Therapeutic Handbook - GGC Prescribing

Table 1 – Antibiotic IV to oral switchInfectionsIV antibioticAmoxicillinAmoxicillin + Gentamicin(for pyelonephritis withsepsis)BenzylpenicillinClarithromycinClindamycinCo-amoxiclavCo-trimoxazoleFlucloxacillinGentamicinGentamicin + Amoxicillin +Metronidazole(intra-abdominal sepsis)MetronidazoleVancomycinVancomycin + Gentamicin+ Metronidazole(intra-abdominal sepsis)Oral antibioticAmoxicillin 500 mg - 1 g 8 hourlyCo-amoxiclav 625 mg 8 hourly (assuming narrow spectrum agentnot appropriate).Amoxicillin 500 mg - 1 g 8 hourly (for suspected pneumococcalinfection).Phenoxymethylpenicillin ( Pen V) 500 mg 6 hourly or 1 g 12 hourly(for pharyngitis / tonsillitis).Clarithromycin 500 mg 12 hourlyClindamycin is indicated in: suspected necrotising fasciitis, severe/ rapidly progressive skin and soft tissue infection, possiblestreptococcal / staphylococcal toxic shock or severe pharyngitis.Clindamycin 450 mg 8 hourly (< 70 kg)Clindamycin 600 mg 8 hourly (> 70 kg)Is there a narrow spectrum alternative? (e.g. Amoxicillin500 mg - 1 g 8 hourly) otherwise Co-amoxiclav 625 mg 8 hourlyCo-trimoxazole 960 mg 12 hourly (unless PCP or multi-resistantinfections in which case seek advice from microbiology / infectiousdiseases unit). Use trimethoprim if a sensitive organism is isolated.Flucloxacillin 500 mg -1 g 6 hourlyStop after a maximum of 3 - 4 days unless there is a clear clinicaland microbiological need. If required for longer, seek microbiology/ infectious diseases unit advice. Monitor for signs of oto andvestibular toxicity (see page 265). Consider:• Is gram negative cover still required? If not stop• Is there any positive microbiology? If so simplify• See above / below for intra-abdominal / urinary sepsis switches.Co-amoxiclav 625 mg 8 hourlyMetronidazole 400 mg 8 hourlyContact microbiology / infectious diseases unit for adviceCiprofloxacin 500 mg 12 hourly + Metronidazole 400 mg 8 hourlyMost infections will require < 7 days total antibiotic therapy (IV and oral).Page 206