

Post-TRUS sepsis
Follow this guideline to treat sepsis after a Transrectal Ultrasound-guided Prostate (TRUS) biopsy.
- Consult urgently with Infectious Diseases/Clinical Microbiology if severe infection and recent admission to overseas healthcare facility or carbapenemase-producing organisms positive.
Pathogen:
E. coli
Empiric
piperacillin+tazobactam
HMLNZFPMLnoids
|
IV 4 g/500 mg every eight hours
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- If still on piperacillin+tazobactam beyond 48 hours, consider measuring a trough concentration. Consult Infectious Diseases for interpretation.
- fe (piperacillin) = 0.8, fe (tazobactam) = 0.6, consider adjusting dose if CrCl reduced.
Mild penicillin allergy or risk factors for multidrug-resistant gram-negative bacilli
(MDR-GNB):
Cover for MDR-GNB organisms if:
- MDR-GNB positive
- Current or recent inpatient in a high-risk ward (e.g. ICU, BMTU, SPCU) for 5 days or more
- Admission to overseas healthcare facility
- Travel to developing country in previous six months
- Household contact with MDR-GNB
- Residence or admission to any facility with high prevalence of MDR-GNB
- Broad-spectrum antimicrobial treatment.
- Meropenem rapidly and significantly reduces sodium valproate concentrations. Concomitant administration may precipitate seizures in patients with a pre-existing seizure disorder. Discuss alternative antibiotic options with Infectious Diseases/Clinical Microbiology.
- If still on meropenem beyond 48 hours, consider measuring a trough concentration. Consult Infectious Diseases for interpretation.
- fe = 0.7, start with full dose initially then consider extending dose interval and/or decreasing dose for subsequent doses if CrCl is reduced (< 30 mL/min). Consult pharmacist.
Severe penicillin allergy
Consult Infectious Diseases/Clinical Microbiology.
Oral follow-on
- Based on susceptibilities, if available.
- Do not use nitrofurantoin as serum and prostate concentrations are very poor and inadequate to treat an infection in these sites.
If susceptibilities are not available
Mild penicillin allergy
- fe = 0.9, consider adjusting dose if CrCl is reduced.
If proven susceptibility
OR
trimethoprim+sulfamethoxazole
HMLSchedNZFPMLnoids
(co-trimoxazole)
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PO 160 mg/800 mg twice a day
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Topic Code: 606698