Antibiotic Formulary Prescribing Advice Adult V7.1.docx Printed copies are not controlled and are valid on date of printing only. This version was last printed:15/12/2016 ANTIBIOTIC FORMULARY AND PRESCRIBING ADVICE FOR ADULT PATIENTS VERSION 7.1 EFFECTIVE 16 DECEMBER 2016 THIS DOCUMENT SUPERSEDES ALL ANTIBIOTIC GUIDANCE FROM ANY SOURCE REGARDING ADULT PATIENTS DATED PRIOR TO THE ABOVE DATE Northern Lincolnshire and Goole NHS Foundation Trust and United Lincolnshire Hospitals NHS Trust actively seek to promote equality of opportunity and good race relations. The Trusts seek to ensure that no employee, service user, or member of the public is unlawfully discriminated against for any reason, including their religion, beliefs, race, colour, gender, marital status, disability, sexual orientation, age, social and economic status or national origin. These principles will be expected to be upheld by all who act on behalf of the Trusts, with respect to all aspects of this document. 1 Antibiotic Formulary Prescribing Advice Adult V7.1.docx Printed copies are not controlled and are valid on date of printing only. This version was last printed:15/12/2016 Major Changes From Last Edition .......................................................................... 6 1 Introduction ....................................................................................................... 7 1.1 Aim ............................................................................................................... 7 1.2 Personnel ..................................................................................................... 7 1.3 Areas Covered ............................................................................................. 7 1.4 Antimicrobials ............................................................................................... 7 1.5 Samples ....................................................................................................... 7 1.6 Contact Information ...................................................................................... 7 2 Prescribing of Antimicrobials .......................................................................... 8 2.1 General Points ............................................................................................. 8 2.2 Allergy Information (see Section 3.3 also).................................................... 8 2.3 Indication...................................................................................................... 9 2.4 Timely Administration ................................................................................... 9 2.5 Course Duration and “Stop”/“Review” Date.................................................. 9 2.5.1 Oral Antimicrobial Therapy ................................................................ 9 2.5.2 IV Antimicrobial Therapy ................................................................. 10 2.5.3 Review of Antimicrobial Therapy ..................................................... 10 2.5.3.1 IV To Oral Switch Criteria ................................................................ 10 2.5.3.2 Recording the Route of Administration ............................................ 11 2.6 Actions for Healthcare Professionals ......................................................... 11 2.6.1 Actions For Doctors ......................................................................... 11 2.6.2 Actions For Nurses .......................................................................... 13 2.6.3 Actions For Pharmacists ................................................................. 13 2.7 De-escalation Of IV To Oral ....................................................................... 13 3 Notes on Specific Compounds ...................................................................... 14 3.1 List of Antimicrobials .................................................................................. 14 3.2 Note On The Use of Co-amoxiclav ............................................................ 19 3.3 Note On Penicillin Allergy .......................................................................... 19 3.3.1 Inadvertent administration of a beta-lactam based antibiotic to a patient with a history of adverse reactions to penicillin, with no apparent reaction. 22 3.4 Therapeutic Drug Monitoring ...................................................................... 23 3.4.1 Creatinine Clearance (Cockcroft-Gault) .......................................... 23 3.4.2 Glycopeptides ................................................................................. 23 3.4.2.1 Vancomycin ..................................................................................... 23 3.4.2.2 Continuous Infusion Vancomycin (Critical Care only) ...................... 26 3.4.2.3 Teicoplanin ...................................................................................... 26 3.4.3 Aminoglycosides ............................................................................. 26 3.4.3.1 Stat Dosing Of Aminoglycosides ..................................................... 26 3.4.3.2 Hartford Aminoglycoside Protocol (Adults) ...................................... 27 3.4.3.3 Multiple Dosing Aminoglycoside Protocol (Gram negative sepsis) .. 30 3.4.3.4 Aminoglycoside dosing for Endocarditis, Listeriosis and other complex Gram positive infections .................................................................. 31 3.4.3.5 Amikacin Once A Day ..................................................................... 32 3.4.4 Co-trimoxazole ................................................................................ 34 3.4.5 Other Antibiotics Requiring Monitoring ............................................ 34 4 Regimens For Treatment Of Common Infections ......................................... 35 4.1 Urinary Tract Infections .............................................................................. 35 4.1.1 Tuberculosis, Renal......................................................................... 35 4.1.2 Uncomplicated Urinary Tract Infections (Simple cystitis)................. 35 4.1.3 Uncomplicated Urinary Tract Infections, Acute, Hospital-Acquired . 36 4.1.4 Lower Urinary Tract Infections, Chronic .......................................... 36 4.1.5 Complicated Urinary Tract Infection inc. Pyelonephritis .................. 36 2 Antibiotic Formulary Prescribing Advice Adult V7.1.docx Printed copies are not controlled and are valid on date of printing only. This version was last printed:15/12/2016 4.1.6 Acute Prostatitis .............................................................................. 37 4.1.7 Chronic Prostatitis ........................................................................... 37 4.1.8 Epididymo-orchitis ........................................................................... 37 4.2 Upper Respiratory Tract Infections ............................................................ 37 4.2.1 Common Cold ................................................................................. 37 4.2.2 Influenza .......................................................................................... 37 4.2.3 Mastoiditis, Chronic ......................................................................... 37 4.2.4 Otitis Externa, Infective ................................................................... 37 4.2.5 Malignant Otitis Externa .................................................................. 38 4.2.6 Otitis Media, Acute .......................................................................... 38 4.2.7 Otitis Media, Chronic ....................................................................... 38 4.2.8 Peritonsillar Abscess (Quinsy) ........................................................ 38 4.2.9 Sore Throat/ Pharyngitis /Tonsillitis ................................................. 38 4.2.10 Epiglottitis ........................................................................................ 39 4.2.11 Sinusitis, Acute ................................................................................ 39 4.2.12 Sinusitis, Chronic ............................................................................ 39 4.2.13 Tonsillitis (see Pharyngitis) .............................................................. 39 4.2.14 Whooping Cough ............................................................................ 39 4.3 Lower Respiratory Tract Infections Inc. COPD, Pneumonia, TB ................ 40 4.3.1 Bronchitis, Acute ............................................................................. 40 4.3.2 Bronchitis, Chronic And COPD, Acute Exacerbations Of ................ 40 4.3.3 Pneumonia ...................................................................................... 40 4.3.4 Community Acquired Pneumonia .................................................... 40 4.3.5 Hospital-Acquired Pneumonia ......................................................... 42 4.3.6 Pneumonia, Aspiration .................................................................... 42 4.3.7 Empyema or Lung Abscess ............................................................ 43 4.3.8 Bronchiectasis ................................................................................. 43 4.3.9 Tuberculosis .................................................................................... 43 4.4 Soft Tissue Infections ................................................................................. 43 4.4.1 Bed Sores (See Ulcers) ..................................................................