NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update Acute

Therapeutics Handbook: Infection Section Changes February 2017

Information below is specific to the use of medicines in the adult setting.

 

Immunocompromised Patients with Fever

 - If neutropenic (or if not neutropenic but the source of infection is unknown) treat as per the Initial Management of Neutropenic Sepsis in Adults Guidelines.

 - If not neutropenic and the source of infection has been identified (excluding stem cell transplant patients) then manage as per empirical management guidelines based on identified source of infection.

Community Acquired Pneumonia (CAP)

 - Moderate CAP: The recommended course duration has been reduced from 7 to 5 days.
 - Severe CAP: The recommended course duration for treatment of Legionella pneumonia has been changed from 21 days to 10-14 days.

Hospital Acquired Pneumonia (HAP) [No sepsis]

 - Co-amoxiclav option has been removed and replaced with amoxicillin.
 - The recommended course duration has been reduced from 7 to 5 days.

Suspected Staphylococcus Aureus Pneumonia

 - The recommended antibiotic course length has been reduced from 10 days to 7-10 days.

Bone and Joint Infections

 - Gentamicin has been removed from the empirical antibiotic regimen for native joint septic arthritis/ osteomyelitis as the infection is usually due to Gram-positive organisms. The exception is in patients at high risk of Gram-negative infections e.g. immunocompromised, recurrent UTI, sickle cell disease.

Bacterial Meningitis

 - The recommended course duration (dependent on aetiology) has been reduced for N. meningitides from 7 days to 5 days and for S. pneumoniae from 14 days to 10-14 days.
 - The treatment group age classification cut off has changed from 50 years to 60 years.
 - In penicillin allergic patients the dosing of chloramphenicol has been changed to weight based dosing of 25 mg/Kg 6 hourly. In patients weighing > 80 Kg a maximum of 2 g per dose should be given.

Skin and Soft Tissue Infections

 - A new guideline on the antibiotic treatment of vascular graft infection has been added to the skin and soft tissue section.
 - Human or animal bites (mild): The list of patient groups who require antibiotic prophylaxis has been extended and the duration of antibiotic prophylaxis has been increased from to 5 days to 7 days.

Teicoplanin Guidelines

 - Inpatient adult teicoplanin guidelines covering the dosing and monitoring of teicoplanin in hospital have been added.

Vancomycin - Management of Unintended Delayed Doses

 - A new section has been added. Vancomycin doses can be delayed for a number of reasons e.g. loss of venous access or the patient is temporarily out of the ward. Such delays often result in subsequent inconvenient administration times for both the patient and the ward. This section provides practical guidance on how to manage this whilst maintaining the patient on a safe and appropriate vancomycin dosing regimen.