34 NNUH Antibiotic policy Flashcards
When prescribing antibiotics, what are key things to be aware of with the patient?
How unwell - IV or oral
Micro results/ previous antibiotics
Allergies
Renal/ hepatic function
Age
Pregnancy/ breastfeeding
Immunocompormised
Risk of C.diff
What clinical history would point towards true penicillin allergy?
Patients with a history of anaphylaxis or urticaria occurring immediately after penicillin therapy are at increased risk of immediate hypersensitivity to penicillins and should not receive treatment with a beta- lactam antibiotic (this includes cephalosporins) or carbapenem, unless they have previously received a beta-lactam and had no adverse effects.
Patients with a history of rash occurring more than 72 hours after administration of penicillins are probably not allergic to penicillins, (SIGN, 2000) and many patients with a history of rash after penicillins will have received cephalosporins with no ill effect.
For patients who do NOT report an anaphylactic or urticarial response to penicillins, a cephalosporin or carbapenem (e.g. meropenem) may be administered with caution.
Which antibiotics are contra-indicated in penicillin allergy?
Anaphylaxis
Amoxicillin Benzylpenicillin Co-amoxiclav Flucloxacillin Penicillin V Tazocin
Which antibiotics can be used in caution with penicillin allergy?
e.g rash after 72 hours
Cephalosporins -
- cefotaxime
- ceftriaxone
- ceftazidime
- cefuroxime
- cefalexin
Beta-lactam
- aztreonam
- ertapenem
- meropenem
What is treatment duration approximately for these conditions?
CAP – mild-moderate
CAP – severe
HAP
Aspiration pneumonia
IECOPD
bronchiectasis
Empyema
CAP – mild-moderate 5-7 days
CAP – severe 7 days
HAP 5-7 days
Aspiration pneumonia 5-7 days
IECOPD 5 days
Bronchiectasis 14 days
empyema usually >14 days, depends on clinical response
What is treatment duration approximately for these conditions?
C.diff
Biliary tract/pancreatitis
Abdominal infection
C.diff 10-14 days
Biliary tract/pancreatitis 5-14 days
Abdominal infection 5-7 days
What is treatment duration approximately for these conditions?
Female uncomplicated UTI
Male UTI/female complicated UTI
Severe UTI (e.g. with sepsis)
Pyelonephritis
Prostatitis
Epididymo-orchitis
Female uncomplicated UTI 3 days
Male UTI/female complicated UTI 7 days
Severe UTI (e.g. with sepsis) 7 days
Pyelonephritis Minimum 7 days
Prostatitis 28 days
Epididymo-orchitis 10-14 days
What is treatment duration approximately for these conditions?
Cellulitis (non-severe)
Cellulitis – severe
Leg ulcer infection
Necrotising fasciitis
Animal bite
Cellulitis (non-severe) 7 days
Cellulitis – severe 7-10 days
Leg ulcer infection - 7 days
Necrotising fasciitis - 14 days
Animal bite - 5-7 days
