Empirical antibiotic guidelines Flashcards
Name some broad spectrum antimicrobial agents that also have anaerobic activity
Tazocin
Augmentin
Meropenem
What is the first line treatment for Infective exacerbation of COPD or asthma?
Amoxicillin (oral) for 5 days
What is the penicillin allergy alternative for infective exacerbation of COPD/Asthma?
Doxyclycline (oral) for 5 days
CAP-low risk of progression/fit for discharge/admitted for other reasons (CURB-65 of 0 or 1)
Amoxicillin (oral) for 7 days
CAP - moderate severity/high risk fo progression (CURB-65 of 2)
Amoxicillin (oral/IV) for 7 days
Consider addition of doxycline (oral) on post-take ward-round
What is the penicillin alternative for low risk/moderate severity CAP?
Doxycycline (oral) for 7 days
CAP-high severity or systemic sepsis (CURB-65 of >3)
Amoxicillin (IV) and Doxycycline (oral) - give Clarith if oral route not available
Give Gent STAT if g-ve cover required
Review at 48hours - switch to oral Amox/Doxy
What is the penicillin allergy alternative for CAP high severity/systemic sepsis?
Ceftriaxone (IV) and Doxy (oral)
review at 48 hours then 7d then oral switch to doxy
In IgE mediated allergy only give Levofloxacin (IV) then oral switch to doxy
Community acquired aspiration pneumonia?
< 5 days post admission AND no risk factors for MDR
Amoxicillin (IV) tds
and
Metronidazole IV tds
for 3 days
What is the penicillin allergy alternative for community acquired aspiration pneumonia?
Doxy oral od
if oral route unavailable give clarith IV bd
AND
Metronidazole IV tds
for
3 days
Early onset HAP (less than 5 days post admission and no risk factors for MDR)
Treat as CAP
Late onset HAP (>5 days post admission/risk factors)
Hospital stay within previous 4 weeks of +2 days duration
Dialysis
Immunosuppression
Tazocin (IV) tds
Review at 48 hours
Penicllin allergy alternative for late onset HAP?
Levofloxacin (IV)
Review at 48 hours
First line treatment for UTI
Nitrofurantoin qds or Trimethoprim bd (oral)
3 days female
7 days male
Complex UTI/Urosepsis
failiure after 1st line
recent urological surgery
structural abnormalities
oral route unviable
1st lien drugs contraindicated
Gentamicin (IV) for 2 doses then review
If CrCl < 20ml/min use Augmentin IV stat
or Ciprofloxacin IV if pen allergy
Check winpath for ESBL producers in the past-check with micro for advice
Pyelonephritis
Augmentin IV for 7 days
(add Gentamicin if severe sepsis/septic shock)
Penicillin allergy alternative for Pyelonephritis?
Gentamicin IV for 7 days
If CrCl <20ml/min use Cipro IV od
oral switch to cipro bd
7d
Intra-abdominal sepsis
Peritonitis
Cholecystitis (biliary sepsis)
Cholangitis
Diverticulitis
COMMUNITY ACQUIRED
Augmentin IV for 5 days
oral switch to oral Augmentin tds
Intra-abdominal sepsis
Peritonitis
Cholecystitis
Cholangitis
Diverticulitis
HOSPITAL ACQUIRED
Tazocin IV for 5 days
oral switch to Augmenin tds unless cultures indicate resistance
Penicillin allergy for intra-abdominal infections?
Gentamicin IV for 2 doses
Metronidazole IV tds
oral switch to Cipro bd and Met tds 5 days
Digestive disease-
Variceal bleeding
Spontaneous bacterial peritonitis
Tazocin IV for 5 days
oral switch to Cipro bd 5d
Digestive diseases: non-IgE mediated allergy
Ceftazidime IV tds
review after 48 hours and switch to oral ciprofloxacin to complete 5 days if clinically appropriate
Mild cellulitis (no signs of systemic toxicity)
Flucloxacillin (oral) for 7 days qds
Mild cellulitis - penicilling allergy alternative
Clarithromycin oral for 7 days
Moderate/Severe Cellulitis
Sepsis syndrome
complicating co-morbidities
Flucloxacillin IV, switch to oral for OPAT if suitbale for 7-14 days
Moderate/Severe Cellulitis - Penicllin allergy
Teicoplanin IV 12 hourly for 3 doses then od (also for MRSA colonisation) - IgE mediated
non IgE Ceftriaxone oral
Non-IgE: ceftriaxone IV until resolved oral switch clindamycin qds
Diabetic foot
no systemic toxicity
First line: Flucloxacillin oral qds 7d
Pen allergy: Clarith oral bd 7d
Diabetic foot (systemic toxicity/comorbidities)
Teicoplanin IV for 3 doses then od
and Tazocin IV
untill clinically resolved
Diabetic foot (systemic toxicity etc) - penicillin allergy
Teicoplanin for 3 doses then od
and
Metronidazole IV
and
Gentamicin IV for 2 doses then review
Human bites
Augmentin oral for 7 days
Asess risk of BBVs
Animal bites
Augmentin oral tds 7d
Pen allergy: Doxy oral od AND met oral tds 7d
Meningitis - Community acquired
Ceftriaxone IV
If >55y/immunocompromised/alchoholic, add amoxicillin IV for 7-14 days
and
dexamethosone IV for 4 days unless septic shock, immunocompromised or post-neurosurgery
Meningitis - community acquired, penicillin allergy
Chloramphenicol IV qds and reduce after 48hrs
AND
add Co-trimoxazole IV if >55y/immunocompromised/alcoholic
7-14 days
AND
add aciclovir if signs of encephalitis e.g. seizures, alterterd mental staus or focal neurology
Post neurosurgery meningitis/ventriculitis/infected EVD
Meropenem IV tds
AND
Linezolid IV bd
add gent if g-ve cover required
Pen allergy: chloramphenicol IV qds and if required gent intra ventricular od
Neutropenic sepsis
Take blood culture first then
Tazocin IV qds
Add Gentamicin IV if hypotensive
Add Teicoplanin IV for 3 doses then od (if central line infected or MRSA colonised)
Neutropenic sepsis - non IgE mediated
Ceftazidime IV
add Gentamicin IV if hypotensive
add Teicolanin IV for 3 doses (if central line infected/MRSA colonised)
Neutropenic sepsis - IgE mediated
Ciprofloxacin IV
and
Gentamicin IV for 2 doses
Add Teicoplanin IV for 3 doses (if central line infected/MRSA colonised)
Severe sepsis/septic shock
no clear focus
community assocaited
Augmentin IV and Gentamicin IV for a single dose
Severe sepsis/septic shock - Penicllin allergy
community assocaited
Vancomycin IV and Gentamicin IV and Metronidazole IV
Severe sepsis/septic shock - risk factors for MDR
Tazocin IV stat
AND
Gent IV stat
Penicillin allergy: Vanc IV AND Gent IV
Endocarditis
- severe sepsis
- prosthetic valves
- IVDU
- MRSA colonised
Vancomycin IV and Gentamicin IV and Rifampicin oral
Endocarditis
-indolent presentation
Amoxicillin IV 4 hourly and Gentamicin IV bd
Endocarditis
- indolent presentation
- penicillin allergy
Vancomycin IV and Gentamicin IV
Osteomyelitis/septic arthritis
Flucloxacillin IV 4-6 weeks first line
Osteomyelitis/septic arthritis - penicillin allergy/MRSA colonised
Teicoplanin IV for 12 hourly 3 doses then od
Quinsy/tonsillar abscess
BenPen IV and Metronidazole IV for 10 days
(can switch to PenV oral post incision and drainage)
Quinsy/tonsillar abscess - penicillin allergy
Clarithromycin IV and Metronidazole IV for 10 days
Can switch to clarithromycin oral post incision and drainage
Epiglottitis
Ceftriaxone IV for 7 days
Epiglottitis - penicillin allergy
Chloramphenicol IV qds and reduce dose after 48 hrs for 7 days
Surgical site infection
-localised signs
First line: Flucloxacillin oral qds 5days
Surgical site infection
localised signs
penicillin allergy
Clarithromycin 500 mg oral 5days
Surgical site infection - deep incisional - pus, abscess, fever and tenderness
first line
Flucloxacillin IV qds
OR
Augmentin (Co-Amoxiclav) IV tds if gastrointesinal/gynaecogical/urological
5 days and review
Oral switch to Flucloxacillin oral qds/Augmentin oral qds
