Antimicrobial prescribing: NHS Lothian
Required Investigations
- Blood cultures
- EDTA blood: request on TRAK: Bacterial Meningitis Profile
- Bacterial throat swab if safe to perform (specifically request culture for Neisseria & Haemophilus)
Epiglottitis
- Isolate patients with suspected epiglottitis in a side room and use PPE for droplet precautions.
- Haemophilus influenzae Type B (HiB) is now uncommon.
- Involve ENT early.
- Suspected epiglottitis can mimic a retropharyngeal abscess.
- Use PPE for airborne precautions when performing airway interventions as there is a risk of Neisseria meningitidis causing epiglottitis.
Recommended total duration: Duration dependent on organism and severity, discuss with microbiology
| Antimicrobial recommendation |
Ceftriaxone 2g every 12 hours IV AND Metronidazole 500mg every 8 hours IV If known MRSA, consider adding: Vancomycin (use NHS Lothian Calculator located AMT intranet page) select trough level 15-20mg/L |
| Severe Penicillin Allergy or known cephalosporin allergy |
Vancomycin (use NHS Lothian Calculator located AMT intranet page) select trough level 15-20mg/L PLUS Ciprofloxacin 400mg every 12 hours IV PLUS Metronidazole 500mg every 8 hours IV |
Review microbiology investigations
| Antimicrobial recommendation | Co-amoxiclav 625mg every 8 hours orally |
| Penicillin Allergy | Phone microbiology |
Notes
Likely organisms: Neisseria meningitidis, Streptococci, Staphylococcus aureus; historically Haemophilus influenzae type B, but with routine vaccination no longer prevalent.