Check MRSA status and contact microbiologist if positive.
**Ongoing management and duration of therapy to be discussed with Microbiology during working hours.
Antibiotic – 1st line
Co-amoxiclav IV 1.2g q8h
Penicillin allergy and high risk of MRSA
Teicoplanin IV 10mg/kg q12h for 3 doses then q24h (round to nearest 200mg or 400mg vial) plus
Metronidazole 500mg q8h IV plus Gentamicin one stat dose (click here for full gentamicin policy) Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.
5mg/kg IV one stat dose (max 500mg): if <70 years and CrCl≥30mL/min or
3mg/Kg IV one stat dose (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation. If patient is obese ie. 20% over ideal body weight – use adjusted body weight
Duration of therapy 5 days (guided by clinical response)
Antibiotic – 1st line
Flucloxacillin 1g q6h IV (500mg q6h PO). Review IV antibiotics at 48 hours.
2nd Line
Clindamycin 600mg q6h IV/PO
Duration of therapy and the need for further gentamicin after 24 hours should be guided by clinical response and discuss with microbiologist in working hours if necessary
Antibiotic – 1st line
Flucloxacillin 2g 6 hourly IV plus
Metronidazole 500mg q8h IV plus Gentamicin one stat dose (click here for full gentamicin policy) Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.
5mg/kg IV one stat dose (max 500mg): if <70 years and CrCl≥30mL/min or
3mg/Kg IV one stat dose (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation. If patient is obese ie. 20% over ideal body weight – use adjusted body weight
2nd Line
Clindamycin 600mg IV/PO 6 hourly plus Gentamicin one stat dose (click here for full gentamicin policy) Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.
5mg/kg IV one stat dose (max 500mg): if <70 years and CrCl≥30mL/min or
3mg/Kg IV one stat dose (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation. If patient is obese ie. 20% over ideal body weight – use adjusted body weight
Comment
Gentamicin*: 5mg/ kg but for elderly patients or with moderate/severe renal impairment(CrCl <30ml/min), may require 3mg/ kg or shorter duration treatment.
Duration of therapy to be discussed with Microbiologyduring working hours
Antibiotic – 1st line
Flucloxacilin 2g 6 hourly IV plus
Metronidazole 500mg q8h IV plus Gentamicin (click here for full gentamicin policy) Note: If serum creatinine is not yet known then 5mg/kg may still be initiated unless 70years or above or there is evidence of existing severe renal impairment. CrCl must still be calculated once U+Es are available. ALL SUBSEQUENT DOSES MUST BE ADJUSTED AS PER CrCl once known. Must check pre-dose level as per policy.
5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or
3mg/Kg IV q24h (max 300mg): If ≥70 years or CrCl 10-29.9ml/min, known renal impairment, or clinician has concerns about higher dose (e.g. clinical signs of renal impairment)
Round to nearest 20mg for ease of administration
CrCl known to be under <10ml/min discuss with microbiology during working hours for gentamicin dosing/or alternative antibiotic recommendation. If patient is obese ie. 20% over ideal body weight – use adjusted body weight
2nd Line
Cefuroxime 1.5g q8h IV plus Metronidazole 500mg q8h IV.
Comment
Clindamycin, Co-amoxiclav and Piperacillin-tazobactam usually have sufficient anaerobic cover. Addition of Metronidazole is only required for dirty trauma wounds at the discretion of the patient’s Consultant.
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