Antimicrobial Stewardship: Start Smart Then Focus. 'Antimicrobial Stewardship' is defined as 'an organisational or healthcare system wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness.'
Adult Antibiotic Treatment Guidelines by site of infection
Treatment and guidelines and other useful resources.
Paediatric Antibiotic Treatment Guidelines by site of infection
These guidelines are empiric antibiotic choices only and should always be reviewed when positive microbiology results are known.
Drug Safety (MHRA) - Fluoroquinolones antibiotics - safety warning : new restrictions and precautions for use
Click here to access the full MHRA document.
Suspected community acquired bacterial lower respiratory tract infection in patients with suspected/confirmed COVID-19 and laboratory evidence of pneumococci
CURB-65 is a BTS recommended severity rating for community acquired pneumonia (CAP) and should not be confused with the ABC criteria defined in the flow diagram. Patients with a CURB-65 score of 3 or more are at highest risk of death and should be managed as having severe pneumonia. Patients with a score of 2 are at increased risk of death and should be considered for short stay inpatient treatment or hospital supervised outpatient treatment. Patients with a score of 0 or 1 are at low risk of death and can be treated as having non-severe pneumonia possibly suitable for home treatment.
Suspected community acquired bacterial lower respiratory tract infection in pregnant patients with suspected / confirmed COVID-19
Most individuals with COVID-19 will not have bacterial co-infection. However antibiotics should be commenced if clinical or radiological evidence of possible respiratory bacterial co-infection. Any patients with suspected sepsis should receive antibiotic treatment within 1 hour of diagnosis.
How severe is my patient's infection? Infection severity classification:
Do any 2 apply?
- Temperature less than 36ºC or more than 38.3ºC
- Respiratory Rate more than 20/minute
- Heart Rate more than 90/minute
- Acutely altered mental state
- WBC >12x109/L or <4x109/L
- CRP >100
No? Treat as A (minor to moderate infection/ admit patient?) Yes? see below
Do any apply?
- Systolic Blood Pressure less than 90 mm Hg
- Mean Arterial Pressure less than 65 mm Hg
- Lactate greater than 2
- Urine output < 0.5ml/kg/hr OR creatinine >177
- SpO2 < 90%
- Platelets < 100
- INR > 1.5
- Bilirubin >34
No? Treat as B (moderate to severe infection/ admit patient) Yes? Treat as C (serious life-threatening infection/ mortality ~ 35%)
Have you considered Sepsis?
The 'Sepsis Six' are six tasks which, when delivered to patients within one hour of recognition of sepsis, can half the risk of death for patients (Surviving Sepsis Campaign).
- 100% Oxygen
- IV fluid bolus
- Blood cultures
- IV antibiotics
- Lactate & bloods
- Monitor urine output
Please see the Sepsis Six pathway for more information.
- Blood cultures: 2 sets from 2 sites
- Obtain appropriate samples BEFORE treatment
- When prescribing on inpatient chart include indication & 48 hours review box
- Dosing is based on an average weight of 70kg
- Adjustment may be required for renal or hepatic disease, consult pharmacy for dosing advice
- Pregnancy - See BNF for initial advice or consult pharmacy
- Pharmacy Medicines Information: CGH 3030, GRH 6108. Out of hours via switchboard.
- This site contains guidelines registered with Gloucestershire Hospitals NHS Foundation Trust and is intended solely for use by healthcare professionals to aid the treatment of patients currently within the Trust's care
- The guidelines reflect local sensitivities and infection control issues and, unless otherwise stated, are intended for the treatment of immunocompetent adult patients.
- The guidelines are intended for initial treatment and may be modified when microbiology results are available.
- For clinical advice or if the patient fails to respond, discuss with senior member of the clinical team and if necessary, the Consultant Microbiologist.
- Mon-Fri 09.00-17.00 ext. 4430 CGH and 5050 GRH
- For urgent advice out of hours, contact the "On-Call Consultant Microbiologist" via the switchboard.
C. difficile WARNING
Inappropriate antimicrobial use drives antimicrobial resistance and increases the risk of C. difficile infection. High risk antimicrobials are: CEPHALOSPORINS, CIPROFLOXACIN, CLINDAMYCIN, CO-AMOXICLAV, LEVOFLOXACIN.