Empirical antimicrobial therapy for surgical infections in adults

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IV if on Piperacillin/Tazobactam (Tazocin ®)), send MRSA screen, andcontact Microbiology for sensitivitiesIf failure to respond after 48 hours: Discuss with senior surgeon +/-MicrobiologyOral switch: Doxycycline 200mg od PO + Metronidazole 400mg tdsPO [this can be given from onset with addition of gentamicin 5mg/kg odIV for a minimum of 48 hours (see Trust guideline) if clinical conditionallows]As above for complicated post-op infectionsPLUS Fluconazole 400mg od IVPost-opoesophagealperforationSevere Sepsis (see definition below)Upper GI andlower GISevere Sepsis: ≥2SIRS criteriaAND evidence ofinfection ANDorgan dysfunctionAntibiotic naïve (excluding surgical prophylaxis): Amoxicillin 1g tdsIV + Metronidazole 500mg tds IV + Gentamicin 5mg/Kg od IV (seeTrust guideline)If Crcl ≤ 20mls/min: Piperacillin/Tazobactam (Tazocin ®) 4.5g bd IV.Consider addition of stat dose of gentamicin 2mg/Kg IV.Penicillin allergy: Co-trimoxazole 960mg bd IV replaces AmoxicillinMRSA or high risk of MRSA: Give Vancomycin IV (see Trustguideline) instead of Amoxicillin / Co-trimoxazole, send MRSA screen,and contact Microbiology for sensitivitiesHealthcare associated or recent treatment course (last 10 days)with IV antibiotics: Piperacillin/Tazobactam (Tazocin ®) 4.5g tds IV ±Vancomycin IV (see Trust guideline). Send MRSA screen and stopVancomycin if screen & diagnostic specimens negative. If penicillinallergy contact Microbiology for treatment optionsPANCREATITIS – calculate *Glasgow scoreMild (score 0-2) Antibiotics not indicatedDependant on surgicalmanagementTreat within ONE hourof diagnosis.Review daily – discusswith Microbiology withinnext 24 – 48 hoursSend MRSA screenIf source control notachieved, discuss withconsultant re: furthersurgical interventionSevere(score 3-8)>30% necrosis onCT scan at 48hours1st choice: Piperacillin/tazobactam (Tazocin®) 4.5g tds IVMild penicillin allergy: Meropenem 1g tds IVSevere allergy: Discuss with MicrobiologyMRSA: Add Vancomycin IV (see Trust guideline)Add Fluconazole 400mg od IV to above regimenMaximum 10 days*Glasgow score: score 1 point for any of the following occurring at any time in the first 48 hours of admission:• Age >55 years• Serum albumin 16.1 mmols/L (45 mg/dL)• WBC count >15 x 10^9/L (15 x 10^3/microlitre)Glasgow Score Severity Assessment0-2 Mild3-8 SevereEmpirical antimicrobial therapy for surgical infections in adults (Version 10. 17.09.12)Approved by the Antimicrobial Stewardship Group: September 18 th 2012Review date: September 2014Page 2 of 4
Breast Antibiotic choice DurationMastitis1 st choice: Flucloxacillin 1g qds PO/IVAbscessBreastuncomplicatedsurgical siteinfectionsPenicillin allergy: Doxycycline 200mg od PO or Vancomycin IV (seeTrust guideline)MRSA: Add Vancomycin IV if not already on (see Trust guideline) orcheck lab sensitivities for oral optionIf necrotising infection suspected: Add Clindamycin 1.2g qds IV anddiscuss urgently with senior surgeon +/- MicrobiologyN.B. Doxycycyline is not suitable if pregnant or breastfeeding – contactMicrobiology for alternative treatment options for these patients.Abscesses andcollections should bedrained4-10 days total basedon CRP/WCC/Obs etcAcute breastimplant infectionMust bediscussed withConsultantsurgeon1 st choice: Flucloxacillin 1-2 g qds IVPenicillin allergy: Vancomycin IV (see Trust guideline)If sub-acute or late infection: discuss antimicrobial management withMicrobiology14 days total (discussoral switch withMicrobiology)Urology Antibiotic choice DurationUTIUncomplicatedCheck cultureresults & modifytreatmentaccordingly1 st choice: Trimethoprim 200mg bd PO2 nd Choice: Nitrofurantoin 50–100mg qds POIf pregnant: Cefalexin 500mg bd PO for 7 days – send urine cultureseven days after completion to confirm cure3 days for female7 days for male7 days for pregnantComplicated (e.g. catheter, structural abnormality, post-op etc)7 days1 st choice: Amoxicillin 1g tds IV + Gentamicin 5mg/kg od IV (see Trustguideline, max 5 days). Oral switch asap Trimethoprim 200mg bd PO2 nd Choice (penicillin allergic): Gentamicin 5mg/kg od IV (see Trustguideline, max 5 days). Oral switch asap Trimethoprim 200mg bd POPyelonephritis:10-14 daysAcute prostatitisEpididymo-orchitisSee full guideline1 st choice: Amoxicillin 1g tds IV + Gentamicin 5mg/kg od IV (see Trustguideline, max 5 days). Oral switch asap Co-amoxiclav 625mg tds PO2 nd Choice (penicillin allergic): Gentamicin 5mg/kg od IV (see Trustguideline, max 5 days). Oral switch asap discuss with MicrobiologyUrological severe sepsis see below1 st choice: Trimethoprim 200mg bd PO2 nd choice after discussion with Microbiology: Ciprofloxacin 500mgbd POLikely STD cause: Doxycycline 100mg bd PO + Ceftriaxone 500mgIM single dose (omit if gonorrhoea unlikely)Likely enteric cause: Ciprofloxacin 500mg bd PO14 days10-14 days10 daysEmpirical antimicrobial therapy for surgical infections in adults (Version 10. 17.09.12)Approved by the Antimicrobial Stewardship Group: September 18 th 2012Review date: September 2014Page 3 of 4
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Empirical antimicrobial therapy for surgical infections in adults

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