Warning

Micro Organisms

Neisseria gonorrhoea, Chlamydia trachomatis, Gram negative enteric organisms

Patients at increased risk of gram-negative enteric organisms include: those with structural abnormalities of the urinary tract, recent urological surgery or instrumentation including urinary catheterisation, positive urine dipstick test, and men who have insertive anal sex.

Duration

10 days

Notes

Important: Therapy

  • Send MSSU or catheter urine sample.
  • Send first void urine sample if suspected STI.
  • If STI is suspected patients should be referred to Sexual Health Service (0345 337 9900) for partner notification and advice if required.
  • Send blood for culture if pyrexial.
  • Consider testing for HIV.
  • Consider IV treatment if features of severe infection.

Notes:

High risk of sexually transmitted infection - 1st line

Important: Therapy

IM or IV Ceftriaxone 1g single dose

+

Oral Doxycycline 100mg 12 hourly for 10 days

Notes:

High risk of sexually transmitted infection - penicillin allergy with high risk of type 1 or 4 hypersensitivity reaction

Important: Therapy

Oral Doxycycline 100mg 12 hourly for 10 days

Notes:

Treatment for a positive gonorrhoea result should be based on microbiology sensitivities.

Suspected gram negative enteric organisms AND high risk of sexually transmitted infection - 1st line

Important: Therapy

IM or IV Ceftriaxone 1g single dose

+

Oral Ofloxacin 400mg once daily for 10 days

Notes:

Avoid ofloxacin in frail elderly patients where possible due to CDI risk. Check important safety information in BNF & give MHRA patient information leaflet to patient

Suspected gram negative enteric organisms AND high risk of sexually transmitted infection - 2nd line

Important: Therapy

Please contact duty microbiologist for further advice

Notes:

Low risk of sexually transmitted infection, likely gram-negative enteric organisms - 1st line

Important: Therapy

Oral Co-trimoxazole 960mg twice daily for 10 days

Notes:

Low risk of sexually transmitted infection, likely gram negative enteric organisms - 2nd line

Important: Therapy

Oral Ciprofloxacin 500mg twice daily for 10 days

Notes:

Avoid ciprofloxacin in frail elderly patients where possible due to CDI risk. Check important safety information in BNF & give MHRA patient information leaflet to patient

Systemically unwell - 1st line

Important: Therapy

Gentamicin IV (Hartford Regimen) as per guideline

Use calculator on app.

If reduced or unstable renal function, give single dose only then review with Infectious Diseases or Microbiology

+

If risk of STI,

IM or IV Ceftriaxone 1g single dose

Switch to oral antibiotic option when clinically stable. Use microbiology results or empirical options above.

Notes:

Systemically unwell and penicillin allergy with high risk of type 1 or 4 hypersensitivity

Important: Therapy

Gentamicin IV (Hartford Regimen) as per guideline

Use calculator on app.

If reduced or unstable renal function, give single dose only then review with Infectious Diseases or Microbiology.

+

If risk of STI,

Oral Ciprofloxacin 500mg single dose

Switch to oral antibiotic option when clinically stable. Use microbiology results or empirical options above.

Notes:

Ciprofloxacin: Avoid ciprofloxacin in frail elderly patients where possible due to CDI risk. Check important safety information in BNF and give MHRA patient information leaflet to patient.

Editorial Information

Last reviewed: 28/11/2024

Next review date: 28/11/2027

Author(s): Specialist Antimicrobial Pharmacists.

Version: 1

Author email(s): gram.antibioticpharmacists@nhs.scot.

Approved By: Antimicrobial Management Team

Document Id: AMT_Emp_Hosp_Epididymitis-Orchitis_1