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Guideline for the Empirical Treatment of Infections in Adults
1. Guideline for the Empirical
Treatment of Infections in Adults
Dr. Tarek Abd-Elkader Aboulmagd
Infectious Diseases Consultant
2. Decision to prescribe
• clinical evidence of bacterial infection
• patient is gravely ill and sepsis is part of the
differential diagnosis
3. Decision to prescribe
• If the clinical picture is not clear and the
patient is stable, it may be possible to wait,
monitor the patient clinically and review with
laboratory results.
4. Decision to prescribe
If there is
evidence/suspicion of
sepsis
initiate broad
spectrum antibiotic
treatment within one
hour of diagnosis
To avoid increased
morbidity and
mortality
5. Decision to prescribe
previous antimicrobial history
previous colonisation or infection with multi-resistant organisms
allergies and other side effects (including risk of Clostridium difficile infection)
contraindications and cautions
availability of and absorption by oral route
6. Minimising the use of broad-
spectrum antibiotics
• To reduce:
1. C. difficile infection
2. MRSA prevalence
7. Minimising the use of broad-
spectrum antibiotics
• Clinicians should avoid the use of
cephalosporins, quinolones, broad-spectrum
penicillins (including amoxicillin) and
clindamycin unless there are clear clinical
indications for their use.
9. Review of antibiotic treatment
• To:
1. Stop antibiotics if there is no evidence of
infection
2. Switch IV to Oral
3. Change antibiotics – ideally to a narrower
spectrum – or broader if required
4. Continue and review again after a further 24
hours
10. Review of antibiotic treatment
• Treatment with antibiotics should not
continue beyond 7 days (IV and oral) unless
recommended by a local guideline or
microbiologist.
11. Intravenous or oral therapy
• Intravenous (IV) therapy should only be used for:
1. patients with severe infections,
2. patients who have a focus of infection requiring
high doses of antibiotics,
3. patients who are unable to take or absorb oral
antibiotics,
4. when there are no alternative suitable oral
agents.
12. Intravenous or oral therapy
Oral switch criteria are:
1. temperature < 37.5 °C for 24 hours
2. signs and symptoms of infection are improving
3. inflammatory markers are decreasing
4. patient able to tolerate oral food and fluids
5. absence of on-going or potential problem of absorption
6. oral formulation or suitable oral alternative is available
13. Using this guideline
• Do not use Gentamicin for more than 7 days
• Penicillin allergy - patients with a history of
anaphylaxis, urticarial rash or a rash
immediately after penicillin administration
(type 1 allergy) should not receive a penicillin,
cephalosporin or other beta-lactam
antibiotic.
14. Using this guideline
• MRSA - If LOS > five days, or colonised or is at
risk with MRSA colonisation, consider using
Vancomycin or Teicoplanin.
15. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Sepsis (antibiotics should be initiated within 1 hour of
diagnosis)
Infection Antibiotic Treatment IV Option
Community-acquired sepsis of
unknown origin, meningitis not
suspected
Co-amoxiclav 1.2g tds & Gentamicin 5mg/kg od +/-
Metronidazole 500mg tds if anaerobic infection
suspected
Penicillin allergy:
Teicoplanin 600mg 12 hourly for first 3 doses then
600mg od & Gentamicin 5mg/kg od +/-Metronidazole
500mg tds if anaerobic infection suspected
16. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: CNS Infections
Infection Antibiotic Treatment IV Option
Suspected Bacterial
Meningitis
Ceftriaxone 4g od
Add Amoxicillin 2g
4 hourly if patient >50 years old or if
immunocompromised or pregnant
Discuss with Microbiology if recent travel abroad or
penicillin allergy
17. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: CNS Infections
Infection Antibiotic Treatment IV Option
Suspected HSV encephalopathy Aciclovir 10mg/kg tds
Dose reduction required if eGFR<50
Treat for 14-21 days
CSF should be sent for viral PCR
18. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Genitourinary
Infection Antibiotic Treatment Total
Duration
Additional Comments
Uncomplicated
UTI in women
Trimethoprim 200mg po
bd
3 days Nitrofurantoin is contra-
indicated in patients with
eGFR <20ml/min and may be
ineffective if eGFR 20-
60ml/min
Discuss with Microbiology if
there is high risk of, or
previous infection/
colonisation with a VRE, ESBL
producing isolate, or other
multi-resistant organism
If recent Trimethoprim use
or known Trimethoprim
resistant isolate:
Co-amoxiclav 625mg po
tds
Penicillin allergy:
Nitrofurantoin 50mg po
qds
19. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Genitourinary
Infection Antibiotic Treatment Total
Duration
Additional Comments
UTI in men Trimethoprim 200mg po bd 7 days
If recent Trimethoprim use or
known Trimethoprim resistant
isolate:
Co-amoxiclav 625mg po tds
Penicillin allergy: Nitrofurantoin
50mg po qds
Mild UTI in
pregnancy
Cefalexin 500mg po bd 7 days Repeat UA 7 days after
completion of antibiotics
as test of cure
20. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Genitourinary
Infection IV treatment: Oral treatment: Total
Duration
Additional Comments
Pyelonephritis Co-amoxiclav 1.2g tds &
single dose of
Gentamicin 5mg/kg
Co-amoxiclav
625mg tds
10-14 days Discuss with Microbiology if
there is high risk of, or
previous infection/
colonisation with a VRE,
ESBL producing isolate, or
other multi-resistant
organism
Review oral switch with
culture results and clinical
progress
Penicillin allergy:
Ciprofloxacin 500mg po
bd & single dose of
Gentamicin 5mg/kg iv
Penicillin allergy:
Ciprofloxacin
500mg bd (7 days
treatment only
required if
ciprofloxacin used)
7 days
21. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Genitourinary
Infection IV treatment: Oral treatment: Total
Duration
Additional Comments
Urinary Catheter
Infection (Urinary
symptoms, fever,
sepsis, ↑
inflammatory
markers).
Amoxicillin1g
tds &
Gentamicin
5mg/kg od
Oral treatment
not
recommended
for empirical
treatment
7 days Discuss with previously
infection/ colonisation
with a VRE, ESBL or
other multi-resistant
organism
Consider catheter
change
Penicillin allergy:
Gentamicin
5mg/kg once
daily & single
dose of
Vancomycin 1g
22. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Genitourinary
Infection Antibiotic Treatment Total
Duration
Additional
Comments
Epididymo-
orchitis STI
suspected
Ceftriaxone 500mg im single dose & Doxycycline 100mg po bd
for 14 days
OR
If likely due to chlamydia or other non-gonococcal organisms:
Doxycycline 100mg po bd or
Ofloxacin 200mg po bd
OR
If severe epididymo-orchitis or features of bacteraemia,
Ceftriaxone 1g iv od & Gentamicin 5mg/kg iv od for 3-5 days
until fever subsides, and then review with culture
OR
Ofloxacin 200mg po bd
14 days
23. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Genitourinary
Infection Antibiotic Treatment Total
Duration
Additional
Comments
Epididymo-
orchitis STI
not
suspected
If systemically well
Ciprofloxacin 500mg po bd
If severe epididymo-orchitis or features suggestive of
bacteraemia, Ceftriaxone 1g iv od & Gentamicin
5mg/kg iv od for 3-5 days until fever subsides, and
then review with culture results
10 days
Bacterial
Prostatitis
STI not
suspected
Ciprofloxacin 500mg po bd 28 days Review with
culture results
24. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Infective Endocarditis
(IE)
Infection Antibiotic Treatment IV Option
Infective
Endocarditis:
indolent
presentation
Amoxicillin 2g iv 4 hourly & Gentamicin 1mg/kg (ideal body weight) iv bd
It is preferable to wait for blood culture results before commencing
treatment
25. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Infective Endocarditis
(IE)
Infection Antibiotic Treatment IV Option
Infective Endocarditis: acute
presentation (or indolent
presentation with penicillin
allergy) with no risk factors for
multi-resistant bacteria
Vancomycin iv 15 to 20 mg/kg IV every 8 to 12 hours &
Gentamicin 1mg/kg (ideal body weight) iv bd. If eGFR <45
use Ciprofloxacin 750mg po bd/ 400mg iv bd 12 hourly
instead of Gentamicin
26. Empirical Treatment Guidelines
Adult Empirical Treatment Guidelines: Infective Endocarditis
(IE)
Infection Antibiotic Treatment IV Option
Infective Endocarditis: prosthetic
heart valve or suspected MRSA
Vancomycin 15 to 20 mg/kg IV every 8 to 12 hours &
Gentamicin 1mg/kg ideal body weight 12 hourly &
rifampicin 300-600mg 12 hourly po/iv (use lower dose of
rifampicin if severe renal impairment)
28. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Non-severe
exacerbations of
COPD
Treat as low severity Community Acquired Pneumonia 5 days
Low severity
CAP (0 - 1)
Amoxicillin 1g tds Amoxicillin 500mg tds 5 days Use IV only if unable
to swallow or absorb
orally
If there is a high
clinical suspicion of
pneumonia caused by
atypical pathogens
(including legionella)
add Clarithromycin
500mg bd to
Amoxicillin
Penicillin allergy or
recent Amoxicillin:
Clarithromycin 500mg
po/iv bd
Penicillin allergy or recent
Amoxicillin:
Doxycycline
200mg on day 1 then 100mg od
OR
continue Clarithromycin 500mg
bd if switching from IV
29. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic Treatment
IV Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Moderate
severity CAP
(2)
Amoxicillin 1g tds
& Clarithromycin
500mg po/iv bd
Amoxicillin 500mg tds
& Clarithromycin 500mg
bd
7-10 days Treat with Co-
amoxiclav 1.2g iv
tds instead of
Amoxicillin if
recent
Amoxicillin use in
the community
Send urine for
legionella
antigen
Penicillin allergy:
Vancomycin dosed
according to local
guidelines &
Clarithromycin 500mg
po/iv bd
Penicillin allergy:
Doxycycline 200mg day 1
and then 100mg od
OR
continue Clarithromycin
500mg bd if switching
from IV
30. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
High severity
CAP
(≥ 3)
Use iv
treatment
initially
Co-amoxiclav 1.2g tds
& Clarithromycin 500mg iv bd
Follow on from iv treatment:
Co-amoxiclav 625mg tds &
Clarithromycin 500mg bd
7 - 10 days If MRSA pneumonia
suspected add iv
Vancomycin
Send urine for
legionella antigen and
pneumococcal antigen
Penicillin allergy: Vancomycin
dosed according to local
guidelines & Clarithromycin
500mg iv bd (if pre-existing
chest disease, consider using
Ciprofloxacin in place of
Clarithromycin)
Follow on from iv treatment if
Penicillin allergy:
Doxycycline 200mg on day 1
then 100mg od
31. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic Treatment
IV Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Aspiration
pneumonia
(inpatient <
48 hours)
Co-amoxiclav 1.2g tds Amoxicillin 500mg po tds 5-10 days in the first 48 hours
post aspiration, the
patient may present
with chemical
pneumonitis for which
antibiotics are not
indicated
If suspected lung
abscess, necrotising
pneumonia or patient
very unwell , discuss
with Microbiology
Penicillin allergy:
Clarithromycin 500mg po/iv BD & Metronidazole
po/iv tds
32. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic Treatment
IV Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Aspiration
pneumonia
(inpatient
>48 hours)
Co-amoxiclav 1.2g tds Co-amoxiclav 625mg
tds
5-10
days
As before
Penicillin allergy:
Clarithromycin 500mg po/iv BD &
Metronidazole po/iv tds
33. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Infective
exacerbation
of
bronchiectasis,
Cystic Fibrosis
or other
suppurative
lung condition
Discuss with Respiratory/ Microbiology Accordin
g to
clinical
response
Empirical therapy
depends upon
culture results. Two
agents may be
required.
34. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
CAP pregnancy
or breast
feeding
Cefuroxime 1.5g tds
& Clarithromycin
500mg po / iv bd
Amoxicillin 500mg tds
&
Clarithromycin 500mg
bd
5 -10
days
Send urine for
legionella antigen
Treat with Co-
amoxiclav 625mg po
tds instead of
Amoxicillin if recent
Amoxicillin use in
the community
Penicillin allergy:
Discuss with
Microbiology
Penicillin allergy:
Clarithromycin 500mg
bd
Discuss with
Microbiology if
concerns
35. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
HAP
(Hospital < 5
days and no
previous
antibiotics)
Co-amoxiclav 1.2g tds Co-amoxiclav 625mg tds 7 - 10 days Add Vancomycin iv
dosed according to
local guidelines if
MRSA suspected
Send legionella urinary
antigen and discuss
with Microbiology if
any history
suggestive of legionella
If not responding to
therapy, discuss with
Microbiology
Penicillin allergy:
Vancomycin iv dosed
according to local
guidelines
& Ciprofloxacin po
500mg bd (or 400mg
iv bd if oral route not
appropriate)
Penicillin allergy:
Discuss with
Microbiology
36. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
HAP
(Hospital > 5
days or
previous Co-
amoxiclav)
Piperacillin-
tazobactam 4.5g tds
Discuss with
Microbiology
7 - 10
days
Add Vancomycin iv
dosed according to
local guidelines if
MRSA suspected or
patient very unwell
Send urine for
legionella antigen
If not responding to
therapy, discuss with
Microbiology
Penicillin allergy:
Vancomycin iv
dosed according to
local guidelines
& Ciprofloxacin po
500mg bd (or
400mg iv bd if oral
route not
appropriate)
37. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Tonsillitis/
Quinsy
Benzylpenicillin
1.2g qds
Penicillin V 500mg qds 10 days Consider infectious
mononucleosis
Add Metronidazole
500mg iv tds if
quinsy
Penicillin allergy:
Clarithromycin
500mg bd
Penicillin allergy:
Clarithromycin 500mg
po bd
38. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Epiglottitis Ceftriaxone 2g iv od Follow on from iv
treatment:
Co-amoxiclav 625mg
tds
10-14
days
Add Metronidazole
500mg iv tds if
abscess
Penicillin allergy:
Discuss with Microbiology
39. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Acute sinusitis Co-amoxiclav 1.2g
tds
Co-amoxiclav 625mg
tds
OR
Doxycycline 200mg on
day 1 then 100mg od
5-7 days Use iv only if unable
to swallow or absorb
po antibiotic
Penicillin allergy:
Doxycycline 200mg
po on day 1 then
100mg po od
40. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Acute sinusitis Co-amoxiclav 1.2g
tds
Co-amoxiclav 625mg
tds
OR
Doxycycline 200mg on
day 1 then 100mg od
5-7 days Use iv only if unable
to swallow or absorb
po antibiotic
Penicillin allergy:
Doxycycline 200mg
po on day 1 then
100mg po od
41. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Acute severe
otitis externa
Flucloxacillin 1g qds Flucloxacillin 500mg
qds
Accordin
g to
clinical
responsePenicillin allergy or
MRSA suspected:
Vancomycin iv
dosed according to
local guidelines
Penicillin allergy:
Doxycycline 200mg on
day 1 then 100mg od
42. Adult Empirical Treatment Guidelines: Respiratory Tract
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Invasive otitis
externa
Piperacillin-
tazobactam 4.5g tds
& Gentamicin
5mg/kg iv od
Discuss with
Microbiology
According
to clinical
response
Add Teicoplanin
600mg iv 12
hourly for first 3
doses then 600mg
iv od if MRSA
isolated or
suspected
Penicillin allergy:
Discuss with
Microbiology
43. Adult Empirical Treatment Guidelines: Bone
and Joint
Infection Antibiotic Treatment
IV Option
Total Duration Additional Comments
Always try to take appropriate specimens for culture prior to antibiotic therapy
Septic arthritis native
joint
Flucloxacillin 2g iv qds
& Gentamicin 5mg/kg
iv od
Consider gonorrhoea
Please discuss with
Microbiology within 1
week
Treatment usually
requires 2 weeks iv
then 4 weeks oral
antibiotics
If MRSA isolated or
suspected, discuss
with Microbiology
Rationalise therapy
based on results of
deep tissue culture
results
Penicillin allergy:
Vancomycin iv dosed
according to local
guidelines &
Ciprofloxacin 750mg
po bd
44. Adult Empirical Treatment Guidelines: Bone
and Joint
Infection Antibiotic Treatment
IV Option
Total Duration Additional Comments
Acute osteomyelitis Flucloxacillin 2g iv qds
& Gentamicin 5mg/kg
iv od
Please discuss with
Microbiology within 1
week
Chronic osteomyelitis Discuss individual case
with Microbiology
45. Adult Empirical Treatment Guidelines: Bone
and Joint
Infection Antibiotic Treatment
IV Option
Total Duration Additional Comments
Diabetic foot with
possible underlying
osteomyelitis
If sepsis, Piperacillin-
tazobactam 4.5g iv
tds. Add Vancomycin
iv dosed according to
local guidelines if
MRSA is suspected
Penicillin allergy:
Discuss with
Microbiology
If MRO suspected,
discuss with
Microbiology
If not septic, discuss
with Microbiology
communicate with
Diabetic Foot TeamPenicillin allergy:
Discuss with
Microbiology
46. Adult Empirical Treatment Guidelines: Bone
and Joint
Infection Antibiotic Treatment
IV Option
Total Duration Additional
Comments
Suspected prosthetic
joint infection
Vancomycin iv dosed according
to local guidelines.
Add Piperacillin-tazobactam
4.5g iv tds if previous or
suspected infection with Gram
negative organisms or patient
septic or sinus present
Continue
antibiotics until
culture results are
available, then
review treatment
with Microbiology
Penicillin allergy: Discuss with
Microbiology
47. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Human or
animal bite
Co-amoxiclav 1.2g
tds
Co-amoxiclav 625mg
tds
7 days Check tetanus
status and discuss
with Microbiology
if human bite or
concern regarding
rabies
Penicillin allergy:
Ciprofloxacin
400mg iv bd
& Clindamycin
600mg iv qds
Penicillin allergy:
Ciprofloxacin 500-
750mg bd &
Clindamycin 300-
450mg qds
48. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Cellulitis Flucloxacillin 1g qds Flucloxacillin 500mg
qds
5 - 7 days Only if severe
consider adding
Clindamycin 300-
450mg po qds to
Flucloxacillin /
Vancomycin
(substitute if on
Doxycycline)
Penicillin allergy or
MRSA suspected:
Vancomycin iv
dosed according to
local guidelines
Penicillin allergy:
Doxycycline 200mg po
on day 1 then 100mg
po od
49. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic
Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Bursitis Flucloxacillin 1g qds Flucloxacillin 500mg
qds
7 days
Penicillin allergy or
MRSA suspected:
Vancomycin iv
dosed according to
local guidelines
Penicillin allergy:
Doxycycline 200mg po
on day 1 then 100mg
po od
50. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Mastitis Flucloxacillin 1g qds
OR
consider Co-amoxiclav
1.2g tds if
breastfeeding, post-
operative or recent
Flucloxacillin
Flucloxacillin 500mg qds
OR
consider Co-amoxiclav
625mg tds if
breastfeeding, post -
operative or recent
Flucloxacillin
5-7days
Penicillin allergy or
MRSA suspected:
Vancomycin iv dosed
according to local
guidelines
Penicillin allergy or
MRSA suspected:
Discuss with
Microbiology
51. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Moderate-
severe
cellulitis in
association
with diabetes
or post GI
surgery
Co-amoxiclav 1.2g tds
If severe consider
adding Clindamycin
300-450mg po qds
Co-amoxiclav 625mg tds 7 -10 days If MRSA is
suspected add
Vancomycin iv
dosed
according to
local
guidelines
communicate
with Diabetic
Foot Team
Penicillin allergy:
Clindamycin 600mg iv
qds
& Ciprofloxacin 750mg
po bd (or 400mg iv bd if
oral route not
appropriate)
Penicillin allergy:
Discuss with
Microbiology
52. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Necrotising
Fasciitis
Meropenem 1g tds
& Clindamycin 600mg iv
qds
& Metronidazole
500mg tds & single
dose Gentamicin
5mg/kg
Not appropriate According
to clinical
response
If suspected get
an URGENT
surgical opinion
and discuss with
a Microbiologist
If MRSA is
suspected add
Vancomycin iv
dosed according
to local
guidelines
53. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Severe pre
septal and
orbital
cellulitis
Ceftriaxone 2g bd Discuss with
Microbiology
According
to clinical
response
Discuss with
Microbiology,
Ophthalmology
and ENT
Consider urgent
imaging
54. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Cellulitis
surrounding
ulcer or
pressure sore
Flucloxacillin 1g qds
+/- Metronidazole 500mg
tds
Flucloxacillin 500mg qds
+/- Metronidazole 400mg
tds
OR
Co-amoxiclav 625mg tds
According
to clinical
response
Consider
possibility of a
deep seated
infection and
referral to Tissue
Viability
Penicillin allergy or MRSA
suspected: Vancomycin iv
dosed according to local
guidelines +/-
Metronidazole 500mg tds
Penicillin allergy or MRSA
suspected: Doxycycline
200mg on day 1 then
100mg od +/-
Metronidazole 400mg tds
55. Adult Empirical Treatment Guidelines: Skin and Soft Tissue
Infection Antibiotic Treatment IV
Option
Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Ulcer or
pressure sore
with no
evidence of
cellulitis
Pressure relief and topical wound care should be adequate
56. Adult Empirical Treatment Guidelines: Intra-abdominal Infections
Infection Antibiotic Treatment IV Option Antibiotic
Treatment Oral
Option
Total
Duration
Additional
Comments
Appendicitis,
diverticulitis
or peritonitis
Amoxicillin 1g tds & Metronidazole
500mg tds &
Gentamicin 5mg/kg od
OR
If eGFR <45, treat with Piperacillin-
tazobactam 4.5g tds & Metronidazole
500mg iv tds
Co-amoxiclav 625mg
tds & Metronidazole
400mg tds
5 - 7 days Continue IV for 5-7
days if peritoneal
contamination
Review with
culture results
prior to switching
to oral therapy
Penicillin allergy:
Teicoplanin 600mg 12 hourly for 3 doses
then 600mg od & Metronidazole 500mg
tds & Gentamicin 5mg/kg od
OR
If eGFR <45, discuss with Microbiology
Penicillin allergy:
Ciprofloxacin 500 mg bd
& Metronidazole 400mg
tds
57. Adult Empirical Treatment Guidelines: Intra-abdominal Infections
Infection Antibiotic Treatment IV Option Antibiotic Treatment
Oral Option
Total
Duration
Additional
Comments
Cholecystitis
and Cholangitis
Amoxicillin 1g tds & Metronidazole
500mg tds &
Gentamicin 5mg/kg od
OR
If eGFR <45, treat with Piperacillin-
tazobactam 4.5g iv tds & Metronidazole
500mg iv tds
Co-amoxiclav 625mg tds &
Metronidazole 400mg tds
7 days
Penicillin allergy:
Teicoplanin 600mg 12 hourly for 3 doses
then 600mg od &
Metronidazole 500mg tds &
Gentamicin 5mg/kg od
OR
If eGFR <45, discuss with Microbiology
Penicillin allergy:
Ciprofloxacin 500 mg bd &
Metronidazole 400mg tds
58. Adult Empirical Treatment Guidelines: Intra-abdominal Infections
Infection Antibiotic
Treatment IV
Option
Antibiotic
Treatment
Oral Option
Total
Duration
Additional Comments
Severe
Pancreatitis
with infected
necrosis
Piperacillin/
tazobactam 4.5g tds&
Metronidazole
500mg iv tds
Not appropriate 7 days Add Gentamicin 5mg/ kg od if
septic
Note:
Infected necrosis is rare in the first
week. Infection is presumed when
there is extraluminal gas in the
pancreatic and/or peripancreatic
tissues or when Fine-Needle
Aspiration is positive for bacteria
and / or fungi on Gram stain and
culture.
Penicillin allergy:
Discuss with
Microbiology
59. Adult Empirical Treatment Guidelines: Intra-abdominal Infections
Infection Antibiotic
Treatment IV
Option
Antibiotic
Treatment
Oral Option
Total
Duration
Additional Comments
Spontaneous
Bacterial
Peritonitis
Piperacillin/
tazobactam 4.5g iv
tds
Be guided by
culture results
5-7 days
Penicillin allergy:
Discuss with
Microbiology
60. Adult Empirical Treatment Guidelines: Intra-abdominal Infections
Infection Antibiotic Treatment IV
Option
Antibiotic
Treatment Oral
Option
Total
Duration
Additional
Comments
Variceal
haemorrhage
with cirrhosis
Piperacillin/ tazobactam
4.5g iv tds
5-7 days
Penicillin allergy:
Teicoplanin 600mg 12
hourly for 3 doses then
600mg od &
Gentamicin 5mg/kg od
OR
If eGFR <45, discuss with
Microbiology