Main page Antimicrobial prescribing

THINK SEPSIS EVEN WITHOUT FEVER (the older, the colder)

G +ve cover

• Flucloxacillin
  • PO 250-500mg QID max 4g
  • IV 1-2g QID max 12g
• Vancomycin
  • PO 125mg QID 10-14days for C-diff ONLY
  • IV for MRSA or penicillin allergy
    • Loading dose in sick 25-30mg/Kg
    • maintenance dose 15-20mg/kg BD/TDS
    • 2g BD MAX DOSE WITHOUT OVERSIGHT
    • monitor pre 4th dose (~36 hrs)
      • aim trough level of 15-20
  • if renal impairment, decrease dose or extend intervals
    • make sure to give after dialysis not before to avoid washout
  • if red man syndrome, slow infusion and give antihistamine

G +ve and enterococcus cover

• Ampicillin
  • IM/IV 500mg-1g QID
  • 200mg/kg daily divided doses in meningitis/septicaemia
  • MAX 14g/day

Pseudomonas cover

• Piptaz (piperacillin + tazobactam)
  • IV 4d+0.5g
• PO/IV fluclox
• IV meropenem
  • 1-2g TDS

Anaerobic cover

• metronidazole
  • PO 200-400mg TDS/BD max 4g
  • IV 500mg TDS/BD (severe infxn) max 4g