Aim To evaluate the current practice of intra-operative repeat dosing of antibiotics during prolonged paediatric surgery.

Method The proportion of procedures that lasted longer than four hours were identified from anaesthetic records over a 12 week period. The medical notes, anaesthetic record and medication charts were retrospectively reviewed for a convenience sample of 50 patients. Data were collected on: speciality, the procedure undertaken, antibiotic(s) prescribed, timing of administration in relation to surgery and the timing of additional doses. The data were recorded using Excel and analysed by descriptive statistics.

Results A total of 3202 procedures were undertaken over 12 weeks with 163 (5.1%) lasting longer than 4 hours. The most common specialities were cardiac surgery (71/163, 43.6%), neurosurgery (23/163, 14.1%), hepatic and craniofacial surgery (13/163, 8.0% each).

In the detailed analysis of 50 patients, the pre-operative dose was administered within 60 minutes prior to incision in 45/50 (90%) cases. A repeat intra-operative dose was administered in 3 (6%) procedures. These were cardiac, neurosurgical and orthopaedic procedures. All repeat doses were administered approximately 4 hours after the initial pre-operative dose.

Conclusion The practice of administering an intra-operative repeat dose of prophylactic antibiotics during prolonged surgery was not established practice. National guidance recommends a repeat intra-operative dose in surgery lasting longer than 4 hours or where the duration of surgery exceeds the half-life of the antibiotic administered.1 ,2 The evidence base for surgical prophylaxis in paediatric patients is limited, however, a repeat intra-operative dose should be considered in prolonged surgery.3 Current practice in paediatric surgery should be reviewed in order to consider the routine use of intra-operative doses of antibiotic prophylaxis.