WESTERN CAPE ACADEMIC HOSPITALS ANTIMICROBIAL RECOMMENDATIONS 2013 2 Acknowledgements This booklet has been made possible by valuable input from many different people at both Groote Schuur and Tygerberg Hospitals. As far as possible members of different departments were consulted about issues that particularly affect their discipline. Suggestions for changes are always welcome and should be communicated to Prof Andrew Whitelaw at Tygerberg Hospital and Dr Colleen Bamford at Groote Schuur. For further advice please contact the microbiology departments at Tygerberg Hospital (021-9384006) or Groote Schuur Hospital (0829075282 – GSH speed-dial 76652 or 021-4045137) This booklet is an initiative of the National Health Laboratory Service (NHLS) at Groote Schuur and Tygerberg Hospitals Originally compiled by Dr S Oliver for the Departments of Medical Microbiology and Infectious Diseases Groote Schuur and Tygerberg Hospitals 3 TABLE OF CONTENTS page GENERAL COMMENTS ................................................................................................................ 7 Duration of therapy .................................................................................................................................... 7 Antibiotic levels .......................................................................................................................................... 8 Antibiotic prescribing in renal impairment .............................................................................................. 8 Nosocomial Infection ................................................................................................................................. 9 NOTES ON SPECIFIC AGENTS ................................................................................................. 10 PENICILLINS ............................................................................................................................................. 10 CEPHALOSPORINS ................................................................................................................................. 12 CARBAPENEMS ....................................................................................................................................... 13 QUINOLONES ........................................................................................................................................... 13 COTRIMOXAZOLE .................................................................................................................................... 14 AMINOGLYCOSIDES ................................................................................................................................ 14 VANCOMYCIN ........................................................................................................................................... 16 COLISTIN ................................................................................................................................................... 16 METRONIDAZOLE .................................................................................................................................... 17 ANTIFUNGAL AGENTS ............................................................................................................................ 18 ANTIVIRAL AGENTS ................................................................................................................................ 19 RESTRICTED AGENTS ............................................................................................................... 21 THERAPY .................................................................................................................................... 23 SEPTICAEMIA ........................................................................................................................................... 23 ENDOCARDITIS ........................................................................................................................................ 24 RESPIRATORY TRACT INFECTIONS ..................................................................................................... 26 CNS INFECTIONS ..................................................................................................................................... 31 URINARY TRACT INFECTIONS ............................................................................................................... 32 OBSTETRIC AND GYNAECOLOGICAL INFECTIONS ........................................................................... 33 SEXUALLY TRANSMITTED INFECTIONS .............................................................................................. 34 PERITONITIS ............................................................................................................................................. 35 GASTROINTESTINAL INFECTIONS ........................................................................................................ 35 HELMINTHIC INFESTATIONS.................................................................................................................. 36 SOFT TISSUE INFECTIONS ..................................................................................................................... 37 BURNS ....................................................................................................................................................... 37 4 ORTHOPAEDIC INFECTIONS .................................................................................................................... 38 EYE INFECTIONS ..................................................................................................................................... 38 FUNGAL INFECTIONS .............................................................................................................................. 39 MALARIA ................................................................................................................................................... 40 TOXOPLASMOSIS .................................................................................................................................... 41 BRUCELLOSIS .......................................................................................................................................... 42 TICK BITE FEVER ..................................................................................................................................... 42 OPPORTUNISTIC INFECTIONS IN AIDS PATIENTS .............................................................................. 42 PROPHYLAXIS ............................................................................................................................44 SURGICAL PROPHYLAXIS ...................................................................................................................... 44 TRAUMA .................................................................................................................................................... 46 RHEUMATIC FEVER ................................................................................................................................. 46 ENDOCARDITIS ........................................................................................................................................ 46 MALARIA ................................................................................................................................................... 49 MENINGOCOCCAL MENINGITIS ............................................................................................................. 50 RAPE SURVIVORS ................................................................................................................................... 50 OCCUPATIONAL POST-EXPOSURE HIV PROPHYLAXIS .................................................................... 51 HEPATITIS A ............................................................................................................................................. 52 HEPATITIS B ............................................................................................................................................. 52 HEPATITIS C ............................................................................................................................................. 52 INFLUENZA ............................................................................................................................................... 52 MEASLES .................................................................................................................................................. 53 MUMPS ...................................................................................................................................................... 53 RUBELLA .................................................................................................................................................. 53 RABIES ...................................................................................................................................................... 53 VARICELLA ............................................................................................................................................... 53 ANTIMICROBIAL AGENTS IN PREGNANCY .............................................................................55 ANTIMICROBIAL AGENTS DURING LACTATION .....................................................................56