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CTC - thoracic surgery

Content version
U-142.2
Updated
10/20/2025 - 15:01

Recommendations

≥ 18 years

Indications: Cardiac surgery
Dosage Remarks
cefazolin iv 2 g single dose

CABG, valves, aortic prosthesis, TAVI

For advice regarding timing and any repeat dosing, see remarks*
≥ 18 years

Indications: Cardiac devices
Dosage Remarks
cefazolin iv 2 g single dose

pacemaker, ICD implantation

 

For advice regarding timing and any repeat dosing, see remarks*

 
≥ 18 years

Indications: Lung surgery
Dosage Remarks
cefuroxime iv 1500 mg single dose

thoracotomy, VATS

 

Extended prophylaxis for:

- Sleeve lobectomy: 5 days amoxicillin/clavulanic acid 500/125 mg three times daily.

- On placement of foreign material: 5 days amoxicillin/clavulanic acid 500/125 mg three times daily.

- Tracheal resection: 5 days amoxicillin/clavulanic acid 500/125 mg three times daily.

 

For advice regarding timing and any repeat dosing, see remarks**
≥ 18 years

Indications: Allergy
Dosage Remarks
vancomycin iv 1 g single dose

of

clindamycin iv 600 mg single dose

This advice applies in case of a strong suspicion of, or proven, cefazolin allergy, or a previous severe 'delayed-type' allergy to a β-lactam antibiotic.

Comments

* Cardiac surgery/cardiac devices:

 

Pre-operative: Cefazolin 2 g iv pre-operatively <60 min before incision

 

Intra-operative: Cefazolin should be repeated if:

  • Surgery lasts longer than 4 hours after the pre-operative dose of cefazolin, and/or
  • >1500 ml blood loss during surgery

Subsequent intra-operative dosing:

  • If remaining operative time <3 hours, then cefazolin 1 g
  • If remaining operative time >3 hours, then cefazolin 2 g

 

Post-operative: Cefazolin iv up to a maximum of 24 hours post-operatively:

  • 8 hours after the last pre-/intra-operative dose: cefazolin 1 g iv
  • 16 hours after the last pre-/intra-operative dose: cefazolin 1 g iv

Cardiac operations and pacemaker/ICD implantation: in known S. aureus carriers it is recommended to pre-treat with mupirocin nasal ointment.

 

 

** Lung surgery:

 

Pre-operative:  Cefuroxime 1500 mg iv pre-operatively <60 min before incision

 

Intra-operative: Cefuroxime 1500 mg iv should be repeated if:

  • Surgery lasts longer than 3 hours after the pre-operative dose of cefuroxime, and/or
  • >1500 ml blood loss during surgery

 

This advice is based on the SWAB guideline for peri-operative prophylaxis (revised version 2019) 89 (swab.nl)