Greater Glasgow and Clyde Medicines

Topic

Change to guidance

Further information

Promotion of highly bioavailable oral options.

Please note reference and the emboldening of oral options for ciprofloxacin, metronidazole and levofloxacin to promote the use of highly bioavailable antibiotics.

Clostridioides Difficile Infection (CDI)

First line treatment is oral vancomycin 125mg 6 hourly. Guideline now states to refer to CDI guidelines with hyperlink.

Previously metronidazole.
Refer to:
NHSGGC guideline:
Suspected or Proven Clostridioides Difficile Infection Management in Adults

Medicines Update blog:
Clostridioides difficile infection management in adults – guideline update

Pneumonia

If patient admitted from nursing home, treat as Community Acquired Pneumonia (CAP). 

For management of pneumonia refer to Adult Therapeutics Handbook guideline:
GGC Medicines - Management of Pneumonia

Severe Hospital Acquired Pneumonia (HAP)

IV co-amoxiclav + IV gentamicin

If true penicillin/beta-lactam allergy:

Oral/IV levofloxacin monotherapy

Previously IV co-trimoxazole + IV gentamicin.

For management of pneumonia refer to Adult Therapeutics Handbook guideline:
GGC Medicines - Management of Pneumonia

Spontaneous Bacterial Peritonitis (SBP)

Link added:

BSG - BASL Decompensated Cirrhosis Care Bundle - First 24 Hours - The British Society of Gastroenterology

Management unchanged.

SBP if receiving co-trimoxazole prophylaxis

IV piperacillin/tazobactam

If true penicillin/beta-lactam allergy:

Oral/IV levofloxacin monotherapy

Previously IV co-amoxiclav or if true penicillin/beta-lactam allergy: Oral/IV ciprofloxacin + IV vancomycin

Decompensated chronic liver disease with sepsis of unknown source if true penicillin/beta- lactam allergy 

Oral/IV levofloxacin monotherapy

Previously Oral/IV ciprofloxacin + IV vancomycin

Possible bacterial meningitis

IV dexamethasone now added at the same time or prior to antibiotics.

Previously no advice on timing of dexamethasone.

Refer to
Adult Therapeutics Handbook guideline:
GGC Medicines - Central nervous system infections
(as per the British Infection Association (BIA)) and discuss with clinician responsible for the patient.

Lower Urinary Tract Infection (UTI)/cystitis

Nitrofurantoin modified release (MR) 100mg 12 hourly added as an alternative to nitrofurantoin 50mg 6 hourly. 

To reflect changes to pre-packs available within NHSGGC.

For management of UTIs refer to Adult Therapeutics Handbook guideline:
GGC Medicines - Urinary tract infections (UTIs)

Gentamicin/Vancomycin

Advice added:
Refer to the GGC Adult Therapeutics Handbook for Prescribing.

Avoid Gentamicin in known family history of aminoglycoside auditory toxicity or maternal relative with deafness due to mitochondrial mutation A1555G.

Septic arthritis/Osteomyelitis/Prosthetic Joint Infection

Advice added:

Urgent orthopaedic referral if underlying metal work or recent surgery.

Suspected COVID-19 pneumonia

Link added to Adult Therapeutics Handbook: COVID19 guidelines

COVID-19 guidelines are being continually updated – please refer to link for most up to date information.