Hospital Adult Empirical Treatment of Infection Guidelines Flashcards
Meningitis
Ceftriaxone IV 2g bd + Dexamethasone IV 10mg qds (started with or just before first dose of antibiotics for 4 days)
Duration: refer to guidance
Aciclovir IV (10mg/kg tds) if encephalitis suspected (oral treatment never appropriate)
Add Amoxicillin IV 2g 4 hourly if ≥ 60 years or immunocompromised
Epiglottitis/supraglottitis
Ceftriaxone IV 2g od
CAP
> 0-2 Mild/Mod Amoxicillin 1g tds IV/PO (5 days)
(If penicillin allergic: Doxycycline PO 200mg on day 1 then 100mg od or IV Clarithromycin* if NBM)
> 3-5 Severe Co-amoxiclav IV 1.2g tds + Doxycycline PO 100mg bd
(If penicillin allergic: IV Levofloxacin 500mg bd monotherapy)
> ICU/HDU or NBM Co-amoxiclav IV 1.2g tds + Clarithromycin* IV 500mg bd (If penicillin allergic: IV Levofloxacin 500mg bd monotherapy)
> Step down to Doxycycline 100mg bd for ALL patients with severe CAP TOTAL IV/PO 5 days
HAP
> Non severe: PO Amoxicillin
(If penicillin allergic: Doxycycline 100mg bd)
TOTAL 5 days
> Severe: IV Amoxicillin + Gentamicin
(If penicillin allergic:IV Co-trimoxazole + Gentamicin)
Step down: PO Co-trimoxazole
TOTAL IV/PO 7 days
Previous ICU admission or history of MRSA: seek advice
Aspiration pneumonia
> Non severe PO Amoxicillin + Metronidazole
(If penicillin allergic: PO Doxycycline 100mg bd + Metronidazole)
TOTAL 5 days
> Severe IV Amoxicillin + Metronidazole + Gentamicin
(If penicillin allergic: replace amoxicillin with PO Doxycycline or IV Clarithromycin*)
Step down: PO Amoxicillin + Metronidazole
(If penicillin allergic: Doxycycline 100mg bd + Metronidazole)
TOTAL IV/PO 7 days
Acute exacerbation of COPD
Give antibiotics if increased sputum purulence. If no increased sputum purulence then no antibiotics unless consolidation on CXR or signs of pneumonia.
1ST LINE Amoxicillin 500mg tds
2ND LINE Doxycycline 200mg on day 1 then 100mg od (5days)
Acute cough/Acute bronchitis
Antibiotics give no significant benefit in clinical improvement but may be considered in the frail elderly.
1ST LINE Amoxicillin 500mg tds
2 ND LINE Doxycycline 200mg on day 1 then 100mg od (5 days)
Endocarditis
Take appropriate blood cultures
Start empirical therapy and refer to ID/Microbiology
ALWAYS check full endocarditis guidance for gentamicin/vancomycin dosing especially if reduced renal function
Do not use gentamicin chart/calc
Native valve indolent (Subacute): Amoxicillin IV 2g 4 hourly + Gentamicin (See synergistic gentamicin guidance)
Native valve severe sepsis (Acute): Flucloxacillin IV 2g 6 hourly (4 hourly if >85kg)
Prosthetic valve or Suspected MRSA: Vancomycin IV + Gentamicin (See synergistic gentamicin guidance)
+ when therapeutic vancomycin levels reached add Rifampicin PO 600mg bd (always check for interactions)
C. diff
Non severe: Metronidazole PO 400mg tds (10 days)
Severe: Vancomycin 125mg qds PO/NG +/- IV Metronidazole (10 days)
Peritonitis/biliary tract/intra-abdominal
IV Amox + Met + Gent
Step down: PO co-trimoxazole + Metronidazole
(If penicillin allergic: IV vancomycin + metronidazole + gentamicin
Step down PO co-trim + metronidazole)
TOTAL IV/PO 7 Days
Proven spontaenous bacterial peritonitis
Mild: co-trim PO
Severe: piperacillin/tazobactam IV 4.5g tds then step down to co-trimoxazole PO
Complicated UTI/pyelonephritis/urosepsis
IV Amoxicillin + Gentamicin (If penicillin allergic: IV Co-trimoxazole + Gentamicin)
Step down: PO Co-trimoxazole or as per sensitivities TOTAL IV/PO 7 days
Open fracture prophylaxis
Cefuroxime 1.5g IV every 8 hours
Start within 3 hours for max 72 hours
Diabetic foot infection
Mild: Flucloxacillin 1g qds or Doxycycline 100mg bd
Moderate: Flucloxacillin 1g qds + Metronidazole 400mg tds
(7 days)
Acute septic arthritis/osteomyelitis
IV flucloxacillin 2g qds
