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5.1 Antibacterial: Penicllins, antipseudomonal, penicillins, mecillinams, cephalosporins, carbapenems, other beta lactams

5.1.1 Penicillins

ORAL
Amoxicillin capsules, syrup, sachets                                           
Co-amoxiclav tablets 250/125 and 500/125     
Co-amoxiclav suspension 125/31 and 250/62 
Flucloxacillin capsules,syrup                                          
Phenoxymethylpenicillin tablets, syrup (Penicillin V)

 

PARENTERAL
Amoxicillin IM/IV  (For ALL Paediatrics-use Bowmed brand only)                                                                    
Benzylpenicillin IM/IV (Penicillin G)                             
Flucloxacillin IM/IV
Co-amoxiclav IV 500/100 and 1000/200 (see note)       
Temocillin IV Infusion - Consultant Microbiolgist Use Only

Note:

Temocillin is for use in urinary tract infections with ESBL/AMPC/Hypercefalosporinase producers.

 

5.1.1.4 Antipseudomonal Penicillins

Piperacillin with Tazobactam (Tazocin) injection - first-line antibiotic to manage febrile neutropenia otherwise, use under specific guidelines only, or on the advice of a consultant microbiologist.

 

5.1.1.5 Mecillinams

Pivmecillinam Tablets (second line antibiotic for urinary tract infections when renal impairment does not permit nitrofurantoin use)

Note: Pivmecillinam is a penicillin. It is associated with a lower rate of C.difficile infection than co-amoxiclav. It is only suitable for lower UTIs, but may be given in a higher dose for treatment of ESBL-producing E.coli infections – see guidance

 

5.1.2  Cephalosporins, cephamycins and other beta-lactams

ORAL
Cefadroxil capsules
Cefuroxime tablets, suspension
Cefaclor tablets, suspension
Cefalexin tablets, suspension
Cefixime tablets - see note
PARENTERAL
Cefuroxime IM/IV
Cefotaxime  - under specific guidelines or only on the advice of a Consultant Microbiologist.
Ceftazidime - under specific guidelines or only on the advice of a Consultant Microbiologist.
Ceftriaxone injection Meningitis, Septicemia, Pelvic Inflammatory Disease or Gonorrhoea, epiglotitis.

Notes:

1. Due to the risk of C difficile the use of cephalosporins is restricted on medical wards, with the exception of ceftriaxone for the treatment of meningitis. Other cephalosporins should only be used on medical wards following consultant request. See corporate antibiotic guidelines for alternative.

2. Cefuroxime - The oral preparation is very expensive and it is included in the formulary for the treatment of patients infected with penicillinase (B lactamase) producing strains of Haemophilus influenzae or Neisseria gonorrhoeae. It may also be used, with caution to treat susceptible infecting organisms in patients known to be allergic to penicillin, where other less expensive anti-microbials are not suitable. Oral cefuroxime must not be used to extend courses of prophylactic cefuroxime in surgical patients. Clinical pharmacists will carefully monitor use.

3. Cefotaxime is generally reserved for CNS infections or serious paediatric sepsis. Other uses only in consultation with Microbiology.

4. Cefixime tablets are for Gonorrhea only if patients refuse IM injections and sensitivity results are available. Will be used in combination with aziththromycin.

5. Ceftriaxone should not be given simultaneously with calcium-containing solutions (other than total parenteral nutrition solutions) for intravenous administration because of a risk of calcium precipitation. See the MHRA Drug Safety Update for October 2009.

 

5.1.2.2 Carbapenems

Meropenem injection
Ertapenem infusion- Outpatient management of severe infection due to ESBL-producing Gram positive organisms (Microbiologist recommended only).

 

5.1.2.3 Other beta lactam antibiotics

Aztreonam injection - restricted to consultant microbiologist use only for Gram-negative cover in patients with penicillin allergy. For empirical treatment it must be used in conjunction with an agent with Gram-positive cover. See guidance

 

 For link to BNF section: 5.1 Antibacterial drugs