Staph. aureus Flucloxacillin IV. Consider debridement, vacuum-assisted If no debridement required, 2 weeks. If closure. debridement, for 4 weeks. [Clindamycin if penicillin allergy] Consider IV to oral switch: Sternal wound cefalexin infections post If no improvement, consider switch to vancomycin IV co-amoxiclav cardiothoracic flucloxacillin surgery Vancomycin IV empirically if known MRSA colonised. [Clarithromycin if penicillin allergy] 7-10 days (longer duration if lack of clinical Amoxicillin IV, gentamicin IV and metronidazole IV. Gram negative organisms such as E. improvement) If central line in situ, consider vancomycin IV, gentamicin coli and Klebsiella. IV and metronidazole IV (teicoplanin used empirically in Enterococcus Discontinue Abs after 2-3 days if NEC Portsmouth and HHFT). If overwhelming sepsis or bowel Pseudomonas spp. thought unlikely perforation, consider piperacillin/tazobactam, gentamicin Anaerobes and (+- if central line in IV metronidazole IV vancomycin IV Necrotising situ). enterocolitis or If CNS infection likely, use meropenem instead of typhlitis piperacillin/tazobactam and metronidazole.
Sternal wound infections post cardiothoracic surgery Staph. aureus Flucloxacillin IV. Consider debridement, vacuum-assisted closure. [Clindamycin if penicillin allergy] If no improvement, consider switch to vancomycin IV Vancomycin IV empirically if known MRSA colonised. If no debridement required, 2 weeks. If debridement, for 4 weeks. Consider IV to oral switch: cefalexin co-amoxiclav flucloxacillin [Clarithromycin if penicillin allergy] Necrotising enterocolitis or typhlitis Gram negative organisms such as E. coli and Klebsiella. Enterococcus Pseudomonas spp. Anaerobes Amoxicillin IV, gentamicin IV and metronidazole IV. If central line in situ, consider vancomycin IV, gentamicin IV and metronidazole IV (teicoplanin used empirically in Portsmouth and HHFT). If overwhelming sepsis or bowel perforation, consider piperacillin/tazobactam, gentamicin IV and metronidazole IV (+- vancomycin IV if central line in situ). If CNS infection likely, use meropenem instead of piperacillin/tazobactam and metronidazole. 7-10 days (longer duration if lack of clinical improvement) Discontinue Abs after 2-3 days if NEC thought unlikely
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