- 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
- Lower UTI – Trimethoprim, cefalexin or nitrofurantoin. (amoxicillin only if lab report indicates sensitivity). 3 days therapy is usually adequate in women.
- 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
- Wound Infection – Flucloxacillin
- Erysipelas – Flucloxacillin
- Cellulitis – Amoxicillin and flucloxacillin (benzylpenicillin and flucloxacillin IV if severe).
- Necrotising Fasciitis – usually benzylpenicillin and clindamycin (both high dose). Discuss with Microbiologist. Early debridement of dead tissue is critical.
- Leg ulcer/pressure sores – avoid antibiotics unless cellulitis or systemic upset.
BONE/JOINT INFECTION
Flucloxacillin (and fucidin/rifampicin if required). Prolonged therapy usually needed. See rheumatology/orthopaedic antibiotic policy.
DIARRHEAL DISEASE
- Campylobacter and Salmonella are self-limiting – antimicrobials are generally not required. Microbiologist may recommend ciprofloxacin for invasive salmonella or typhoid fever.
- 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.
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.