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Empirical Antibiotic Management of Common Infections in Adults: Med Microbiology x1970 (emergency blp 6480). Pharmacy blp 7508. Out of hours reg. SG395, Pharm blp 6267
Infection
1st line Antibiotics
Alternative if allergic to 1st line
Oral switch
Duration
Community acquired pneumonia (CAP)
LOW SEVERITY (CURB-65 score 0-1)
Record CURB-65 score and evidence of Chest X-Ray consolidation. (If clear, treat as COPD/LRTI) • Confusion (new onset) ºAge >65yrs
MODERATE-SEVERE
(CURB-65 score 2-5)
• BP<90mmHg (systolic) or <60 (diastolic) If severe send blood & sputum cultures, & urine for
pneumoccocal and legionella antigen detection Patients with moderate CAP (CURB=2) may be suitable for a more rapid IV to oral switch Infective Exacerbation of COPD and LRTI
100-200mg OD (or Amoxicillin IV 1g 8-hrly if OR Clarithromycin PO 500mg 12-hrly Hospital Acquired Pneumonia (HAP)
Benzyl Penicillin IV 1.2g, 4-hrly + once-daily Gentamicin IV (if severe or unable to take orally) OR Record Chest X-ray evidence of consolidation Aspiration Pneumonia
Treat as severe CAP or
Record Chest X-Ray evidence of consolidation HAP +Metronidazole IV 500mg, 8-hrly (unless
Urinary Tract Infection
Uncomplicated UTI
Always collect urine specimen before starting Complicated UTI
Only treat positive CSU if features of urinary Pyelonephriti
Ciprofloxacin PO 500mg, 12-hrly +
Change treatment according to microbiology results Intra-abdominal Sepsis
(Hepatobiliary, peritonitis, diverticulitis, gastro- intestinal sepsis associated with surgery) Cellulitis
NON SEVERE
If cellulitis associated with diabetic foot ulcer, see specific guidelines for diabetic foot infection. Contact microbiology if patient is shocked and Osteomyelitis/ Septic Arthritis
Refer patient to OPAT (SG278) if fit for discharge on Clostridium difficile SEE ‘micro’ guide
Clostridium difficile SEE ‘micro’ guide
SEE ‘micro’ guide
SEE ‘micro’ guide
SEE ‘micro’ guide

Suspected Sepsis – site unknown
Co-amoxiclav PO 625mg or IV 1.2g, 8-hrly + Meningitis** (Start antibiotics immediately)
Take blood cultures plus blood in EDTA for molecular Aciclovir IV 10mg/kg 8hrly if viral encephalitis studies and a throat swab. Seek advice on need for a
CT scan, timing of LP and need for dexamethasone. Amoxicillin IV 2g 4hrly if immunocompromised or **Remember tuberculous meningitis - seek advice
>55 years to cover for listeria. from CIU if suspected

Source: http://www.greybook.sgul.ac.uk/current-guidance-1/images/Antibiotic_Management_Table.pdf