1 Star2 Stars3 Stars4 Stars5 Stars (No Ratings Yet)
Loading...

Guide to antimicrobial use in adults

  • All IV antibiotics should be reviewed at 48 hours, with a view to switching to oral
  • All antibiotic courses should be reviewed at 5 days, with a view to stopping

URINARY TRACT INFECTION

  1. Lower UTI – Trimethoprim, cefalexin or nitrofurantoin. (amoxicillin only if lab report indicates sensitivity). 3 days therapy is usually adequate in women.
  2. Acute Pyelonephritis – Cefuroxime IV.

RESPIRATORY TRACT INFECTION

MENINGITIS

An initial dose of antibiotic should be given immediately if meningitis / meningcoccaemia is suspected.

Cefotaxime 2-3 g qds

Length of course:

  • Meningococcal – 5-7 days
  • Haemophilus – 10 days
  • Pneumococcal – 10 -14 days

Notify Consultant in Communicable Disease Control (CCDC) as soon as diagnosis is suspected, who will organise contact-tracing if necessary.

ENDOCARDITIS

Blind therapy: – Benzylpenicillin 1.2g 4-hourly and gentamicin 80mg bd. Modify, depending upon culture results. Monitor gentamicin * levels at least twice per week.

NEUTROPENIC PATIENTS

First-line therapy: Tazocin and Gentamicin* (once daily 5-7 mg/kg).

SKIN INFECTION

  1. Wound Infection – Flucloxacillin
  2. Erysipelas – Flucloxacillin
  3. Cellulitis – Amoxicillin and flucloxacillin (benzylpenicillin and flucloxacillin IV if severe).
  4. Necrotising Fasciitis – usually benzylpenicillin and clindamycin (both high dose). Discuss with Microbiologist. Early debridement of dead tissue is critical.
  5. Leg ulcer/pressure sores – avoid antibiotics unless cellulitis or systemic upset.
Guide to antimicrobial use in adults

BONE/JOINT INFECTION

Flucloxacillin (and fucidin/rifampicin if required). Prolonged therapy usually needed. See rheumatology/orthopaedic antibiotic policy.

DIARRHEAL DISEASE

  1. Campylobacter and Salmonella are self-limiting – antimicrobials are generally not required. Microbiologist may recommend ciprofloxacin for invasive salmonella or typhoid fever.
  2. Pseudomembranous Colitis (C.difficile) Antibiotics are not required unless there is severe or worsening infection. Stop all antimicrobials if possible. Metronidazole 10-14 days if necessary. If unresponsive or relapse, discuss with Microbiologist.

ENT INFECTION

Streptococcal Pharyngitis – Penicillin V 10 days.

Guide to antimicrobial use in adults

ANTIMICROBIAL SERUM MONITORING

Patients on gentamicin* require careful monitoring – liaise closely with Microbiologist. Monitoring of teicoplanin levels may be advised by Microbiologist, e.g. if deep or unresponsive infection. (See “Teicoplanin – Use and Monitoring”).

NON-FORMULARY ANTIBIOTICS

The following antibiotics may be prescribed only with the approval of a Microbiologist, unless a formal directorate agreement or guideline exists: Ciprofloxacin Ceftazidime Cefotaxime (except meningitis) Co-amoxiclav Meropenem Tazocin Teicoplanin Vancomycin *See gentamicin prescribing andmonitoring pathway (on dedicated drugprescription sheets) on wards for guidance.

Leave a Reply
  Subscribe  
Notify of