Canterbury DHB

Context

Antibiotics used in Bacterial Infections

In This Section

Piperacillin/tazobactam (Tazocin®)

Aminoglycosides

Vancomycin

Teicoplanin

Meropenem

Imipenem (Primaxin®)

Cefepime

Ertapenem

Flucloxacillin

Piperacillin/tazobactam (Tazocin®)

Usual dosage: 4.5 g IV 6 hourly.

Method of delivery: Inject IV slowly over 3 to 5 minutes. Consider dose reduction in renal impairment.

For more information, see the piperacillin/tazobactam Data Sheets on Medsafe.

Aminoglycosides

Vancomycin

See the Vancomycin Dosing Guidelines in the Pink Book.

Teicoplanin

Teicoplanin is a useful drug for treatment of coagulase negative staphylococcal line infections for patients who are outpatients or where there is concern with regard to renal impairment. Dose 400 mg BD for three doses (i.e. 0h, 12h, 24h), then 400 mg once daily. 7–10 days treatment is usually required to clear line infections. Levels are not required.

Teicoplanin is not first choice for in-hospital therapy but is used as outpatient therapy because of the convenience of once daily dosing. There is some relatively weak data to support it being less nephrotoxic than vancomycin.

For more information, see the Teicoplanin Data Sheets on Medsafe.

Meropenem

Meropenem is now a second-line broad spectrum antibiotic, replacing imipenem since there now is a less expensive generic version. It is a good broad-spectrum antibiotic and effective against S. aureus. It is useful for those allergic to penicillin and those with renal impairment where gentamicin is contraindicated.

The dose is 1 g three times a day given over 5 minutes.

Sensitivity testing for S. aureus is not done for meropenem. However, if the organism is methicillin-sensitive, it will also be meropenem-sensitive. Conversely, if the organism is methicillin-resistant it will also be resistant to meropenem. This is the case for coagulase negative staphylococci. However, meropenem is less effective for S. aureus than imipenem (with flucloxacillin being the first choice in this situation). Meropenem is somewhat better than imipenem for gram negative organisms.

For more information, see the Meropenem Data Sheets on Medsafe.

Imipenem (Primaxin®)

Imipenem is only available in combination with sodium cilastatin. It is another second line antibiotic for neutropenic sepsis but is no longer cheaper than meropenem. Imipenem is more active against gram positive organisms such as E. faecalis.

The dose is 500 mg 6 hourly in 100 mL of normal saline over 20-30 minutes. This can be slowed further if nausea is a problem (60 minutes).

Sensitivity testing for S. aureus is not done for imipenem. However, if the organism is methicillin-sensitive, it will also be imipenem-sensitive. Conversely, if the organism is methicillin-resistant it will also be resistant to imipenem. This is the case for coagulase negative staphylococci.

Note: There is a risk of seizures in patients with impaired renal function, so dose reduction is required. Seek advice.

Dosing in renal impairment

Where the creatinine clearance is 41-70 mL/min, give 500 mg 8-12 hourly. When creatinine clearance is 21-40 mL/min, give 250-500 mg 12 hourly. If less than 20 mL/min, consider another drug.

For more information, see the Imipenem Data Sheets on Medsafe.

Cefepime

Cefepime provides effective monotherapy in febrile, neutropenic patients, and our third line agent at present. It has a broad spectrum of antibacterial activity, including against gram-positive and gram-negative aerobic bacteria.

The usual dose is Cefepime 2 g 8-12 hourly. Consider dose reduction in renal impairment.

For more information, see the Cefepime Data Sheets on Medsafe.

Ertapenem

Ertapenem offers a once-daily treatment for patients requiring antibiotic cover in an outpatient setting, or for daily visit to the day ward.

Ertapenem is a methyl-carbapenem, structurally related to beta-lactam antibiotics. It has activity against a large number of gram-positive and gram-negative aerobic and anaerobic bacteria. It does not cover pseudomonas strains.

Recommended dose: Ertapenem 1 g IV daily.

Consider dose reduction is required in renal impairment.

No dose reduction is indicated in patients with impaired hepatic function.

For more information, see the Ertapenem Data Sheets on Medsafe.

Flucloxacillin

Initial dose:

Consult with Infectious Diseases early for advice on investigations and duration of treatment.

For more information, see:

About this Canterbury DHB document (4996):

Document Owner:

Ruth Spearing and Sarah Metcalfe (see Who's Who)

Issue Date:

November 2016

Next Review:

November 2018

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 4996