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.'

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).

  1. 100% Oxygen
  2. IV fluid bolus
  3. Blood cultures
  4. IV antibiotics
  5. Lactate & bloods
  6. 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.