CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Please email any recommendations for improvement (big or small) to danny.tsai@nt.gov.au


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Choose an organism for local susceptibilities

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Staphylococcus aureus % susceptible

MSSA nmMRSA mMRSA
Amikacin - - -
Ampicillin 9 0 0
Amoxi-Clavulanate 100 0 0
Cefazolin 100 0 0
Ceftriaxone 100 0 0
Ceftazidime - - -
Ciprofloxacin 99 99 -
Clindamycin 67 60 -
Erythromycin 67 60 -
Flucloxacillin 100 0 0
Fusidic acid 97 96 80
Gentamicin 99 100 0
Meropenem - - -
Nitrofurantoin - - -
Penicillin 9 0 0
Piperacillin/tazobactam - - -
Rifampicin 100 99 100
Trimethoprim - - -
Trimethoprim-SMX 98 83 30
Vancomycin 100 100 100
Teicoplanin - - -
Linezolid - 100 100
Total percentage of isolates: 47.1% 52.5% 0.4%

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Enterococcus spp % susceptible

E.faecalis E.faecium
Amikacin - -
Ampicillin 99 10
Amoxi-Clavulanate 99 10
Cefazolin - -
Ceftriaxone - -
Ceftazidime - -
Ciprofloxacin - -
Clindamycin - -
Erythromycin - -
Flucloxacillin - -
Fusidic acid - -
Gentamicin - -
Meropenem - -
Nitrofurantoin 99 24
Penicillin 98 5
Piperacillin/tazobactam - -
Rifampicin - -
Tobramycin - -
Trimethoprim - -
Trimethoprim-SMX - -
Vancomycin 98 52
Teicoplanin 100 95
Linezolid 99 95

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Escherichia coli % susceptible

E.coli - urine; E.coli - other;
Amikacin 100 100
Ampicillin 32 28
Amoxi-Clavulanate 78 71
Cefazolin 77 60
Ceftriaxone 81 75
Ceftazidime 95 92
Ciprofloxacin 78 69
Clindamycin - -
Erythromycin - -
Flucloxacillin - -
Fusidic acid - -
Gentamicin 84 80
Meropenem 100 100
Nitrofurantoin 80 -
Penicillin - -
Piperacillin/tazobactam 94 91
Rifampicin - -
Trimethoprim 43 -
Trimethoprim-SMX 45 42
Vancomycin - -
Teicoplanin - -
Linezolid - -

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Klebsiella spp. % susceptible

Klebsiella spp. - urine; Klebsiella spp. - other;
Amikacin 100 100
Ampicillin - -
Amoxi-Clavulanate 87 94
Cefazolin 79 85
Ceftriaxone 81 85
Ceftazidime 89 95
Ciprofloxacin 83 89
Clindamycin - -
Erythromycin - -
Flucloxacillin - -
Fusidic acid - -
Gentamicin 91 98
Meropenem 100 100
Nitrofurantoin 39 -
Penicillin - -
Piperacillin/tazobactam 85 91
Rifampicin - -
Trimethoprim 82 -
Trimethoprim-SMX 84 82
Vancomycin - -
Teicoplanin - -
Linezolid - -

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Proteus mirabilis % susceptible

P.mirabilis
Amikacin 100
Ampicillin 90
Amoxi-Clavulanate 98
Cefazolin94
Ceftriaxone 100
Ceftazidime 100
Ciprofloxacin 100
Clindamycin -
Erythromycin -
Flucloxacillin -
Fusidic acid -
Gentamicin 100
Meropenem 100
Nitrofurantoin -
Penicillin -
Piperacillin/tazobactam 100
Rifampicin -
Trimethoprim 93
Trimethoprim-SMX 93
Vancomycin -
Teicoplanin -
Linezolid -

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Enterobacter spp % susceptible

Enterobacter spp
Amikacin 100
Ampicillin -
Amoxi-Clavulanate -
Cefazolin -
Ceftriaxone -
Ceftazidime 88
Ciprofloxacin 97
Clindamycin -
Erythromycin -
Flucloxacillin -
Fusidic acid -
Gentamicin 99
Meropenem 100
Nitrofurantoin -
Penicillin -
Piperacillin/tazobactam -
Rifampicin -
Trimethoprim -
Trimethoprim-SMX 94
Vancomycin -
Teicoplanin -
Linezolid -

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Salmonella spp. % susceptible

Salmonella spp.
Amikacin -
Ampicillin 94
Amoxi-Clavulanate -
Cefazolin -
Ceftriaxone 100
Ceftazidime -
Ciprofloxacin 100
Clindamycin -
Erythromycin -
Flucloxacillin -
Fusidic acid -
Gentamicin -
Meropenem 100
Nitrofurantoin -
Penicillin -
Piperacillin/tazobactam -
Rifampicin -
Tobramycin -
Trimethoprim -
Trimethoprim-SMX 100
Vancomycin -
Teicoplanin -
Linezolid -

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Pseudomonas aeruginosa % susceptible

Pseudomonas
Amikacin 97
Ampicillin -
Amoxi-Clavulanate -
Cefazolin -
Ceftriaxone -
Ceftazidime 92
Ciprofloxacin 88
Clindamycin -
Erythromycin -
Flucloxacillin -
Fusidic acid -
Gentamicin 97
Meropenem 93
Nitrofurantoin -
Penicillin -
Piperacillin/tazobactam 84
Rifampicin -
Trimethoprim -
Trimethoprim-SMX -
Vancomycin -
Teicoplanin -
Linezolid -

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiogram CAHS

CAHS Acinetobacter spp. % susceptible

Acinetobacter spp.
Amikacin 100
Ampicillin -
Amoxi-Clavulanate -
Cefazolin -
Ceftriaxone -
Ceftazidime 93
Ciprofloxacin 100
Clindamycin -
Erythromycin -
Flucloxacillin -
Fusidic acid -
Gentamicin 100
Meropenem 100
Nitrofurantoin -
Penicillin -
Piperacillin/tazobactam 88
Rifampicin -
Trimethoprim -
Trimethoprim-SMX 96
Vancomycin -
Teicoplanin -
Linezolid -

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Antibiotics list

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

This section is awaiting completion



Unfortunately the sections for ampicillin, valaciclovir, anidulafungin and azithromycin are still incomplete. Please check later for these sections
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

BENZATHINE BENZYLPENICILLIN

Synonym:
penicillin G benzathine
Antibacterial ? Penicillin

PREPARATIONS:

Trade name(s):
Bicillin L-A (Pfizer).1
Stock preparation(s):
Injection: Prefilled syringe ? 900 mg in 2.3 mL suspension. Each prefilled syringe contains 900 mg benzathine benzylpenicillin equivalent to 1.2 MU (million units).
Properties:
Physical description: Viscous, opaque suspension.
Excipients: Sodium citrate, lecithin, carmellose sodium, povidone, methyl hydroxybenzoate, propyl hydroxybenzoate.
pH: 5 to 7.5 7.
Sodium content: Contains sodium ? amount not stated.
Storage:
Prefilled syringe: Refrigerate (2?C to 8?C).Do not freeze.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: benzathine benzylpenicillin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Must NOT be used (risk of severe neurovascular damage)7.
Intermittent IV infusion Must NOT be used.
Continuous IV infusion Must NOT be used.
IM injection Streptococcal Group A upper respiratory infections: 900 mg as a single dose
Syphilis: 1.8 g as a single dose; for latent syphilis may be 3 doses at weekly intervals
Yaws, bejel and pinta: 900 mg as a single dose.
Rheumatic fever, acute glomerulonephritis prophylaxis: following an acute attack 900 mg once a month or 450 mg every 2 weeks 2.
Subcutaneous injection Must NOT be used.

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Bicillin L-A [Medsafe Datasheet]. Pfizer New Zealand Ltd, 08 June 2012
  2. New Zealand Formulary. Benzathine benzylpenicillin [Accessed 20 June 2015]
  3. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  4. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  5. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 20 June 2015]
  6. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  7. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
  8. Administration of IM lignocaine & Bicillin. [Accessed via Norther Region Clinical Pathways http://www.healthpointpathways.co.nz/assets/RF/IM_BICILLIN_Administration_Procedure_with_glass_ampoule%20pdf1.pdf?v=14347 85890048 / 20 June 2015]
  9. Russell K, Nicholson R, Naidu R. Reducing the pain of intramuscular benzathine penicillin injections in the rheumatic fever population of Counties Manukau District Health Board. J Paediatr Child Health 2014; 50(2):112-7 [Accessed via PubMed http://www.ncbi.nlm.nih.gov/pubmed/24134180 / 20 June2015]
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

PROCAINE BENZYLPENICILLIN

Synonym:
penicillin G procaine, procaine penicillin
Antibacterial ? Penicillin

PREPARATIONS:

Trade name(s):
Cilicaine (Healthcare Logistics) 1
Stock preparation(s):
Injection: Prefilled syringe ? 1.5 gram in 3.4 mL suspension. Each prefilled syringe contains 1.5 grams procaine benzylpenicillin equivalent to 1.5 MU (million units) 6,7.
Properties:
Physical description: Viscous, white suspension.
Excipients: Phenyl mercuric acetate (preservative), sodium citrate, polysorbate 80, water for injections.
pH: 5 to 7.5 6,7.
Sodium content: Contains sodium ? amount not stated.
Storage:
Prefilled syringe: Refrigerate (between 2?C to 8?C). Do not freeze 7.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ datasheet

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Must NOT be used (risk of neurovascular damage) 11.
Intermittent IV infusion Must NOT be used.
Continuous IV infusion Must NOT be used.
IM injection Usual dose: 1.5 g daily for 2 to 5 days.
Gonorrhoea: 1 g daily for 1 to 2 weeks, or up to 4.8 g as a single dose in combination with probenecid.
Syphilis: 1 g daily for 10 to 14 days.
Subcutaneous injection Must NOT be used.

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Cilicaine [Medsafe Datasheet]. Pharmacy Retailing (NZ) Limited, 13 February 2013
  2. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  3. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  4. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 22 June 2015]
  5. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  6. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

ACICLOVIR SODIUM

Synonym:
acyclovir
Antiviral

PREPARATIONS:

Trade name(s):
Zovirax IV for Infusion (GlaxoSmithKline) 1
Stock preparation(s):
Infusion: Vial ? 250 mg powder for reconstitution.
Properties:
Physical description: White to off-white powder.
Excipients: No information.
pH: ~11
Sodium content: 26 mg (~1.05 mmol 5,10) sodium per 250 mg acyclovir sodium.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted solution: Prepare immediately before use (no preservative). However, reconstituted solutions (25 mg/mL) are stable at room temperature (below 25oC) for up to 12 hours. Do not refrigerate (may cause precipitation 7).
Diluted solution: Stable at room temperature (below 25oC) for up to 24 hours. Do not refrigerate (may cause precipitation 7). Storage and in-use time must not exceed 24 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: aciclovir.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Dose in obese patients should be calculated using ideal body weight, not actual body weight.
Direct IV injection MUST NOT be used (may cause renal damage/tubular necrosis 3,4,7,9,11).
Intermittent IV infusion Herpes simplex, Varicella zoster: 5 mg/kg (10 mg/kg in immunocompromised 2) every 8 hours.
Herpes encephalitis, Herpes zoster (shingles): 10 mg/kg every 8 hours.
CMV prophylaxis: 500 mg/m2 every 8 hours. Refer to local protocol.
In patients with renal impairment:
GFR 25 to 50 mL/minute: every 12 hours 3.
GFR 10 to 25 mL/minute: every 24 hours 3.
GFR less than10 mL/minute: 2.5 to 5 mg/kg every 24 hours 3
. Seek specialist advice for renal replacement patients.
Continuous IV infusion Not recommended.
IM injection Not recommended (highly alkaline).
Subcutaneous injection Not recommended (highly alkaline).

INTRAMUSCULAR INJECTION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Zovirax [Medsafe Datasheet]. GlaxoSmithKline NZ Ltd, 10 October 2014
  2. New Zealand Formulary. Aciclovir [Accessed 13 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 13 June 2015] 7
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014 8
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014.
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013.
  11. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014.
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

AMIKACIN

Synonym:
Antibacterial ? Aminoglycoside

PREPARATIONS:

Trade name(s):
DBLTM Amikacin Injection (Hospira) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 500 mg (amikacin) in 2 mL solution. Each vial contains amikacin sulfate equivalent to 500 mg amikacin.
Properties:
Physical description: Clear, colourless 1 to light straw or pale yellow 5,6,10 solution.
Excipients: Sodium metabisulfite and sodium citrate.
pH: 4.5 7; range 3.5 to 5.5 10.
Sodium content: 0.64 mmol per 500 mg amikacin 10
Storage:
Stock solution (undiluted for IM injection): Store at room temperature (below 25?C).
Diluted solutions: Store at room temperature (below 25oC) for up to 12 hours. Discard any unused solution after 12 hours. Some sources recommend longer storage 4,5; consult a pharmacist.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: amikacin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Dose usually based on ideal body weight. If patient weighs less than ideal body weight then use actual body weight. Some hospitals will use adjusted body weight in obese patients. Therapeutic drug monitoring: refer to local hospital protocols.
Direct IV injection Not recommended.
However, some sources recommend administration by slow IV injection over 3 to 5 minutes using the same dosage as for IM injection 3,6.
Intermittent IV infusion Reserved for life-threatening infection or when the IM route is not feasible.
Multiple daily dose regimen 1,2:
7.5 mg/kg every 12 hours or 5 mg/kg every 8 hours 1,2, increased to 7.5 mg/kg every 8 hours in severe infections 2. Do not exceed total daily dose 1.5 g 2,3; or maximum cumulative dose 15 g 2.
Once daily dose regimen (unapproved regimen) 2:
15 mg/kg (maximum 1.5 g per dose), then adjusted according to serum amikacin concentrations (maximum total cumulative dose 15 g).
Consult local hospital protocols which usually recommend dosing based on therapeutic drug monitoring, or seek guidance from a pharmacist.
In patients with renal impairment:
Dose regimen is best adjusted using therapeutic drug monitoring.
However, if therapeutic drug monitoring is not feasible manufacturer recommends adjusting dose by extending the dose interval or reducing each dose.
Requires regular monitoring of serum creatinine throughout therapy 1,5. Consult local protocols or seek guidance from a pharmacist or renal physician
Continuous IV infusion Not recommended.
IM injection Preferred route unless life-threatening infection.
Multiple daily dose regimen 1,2:
7.5 mg/kg every 12 hours or 5 mg/kg every 8 hours 1,2, increased to 7.5 mg/kg every 8 hours in severe infections 2. Do not exceed total daily dose 1.5 g 2,3 or maximum cumulative dose 15 g 2.
In patients with renal impairment:
Same recommendations as for intermittent IV infusion above.
Subcutaneous injection Not recommended.
Intrathecal/Intraventricular Unapproved routes reserved solely as adjunctive routes for meningitis. To be used on an ad-hoc basis only under strict instruction from infectious diseases.

INTERMITTENT IV INFUSION:

Injection solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration if dilution required:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

Therapeutic Drug Monitoring:

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. DBLTM Amikacin Injection [Medsafe Datasheet]. Hospira NZ Limited, 19 August 2014.
  2. New Zealand Formulary. Amikacin [Accessed 15 June 2015].
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014.
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 15 June 2015].
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4, Feb 2014). United Kingdom Clinical Pharmacy Association; 2012.
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014.
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013.
  11. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014.
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

AMPHOTERICIN B LIPOSOMAL

Antifungal

PREPARATIONS:

Trade name(s):
AmBisome for Injection (Gilead Sciences) 1.
Stock preparation(s):
Infusion: Vial ? 50 mg powder for reconstitution.
Properties:
Physical description: Lyophilised powder. Reconstituted solution yellow and translucent.
Excipients: Hydrogenated soy phosphatidylcholine, cholesterol, distearoylphosphatidylglycerol, alpha-tocopherol, sucrose, sodium succinate hexahydrate.
pH: 5 to 6 when reconstituted 7
Sodium content: Contains sodium ? amount not stated.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted and diluted solutions: Prepare immediately before use. However, solutions may be refrigerated (2?C to 8?C) provided the storage and in-use time is less than 24 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: amphotericin B.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion Usual dose: 1 to 3 mg/kg/day, up to 5 mg/kg/day.
Continuous IV infusion Not recommended.
IM injection Not recommended.
Subcutaneous injection Not recommended.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Ambisome [Medsafe Datasheet]. Gilead Sciences NZ, 10 September 2014
  2. New Zealand Formulary. Amphotericin B [Accessed 12 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014.
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014.
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 12 June 2015].
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.2 May 2013). United Kingdom Clinical Pharmacy Association; 2012.
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014.
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013.
  11. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014.
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

AMOXICILLIN plus CLAVULANIC ACID

Antibacterial ? Penicillin plus Beta-Lactamase Inhibitor

PREPARATIONS:

Trade name(s):
m-Amoxiclav (Multichem) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 600 mg vial: 500 mg/100 mg amoxicillin/clavulanic acid powder for reconstitution.
Injection/Infusion: Vial ? 1.2 g vial: 1 g/200 mg amoxicillin/clavulanic acid powder for reconstitution.
Each vial contains amoxicillin sodium equivalent to 500 mg or 1 g amoxicillin plus potassium clavulanate equivalent to 100 mg or 200 mg clavulanic acid.
Properties:
Physical description: White to off-white crystalline powder. Reconstituted solution range from transient pink to pale yellow.
Excipients: None.
pH: No information.
Sodium content: 31.6 mg (1.4 mmol) sodium per 600 mg, or 63.1 mg (2.7 mmol) sodium per 1.2 g vials.
Storage:
Powder for reconstitution: Store at room temperature (below 30?C). Protect from moisture.
Reconstituted solutions: Prepare immediately before use. Use within 20 minutes of preparation.
Diluted solutions: Prepare immediately before use. Use within 60 minutes of preparation. Stable when:
  • diluted with water for injection (50 mL): at room temperature (below 25?C) or refrigerated (2?C to 8?C) for up to 4 hours.
  • diluted with sodium chloride 0.9% (50 mL): refrigerated (2?C to 8?C) for up to 4 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: amoxicillin + clavulanic acid.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 1.2 g every 8 hours 2.
Severe infection: 1.2 g every 6 hours.
Surgical prophylaxis: 1.2 g as a single dose up to 30 minutes before surgery. Dose may be repeated every 8 hours for a total of 2 or 3 doses.
In patients with renal impairment:3
GFR 10 to 30 mL/minute: 1.2 g every 12 hours. GFR less than 10 mL/minute: 1.2 g initially, followed by 600 mg every 8 hours or 1.2 g every 12 hours.
Intermittent IV infusion
Continuous IV infusion Not recommended.
IM injection Not recommended.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Amoxiclav [Medsafe Datasheet]. Multichem NZ Limited, 04 April 2012
  2. New Zealand Formulary. Amoxicillin + clavulanic acid [Accessed 20 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

AMPICILLIN SODIUM

SYNONYMS:
Ampicillin
TRADE NAME:
AMPICYN, AUSTRAPEN, IBIMYCIN
DRUG CLASS:
Penicillin antibiotic
AVAILABILITY:
Vial contains 500 mg or 1 g of ampicillin as ampicillin sodium.1
pH:
8?10 when reconstituted2.
PREPARATION:
For IM use : Reconstitute the vial with 1.5 mL of water for injections.1
For IV use : Reconstitute the vial with 10?20 mL of water for injections.1
If a part dose is required, alternative dilutions are:1
Vial size 500 mg 500 mg 500 mg 1 g 1 g 1 g
Reconstitute with 1.7 mL 2.2 mL 4.7 mL 1.3 mL 3.3 mL 9.3 mL
Approximate concentration 250 mg/mL 200 mg/mL 100 mg/mL 500 mg/mL 250 mg/mL 100 mg/mL
Powder volume : 500 mg ? 0.3 mL, 1 g ? 0.7 mL3
ADMINISTRATION:
IM injection : Inject deep into a large muscle.1
SUBCUT injection : Not recommended
IV injection : Dilute dose in 10?20 mL of compatible fluid and inject over 3 to 5 minutes.1
IV infusion : Dilute with a compatible fluid to a convenient volume (e.g. 50?100 mL) and infuse over 30 to 40 minutes.1
IV use for infants and children: Dilute to 100 mg/mL and inject over at least 3 to 5 minutes. For doses larger than 500 mg, dilute to 30 mg/mL and infuse over 15 to 30 minutes.4,5
STABILITY:
Vial : Store below 25 ?C.1
Reconstituted solution : Use immediately after reconstitution.1
Diluted solutions : Use immediately after dilution. Stable for 24 hours at 2 to 8 ?C in sodium chloride 0.9% (30 mg/mL) and Ringer?s solution (8 mg/mL). More concentrated solutions are unstable.1
COMPATIBILITY:
Compatible fluids : Ringer's1,2, sodium chloride 0.9%1,2
Compatible via Y-site : Aciclovir2, amifostine2, anidulafungin2, aztreonam2, bivalirudin2, dexmedetomidine2, esmolol2, filgrastim2, foscarnet2, granisetron2, heparin sodium2, labetalol2, linezolid2, magnesium sulfate2, morphine sulfate2, pethidine2, potassium chloride2, remifentanil2
Compatible in syringe : Chloramphenicol2, colistin2, heparin sodium (for at least 5 minutes)2
INCOMPATIBILITY:
Incompatible fluids : Dextran1,2, glucose 5%1, glucose in sodium chloride solutions1
However, ampicillin can be injected into the side arm of a glucose infusion as the contact time with the solution is insufficient to cause significant drug degradation.1
Other incompatibilities include: blood products2, fat emulsions2, polygeline6
Incompatible drugs : Adrenaline hydrochloride2, aminoglycosides ? amikacin, gentamicin, tobramycin2, aminophylline6, atropine1, buprenorphine6, caspofungin2, chlorpromazine2, clindamycin1, dobutamine6, dolasetron1, dopamine2, ergometrine1, fluconazole2, ganciclovir6, haloperidol lactate6, hydralazine2, ketamine6, lincomycin2, lorazepam6, metoclopramide2, midazolam2, mycophenolate mofetil6, ondansetron2, pentamidine6, prochlorperazine2, promethazine6, protamine6, sodium bicarbonate2, tranexamic acid6, verapamil2
SPECIAL NOTES:
Contraindication: Patients with severe hypersensitivity to penicillins, carbapenems and cephalosporin antibiotics.
Rapid IV administration can cause seizures.1
Each gram of ampicillin sodium contains 2.7 mmol of sodium.1

REFERENCES

  1. Product information. AusDI [Internet]. Sydney: Phoenix Medical Publishing; 2006. Updated 02/08/13. Accessed 22/08/13.
  2. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, Maryland: American Society of Health System Pharmacists; 2013.
  3. Royal Children?s Hospital Pharmacy Department. Paediatric injectable guidelines. 4th ed. Flemington, Vic: The Royal Children?s Hospital; 2011.
  4. Taketomo C, Hodding J, Kraus D. Paediatric and neonatal dosage handbook. 19th ed. Hudson, Ohio: American Pharmacists Association. Lexicomp; 2012.
  5. Phelps SJ, Hageman TM, Lee KR, Thompson AJ. Paediatric injectable drugs. The teddy bear book. 10th ed. Bethesda, Maryland: American Society of Health System Pharmacists; 2013.
  6. Ampicillin. In: IV index. Trissel's 2 clinical pharmaceutics database (parenteral compatibility). Greenwood Village, Colorado: Truven Health Analytics. Accessed 21/02/11.
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

ANIDULAFUNGIN

TRADE NAME:
ERAXIS
DRUG CLASS:
Echinocandin antifungal
AVAILABILITY:
Vial contains 100 mg of anidulafungin. Also contains fructose, mannitol, polysorbate-80, tartaric acid, hydrochloric acid and/or sodium hydroxide.
pH:
5 when reconstituted2.
PREPARATION:
Reconstitute the vial with 30 mL of water for injections to make a concentration of 3.33 mg/mL. It may take up to 5 minutes to dissolve.1
ADMINISTRATION:
IM injection : No information
SUBCUT injection : No information
IV injection : Not recommended
IV infusion : Dilute the reconstituted solution with sodium chloride 0.9% or glucose 5% using the following table.1 The concentration of the infusion solution is 0.77 mg/mL. Infuse at a rate of 1.4 mL/minute (1.1 mg/minute) or slower. Inspect for particles or discolouration.1
Dose No of vials Reconstituted volume Fluid volume Total infusion volume Rate of infusion Minimum infusion time
100 mg 1 30 mL 100 mL 130 mL 1.4 mL/min 90 minutes
200 mg 2 60 mL 200 mL 260 mL 1.4 mL/min 180 minutes
STABILITY:
Vial : Store at 2 to 8 ?C. Do not freeze.1
Reconstituted solution : Stable for 1 hour when stored at 2 to 8 ?C.1
Diluted solutions : Store at 2 to 8 ?C and complete infusion within 24 hours of reconstitution.1
COMPATIBILITY:
Compatible fluids : Glucose 5%1, sodium chloride 0.9%1
Compatible via Y-site : Aciclovir3, adrenaline hydrochloride3, amikacin3, aminophylline3, ampicillin3, calcium folinate3, cefepime3, cefoxitin3, ceftazidime3, ceftriaxone3, cefazolin3, ciprofloxacin3, clindamycin3, cyclosporin3, dexamethasone3, digoxin3, dobutamine3, dopamine3, doripenem3, erythromycin3, fentanyl3, fluconazole3, frusemide3, ganciclovir3, gentamicin3, heparin sodium3, hydrocortisone sodium succinate3, imipenem-cilastatin3, linezolid3, meropenem3, methylprednisolone sodium succinate3, metronidazole3, midazolam3, morphine sulfate3, mycophenolate mofetil3, noradrenaline3, pethidine3, phenylephrine3, piperacillin-tazobactam (EDTA-free)3, potassium chloride3, ranitidine3, tacrolimus3, ticarcillin-clavulanate3, tobramycin3, trimethoprim-sulfamethoxazole,3 vancomycin3, voriconazole3, zidovudine3
Compatible in syringe : No information
INCOMPATIBILITY:
Incompatible fluids : No information
Incompatible drugs : Ertapenem3, magnesium sulfate2, potassium phosphates2, sodium bicarbonate3, sodium phosphates2
SPECIAL NOTES:
Minimise infusion-related reactions such as rash, urticaria, flushing and pruritis by infusing at a rate of 1.1 mg/minute or slower.1

REFERENCES

  1. Product information. AusDI [Internet]. Sydney: Phoenix Medical Publishing; 2006. Updated 02/08/13. Accessed 26/08/13.
  2. Anidulafungin. In: IV index [Internet]. Trissel's 2 clinical pharmaceutics database (parenteral compatibility). Greenwood Village, Colorado: Truven Health Analytics. Accessed 26/08/13.
  3. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, Maryland: American Society of Health System Pharmacists; 2013.
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

AZITHROMYCIN

TRADE NAME:
AZITH, AZITHROMYCIN ALPHAPHARM, AZITHROMYCIN DBL, ZITHROMAX
DRUG CLASS:
Macrolide antibiotic
AVAILABILITY:
Vial contains 500 mg of azithromycin. Also contains citric acid and sodium hydroxide.1
pH:
6.3?7 when reconstituted1.
PREPARATION:
Reconstitute each vial with 4.8 mL of water for injections to make a concentration of 100 mg/mL. Shake until dissolved. Discard if particles present.1
ADMINISTRATION:
IM injection : Not recommended1
SUBCUT injection : No information
IV injection : Not recommended1
IV infusion : Dilute 5 mL of the reconstituted solution in either 500 mL to make a concentration of 1 mg/mL and infuse over 3 hours or in 250 mL to make a concentration of 2 mg/mL and infuse over 1 hour1
IV use for infants and children: Dilute to 1 mg/mL and infuse over 3 hours or dilute to 2 mg/mL and infuse over 1 hour.2
STABILITY:
Vial : Store below 25 ?C. Protect from light.1
Reconstituted solution : Stable for 24 hours at 30 ?C.1
Diluted solutions : Stable for 24 hours at 30 ?C or 2 to 8 ?C.1
COMPATIBILITY:
Compatible fluids : Glucose 5%1, glucose in sodium chloride solutions1, Hartmann's1, sodium chloride 0.9%1, sodium chloride 0.45%1
Compatible via Y-site : Bivalirudin3, ceftaroline fosamil3, dexmedetomidine3, doripenem3, tigecycline3
Compatible in syringe : Not applicable1
INCOMPATIBILITY:
Incompatible fluids : No information
Incompatible drugs : Amikacin3, amiodarone4, aztreonam3, cefotaxime3, ceftazidime3, ceftriaxone3, chlorpromazine4, ciprofloxacin3, clindamycin3, fentanyl3, frusemide3, gentamicin3, imipenem-cilastatin3, ketorolac3, midazolam4, morphine sulfate3, mycophenolate mofetil4, pentamidine4, piperacillin-tazobactam (EDTA-free)3, potassium chloride3, ticarcillin-clavulanate3, tobramycin3
SPECIAL NOTES:
Solutions of a concentration greater than 2 mg/mL may cause local infusion-site reactions.1
Severe allergic reactions may occur.1
Azithromycin contains 114 mg (4.96 mmol) sodium per vial.5

REFERENCES

  1. Product information. AusDI [Internet]. Sydney: Phoenix Medical Publishing; 2006. Updated 02/08/13. Accessed 29/08/13
  2. Phelps SJ, Hageman TM, Lee KR, Thompson AJ. Paediatric injectable drugs. The teddy bear book. 10th ed. Bethesda, Maryland: American Society of Health System Pharmacists; 2013.
  3. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, Maryland: American Society of Health System Pharmacists; 2013.
  4. Azithromycin. In: IV index. Trissel's 2 clinical pharmaceutics database (parenteral compatibility). Greenwood Village, Colorado: Truven Health Analytics. Accessed 29/09/10.
  5. McEvoy GK. editor. AHFS 2013 drug information. Bethesda, Maryland: American Society of Health System Pharmacists; 2013
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

AMOXICILLIN

Synonym:
amoxicillin
Antibacterial ? Penicillin

PREPARATIONS:

Trade name(s):
Ibiamox (Douglas Pharmaceuticals) 1.
Stock preparation(s):
Injection/Infusion: Vial ?250 mg. 500 mg and 1 g powder for reconstitution. Each vial contains amoxicillin sodium equivalent to 250 mg. 500 mg or 1 g amoxicillin.
Properties:
Physical description: White to cream powder. Reconstituted solution is red initially, but ranges to from clear to pale yellow.
Excipients: No information.
pH: 8 to 10 6,7.
Sodium content: 2.6 mmol per 1 gram of amoxicillin sodium 5,7,10 = 15 mg per 250 mg, 30 mg per 500 mg, and 60 mg per 1 gram vial of Ibiamox 12.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from moisture. Protect from light.
Reconstituted and diluted solutions: Prepare immediately before use. However solutions are stable at room temperature for up to 1 hour and longer in: sodium chloride 0.9% stable for up to 6 hours, Lactated Ringer?s (Hartmann?s) stable for up to 3 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring toNZ Formulary: amoxicillin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 250 mg to 500 mg every 8 hours; increased to 1 g every 6 hours in severe infection.
Intermittent IV infusion Usual dose: 500 mg every 8 hours increased to 1 g every 6 hours in severe infection 2.
Listeria meningitis, endocarditis: 2 g every 4 hours 2.
In patients with renal impairment: GFR less than 10 mL/minute: maximum dose 6 g per day 3.
Continuous IV infusion Not recommended.
IM injection Usual dose: 500 mg every 8 hours 2.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Solutions containing carbohydrate, e.g. glucose - amoxicillin sodium is less stable.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Ibiamox [Medsafe Datasheet]. Douglas Pharmaceuticals, 06 October 2011
  2. New Zealand Formulary. Amoxicillin [Accessed 20 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ Accessed 20 June 2015]
  5. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  6. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  7. Personal communication. Sodium content in Ibiamox preparations. Data on file. Douglas Pharmaceuticals, 16 July 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

AZTREONAM

Antibacterial ? Monobactam

PREPARATIONS:

Trade name(s):
Azactam (Bristol-Myers Squibb) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 1 gram powder for reconstitution.
Properties:
Physical description: White to off-white powder. Reconstituted solutions range from colourless, light straw yellow to a slight pink tint solution (pink tint does not affect potency).
Excipients: L-arginine.
pH: 4.5 to 7.5.
Sodium content: None.
Storage:
Powder for reconstitution: Store at room temperature (below 30?C). Protect from moisture and light 5.
Exposure to strong light may cause yellowing of powder 10.
Reconstituted solution for IM injection: Prepare immediately before use. However, solutions are stable at room temperature (below 25?C) for up to 48 hours and refrigerated (2?C to 8?C) for up to 7 days.
Reconstituted solution for IV injection (greater than 20 mg/mL): Prepare immediately before use and use promptly. Discard any unused solution.
Diluted solution for IV infusion (20 mg/mL or less): Prepare immediately before use. However, solutions are stable at room temperature (below 25?C) for up to 48 hours and refrigerated (2?C to 8?C) for up to 7 days.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: aztreonam.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 500 mg to 2 g every 8 to 12 hours, increased to 2 g every 6 to 8 hours for severe infections. Maximum 8 g/day.
In patients with renal impairment:
GFR 10 to 30 mL/minute: 1 to 2 g loading dose followed by 50% of appropriate maintenance dose 3,5.
GFR less than 10 mL/minute: 1 to 2 g loading dose followed by 25% of appropriate maintenance dose 3,5.
Seek specialist advice for renal replacement patients.
Intermittent IV infusion
Continuous IV infusion Not recommended.
IM injection Usual dose: 500 mg to 1 g every 8 to 12 hours 2,5.
Gonorrhoea; cystitis: 1 g as a single dose. Doses larger than 1 g should be administered by the IV route.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Azactam [Medsafe Datasheet]. Bristol-Myers Squibb (NZ) Limited, 1 October 2013
  2. New Zealand Formulary. Aztreonam [Accessed 14 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 14 June 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

BENZYLPENICILLIN SODIUM

Synonym:
penicillin G sodium
Antibacterial ? Penicillin

PREPARATIONS:

Trade name(s):
Penicillin G Sodium (Novartis) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 600 mg powder for reconstitution.
Each vial contains benzylpenicillin sodium 600 mg equivalent to 1 MU (million units).
Properties:
Physical description: White to whitish powder. Reconstituted and diluted solutions are clear.
Excipients: None.
pH: 5.5 to 7.5 10.
Sodium content: 1.68 mmol sodium per 600 mg of benzylpenicillin sodium.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted and diluted solutions: Prepare immediately before use (rapid degradation in solution unless buffered).

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: benzylpenicillin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 600 mg to 1.2 g every 6 hours, increased if necessary up to 1.2 g to 2.4 g every 4 hours for more serious infections 2. Usual maximum dose 14.4 g/day 3.
Intrapartum prophylaxis against group B streptococcal infection: initially 3 g then 1.5 g every 4 hours until delivery 2.
In patients with severe renal impairment 3: Maximum dose 4.8 g/day.
Intermittent IV infusion
Continuous IV infusion Suitable for total daily doses of 6 g (10 MU) or more 10. Dilute total daily dose in 1,000 mL compatible IV fluid (needs to be prepared as a buffered solution to improve stability) and infuse over 24 hours 4,7. Consult pharmacy.
IM injection Preferred route.
Usual dose: 600 mg to 1.2 g every 6 hours.
Doses greater than 1.2 g may be better administered via the IV route, however, up to 6 g doses may be given if divided between more than one injection sites.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV injection:

Infusion solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Injection solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Lactated Ringer's (Hartmann's), Ringer's.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Penicillin G Sodium [Medsafe Datasheet]. Novartis, 09 December 2014
  2. New Zealand Formulary. Benzylpenicillin [Accessed 20 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 20 June 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CASPOFUNGIN

Antifungal

PREPARATIONS:

Trade name(s):
Cancidas ® (Merck Sharp & Dohme) 1
Stock preparation(s):
Infusion: Vial ? 50 mg powder for reconstitution.
Infusion: Vial ? 70 mg powder for reconstitution.
Each vial contains caspofungin acetate equivalent to 50 mg or 70 mg caspofungin base.
Properties:
Physical description: White to off-white lypophilised powder. Reconstituted solution is clear.
Excipients: Sucrose, mannitol, glacial acetic acid, sodium hydroxide (for pH adjustment).
pH: 6.6 7,10.
Sodium content: No information.
Storage:
Powder for reconstitution: Refrigerate (between 2?C to 8?C). Do not freeze 7. Discard if exposed to room temperature for longer than 48 hours 10.
Reconstituted solution: Stable when stored at room temperature (below 25?C) for up to 24 hours before the diluted solution is prepared for use.
Diluted solution for infusion: Stable when stored at room temperature (below 25?C) for up to 24 hours, or when refrigerated (between 2?C and 8?C) for up to 48 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: caspofungin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection MUST NOT be used.
Intermittent IV infusion Empirical therapy, invasive candidiasis, invasive aspergillosis: 70 mg loading dose on day 1, followed by 50 mg daily thereafter.
Oesophageal or oropharyngeal candidiasis: 50 mg daily.
Continuous IV infusion Not recommended.
IM injection MUST NOT be used.
Subcutaneous injection MUST NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Dose Volume of reconstituted solution for transfer to IV bag Infusion concentration when added to 250 mL Infusion concentration when added to 100 mL
70 mg 10 mL 0.28 mg/mL -
70 mg (from two 50 mg vials) 14 mL 0.28 mg/mL -
50 mg 10 mL 0.2 mg/mL 0.47 mg/mL
35 mg (from one 70 mg vial) 5 mL 0.14 mg/mL 0.34 mg/mL
35 mg (from one 50 mg vial) 7 mL 0.14 mg/mL 0.34 mg/mL

Compatibility ? Diluent appropriate to RECONSTITUTE solution:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Cancidas? [Medsafe Datasheet]. Merck Sharp & Dohme (New Zealand) Limited, 03 October 2014
  2. New Zealand Formulary. Caspofungin [Accessed 22 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 22 June 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.2 May 2013). United Kingdom Clinical Pharmacy Association; 2012
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CEFEPIME (cefEPIME) HYDROCHLORIDE

Antibacterial ? Cephalosporin - 4th generation

PREPARATIONS:

Trade name(s):
DBL Cefepime (Hospira) 1
Stock preparation(s):
Injection/Infusion:Vial ?1 g and 2 g powder for reconstitution.
Properties:
Physical description: White to pale yellow powder. Reconstituted solutions range from pale yellow to amber coloured transparent solution.
Excipients: L-arginine (to control pH).
pH: 4 to 6.
Sodium content:No information.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light.
Reconstituted solution: Prepare immediately before use (contains no preservative). However solutions may be refrigerated (2?C to 8?C) for up to 24 hours. Protect from light. Solution may darken on storage without affecting potency.
Diluted solution: Prepare immediately before use (contains no preservative). However solutions at concentrations between 1 mg/mL and 40 mg/mL may be stored at room temperature (below 25?C) for up to 24 hours 7.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: cefepime.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 500 mg to 1 g every 12 hours; increased in severe infections to 2 g every 12 hours; and in life-threatening infections up to 2 g every 8 hours.
In patients with renal impairment: GFR 30 to 50 mL/minute: reduce dose frequency.
GFR 10 to 30 mL/minute: reduce dose frequency ? reduce dose.
GFR less than 10 mL/minute: reduce dose frequency and reduce dose.
Seek specialist advice for renal replacement patients.
Intermittent IV infusion
Continuous IV infusion Not recommended.
IM injection Usual dose: 500 mg to 1 g every 12 hours.
This route is NOT recommended for doses greater than 1 g.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

DOSE TABLE ? check your calculation
Cefepime - dose conversion chart: gram/hour to mL/hour
Dose Example
500 mg infused over 30 minutes 1 g infused over 30 minutes 2 g infused over 30 minutes -
Dose rate in g/h
1 2 4 -
Infusion solution concentration Convert to
Dose rate in mL/h
5 mg/mL 500 mg in 100 mL 200 - - -
10 mg/mL 500 mg in 50 mL 100 - - -
10 mg/mL 1 g in 100 mL - 200 - -
20 mg/mL 1 g in 50 mL - 100 - -
20 mg/mL 2 g in 100 mL - - 200 -
40 mg/mL 2 g in 50 mL - - 100 -

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. DBL? Cefepime Powder for Injection [Medsafe Datasheet]. Hospira NZ Limited, 17 August 2011
  2. New Zealand Formulary. Cefepime [Accessed 06April 2015]
  3. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  4. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  5. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 22 June 2015]
  6. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  7. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  8. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  9. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CEFOTAXIME (cefOTAXIME) SODIUM

Antibacterial ? Cephalosporin - 3rd generation

PREPARATIONS:

Trade name(s):
Cefotaxime Sandoz (Novartis)1a, DBL Cefotaxime (Hospira)1b.
Stock preparation(s):
Injection/Infusion: Vial ?500 mg and 1 g powder for reconstitution.
Properties:
Physical description: White to pale yellow powder 1a,1b. Reconstituted solutions are pale yellow 1b.
Excipients: None 1a.
pH: 4.5 to 6.5 1b,5,6.
Sodium content: ~48 mg of sodium per 1 gram of cefotaxime 1a,1b.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light.
Reconstituted and diluted solution: Prepare immediately before use. However solutions are stable at room temperature (below 25?C) for up to 8 hours 1b, and refrigerated (2?C to 8?C) for up to 24 hours 1b.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: cefotaxime.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 1 g every 12 hours, increased in moderate infections to 1 to 2 g every 8 hours; in severe infections (e.g. meningitis) to 2 g every 6 hours; and in life-threatening infections up to 12 g per day in divided doses, e.g.4 g every 8 hours or 2 g every 4 hours, may be required 2,4
In patients with renal impairment: GFR less than 10 mL/minute: reduce dose by 50% and administer at the same frequency 1a,1b,4. Seek specialist advice for renal replacement patients.
Intermittent IV infusion
Continuous IV infusion Not generally recommended. Consult pharmacist.
Some sources refer to this method but specific details are not provided 5,7,10.
One source recommends adding the dose to up to 1,000 mL of compatible IV fluid 5.
IM injection Usual dose: 1 g every 8 to 12 hours.
Gonorrhoea: 500 mg as a single dose (with oral probenecid) 1a,1b, or 1 g as a single dose 1a,1b depending on the organism.
This route is NOT recommended for severe infections 5
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Sodium bicarbonate or other alkaline solutions (pH > 7.5).

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

DOSE TABLE ? check your calculation
Cefotaxime - dose conversion chart: gram/hour to mL/hour
Dose Example
1 g infused over 1 hour 1 g infused over 30 minutes or 2 g infused over 1 hour 2 g infused over 30 minutes or 4 g infused over 60 minutes 2 g infused over 15 minutes or 4 g infused over 30 minutes
Dose rate in g/h
1 2 4 8
Infusion solution concentration Convert to
Dose rate in mL/h
10 mg/mL 1 g in 100 mL 100 200 - -
20 mg/mL 1 g in 50 mL 50 100 - -
20 mg/mL 2 g in 100 mL - 100 200 400
40 mg/mL 2 g in 50 mL - 50 100 200
40 mg/mL 4 g in 100 mL - - 100 200

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. (a) Cefotaxime Sandoz [Medsafe Datasheet]. Novartis NZ Limited, 09 December 2014
    (b) DBL Cefotaxime Sodium[Medsafe Datasheet]. Hospira NZ Limited, 13 February 2014
  2. New Zealand Formulary. Cefotaxime [Accessed 6 April 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014.
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 06 April 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CEFOXITIN (cefOXITIN) SODIUM

Antibacterial ? Cephalosporin - 2nd generation

PREPARATIONS:

Trade name(s):
HospiraTM Cefoxitin Sodium (Hospira) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 1 g powder for reconstitution.
Properties:
Physical description: White to off-white powder. Reconstituted solution is clear to light amber 10.
Excipients: No information.
pH: 4.2 to 7.
Sodium content: 51.2 mg (2.2 mmol) sodium per 1 gram of cefoxitin.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light.
Reconstituted solutions for IV or IM injection: Prepare immediately before use. However, reconstituted solutions are chemically stable at room temperature (below 30?C) for at least 6 hours 4,7,10,11 and when refrigerated (2?C to 8?C) for several days 10,11, although it is recommended that the solution is stored only for up to 24 hours to reduce the risk of microbiological contamination.
Diluted solutions for IV infusion: Prepare immediately before use. However, diluted solutions are chemically stable at room temperature (below 30?C) for 18 hours 4,5,9 and when refrigerated (2?C to 8?C) for several days 10, although it is recommended that the solution is stored only for up to 24 hours to reduce the risk of microbiological contamination.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: cefoxitin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 1 to 2 g every 6 to 8 hours.
Severe or life-threatening infection: 3 g every 6 hours or 2 g every 4 hours.
Surgical prophylaxis: 2 g prior to surgery; repeated twice at 6-hourly intervals.
Caesarean section: 2 g as soon as the umbilical cord is clamped; repeated twice at 4-hourly intervals.
In patients with renal impairment:
GFR 30-50 mL/minute: 1 to 2 g every 8 to 12 hours 1,4,6.
GFR 10-30 mL/minute: 1 to 2 g every 12 to 24 hours 1,4,6.
GFR <10 mL/minute: 0.5 to 1 g every 12 to 24 hours 1,4,6.
Seek specialist advice for renal replacement patient.
Intermittent IV infusion
Continuous IV infusion Not generally recommended. Consult pharmacist.
Some sources refer to this method but specific details are not provided 4,5,6,7. One source recommends adding the dose to up to 1,000 mL of compatible IV fluid 9,10.
IM injection Usual dose: 1 to 2 g every 6 to 8 hours.
Surgical prophylaxis: 2 g prior to surgery; repeated twice at 6 hour intervals.
Caesarean section: following an initial IV dose, 2 g twice at 4 hour intervals.
Gonorrhoea: 2 g as a single dose (with oral probenecid).
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

DOSE TABLE ? check your calculation
Cefoxitin - dose conversion chart: gram/hour to mL/hour
Dose Example
1 g infused over 30 minutes or 2 g infused over 1 hour 1 g infused over 15 minutes or 2 g infused over 30 minute 3 g infused over 1 hour 3 g infused over 30 minutes
Dose rate in g/h
2 4 3 6
Infusion solution concentration Convert to
Dose rate in mL/h
10 mg/mL 1 g in 100 mL 200 400 - -
20 mg/mL 1 g in 50 mL 100 200 - -
20 mg/mL 2 g in 100 mL 100 200 - -
30 mg/mL 3 g in 100 mL - - 100 200
40 mg/mL 2 g in 50 mL 50 100 - -

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Hospira Cefoxitin Sodium Powder for Injection [Medsafe Datasheet]. Hospira NZ Limited, 15 November 2011
  2. New Zealand Formulary. Cefoxitin [Accessed 05 April 2015]
  3. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  4. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  5. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 05 April 2015]
  6. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  7. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  8. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  9. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CEFTAZIDIME (cefTAZIDIME) PENTAHYDRATE

Antibacterial ? Cephalosporin - 3rd generation

PREPARATIONS:

Trade name(s):
Fortum (GlaxoSmithKline) 1.
Stock preparation(s):
Injection/Infusion: Vial ?500 mg, 1 g and 2 g powder for reconstitution.
Properties:
Physical description: White to faintly yellow powder. Reconstituted solution is clear initially but may range from light yellow to amber depending on concentration, diluent and storage conditions.
Excipients: Sodium carbonate.
pH: 5 to 8 7.
Sodium content: 54 mg sodium per 1 gram of ceftazidime 10.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light.
Reconstituted solution: Prepare immediately before use. However, reconstituted solutions are stable:
  • when reconstituted with water for injection: at room temperature (below 25?C) for 12 hours and when refrigerated (2?C to 8?C) for up to 24 hours 7.
  • when reconstituted with lignocaine: at room temperature (below 25?C) for 6 hours and when refrigerated (2?C to 8?C) for up to 24 hours 7.
Diluted solution: Prepare immediately before use. However, solution may be stable when refrigerated (2?C to 8?C) for up to 24 hours 7.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: ceftazidime.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 1 g every 8 hours or 2 g every 12 hours.
Severe or life-threatening infection: 2 g every 8 hours or 3 g every 12 hours. Maximum dose 6 g/day (3 g/day in the elderly).
Cystic fibrosis (Pseudomonal infection): 100 to 150 mg/kg per day in 3 divided doses.
Surgical prophylaxis (prostatic surgery): 1 g up to 30 minutes before the procedure, repeat if necessary when catheter is removed 2.
In patients with renal impairment:
GFR 30 to 50 mL/minute: 1 to 2 g every 12 hours 3.
GFR 16 to 30 mL/minute: 1 to 2 g every 24 hours 3.
GFR 6 to 15 mL/minute: 500 mg to 1 g every 24 hours 3.
GFR less than 5 mL/minute: 500 mg to 1 g every 48 hours 3.
GFR less than 5 mL/minute: 500 mg to 1 g every 48 hours 3.
Intermittent IV infusion
Continuous IV infusion Not generally recommended. Consult pharmacist.
One source refers to this method but specific details are not provided 5.
IM injection Usual dose: 500 mg to 1 g every 8 hours.
Do not administer single doses of more than 1 g intramuscularly 7.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Injection solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Sodium bicarbonate.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

DOSE TABLE ? check your calculation
Ceftazidime - dose conversion chart: gram/hour to mL/hour
Dose Example
1 g infused over 30 minutes 1 g infused over 15 minutes or 2 g infused over 30 minute 3 g infused over 30 minutes 2 g infused over 15 minutes
Dose rate in g/h
2 4 6 8
Infusion solution concentration Convert to
Dose rate in mL/hour
10 mg/mL 1 g in 100 mL 200 400 - -
20 mg/mL 1 g in 50 mL 100 200 - -
20 mg/mL 2 g in 100 mL - 200 - 400
30 mg/mL 3 g in 100 mL - - 200 -
40 mg/mL 2 g in 50 mL - 100 - 200

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Fortum [Medsafe Datasheet]. GlaxoSmithKiline NZ Limited, 26 February 2015
  2. New Zealand Formulary. Ceftazidime [Accessed 06 April 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 06 April 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CEFTRIAXONE (cefTRIAXONE) SODIUM

Antibacterial ? Cephalosporin - 3rd generation

PREPARATIONS:

Trade name(s):
Ceftriaxone-AFT (AFT Pharmaceuticals) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 500 mg, 1 g and 2 g powder for reconstitution.
Properties:
Physical description: White to pale yellow powder. Reconstituted and diluted solutions range in colour from pale amber to yellow.
Excipients: No information.
pH: ~6.7; range 6 to 8 7,10.
Sodium content: 83 mg (3.6 mmol) sodium per 1 gram of ceftriaxone.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light. Protect from moisture.
Reconstituted and diluted solutions: Prepare immediately before use. However, solutions are stable at room temperature (below 25?C) for 6 hours and refrigerated (2?C to 8?C) for 24 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: ceftriaxone.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 1 g every 24 hours.
Surgical prophylaxis: 1 g given 30 to 90 (up to 120 9) minutes prior to incision. Single doses above 1 g should preferably be infused 2.
Cystic fibrosis (Pseudomonal infection): 100 to 150 mg/kg per day in 3 divided doses.
Intermittent IV infusion Usual dose: 1 g every 24 hours, 2 to 4 g daily in severe infections (maximum 4 g per day). Doses may be divided and given every 12 hours.
In patients with renal impairment:
GFR less than 10 mL/minute: maximum 2 g per day 3.
Seek specialist advice for renal replacement patients.
Continuous IV infusion Not recommended.
IM injection Usual dose: 500 mg to 2 g every 24 hours.
Gonorrhoea: 250 mg as a single dose.
Doses larger than 1 g should be divided and injected at more than one site.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

AVOID: Solutions containing calcium including Lactated Ringer's (Hartmann's) and Ringer's solution.

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Injection solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Solutions containing calcium.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

DOSE TABLE ? check your calculation
Ceftriaxone - dose conversion chart: gram/hour to mL/hour
Dose Example
1 g infused over 1 hour 1 g infused over 30 minutes or 2 g infused over 1 hour 1 g infused over 15 minutes or 2 g infused over 30 minutes 2 g infused over 15 minutes
Dose rate in g/h
1 2 4 8
Infusion solution concentration Convert to
Dose rate in mL/hour
10 mg/mL 1 g in 100 mL 100 200 400 -
20 mg/mL 1 g in 50 mL 50 100 200 400
20 mg/mL 2 g in 100 mL - 100 200 400
40 mg/mL 2 g in 50 mL - 50 100 200

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

AVOID: Solutions containing calcium.

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Ceftriaxone-AFT [Medsafe Datasheet]. AFT Pharmaceuticals August 2014
  2. New Zealand Formulary. Ceftriaxone. [Accessed 23 March 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 18 June 2014]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer Lippincott Williams & Wilkins, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CEFUROXIME (cefUROXIME) SODIUM

Antibacterial ? Cephalosporin - 2nd generation

PREPARATIONS:

Trade name(s):
Zinacef (GlaxoSmithKline) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 750 mg and 1.5 g powder for reconstitution.
Properties:
Physical description: White to faintly yellow powder. Reconstituted solutions range in colour from off-white to yellow.
Excipients: No information.
pH: 5.5 to 8.5 5,6,10.
Sodium content: 42 mg (1.8 mmol) sodium per 750 mg of cefuroxime.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light.
Reconstituted solution: Prepare immediately before use. However, reconstituted solutions are stable at room temperature (below 25?C) for 5 hours and refrigerated (2?C to 8?C) for 48 hours. Some increase in colour may occur on storage.
Diluted solution: Prepare immediately before use. However, diluted solutions are stable at room temperature (below 25?C) for 24 hours. Some increase in colour may occur on storage.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: cefuroxime.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 750 mg every 8 hours. For severe infections 1.5 g every 8 hours - the frequency may be increased to every 6 hours if necessary. Some infections may respond to a 12 hour dose interval.
Meningitis: 3 g every 8 hours.
Surgical prophylaxis: 1.5 g given 30 to 60 minutes before the procedure; followed by 750 mg IV (or IM) every 8 hours for up to 24 to 48 hours depending on the procedure 1,2,6,9.
In patients with renal impairment:
GFR 10 to 20 mL/minute: extend dose interval to every 12 hours.
GFR less than 10 mL/minute: extend dose interval to every 24 hours.
Seek specialist advice for renal replacement patients.
Intermittent IV infusion Usual dose: 1 g every 24 hours, 2 to 4 g daily in severe infections (maximum 4 g per day). Doses may be divided and given every 12 hours.
In patients with renal impairment:
GFR less than 10 mL/minute: maximum 2 g per day 3.
Seek specialist advice for renal replacement patients.
Continuous IV infusion Not generally recommended. Consult pharmacist.
Some sources refer to this method but specific details are not provided 5,6,10. One source recommends adding the dose to 500 to 1,000 mL of compatible IV fluid and administering over 6 to 24 hours, depending on the total dose and concentration 9.
IM injection Usual dose: 750 mg every 8 hours. Some infections may respond to a 12 hour dose interval.
Surgical prophylaxis: following an initial IV dose, 750 mg IM every 8 hours for up to 24 to 48 hours depending on the procedure 1,2,6,9.
Gonorrhoea: 1.5 g as a single dose.
Doses greater than 750 mg should be divided and injected at more than one site.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Injection solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Sodium bicarbonate. However, if required cefuroxime sodium may be given into the tubing of a sodium bicarbonate infusion.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

DOSE TABLE ? check your calculation
Cefuroxime - dose conversion chart: gram/hour to mL/hour
Dose Example
750 mg infused over 1 hour 750 mg infused over 30 minutes or 1.5 g infused over 1 hour 750 mg infused over 15 minutes or 1.5 g infused over 30 minutes 1.5 g infused over 15 minutes
Dose rate in g/hour
0.75 1.5 3 6
Infusion solution concentration Convert to
Dose rate in mL/hour
7.5 mg/mL 750 mg in 100 mL 100 200 400 -
15 mg/mL 750 mg in 50 mL 50 100 200 400
15 mg/mL 1.5 g in 100 mL - 100 200 400
30 mg/mL 1.5 g in 50 mL - 50 100 200

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Zinacef [Medsafe Datasheet]. GlaxoSmithKline NZ Limited, 28 January 2015
  2. New Zealand Formulary: Cefuroxime [Accessed 05 April 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 05 April 2015]
  7. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  8. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  9. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
  10. Personal communication. Displacement values of cefuroxime injection when reconstituted for intravenous administration. Data on file. GlaxoSmithKline, 29 August 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CEFAZOLIN (cefaZOLin) SODIUM

Antibacterial ? Cephalosporin - 1st generation

PREPARATIONS:

Trade name(s):
Cefazolin-AFT (AFT Pharmaceuticals) 1.
Stock preparation(s):
Injection/Infusion: Vial ?500 mg and 1 g powder for reconstitution.
Properties:
Physical description: White to off-white powder. Reconstituted solutions range from pale yellow to yellow 5.
Excipients: No information.
pH: 4.5 to 6.
Sodium content: 48.3 mg sodium per 1 gram of cefazolin.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light.
Reconstituted and diluted solutions: Prepare immediately before use. However, solutions are stable at room temperature (below 25?C) for up to 12 hours and refrigerated (2?C to 8?C) for up to 24 hours. Do not freeze. Crystals may form if solution is refrigerated; redissolve by shaking the vial and warming in the hands 7.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: cefazolin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection 2 Usual dose: 250 mg to 1.5 g every 6, 8 or 12 hours depending on type and severity of infection. Maximum dose 12 g daily in divided doses.
Perioperative prophylaxis: 1 to 2 g as a single dose within 1 hour of surgery, consider an additional dose if procedure longer than 2 hours; dose may be repeated every 6 to 8 hours for 24 hours if required 2.
In patients with renal impairment:
GFR 35 to 54 mL/minute: alter dose frequency to every 8 hours or less frequently.
GFR 10 to 34 mL/minute: 50% dose every 12 hours.
GFR less than 10 mL/minute: 50% dose every 18 to 24 hours
Seek specialist advice for renal replacement patients.
Intermittent IV infusion
Continuous IV infusion May be given by this method 1,5,6,7,11. Consult pharmacist.
Specific details are not provided in the standard sources. Total daily dose diluted in an appropriate volume of compatible IV fluid may be administered over 24 hours.
IM injection Same dose as for direct IV injection or intermittent IV infusion above.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Injection solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

DOSE TABLE ? check your calculation
Cefazolin - dose conversion chart: gram/hour to mL/hour
Dose Example
500 mg infused over 15 minutes or 1 g infused over 30 minutes 1 g infused over 15 minutes 1 g infused over 10 minutes or 1.5 g infused over 15 minutes or 3 g infused over 30 minutes 3 g infused over 15 minutes
Dose rate in g/hour
2 4 6 12
Infusion solution concentration Convert to
Dose rate in mL/hour
5 mg/mL 500 mg in 100 mL 400 - - -
10 mg/mL 1 g in 100 mL 200 400 600 -
15 mg/mL 1.5 g in 100 mL - - 400 -
20 mg/mL 1 g in 50 mL 100 200 300 -
30 mg/mL 1.5 g in 50 mL - - 200 -
30 mg/mL 3 g in 100 mL - - 200 400

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Cefazolin-AFT [Medsafe Datasheet]. AFT Pharmaceutical Limited, 24 August 2011
  2. New Zealand Formulary. Cefazolin [Accessed 31 March 2015]
  3. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  4. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  5. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 31 March 2015]
  6. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  7. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  8. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  9. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CIPROFLOXACIN (cIPROFLOXAcin)

Antibacterial ? Fluoroquinolone

PREPARATIONS:

Trade name(s):
Aspen-Ciprofloxacin Injection (Healthcare Logistics) 1.
Stock preparation(s):
Infusion: Premixed bag ? 200 mg in 100 mL solution.
Each 100 mL infusion solution contains ciprofloxacin lactate equivalent to 200 mg ciprofloxacin.
Properties:
Physical description: Clear, colourless to slightly yellow solution.
Excipients: Lactic acid, glucose, water for injection.
pH: 3.5 to 4.6 7,10.
Sodium content: None 7.
Storage:
Premixed bag: Store at room temperature (below 25?C). Protect from light. Do not refrigerate or freeze 7.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: ciprofloxacin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection MUST NOT be used (irritant).
Intermittent IV infusion Use only when unable to administer via the oral route.
Usual dose: 200 mg to 300 mg every 12 hours, maximum dose 400 mg every 12 hours.
In patients with renal impairment 3:
GFR 10 to 20 mL/minute: 50 to 100% of normal dose.
GFR less than 10 mL/minute: 50% of normal dose.
Continuous IV infusion Not recommended.
IM injection MUST NOT be used.
Subcutaneous injection MUST NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Aspen-Ciprofloxacin Injection [Medsafe Datasheet]. Pharmacy Retailing (NZ) Ltd, Datasheet date 24 July 2012
  2. New Zealand Formulary. Ciprofloxacin [Accessed 11 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 11 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

COLISTIMETHATE

Synonyms:
colistin sulphomethate, colistin methasulfonate, polymyxin E Antibacterial ? Polymyxin

PREPARATIONS:

Trade name(s):
Colistin-Link? (Link Pharmaceuticals) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 150 mg (colistin) powder for reconstitution.
Each vial contains colistimethate sodium equivalent to 150 mg colistin.
Properties:
Physical description: White to slightly yellow powder.
Excipients: No information.
pH: 7 to 8 7,10.
Sodium content: 0.54 mmol of sodium per 150 mg (colistin) vial 7.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted and diluted solutions: Prepare immediately before use (no preservative). However, solutions are stable refrigerated (2?C to 8?C) for up to 24 hours. Do not freeze. Must be administered within 24 hours of preparation or discarded.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: colistimethate.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Dose in obese patients should be calculated using ideal body weight, not actual body weight.

Direct IV injection Dose range: 2.5 to 5 mg/kg/day divided into 2 to 4 doses by direct IV injection 1 or intermittent IV infusion 7.
Alternate dosing regimen:
Administer half the daily dose (1.25 to 2.5 mg/kg) by direct IV injection, followed by a continuous IV infusion starting 1 to 2 hours after the initial dose and delivering the other half of the daily dose (1.25 to 2.5 mg/kg) over the next 22 hours.
Intermittent IV infusion
Continuous IV infusion
IM injection Usual dose: 2.5 to 5 mg/kg/day in 2 to 4 divided doses.
Subcutaneous injection MUST NOT be used.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT OR CONTINUOUS IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Colistin-Link? [Medsafe Datasheet]. Link Pharmaceuticals Ltd, 30 June 2014
  2. New Zealand Formulary. Colistimethate [Accessed 13 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 14 June 2014] 7
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

DAPTOMYCIN (daPTomycin)

Antibacterial ? Cyclic Lipopeptide

PREPARATIONS:

Trade name(s):
Cubicin? (Novartis) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 350 mg and 500 mg powder for reconstitution.
Properties:
Physical description: Pale yellow to light brown powder. Reconstituted and diluted solutions range in colour from pale yellow to light brown 9.
Excipients: Sodium hydroxide.
pH: No information.
Sodium content: Contains sodium ? amount not stated.
Storage:
Powder for reconstitution: Refrigerate at (between 2?C and 8?C).
Reconstituted and diluted solutions: Prepare immediately before use. However solutions are stable at room temperature (below 25?C) for up to 12 hours and refrigerated (2?C to 8?C) for up to 48 hours. Combined storage time (reconstituted time in vial and diluted solution in bag or burette) must not exceed 12 hours at room temperature or 48 hours when refrigerated.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: daptomycin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 4 mg/kg once daily; increased to 6 mg/kg once daily in severe infections.
Staphylococcal endocarditis: 6 mg/kg once daily.
In patients with renal impairment:
GRF less than 30 mL/minute: an extended dosing interval of 48 hours is recommended.
Seek specialist advice for renal replacement patients.
Intermittent IV infusion
Continuous IV infusion Not recommended.
IM injection Not recommended.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

AVOID: Glucose (dextrose)-containing diluents.

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Glucose (dextrose)-containing IV fluids

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Cubicin [Medsafe Datasheet]. Novartis New Zealand Limited, 10 March 2015
  2. New Zealand Formulary. Daptomycin [Accessed 17 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 17 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

DOXYCYCLINE HYCLATE

Antibacterial ? Tetracycline
PREPARATION NOT REGISTERED IN NZ
Only available under the provisions of SECTION 29 of the Medicines Act

PREPARATIONS:

Trade name(s):
Doxycycline Hyclate Injection (Pfizer) 1.
Stock preparation(s):
Infusion: Vial ? 100 mg powder for reconstitution.
Each vial contains doxycycline hyclate equivalent to 100 mg doxycycline.
Properties:
Physical description: Yellowish powder. Reconstituted solution is clear, almost colourless.
Excipients: Ascorbic acid, mannitol, water for injection.
pH: 1.8 to 3.3.
Sodium content: No information.
Storage:
Powder for reconstitution: Store at room temperature (20?C to 25?C). Protect from light.
Reconstituted solution: May be refrigerated for up to 72 hours 9. Protect from light.
Diluted solution: Prepare immediately before use. However, diluted solution stability is dependent on IV fluid used at concentrations between 0.1 and 1 mg/mL:
  • with sodium chloride 0.9% or glucose 5%: stable at room temperature (below 25?C) for up to 48 hours when protected from sunlight, and refrigerated for up to 72 hours when protected from sunlight and artificial light. Infusion must then be completed within 12 hours.
  • Lactated Ringer's (Hartmann's): prepare immediately before use and infusion must be completed within 6 hours while being protected from direct sunlight.
  • Ringer's: stable when refrigerated for up to 72 hours when protected from sunlight and artificial light. Infusion must then be completed within 12 hours.
  • Plasma-Lyte: stable when refrigerated for up to 12 hours when protected from sunlight and artificial light. Infusion must then be completed within 12 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to Manufacturer?s Package Insert.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Parenteral doxycycline should be used only when oral therapy is not feasible.

Direct IV injection Not recommended.
Intermittent IV infusion Usual dose: 100 mg to 200 mg every 24 hours, or 100 mg every 12 hours.
Syphilis: 300 mg every 24 hours.
Continuous IV infusion Not recommended.
IM injection Must NOT be used.
Subcutaneous injection Must NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Doxycycline Hyclate Injection [Manufacturer Datasheet]. Pfizer Inc., November 2012
  2. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  3. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  4. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 18 July 2015]
  5. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  6. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  7. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

ERTAPENEM

Antibacterial ? Carbapenem

PREPARATIONS:

Trade name(s):
Invanz® (Merck Sharp & Dohme) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 1 g powder for reconstitution.
Each vial contains ertapenem sodium equivalent to 1 gram ertapenem as free acid.
Properties:
Physical description: White to off-white powder. Reconstituted solution ranges from colourless to pale yellow.
Excipients: Sodium bicarbonate and sodium hydroxide (to adjust pH).
pH: 7.5.
Sodium content: 137 mg (6 mmol) sodium per 1 gram of ertapenem 7,10.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted solution (for IM injection): Prepare immediately before use. Use within 1 hour of preparation.
Diluted solution (for IV infusion): Prepare immediately before use. However solutions are stable at room temperature (below 25?C) for up to 6 hours, and refrigerated (below 5?C) for up to 24 hours and used within 4 hours of after removal from refrigeration. Do not freeze.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: ertapenem.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion Usual dose: 1 g every 24 hours.
Surgical prophylaxis (colorectal surgery): 1 g given 1 hour prior to surgical incision.
In patients with renal impairment 3:
Continuous IV infusion Not recommended.
IM injection Usual dose: 1 g every 24 hours.
Subcutaneous injection Not recommended.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? Diluent for reconstituting powder intended for IV use after further dilution:

AVOID: Glucose-containing solutions, lidocaine (for IM use only).

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Glucose-containing solutions, Lactated Ringer's (Hartmann's) 7, mannitol 10, Ringer's 10. sodium bicarbonate 10.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

AVOID: Glucose 5%, water for injection (may be painful).

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Invanz [Medsafe Datasheet]. Merck Sharp and Dohme (NZ) Limited, July 2015
  2. New Zealand Formulary. Ertapenem [Accessed 21 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 21 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

ERYTHROMYCIN (ERYthromycin)

Antibacterial ? Macrolide

PREPARATIONS:

Trade name(s):
Erythrocin IV (AFT Pharmaceuticals) 1.
Stock preparation(s):
Infusion: Vial ? 1 g powder for reconstitution.
Each vial contains erythromycin lactobionate equivalent to 1 gram erythromycin base.
Properties:
Physical description: White to slightly yellow powder 5.
Excipients: No information.
pH: 6.5 to 7.5 when reconstituted 7.
Sodium content: No information.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted solution: Prepare immediately before use. However, stable at room temperature or refrigerated for up to 24 hours 5,7.
Diluted solution: Prepare immediately before use, and use within 8 hours of preparation. However, stable when refrigerated (2?C to 8?C) for up to 24 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: erythromycin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection MUST NOT be used (risk of arrhythmias and irritation at injection site).
Intermittent IV infusion Usual dose:
Severe infections: 12.5 mg/kg every 6 hours 2, maximum 4 g/day.
Milder infections (when oral therapy not feasible): 6.25 mg/kg every 6 hours 2.
In patients with renal impairment:
GFR less than 10 mL/minute: use 50% to 75% of normal dose; maximum 2 g daily 3.
Continuous IV infusion Preferred route.
Usual dose: 25 to 50 mg/kg per day over 24 hours; maximum 4 g/day 3
In patients with renal impairment:
GFR less than 10 mL/minute: use 50% to 75% of normal dose 3; maximum 2 g daily 3.
IM injection Not recommended.
Subcutaneous injection Not recommended.

INTERMITTENT OR CONTINUOUS IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? Diluent for reconstituting powder intended for IV use after further dilution:

AVOID: Any other diluent as may cause precipitation.

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Erythrocin IV [Medsafe Datasheet]. AFT Pharmaceuticals Limited, April 2015
  2. New Zealand Formulary. Erythromycin [Accessed 24 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 24 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.2 May 2013). United Kingdom Clinical Pharmacy Association; 2012
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

FLUCLOXACILLIN

Antibacterial ? Penicillin

PREPARATIONS:

Trade name(s):
Flucloxin (Douglas) 1.
Stock preparation(s):
Injection/Infusion: Vial ?250 mg, 500 mg, and 1 g powder for reconstitution.
Each vial contains flucloxacillin sodium equivalent to 250 mg, 500 mg or 1 gram flucloxacillin.
Properties:
Physical description: White powder.
Excipients: No information.
pH: No information.
Sodium content: Contains sodium ? amount not stated.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light.
Reconstituted solution: Prepare immediately before use. However, solutions are stable (reconstituted with water for injection) when refrigerated (below 5?C) for up to 72 hours.
Diluted solution: Prepare immediately before use. However, diluted solution stability is dependent on IV fluid used and is stable when diluted:
  • with sodium chloride 0.9% and/or glucose 5%: at room temperature (below 25?C) for up to 1 hour and when refrigerated (below 5?C) for up to 72 hours.
  • with Lactated Ringers (Hartmann?s): at room temperature (below 25?C) for up to 1 hour.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: flucloxacillin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 250 mg to 2 g every 6 hours 2,3. For doses greater than 1 g consider intermittent IV infusion.
Endocarditis (in combination with another antibacterial):
Weight less than 85 kg: 8 g daily in 4 divided doses 2.
Weight greater than 85 kg: 12 g daily in 6 divided doses 2.
Osteomyelitis: up to 8 g daily in 3 to 4 divided doses 2.
Surgical prophylaxis: 1 g to 2 g up to 30 minutes before the procedure; up to 4 further doses of 500 mg may be given every 6 hours, for high risk procedures 2.
In patients with renal impairment:
GFR less than 10 mL/minute: dose as above up to a total daily dose of 4 g 3.
Intermittent IV infusion
Continuous IV infusion May be used in the ambulatory setting. Buffering may be required to extend stability at body temperature 7. Consult pharmacist.
IM injection Usual dose: 250 mg to 500 mg every 6 hours 2.
Surgical prophylaxis: following an initial IV dose, up to 4 further IM doses of 500 mg may be given every 6 hours 2.
Subcutaneous injection Not recommended.
Intra-articular injection Usual dose: 250 mg to 500 mg once daily.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

INTRA-ARTICULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Flucloxin [Medsafe Datasheet]. Douglas Pharmaceuticals Ltd, 18 December 2014
  2. New Zealand Formulary. Flucloxacillin [Accessed 16 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 27 July 2015]
  5. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  6. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

FLUCONAZOLE

Antifungal Agent ? Triazole

PREPARATIONS:

Trade name(s):
Fluconazole-Claris (AFT Pharmaceuticals) 1.
Stock preparation(s):
Infusion: Premixed infusion solution ? 100 mg in 50 mL solution.
Infusion: Premixed infusion solution ? 200 mg in 100 mL solution.
Properties:
Physical description: Clear, colourless solution.
Excipients: Sodium chloride, water for injection.
pH: 4-8 7,10.
Sodium content: 15.4 mmol per 100 mL infusion solution.
Storage:
Premixed infusion solution: Store at room temperature (below 30?C). Do not refrigerate or freeze.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: fluconazole.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion Usual dose: 50 mg to 400 mg daily (maximum 800 mg daily for severe infections [unapproved dose] 2).
In patients with renal impairment:
GFR less than 50 mL/minute: 50% of normal dose 1,9. No adjustments are required for single doses.
Continuous IV infusion Not recommended.
IM injection Not recommended.
Subcutaneous injection Not recommended.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to administer concomitantly via Y-site:

Manufacturer recommends that fluconazole may be administered through an existing IV line running one of the following IV fluids (otherwise administer separately):

Compatibility ? Drugs administered via Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Fluconazole-Claris [Medsafe Datasheet]. AFT Pharmaceuticals Ltd, 05 May 2010
  2. New Zealand Formulary. Fluconazole [Accessed 26 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 26 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

GANCICLOVIR

Antiviral
CYTOTOXIC AGENT
Prepare, administer and dispose of according to guidelines for handling cytotoxic medicines

PREPARATIONS:

Trade name(s):
Cymevene® (Roche) 1.
Stock preparation(s):
Infusion: Vial ? 500 mg powder for reconstitution.
Each vial contains 543 mg ganciclovir sodium equivalent to 500 mg ganciclovir.
Properties:
Physical description: White to off-white powder 5.
Excipients: No excipients.
pH: 11 when reconstituted.
Sodium content: Approximately 43 mg (2 mmol) sodium per 500 mg ganciclovir.
Storage:
Powder for reconstitution: Store at room temperature (below 30?C). Protect from light.
Reconstituted solution: Prepare immediately before use. However, solutions are stable when refrigerated (2oC to 8oC) for up to 24 hours. Do not freeze. Reconstituted solution should be used within 24 hours.
Diluted solution: Prepare immediately before use. However, solutions are stable when refrigerated (2oC to 8oC) for up to 24 hours. Do not freeze. Diluted solution should be used within 24 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: ganciclovir.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion CMV retinitis: induction, 5 mg/kg every 12 hours for 14 to 21 days for treatment or for 7 to 14 days for prevention; maintenance (for patients at risk of relapse of retinitis) 6 mg/kg daily on 5 days per week or 5 mg/kg daily until adequate recovery of immunity; if retinitis progresses initial induction may be repeated 2.
Prevention of CMV disease in transplant recipients: 5 mg/kg every 12 hours for 7 to 14 days (depending on the organ transplanted). Maintenance 6 mg/kg daily on 5 days per week or 5 mg/kg daily.
In patients with renal impairment:
GFR 50 to 69 mL/minute: 2.5 mg/kg every 12 hours 3.
GFR 25 to 49 mL/minute: 2.5 mg/kg every 24 hours 3.
GFR 10 to 24 mL/minute: 1.25 mg/kg every 24 hours 3.
Seek specialist advice for renal replacement patients. 3.
Continuous IV infusion Not recommended.
IM injection Must NOT be used (irritant; due to high pH).
Subcutaneous injection Must NOT be used (irritant; due to high pH).

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: All other IV fluids.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Cymevene® [Medsafe Datasheet]. Roche Products (New Zealand) Limited, 31 May 2011
  2. New Zealand Formulary. Ganciclovir [Accessed 27 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 27 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.2 May 2013). United Kingdom Clinical Pharmacy Association; 2012
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

GENTAMICIN

Antibacterial ? Aminoglycoside

PREPARATIONS:

Trade name(s):
Gentamicin 80 mg/2 mL Injection (Pfizer) 1a, DBL™ Gentamicin Injection BP (Hospira) 1b.
Stock preparation(s):
Injection/Infusion: Ampoule ? 80 mg in 2 mL solution.
Each vial contains gentamicin sulfate equivalent to 80 mg gentamicin.
Weaker solutions 20 mg/2 mL (section 29) and 10 mg/1 mL are available but are usually reserved for paediatric use.
Properties:
Physical description: Clear, colourless to pale yellow solution 4,10.
Excipients: Disodium edetate, water for injection.
pH: 3.0 to 5.5 7,10.
Sodium content: No information.
Storage:
Ampoules: Store at room temperature (below 25?C). Protect from light.
Diluted solutions: Stable at room temperature (below 25?C) for 24 hours (no preservative) or refrigerated (2oC to 8oC) for up to 48 hours 4.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: gentamicin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Dose usually based on ideal body weight. If patient weighs less than ideal body weight then use actual body weight.
Some hospitals will use adjusted body weight in obese patients.
Therapeutic drug monitoring: refer to local hospital protocols.
Direct IV injection Unapproved regimen 2,7,6,8. Avoid this method in patients with renal impairment.
Manufacturer expresses concern that bolus injection produces serum gentamicin levels which are initially in excess of what is regarded as safe from toxic side effects.
However, they do concede that these levels fall rapidly and suggest that it is prolonged serum concentrations above 10 or 12 microgram/mL should be avoided 1a,1b.
One source recommends doses up to 3 to 5 mg/kg 2, another up to 240 mg 7, by slow IV injection. Maximum dosing limits may vary between hospitals 7. Refer to local hospital protocols.
Intermittent IV infusion Reserved for life-threatening infection, specific indications or when the IM route is not feasible.
Multiple daily dosing regimen:
3 to 5 mg/kg/day depending on severity of infection given in 3 divided doses.
Once daily dosing regimen (unapproved regimen) 2,4:
4 to 7 mg/kg as a single dose once daily, then adjust according to serum gentamicin concentrations.
Consult local hospital protocols which usually recommend dosing based on therapeutic drug monitoring, or seek guidance from a pharmacist.
In patients with renal impairment:
Dose regimen is best adjusted using therapeutic drug monitoring.
However, if therapeutic drug monitoring is not feasible manufacturer recommends adjusting dose by extending the dose interval or reducing each dose 1a,1b,3.
Requires regular monitoring of serum creatinine throughout therapy 1a,1b.
Consult local protocols or seek guidance from a pharmacist or renal physician.
Continuous IV infusion Not recommended.
IM injection Preferred route (IV route may be used for specific indications, see local protocols).
Multiple daily dosing regimen:
3 to 5 mg/kg/day depending on severity of infection given in 3 divided doses.
Subcutaneous injection Not recommended.
Intrathecal/Intraventricular Unapproved routes reserved solely for adjunctive therapy in meningitis or ventriculitis. See local hospital protocols.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

Therapeutic Drug Monitoring

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. (a) Gentamicin Injection [Medsafe Datasheet]. Pfizer New Zealand Ltd, 04 July 2005
    (b) DBL™ Gentamicin Injection BP [Medsafe Datasheet]. Hospira NZ Limited, 02 May 2012
  2. New Zealand Formulary. Gentamicin [Accessed 15 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 15 June 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

IMIPENEM plus CILASTATIN

Antibacterial ? Carbapenem

PREPARATIONS:

Trade name(s):
Imipenem+Cilastatin RBX (Douglas) 1.
Stock preparation(s):
Infusion: Vial ? 500 mg imipenem + 500 mg cilastatin powder for reconstitution.
Properties:
Physical description: White to pale yellow powder. Reconstituted solution is clear, colourless to yellow.
Excipients: Sodium bicarbonate (for pH adjustment).
pH: 6.5 to 8.5 when reconstituted.
Sodium content: 37.5 mg (1.6 mmol) sodium per 500 mg imipenem/500 mg cilastatin.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted and diluted solution: Prepare immediately before use. However, solution is stable at room temperature (below 25?C) for up to 4 hours, and refrigerated (2?C to 8?C) for up to 24 hours 4,7,9,11.
Do not freeze 7.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: cilastatin + imipenem.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Dose represents the quantity of imipenem to be administered. Cilastatin prevents metabolism of imipenem within the kidney.
Direct IV injection MUST NOT be used 4.
Intermittent IV infusion Usual dose: 1 to 2 g daily in 3 to 4 divided doses.
Mild infection: 250 mg every 6 hours.
Moderate infection: 1 g every 12 hours, or 500 mg every 8 hours.
Severe infection: 500 mg every 6 hours, 1 g every 6 to 8 hours.
Maximum dose: usually 50 mg/kg/day or 4 g/day, whichever is lower, cystic fibrosis: up to 90 mg/kg/day, maximum 4 g/day.
In patients with renal impairment:
GFR 31 to 70 mL/minute: 500 mg every 6 to 8 hours 3.
GFR 21 to 30 mL/minute: 500 mg every 8 to 12 hours 3.
GFR less than 20 mL/min: 250 to 500 mg (or 3.5 mg/kg whichever is lower) every 12 hours 3.
Seek specialist advice for renal replacement patients.
Continuous IV infusion Not recommended.
IM injection Not recommended (IM formulation is not available in New Zealand).
Subcutaneous injection Not recommended.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation (concentration expressed as quantity of imipenem):

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Lactated Ringer?s (Hartmann?s), any solution containing lactate, mannitol 20% 7.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Imipenem+Cilastatin RBX [Medsafe Datasheet]. Douglas Pharmaceuticals Ltd, 21 January 2015
  2. New Zealand Formulary. Cilastatin + imipenem [Accessed 21 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  7. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

LINCOMYCIN

Antibacterial ? Lincosamide

PREPARATIONS:

Trade name(s):
Lincocin® (Pfizer) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 600 mg in 2 mL solution.
Each vial contains lincomycin hydrochloride equivalent to 600 mg lincomycin base.
Properties:
Physical description: Clear, colourless to almost colourless solution.
Excipients: Benzyl alcohol, water for injection.
pH: 3 to 5.5 5,10
Sodium content: No information.
Storage:
Stock solution: Store at room temperature (below 25?C). Protect from light. Do not freeze.
Diluted solution: Prepare immediately before use. However, solutions are stable at room temperature for up to 24 hours 9.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: lincomycin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion Usual dose: 600 mg to 1 g every 8 to 12 hours; up to a maximum of 8 g/day for serious life-threatening infections.
In patients with renal impairment:
In severe renal impairment an appropriate dose is 25 to 30% less.
Continuous IV infusion Not recommended.
IM injection Usual dose: 600 mg every 24 hours; may increase frequency to 600 mg every 12 hours or more frequently in serious infections.
In patients with renal impairment:
In severe renal impairment an appropriate dose is 25 to 30% less.
Subcutaneous injection Not recommended.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Lincocin® [Medsafe Datasheet]. Pfizer New Zealand Limited, 20 February 2015
  2. New Zealand Formulary. Lincomycin [Accessed 19 August 2015]
  3. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 19 August 2015]
  4. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  5. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  6. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

LINEZOLID

Antibacterial ? Oxazolidinone

PREPARATIONS:

Trade name(s):
Zyvox® (Pfizer) 1.
Stock preparation(s):
Infusion: Premixed bag ? 600 mg in 300 mL solution.
Properties:
Physical description: Clear, colourless to yellow solution.
Excipients: Glucose, sodium citrate, citric acid, hydrochloric acid/sodium hydroxide and water for injection.
pH: 4.8 10.
Sodium content: 5 mmol sodium per 600 mg of linezolid 3,10.
Storage:
Premixed solution (ready for infusion): Store at room temperature. Do not freeze. Protect from light 4,9,10. Discard any unused solution (no preservative). Keep the infusion bag in the foil overwrap until time of use.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: linezolid.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion Usual dose: 600 mg every 12 hours. In
In patients with renal impairment:
GFR less than 10 mL/minute: consider reducing dose if platelet count drops 3.
Continuous IV infusion Not recommended.
IM injection Not recommended.
Subcutaneous injection Not recommended.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Zyvox® [Medsafe Datasheet]. Pfizer New Zealand Pty Ltd, 30 August 2013
  2. New Zealand Formulary. Linezolid [Accessed 14 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 23 August 2014]
  7. Burridge N, Deidun D, eds. Australian Injectable Drugs Handbook. 5th ed. (revised July 2012). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2012
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

MEROPENEM

Antibiotic ? Carbapenem

PREPARATIONS:

Trade name(s):
DBL™ Meropenem for Injection (Hospira) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 500 mg and 1 g powder for reconstitution.
Each vial contains meropenem trihydrate equivalent to 500 mg or 1 g meropenem.
Properties:
Physical description: White powder. Reconstituted solution ranges from clear to pale yellow.
Excipients: Sodium carbonate.
pH: 7.3 to 8.3 7,10.
Sodium content: 90.2 mg (3.92 mmol) sodium per 1 gram meropenem 10.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted solution (for direct IV injection): Prepare immediately before use. Stable when stored at room temperature (below 25?C) for 8 hours, or when refrigerated (2?C to 8?C) for 24 hours.
Diluted solution (for intermittent IV infusion): Prepare immediately before use. Do not freeze. Stable at concentrations between 1 and 20 mg/mL, when:
  • diluted in sodium chloride 0.9%: at room temperature (below 25?C) for 8 hours, or when refrigerated (2?C to 8?C) for 24 hours.
  • diluted in glucose (dextrose) 5%, glucose in sodium chloride combinations, mannitol 2.5% or 10%: at room temperature (below 25?C) for 3 hours, or when refrigerated (2?C to 8?C) for 14 hours.
  • diluted in glucose 10%: at room temperature (below 25?C) for 2 hours, or when refrigerated (2?C to 8?C) for 8 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: meropenem.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 500 mg to 1 g every 8 hours.
Severe infections: 2 g every 8 hours.
In patients with renal impairment:
GFR 20 to 50 mL/minute: 500 mg to 2 g every 12 hours 3.
GFR 10 to 20 mL/minute: 500 mg to 1 g every 12 hours or 500 mg every 8 hours 3.
GFR less than 10 mL/minute: 500 mg to 1 g every 24 hours 3.
Seek specialist advice for renal replacement patients.
Intermittent IV infusion
Continuous IV infusion Not recommended.
IM injection Not recommended.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. DBL Meropenem [Medsafe Datasheet]. Hospiral NZ Limited, 11 May 2011
  2. New Zealand Formulary. Meropenem [Accessed 21 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 21 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

METRONIDAZOLE

Antibacterial and Antiprotozoal

PREPARATIONS:

Trade name(s):
Metronidazole-Claris (AFT Pharmaceuticals) 1.
Stock preparation(s):
Infusion: Premixed bag ? 500 mg in 100 mL solution.
Properties:
Physical description: Clear, colourless to pale yellow solution.
Excipients: Sodium chloride, disodium hydrogen phosphate, citric acid monohydrate and water for injection.
pH: 4.5 to 6.
Sodium content: 326.4 mg sodium per 500 mg of metronidazole.
Storage:
Premixed solution (ready for infusion): Store at room temperature (below 25?C). Protect from light. Do not refrigerate or freeze (may result in crystallisation) 10. Use within 7 days after removing the infusion bag from its carton. Keep the infusion bag in the plastic overwrap until time of use.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: metronidazole.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion Usual dose: 500 mg every 8 hours. Maximum 4 g in 24 hours.
Surgical prophylaxis: 500 mg before the procedure; repeated every 8 hours for the next 24 hours. See local protocols.
Continuous IV infusion Not recommended.
IM injection Not recommended.
Subcutaneous injection Not recommended.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Mixing with lactated Ringer's (Hartmann's) or Ringer's - not chemically compatible over extended periods but may be infused via a Y-site.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Metronidazole-Claris [Medsafe Datasheet]. AFT Pharmaceuticals Ltd, 13 July 2012
  2. New Zealand Formulary. Metronidazole [Accessed 24 August 2014]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 24 August 2014]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

MOXIFLOXACIN (MOXIfloxacin)

Antibacterial ? Fluoroquinolone

PREPARATIONS:

Trade name(s):
Avelox IV 400 (Bayer) 1.
Stock preparation(s):
Infusion: Premixed bag ? 400 mg in 250 mL solution.
Each premixed bag contains moxifloxacin hydrochloride equivalent to 400 mg moxifloxacin base.
Properties:
Physical description: Transparent, yellow solution.
Excipients: Sodium chloride, hydrochloric acid, sodium hydroxide, water for injection.
pH: 4.1 to 4.6 7.
Sodium content: 34 mmol sodium per 400 mg of moxifloxacin.
Storage:
Premixed solution (ready for infusion): Store at room temperature (between 15?C and 30?C). Do not store below 15?C (risk of precipitation). Do not refrigerate or freeze. Use immediate after opening.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: moxifloxacin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection MUST NOT be used.
Intermittent IV infusion Usual dose: 400 mg once every 24 hours.
Switch to oral therapy as soon as clinically feasible.
Continuous IV infusion Not recommended.
IM injection MUST NOT be used.
Subcutaneous injection MUST NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to administer concomitantly via Y-site:

AVOID: Sodium chloride 10% and 20%, sodium bicarbonate.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Avelox IV 400 [Medsafe Datasheet]. Bayer New Zealand Ltd, 18 May 2015
  2. New Zealand Formulary. Moxifloxacin [Accessed 23 August 2015]
  3. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  4. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  5. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 23 August 2015]
  6. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  7. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  8. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  9. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

PIPERACILLIN plus TAZOBACTAM

Antibacterial ? Penicillin plus Beta-Lactamase Inhibitor

PREPARATIONS:

Trade name(s):
DBL™ Piperacillin and Tazobactam for Injection (Hospira) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 4 g/500 mg piperacillin/tazobactam powder for reconstitution.
Each vial contains piperacillin sodium equivalent to 4 g piperacillin plus tazobactam sodium equivalent to 500 mg tazobactam. Dose is expressed as a combination of both, i.e. 4.5 gram per vial.
Properties:
Physical description: White to off-white powder. Reconstituted solutions range from clear to slightly yellow in colour.
Excipients: No information.
pH: 4.5 to 6.8 7,10
Sodium content: 217 mg (~9.5 mmol) sodium per 4.5 gram vial of piperacillin/tazobactam.
Storage:
Powder for reconstitution: Store at room temperature (below 30?C).
Reconstituted solution: Prepare immediately before use. However, reconstituted solutions are stable when refrigerated (2?C to 8?C) for up to 24 hours.
Diluted solution (for IV infusion): Prepare immediately before use. However, diluted solutions are stable at room temperature (below 25?C) for up to 24 hours 7.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: piperacillin + tazobactam.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Usual dose: 2.25 to 4.5 g every 6 to 8 hours.
Neutropenia (in combination with an aminoglycoside): 4.5 g every 6 hours 2.
In patients with renal impairment:
GFR 10 to 20 mL/minute: 4.5 g every 8 to 12 hours, or 2.25 g every 6 hours 3.
GFR less than 10 mL/minute: 4.5 g every 12 hours, or 2.25 g every 8 hours 3.
Intermittent IV infusion Dose as for direct IV injection above 2.
Continuous IV infusion Not recommended.
IM injection Not recommended
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for reconstitution for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Lactated Ringer's (Hartmann's), sodium bicarbonate, blood products.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. DBL™ Piperacillin and Tazobactam for Injection [Medsafe Datasheet]. Hospira NZ Limited, 18 January 2011
  2. New Zealand Formulary. Piperacillin + tazobactam [Accessed 29 August 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 29 August 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

PROCAINE BENZYLPENICILLIN

Antibacterial ? Penicillin

PREPARATIONS:

Synonyms:
penicillin G procaine, procaine penicillin.
Trade name(s):
Cilicaine (Healthcare Logistics) 1.
Stock preparation(s):
Injection: Prefilled syringe ? 1.5 gram in 3.4 mL suspension.
Each prefilled syringe contains 1.5 grams procaine benzylpenicillin equivalent to 1.5 MU (million units) 6,7.
Properties:
Physical description: Viscous, white suspension.
Excipients: Phenyl mercuric acetate (preservative), sodium citrate, polysorbate 80, water for injections.
pH: 5 to 7.5 6,7.
Sodium content: Contains sodium ? amount not stated.
Storage:
Prefilled syringe: Refrigerate (between 2?C to 8?C). Do not freeze 7.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ datasheet.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Must NOT be used (risk of neurovascular damage) 11.
Intermittent IV infusion Must NOT be used.
Continuous IV infusion Must NOT be used.
IM injection Usual dose: 1.5 g daily for 2 to 5 days.
Gonorrhoea: 1 g daily for 1 to 2 weeks, or up to 4.8 g as a single dose in combination with probenecid.
Syphilis: 1 g daily for 10 to 14 days.
Subcutaneous injection Must NOT be used.

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Cilicaine [Medsafe Datasheet]. Pharmacy Retailing (NZ) Limited, 13 February 2013
  2. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  3. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  4. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 22 June 2015]
  5. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  6. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

TEICOPLANIN

Antibacterial ? Glycopeptide

PREPARATIONS:

Synonyms:
teicomycin.
Trade name(s):
Targocid® (Sanofi-Aventis) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 400 mg powder for injection plus 3 mL diluent.
Properties:
Physical description: Off-white powder. Diluent: water for injection.
Excipients: Sodium chloride 7.
pH: 7.2 to 7.8 (when reconstituted).
Sodium content: Contains sodium ? amount not stated.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted solution (for IM or IV injection): Prepare immediately before use. However, may be refrigerated (2?C to 8?C) and used within 24 hours. Store in the vial; do not store in a syringe.
Diluted solution (for IV injection or infusion): Prepare immediately before use. However, may be refrigerated (2?C to 8?C) and used with 24 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: teicoplanin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Septicaemia/bacteraemia: Weight less than 70 kg: initially 400 mg every 12 hours for 3 doses, followed by 400 mg once daily 2,6.
Weight greater than 70 kg: initially 6 mg/kg every 12 hours for 3 doses, followed by 6 mg/kg once daily 2,6. Higher doses may be required in severe infection 2.
Bone and joint infections:
Initially 12 mg/kg (~800 mg) every 12 hours for 3 to 5 doses, followed by 12 mg/kg (800 mg) once daily 2,6. In patients with renal impairment:
Manufacturer suggests reducing the dose from day 4 of treatment.
GFR 40 to 60 mL/minute: from day 4 reduce dose to 50% (one-half) either by giving on alternate days or by administering one-half of the dose daily.
GFR less than 40 mL/minute: from day 4 reduce dose to 33% (one-third) either by giving every third day or by administering one-third of the dose daily.
Another source recommends:
GFR 10 to 20 mL/minute: give normal loading dose (first 3 doses), then 200 mg to 400 mg every 24 to 48 hours 3.
GFR less than 10 mL/minute: give normal loading dose (first 3 doses), then 200 mg to 400 mg every 48 to 72 hours 3.
Seek specialist advice for renally impaired and renal replacement patients.
Intermittent IV infusion
Continuous IV infusion Not recommended.
IM injection Dose as for IV above.
Maximum dose 3 mL (400 mg) at a single site.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

Therapeutic drug monitoring.

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Targocid® [Medsafe Datasheet]. Sanofi-Aventis New Zealand Limited, 31 July 2015
  2. New Zealand Formulary. Teicoplanin [Accessed August 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 29 August 2015]
  5. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  6. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

TICARCILLIN plus CLAVULANIC ACID

Antibacterial ? Penicillin plus beta-lactamase inhibitor

PREPARATIONS:

Trade name(s):
TimentinZ® (GlaxoSmithKline) 1.
Stock preparation(s):
Infusion: Vial ? 3 g/100 mg ticarcillin/clavulanic acid powder for reconstitution. Each vial contains ticarcillin disodium equivalent to 3 g ticarcillin and potassium clavulanate equivalent to 100 mg clavulanic acid. Dose is expressed as ticarcillin content.
Properties:
Physical description: White to pale yellow powder. Reconstituted solutions range from colourless to pale yellow.
Excipients: No information.
pH: 5.5 to 7.5 (reconstituted).
Sodium content: 333 mg (14.4 mmol) sodium per 3.1 gram of ticarcillin/clavulanic acid.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted solution: Stable at room temperature (below 25?C) for up to 6 hours. May be stable for longer when refrigerated (2?C to 8?C). Seek pharmacist advice.
Diluted solution (for IV infusion): Stable at room temperature (below 25?C) for up to 24 hours. May be stable for longer when refrigerated (2?C to 8?C). Seek pharmacist advice.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring toNZ Formulary: ticarcillin + clavulanic acid.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion Dose expressed as ticarcillin content.
Usual dose:
Weight greater than 60 kg: 3 g every 4 to 6 hours.
Weight less than 60 kg: 200 to 300 mg/kg/day in divided doses every 4 to 6 hours.
Surgical prophylaxis: 3 g as a single dose within 1 hour of surgery. Dose may be repeated every 4 to 6 hours for a total of 3 doses.
Caesarean section: 3 g as soon as the umbilical cord is clamped; repeated twice at 4-hourly intervals.
In patients with renal impairment:
Initial loading dose of 3 g followed by:
GFR 30 to 60 mL/minute: 2 g every 4 hours.
GFR 10 to 30 mL/minute: 2 g every 8 hours.
GFR less than 10 mL/minute: 2 g every 12 hours.
Seek specialist advice for renal replacement patients.
Continuous IV infusion Not recommended.
IM injection Not recommended.
Subcutaneous injection Not recommended.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Sodium bicarbonate.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Timentin® Injection [Medsafe Datasheet]. GlaxoSmithKline NZ Limited, 08 April 2014
  2. New Zealand Formulary. Ticarcillin + clavulanic acid [Accessed 29 August 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  7. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  8. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  9. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

TIGECYCLINE

Antibacterial ? Glycylcycline

PREPARATIONS:

Trade name(s):
Tygacil® (Pfizer) 1.
Stock preparation(s):
Infusion: Vial ? 50 mg powder for reconstitution.
Properties:
Physical description: Orange powder. Reconstituted solutions range from yellow to orange.
Excipients: Lactose, sodium hydroxide/hydrochloric acid (for pH adjustment).
pH: 7.8 9.
Sodium content: May contain sodium (for pH adjustment) ? amount not stated.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C).
Reconstituted solutions: Prepare immediately before use. However, reconstituted solutions are stable at room temperature (below 25?C) for up to 6 hours, or refrigerated (2?C to 8?C) for up to 24 hours.
Diluted solutions: Prepare immediately before use. However, diluted solutions are stable at room temperature (below 25?C) for up to 6 hours or, if immediately diluted after reconstitution, may be stored refrigerated (2?C to 8?C) for up to 48 hours 4,9.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: tigecycline.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion Usual dose: 100 mg initially, followed by 50 mg every 12 hours.
Continuous IV infusion Not recommended.
IM injection MUST NOT be used.
Subcutaneous injection MUST NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to reconstitute and dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Tygacil® [Medsafe Datasheet]. Pfizer New Zealand Ltd, 30 April 2015
  2. New Zealand Formulary. Tigecycline [Accessed 30 August 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 30 August 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

TOBRAMYCIN

Antibacterial ? Aminoglycoside

PREPARATIONS:

Trade name(s):
DBL™ Tobramycin Injection BP (Hospira) 1a, Tobra-day™ (Phebra) 1b.
Stock preparation(s):
Injection/Infusion: Vial ? 80 mg (tobramycin) in 2 mL solution (Hospira).
Infusion: Vial ? 500 mg (tobramycin) in 5 mL solution (Phebra).
Properties:
Physical description: Clear, colourless to pale yellow solution.
Excipients: Disodium edetate 1a, sodium metabisulfite 1a, sulphuric acid 1a, water for injection 1a,1b plus additional sulphuric acid and/or sodium hydroxide (for pH adjustment) 1a,1b.
pH: 5.5 1a; 3.5 to 6 1b.
Sodium content: Contains sodium ? amount not stated.
Storage:
Stock solutions: DBL™ Tobramycin Injection BP (Hospira): Store at room temperature (below 25?C).
Protect from light. Tobra-day™ (Phebra): Refrigerate (between 2?C to 8?C). Do not freeze.
Diluted solutions: DBL™ Tobramycin Injection BP (Hospira): Stable at room temperature (below 25?C) for up to 24 hours 4. Tobra-day™ (Phebra): Stable refrigerated (between 2?C to 8?C) for up to 24 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: tobramycin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Dose usually based on ideal body weight. If patient weighs less than ideal body weight then use actual body weight. Use adjusted body weight for obese patients.
Therapeutic drug monitoring: refer to local hospital protocols.
Direct IV injection Multiple daily dosing regimen:
Multiple daily dosing regimen: 3 mg/kg daily in 3 divided doses every 8 hours; increased to 5 mg/kg daily in 3 or 4 divided doses every 6 to 8 hours. One source suggests restricting each dose to 120 mg 7. Maximum dosing limits may vary between hospitals 7. Serum tobramycin levels may exceed 12 microgram/mL for a short period.
Intermittent IV infusion Multiple daily dosing regimen:
3 mg/kg daily in 3 divided doses every 8 hours; increased to 5 mg/kg daily in 3 or 4 divided doses every 6 to 8 hours 1a.
Cystic fibrosis: 8 to 10 mg/kg daily in 3 or 4 divided doses 1a and adjust according to therapeutic drug monitoring.
Once daily dosing regimen:
Cystic fibrosis (Tobra-day): usually initiate at 10 mg/kg as a once daily dose and adjust according to therapeutic drug monitoring 1b.
Other indications (unapproved regimen): many hospitals use once daily dosing for sepsis or septic shock and other indications. Refer to local hospital protocols for dosing (usually 3 to 7 mg/kg) and therapeutic drug monitoring.
In patients with renal impairment:
Dose regimen is best adjusted using therapeutic drug monitoring.
However, if therapeutic drug monitoring is not feasible manufacturer recommends adjusting dose by extending the dose interval or reducing each dose 1a,3.
Requires regular monitoring of serum creatinine throughout therapy 1a.
Consult local protocols or seek guidance from a pharmacist or renal physician.
Continuous IV infusion Not recommended.
IM injection Multiple daily dosing regimen:
Multiple daily dosing regimen: 3 mg/kg daily in 3 divided doses every 8 hours; increased to 5 mg/kg daily in 3 or 4 divided doses every 6 to 8 hours.
In patients with renal impairment:
As for intermittent IV infusion above.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

Therapeutic Drug Monitoring.

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. (a) DBL™ Tobramycin Injection BP [Medsafe Datasheet]. Hospira NZ Limited, 05 August 2010
    (b) Tobra-day? [Medsafe Datasheet]. AFT Pharmaceuticals Ltd, 19 December 2013
  2. New Zealand Formulary. Tobramycin [Accessed 15 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014]
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 15 June 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

TRIMETHOPRIM WITH SULFAMETHOXAZOLE

SYNONYMS
Co-trimoxazole, Trimethoprim compound
TRADE NAME
SULFAMETHOXAZOLE 400 mg AND TRIMETHOPRIM 80 mg DBL
DRUG CLASS
Antibiotic
AVAILABILITY
Ampoule contains 80 mg of trimethoprim and 400 mg of sulfamethoxazole in 5 mL. Also contains diethanolamine, propylene glycol, absolute alcohol, sodium metabisulfite and sodium hydroxide.1
pH
10 1
PREPARATION
Dilute before use. Shake well to ensure thorough mixing.1 Discard if visible turbidity or particles appear in the solution during the preparation or infusion.1
ADMINISTRATION
IM injection : Not recommended
SUBCUT injection : Not recommended
IV injection : Not recommended1
IV infusion : Dilute to 1 in 25 with a compatible fluid as below and infuse over 60 to 90 minutes.1
Dose80/400 mg160/800 mg240/1200 mg
Volume5 mL (1 ampoule)10 mL (2 ampoules)15 mL (3 ampoules)
Dilute to125 mL250 mL500 mL
For fluid-restricted patients, dilute to 1 in 15 i.e. 5 mL (1 ampoule) in 75 mL of glucose 5%.2,3
IV use for infants and children : Dilute to 25 times the volume of the dose with a compatible fluid and infuse over 60 to 90 minutes.3,4 If fluid-restricted, dilute to 10 or 15 times the volume of the dose with glucose 5% and infuse over 60 minutes.3,4 See SPECIAL NOTES
STABILITY
Ampoule : Store below 30 ?C. Do not refrigerate. Protect from light.1
Diluted solution : Start the infusion within 30 minutes of preparation.1
Dilutions of 1 in 25 are stable for 24 hours below 25 ?C. Dilution with Hartmann?s is stable for 8 hours.1 Do not refrigerate diluted solutions.1
Use dilutions of 1 in 10 and 1 in 15 in glucose 5% immediately after preparation as precipitation may occur within 1 to 2 hours.2,4
COMPATIBILITY
Compatible fluids : See SPECIAL NOTES. Glucose 5%1,2, glucose 10%1, glucose in sodium chloride solutions1,2, Hartmann's1,2, sodium chloride 0.9%1
Compatible via Y-site : Aciclovir2, amifostine2, anidulafungin2, atracurium2, aztreonam2, bivalirudin2, ceftaroline fosamil2, dexmedetomidine2, esmolol2, filgrastim2, granisetron2, hydromorphone2, labetalol2, magnesium sulfate2, morphine sulfate2, pancuronium2, pethidine2, piperacillin-tazobactam (EDTA-free)2, remifentanil2, vecuronium2, zidovudine2
Compatible in syringe : Not applicable
INCOMPATIBILITY
Incompatible fluids : No information
Incompatible drugs : Caspofungin2, dolasetron1, foscarnet1,2, linezolid1,2, midazolam2
SPECIAL NOTES
Dilutions of 1 in 10 or 1 in 15 are recommended to be made with glucose 5% as there is limited stability in sodium chloride 0.9%.4 Seek specialist advice if sodium chloride 0.9% is the required fluid. Contains sodium metabisulfite which may cause allergic reactions in susceptible people.1

REFERENCES

  1. Product Information. AusDI [Internet]. Sydney: Phoenix Medical Publishing; 2006. Updated 02/08/13. Accessed 14/08/13.
  2. Trissel LA. Handbook on injectable drugs. 17th ed. Bethesda, Maryland: Am. Society of Health System Pharmacists; 2013.
  3. Paediatric Formulary Committee. BNF for children. Basingstoke, UK: Pharmaceutical Press; 2013-2014.
  4. Taketomo C, Hodding J, Kraus D. Paediatric and neonatal dosage handbook 19th ed. Hudson, Ohio: American Pharmacists Association. Lexicomp; 2012.
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

VANCOMYCIN

Antibacterial ? Glycopeptide

PREPARATIONS:

Trade name(s):
Vancomycin (Mylan) 1.
Stock preparation(s):
Infusion: Vial ? 500 mg powder for reconstitution.
Each vial contains vancomycin hydrochloride equivalent to 500 mg vancomycin.
Properties:
Physical description: White to almost white lyophilised powder.
Excipients: No information
pH: 2.8-4.5 when reconstituted in water.
Sodium content: No information.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light 7.
Reconstituted solution: Stable when refrigerated (between 2?C and 8?C) for up to 96 hours (4 days).
Diluted solution: Prepare immediately before use. However, if storage required, solution is stable when refrigerated (between 2?C and 8?C) for up to 24 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: vancomycin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Dose is usually based on ideal body weight. Refer to local protocols for specific dosing information. Therapeutic drug monitoring: refer to local hospital protocols.
Direct IV injection Not recommended.
Rapid injection may be associated with hypotension including shock and, rarely, cardiac arrest.
Intermittent IV infusion Usual dose: loading dose not less than 15 mg/kg, followed by 500 mg every 6 hours, or 1 g every 12 hours. Higher doses may be required, e.g. 1.5 g every 12 hours 2.
Lower doses may be required in the elderly, e.g. 500 mg every 12 hours or 1 g every 24 hours 2. Consult local protocols.
In patients with renal impairment:
Loading dose as for normal renal function, followed by:
GFR 20 to 50 mL/minute: 500 mg to 1 g every 12 to 24 hours 3
GFR 10 to 20 mL/minute: 500 mg to 1 g every 24 to 48 hours 3
GFR less than 10 mL/minute: 500 mg to 1 g every 48 to 96 hours 3.
Consult local protocols or seek guidance from a pharmacist or renal physician.
Continuous IV infusion Following a loading dose, the total daily dose may be administered over 24 hours.
IM injection MUST NOT be used (irritant, may cause tissue necrosis).
Subcutaneous injection Not recommended.

INTERMITTENT OR CONTINUOUS IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

Therapeutic Drug Monitoring.

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Vancomycin [Medsafe Datasheet]. Mylan New Zealand Ltd, 17 October 2014
  2. New Zealand Formulary. Vancomycin [Accessed 15 June 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 15 June 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

VORICONAZOLE

Antifungal

PREPARATIONS:

Trade name(s):
Vfend® (Pfizer) 1.
Stock preparation(s):
Infusion: Vial ? 200 mg powder for reconstitution.
Properties:
Physical description: White lyophilised powder.
Excipients: Sulfobutyl betadex sodium (SBECD).
pH: 6 to 7 7.
Sodium content: 217.6 mg (9.4 mmol 7) sodium per 200 mg voriconazole
Storage:
Powder for reconstitution: Store at room temperature (below 25?C). Protect from light 7.
Reconstituted solution: Prepare immediately before use. However, reconstituted solutions may be refrigerated (2?C to 8?C) for up to 24 hours.
Diluted solutions (for IV infusion): Prepare immediately before use. However, diluted solutions may be refrigerated (2?C to 8?C) for up to 24 hours including any time stored as reconstituted solution.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: voriconazole.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection MUST NOT be used.
Intermittent IV infusion Switch to oral therapy as soon as clinically feasible.
Serious invasive Candida infections: 6 mg/kg every 12 hours for the first 24 hours, followed by 3 mg/kg every 12 hours.
Invasive aspergillosis/Scedosporium and Fusarium infections/other serious fungal infections:
6 mg/kg every 12 hours for the first 24 hours, followed by 4 mg/kg every 12 hours.
In patients with renal impairment:
GFR less than 50 mL/minute: Intravenous vehicle (sulfobutyl betadex sodium [SBECD]) accumulates in renal impairment. Switch to oral therapy as soon as possible.
Continuous IV infusion Not recommended.
IM injection MUST NOT be used.
Subcutaneous injection MUST NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Sodium bicarbonate.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. VFEND® [Medsafe Datasheet]. Pfizer New Zealand Ltd, 11 August 2014
  2. New Zealand Formulary. Voriconazole [Accessed 30 August 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 30 August 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CHLORAMPHENICOL

Antibacterial ? Broad Spectrum

PREPARATIONS:

Trade name(s):
Kemicetine Succinate (Link Healthcare) 1.
Stock preparation(s):
Injection/Infusion: Vial ? 1 g powder for reconstitution.
Each vial contains 1.377 g chloramphenicol sodium succinate equivalent to 1 g chloramphenicol.
Properties:
Physical description: No information.
Excipients: None.
pH: 6.4 to 7 when reconstituted 7,10.
Sodium content: 3.14 mmol sodium per 1 gram chloramphenicol 3.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C) 7.
Reconstituted and diluted solution: Prepare immediately before use. However, solutions are stable when refrigerated (2?C to 8?C) for up to 24 hours 7,9. Discard 24 hours after preparation.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: chloramphenicol.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Preferred route 6.
Usual dose: 1 g every 6 to 8 hours or 12.5 mg/kg every 6 hours 2,9.
Severe infections (septicaemia, meningitis): 25 mg/kg every 6 hours;
maximum 4 g/24 hours 9.
Intermittent IV infusion
Continuous IV infusion Not recommended.
IM injection Use only when unable to administer via IV route (absorption via IM route may be slow and unpredictable).
Dose same as for IV route above.
Subcutaneous injection Not recommended.

DIRECT IV INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for direct IV injection:

Injection solution properties and stability:

Administration notes:

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Compatibility ? Diluents for IM administration:

Injection solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Kemicetine Succinate [Datasheet].Pharmacia Limited, 6 February 2014 [Accessed via Link Healthcare]
  2. New Zealand Formulary. Chloramphenicol [Accessed 11 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 11 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CLARITHROMYCIN (clarithromycin)

Antibacterial ? Macrolide

PREPARATIONS:

Trade name(s):
Clarithromycin Powder for Concentrate for Solution for Infusion (Max Health) 1.
Stock preparation(s):
Infusion: Vial ? 500 mg powder for reconstitution.
Properties:
Physical description: White to almost white lyophilised powder.
Excipients: Lactobionic acid, sodium hydroxide (for pH adjustment 10).
pH: No information.
Sodium content: May contain sodium ? amount not stated.
Storage:
Powder for reconstitution: Store at room temperature (below 30?C). Protect from light.
Reconstituted solution: Prepare immediately before use. However, may be stored at room temperature (below 25?C) for up to 24 hours, and refrigerated (between 2?C and 8?C) for up to 48 hours.
Diluted solution: Prepare immediately before use. However, in-use and storage time should not exceed 6 hours at room temperature (below 25?C), and 48 hours if refrigerated (between 2?C and 8?C).

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: clarithromycin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection MUST NOT be used.
Intermittent IV infusion Usual dose: 500 mg every 12 hours. Maximum 5 days duration, switch to oral route as soon as practicable.
In patient with renal impairment 3:
GFR less than 30 mL/minute: 250 to 500 mg every 12 hours.
Seek specialist advice for renal replacement patients.
Continuous IV infusion Not recommended.
IM injection MUST NOT be used.
Subcutaneous injection MUST NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Clarithromycin 500 mg Powder for Concentrate for Solution for Infusion [Medsafe Datasheet]. Max Health, 1 November 2013
  2. New Zealand Formulary. Clarithromycin [Accessed 11 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 11 July 2015]
  5. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  6. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

CLINDAMYCIN (clINDAmycin)

Antibacterial ? Lincosamide

PREPARATIONS:

Trade name(s):
Dalacin™ C Phosphate (Pfizer) 1.
Stock preparation(s):
Injection/Infusion: Ampoule ? 600 mg in 4 mL solution.
Each 1 mL contains 150 mg clindamycin base.
Properties:
Physical description: Clear, colourless solution.
Excipients: Water for injection, benzyl alcohol, disodium edetate, sodium hydroxide/hydrochloric acid for pH adjustment.
pH: 5.5 to 7 7,10.
Sodium content: May contain sodium ? amount not stated.
Storage:
Stock solution: Refrigerate (2?C to 8?C). Do not freeze.
Diluted solution: Prepare immediately before use. However, solutions are stable at room temperature (below 25?C) for up to 24 hours 7. Discard any unused portion after 24 hours 4.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: clindamycin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Must NOT be used.
Intermittent IV infusion. Usual dose: 150 mg to 300 mg every 6 hours.
More severe infections: 300 mg to 675 mg every 6 hours 1,2.
Life-threatening infections: up to 4.8 g daily in 4 divided doses 2.
Endocarditis prophylaxis: 600 mg as a single dose just before the procedure 2.
Continuous IV infusion Dose as above.
Administer initial dose by intermittent infusion, followed by a continuous infusion between 0.75 to 1.25 mg/min 5,6,9,10.
IM injection Endocarditis prophylaxis: 600 mg as a single dose just before the procedure 2.
Subcutaneous injection Not recommended.

INTERMITTENT OR CONTINUOUS IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

INTRAMUSCULAR INJECTION:

Injection solution concentration and preparation:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Dalacin® C Phosphate [Medsafe Datasheet]. Pfizer New Zealand Ltd, 20 December 2013
  2. New Zealand Formulary. Clindamycin [Accessed 17 August 2014]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 14 June 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

FOSCARNET SODIUM

Antiviral

PREPARATIONS:

Synonyms:
PFA, phosphonoformic acid trisodium, trisodium phosphonoformate.
Trade name(s):
Foscavir (Healthcare Logistics) 1.
Stock preparation(s):
Infusion: Premixed infusion solution ? 6 grams in 250 mL solution.
Each 1 ml solution contains 24 mg of foscarnet trisodium hexahydrate.
Properties:
Physical description: Clear, colourless solution.
Excipients: Hydrochloric acid, water for injection.
pH: 7.4.
Sodium content: 1.375 grams (60 mmol) per 6 grams foscarnet sodium.
Storage:
Premixed infusion solution: Store at room temperature (15oC to 30oC). Do not refrigerate or freeze (precipitation may occur). Once open discard solution within 24 hours (no preservative).
Diluted solution: Stable at room temperature (below 25oC) or refrigerated for 24 hours when diluted in a PVC infusion bag.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: foscarnet sodium.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Must NOT be used.
Intermittent IV infusion. CMV retinitis: induction, 60 mg/kg every 8 hours for 2 to 3 weeks, followed by a maintenance dose of 90 to 120 mg/kg/day once daily.
Herpes simplex virus infection: induction, 40 mg/kg every 8 hours.
In patients with renal impairment:
GFR 20 to 50 mL/minute: 28 mg/kg every 8 hours 3.
GFR 10 to 20 mL/minute: 15 mg/kg every 8 hours 3.
GFR less than 10 mL/minute: 6 mg/kg every 8 hours 3.
Seek specialist advice for renal impairment and renal replacement patients.
Continuous IV infusion May be given by this method 3. Infuse total daily dose over 24 hours.
IM injection Must NOT be used.
Subcutaneous injection Must NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

AVOID: Glucose 30% 7, Lactated Ringer's (Hartmann's) 7,10, Ringer's 7, solutions containing calcium.

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Foscavir [Medsafe Datasheet]. Pharmacy Retailing (NZ) Ltd, 20 August 2014
  2. New Zealand Formulary. Foscarnet sodium [Accessed 27 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information [online]. Bethesda, MD: American Society of Health-System Pharmacists. [Accessed via http://www.ahfsdruginformation.com/support/not_in_print/a392019.aspx/ 27 July 2015]
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 27 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  9. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  10. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

RIFAMPICIN

Antibacterial/Antituberculosis Agent

PREPARATIONS:

Synonym:
rifampin
Trade name(s):
Rifadin (Sanofi-Aventis) 1.
Stock preparation(s):
Infusion: Vial ? 600 mg powder for reconstitution plus diluent.
Properties:
Physical description: Red powder.
Excipients: No information.
pH: 7.8 to 8.8 (when reconstituted) 7.
Sodium content: No information.
Storage:
Powder for reconstitution: Store at room temperature (below 25?C) 7. Protect from light 7.
Reconstituted solution: Prepare immediately before use. However, reconstituted solutions are stable at room temperature (below 25?C) for up to 24 hours.
Diluted solution: Prepare immediately before use. However, diluted solutions are stable:
  • when diluted in sodium chloride 0.9%: at room temperature for up to 6 hours.
  • when diluted in glucose 5%: at room temperature for up to 4 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: rifampicin.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Direct IV injection Not recommended.
Intermittent IV infusion. Tuberculosis:
Weight less than 50 kg: 450 mg once daily.
Weight greater than or equal to 50 kg: 600 mg once daily.
Other susceptible infections: 600 mg to 1,200 mg daily in 2 to 4 divided doses 2.
In patients with renal impairment:
GFR less than 10 mL/minute: 50% to 100% of usual dose 3.
Continuous IV infusion Not recommended.
IM injection Must NOT be used.
Subcutaneous injection Must NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. Rifadin [Medsafe Datasheet]. Sanofi-Aventis New Zealand Limited, 22 January 2015
  2. New Zealand Formulary. Rifampicin [Accessed 29 August 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 29 August 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2014 Drug Handbook. 34th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

SULFAMETHOXAZOLE plus TRIMETHOPRIM (trimETHOPRIM)

Antibacterial ? Broad spectrum

PREPARATIONS:

Synonym:
co-trimoxazole, trimethoprim plus sulfamethoxazole
Trade name(s):
DBL™ Sulfamethoxazole and Trimethoprim Concentrate for Injection (Hospira) 1.
Stock preparation(s):
Infusion: Ampoule ? 400 mg sulfamethoxazole plus 80 mg trimethoprim in 5 mL solution.
Properties:
Physical description: Clear solution.
Excipients: Diethanolamine, propylene glycol, alcohol, sodium metabisulfite, sodium hydroxide 7.
pH: ~10.
Sodium content: Contains sodium ? amount not stated.
Storage:
Stock solution: Store at room temperature (below 30?C). Do not refrigerate. Protect from light. Risk of precipitation if stored at low temperatures ? discard solution in which precipitation has occurred.
Diluted solution for IV infusion: Prepare immediately before use and commence infusion within 30 minutes of preparation. Do not refrigerate (increases risk of precipitation) 4. Manufacturer recommended dilutions are more stable 4, and may be stored:
  • when diluted with compatible IV fluids except Lactated Ringer's (Hartmann's): at room temperature (below 25?C) for up to 24 hours.
  • when diluted with Lactated Ringer?s (Hartmann's): at room temperature (below 25?C) for up to 8 hours.

BEFORE ADMINISTERING CHECK:

Indications, Contraindications, Cautions, Interactions, Hepatic impairment, Renal impairment, Pregnancy, Breast-feeding, Adverse effects by referring to NZ Formulary: trimethoprim + sulfamethoxazole.

DOSAGE AND ADMINISTRATION

Adults ? usual dose

Doses expressed as combination of sulfamethoxazole and trimethoprim, i.e.:
100 mg sulfamethoxazole + 20 mg trimethoprim equals 120 mg
800 mg sulfamethoxazole + 160 mg trimethoprim equals 960 mg
1,200 mg sulfamethoxazole + 240 mg trimethoprim equals 1,440 mg.
Direct IV injection MUST NOT be used.
Intermittent IV infusion. Use only when unable to administer via the oral route.
Usual dose: 960 mg every 12 hours.
Severe infections: 1,440 mg every 12 hours.
Pneumocystis carinii pneumonia (PCP): 120 mg/kg per day in 2 to 4 divided doses.
In patients with renal impairment: 3
GFR 15 to 30 mL/minute: 50% of usual dose. PCP: 60 mg /kg twice daily for 3 days then 30 mg/kg twice daily.
GFR less than 15 mL/minute: 50% of usual dose. PCP: 30 mg/kg twice daily.
Continuous IV infusion MUST NOT be used.
IM injection MUST NOT be used.
Subcutaneous injection Must NOT be used.

INTERMITTENT IV INFUSION:

Infusion solution concentration and preparation:

Compatibility ? IV fluids appropriate to dilute IV infusion:

Compatibility ? Drugs in the same infusion solution or Y-site:

Infusion solution properties and stability:

Administration notes:

MONITORING/OBSERVATION/CAUTION

REFERENCES

Many thanks go to the New Zealand Hospital Pharmacists Association for permission to use this content.

  1. DBL™ Sulfamethoxazole and Trimethoprim Concentrate for Injection BP [Medsafe Datasheet]. Hospira (NZ) Limited, 8 March 2012
  2. New Zealand Formulary. Trimethoprim + sulfamethoxazole [Accessed 12 July 2015]
  3. Ashley C, Currie A, eds. Renal Drug Handbook. 3rd ed. Oxford, New York: Radcliffe Publishing; 2009
  4. Lexi-Comp Drug Information Handbook. 23rd ed. Hudson, OH: Lexi-Comp; 2014
  5. AHFS Drug Information. 2014 ed. Bethesda, MD: American Society of Health-System Pharmacists; 2014
  6. Martindale: The Complete Drug Reference. [online] London: Pharmaceutical Press. [Accessed via Micromedex 2.0 http://www.micromedexsolutions.com/micromedex2/librarian/ 12 July 2015]
  7. Burridge N, Collard N, Symons K, eds. Australian Injectable Drugs Handbook. 6th ed. (revised April 2014). Collingwood, VIC: Society of Hospital Pharmacists of Australia; 2014
  8. Critical Care Group. Minimum Infusion Volumes: for critically ill patients. 4th ed. (v4.4 13 Feb 2014). United Kingdom Clinical Pharmacy Association; 2014
  9. Gahart BL, Nazareno AR. 2014 Intravenous Medications: A Handbook for Nurses and Health Professionals. 30th ed. St. Louis, MO: Elsevier Mosby; 2014
  10. Trissel LA. Handbook on Injectable Drugs. 17th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2013
  11. Lippincott. Nursing 2015 Drug Handbook. 35th ed. Wolters Kluwer, 2014
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Ascending cholangitis

Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)


History of penicillin allergy or adverse reaction

No penicillin allergy

Immediate or delayed non-severe hypersensitivity to penicillin

Immediate or delayed severe hypersensitivity to penicillin


Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

1. Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of:
  • Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • OR
  • Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence).

OR

2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to penicillin for that patient (within minutes to several hours):
  • Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
  • Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence).
  • Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).

OR

3. Reduced BP after exposure to penicillin in a patient with known penicillin allergy (within minutes to several hours)
  • Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline
  • In infants and children, reduced BP is defined as low systolic BP (age-specific) or greater than 30 percent decrease in systolic BP
    • i.e. Less than 70 mmHg from 1 month up to 1 year
    • Less than (70 mmHg + [2 x age]) from 1 to 10 years
    • Less than 90 mmHg from 11 to 17 years
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Ascending cholangitis

Is gentamicin contraindicated in this patient? (See below for contraindications)

Aminoglycoside Contraindications and Precautions

Contraindications Precautions
History of vestibular or auditory toxicity caused by an aminoglycoside Pre-existing significant auditory impairment (hearing loss or tinnitus)
History of serious hypersensitivity reaction to an aminoglycoside (rare) Pre-existing vestibular condition (dizziness, vertigo or balance problems)
Myasthenia gravis Family history (first-degree relative) of auditory toxicity caused by an aminoglycoside
Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
Advanced age (eg 80 years or older), depending on calculated renal function

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Ascending Cholangitis

Is gentamicin contraindicated in this patient? (See below for contraindications)

Aminoglycoside Contraindications and Precautions

Contraindications Precautions
History of vestibular or auditory toxicity caused by an aminoglycoside Pre-existing significant auditory impairment (hearing loss or tinnitus)
History of serious hypersensitivity reaction to an aminoglycoside (rare) Pre-existing vestibular condition (dizziness, vertigo or balance problems)
Myasthenia gravis Family history (first-degree relative) of auditory toxicity caused by an aminoglycoside
Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
Advanced age (eg 80 years or older), depending on calculated renal function

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Ascending cholangitis treatment

For ascending cholangitis in a patient with immediate or delayed non-severe hypersensitivity to penicillin:

Ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) IV, daily

PLUS if the patient has a history of biliary obstruction ADD:

Metronidazole 500 mg (child 1 month or older: 12.5 mg/kg up to 500 mg) IV, 12-hourly


Code for ceftriaxone is: 3asc
This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Ascending Cholangitis Treatment

For ascending cholangitis in a patient with immediate or delayed severe hypersensitivity to penicillin and is intolerant of gentamicin:

Please contact infectious diseases for advice



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Ascending cholangitis treatment

For ascending cholangitis in a patient with immediate or delayed severe hypersensitivity to penicillin use:

Gentamicin IV, dosed as per nomograms below or use the gentamicin empiric dose calculator for adults

AND if the patient has a history of biliary obstruction ADD

Metronidazole 500 mg (child 1 month or older: 12.5 mg/kg up to 500 mg) IV, 12-hourly

Please contact infectious diseases for advice for ongoing therapy past 72 hours


Code for gentamicin is: 2asc
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Initial Paediatric Gentamicin Dosing (Age < 12 years)

Age Initial
dose
Dosing
frequency
Maximum number
of empirical doses
Neonates <30 weeks
postmenstrual age
postnatal age
0 to 7 days
5 mg/kg 48-hourly 2 doses
(at 0 and 48 hours)
postnatal age
8 to 28 days
4 mg/kg 36-hourly 2 doses
(at 0 and 36 hours)
postnatal age
29 days or older
4 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)
neonates 30 to 34
weeks postmenstrual age
postnatal age
0 to 7 days
4.5 mg/kg 36-hourly 2 doses
(at 0 and 36 hours)
postnatal age
8 days and older
4 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)
neonates 35 weeks
postmenstrual age or older
4 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)
infants and children 7.5 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)

Initial Gentamicin/Tobramycin Dosing (age > 12 years)

Creatinine clearance
(mL/min)
Initial
dose
Dosing
frequency
Maximum number
of empirical doses
More than
60 mL/min
4 to 5 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)
40 to 60 mL/min 4 to 5 mg/kg 36-hourly 2 doses
(at 0 and 36 hours)
less than
40 mL/min
4mg/kg Single dose, then seek expert advice


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Ascending Cholangitis Treatment

For ascending cholangitis in a patient who can tolerate penicillin and gentamicin:

Ampicillin 2 g (child: 50 mg/kg up to 2 g) IV, 6-hourly

AND

Gentamicin IV, dosed as per nomograms below or use the gentamicin empiric dose calculator for adults

AND if the patient has a history of biliary obstruction ADD

Metronidazole 500 mg (child 1 month or older: 12.5 mg/kg up to 500 mg) IV, 12-hourly

If IV treatment is required after 72 hours change to ceftriaxone 1 g daily +/- metronidazole if biliary obstruction present, or use piperacillin 4 g and tazobactam 500 mg 8-hourly (Please contact infectious diseases for advice)


Code for gentamicin is: 2asc
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Initial Gentamicin/Tobramycin Dosing (age > 12 years)

Creatinine clearance
(mL/min)
Initial
dose
Dosing
frequency
Maximum number
of empirical doses
More than
60 mL/min
4 to 5 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)
40 to 60 mL/min 4 to 5 mg/kg 36-hourly 2 doses
(at 0 and 36 hours)
less than
40 mL/min
4mg/kg Single dose, then seek expert advice

Initial Paediatric Gentamicin Dosing (Age < 12 years)

Age Initial
dose
Dosing
frequency
Maximum number
of empirical doses
Neonates <30 weeks
postmenstrual age
postnatal age
0 to 7 days
5 mg/kg 48-hourly 2 doses
(at 0 and 48 hours)
postnatal age
8 to 28 days
4 mg/kg 36-hourly 2 doses
(at 0 and 36 hours)
postnatal age
29 days or older
4 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)
neonates 30 to 34
weeks postmenstrual age
postnatal age
0 to 7 days
4.5 mg/kg 36-hourly 2 doses
(at 0 and 36 hours)
postnatal age
8 days and older
4 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)
neonates 35 weeks
postmenstrual age or older
4 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)
infants and children 7.5 mg/kg 24-hourly 3 doses
(at 0, 24 and 48 hours)


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Ascending Cholangitis Treatment

For ascending cholangitis in a patient tolerant of penicillin but intolerant of gentamicin:

Ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) IV, daily

AND if the patient has a history of biliary obstruction ADD

Metronidazole 500 mg (child 1 month or older: 12.5 mg/kg up to 500 mg) IV, 12-hourly

OR as a single agent (without metronidazole)

Piperacillin+tazobactam 4+0.5 g (child: 100+12.5 mg/kg up to 4+0.5 g) IV, 8-hourly


Code for piperacillin or ceftriaxone is: 3asc
This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Carbuncle


Are there signs of spreading cellulitis or significant systemic features?

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Carbuncle


Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)


History of penicillin allergy or adverse reaction

No penicillin allergy

Immediate or delayed non-severe hypersensitivity to penicillin

Immediate or delayed severe hypersensitivity to penicillin


Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

1. Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of:
  • Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • OR
  • Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence).

OR

2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to penicillin for that patient (within minutes to several hours):
  • Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
  • Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence).
  • Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).

OR

3. Reduced BP after exposure to penicillin in a patient with known penicillin allergy (within minutes to several hours)
  • Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline
  • In infants and children, reduced BP is defined as low systolic BP (age-specific) or greater than 30 percent decrease in systolic BP
    • i.e. Less than 70 mmHg from 1 month up to 1 year
    • Less than (70 mmHg + [2 x age]) from 1 to 10 years
    • Less than 90 mmHg from 11 to 17 years
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Carbuncle

Is the patient a child or adult?

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Carbuncle

Is the patient a child or adult?

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Carbuncle

Is the patient a child or adult?

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Child carbuncle antibiotic treatment

Most carbuncles will require only excision and drainage with no antibiotic treatment. If antibiotic treatment is necessary while awaiting the results of cultures and susceptibility, use:

Cefalexin 12.5 mg/kg (up to 500 mg) orally, 6-hourly for 5 days

OR If compliance is unlikely with QID dosing and the infection is mild

Cefalexin 25 mg/kg orally (up to 1 g) orally, 12-hourly




CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Adult carbuncle antibiotic treatment

Most carbuncles will require only excision and drainage with no antibiotic treatment. If antibiotic treatment is necessary while awaiting the results of cultures and susceptibility, use:

Cefalexin 500 mg orally, 6-hourly for 5 days

OR If compliance is unlikely with QID dosing and the infection is mild

Cefalexin 1 g orally 12-hourly



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Child carbuncle antibiotic treatment

Most carbuncles will require only excision and drainage with no antibiotic treatment. If antibiotic treatment is necessary while awaiting the results of cultures and susceptibility, use:

Trimethoprim+sulfamethoxazole 4+20 mg/kg (up to 160+800 mg) orally, 12-hourly for 5 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Adult carbuncle antibiotic treatment

Most carbuncles will require only excision and drainage with no antibiotic treatment. If antibiotic treatment is necessary while awaiting the results of cultures and susceptibility, use:

Clindamycin 450 mg orally, 8-hourly for 5 days

OR

Trimethoprim+sulfamethoxazole 160+800 mg orally, 12-hourly for 5 days


Code for clindamycin orally is: 5car
This code is valid for FIVE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past five days. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Child carbuncle antibiotic treatment

Most carbuncles will require only excision and drainage with no antibiotic treatment. If antibiotic treatment is necessary while awaiting the results of cultures and susceptibility, use:

Flucloxacillin 12.5 mg/kg (up to 500 mg) orally, 6-hourly for 5 days.

OR, If compliance is unlikely with QID dosing and the infection is mild

Cefalexin 25 mg/kg orally(up to 1 g) orally, 12-hourly



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Adult carbuncle antibiotic treatment

Most carbuncles will require only excision and drainage with no antibiotic treatment. If antibiotic treatment is necessary while awaiting the results of cultures and susceptibility, use:

Dicloxacillin 500 mg orally, 6-hourly for 5 days.

OR If compliance is unlikely with QID dosing and the infection is mild

Cefalexin 1 g orally 12-hourly



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)


History of penicillin allergy or adverse reaction

No penicillin allergy

Immediate or delayed non-severe hypersensitivity to penicillin

Immediate or delayed severe hypersensitivity to penicillin


Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

1. Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of:
  • Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • OR
  • Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence).

OR

2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to penicillin for that patient (within minutes to several hours):
  • Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
  • Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence).
  • Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).

OR

3. Reduced BP after exposure to penicillin in a patient with known penicillin allergy (within minutes to several hours)
  • Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline
  • In infants and children, reduced BP is defined as low systolic BP (age-specific) or greater than 30 percent decrease in systolic BP
    • i.e. Less than 70 mmHg from 1 month up to 1 year
    • Less than (70 mmHg + [2 x age]) from 1 to 10 years
    • Less than 90 mmHg from 11 to 17 years
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Does the patient show signs of sepsis?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Would you class the cellulitis/abscess as mild/moderate or severe?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Is the patient an adult or a child?

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Does the patient show signs of sepsis?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Does the patient have a history of previous nmMRSA colonisation?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Is the patient an adult or a child?

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Does the patient have a history of previous nmMRSA colonisation?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Does the patient have a history of nmMRSA colonisation/infection within the previous 12 months?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitic Carbuncle/Abscess

Does the patient have a history of previous nmMRSA colonisation?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Mild/moderate cellulitis treatment

Mild/moderate cellulitis from carbuncle with non-life threatening penicillin allergy is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility use:

Cefalexin 500 mg (child 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 days

OR, If compliance is unlikely with QID dosing and the infection is mild

Cefalexin 1 g (child 25 mg/kg up to 1 g) orally, 12-hourly for 5 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Mild/moderate cellulitis/abscess/carbuncle treatment

Mild/moderate cellulitis/abscess/carbuncle with life threatening penicillin allergy is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility testing, use:

Trimethoprim+sulfamethoxazole 160+800 mg orally, 12-hourly for 5 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Mild/moderate cellulitis treatment

Mild/moderate cellulitis from carbuncle with life threatening penicillin allergy is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility testing, use:

Trimethoprim+sulfamethoxazole 4+20 mg/kg (up to 160+800 mg) orally, 12-hourly for 5 days



References:

See the CHAMP guidelines on the intranet for further information on antibiotic treatment in a child

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Mild/Moderate cellulitis/abscess/carbuncle treatment

Mild/Moderate cellulitis/abscess/carbuncle with no penicillin allergy is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility testing, use:

Dicloxacillin 500 mg (child flucloxacillin 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 to 10 days.


OR, If compliance is unlikely with QID dosing and the infection is mild

Cefalexin 1 g (child 25 mg/kg up to 1 g) orally, 12-hourly for 5 to 10 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Severe abscess/cellulitis treatment

For empirical therapy in a patient with mild penicillin allergy; while awaiting the results of cultures and susceptibility testing, use:

Cefazolin 2 g (child 50 mg/kg up to 2 g) IV, 8-hourly until systemic features improve then switch to oral



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Severe abscess/cellulitis treatment

For empirical therapy in a patient with no penicillin allergy, while awaiting the results of cultures and susceptibility use:

Flucloxacillin 2 g (child 50 mg/kg up to 2 g) IV, 6-hourly until systemic features improve then switch to oral



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Mild/moderate cellulitis/abscess/carbuncle treatment

Mild/moderate cellulitis/abscess/carbuncle in an adult at risk of nmMRSA or with non-life threatening penicillin allergy is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility testing, use:

Trimethoprim/sulfamethoxazole 160/800 mg orally, 12-hourly for 5 days

OR (if patient is not tolerating orals), use:

Vancomycin as per nomograms below or use the vancomycin empiric dose calculator for adults


Code for Vancomycin is: 2cac
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past five days. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Mild/moderate cellulitis treatment

Mild/moderate cellulitis from a carbuncle in a child at risk of nmMRSA or with non-life threatening penicillin allergy is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility testing, use:

Trimethoprim/sulfamethoxazole 4+20 mg/kg (up to 160+800 mg) orally, 12-hourly for 5 to 10 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Severe abscess/cellulitis treatment

Severe cellulitis/abscess in a patient at risk of nmMRSA can be treated with vancomycin and Cefazolin:

Cefazolin 2 g (child 50 mg/kg up to 2 g) IV, 8-hourly.

AND,

Vancomycin as per nomograms below or use the vancomycin empiric dose calculator for adults


Code for vancomycin is: 2cac
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.


Vancomycin Dosing in Paediatrics

Age Starting Dose
(use actual body weight)
Dosing
frequency
Timing of first
trough concentration
Neonates < 30 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 18-hourly Before the second dose
postnatal age
14 days or older
15 mg/kg 12-hourly Before the third dose
Neonates 30 to 36 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 12-hourly Before the third dose
postnatal age
14 days or older
15 mg/kg 8-hourly Before the fourth dose
Neonates 37 to 44 weeks
postmenstrual age (NB1)
postnatal age
0 to 7 days
15 mg/kg 12-hourly Before the third dose
postnatal age
7 days or older
15 mg/kg 8-hourly Before the fourth dose
Infants and children (NB2) 15 mg/kg up to 750 mg 6-hourly Before the fifth dose
  • NB1- Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)
  • NB2- The Therapeutic Guidelines gives an alternative 12-hourly dosing in this group; however local NT data support using 6-hourly dosing in all children up to 12 years

Vancomycin Dosing in Adults

Actual body
weight (kg)
CrClr
< 20 mL/min
CrClr
20-60 mL/min
CrClr
> 60 mL/min
Administer
over(1)
< 40 Call infectious diseases Call infectious diseases Call infectious diseases ---
40-49 750 mg
48 hly
750 mg
24 hly
750 mg
12 hly
1 hr
15 min
50-64 1000 mg
48 hly
1000 mg
24 hly
1000 mg
12 hly
1 hr
40 min
65-79 1250 mg
48 hly
1250 mg
24 hly
1250 mg
12 hly
2 hrs
5 min
80-94 1500 mg
48 hly
1500 mg
24 hly
1500 mg
12 hly
2 hrs
30 min
95-110 1750 mg
48 hly
1750 mg
24 hly
1750 mg
12 hly
3 hrs
> 110 Call infectious diseases Call infectious diseases Call infectious diseases ---
Timing of 1st
trough level(2)
48 hrs after
the 1st dose(3)
Before the
3rd dose
Before the
4th dose
---
  1. Vancomycin should be administered at a maximum rate of 10 mg/min to avoid Red Man Syndrome
  2. "Trough" levels are taken within 60 minutes of the next dose. If a loading dose is given then it is considered the first dose
  3. In patients with CrClr < 20 mL/min, the clinical context (e.g haemodialysis) determines whether the next dose is given before the trough concentration is available or withheld until the result is known


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Severe cellulitis treatment

Severe cellulitis/abscess in patients at risk of nmMRSA with penicillin hypersensitivity can be treated with vancomycin:

As a single agent use vancomycin as per nomograms below or use the vancomycin empiric dose calculator for adults


Code for vancomycin is: 2cac
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Vancomycin Dosing in Paediatrics

Age Starting Dose
(use actual body weight)
Dosing
frequency
Timing of first
trough concentration
Neonates < 30 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 18-hourly Before the second dose
postnatal age
14 days or older
15 mg/kg 12-hourly Before the third dose
Neonates 30 to 36 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 12-hourly Before the third dose
postnatal age
14 days or older
15 mg/kg 8-hourly Before the fourth dose
Neonates 37 to 44 weeks
postmenstrual age (NB1)
postnatal age
0 to 7 days
15 mg/kg 12-hourly Before the third dose
postnatal age
7 days or older
15 mg/kg 8-hourly Before the fourth dose
Infants and children (NB2) 15 mg/kg up to 750 mg 6-hourly Before the fifth dose
  • NB1- Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)
  • NB2- The Therapeutic Guidelines gives an alternative 12-hourly dosing in this group; however local NT data support using 6-hourly dosing in all children up to 12 years

Vancomycin Dosing in Adults

Actual body
weight (kg)
CrClr
< 20 mL/min
CrClr
20-60 mL/min
CrClr
> 60 mL/min
Administer over(1)
< 40 Call infectious diseases Call infectious diseases Call infectious diseases ---
40-49 750 mg
48 hly
750 mg
24 hly
750 mg
12 hly
1 hr
15 min
50-64 1000 mg
48 hly
1000 mg
24 hly
1000 mg
12 hly
1 hr
40 min
65-79 1250 mg
48 hly
1250 mg
24 hly
1250 mg
12 hly
2 hrs
5 min
80-94 1500 mg
48 hly
1500 mg
24 hly
1500 mg
12 hly
2 hrs
30 min
95-110 1750 mg
48 hly
1750 mg
24 hly
1750 mg
12 hly
3 hrs
> 110 Call infectious diseases Call infectious diseases Call infectious diseases ---
Timing of 1st
trough level(2)
48 hrs after
the 1st dose(3)
Before the
3rd dose
Before the
4th dose
---
  1. Vancomycin should be administered at a maximum rate of 10 mg/min to avoid Red Person Syndrome
  2. "Trough" levels are taken within 60 minutes of the next dose. If a loading dose is given then it is considered the first dose
  3. In patients with CrClr < 20 mL/min, the clinical context (e.g haemodialysis) determines whether the next dose is given before the trough concentration is available or withheld until the result is known


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Severe cellulitis/abscess/carbuncle treatment in a patient from an nmMRSA environment with no penicillin allergy

Severe cellulitis/abscess/carbuncle in adult patients at risk of nmMRSA should be treated with vancomycin and flucloxacillin:

Flucloxacillin 2 g (child 50 mg/kg up to 2 g) IV, 6-hourly.

AND,

Vancomycin, as per nomograms below or use the vancomycin empiric dose calculator for adults


Code for vancomycin is: 2cac
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Vancomycin Dosing in Paediatrics

Age Starting Dose
(use actual body weight)
Dosing
frequency
Timing of first
trough concentration
Neonates < 30 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 18-hourly Before the second dose
postnatal age
14 days or older
15 mg/kg 12-hourly Before the third dose
Neonates 30 to 36 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 12-hourly Before the third dose
postnatal age
14 days or older
15 mg/kg 8-hourly Before the fourth dose
Neonates 37 to 44 weeks
postmenstrual age (NB1)
postnatal age
0 to 7 days
15 mg/kg 12-hourly Before the third dose
postnatal age
7 days or older
15 mg/kg 8-hourly Before the fourth dose
Infants and children (NB2) 15 mg/kg up to 750 mg 6-hourly Before the fifth dose
  • NB1- Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)
  • NB2- The Therapeutic Guidelines gives an alternative 12-hourly dosing in this group; however local NT data support using 6-hourly dosing in all children up to 12 years

Vancomycin Dosing in Adults

Actual body
weight (kg)
CrClr
< 20 mL/min
CrClr
20-60 mL/min
CrClr
> 60 mL/min
Administer over(1)
< 40 Call infectious diseases Call infectious diseases Call infectious diseases ---
40-49 750 mg
48 hly
750 mg
24 hly
750 mg
12 hly
1 hr
15 min
50-64 1000 mg
48 hly
1000 mg
24 hly
1000 mg
12 hly
1 hr
40 min
65-79 1250 mg
48 hly
1250 mg
24 hly
1250 mg
12 hly
2 hrs
5 min
80-94 1500 mg
48 hly
1500 mg
24 hly
1500 mg
12 hly
2 hrs
30 min
95-110 1750 mg
48 hly
1750 mg
24 hly
1750 mg
12 hly
3 hrs
> 110 Call infectious diseases Call infectious diseases Call infectious diseases ---
Timing of 1st
trough level(2)
48 hrs after
the 1st dose(3)
Before the
3rd dose
Before the
4th dose
---
  1. Vancomycin should be administered at a maximum rate of 10 mg/min to avoid Red Person Syndrome
  2. "Trough" levels are taken within 60 minutes of the next dose. If a loading dose is given then it is considered the first dose
  3. In patients with CrClr < 20 mL/min, the clinical context (e.g haemodialysis) determines whether the next dose is given before the trough concentration is available or withheld until the result is known


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis

Is there a purulent focus for infection such as an abscess or carbuncle?

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis

Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)


History of penicillin allergy or adverse reaction

No penicillin allergy

Immediate or delayed non-severe hypersensitivity to penicillin

Immediate or delayed severe hypersensitivity to penicillin


Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

1. Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of:
  • Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • OR
  • Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence).

OR

2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to penicillin for that patient (within minutes to several hours):
  • Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
  • Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence).
  • Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).

OR

3. Reduced BP after exposure to penicillin in a patient with known penicillin allergy (within minutes to several hours)
  • Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline
  • In infants and children, reduced BP is defined as low systolic BP (age-specific) or greater than 30 percent decrease in systolic BP
    • i.e. Less than 70 mmHg from 1 month up to 1 year
    • Less than (70 mmHg + [2 x age]) from 1 to 10 years
    • Less than 90 mmHg from 11 to 17 years
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis

Would you class the cellulitis as mild/moderate or severe?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis

Would you class the cellulitis as mild/moderate or severe?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis

Is the patient an adult or a child?

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis

Would you class the cellulitis/abscess as mild/moderate or severe?


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis

Are there suggestive signs of S.pyogenes? (eg, erysipelas or rapid progression with no associated wound or ulcer) (i.e. erysipelas? or rapid progression)


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis treatment

For mild/moderate cellulitis in a patient with penicillin hypersensitivity (non-life threatening) use as a single agent:

Cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 to 10 days


OR,If compliance is unlikely with QID dosing and the infection is mild

Cefalexin 1000 mg (child: 25 mg/kg up to 1 g), 12-hourly for 5 to 10 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis treatment

For mild/moderate cellulitis in an adult with immediate or delayed severe hypersensitivity to penicillin use as a single agent:

Trimethoprim 800 mg/Sulfamethoxazole 160 mg orally, 12-hourly for 5 to 10 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Mild/moderate cellulitis treatment

Mild cellulitis in a child with immediate (severe) penicillin hypersensitivity is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility testing, use:

Trimethoprim/sulfamethoxazole 4+20 mg/kg (up to 160+800 mg) orally, 12-hourly for 5 to 10 days



References:

See the CHAMP guidelines on the intranet for more information on antibiotic treatment in a child

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis treatment

For mild/moderate cellulitis in a patient with signs of S.pyogenes use as a single agent:

Phenoxymethylpenicillin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 to 10 days

OR

Procaine penicillin 1.5 g (child: 50 mg/kg up to 1.5 g) IM, daily for at least 3 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis treatment

For mild/moderate cellulitis in a patient without signs of S.pyogenes use as a single agent:

Dicloxacillin 500 mg (child: Flucloxacillin 12.5 mg/kg up to 500 mg) orally, 6-hourly for 5 to 10 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Severe cellulitis treatment

For empirical therapy of severe cellulitis in an adult with mild penicillin allergy; while awaiting the results of cultures and susceptibility testing, use:

Cefazolin 2 g (child: 50 mg/kg up to 2 g) IV, 8-hourly

Switch to oral therapy when systemic features have improved (see Therapeutic Guidelines for details)



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Severe cellulitis treatment

For empirical treatment of severe cellulitis in a patient with life threatening penicillin hypersensitivity use vancomycin.

Vancomycin as per nomograms below or use the vancomycin empiric dose calculator for adults


Code for vancomycin is: 2cel
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Vancomycin Dosing in Paediatrics

Age Starting Dose
(use actual body weight)
Dosing
frequency
Timing of first
trough concentration
Neonates < 30 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 18-hourly Before the second dose
postnatal age
14 days or older
15 mg/kg 12-hourly Before the third dose
Neonates 30 to 36 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 12-hourly Before the third dose
postnatal age
14 days or older
15 mg/kg 8-hourly Before the fourth dose
Neonates 37 to 44 weeks
postmenstrual age (NB1)
postnatal age
0 to 7 days
15 mg/kg 12-hourly Before the third dose
postnatal age
7 days or older
15 mg/kg 8-hourly Before the fourth dose
Infants and children (NB2) 15 mg/kg up to 750 mg 6-hourly Before the fifth dose
  • NB1- Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)
  • NB2- The Therapeutic Guidelines gives an alternative 12-hourly dosing in this group; however local NT data support using 6-hourly dosing in all children up to 12 years

Vancomycin Dosing in Adults

Actual body
weight (kg)
CrClr
< 20 mL/min
CrClr
20-60 mL/min
CrClr
> 60 mL/min
Administer over(1)
< 40 Call infectious diseases Call infectious diseases Call infectious diseases ---
40-49 750 mg
48 hly
750 mg
24 hly
750 mg
12 hly
1 hr
15 min
50-64 1000 mg
48 hly
1000 mg
24 hly
1000 mg
12 hly
1 hr
40 min
65-79 1250 mg
48 hly
1250 mg
24 hly
1250 mg
12 hly
2 hrs
5 min
80-94 1500 mg
48 hly
1500 mg
24 hly
1500 mg
12 hly
2 hrs
30 min
95-110 1750 mg
48 hly
1750 mg
24 hly
1750 mg
12 hly
3 hrs
> 110 Call infectious diseases Call infectious diseases Call infectious diseases ---
Timing of 1st
trough level(2)
48 hrs after
the 1st dose(3)
Before the
3rd dose
Before the
4th dose
---
  1. Vancomycin should be administered at a maximum rate of 10 mg/min to avoid Red Person Syndrome
  2. "Trough" levels are taken within 60 minutes of the next dose. If a loading dose is given then it is considered the first dose
  3. In patients with CrClr < 20 mL/min, the clinical context (e.g haemodialysis) determines whether the next dose is given before the trough concentration is available or withheld until the result is known


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Severe cellulitis treatment

For empirical therapy in a patient with no penicillin allergy, while awaiting the results of cultures and susceptibility use:

Flucloxacillin 2 g (child: 50 mg/kg up to 2 g) IV, 6-hourly

Switch to oral therapy when systemic features have improved (see Therapeutic Guidelines for details)



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Animal or human bite


For bites and clenched-fist injuries that are not infected, antibiotic therapy is usually not necessary for otherwise healthy individuals if the risk of wound infection is low (eg small wounds not involving deeper tissues that present within 8 hours and can be adequately debrided and irrigated).

Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)


History of penicillin allergy or adverse reaction

No penicillin allergy

Immediate or delayed non-severe penicillin hypersensitivity

Immediate or delayed severe penicillin hypersensitivity

Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

1. Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of:
  • Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • OR
  • Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence).

OR

2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to penicillin for that patient (within minutes to several hours):
  • Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
  • Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence).
  • Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).

OR

3. Reduced BP after exposure to penicillin in a patient with known penicillin allergy (within minutes to several hours)
  • Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline
  • In infants and children, reduced BP is defined as low systolic BP (age-specific) or greater than 30 percent decrease in systolic BP
    • i.e. Less than 70 mmHg from 1 month up to 1 year
    • Less than (70 mmHg + [2 x age]) from 1 to 10 years
    • Less than 90 mmHg from 11 to 17 years
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Animal or human bite

How severe is the infection? Prophylactic antibiotic therapy may not be required if there is no established infection. (see list below for details on when antibiotic prophylaxis is required)


Antibiotic prophylaxis is only required for bites and fist injuries with established infection or a high risk of infection such as:
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Animal or human bite

How severe is the infection? Prophylactic antibiotic therapy may not be required if there is no established infection. (see list below for details on when antibiotic prophylaxis is required)


Antibiotic prophylaxis is only required for bites and fist injuries with established infection or a high risk of infection such as:
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Animal or human bite

How severe is the infection? Prophylactic antibiotic therapy may not be required if there is no established infection. (see list below for details on when antibiotic prophylaxis is required)


Antibiotic prophylaxis is only required for bites and fist injuries with established infection or a high risk of infection such as:
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Animal or human bite Prophylaxis/Presumptive Therapy

If patient has no penicillin allergy use:

Amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 3 days

OR if oral absorption is likely to be impared (i.e. following trauma)

Amoxicillin + clavulanate intravenously for 3 days

adult:   1 + 0.2 g 8-hourly,
child younger than 3 months and less than 4kg:   25 + 5 mg/kg 12-hourly,
child younger than 3 months and 4kg or more, or 3 months or older:   25 + 5 mg/kg (up to 1 + 0.2g) 8-hourly

OR if at increased risk of methicillin-resistant Staphylococcus aureus (MRSA) infection, in place of the regimen above, use:

Metronidazole 400 mg (child 1 month or older: 10 mg/kg up to 400 mg) orally, 12-hourly for 3 days

AND EITHER

Trimethoprim+sulfamethoxazole 160+800 mg (child 6 weeks or older: 4+20 mg/kg (up to 160+800 mg) orally, 12-hourly for 3 days

OR

Doxycycline 200 mg (child 8 years or older: 4 mg/kg up to 200 mg) orally, for the first dose, then 100 mg (child 8 years or older: 2 mg/kg up to 100 mg) orally, daily


Code for Amoxicillin iv & clavulanate is: 3bit
This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Dog, cat or human bite Prophylaxis/Presumptive Therapy

If patient has a penicillin allergy use:

Metronidazole 400 mg (child 1 month or older: 10 mg/kg up to 400 mg) orally, 12-hourly for 3 days

AND EITHER

Trimethoprim+sulfamethoxazole 160+800 mg (child 6 weeks or older: 4+20 mg/kg (up to 160+800 mg) orally, 12-hourly for 3 days

OR

Doxycycline 100 mg (child 8 years or older and less than 26kg: 50 mg; child 8 years or older and 26-35kg: 75 mg; child 8 years or older and more than 35 kg: 100 mg) orally, 12-hourly for 3 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Dog, cat or human bite Treatment

If patient has no penicillin allergy use:

Amoxicillin+clavulanate 875+125 mg (child 2 months or older: 22.5+3.2 mg/kg up to 875+125 mg) orally, 12-hourly for 5 days

OR if oral absorption is likely to be impared (i.e. following trauma)

Amoxicillin + clavulanate intravenously for 3 days

adult:   1 + 0.2 g 8-hourly,
child younger than 3 months and less than 4kg:   25 + 5 mg/kg 12-hourly,
child younger than 3 months and 4kg or more, or 3 months or older:   25 + 5 mg/kg (up to 1 + 0.2g) 8-hourly

AND if the patient is at increased risk of methicillin-resistant Staphylococcus aureus (MRSA) infection ADD

Vancomycin as per nomograms below or use the vancomycin empiric dose calculator for adults


Code for Amoxicillin iv & Clavulanate is: 5bit
This code is valid for FIVE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past five days. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.


Code for vancomycin is: 2bit
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Vancomycin Dosing in Paediatrics

Age Starting Dose
(use actual body weight)
Dosing
frequency
Timing of first
trough concentration
Neonates < 30 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 18-hourly Before the second dose
postnatal age
14 days or older
15 mg/kg 12-hourly Before the third dose
Neonates 30 to 36 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 12-hourly Before the third dose
postnatal age
14 days or older
15 mg/kg 8-hourly Before the fourth dose
Neonates 37 to 44 weeks
postmenstrual age (NB1)
postnatal age
0 to 7 days
15 mg/kg 12-hourly Before the third dose
postnatal age
7 days or older
15 mg/kg 8-hourly Before the fourth dose
Infants and children (NB2) 15 mg/kg up to 750 mg 6-hourly Before the fifth dose
  • NB1- Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)
  • NB2- The Therapeutic Guidelines gives an alternative 12-hourly dosing in this group; however local NT data support using 6-hourly dosing in all children up to 12 years

Vancomycin Dosing in Adults

Actual body
weight (kg)
CrClr
< 20 mL/min
CrClr
20-60 mL/min
CrClr
> 60 mL/min
Administer
over(1)
< 40 Call infectious diseases Call infectious diseases Call infectious diseases ---
40-49 750 mg
48 hly
750 mg
24 hly
750 mg
12 hly
1 hr
15 min
50-64 1000 mg
48 hly
1000 mg
24 hly
1000 mg
12 hly
1 hr
40 min
65-79 1250 mg
48 hly
1250 mg
24 hly
1250 mg
12 hly
2 hrs
5 min
80-94 1500 mg
48 hly
1500 mg
24 hly
1500 mg
12 hly
2 hrs
30 min
95-110 1750 mg
48 hly
1750 mg
24 hly
1750 mg
12 hly
3 hrs
> 110 Call infectious diseases Call infectious diseases Call infectious diseases ---
Timing of 1st
trough level(2)
48 hrs after
the 1st dose(3)
Before the
3rd dose
Before the
4th dose
---
  1. Vancomycin should be administered at a maximum rate of 10 mg/min to avoid Red Person Syndrome
  2. "Trough" levels are taken within 60 minutes of the next dose. If a loading dose is given then it is considered the first dose
  3. In patients with CrClr < 20 mL/min, the clinical context (e.g haemodialysis) determines whether the next dose is given before the trough concentration is available or withheld until the result is known


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Dog, cat or human bite Prophylaxis/Presumptive Therapy

If patient has a penicillin allergy use:

Metronidazole 400 mg (child 1 month or older: 10 mg/kg up to 400 mg) orally, 12-hourly for 5 days

AND EITHER

Trimethoprim+sulfamethoxazole 160+800 mg (child 6 weeks or older: 4+20 mg/kg )up to 160+800 mg) orally* 12-hourly for 5 days

OR

Doxycycline 100 mg (child 8 years or older and less than 26kg: 50 mg; child 8 years or older and 26-35kg: 75 mg; child 8 years or older and more than 35 kg: 100 mg) orally, 12-hourly for 5 days



CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Dog, cat or human bite Treatment

If patient has a penicillin allergy give:

Ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) IV, 12-hourly

AND

Clindamycin 600 mg (child: 15 mg/kg up to 600 mg) IV, 8-hourly

OR if the patient is at an increased risk of MRSA infection, in place of the regimen above give:

Ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) IV, 12-hourly

AND

Metronidazole 500 mg (child 1 month or older: 12.5 mg/kg up to 500 mg) IV, 12-hourly

AND

Vancomycin as per nomograms below or use the vancomycin empiric dose calculator for adults


Code for ciprofloxacin iv and clindamycin iv is: 3bit
This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.


Code for vancomycin is: 2bit
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Vancomycin Dosing in Paediatrics

Age Starting Dose
(use actual body weight)
Dosing
frequency
Timing of first
trough concentration
Neonates < 30 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 18-hourly Before the second dose
postnatal age
14 days or older
15 mg/kg 12-hourly Before the third dose
Neonates 30 to 36 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 12-hourly Before the third dose
postnatal age
14 days or older
15 mg/kg 8-hourly Before the fourth dose
Neonates 37 to 44 weeks
postmenstrual age (NB1)
postnatal age
0 to 7 days
15 mg/kg 12-hourly Before the third dose
postnatal age
7 days or older
15 mg/kg 8-hourly Before the fourth dose
Infants and children (NB2) 15 mg/kg up to 750 mg 6-hourly Before the fifth dose
  • NB1- Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)
  • NB2- The Therapeutic Guidelines gives an alternative 12-hourly dosing in this group; however local NT data support using 6-hourly dosing in all children up to 12 years

Vancomycin Dosing in Adults

Actual body
weight (kg)
CrClr
< 20 mL/min
CrClr
20-60 mL/min
CrClr
> 60 mL/min
Administer
over(1)
< 40 Call infectious diseases Call infectious diseases Call infectious diseases ---
40-49 750 mg
48 hly
750 mg
24 hly
750 mg
12 hly
1 hr
15 min
50-64 1000 mg
48 hly
1000 mg
24 hly
1000 mg
12 hly
1 hr
40 min
65-79 1250 mg
48 hly
1250 mg
24 hly
1250 mg
12 hly
2 hrs
5 min
80-94 1500 mg
48 hly
1500 mg
24 hly
1500 mg
12 hly
2 hrs
30 min
95-110 1750 mg
48 hly
1750 mg
24 hly
1750 mg
12 hly
3 hrs
> 110 Call infectious diseases Call infectious diseases Call infectious diseases ---
Timing of 1st
trough level(2)
48 hrs after
the 1st dose(3)
Before the
3rd dose
Before the
4th dose
---
  1. Vancomycin should be administered at a maximum rate of 10 mg/min to avoid Red Person Syndrome
  2. "Trough" levels are taken within 60 minutes of the next dose. If a loading dose is given then it is considered the first dose
  3. In patients with CrClr < 20 mL/min, the clinical context (e.g haemodialysis) determines whether the next dose is given before the trough concentration is available or withheld until the result is known


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Dog, cat or human bite Treatment

If patient has no penicillin allergy use:

Amoxicillin + clavulanate intravenously

Adult:   1 + 0.2 g 6-hourly,
Child younger than 3 months and less than 4kg:   25 + 5 mg/kg 12-hourly,
Child younger than 3 months and 4kg or more, or 3 months or older:   25 + 5 mg/kg (up to 1 + 0.2g) 8-hourly

AND if the patient is at increased risk of methicillin-resistant Staphylococcus aureus (MRSA) infection ADD

Vancomycin as per nomograms below or use the vancomycin empiric dose calculator for adults


Code for Amoxicillin iv & Clavulanate is: 5bit
This code is valid for FIVE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past five days. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.


Code for vancomycin is: 2bit
This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Vancomycin Dosing in Paediatrics

Age Starting Dose
(use actual body weight)
Dosing
frequency
Timing of first
trough concentration
Neonates < 30 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 18-hourly Before the second dose
postnatal age
14 days or older
15 mg/kg 12-hourly Before the third dose
Neonates 30 to 36 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 12-hourly Before the third dose
postnatal age
14 days or older
15 mg/kg 8-hourly Before the fourth dose
Neonates 37 to 44 weeks
postmenstrual age (NB1)
postnatal age
0 to 7 days
15 mg/kg 12-hourly Before the third dose
postnatal age
7 days or older
15 mg/kg 8-hourly Before the fourth dose
Infants and children (NB2) 15 mg/kg up to 750 mg 6-hourly Before the fifth dose
  • NB1- Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)
  • NB2- The Therapeutic Guidelines gives an alternative 12-hourly dosing in this group; however local NT data support using 6-hourly dosing in all children up to 12 years

Vancomycin Dosing in Adults

Actual body
weight (kg)
CrClr
< 20 mL/min
CrClr
20-60 mL/min
CrClr
> 60 mL/min
Administer
over(1)
< 40 Call infectious diseases Call infectious diseases Call infectious diseases ---
40-49 750 mg
48 hly
750 mg
24 hly
750 mg
12 hly
1 hr
15 min
50-64 1000 mg
48 hly
1000 mg
24 hly
1000 mg
12 hly
1 hr
40 min
65-79 1250 mg
48 hly
1250 mg
24 hly
1250 mg
12 hly
2 hrs
5 min
80-94 1500 mg
48 hly
1500 mg
24 hly
1500 mg
12 hly
2 hrs
30 min
95-110 1750 mg
48 hly
1750 mg
24 hly
1750 mg
12 hly
3 hrs
> 110 Call infectious diseases Call infectious diseases Call infectious diseases ---
Timing of 1st
trough level(2)
48 hrs after
the 1st dose(3)
Before the
3rd dose
Before the
4th dose
---
  1. Vancomycin should be administered at a maximum rate of 10 mg/min to avoid Red Person Syndrome
  2. "Trough" levels are taken within 60 minutes of the next dose. If a loading dose is given then it is considered the first dose
  3. In patients with CrClr < 20 mL/min, the clinical context (e.g haemodialysis) determines whether the next dose is given before the trough concentration is available or withheld until the result is known


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Cellulitis of the eye

What type of cellulitis does the patient have? (see notes below)

Classification of eye cellulitis


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Periorbital cellulitis

Is the patient severely ill? (i.e. periorbital cellulitis is the primary reason for hospitalisation)


CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Periorbital cellulitis

Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)


History of penicillin allergy or adverse reaction

No penicillin allergy

Immediate or delayed non-severe hypersensitivity to penicillin

Immediate or delayed severe hypersensitivity to penicillin


Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

1. Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of:
  • Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • OR
  • Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence).

OR

2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to penicillin for that patient (within minutes to several hours):
  • Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
  • Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence).
  • Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).

OR

3. Reduced BP after exposure to penicillin in a patient with known penicillin allergy (within minutes to several hours)
  • Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline
  • In infants and children, reduced BP is defined as low systolic BP (age-specific) or greater than 30 percent decrease in systolic BP
    • i.e. Less than 70 mmHg from 1 month up to 1 year
    • Less than (70 mmHg + [2 x age]) from 1 to 10 years
    • Less than 90 mmHg from 11 to 17 years
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Periorbital cellulitis treatment

If patient has no penicillin allergy use:

Dicloxacillin 500 mg (child: Flucloxacillin 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days.



References:

See section on periorbital cellulitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 16. Melbourne: Therapeutic Guidelines Limited; 2019.

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Periorbital cellulitis treatment

If patient has a mild penicillin allergy use:

Cefalexin 500 mg (child: 12.5 mg/kg up to 500 mg) orally, 6-hourly for 7 days.



References:

See section on cellulitis of the eye - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 16. Melbourne: Therapeutic Guidelines Limited; 2014.

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Periorbital cellulitis treatment

If patient has a mild penicillin allergy use:

Clindamycin 450 mg (child: 15 mg/kg up to 450 mg) orally, 8-hourly for 7 days.


Code for clindamycin orally is: 7per
This code is valid for SEVEN days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past one week. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



References:

See section on cellulitis of the eye - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 16. Melbourne: Therapeutic Guidelines Limited; 2014.

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Orbital or Severe Periorbital Cellulitis

Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)


History of penicillin allergy or adverse reaction

No penicillin allergy

Immediate or delayed non-severe hypersensitivity to penicillin

Immediate or delayed severe hypersensitivity to penicillin


Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

1. Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of:
  • Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • OR
  • Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence).

OR

2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to penicillin for that patient (within minutes to several hours):
  • Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
  • Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
  • Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence).
  • Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).

OR

3. Reduced BP after exposure to penicillin in a patient with known penicillin allergy (within minutes to several hours)
  • Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline
  • In infants and children, reduced BP is defined as low systolic BP (age-specific) or greater than 30 percent decrease in systolic BP
    • i.e. Less than 70 mmHg from 1 month up to 1 year
    • Less than (70 mmHg + [2 x age]) from 1 to 10 years
    • Less than 90 mmHg from 11 to 17 years
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Orbital or severe periorbital cellulitis treatment

If patient has no penicillin allergy use:

Ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 G) IV, daily

AND

Flucloxacillin 2 g (child: 50 mg/kg up to 2 G) IV, 6-hourly


Code for ceftriaxone is: 3per
This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



References:

See section on cellulitis of the eye - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 16. Melbourne: Therapeutic Guidelines Limited; 2019.

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Orbital or severe periorbital cellulitis treatment

If patient has immediate or delayed non-severe hypersensitivity to penicillin use:

Cefotaxime 2 g (child: 50 mg/kg up to 2 G) IV, 8-hourly for seven days




References:

See section on cellulitis of the eye - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 16. Melbourne: Therapeutic Guidelines Limited; 2019.

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

Orbital or severe periorbital cellulitis treatment

If patient has a severe penicillin allergy:


Clinamycin 600 mg IV, 8-hourly


Code for clindamycin is: 7cli
This code is valid for SEVEN days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



Vancomycin Dosing in Paediatrics

Age Starting Dose
(use actual body weight)
Dosing
frequency
Timing of first
trough concentration
Neonates < 30 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 18-hourly Before the second dose
postnatal age
14 days or older
15 mg/kg 12-hourly Before the third dose
Neonates 30 to 36 weeks
postmenstrual age (NB1)
postnatal age
0 to 14 days
15 mg/kg 12-hourly Before the third dose
postnatal age
14 days or older
15 mg/kg 8-hourly Before the fourth dose
Neonates 37 to 44 weeks
postmenstrual age (NB1)
postnatal age
0 to 7 days
15 mg/kg 12-hourly Before the third dose
postnatal age
7 days or older
15 mg/kg 8-hourly Before the fourth dose
Infants and children (NB2) 15 mg/kg up to 750 mg 6-hourly Before the fifth dose
  • NB1- Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)
  • NB2- The Therapeutic Guidelines gives an alternative 12-hourly dosing in this group; however local NT data support using 6-hourly dosing in all children up to 12 years

Vancomycin Dosing in Adults

Actual body
weight (kg)
CrClr
< 20 mL/min
CrClr
20-60 mL/min
CrClr
> 60 mL/min
Administer
over(1)
< 40 Call infectious diseases Call infectious diseases Call infectious diseases ---
40-49 750 mg
48 hly
750 mg
24 hly
750 mg
12 hly
1 hr
15 min
50-64 1000 mg
48 hly
1000 mg
24 hly
1000 mg
12 hly
1 hr
40 min
65-79 1250 mg
48 hly
1250 mg
24 hly
1250 mg
12 hly
2 hrs
5 min
80-94 1500 mg
48 hly
1500 mg
24 hly
1500 mg
12 hly
2 hrs
30 min
95-110 1750 mg
48 hly
1750 mg
24 hly
1750 mg
12 hly
3 hrs
> 110 Call infectious diseases Call infectious diseases Call infectious diseases ---
Timing of 1st
trough level(2)
48 hrs after
the 1st dose(3)
Before the
3rd dose
Before the
4th dose
---
  1. Vancomycin should be administered at a maximum rate of 10 mg/min to avoid Red Person Syndrome
  2. "Trough" levels are taken within 60 minutes of the next dose. If a loading dose is given then it is considered the first dose
  3. In patients with CrClr < 20 mL/min, the clinical context (e.g haemodialysis) determines whether the next dose is given before the trough concentration is available or withheld until the result is known


References:

See section on cellulitis of the eye - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 16. Melbourne: Therapeutic Guidelines Limited; 2019.

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

COVID-19

Please refer to the National Guideline

If patient fits the criteria for Paxlovid or Remdesivir in the national guideline, the Code for the antiviral is: 5cov
This code is valid for FIVE day, starting from the first day of treatment for this condition. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

COVID-19


Patients must meet all criteria in Initial Eligibility Criteria, AND ONE of the PBS or NT criteria AND all criteria for the individual medicine. Where uncertainty exists, or if a clinician believes a patient may benefit from treatment but the patient does NOT meet the treatment criteria, these patients should be discussed with the infectious diseases team.

Does the patient fulfill the Initial Eligibility Criteria to be considered for pharmacotherapy? Please see below.


Initial Eligibility Criteria: PBS and NT criteria for treatment:
Immunocompromising Conditions or Immunosuppressive Therapy.
PBS Criteria Risk Factors for Progression to Severe COVID-19:
NT Specific Criteria (non-PBS) Risk Factors for Progression to Severe COVID-19:
CHAMPS - Central Health Antimicrobial Prescribing Software

CHAMPS - Central Health Antimicrobial Prescribing Software

COVID-19


The first line agent for a patient who fit the eligibility criteria listed in the previous page is Paxlovid (Nirmatrelvir plus Ritonavir).
If an inpatient is not eligible for Paxlovid, the next option is Remdesivir; if the inpatient is not eligible for Remdesivir, the next option is Molnupiravir.
If an outpatient is not eligible for Paxlovid, the next option is Molnupiravir; if the outpatient is not eligible for Molnupiravir, the next option is Remdesivir.

Does the patient meet at least ONE of the following clinical crtieria for COVID-19 specific pharmacotherapy?

  • Immunocompromising condition or immunosuppressive therapy as per listed below, or long-term renal dialysis (regardless of vaccination status)
  • Unvaccinated or not up to date with vaccines AND have ONE or more risk factors for progression to severe COVID-19 listed below
  • Up to date with vaccination AND have TWO or more risk factors for progression to severe COVID-19 listed below




  • CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19


    The first line agent for a patient who fit the eligibility criteria listed in the previous page is Paxlovid (Nirmatrelvir plus Ritonavir).
    If an inpatient is not eligible for Paxlovid, the next option is Remdesivir; if the inpatient is not eligible for Remdesivir, the next option is Molnupiravir.
    If an outpatient is not eligible for Paxlovid, the next option is Molnupiravir; if the outpatient is not eligible for Molnupiravir, the next option is Remdesivir.

    Does the patient meet ALL of the following clinical crtieria for the first-line oral treatment medication Paxlovid (Nirmatrelvir plus Ritonavir)?


    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19

    Treatment is likely not required. Please contact ID if patient is symptomatic for more than 5 days, if the patient's weight is less than 40kg, or if the patient is less than 12 years of age.

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19 treatment (MILD disease severity) for those eligible for Paxlovid

    For patients with MILD disease severity who meet all eligibility criteria for oral Paxlovid:

    Give Budesonide turbuhaler 800mcg inhalation 12-hourly within 14 days of symptom onset

    AND

    Give Nirmatrelvir 300mg (if eGFR 30-60mL/min, reduce dose to 150mg) orally TWICE daily AND Ritonavir 100mg orally TWICE daily within 5 days of symptom onset for a treatment duration of 5 days


    Code for Nirmatrelvir plus Ritonair (Paxlovid) is: 5cov
    This code is valid for FIVE day, starting from the first day of treatment for this condition. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



    References:

    See flowchart for Disease-modifying treatments for adults with COVID-19 - National COVID-19 Clinical Evdience Taskforce. Published on 2 August 2022.
    See COVID-19 treatment for at risk adults and adolescents not requiring oxygen - NT Health Guideline. Published on 17 Jul 2022.

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19

    Does the patient meet ALL of the following clinical crtieria for the IV treatment medication Sotrovimab?

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19 treatment (MILD disease severity) and meet all eligibility criteria for Sotrovimab

    For patients with MILD disease severity and meet all eligibility criteria for Sotrovimab:

    Give Budesonide turbuhaler 800mcg inhalation 12-hourly within 14 days of symptom onset

    AND

    Give Sotrovimab 500mg IV as a single dose within 5 days of symptom onset


    Code for Sotrovimab is: 1cov
    This code is valid for ONE day as a stat dose only, starting from the first day of treatment for this condition. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



    References:

    See flowchart for Disease-modifying treatments for adults with COVID-19 - National COVID-19 Clinical Evdience Taskforce. Published on 12 May 2022.

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19

    Does the patient meet ALL of the following clinical crtieria for the oral medication Molnupiravir?

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19 treatment (MILD disease severity) for those eligible for Molnupiravir

    For patients with MILD disease severity and eligible for Molnupiravir:

    Give Budesonide turbuhaler 800mcg inhalation 12-hourly within 14 days of symptom onset

    AND

    Give Molnupiravir 800mg (4x 200mg) capsules TWICE daily within 5 days of symptom onset for a treatment duration of 5 days


    Code for Molnupiravir is: 5cov
    This code is valid for FIVE days only, starting from the first day of treatment for this condition. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



    References:

    See flowchart for Disease-modifying treatments for adults with COVID-19 - National COVID-19 Clinical Evdience Taskforce. Published on 8 August 2022.
    See COVID-19 treatment for at risk adults and adolescents not requiring oxygen - NT Health Guideline. Published on 17 Jul 2022.

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19

    Please contact ID team for advice.

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19

    Does the patient meet ALL of the following clinical crtieria for the IV treatment medication Remdesivir?

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19 treatment (MILD disease severity) for those eligible for Remdesivir

    For patients with MILD disease severity and eligible for Remdesivir:

    Give Budesonide turbuhaler 800mcg inhalation 12-hourly within 14 days of symptom onset

    AND

    Give Remdesivir 200mg IV infusion on day 1, and then 100mg daily for 2 more days for a treatment duration of 3 days


    Code for Remdesivir is: 3cov
    This code is valid for THREE days only, starting from the first day of treatment for this condition. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



    References:

    See flowchart for Disease-modifying treatments for adults with COVID-19 - National COVID-19 Clinical Evdience Taskforce. Published on 8 August 2022.
    See COVID-19 treatment for at risk adults and adolescents not requiring oxygen - NT Health Guideline. Published on 17 Jul 2022.

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    COVID-19 treatment (Moderate and Severe disease severity)

    For patients with Moderate or Severe disease:

    Give Oxygen supplementation and give Dexamethasone 6mg IV/PO once daily for up to 10 days (or an acceptable alternative regimen)

    AND

    Ivermectin 200mcg/kg (to the closest 1.5mg) orally as a single dose for strongyloidiasis chemoprophylaxis (due to the strongyloidiasis endemic in Central Australia)

    AND (only if patient does not require ventilation)

    Load Remdesivir with 200mg IV stat, then 100mg IV once daily from day 2, for a total of 5 days. (Do not use in patients who require invasive or non-invasive ventilation)

    AND (if there is evidence of deterioration with a rise in inflammatory markers: CRP above 75mg/L, D-dimer above 500ng/mL or Ferritin greater than 500 microg/L) use EITHER

    Baricitinib 4mg orally once daily for up to 14 days (Reduce dose to 2mg once daily in patients with an eGFR of less than 60mL/min)

    OR

    Tocilizumab IV as a weight-based single dose. Give 800mg for a weight greater than 95kg; 600mg for 65-95kg; 400mg for 40-64kg; 8mg/kg if less than 40kg. Consider a second dose after 12-24 hours if no clinical improvement is noted, or if the CRP, D-Dimer or ferritin does not start to fall. (Tocilizumab is indicated particularly where there is evidence of systemic inflammation)


    Code for Remdesivir is: 5cov
    This code is valid for FIVE days, starting from the first day of treatment for this condition. Infectious diseases must be contacted. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.


    Code for Ivermectin is: 1cov
    This code is valid for ONE day, starting from the first day of treatment for this condition. Infectious diseases must be contacted. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.


    Code for Baricitinib is: 14cov
    This code is valid for FOURTEEN days, starting from the first day of treatment for this condition. Infectious diseases must be contacted. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.


    Code for Tocilizumab is: 1cov
    This code is valid for ONE day, starting from the first day of treatment for this condition. Infectious diseases must be contacted. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.



    References:

    See flowchart for Disease-modifying treatments for adults with COVID-19 - National COVID-19 Clinical Evdience Taskforce. Published on 12 May 2022.

    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)


    History of penicillin allergy or adverse reaction

    No penicillin allergy

    Immediate or delayed non-severe hypersensitivity to penicillin

    Immediate or delayed severe hypersensitivity to penicillin


    Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

    1. Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalised hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of:
    • Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
    • OR
    • Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse] syncope, incontinence).

    OR

    2. TWO OR MORE OF THE FOLLOWING that occur rapidly after exposure to penicillin for that patient (within minutes to several hours):
    • Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
    • Respiratory compromise (eg, dyspnea, wheeze-bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
    • Reduced BP or associated symptoms (eg, hypotonia [collapse], syncope, incontinence).
    • Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).

    OR

    3. Reduced BP after exposure to penicillin in a patient with known penicillin allergy (within minutes to several hours)
    • Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline
    • In infants and children, reduced BP is defined as low systolic BP (age-specific) or greater than 30 percent decrease in systolic BP
      • i.e. Less than 70 mmHg from 1 month up to 1 year
      • Less than (70 mmHg + [2 x age]) from 1 to 10 years
      • Less than 90 mmHg from 11 to 17 years
    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    How severe is the infection? (see table below)

    Classification of diabetic foot infection

    Severity Features
    Uninfected
    • Wound lacking purulence or any manifestation of inflammation
    Mild
    • Presence of 2 or more manifestations of inflammation (purulence, or erythema, pain, tenderness,warmth, or induration)
    • Extent of cellulitis/erythema: 0.5 - 2cm around ulcer, and infection is limited to the skin or superficial subcutaneous tissues
    • No other local complications or systemic illness.
    Moderate
    • Infection (as above) in a patient who is systemically well and metabolically stable, but which has greater than 1 of the following characteristics:
      • cellulitis > 2 cm, lymphangitic streaking, spread beneath the superficial fascia, deeptissue abscess, gangrene and involvement of muscle, tendon, joint or bone.
    Severe
    • Infection in a patient with systemic toxicity or metabolic instability
      • eg. Fever, chills, tachycardia, hypotension, confusion, vomiting, leukocytosis, acidosis, severe hyperglycaemia, renal impairment
    • Any osteomyelitis, systemic toxicity, bacteraemia, gangrene, ulceration to deep tissues, severe cellulitis
    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    How severe is the infection? (see table below)

    Classification of diabetic foot infection

    Severity Features
    Uninfected
    • Wound lacking purulence or any manifestation of inflammation
    Mild
    • Presence of 2 or more manifestations of inflammation (purulence, or erythema, pain, tenderness, warmth, or induration)
    • Extent of cellulitis/erythema: 0.5 - 2cm around ulcer, and infection is limited to the skin or superficial subcutaneous tissues
    • No other local complications or systemic illness.
    Moderate
    • Infection (as above) in a patient who is systemically well and metabolically stable, but which has greater than 1 of the following characteristics:
      • cellulitis > 2 cm, lymphangitic streaking, spread beneath the superficial fascia, deeptissue abscess, gangrene and involvement of muscle, tendon, joint or bone.
    Severe
    • Infection in a patient with systemic toxicity or metabolic instability
      • eg. Fever, chills, tachycardia, hypotension, confusion, vomiting, leukocytosis, acidosis, severe hyperglycaemia, renal impairment
    • Any osteomyelitis, systemic toxicity, bacteraemia, gangrene, ulceration to deep tissues, severe cellulitis
    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    How severe is the infection? (see table below)

    Classification of diabetic foot infection

    Severity Features
    Uninfected
    • Wound lacking purulence or any manifestation of inflammation
    Mild
    • Presence of 2 or more manifestations of inflammation (purulence, or erythema, pain, tenderness, warmth, or induration)
    • Extent of cellulitis/erythema: 0.5 - 2cm around ulcer, and infection is limited to the skin or superficial subcutaneous tissues
    • No other local complications or systemic illness.
    Moderate
    • Infection (as above) in a patient who is systemically well and metabolically stable, but which has greater than 1 of the following characteristics:
      • cellulitis > 2 cm, lymphangitic streaking, spread beneath the superficial fascia, deeptissue abscess, gangrene and involvement of muscle, tendon, joint or bone.
    Severe
    • Infection in a patient with systemic toxicity or metabolic instability
      • eg. Fever, chills, tachycardia, hypotension, confusion, vomiting, leukocytosis, acidosis, severe hyperglycaemia, renal impairment
    • Any osteomyelitis, systemic toxicity, bacteraemia, gangrene, ulceration to deep tissues, severe cellulitis
    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot treatment

    For mild diabetic foot in a patient with non-life-threatening penicillin allergy:

    Cefalexin 500 mg PO, 6-hourly for 1-2 weeks

    AND

    Metronidazole 400 mg PO, 12-hourly for 1-2 weeks



    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot treatment

    For mild diabetic foot in a patient with life-threatening penicillin allergy:

    Trimethoprim+sulfamethoxazole 160+800 mg PO, 12-hourly for 1-2 weeks

    AND

    Metronidazole 400 mg PO, 12-hourly for 1-2 weeks



    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot treatment

    For mild diabetic foot in a patient with no penicillin allergy:

    Amoxicillin 875 mg/Clavulanic acid 125 mg PO, 12-hourly for 1-2 weeks

    OR if patient is at high risk of MRSA infection, use the combination of:

    Sulfamethoxazole 800 mg/trimethoprim 160 mg orally, 12-hourly for 1-2 weeks

    AND

    Metronidazole 400mg orally, 12-hourly for 1-2 weeks



    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    Are there systemic signs of sepsis?

    Signs of Sepsis

    SIRS response: ≥2 of: AND presence of refractory hypotension or hypoperfusion

    Temp <36 or >38

    Heart rate > 90

    Resp Rate > 20

    WCC > 12.0 or < 4.0

    Hypotension:

    • systolic BP< 90 mmHg OR 40 mmHg below premorbid BP AFTER at least 500 mL fluid challenge.

    Hypoperfusion:

    • Lactate ≥4 mmol/L OR Bicarbonate <16mmol/L
    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    Are there systemic signs of sepsis?

    Signs of Sepsis

    SIRS response: ≥2 of: AND presence of refractory hypotension or hypoperfusion

    Temp <36 or >38

    Heart rate > 90

    Resp Rate > 20

    WCC > 12.0 or < 4.0

    Hypotension:

    • systolic BP< 90 mmHg OR 40 mmHg below premorbid BP AFTER at least 500 mL fluid challenge.

    Hypoperfusion:

    • Lactate ≥4 mmol/L OR Bicarbonate <16mmol/L
    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    Is MRSA infection suspected?


    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    Is MRSA infection suspected?


    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    Are there systemic signs of sepsis?

    Signs of Sepsis

    SIRS response: ≥2 of: AND presence of refractory hypotension or hypoperfusion

    Temp <36 or >38

    Heart rate > 90

    Resp Rate > 20

    WCC > 12.0 or < 4.0

    Hypotension:

    • systolic BP< 90 mmHg OR 40 mmHg below premorbid BP AFTER at least 500 mL fluid challenge.

    Hypoperfusion:

    • Lactate ≥4 mmol/L OR Bicarbonate <16mmol/L
    CHAMPS - Central Health Antimicrobial Prescribing Software

    CHAMPS - Central Health Antimicrobial Prescribing Software

    Diabetic foot infection

    Is MRSA infection suspected?