Antibiotic Guidelines Cephalosporins, Quinolones and Co-Amoxiclav

Antibiotic Guidelines
Cephalosporins, Quinolones and Co-Amoxiclav
The aims of using antibiotics is to provide a simple, effective, economical and empirical approach to the treatment of common infection and to minimise the
emergence of bacterial resistance in the community.
Principals of treatment in relation to cephalosporins, quinolones and co-amoxiclav

Use simple generic antibiotics if possible. Avoid broad spectrum antibiotics (e.g. co-amoxiclav, quinolones, and cephalosporins) when narrow spectrum
antibiotics remain effective, as they increase risk of Clostridium difficile, MRSA and resistant UTIs. Where possible, avoid quinolones in pregnancy.
Clostridium difficile Infections: Prevention and Reduction

Antibiotic use is the most significant and frequently reported predisposing risk factor for C diff. – associated diarrhoea (CDAD) in hospital and community
settings.Proliferation of C diff. is most likely to occur with those antibiotics which have an effect on normal GI flora and including cephalosporins.

Current evidence indicates that second or third generation cephalosporins, (e.g. cefuroxime, cefixime, cefotaxime, ceftriaxone) are significantly more likely
to provoke C. diff associated diarrhoea (CDAD). Studies from North America have specifically identified the role of quinolones in C diff. outbreaks. There is
also increasing evidence for the implication of fluoroquinolones, first-generation cephalosporins(e.g. cephalexin,) and co-amoxiclav. These antibiotics
should be used sparingly, especially for the elderly, for patients in institutions with CDAD, and in patients previously diagnosed and treated for CDAD.
Indications for use of cephalosporins, quinolones and co-amoxiclav
Cephalosporin
Illness
Suspected
meningococcal
disease
Choice of drug
Benzylpenicillin (IV/IM)
Cefotaxime (IV/IM)
UTI in pregnancy
UTI in Children
Adult Dose
Age 10+ yrs: 1200mg
Child 1-9 yrs: 600mg
Child <1 yr: 300mg
Age 12+ yrs: 1 gram
Child < 12 yrs: 50mg/kg
1st line: Nitrofurantoin
100mg m/r BD
If susceptible, Amoxicillin
500mg TDS
2nd line: Trimethoprim
200mg BD (off-label)
3rd line: Cefalexin
500mg BD
Lower UTI: Trimethoprim or Nitrofurantoin, if
susceptible, Amoxicillin. 2nd line: Cefalexin
Upper UTI: Co-Amoxiclav. 2nd line: Cefixime
Pelvic
Inflammatory
Quinolones
Acute prostatis
Acute
pyelonephritis
Co-Amoxiclav
Acute
Rhinosinusitis
Duration
Give IM if
vein cannot
be found
All for 7
days
Lower UTI
3 days
Upper UTI
7-10 days
14 days
14 days
Metronidazole plus
Ofloxacin
If high risk of GC:
Ceftriaxone plus
Metronidazole plus
Doxycycline
Ciprofloxacin or
Orfloxacin
2nd line: trimethoprim
Ciprofloxacin or
Co-Amoxiclav
400mg BD
400mg BD
500mg IM
400mg BD
100mg BD
500mg BD
200mg BD
200mg BD
500mg BD
500/125mg TDS
Stat
14 days
14 days
All for 28
days
Amoxicillin
500mg TDS, 1G (severe)
200mg stat/100mg OD
500mg QDS
All for 7
days
Doxycycline or
Phenoxymethylpenicillin
7 days
14 days
625mg TDS
Acute
exacerbation of
COPD
For persistent symptoms:
Co-Amoxiclav
Amoxicillin
Or Doxycycline
Clarithromycin
If resistance:
Co-Amoxiclav
UTI in Children
Acute
Pyelonephritis
Cellulitis
Bites (human or
animal)
Flucloxacillin
If penicillin allergic:
Clarithromycin or
Clindamycin
Facial: Co-Amoxiclav
Prophylaxis/treatment:
Co-Amoxiclav
If penicillin allergic:
Metronidazole plus
Doxycycline(cat/dog/man)
Or metronidazole plus
Clarithromycin (human
bite)
AND review at 24/48 hrs
500mg TDS
200mg stat/100mg OD
500md BD
Comments
Transfer all patients to hospital immediately. If time
before admission, and non-blanching rash, give IV
benzylpenicillin or cefotaxime, unless definite history
of hypersensitivity.
Send MSU for culture and start antibiotics. 4 week
course may prevent chronic prostatitis. Quinolones
achieve higher prostate levels.
Child <3 months: refer urgently for assessment. Child
≥3 months: use positive nitrite to start antibiotics.
Send pre-treatment MSU for all.
Imaging: refer only if child <6 months, recurrent or
atypical UTI.
Refer woman & contacts to GUM service. Always
culture for gonorrhoea & chlamydia. 28% of
gonorrhoea isolates now resistant to quinolones. If
gonorrhoea likely (partner has it, severe symptoms,
sex abroad) use ceftriaxone regimen or GUM referral.
Send MSU for culture and start antibiotics. 4 week
course may prevent chronic prostatis. Quinolones
achieve higher prostate levels.
If admission not needed, send MSU for culture
&sensitivities and start antibiotics. If no response
within 24 hours, admit.
Avoid antibiotics as 80% resolve in 14 days without,
and they only offer marginal benefit after 7 days. Use
adequate analgesia. Consider 7-day delayed or
immediate antibiotic when purulent nasal discharge.
In persistent infection use an agent with antianaerobic activity (e.g. co-amoxiclav).
Treat exacerbations promptly with antibiotics if
purulent sputum and increased shortness of breath
and/or increased sputum volume. Risk factors for
antibiotic resistant organisms include co-morbid
disease, severe COPD, frequent exacerbations,
625mg TDS
antibiotics in last 3 months.
As above: see previous entry regarding UTI in Children
As above: see previous entry regarding Acute Pyelonephritis
500mg QDS
500mg BD
300-450mg QDS
500/125mg TDS
375-625mg TDS
200-400mg TDS
100mg BD
200-400mg TDS
250-500mg BD
All for 5
days
All for 7
days. If slow
response
continue for
further 7
days
All for 7
days
If patient afebrile and healthy other than cellulitis,
use oral flucloxacillin alone. If river or sea water
exposure, discuss with microbiologist. If febrile and il,
admit for IV treatment. Stop clindamycin if diarrhoea
occurs.
Thorough irrigation is important. Assess risk of
tetanus, HIV, hepatitis B&C. Antibiotic prophylaxis is
advised. Assess risk of tetanus and rabies. Give
prophylaxis if cat bite/puncture wound, bite to hand,
foot, face, joint, tendon, ligament,
immunocompromised/asplenic/cirrhotic.