Antibiotics | Right Decisions

IV antibiotics administration

Prior to making up any antibiotics you need to check MEDUSA (NHS Injectable Medicines Guide).

This contains instructions on how to prepare and administer IV medication.

Go to the bottom of the intranet homepage.

Select Medusa Injectable Medicines Guide then click on homepage link.

Alternatively, you can click here to link directly to Medusa Injectable Medicines Guide .

Click Adult IntraVENOUS medicines.

Search for medication press go.

Then click on correct medication from drop down list.

Click show monograph.

Follow 'Preparation and Administration' instructions.

Medication	Indication	Anything of note
IV Pipercillin Tazobactam (Taz)	1st line for new pyrexia	Broad spectrum antibiotic Contains penicillin
IV Ceftazadime	1st line for new pyrexia if allergic to penicillin
IV Aztreonam	1st line if severe allergy to penicillin
IV Gentamicin
IV Vancomycin
IV Meropenem
Metronidazole

Further treatment guidance / reference documents:

More information can be found at Antimicrobial prescribing: NHS Lothian on the Right Decisions Service.

Gentamicin is a broad spectrum antibiotic.

It is given to haematology patients if they are neutropenic septic.

Given to patients prior to catheter insertion if they are neutropenic.

Dosing is weight related, ensure your patient has an up to date weight.

Given once a day unless renal function impaired. Gentamicin dosing calculator works out the recommended frequency.

Check dose on dosing calculator and monitoring chart (specific to patient) and Hepma.

Levels must be taken to ensure gentamicin is at a therapeutic level.

Gentamicin levels
Record the exact date and time the sample was taken, on the monitoring chart. Ensure that gentamicin level has been checked prior to administration of next dose.
Take a gentamicin level at the time suggested on the calculator, as dosing and level times are dependent on specific patient.
If CrCL is 21 or higher	Level to be taken 6 to 14 hours after the start of the infusion.
If CrCL is lower than 21	Level to be taken 24 hours after the start of the infusion.

Further treatment guidance / reference documents:

More information can be found at Gentamicin - how to use it well! on the Right Decisions Service.

Full guidance should always be accessed in conjunction with the information above, table should not be used in isolation.

Vancomycin is an antibiotic used to treat a variety of bacterial infections.

Dosing is weight related, ensure your patient has an up to date weight.

Daily U&E’s to check creatinine clearance as vancomycin is eliminated via kidneys.

Check dose on form and HEPMA.

Levels must be taken to ensure vancomycin is at a therapeutic level.

Check dose on form and HEPMA.

Vancomycin Levels
Blood levels should be taken up to 1 hour before the dose. Do not wait for the level result before administering the next dose. Document date and time that the vancomycin level was taken on the monitoring form.
12 hourly maintenance dosing	Trough level should be taken before 3rd maintenance dose. When dose changed re-check trough level before 3rd new maintenance dose if remains on 12 hourly dosing.
24 hourly maintenance dosing	Trough level should be taken before 2nd maintenance dose. When dose changed re-check trough level before 2nd new maintenance dose if remains on 24 hourly dosing.
48 hourly maintenance dosing	Trough level should be taken before 1st maintenance dose. When dose changed re-check trough level before 3rd new maintenance dose if remains on 48 hourly dosing.

Further treatment guidance / reference documents:

More information can be found at Vancomycin - adult intermittent infusion on the Right Decisions Service.

Full guidance should always be accessed in conjunction with the information above, table should not be used in isolation.

Commonly Used Oral antibiotics within Edinburgh Cancer Centre (For IV antibiotics see Commonly used IV antibiotics, above)

Further treatment guidance / reference documents:

Only accessible from an NHS Lothian Device: