Therapeutic Handbook - GGC Prescribing

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InfectionsSkin and soft tissue infections (continued from previous page)Infection Antibiotic Therapy Notes / CommentsSevere or rapidly spreadingcellulitis / erysipelas orstreptococcal toxic shock(non-drug user)Flucloxacillin IV 2 g4 - 6 hourlyandGentamicin* IV (dosing infopage 262)andClindamycin** IV 600 mg6 hourlyIf true penicillin / beta-lactamallergy:Vancomycin IV (dosing infopage 266)andGentamicin IV (dosing infopage 262)andClindamycin** IV 600 mg6 hourlyTotal course duration usually10 days (IV and oral).If clinically clear cut ormicrobiologically proven Betahaemolytic Streptococcalinfection (erysipelas) thenadd: Benzylpenicillin IV 1.2 g6 hourly.See IVOST protocol page 205for appropriate time to changeto oral therapy and switchoptions. If using Vancomycinor Gentamicin contactmicrobiology / infectiousdiseases unit for oral switchguidelines.Consider referral to OPAT (seeAppendix 6 for contact details)*Do not continue Gentamicinbeyond 3 - 4 days unlesson the advice of an infectionspecialist. If you are unsurewhether > 4 days is needed,contact an infection specialist.**Alert antibiotic – completeAlert Form.Table continues on next pagePage 242
Skin and soft tissue infections (continued from previous page)Infection Antibiotic Therapy Notes / CommentsSuspected necrotising fasciitis(non drug user or drug user)or any rapidly spreading orsevere infection in parenteraldrug userLeg ulcersBenzylpenicillin IV 2.4 g6 hourlyandFlucloxacillin IV 2 g 4 - 6 hourlyandGentamicin IV (dosing infopage 262)andClindamycin* IV 600 mg6 hourly (up to 1200 mg6 hourly)Metronidazole IV 500 mg8 hourlyIf MRSA suspected or if truepenicillin / beta-lactam allergy:Treat as above butreplace flucloxacillin andbenzylpenicillin with:Vancomycin IV (dosing infopage 266)Total course duration 10 - 14days**.Treat only if additionalevidence of clinical infection* ispresent.If antibiotic therapy is requiredtreat as cellulitis and refer forspecialist opinion followingclinical review and if judged tobe severe.Seek urgent surgical /orthopaedic review and advicefrom microbiology / infectiousdiseases unit.*Clindamycin is an alertantibiotic. Complete alert formto obtain supply.** At 48 hours consultmicrobiology / infectiousdiseases unit beforediscontinuing or switching fromIV to oral.*Signs of clinical infection are:Inflammation / redness /cellulitis with at least one of:- Increased pain;- Purulent exudate;- Rapid deterioration ofulcer; or- Pyrexia.If no signs of clinical infection,antibiotics do not improvehealing. Bacteria will alwaysbe present.Diabetic foot ulcers requirespecialist podiatry / diabetesteam assessment for evidenceof deep seated (bone) infection(management of infection seepage 245).Table continues on next pageInfectionsPage 243
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ContentsEditorial GroupAcknowledgem
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AppendicesAppendix 1 - Nicotine Rep
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AcknowledgementsA huge number of pe
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Summary of Major changes in Therape
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On discharge• As the discharge pr
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Other examples• Sevredol 10 mg ta
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Antiplatelets and anticoagulants:In
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non-Formulary medicines, a complete
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Quick guide to using the handbookWh
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Sections1. Resuscitation and Anaphy
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Section 1Resuscitation and Anaphyla
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Continued from previous page2. Adre
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Peri-arrest ArrhythmiasGeneral advi
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Broad QRS - continuedNarrow QRS - c
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Guidelines on Blood TransfusionThis
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Management of Major Haemorrhage(See
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Hospital Specific Information on Ma
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Table continued from previous pageG
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Assessment / MonitoringAKI stage I
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Section 2Drug Overdose and Toxicity
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Treatment of Paracetamol OverdoseTh
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Management of paracetamol overdose
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Lithium toxicityNormal range 0.4 -
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Management of DyspepsiaGastrointest
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Table continued from previous pageR
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Management of Gastroduodenal Ulcers
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Management of Upper Gastrointestina
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Post endoscopy continuedb. Arrange
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General management and treatment op
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- SAAG can differentiate ascites re
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General management and drug therapy
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Drug therapy• Unless contraindica
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Consider:• Serum caeruloplasmin,
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Section 4Cardiovascular SystemCardi
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Table 1 - Indicators of patients at
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Continued from previous pageIf the
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Diagnosis and Treatment of VenousTh
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Wells Clinical score should be util
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IV Drug Misusers• Given their cha
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Drug therapy / treatment options co
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RivaroxabanRivaroxaban is an oral d
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Diagnosis of VTE in pregnancy• If
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Referral of Patients to Anticoagula
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Reversal of Anticoagulant TherapyIn
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Elective admissions - Risk Stratifi
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Elective admissions - restarting an
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Suspected Acute Coronary Syndrome (
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If patient is for PPCI go to Box 1.
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Drugs for acute coronary syndrome /
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Secondary Prevention of Coronary He
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Cardiovascular SystemTroponin posit
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Atherosclerotic arterial disease is
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Algorithm for Cardioversion of AFSt
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Cardiovascular SystemVentricular ra
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Prevention of stroke / thromboembol
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Drugs for atrial fibrillation conti
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CPAP in cardiogenic pulmonary oedem
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Management of HypertensionCardiovas
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Cardiovascular SystemGeneral manage
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Management of Acute Stroke 3Transie
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Secondary prevention of stroke and
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Cardiovascular SystemPage 126
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Guidelines for Blood Gas AnalysisRe
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Respiratory SystemNext consider aci
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Management of Acute Severe Asthmain
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Management of Acute Severe Asthma i
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Management of Chronic ObstructivePu
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Acute Exacerbation of Chronic Obstr
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Treatment options continued• If p
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Step 4 - Initiation of NIVAIM = To
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Investigation of Unilateral Pleural
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Investigation of unilateral pleural
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General management• Oxygen as app
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Management of PneumothoraxIntroduct
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Management of StridorIntroductionSt
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Initial Management of Superior Vena
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Section 6Central Nervous SystemCent
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Analgesics for acute painSTEP 3STEP
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Analgesics for acute pain - prescri
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Management of Postoperative Nausea
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Management of Acutely Disturbed Pat
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Pharmacological Management - Patien
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Guidance on Night SedationPatients
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Management of Alcohol Withdrawal Sy
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Continued from previous pageUnable
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Continued from previous pageImporta
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Flow diagram for use with Hospital
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Continued from previous pageMethado
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Management of Suspected Subarachnoi
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Sampling requirements for the Bioch
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Referral to Neurosurgical Unit cont
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Management of Status EpilepticusInt
Page 201 and 202: OtherInitiating Long-term Anti-epil
Page 203 and 204: Continued from previous page2. 'Top
Page 205 and 206: Decision making algorithm for the a
Page 207 and 208: Drug therapy / treatment optionsNil
Page 209 and 210: Section 7InfectionsInfectionsPage 1
Page 211 and 212: • In patients with sepsis -- Star
Page 213 and 214: Gentamicin and Vancomycin: Reducing
Page 215 and 216: IV-Oral Antibiotic Switch Therapy (
Page 217 and 218: Alert Antibiotic Policy(The full ve
Page 219 and 220: Table 1 - Alert Antibiotics continu
Page 221 and 222: Infection Management GuidelinesSeve
Page 223 and 224: Sepsis Source Unknown (not immunoco
Page 225 and 226: Table continued form previous pageI
Page 227 and 228: Table continued from previous pageE
Page 229 and 230: UTI in non-pregnant women Antibioti
Page 231 and 232: UTI in pregnant women Antibiotic Th
Page 233 and 234: Table continued from previous page
Page 235 and 236: Catheter-related UTI Antibiotic The
Page 237 and 238: Table continued from previous pageU
Page 239 and 240: Table continued from previous pageU
Page 241 and 242: Pneumonia(Also see page 148 for man
Page 243 and 244: Table continued from previous pageC
Page 245: Pneumonia (continued from previous
Page 248 and 249: InfectionsTable continued from prev
Page 250 and 251: Treatment of Clostridium difficile
Page 254 and 255: InfectionsSkin and soft tissue infe
Page 256 and 257: Central nervous system infectionsBa
Page 258 and 259: Meningitis Contacts• All suspecte
Page 260 and 261: Viral infectionsViral Encephalitis
Page 262 and 263: Guideline updated 11/10/13Genito-ur
Page 264 and 265: Genito-urinary infections (continue
Page 266 and 267: Patients with absent or non-functio
Page 268 and 269: MRSA Eradication Policy• In newly
Page 270 and 271: InfectionsDosage regimens for antib
Page 272 and 273: Gentamicin dosing guidelines (For p
Page 274 and 275: Step 2 continued from previous page
Page 276 and 277: Vancomycin dosing guidelines (For p
Page 278 and 279: Continued from previous page - If t
Page 280 and 281: B. Vancomycin continuous infusionSt
Page 282 and 283: Vancomycin - continuous infusion re
Page 284 and 285: InfectionsPage 274
Page 286 and 287: Management of Diabetic Ketoacidosis
Page 288 and 289: Endocrine System5. Signs of cerebra
Page 290 and 291: Assessment / monitoring• Glucose
Page 292 and 293: Important points1. This regimen is
Page 294 and 295: Diabetes therapy continued• Retro
Page 296 and 297: Insulin Sliding Scale (Not for use
Page 298 and 299: Management of HypoglycaemiaIntroduc
Page 300 and 301: Endocrine SystemContinued from prev
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Oral antidiabetic drugs continued3.
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Other InformationGeneral advice on
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Guideline updated 18/09/13Managemen
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Management of hypomagnesaemia in ad
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Management of Hyponatraemia• Earl
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Section 10Musculoskeletal and Joint
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Treatment optionsManagement of acut
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Treatment options continuedNSAIDs a
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Section 11Palliative CarePalliative
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Analgesic Step LadderStep 1: Mild P
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Opioid Conversion ChartThis is advi
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Palliative Care - SymptomsSee BNF,
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Table continued from previous pageP
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Management of symptoms present in l
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Section 12Oncological EmergenciesOn
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Malignant Spinal Cord Compression (
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Raised intracranial pressure in can
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Treatment /drug therapy continued5.
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N.B.• Laboratory TLS = > 2 labora
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• Avoid serum CA125 testing as it
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AppendicesAppendicesPage 339
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Appendix 2Preparation of Intravenou
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Glyceryl Trinitrate (GTN) infusionG
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Table 2 - Other drugsDrug Time to s
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Appendix 5Normal ImmunoglobulinsNor
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Drug MisuseHospital Liaison Addicti
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Outpatient Parenteral Antibiotic Th
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IndexPage 353
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AnticoagulantsIn treatment of VTE/P
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CiprofloxacinAlert Antibiotic Polic
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EEmergency sedationGeneral principl
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Hyoscine butylbromideIn palliative
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Mesalazine, oralIn inflammatory bow
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PhenytoinDosing and monitoring guid
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TeicoplaninDosing and monitoring...
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Notes
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Notes
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© NHS Greater Glasgow and ClydeAug
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Therapeutic Handbook - GGC Prescribing

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