Canterbury DHB

Context

October 2016

Antimicrobial Guidelines

Gentamicin/tobramycin dosing guidelines (adults)

  • Change to how these agents should be prescribed, i.e. in Medchart.

Gentamicin/tobramycin dosing in patients with spinal injuries

  • Change to how these agents should be prescribed, i.e. in Medchart.

Vancomycin dosing guidelines (adults)

Intermittent dosing:

  • Change to how vancomycin should be prescribed in MedChart.
  • Statement added to point 2b: "The first maintenance dose should be started 12 hours after the loading dose."

Continuous infusions:

  • Change to how vancomycin should be prescribed, i.e. in MedChart.
  • Statement added under point 2: "The first maintenance dose should start immediately following completion of the loading dose".

Meningitis – adults

Empiric.

  • Indications for vancomycin use for pneumococcal cover have been expanded.
  • Patients with severe penicillin allergy. Two changes:
    • ciprofloxacin IV dosing to be eight hourly (not twelve hourly).
    • trimethoprim+sulfamethoxazole IV to be added for listeria cover if warranted. Revised dose to 5 mg/kg (trimethoprim component) IV six hourly (round dose down to the nearest whole vial).

Pathogens known:

  • Listeria monocytogenes (notifiable): Trimethoprim+sulfamethoxazole – revised dose to 5 mg/kg (trimethoprim component) IV six hourly (round dose down to nearest whole vial).

Cholecystitis/cholangitis and Acute peritonitis

  • Change to initial empiric treatment options – cefuroxime and metronidazole (± gentamicin) now first line (note addition of PO route for metronidazole); deleted – amoxicillin + gentamicin + metronidazole.
  • Reorder of oral follow-on options.
  • Amendment of ID/Micro consult to ≥ 3 days.

Group B Streptococcus Agalactiae (GBS) prophylaxis

  • Increased doses of both benzylpenicillin and cefazolin to align with Australian, UK, and US guidelines.

Candidal vulvovaginitis

  • Bullet added under clotrimazole: "If pregnant, the 6 night treatment should be used. Applicator to be inserted gently".

Urinary Tract Infections

  • Uncomplicated acute lower urinary tract infections (cystitis): Significant revision.

Exacerbations of COPD and chronic bronchitis

  • Changes made to align with HealthPathways.

Herpes simplex – orofacial/genital

  • Valaciclovir has been added ahead of aciclovir for both primary infections and secondary attacks.

Non-gonococcal urethritis

  • Valaciclovir has been added ahead of aciclovir.

Varicella zoster (shingles)

  • Valaciclovir has been added ahead of aciclovir for empiric treatment.

Antimicrobial surgical prophylaxis

  • General surgery. Orthopaedic – only two doses of cefazolin to be given post-operatively.

Surgical post-operative antimicrobial guidelines

  • Presumed septicaemia. Post-orthopaedic surgery. Division of antibiotic options to clarify choice in mild penicillin allergy.

Costings

  • Changes made throughout section.

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Topic Code: 312099