placements, etc.).
11. If intra-op wound infection or spillage of bile/bowel contents is discovered, then antibiotics need to be customized by the practitioner.

Subsection b. should read "cardiovascular or thoracic surgery post-op orders ≤ 48 hours" to encompass other procedures (e.g. thoracotomy). I have been told that the surgery department will be meeting to discuss these procedures and to determine which do and do not require post-operative antibiotics. I will update everyone as I am able.

Thank You,

Philip Logan Whitfield, PharmD
PGY2 Infectious Disease Pharmacy Resident Huntsville Hospital