Severity(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A/B/C

Grading not applicable

Review doses in renal impairment

MEROPENEM 1g iv tds
plus
TEICOPLANIN 400mg iv every 12 hours for 3 doses then 600mg iv once daily
Maintain treatment pending pre-dose (trough) level on Day 5
Mild to moderate infection (10-20mg/L) Severe(>20mg/L , <60mg/L)
Re-assay after 6 to 8 days (assay details)

Review initial therapy within 24 hrs.
If a source of infection becomes apparent use the appropriate antibiotic guideline. Modify therapy based on results of microbiological or other investigations. Discuss with microbiologist if required.

AMIKACIN 15mg/kg iv od (max 1.5g od)
Only if serum creatinine <150micromol/L.
Maintain pre-dose (trough) serum level <5mg/l
plus
TEICOPLANIN 400mg iv every 12 hours for 3 doses then 600mg iv once daily
Maintain treatment pending pre-dose (trough) level on Day 5
Mild to moderate infection (10-20mg/L) Severe(>20mg/L , <60mg/L)
Re-assay after 6 to 8 days (assay details)

OR
if AMIKACIN is contra-indicated (see local policy):
DISCUSS WITH MICROBIOLOGIST