Antimicrobial prescribing: NHS Lothian
- Send blood and urine cultures prior to starting antibiotics.
- Review wounds and consider sending swabs if signs of infection.
Sepsis in urology patients
- Request review by senior member of urology team.
- Manage Sepsis 6.
- Send blood cultures.
- Review:
- Has a gentamicin resistant bacteria been isolated in blood or urine in last 6 months? If so ask for advice.
- Was gentamicin given for surgical antimicrobial prophylaxis? Consider discussing dosing with clinical pharmacist if patient received gentamicin as part of surgical prophylaxis.
- Review wounds and consider swabs if signs of infection - follow Post-operative wound infection assessment if wound infection is felt likely.
- Start antibiotics as outlined below.
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Recommended Antibiotic
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Amoxicillin 1g every 8 hours IV AND Gentamicin use NHS Lothian Calculator on AMT intranet page CONSIDER ADDITION OF Metronidazole if bowel injury possible
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| Penicillin allergy |
Vancomycin use NHS Lothian Calculator on AMT intranet page AND Gentamicin use NHS Lothian Calculator on AMT intranet page CONSIDER ADDITION OF Metronidazole if bowel injury possible
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At 48-72 hours review the need for ongoing antibiotics & review microbiology results
Is the patient improving?
NO, ask for advice.
YES, review questions below:
- Has an AKI developed whilst in hospital (AKI = x1.5 rise in creatinine from baseline)?
- Has the patient developed gentamicin toxicity (hearing loss or disturbed balance)?
- Has the patient grown gentamicin-resistant organisms?
If the answer is "Yes" to any of these questions ask for advice.
If the answer is “No” to all these questions and IV antibiotics are still required, continue gentamicin up to Day 5.
At day 5 review the patient and the antibiotic plan:
- Is IV to oral switch possible?
- If not, ask for advice.
Gentamicin is associated with irreversible hearing loss and balance problems; only continue regimens containing gentamicin past 5 days on recommendation from Microbiology/Infectious Diseases.