Introduction: Empiric antibiotic choices at CHBAH

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. There is a 24-hour ID and (telephonic) microbiology service at CHBAH: please contact the clinician on call (consult the Care coordination section on the EMGuidance platform) even in situations where patients require ID input after hours.

• General principles to remember with regard to empiric antibiotic use at CHBAH:
• Where clinically indicated, de-escalate to an oral antibiotic as soon as possible
• Antibiotics should be dosed according to each patient’s glomerular filtration rate (GFR), and therapeutic drug monitoring should be done if nephrotoxic antibiotics (aminoglycosides, vancomycin) are used
• Consider health-care associated infection in any patient that experiences clinical deterioration that is associated with symptoms and signs of infection within 2 weeks of a previous hospitalization episode, or beyond 48 hours of the current hospitalization
• Consider health-care associated infection in neonates previously managed in the CHBAH Neonatal Unit, within 90 days of prior hospitalization
• The extended (90 day) window should also be considered in children managed by Paediatric Oncology
• Note: Ertapenem does not cover Pseudomonas aeruginosa and Acinetobacter baumannii infections
• Acinetobacter baumannii infections should be treated according to isolate susceptibility and after discussion with clinical microbiology and/or ID

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The Guidelines are presented according to Medical and Surgical Disciplines:

1. Department of Internal Medicine

2. Department of Obstetrics and Gynaecology

2.1 Gynaecology

2.2 Obstetrics/ Post-natal

3. Department of Surgery

3.1 General Surgery

3.2 Paediatric Surgery

4. Department of Paediatrics and Child Health

5. Quick Sepsis-related Organ Assessment (qSOFA)

6. Therapeutic Drug Monitoring for Aminoglycosides and Vancomycin

7. Renally Adjusted dosing of Vancomycin in adults

8. Renally Adjusted dosing of Amikacin in adults