Antibiotic Therapy (BNF)

• Penicillins
• Benzylpen., Phenoxymethylpen: Strep, Pneumoc, Gonoc, Meningoc
• Penicillinase-resistant Pen: Flucloxacillin: G+ esp. Staph | Temocillin: G-
• Broad-spectrum Pen.: Amoxicillin | Ampicillin | Co-amoxiclav | Co-fluampicil
• Anti-pseudomonal Pen: Piperacillin [with tazobactam=Tazocin] | Ticarcillin [with clavulanic acid=Timentin]
• Mecillinams: Pivmecillinam
• Cephalosporins & other beta-lactams:
• Cefalexin | Cefradine | Cefadroxil =1st gen, po
• Cefaclor = 2nd gen po
• Cefuroxime = 2nd gen (also some G+ eg Staph)
• Cefotaxime | Ceftazidime [esp. pseudomon] | Ceftriaxone [od] = 3rd gen (better G-, less G+)
• ['Monobactam'] Aztreonam [=Azactam]: G- aerobic
• Ertapenem [=Invanz]: G+, G-, Anaerob [not atyp pneumonia or pen-resistant pneumoc or pseudomon]
• ['Carbapenem'=] Imipenem [with Cilastatin=Primaxin]: G+ G- Anaerob | Meropenem [=Meronem]: esp CNS (less seizures)
• Tetracyclines: Tetracycline | Demeclocycline | Doxycycline | Lymecycline | Minocycline | Oxytetracycline | Tigecycline
• Aminoglycosides: Gentamicin | Amikacin | Neomycin | Tobramycin
• Macrolides: Erythromycin | Azithromycin | Clarithromycin | Telithromycin
• Clindamycin: G+ cocci (incl Strep and Pen-resist Staph), many anaerobes, esp. bone, bile, urine [NB: C.diff]
• Other:
• Chloramphenicol: only thyphoid or H. influenzae
• Fusidic acid: pen-resistant staph (esp. bone)
• [Glycopeptides:] Vancomycin | Teicoplanin: aerob & anaerob G+ bact incl multi-resist staph [but emerging reduced suscept Staph and enterococci=VRE]
• [Lipopeptide:] Daptomycin: sim to Vancomycin: eg MRSA
• [Oxazolidinone:] Linezolid: MRSA, VRE; no activity against G-
• [Streptogramins:] Quinupristin and dalfopristin: MRSA, no activity against G- or Enterococcus faecalis
• [Polymyxins:] Colistin: G- esp pseudomon, acinetobacter, klebsiella;

Antibiotic Guidelines (FGH)

• Sepsis
• moderate
• Co-amoxiclav 1.2g IV tds
• + Gentamicin min(7mg/kg * wt, 480mg) IV stat
• severe / neutropenic
• Tazocin 4.5g IV tds
• + Gentamicin min(7mg/kg *wt, 480mg) IV od [avoid in CKD / platinum chemo]
• Pneumonia
• CAP
• Non-severe (CURB65<3)
• Amoxicillin 500-1000 tds
• +- Erythromycin 500 qds [or Clarithromycin 500 bd if intol] if likely atypical infection
• if pen-allergy: Levofloxacin 500 od
• Severe (CURB65>=3)
• Co-amoxiclav 1.2g IV tds
• + Clarithromycin 500 IV bd
• +- Rifampicin (on ITU)
• if pen-allergy: Levofloxacin PO/IV 500 od/bd
• HAP
• mild, <5/7 since admission, no recent Abx:
• Co-amoxiclav {625 PO | 1.2g IV} tds
• if pen-allergy: Levofloxacin 500 PO/IV od/bd
• else:
• Tazocin 4.5g IV tds
• if pen-allergy: Ciprofloxacin {400 IV | 500 PO} bd
• +- Gentamicin
• Aspiration pneumonia
• Co-amoxiclav {1.2g IV| 625 PO} tds
• pen-allergy: d/w micro
• UTI
• Simple
• Trimethoprim 200 bd for 3-5/7; OR
• Nitrofurantoin 50 qds for 3-5/7; OR
• Cefalexin 500 tds for 5/7 [avoid if prev. C.diff]
• Pyelonephritis
• Co-amoxiclav 1.2g IV tds +- Gentamicin min(7mg/kg * wt, 480mg) IV, OR
• Ciprofloxacin {400 IV| 500 PO} bd [not if pregnant or epileptic] +- Gentamicin min(7mg/kg * wt, 480mg) IV, OR
• Cefuroxime 750-1500 IV tds [1st line in pregnancy]
• after 24-48h: Ciprofloxacin 500 PO bd [not in pregnancy] for total 7-14/7
• Cellulitis
• mild
• Flucloxacillin 500-1000 PO qds
• if pen-allergy: Erythromycin 500 PO qds [or Clarithromycin 500 PO bd if intolerant]
• moderate/severe:
• Benzylpen. 1.2g IV
• + Flucloxacillin 1g IV qds
• +- {Vancomycin | Teicoplanin} if MRSA of concern
• if pen-allergy: Clindamycin {600 IV | 300-450 PO} qds
• C. diff. diarrhoea
• Metronidazole 400 PO tds x 10/7, OR
• Vancomycin 125-250mg PO qds [if severe]
• Fungal infections
• Simple oral candidiasis:
• Nystatin mouth suspension 1ml qds for 7/7, OR
• Amphotericin lozenges 10mg qds for 10-15/7, OR
• Fluconazole 50 od for 7/7 [resistant cases]

 Endocarditis

• Gentamicin in BE: html; pdf;