Antimicrobial prescribing: NHS Lothian
- Blood cultures
- Urine culture
Urosepsis post stent change/insertion
Warning
Temperature as part of SIRS response can be a normal post-operative phenomenon, please only consider starting antibiotics when there is a suspected or present source of infection, and after appropriate senior review.
Review any recent microbiology samples, any samples from theatre, and review the last three cultures (up to 12 months ago). If gentamicin resistant organism isolated please contact microbiology.
For patients failing to respond to antimicrobials senior review is required, with imaging/source control to be considered. Please discuss with microbiology after senior review.
If the patient is well at three days post procedure, with no clinical evidence of urinary tract infection and negative cultures, antibiotics can be stopped.
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Recommended Antibiotic
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Amoxicillin 1g every 8 hours IV AND Gentamicin* (use NHS Lothian Calculator on AMT intranet page) |
| Penicillin allergy/MRSA |
Vancomycin IV (use NHS Lothian Calculator on AMT intranet page: aim trough levels 15-20mg/L AND Gentamicin* (use NHS Lothian Calculator on AMT intranet page) |
* Was gentamicin given for surgical antimicrobial prophylaxis?
If patient has features of sepsis and received Gentamicin prophylaxis within the prior 24 -48 hours (i.e. unable to give further Gentamicin) consider first discussing with clinical pharmacist in hours and microbiology out of hours and for suitable alternatives.
Noted SIRS response is common in the early post-op period.
- Review the need for IV antibiotics daily and IVOS when able.
- Review microbiology results. Where a urine or blood culture result is positive choose an antibiotic to which the isolate is sensitive preferentially from the Access group of antibiotics (e.g. amoxicillin, usual dose is 1g every 8 hours, or co-trimoxazole as per dosing below).
- Nitrofurantoin and Pivmecillinam are not suitable for IV oral step down for systemic infections. Cefalexin should only be used for IVOST after discussion with an infection specialist.
If no positive microbiology results available:
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Recommended Antibiotic (including for penicillin allergy)
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Co-trimoxazole 960mg every 12 hours orally. In patients with renal impairment please adjust dose as per BNF and monitor U+Es. Not suitable if patient allergic to trimethoprim, or urine cultures in previous 12 months have shown a trimethoprim-resistant organism. If resistance or alternative agent required contact microbiology for advice. |