Antibiotic Guidance for Hospital at Home

NHS Borders clinical guidelines
NHS Borders
  • All doses given are for normal renal Do not use Nitrofurantoin if eGFR is < 451; do not use Co-trimoxazole or Trimethoprim if eGFR is < 30
  • Review MHRA safety advicewhen prescribing fluoroquinolones
  • Always check the BNF for drug interactions before prescribing antibiotics
  • If no agent listed is suitable due to allergy or resistant isolates, discuss with Microbiology
  • Stop Gentamicin after 3 days unless advised by Check culture results when available. Ask daily if hearing or balance are affected
  • In suspected or confirmed COVID-19 infection, antibiotics should only be given if there is purulent sputum, or clinical evidence of consolidation

Indications/Therapies/Duration & Comments

 

 

*1 May be used with caution if eGFR 30-44 ml/minute as a short course only (3-7 days) to treat uncomplicated lower UTI if caused by suspected or proven multidrug resistant bacteria only if potential benefit outweighs risk.

2See Gentamicin dosing calculator https://www.antimicrobialcompanion.scot/nhs-borders/

Do not give more than 3 days of Gentamicin unless advised by Microbiology. Check culture results to guide ongoing treatment

3These antibiotics are associated with a higher risk of developing Clostridium difficile infection, particularly in elderly patients

4Significant drug interactions

Also available via NHS Borders Antimicrobial Microsite 

Appendix 1

NOTE: There are other Teicoplanin regimens in use in NHS Borders.  This guidelines is for HOSPITAL AT HOME USE ONLY 

Teicoplanin is loaded over three consecutive days (Days 1, 2 and 3) and this will provide equivalent to 5 days of treatment.

Teicoplanin should not be extended past the initial 5 days loading duration without input from an Infection specialist.

Patient’s age, height, weight and a stable serum creatinine are required to calculate the teicoplanin

loading dose using the following steps:

Step 1:  Calculate Creatinine clearance

    • Use Cockroft-Gault formula

CrCl (ml/min) = [ (140 - Age) X weight* X 1.23(male) or 1.04(female) ]
                        ____________________________________________

                                                Serum creatinine**

*Use total body weight

**If Cr <60 micromol/L , use a value of 60 micromol/L

Step 2: Decide on using ideal or Actual Body Weight

Step 3: Prescribe doses

Prescribe daily for first 3 days:

Creatinine
clearance
(ml/min)		 Ideal/Total body weight (kg)
40-59kg 60-79kg >80kg
< 600mg 800mg 1000mg

≥

  800mg  800mg 1000mg

See Medusa monograph for reconstitution guidance.

Doses <800mg as IV infusion in 100ml over 30 minutes

Doses ≥800mg as IV infusion in 100ml over 60 minutes

 

Patient Details

Name  ____________________________________________

DOB______________________________________________

Address ___________________________________________

Use attached Teicoplanin dosage guideline to calculate doses

  • Creatinine  =  __________________________________micromol/L

  • Height = ______________________________________feet/inches

  • Age =  ________________________________________years

  • Total body weight (TBW) (weight as per scales) = ______kilograms

  • Creatinine clearance = ____________________________mL/min

  • Ideal body weight (IBW) = _________________________kilograms


Choose appropriate LOADING dose regimen from table. Using IBW if patient overweight. Use TBW is this is lower than IBW 

  • Loading dose

To be administered on the following consecutive days:

Day 1 __________________

Day 2 __________________

Day 3 __________________                                   

Editorial Information

Last reviewed: 31/07/2023

Next review date: 31/07/2026

Author(s): Duguid A, James E.

Version: V1.1

Author email(s): anne.duguid@borders.scot.nhs.uk.

Co-Author(s): NHS Borders Hospital at Home Team.

Approved By: NHS Borders Antimicrobial Management Team members

Reviewer name(s): Duguid A.

References

Lamont et al. Journal of Antimicrobial Chemotherapy 2009; 64 : 181-187

Summary of Product Characteristics, Targocid 400mg