Severity(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A/B/C

Grading not applicable

Review doses in renal impairment

BENZYLPENICILLIN 2.4g iv qds or every 4 hours depending on severity
plus
FLUCLOXACILLIN 1g iv qds
plus
GENTAMICIN 5mg/kg iv stat dose
Only use if serum creatinine <150micromol/L. (nb use 3mg/kg if >65 years old)
If serum creatinine 150-300 micromol/L use GENTAMICIN 80-120mg iv stat
Check level 12-18hrs after first dose
Continue according to local policy if required
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.

DISCUSS WITH MICROBIOLOGIST