Biliary tree

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A

Minor to moderate infection

Antibiotic therapy may not be required. Consider a period of observation. If treatment is indicated see schedule B

Not Applicable

B

Moderate to severe infection

Review doses in renal impairment

CIPROFLOXACIN 750mg po bd

plus

METRONIDAZOLE 400mg po tds
If nil by mouth go to schedule C

Not Applicable

C

Severe life threatening infection

Review doses in renal impairment

If oral antibiotics tolerated and patient absorbing, use:
CIPROFLOXACIN 750mg po bd

plus

METRONIDAZOLE 400mg po tds

plus

TEICOPLANIN iv every 12 hours for 4 doses then once daily.
Dose
<50kg: 400mg
50-74kg: 600mg
75-100kg: 800mg
>100kg: 1000mg
Maintain treatment pending pre-dose (trough) level on day 5. Target level 15-60mg/L. (Click for dosing)


If intravenous antibiotics required, use:
CIPROFLOXACIN  400mg iv bd

plus

METRONIDAZOLE 500mg iv tds

plus


TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose
<50kg: 400mg
50-74kg: 600mg
75-100kg: 800mg
>100kg: 1000mg
Maintain treatment pending pre-dose (trough) level on day 5. Target level 15-60mg/L. (Click for dosing)
 

Non-Severe Penicillin Allergy:

MEROPENEM 1g iv tds

plus

TEICOPLANIN iv every 12 hours for 4 doses then once daily.
Dose
<50kg:
400mg
50-74kg:
600mg
75-100kg:
800mg
>100kg:
1000mg
Maintain treatment pending pre-dose (trough) level on day 5. Target level 15-60mg/L. (Click for dosing)

 

Severe Penicillin Allergy:
If oral antibiotics tolerated and patient absorbing, use:
CIPROFLOXACIN 750mg po bd

plus

METRONIDAZOLE 400mg po tds

plus

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose
<50kg: 400mg
50-74kg: 600mg
75-100kg: 800mg
>100kg: 1000mg
Maintain treatment pending pre-dose (trough) level on day 5. Target level 15-60mg/L. (Click for dosing)


If intravenous antibiotics required, use:
CIPROFLOXACIN  400mg iv bd

plus


METRONIDAZOLE 500mg iv tds

plus

TEICOPLANIN iv every 12 hours for 4 doses then once daily.

Dose
<50kg: 400mg
50-74kg: 600mg
75-100kg: 800mg
>100kg: 1000mg
Maintain treatment pending pre-dose (trough) level on day 5. Target level 15-60mg/L. (Click for dosing)

 IV to Oral Switch
(explanatory notes)

CIPROFLOXACIN 750mg po bd

plus

METRONIDAZOLE 400mg po tds

 

For a total of 7 days therapy unless lab results indicate otherwise

Last reviewed: 09/05/17

For guidance on the administration of intravenous antibiotics click here
(GHNHSFT intranet)