Specific guidance for the use of antimicrobial agents
- Immediate penicillin or cephalosporin hypersensitivity – most common entities are anaphylaxis or urticaria which generally occurs within one hour. In anaphylaxis usually more than one organ is involved, however some patients might have only hypotension or shock.
- If aminoglycosides are used close monitoring of renal functions and adequate hydration is essential. Ideally assess serum levels when given for more than 48 hours and vestibular functions when given for more than 5 days.
- Ideally assess serum levels of vancomycin when given for more than 48 hours to avoid under dosing and to minimize the risk of toxicity. If facilities are not available monitor renal functions with serum creatinine and adjust vancomycin dose accordingly.
For elderly over 65 years, vancomycin dose should be 500 mg every 12 hours or 1g once daily. - If patient develops diarrhoea while on clindamycin discontinue therapy and contact microbiologist.
Dose calculation and administration of some parenteral antibiotics
This guideline is for immunocompetent, average adults with normal renal and liver functions.
For severe infections like meningitis, endocarditis and surgical prophylaxis refer the relevant guideline.
This guideline is for immunocompetent, average adults with normal renal and liver functions.
For severe infections like meningitis, endocarditis and surgical prophylaxis refer the relevant guideline.
Antibiotic Dose Administration
Ampicillin 500mg-1g 6 hourly IV injection, IM or IV infusion
IV infusion given over 30-60 minutes
Penicillin 0.6-1.2g 6 hourly Slow IV injection, IM or IV infusion
IV infusion over 30-60 minutes
Cefotaxime 1g 8 hourly IM, IV injection or IV infusion
IM doses over 1g need to be divided and given to more than one site
Ceftazidime 1g 8 hourly IV injection or IV infusion
Deep IM injection only if IV route is not possible
Ceftriaxone 1-2g daily 1g can be given by either IV injection or deep IM injection but more
than 1g by IV infusion only
Cefuroxime 750mg 6-8 hourly Lesser amounts can be given IM but 750 mg should be given by IV
injection or IV infusion only
Clindamycin 600 mg 6-8 hourly ≥600mg IV infusion only
IM injection possible for less than 600mg
Amikacin Calculated for ideal body weight 15mg/kg/day
Once daily dose by IV infusion only given over 60 minutes
Multiple daily doses by slow IV injection over 3 minutes, IV infusion over 30 minutes or IM injection
Adjust doses according to serum levels
Gentamicin Calculated for ideal body weight 5-7mg/kg/day
Once daily dose by IV infusion only given over 60 minutes
Multiple daily doses by slow IV injection over 3 minutes, IV infusion over 30 minutes or IM injection. Adjust doses according to serum levels
Ciprofloxacin 200mg – 400mg 12 hourly 400mg over 60 minutes or 200 mg over 30 minutes IV infusion
Levofloxacin 500 mg once daily or 12 hourly
500 mg IV infusion over 60 minutes
Co-amoxiclav 1.2g 8 hourly IV injection over 3-4 minutes or IV infusion over 3 hours
Piperacillin–tazobactam 4.5g 8 hourly IV infusion over 3 hours
Ticarcillin-clavulanate 3.2g 6-8 hourly IV infusion over 3 hours
Imipenem 500mg 6 hourly or 1g 8 hourly
IV infusion given for 40 – 60 minutes
Meropenem 0.5 -1g 8 hourly Slow IV injection over 5 minutes or IV infusion over 3 hours
Teicoplanin 400 mg every12 hourly for 3 doses then 400 mg once daily or 6mg/kg every 12 hourly for 3 doses then once daily
IV injection, IV infusion or IM injection
Infusion is preferred over bolus injection
Vancomycin 1-1.5g 12 hourly
for loading dose when indicated IV infusion over 100 minutes
Metronidazole 400mg 8 hourly IV Infusion over 20 minutes