Late Onset (> 5 days)

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

Micro Organisms

Pseudomonas spp. more likely

<1 month - (First line)

Therapy

Cefotaxime IV

Duration: 5 days (extended to 10 days Only if slow to respond) 

Add gentamicin IV if severe infection

Add vancomycin IV if MRSA suspected or confirmed

Notes:

Consider IV to oral switch when afebrile > 24 hours and clinically improving

>1 month - 18 years - (First line)

Therapy

Ceftriaxone IV 

Duration: 5 days (extended to 10 days Only if slow to respond) 

Add gentamicin IV if severe Pseudomonal infection

Add vancomycin IV if MRSA suspected or confirmed

Notes:

Consider IV to oral switch when afebrile > 24 hours and clinically improving

>1 month - 18 years (escalation) - (Second line)

Therapy

Tazocin 6-hourly IV 

Duration: 5 days (extended to 10 days only if slow to respond) 

Add gentamicin IV if severe Pseudomonal infection

Add vancomycin IV if MRSA suspected or confirmed

Notes:

Consider IV to oral switch when afebrile > 24 hours and clinically improving

>1 month - 18 years - Anaphylaxis (including severe skin reaction) to penicillin - (Penicillin allergy)

Therapy

Vancomycin IV + Ciprofloxacin IV (use higher dosing as per BNFC)

Notes:

Consider IV to oral switch when afebrile > 24 hours and clinically improving