GuidelinesOther guideline
Department of Internal Medicine
The current recommended empiric antibiotic choices and empiric durations for suspected bacterial infections at CHBAH, based on consensus agreement between Infectious Diseases (ID), Microbiology and specialties after review of our 2018 antibiogram data, is as follows until directed therapy is possible.
Community Acquired non-central nervous system (CNS) Infections (first 48 hours of admission):
- GFR>30: Co-amoxiclav 1.2g IV 8 hourly, max 5 days
- GFR<30: Co-amoxiclav 600mg IV 8 hourly, max 5 days
Community Acquired CNS Infections (first 48 hours of admission):
- Ceftriaxone 2g IV 12 hourly, max 10 days (stop if LP/ CTB not suggestive)
Health-care Associated Infections (after 48 hours of admission or readmission within 2 weeks):
- GFR>50: Piptaz 4.5g IV 6 hourly (max 5 days if cultures negative) + Amikacin 15mg/kg/day (max 3 days if cultures negative)
- GFR<50*:
- Day 1: Piptaz 4.5g IV stat + Amikacin 15mg/kg IV stat (loading dose) followed by Piptaz 2.25g IV 6 hourly
- Day 2: Continue Piptaz 2.25g IV 6 hourly, do Amikacin trough level and hold Amikacin
- Day 3: Continue Piptaz 2.25g IV 6 hourly (max 5 days if cultures negative), check Amikacin trough level and dose according to drug level and GFR **If Amikacin trough level still pending, give a renally adjusted dose of Amikacin and stop (max 3 days if cultures negative, thereafter directed therapy)
*Consult ID for all patients with suspected Health-Care Associated Infections and GFR <50