Department of Surgery
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.
General Surgery
Community Acquired non-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) + Amikacin 15mg/kg/day (max 3 days)
- GFR<50: Renally adjusted doses of Piptaz and Amikacin (max 5 days). Do drug trough and/or peak levels (See: Therapeutic Drug Monitoring for Aminoglycosides and Vancomycin) on all patients on amikacin with GFR<50
* Recommendations for Trauma/ Colorectal/ Breast/ General Surgery/ Vascular Surgery
Paediatric Surgery
Neonates (admitted from community)
Neonatal sepsis:
- Ampicillin 50mg/kg/dose IV (First week of life: 12 hourly, weeks 2-3: 8 hourly, >3 weeks: 6 hourly) + Cefotaxime 50mg/kg/dose IV (First week of life: 12 hourly, weeks 2-4: 8 hourly, >3 weeks: 8 hourly)*, with an LP prior to antibiotics
Children ≥ 1 month of age (corrected age)
Community Acquired non-CNS Infections (first 48 hours of admission):
- Severe infections eg. Complicated intra-abdominal infections:
- Co-amoxiclav 25 mg/kg/dose – IV 8 hourly, max 5 days
- If penicillin allergy, or atypical organism suspected at 48 hour review: Azithromycin 10mg/kg/dose – once daily po x 3 days
- Add Clindamycin 10 mg/kg/dose IV 8 hourly for skin and soft tissue infections
- Non-severe infections:
- Co-amoxiclav if <20 kg: 10-15 mg/kg/dose (of amoxicillin), if >20 kg: 375mg (250mg amoxicillin, 125mg clavulanate) – 8 hourly po, max 5 days
-
If penicillin allergy, or atypical organism suspected: Azithromycin 10mg/kg/dose – once daily po x 3 days
Community Acquired CNS Infections (first 48 hours of admission):
- Ceftriaxone 25–40 mg/kg/dose 12 hourly IV, 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 150 mg/kg/dose IV stat (loading dose) followed by 75 mg/kg IV 6 hourly (max 5 days) + Amikacin <10 years: 25 mg/kg (day 1) then 20 mg/kg/24 hourly >10 years: 20mg/kg (day 1) then 15 mg/kg/24 hourly (max 3 days)
-
GFR<50**:
-
Renally adjusted doses (max 5 days). Do drug trough and/or peak levels (See: Therapeutic Drug Monitoring for Aminoglycosides and Vancomycin) on all children on amikacin
-
If skin and soft tissue infection, add MRSA cover: Vancomycin 10 mg/kg IV 6 hourly (max 3 days if cultures negative). Do drug trough levels on all children on vancomycin (See: Therapeutic Drug Monitoring for Aminoglycosides and Vancomycin)
*If Cefotaxime is unavailable, Ceftazidime may be used as a non-ideal alternative agent. Ceftazidime 50mg/kg/dose IV (First week of life: 24 hourly, weeks 2-3: 12 hourly, >3 weeks: 8 hourly).
**Reassess daily
- If clinical deterioration do CRP, repeat cultures and consult Paeds ID urgently for possible escalation to meropenem and vancomycin
- If cultures negative at 72 hours and no clinical improvement, consult Paeds ID