PRINCIPLES FOR USE OF GUIDELINES

  • These guidelines are intended for initial treatment of ADULTS only. Dosing based on average weight of 70kg.
  • Consult pharmacy for advice on dose adjustment in renal or hepatic disease
  • PRESCRIBE ANTIBIOTICS ONLY WHEN THERE IS LIKELY TO BE CLEAR CLINICAL BENEFIT
  • Avoid wherever possible all Cephalosporins and Quinolones to prevent C.difficile
  • Specimens for Microscopy, Culture & Sensitivity (M,C&S) should always be taken before starting antibiotics.
  • (Blood cultures – 2 sets from 2 sites)
  • Check previous microbiology results before prescribing and check new results daily and rationalise antibiotic therapy accordingly
  • Individual patient factors to consider in all cases:
 
  • Previous antibiotic history
  • Previous infection with multi-resistant organisms (e.g. MRSA, ESBLs)
  • Allergies
  • Renal & Hepatic function
  • Pregnancy or breastfeeding
  • Immunocompromised
  • Availability and absorption by oral route
  • If patient is said to be “allergic” to an antibiotic, check and record type & severity of reaction (see POPAM and Penicillin Allergy)
  • Intravenous therapy (IV) to be used only for severe conditions and if oral route unavailable. In these patients the sooner the antibiotic is given the better the prognosis: aim to give IV antibiotics within 1 hour of decision to treat. For further information see www.survivesepsis.org
  • Review IV therapy every 48 hours until signs/symptoms classify the patient as Schedule A (see flowchart). Then follow "IV to Oral Switch" (see individual guidelines) unless lab or protocol details indicate otherwise

INDICATION AND REVIEW / STOP BOXES MUST BE COMPLETED ON THE DRUG CHART (local policy)