CRITERIA FOR ‘SWITCHING’ IV TO ORAL GENERAL MEDICAL UROLOGY

FOR EXCEPTIONS, SEE FULL POLICY ON INTRANET Infection Antibiotic Length of Infection Antibiotic Length of
treatment treatment
 Temp < 37.5 deg C for 24 hours
CELLULITIS BENZYLPENICILLIN 1.2Gm IV For 7 days ACUTE Age <35 years
 Condition improving or stabilising (Severe and/or 4-6 hourly plus or until EPIDIDYMO- CIPROFLOXACIN 500mg po For 10
 Signs and symptoms of infection improving spreading ± systemic FLUCLOXACILLIN 1Gm IV qds symptoms ORCHITIS stat AND DOXYCYCLINE days.
 Decreasing ESR/CRP/WBC symptoms) (2Gm if >80kg). resolve. 100mg po bd.
 No ongoing or potential absorption problems Age >35 years
 Oral formulation or suitable oral alternative available Oral switch: AMOXICILLIN
CIPROFLOXACIN 500mg po For 10
500mg-1Gm po tds plus
 Not known to be, or suspected to be, suffering from bd. days.
FLUCLOXACILLIN 500mg – 1Gm
high risk infection (meningitis, endocarditis, etc) PROSTATITIS CIPROFLOXACIN 500mg po For 28
po qds.
bd. days.
Please consider oral therapy if your patient fits Penicillin allergy or MRSA: PYELONEPHRITIS TAZOCIN 4.5Gm IV tds For 14
the criteria. TEICOPLANIN 400mg every 12 ADD GENTAMICIN 7mg/kg/ days.
Note that switching to oral may also require a change of antibiotic. hrs X 3 doses IV then same dose day if severe Review
OD. Oral switch: treatment
RESPIRATORY
CELLULITIS TRIMETHOPRIM (IF at 48 hrs
Infection Antibiotic Length of (Outpatient treatment
SENSITIVE) OR CO-AMOX. & switch
treatment following assessment CEFTRIAXONE 1Gm IV od.
Penicillin allergy: to oral if
AC EXAC COPD OXYTETRACYCLINE po 500mg For 5 days on ECC) See protocol on EEC.
possible.
CIPROFLOXACIN 750mg po
NON- qds. CLOSTRIDIUM METRONIDAZOLE 400mg po For 10-14 bd. ADD GENTAMICIN
PNEUMONIC DIFFICILE tds if <75y and no severe co- days. 7mg/kg/ day if severe.
CHEST (Refer to full guideline morbidities OR
UNCOMPLICATED NITROFURANTOIN 50 mg po For 3 - 7
INFECTIONS on the Microbiology VANCOMYCIN 125mg po qds if
UTI qds or CO-AMOXICLAV days.
intranet site) ≥75y or severe co-morbidities.
COMMUNITY MILD (CURB-65 0-1): 375mg po tds.
ACQUIRED AMOXICILLIN 500mg po tds. For 5 days
Pen allergic: OXYTET or CLARI
Stop precipitating antibiotics if SURGERY
PNEUMONIA possible.
MODERATE (CURB-65:2) ENDOCARDITIS Refer to guidelines in main policy Infection Antibiotic Length of
AMOXICILLIN 500mg-1Gm po on the intranet. treatment
or IV tds plus MENINGITIS CEFTRIAXONE 2Gm IV BD Streptococcus PERITONITIS CO-AMOXICLAV 1.2 For 5 days
CLARITHROMYCIN 500mg po DON’T DELAY! ADD AMOXICILLIN IF pneumoniae - ABDO COLLECTION Gm IV tds
For 7 days 14 days
bd START TREATMENT LISTERIA SUSPECTED PANCREATITIS TAZOCIN 4.5Gm IV For 7days
Haemophilus
Pen allergic: CEFTRIAXONE IMMEDIATELY Severe penicillin allergy: influenzae – CHOLANGITIS tds
plus CLARITHROMYCIN CHLORAMPHENICOL 25mg/kg 10 days CHOLECYSTITIS Penicillin allergy:
IV qds ± VANCOMYCIN 1Gm IV Neisseria
SEVERE CO-AMOXICLAV 1.2Gm IV tds Tigecycline
bd meningitidis -
COMMUNITY plus CLARITHROMYCIN 500mg Review IV at
5 days SEPTICAEMIA WITH TAZOCIN 4.5Gm IV
po or IV bd 48hrs PRIOR LAPAROTOMY &
ACQUIRED SEPTICAEMIA TAZOCIN 4.5Gm IV tds For 7 days. tds + GENTAMICIN
Oral Switch: ANTIBIOTIC THERAPY
PNEUMONIA CO-AMOXICLAV 625mg po tds For 7 days Staph. aureus
If severe infection or ADD GENTAMICIN 7mg/kg/ SPLENECTOMY See Splenectomy
(CURB-65 3 plus CLARITHROMYCIN 500mg if Pseudomonas is a day. septicaemia
requires guidelines on the
and above) po bd. likely pathogen
treatment for intranet.
Penicillin allergic: as MODERATE 2 weeks WOUND INFECTIONS FLUCLOXACILLIN For 5 days
HOSPITAL TAZOCIN 4.5Gm IV tds Review IV at 4For more information see main minimum in
policy on the intranet.  Clean 1Gm IV (500mg po) qds
ACQUIRED 48hrs total to
Oral Switch: 4See separate guideline for prevent
PNEUMONIA MRSA bacteraemia/septicaemia. endocarditis CO-AMOXICLAV
CO-AMOXICLAV 625mg tds. Total course
HIGH-RISK FEBRILE  Containing bowel 625mg po tds. For 5 days
7 days
NEUTROPENIA MEROPENEM 1g IV tds ± flora Penicillin allergy: see
Penicillin allergic:
TEICOPLANIN 400mg IV every guidelines in main
CEFTRIAXONE 1-2GM OD ±
12 hrs X 3 doses, then 400mg policy on the intranet.
GENTAMICIN 7mg/kg/day
OD.
 ORTHOPAEDIC
Infection Antibiotic Length of ANTIMICROBIAL PRESCRIBING LIST
treatment ORAL/PARENTERAL/RECTAL/
IMPLANT 30-60 min before incision:
UNRESTRICTED TOPICAL
SURGERY Aciclovir O, P
FLUCLOXACILLIN* 1Gm IV stat. Amoxicillin O, P
RAEI Site Post-op: 1Gm IV 6 hourly X 4 doses (24 Benzylpenicillin P POCKET GUIDE TO
hours cover only) Cefradine O, P
WRIGHTINGTON CEFUROXIME* 1.5Gm IV. Chloramphenicol Topical ANTIBIOTIC TREATMENT
Site Post op 750mg IV 8 hourly 1-2 doses. Co-amoxiclav O, P
OPEN Co-amoxiclav 1.2Gm IV tds For 24-48 Clarithromycin O, P This does not include all of the antibiotic policies but is a
FRACTURES* hrs. Colistin Topical supplement to the full antibiotic guidelines, which have
SEPTIC FLUCLOXACILLIN 2Gm IV IV for at Doxycycline O complete policy details and are available on the hospital
ARTHRITIS* 4-6 hourly least 2 Erythromycin O, P intranet.
weeks. Flucloxacillin O, P
Note: Take ADD GENTAMYCIN Usually 6 Fusidic acid O, topical GENERAL PRINCIPLES
specimens then 7mg/kg/ day if Gram –ve weeks total Gentamicin P
 TARGET EMPIRICAL THERAPY TO COVER MOST LIKELY
start treatment organisms suspected. course – see Metronidazole O, P, R ORGANISM(S)
immediately details on Mupirocin Nasal, topical
Intranet Nitrofurantoin O  CONSIDER PATIENT ALLERGY STATUS (DOCUMENT IF
Oxytetracycline O RASH OR ANAPHYLAXIS)
PROSTHETIC TEICOPLANIN** IV PLUS Minimum 6 Phenoxymethylpenicillin O
JOINT CIPROFLOXACIN 750mg weeks. Alter  SEND SPECIMENS TO LAB BEFORE STARTING THERAPY
Trimethoprim O
INFECTION po bd therapy
SPECIFIED USE ONLY  REVIEW ALL ANTIBIOTIC THERAPY AS SOON AS
Review when sensitivities according to
CULTURE & SENSITIVITY RESULTS BECOME
are available. culture Use is restricted to indications specified within Trust Antibiotic AVAILABLE
results. Guidance (see Intranet site). Inappropriate usage will be
challenged by Pharmacist and/ or Microbiologist.  GIVE SHORT COURSES, REVIEW IV AFTER
Azithromycin O 48 HOURS AND ORAL AFTER 5 DAYS
*If MRSA history or Penicillin allergy/anaphylaxis –
Teicoplanin IV.
Cefixime O
 ALWAYS ENDORSE THE PATIENT’S CHART WITH THE
**For details of Teicoplanin dosage, etc see Antibiotic
Ceftriaxone, Cefotaxime P
LENGTH OF COURSE OR ANTICIPATE REVIEW DATE
guidelines on the Intranet. Cefuroxime, Ceftazidime P
Ciprofloxacin O, P  RESTRICTED ANTIBIOTICS CAN ONLY BE
Please Note: Clindamycin O, P PRESCRIBED ON ADVICE FROM MICROBIOLOGY (SEE
CO-AMOXICLAV (AUGMENTIN) Meropenem P ANTIBIOTIC PRESCRIBING LIST)
 SHOULD NOT BE CO-PRESCRIBED WITH Piperacillin/Tazobactam(Tazocin) P
METRONIDAZOLE FOR ANAEROBIC INFECTIONS as both drugs cover a  AVOID USE OF BROAD SPECTRUM ANTIBIOTICS.
Rifampicin O, P
similar spectrum of activity. CEFUROXIME, CEFTRIAXONE, CIPROFLOXACIN AND
Teicoplanin P CLINDAMYCIN SHOULD BE AVOIDED EXCEPT IN THE
 SHOULD NOT BE USED WHERE AMOXICILLIN or
FLUCLOXACILLIN WOULD BE APPROPRIATE.
Vancomycin O, P CIRCUMSTANCES INDICATED IN THE ANTIBIOTIC
*Co–amoxiclav can cause cholestatic jaundice during or shortly after RESTRICTED USE POLICY.
treatment and is 3 to 4 times more expensive than Amoxicillin and
CONSULTANT MICROBIOLOGIST APPROVAL REQUIRED  IF PRESCRIBING VANCOMYCIN OR GENTAMICIN,
Metronidazole. It should not be used in those with penicillin allergy.
MRSA
Amphotericin B Liposomal P SERUM LEVELS WILL NEED TO BE MONITORED (SEE
 SEE FULL ANTIBIOTIC GUIDELINES ON THE HOSPITAL Caspofungin P INTRANET FOR DETAILS).
INTRANET FOR DETAILS OF TREATMENT AND DECOLONISATION. Meropenem P
NOTE: Please check that this is the most up-to date
 MICROBIOLOGY CAN PROVIDE ADVICE ON ANTIBIOTIC Linezolid, Phosphomycin O, P information. The latest edition of this leaflet and the full
SELECTION AND LENGTH OF TREATMENT. Ertapenem, Tigecycline P antibiotics policy can be found on the intranet.

IF YOU HAVE ANY QUERIES REGARDING ANTIBIOTIC PRESCRIBING, PLEASE CALL

Produced by Dr Camelia Faris. Edition February 2011
THE CONSULTANT MICROBIOLOGISTS DR. CAMELIA FARIS OR DR. R NELSON ON
EXT 2131 OR MS JANE DORMAND, ANTIBIOTIC PHARMACIST ON BLEEP 6631.
Review Date: February 2013