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​​​​​​​​​​​​​​​​​​​Intra-abdominal Infections
(C difficile Period of increased incidence)

Gentamicin is contraindicated in Myasthenia Gravis. Discuss with medical microbiology for an alternative antibiotic and see this guideline​ for further advice.

Refer to the Sepsis guideline - full version.pdfSepsis guideline - full version.pdf for full investigation and management recommendations in patients with sepsis.​

 
 ​
 First line​
​Second line​
​Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)
​Confirm allergy status prior to choosing antimicrobial regime
Antimicrobial
 
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Check for interactions
Gentamicin STAT

AND

Tigecycline*
​​Gentamicin STAT

AND

Co-trimoxazole**

AND

Metronidazole

Dose

Gentamicin 5mg/kg STAT

(Dose and frequency according to calculator – maximum 450mg in 24 hours)

AND

Tigecycline* 100mg STAT then 50mg every 12 hours

Gentamicin 5mg/kg STAT

(Dose and frequency according to calculator​ – maximum 450mg in 24 hours) 

AND

Co-trimoxazole** 960mg every 12 hours

AND

Metronidazole 400mg every 8 hours
Route
 IV gentamicin
IV tigecycline*
IV gentamicin
IV co-trimoxazole**
PO metronidazole
Duration
 Review at 48 - 72 hours 

If patient remains unwell at 24 hours or deteriorating discuss with medical microbiology
 
 Additional information:
  • ​*Tigecycline is not suitable for use as monotherapy for patients with ongoing sepsis or bloodstream infection. If there is a contraindication to gentamicin use or there are on-going features of sepsis at 24 hours, discuss with Medical Microbiology for advice on an alternative regime.
  • **Co-trimoxazole contains trimethoprim - it should not be used in patients with history of trimethoprim allergy or trimethoprim-resistant organisms. Discuss with Medical Microbiology if there is a previous history of resistant gram negative bacteria and/or of recurrent UTIs.
  • **For patients >100kg, discuss co-trimoxazole dosing with pharmacy.
  • Refer to interactions page or ward pharmacist for co-trimoxazole interactions.​
 
 
IV to PO arrow.png 
 
 
First Line
Second Line 
 ​Second line​
​Allergy status

 ​​​ ​(Confirm allergy status prior to choosing antimicrobial regime)​
Antimicrobial
Co-trimoxazole**
​
AND 

Metronidazole
​Ciprofloxacin***
 
AND
 
Metronidazole​
Dose
 Co-trimoxazole** 960mg every 12 hours

AND

Metronidazole 400mg every 8 hours
Ciprofloxacin*** 500mg every 12 hours

AND

Metronidazole 400mg every 8 hours
Route
 PO
PO 
Duration
7 days total (including IV therapy)
In persistent infections, discuss duration with Medical Microbiology/Infectious Diseases 
 ​
***Ciprofloxacin can lower the seizure threshold and should be avoided in those with a history of seizures.​


***Fluoroquinolone are ineffective if given with multi-valent cation containing products e.g. antacids, supplements or feeds containing calcium, iron, magnesium, zinc, sucralfate or bismuth. These products bind to the antibiotics and reduce their absorption by up to 90%.
 
If patients are prescribed antacids or supplements containing calcium iron, magnesium zinc or bismuth. It is advised these medications are stopped/withheld for the duration of antibiotic treatment. If this is not possible due to a clinical need, then an alternative antibiotic must be considered
If ciprofloxacin and a cation containing product must be prescribed together:
·         Administration times should be as far apart as possible
·         Reduce the dosing frequency of the interacting product if possible
·         In the case of oral nutritional supplements, multiple sips throughout the day should be replaced with set administration times to enable adequate spacing from oral antibiotic administration
·         If a patient is receiving an enteral feed tetracyclines and fluoroquinolones should generally be avoided unless there is a specific feed free window  
 
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 Empirical Treatment Guidelines 
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          Antibiotic Prophylaxis
  
Antimicrobial agents
 
Sepsis guidelines
 
Antimicrobial interactions

Antibiotic administration​

Antimicrobials in renal impairment​​​
 
Antimicrobials in hepatic impairment​
 
Antimicrobial stewardship
 
Infection prevention & control

Laboratory information
 
Outpatient IV antibiotic therapy (OPAT)
 
Educational resources
 
Useful links
 
Contacts

Infection consult service guidelines (log in required)
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