Therapeutic Handbook - GGC Prescribing

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Meningitis Contacts• All suspected cases of meningococcal disease are notified to the NHS<strong>GGC</strong> Board, Public HealthProtection Unit (see Appendix 6 for contact detail)• Specialists in Communicable Disease will identify close family and friends of the patient who mayrequire antibiotic prophylaxis.• This should be given as soon as possible (ideally within 24 hours) after diagnosis of the indexcase.InfectionsMeningitis ContactProphylaxisOral therapy (wheneverpossible)When oral therapy notappropriateAntibiotic TherapyCiprofloxacin oral 500 mg as asingle doseCeftriaxone* 250 mg IM as asingle doseNotes / CommentsCiprofloxacin has anunpredictable effect onepilepsy but is preferred torifampicin if the patient is onphenytoin. Ciprofloxacin is alsothe recommended option inpregnancy.Ciprofloxacin is unlicensed forthis purpose.See BNF for children’s doses.N.B. Ciprofloxacin QTcprolongation.*Ceftriaxone:• Is an Alert antibiotic –complete Alert Form.• It must not be mixedwith calcium-containingsolutions, and mustnot be given to anypatient simultaneouslywith calcium-containingsolutions – even viadifferent infusion lines.Continues on next pagePage 248
Brain abscess• Perform blood cultures.• Discuss treatment and duration with neurosurgery and microbiology / infectious diseases unit.Potential source:• Sinus (Strep milleri, Pneumococcus, H. influenzae)• Middle ear (mixed aerobes and anaerobes)• Post traumatic (Staph aureus or mixed infections)• Blood stream, endocarditis (Staph and Strep species)Infection Antibiotic Therapy Notes / CommentsUpper respiratory tract source*Ceftriaxone:(sinus and middle ear)Post traumatic or blood streamsourceCeftriaxone* IV 2 g 12 hourlyandMetronidazole IV 500 mg8 hourlyTotal course duration – discusswith neurology or microbiology/ infectious diseases unit.If true penicillin / beta-lactamallergy: contact microbiology/ infectious diseases unit foradvice (Appendix 6 for contactdetails).As above and add:Flucloxacillin IV 2 g 4 hourlyIf true penicillin / beta-lactamallergy: contact microbiology/ infectious diseases unit foradvice (Appendix 6 for contactdetails).Total course duration – discusswith neurology or microbiology/ infectious diseases unit.• Is an Alert antibiotic -complete Alert Form.• Must not be mixed withcalcium-containingsolutions, and mustnot be given to anypatient simultaneouslywith calcium-containingsolutions – even viadifferent infusion lines.InfectionsPage 249
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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
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OtherInitiating Long-term Anti-epil
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Continued from previous page2. 'Top
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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 252 and 253: InfectionsSkin and soft tissue infe
Page 254 and 255: InfectionsSkin and soft tissue infe
Page 256 and 257: Central nervous system infectionsBa
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
Page 302 and 303: Oral antidiabetic drugs continued3.
Page 304 and 305: Other InformationGeneral advice on
Page 306: 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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