Late Onset (> 5 days)

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

Micro Organisms

Pseudomonas spp. more likely

First Line

Therapy

<1 month: Cefotaxime IV

Add gentamicin IV if severe infection

Add vancomycin IV if MRSA suspected or confirmed

 

>1 month - 18 years: Ceftriaxone IV 

Add gentamicin IV if severe infection

Add vancomycin IV if MRSA suspected or confirmed

Notes:

Consider IV to oral switch when afebrile > 24 hours and clinically improving

Escalation - (Second line)

Therapy

>1 month - 18 years: Tazocin 6-hourly IV 

Add gentamicin IV if severe Pseudomonal infection

Add vancomycin IV if MRSA suspected or confirmed

Notes:

Consider IV to oral switch when afebrile > 24 hours and clinically improving

Escalation - (Penicillin allergy)

Therapy

>1 month - 18 years: Vancomycin IV + Ciprofloxacin IV (use higher dosing as per BNFc to cover pseudomonas spp.)

Notes:

IV to oral switch when afebrile > 24 hours and clinically improving

Ceftriaxone is suitable for those with a previous allergy to penicillin antibiotics. Vancomycin + ciprofloxacin should only be used when an escalation in therapy is required and Tazocin is not suitable.