Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A

Minor to moderate infection

Review doses in renal impairment

FLUCLOXACILLIN 1g po qds
plus
AMOXICILLIN 500mg po tds

 If suspected/confirmed MRSA, use:

DOXYCYCLINE 200mg po od

CLINDAMYCIN 450mg po qds
STOP and review if patient develops diarrhoea

 If suspected/confirmed MRSA, use:

DOXYCYCLINE 200mg po od

B

Moderate to severe infection

Review doses in renal impairment

BENZYLPENICILLIN 2.4g iv qds
plus
FLUCLOXACILLIN 1g iv qds

 If suspected/confirmed MRSA, initially ADD:

TEICOPLANIN 400mg iv every 12 hours for 3 doses then 600mg iv once daily and review with microbiologist
Maintain TEICOPLANIN treatment pending pre-dose (trough) level on Day 5 (unless advised otherwise by microbiologist )
Mild to moderate infection (10-20mg/L)
Severe(>20mg/L, <60mg/L)
Re-assay after 6 to 8 days

CLINDAMYCIN 1.2g IV qds
STOP and review if patient develops diarrhoea

 If suspected/confirmed MRSA, initially add:

TEICOPLANIN 400mg iv every 12 hours for 3 doses then 600mg iv once daily and review with microbiologist
Maintain TEICOPLANIN treatment pending pre-dose (trough) level on Day 5 (unless advised otherwise by microbiologist )
Mild to moderate infection (10-20mg/L)
Severe(>20mg/L, <60mg/L)
Re-assay after 6 to 8 days

C

Severe life threatening infection

Review doses in renal impairment

BENZYLPENICILLIN 2.4g iv every 4 hours
plus
FLUCLOXACILLIN 1g iv qds
plus
CLINDAMYCIN 1.2g iv qds
STOP and review if patient develops diarrhoea

If suspected/confirmed MRSA, ADD:

TEICOPLANIN 400mg iv every 12 hours for 3 doses then 600mg iv once daily and urgently review with microbiologist

For traumatic wounds assess tetanus immune status. Consider adding:

METRONIDAZOLE 400mg po tds or 500mg iv tds unless using Clindamycin

CLINDAMYCIN 1.2g iv qds
STOP and review if patient develops diarrhoea

 If suspected/confirmed MRSA, initially ADD:

TEICOPLANIN 400mg iv every 12 hours for 3 doses then 600mg iv once daily and urgently review with microbiologist

IV to Oral Switch(explanatory notes)

As in Schedule A
Duration: Total duration of 7 days therapy and then review