Empirical Antibiotic Therapy, Infection Management, Adults GGC PDF

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Empirical Antibiotic Therapy, Infection Management, Adults GGC...

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CLINICAL GUIDELINE

Empirical Antibiotic Therapy, Infection Management, Adults

A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments. Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty. If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Version Number:

6

Does this version include changes to clinical advice:

Yes

Date Approved:

29 August 2017

Date of Next Review:

1st August 2020

Lead Author:

Ysobel Gourlay

Approval Group:

Antimicrobial Utilisation Committee

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Important Note: The Intranet version of this document is the only version that is maintained. Any printed copies should therefore be viewed as ‘Uncontrolled’ and as such, may not necessarily contain the latest updates and amendments.

Infection Management G

STOP AND THINK BEFORE YOU GIVE ANTIBIOTIC THERAPY: Antibiotics related infections & S. aureus bacteraemia. Always justify use and obta

Key Steps in Infection Management 1. 2. 3. 4. 5. 6.

ESTABLISH DIAGNOSIS & SEVERITY – follow guidelines and if unsure seek senior c MICRO SAMPLING – Blood cultures (and other micro) before antibiotic. Don’t rou DOCUMENT INDICATION for antibiotic and proposed DURATION OF THERAPY (cli PENICILLIN ALLERGY – Confirm nature with patient/ G.P. Often not true allergy – V REVIEW & RECORD clinical response, micro results and prescription DAILY. Can yo BEFORE CONTACTING INFECTION SPECIALIST: SENIOR CLINICAL REVIEW within y missed doses), check micro results (clinical portal/ Trakcare), source control – drai Lower Respiratory Tract Infections

Obtain respiratory samples for microbiology (sputum) and virology (throat gargle) and consider influenza during peak season. If clinical suspicion of influenza please refer to HPS guidelines for latest treatment options.

Pneumonia CURB 65 score: •Confusion (new onset) •Urea > 7 mmol/L •RR ≥ 30 breaths/ min •BP – diastolic ≤ 60 mmHg or systolic < 90 mmHg •Age ≥ 65 years Assess also for SEPSIS

Non-severe community acquired pneumonia (CAP) CURB 65 score: ≤ 2 (and no sepsis) Oral Amoxicillin 500mg 8 hrly Or Oral ▲Doxycycline 200mg as a one-off single dose then 100mg daily Or Oral ■Clarithromycin 500mg 12 hrly Duration 5 days

Severe community acquired pneumonia (CAP) CURB 65 score ≥ 3 or CAP (with any CURB 65 score) PLUS sepsis syndrome: IV/oral ■Clarithromycin 500mg 12 hrly PLUS either: IV Amoxicillin 1g 8 hrly

Exacerbation of COPD/ LRTI Antibiotics (usually oral) only if purulent sputum. Dual therapy not recommended & increases risk of harm. Oral Amoxicillin 500mg 8 hrly or Oral ▲Doxycycline 200mg as a one-off single dose then 100mg daily or Oral ■Clarithromycin 500mg 12 hrly Duration 5 days

Severe/ complicated infective exacerbation of COPD Use IV therapy if indication for IV route or ventilation required or sepsis. IV Amoxicillin 1g 8 hrly or if true penicillin/beta-lactam allergy IV ■Clarithromycin 500mg 12 hrly Duration 7 days (IV/oral)

Uncertain if LRTI/ UTI Do not prescribe Co-amoxiclav. Non-severe infection Monotherapy Oral ▲Doxycycline

Skin/ Soft Tissu

Mild soft tissu Oral Flucloxacillin 1g

or if true penicillin/be Oral ▲Doxycycline 10 Duration 5 days

Moderate celluli

Consider OPAT/ ambu

(consult local managem

If requires inpatient m IV Flucloxacillin 2g 6 h If MRSA suspected or beta-lactam allergy IV Vancomycin** Duration 7 days (IV/

Mild infected hum

Oral Co-amoxiclav 625

or if true penicillin/bet Oral ▲Doxycycline 100 + Oral Metronidazole Duration 7 days

Severe infecte animal

Consider surgical revie IV Co-amoxiclav 1.2g 8

or if true penicillin/bet...