Right Decisions
Antimicrobial prescribing: NHS Lothian
Specialty guidelines
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Hospital at Home (H@H)
Sepsis of Unknown Source and Systemically Unwell (H@H)

Update your RDS mobile app to v4.7.1 to download toolkits even when website is down.

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.

Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Sepsis of Unknown Source and Systemically Unwell (H@H)

Antimicrobial prescribing: NHS Lothian

Length of treatment: 5 days

Investigations:

Send blood cultures

If patient has urinary symptoms or febrile and unable to give a history send urine for culture where possible

If patient has respiratory symptoms consider a viral throat swab

Amoxicillin 1g orally every 8 hours

PLUS

Gentamicin intravenous as per NHS Lothian online calculator

PLUS

Metronidazole 400mg orally every 8 hours only if concerns regarding intra-abdominal

source of infection.

OR (Penicillin allergy)

Co-trimoxazole 960mg orally every 12 hours

(see Appendix 1) for dose reduction in renal impairment)

PLUS

Gentamicin intravenous as per NHS Lothian online calculator

PLUS

Metronidazole 400mg orally every 8 hours only if concerns regarding intra-abdominal

source of infection.

If after 48 hours the patient is responding and no positive culture results complete treatment with either amoxicillin or co-trimoxazole.

If patient is not responding then discuss with MoE/consultant from H@H service in the first instance, then seek advice from an infection specialist and consider whether continuation of antibiotics is appropriate