Alternative Antibiotic Options for Potential Shortage of IV Aztreonam Guidance Indication for IV Aztreonam Alternative if no IV Aztreonam available Follow IVOST guidance and step down to oral if possible. Check microbiology results and review potential for IVOST daily or prescribe targeted IV therapy If IV still required: Empirical Treatment IV Amoxicillin/Metronidazole/Temocillin Intra-abdominal • patient excluded from gentamicin guidance or not If IV still required + pencillin allergy: sepsis/Severe HAP or appropriate for further doses of gentamicin IV Vancomycin/Metronidazole/Ciprofloxacin(refer to Fluoroquinolones Warnings Aspiration Pneumonia document) In both situations IV co-trimoxazole + metronidazole may be suitable if patient is stable Follow IVOST guidance and step down to oral if possible. Check microbiology results and review potential for IVOST daily or prescribe targeted IV therapy IV still required: Empirical Treatment IV Amoxicillin /Temocillin Urosepsis/Pyelonephritis • patient excluded from gentamicin guidance or not IV still required + pencillin allergy: appropriate for further doses of gentamicin IV Vancomycin /Ciprofloxacin (refer to Fluoroquinolones Warnings document) In both situations IV co-trimoxazole may be suitable if patient is stable patients where gentamicin indicated but eGFR 15-30ml/min Temocillin 1g Urology Surgical and no penicillin allergy or penicillin allergy but without history Prophylaxis of anaphylaxis or angiodema patients with low eGFR Temocillin (in combination with flucloxacillin) Vascular Surgical Prophylaxis patients with low eGFR and penicillin allergy or MRSA positive Ciprofloxacin (in combination with vancomycin): refer to Fluoroquinolones Warnings document Neutropenic Sepsis Ciprofloxacin 400mg tds (refer to Fluoroquinolones Warnings document)– adjust patients with pencillin allergy dose for renal function (in combination with teicoplanin) or consider gentamicin Note: Temocillin – does not provide cover for Pseudomonas Approved by AMG: March 2016 Updated: Feb 2019 Review: Feb 2022 .