PIPERACILLIN- TAZOBACTAM INJECTION - SUPPLY PROBLEMS

Transcription

1 PIPERACILLIN- TAZOBACTAM INJECTION - SUPPLY PROBLEMS The current supply of piperacillin- tazobactam should be reserved f Microbiology / Infectious Diseases approval and f neutropenic sepsis, severe sepsis of unknown source and ventilat acquired pneumonia as priity settings. Piperacillin- tazobactam use outside of these priity areas should require a Micro / ID approval consultation. 1 All patients should be reviewed once Microbiology results are available (48-72h post sampling) and treatment refined, favouring narrow spectrum and al agents. Other indications should use the alternatives suggested below, can be discussed with Microbiology / ID on a case- by- case basis. Carbapenems are recommended in some settings, but should not be seen as a default alternative to piperacillin- tazobactam. The doses suggested in the document are equivalent to Piperacillin- tazobactam 4.5g 8- hourly; doses will need to be adjusted in children (BNFc), renal hepatic failure, in the critically ill with continuous infusions. Note: 1. All- cause mtality was higher in patients treated with Tigecycline compared to other antibiotics. Tigecycline should be reserved f use in situations when alternative antibiotics are not suitable. 2. Ticarcillin/clavulanate may be an alternative antibiotic to Piperacillin/tazobactam if local antibiotic susceptibility patterns known. Guideline Antibiotic Options f each condition Ciprofloxacin IV 400mg 12- hourly al mg 12- hourly Levofloxacin 500mg daily IV/al Acute Bacterial Prostatitis Cefotaxime 1g 8- hourly Ceftriaxone 1g once daily FOR ALL OPTIONS, Add Gentamicin Amikacin when ESBLs are likely Piperacillin- tazobactam shtage Antibiotic options v1.0 24/4/17

2 Cefuroxime 1.5g IV 8- hourly plus Metronidazole IV/al 2 Acute Diverticulitis (>65 years) Ciprofloxacin ( Levofloxacin) IV 400mg 12- hourly plus Metronidazole IV/al [FOR ALL OPTIONS, in cases with associated sepsis consider adding gentamicin 7mg/kg amikacin 15mg/kg stat] Cefuroxime 1.5g IV 8- hourly plus Metronidazole IV/al Appendicitis Ciprofloxacin 400mg IV 12- hourly Levofloxacin 500mg IV once- daily plus Metronidazole IV/al [FOR ALL OPTIONS, in cases with associated sepsis consider adding gentamicin amikacin stat] Community onset Cefuroxime 1.5g IV 8- hourly plus Metronidazole IV/al Levofloxacin IV 500mg once daily plus Metronidazole IV/al Aspiration pneumonitis and aspiration pneumonia (moderate to severe) Hospital onset: Temocillin 2g 12 hourly (if pseudomonas not an expected pathogen) plus Amoxicillin 1g 8 hourly plus Metronidazole IV/al Ciprofloxacin ( Levofloxacin) IV 400mg 12- hourly plus Metronidazole IV/al Ceftazidime IV 1-2g 8- hourly plus Metronidazole IV/al Bronchiectasis (high Pseudomonas risk) Ciprofloxacin IV 400mg 12- hourly Piperacillin- tazobactam shtage Antibiotic options v1.0 24/4/17

3 Ceftazidime IV 1-2g 8- hourly 3 Aztreonam 3g 8- hourly FOR ALL OPTIONS, consider +/- Aminoglycosides depending on previous isolate susceptibility +/- Co- amoxiclav Flucloxacillin if Gram- positive ganisms could be present Cefuroxime 1.5g IV 8- hourly plus Metronidazole IV/al Cholecystitis/cholangitis +/- Aminoglycoside if evidence of sepsis Ciprofloxacin IV 400mg 12- hourly plus Metronidazole IV/al Temocillin 2g 12 hourly (if pseudomonas not an expected pathogen) plus Metronidazole IV/al Complicated Intra- abdominal Infection (including surgical site infection) Vancomycin/ Teicoplanin IV + Ciprofloxacin 400mg IV 12- hourly + Metronidazole 500mg IV 8- hourly. Add Amikacin if ESBL producers are likely Cefuroxime 1.5g 8- hourly Cefotaxime 1h IV 8- hourly Ceftriaxone 1g daily + Metronidazole 500mg IV 8- hourly. Add Amikacin if ESBL producers are likely Tigecycline IV 100mg loading dose, 50mg 12- hourly Cystic fibrosis Hospital acquired pneumonia - late onset severe (high risk Pseudomonas/MRSA) Liaise with Microbiology Ceftazidime IV 1-2g 8- hourly Ciprofloxacin IV 400mg 12- hourly FOR ALL OPTIONS, ADD Piperacillin- tazobactam shtage Antibiotic options v1.0 24/4/17

4 Flucloxacillin IV (substitute Glycopeptide Linezolid if MRSA risk) Amikacin when ESBLs producers are likely 4 Infected Long- term tempary Intravascular Access Devices in Adults Necrotising (malignant) Otitis Externa Vancomycin ( Teicoplanin) IV + Ciprofloxacin 400mg IV 12- hourly Vancomycin ( Teicoplanin) IV and Gentamicin/ Amikacin IV Ciprofloxacin IV 400mg 12- hourly Ceftazidime IV 1-2g 8- hourly Cefuroxime 1.5g 8- hourly Cefotaxime IV 1-2g 8- hourly + Metronidazole IV/al Spontaneous bacterial peritonitis Ciprofloxacin IV 400mg 12- hourly plus metronidazole IV/al F patients on Ciprofloxacin prophylaxis, consider Tigecycline IV 100mg loading dose, 50mg 12- hourly Temocillin IV 2g 12- hourly Gentamicin/Amikacin once daily Pyelonephritis and sepsis Fosfomycin IV 3g 6- hourly Ertapenem 1g once daily Ceftriaxone 1g once daily (+ consider gentamicin/ amikacin if ESBL risk) Ceftriaxone 2g daily plus Metronidazole 500mg IV 8- hourly Diabetic foot infection (moderate severe) Ceftazidime 1-2g 8 hourly plus Metronidazole 500mg IV 8- hourly Piperacillin- tazobactam shtage Antibiotic options v1.0 24/4/17

5 Ciprofloxacin 400mg IV 12- hourly plus Metronidazole 500mg IV 8- hourly ADD Vancomycin/ Teicoplanin if MRSA risk 5 If there are no supplies of piperacillin- tazobactam available, alternatives f the priity indications are listed below: Guideline Antibiotic Options f each condition Ciprofloxacin ( levofloxacin) IV 400mg 12- hourly PLUS Flucloxacillin IV (substitute Glycopeptides/ Linezolid if MRSA risk) Hospital acquired pneumonia - late onset severe (high risk Pseudomonas) Ceftazidime IV 1-2g 8- hourly PLUS Flucloxacillin IV (substitute Linezolid if MRSA risk) Meropenem IV 1g 8- hourly, IV (add Glycopeptides/ Linezolid if MRSA risk) High risk: Ceftazidime 2g 8- hourly plus Gentamicin ( Amikacin, depending on local resistance epidemiology) Meropenem IV 1g 8- hourly Neutropenic Fever/ Sepsis adults Low risk: Vancomycin/ Teicoplanin IV plus ciprofloxacin IV 400mg 12- hourly (not if received pri fluoquinolone prophylaxis) Vancomycin/ Teicoplanin IV plus gentamicin IV (if received pri fluoquinolone prophylaxis) (F Patients on Levofloxacin prophylaxis - Consider Gentamicin plus Vancomycin/ Teicoplanin Aztreonam (low cross hypersensitivity in penicillin allergy) plus Vancomycin/ Teicoplanin Neutropenic Fever/ Sepsis Ceftazidime and Gentamicin +/- Glycopeptide Piperacillin- tazobactam shtage Antibiotic options v1.0 24/4/17

6 children Meropenem IV Contact Microbiology 6 Severe sepsis - unknown source Ventilat acquired pneumonia: Ceftriaxone 1g daily + Metronidazole 500mg IV 8- hourly Vancomycin/ Teicoplanin IV + Ceftazidime 1-2g IV 8- hourly + Metronidazole 500mg IV 8- hourly Vancomycin/ Teicoplanin IV plus Ciprofloxacin 400mg IV 12- hourly + Metronidazole 500mg IV 8- hourly (hospital onset) Meropenem IV 1g 8- hourly FOR ALL OPTIONS, Consider adding stat Amikacin Early onset antibiotics in last week: Levofloxacin IV Late onset: Ciprofloxacin IV and PLUS Flucloxacillin IV (substitute Linezolid if MRSA risk) Ceftazidime IV 1-2g 8- hourly, PLUS Flucloxacillin IV (substitute Linezolid Vancomycin Teicoplanin if MRSA risk) Meropenem IV 1g 8- hourly, (and add Linezolid Vancomycin Teicoplanin if MRSA risk) Approved Department of Health expert advisy group Antimicrobial Prescribing, Resistance & Healthcare- Associated Infections Chair Public Health England English Surveillance Programme f Antimicrobial Use and Resistance oversight group Chair Piperacillin- tazobactam shtage Antibiotic options v1.0 24/4/17