Perform MRSA screening prior to all planned surgery. High risk if: previous/ current MRSA carriage, hospitalisation or antibiotic therapy in previous 4 weeks, poorly controlled diabetes, tissue loss or recent foot sepsis.
Procedure | Recommended Antibiotics and Comments |
Above knee amputation |
Flucloxacillin IV 2g + Metronidazole IV 500mg + Gentamicin IV as per Gentamicin prophylactic dosing table. Continue metronidazole oral 400mg every 8 hours for up to 5 days post op. If penicillin allergy or high MRSA risk: Teicoplanin IV 400mg + Metronidazole IV 500mg + Gentamicin IV as per Gentamicin prophylactic dosing table. Continue metronidazole oral 400mg every 8 hours for up to 5 days post op. |
Below knee amputation |
Flucloxacillin IV 2g + Metronidazole IV 500mg If penicillin allergy or high MRSA risk: Teicoplanin IV 400mg + Metronidazole IV 500mg |
Arterial reconstruction / graft / prosthetic |
Flucloxacillin IV 2g + Gentamicin IV as per Gentamicin prophylactic dosing table. If penicillin allergy or high MRSA risk: Teicoplanin IV 400mg + Gentamicin IV as per Gentamicin prophylactic dosing table. |
Guideline reviewed | March 2024 |
Page updated | September 2024 |