Severity
(classification)

1st line oral/iv antibiotics

Anaphylactic penicillin allergy
(see explanatory notes)

A/B

Minor to severe  infection

Review doses in renal impairment

CO-AMOXICLAV 1.2g iv tds

Duration: 5 -7 days and then review

GENTAMICIN iv (as per local protocol)
plus
CLINDAMYCIN 1.2g iv qds
STOP and review if patient develops diarrhoea or if gentamicin is contra-indicated (see GHNHSFT protocol) consult microbiologist

Duration: 5 -7 days and then review 

C

Severe life threatening infection

Review doses in renal impairment

TAZOCIN 4.5g iv tds

For severe sepsis ADD:
GENTAMICIN 5mg/kg iv stat dose
(nb use 3mg/kg if >65 years old)

If serum creatinine 150-300 micromol/L use GENTAMICIN 80-120mg IV stat

GENTAMICIN THERAPY TO BE REVIEWED AFTER FIRST 24HRS. Continue only if evidence of gram –ve sepsis. Check level 12-18hrs after first dose. Continue according to local protocol if required

OR
if gentamicin is contra-indicated (see GHNHSFT protocol): Consult microbiologist

OR
If definite history of rash allergy but no anaphylactic penicillin allergy (see explanatory notes) use:
MEROPENEM 1g iv tds

GENTAMICIN iv (as per local protocol)
plus
CLINDAMYCIN 1.2g iv qds
STOP and review if patient develops diarrhoea or if gentamicin is contra-indicated (GHNHSFT protocol) consult microbiologist 

Duration: 5 -7 days and then review

IV to Oral Switch
(explanatory notes)

CO-AMOXICLAV 625mg po tds for a total of 5 - 7 days therapy and then review

Consult Microbiologist