Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A/B/C

Minor to severe life threatening infection

Review doses in renal impairment

CEFTRIAXONE 2g iv bd
plus
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

LINEZOLID 600mg po/iv bd
plus
CIPROFLOXACIN 750mg po bd
plus
METRONIDAZOLE 400mg po tds or 500mg iv tds.

• If suspected/confirmed MRSA, note LINEZOLID has activity against MRSA