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Secondary Care Guidelines for Management of Infections in Adults

Secondary Care Guidelines for Management of Infection

Click below to access the most up to date version of the adult and paediatric guidelines for East Lancashire Hospitals NHS Trust.  

Adult Antimicrobial Guide

Paediatric Antimicrobial Guide

(these can be saved to desktops for ease of access)

The primary objective of this Formulary is to ensure appropriate selection of antimicrobials for treatment of common infections. The choice of antimicrobials in the Formulary has been carefully selected to move to agents with a lower risk of precipitating Healthcare Associated Infections, including MRSA, Clostridium difficile and ESBLs. 

These guidelines are evidence based and reflect nationally agreed practice. They specify the recommended antimicrobial, dose, route and duration of treatment for common infections encountered in secondary care.

The doses mentioned in this formulary are for adults with normal renal and hepatic function. Please speak to your ward pharmacist or contact Pharmacy Medicines Information for advice on dosing in renal or hepatic impairment.

There are separate guidelines for the use of antibiotics in paediatrics (age 1 month - 18 years) and neonates (age birth - 28 days). These should be referred to when prescribing antibiotics for these age groups in conjunction with BNFc.

Principles of good antimicrobial prescribing

  • Antimicrobials must only be prescribed where there are good clinical indications
  • Every effort must be made to collect relevant specimens for microbiological investigations prior to starting antimicrobial therapy.
  • The indication and choice of antimicrobial agent(s) must be clearly documented in the medical notes. All prescriptions should be written clearly.
  • The anticipated course length or review date must be clearly documented on the prescription chart.
  • Antimicrobial therapy must be prescribed according to the ELHT Formulary which is informed by local pathogen epidemiology and local antimicrobial sensitivity patterns.
  • Antimicrobial therapy must be prescribed at an appropriate dose and frequency.
  • Restrict the use of broad spectrum antimicrobials to the empiric treatment of serious infections when the pathogen is not known, or when other effective agents are unavailable, or patient has known allergies.
  • Narrow spectrum antimicrobials must be prescribed in preference to broad spectrum antimicrobials where possible in conjunction with Microbiology results.
  • Empiric antimicrobial prescriptions must be reviewed no later than 48 hours (automatic stop at 5 days) to consider switching to narrow spectrum agents.
  • Review ALL antimicrobials DAILY.
  • The oral route must be used in preference to the intravenous route whereever possible.
  • Intravenous therapy must be reviewed within 48 hours and switched to oral therapy if appropriate.
  • Antimicrobials with a high risk of precipitating Clostridium difficile infection (e.g. cephalosporins and quinolones) must be used with caution.
  • Do NOT prescribe antimicrobials from the restricted list without Consultant Microbiologist approval and document this in the medical notes.
  • Expert advice must be sought from a medical microbiologist for complicated infections, interpretation of culture and sensitivity results or in the case of failure of empiric treatment