Information for health care professionals - Intravenous antibiotics
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Information for health care professionals

Intravenous antibiotics

For a standard course of ivs given for a chest exacerbation use ceftazidime and tobramycin. If there is a poor response to this combination, such that ivs are required again within 3 months, second line treatment is meropenem and colistin. We do not routinely use tobramycin more often then every 6 months; for ivs required within that period use either iv ceftazidime and nebulised tobramycin tds or iv meropenem and iv colistin. In exceptional circumstances, the following additional iv agents may be considered: Lizenolid (for MRSA not responding to standard treatment), Teicoplanin (for MRSA), Temocillin (for cepacia), Timentin (Ticarcillin/ Clavulanic acid) (for cepacia). Doses can be found in the Brompton guidelines, and need to be checked with pharmacy before use.

  Amikacin Aztreonam Cefoxitin Ceftazidime Colistin Meropenem Tigecycline Tobramycin Imipenem with cilastatin
Amount PER DOSE 15mg/kg 50mg/kg 50mg/kg 50mg/kg 20,000iu/kg 40mg/kg upto 12 years
2gm over 12 years 		1mg/kg 10mg/kg 25mg/kg (20mg/kg-40mg/kg) of imipenem
Dose frequency ONCE daily TDS TDS TDS TDS TDS TWICE daily ONCE daily TDS
MAX DOSE 1g od 2g tds 4g tds 3g tds 2 mega units tds 2g tds 50mg bd 660mg od 1g tds (of imipenem)
Notes Round weight down to nearest whole Kg and then calculate dose.
If previous course had any high trough levels reduce dose for this course by 20%.
Trough level 1-4 hours BEFORE 2nd dose and BEFORE 8th dose. Check creatinine before starting and with each amikacin level. Trough should be <5mg/L
To be given before 4pm.
Infuse over 30 mins.
Peak levels to be taken 1 hour after end of infusion - aim for peak of 25-35mg/L
Used for treatment of M. abscessus and other pathogens resistant to tobramycin. 		Has no activity against Staph. or any other Gram-positive pathogen. For treatment of M. abscessus.
Can give as infusion over 30 minutes. 		Round dose to the nearest 100mg in children under 20kg and to the nearest 250mg in children over 20kg. Measure creatinine before starting and once per week.
Slow infusion over 30 mins. Max concentration for peripheral infusion is 40,000 units/ml.
Can be given as a slow bolus into a port (not long line) at 90,000 units/ml for children under 12 yrs and 200,000 units/ml for children over 12 years. 		Round dose to the nearest 100mg in children under 20kg and to the nearest 250mg in children over 20kg. ONLY for children over 12ys for treatment of M. abscessus. Nausea and vomiting common – use ondansatron. Round weight down to nearest whole Kg and then calculate dose.
If previous course had any high trough levels reduce dose for this course by 20%.
Trough level 1-4 hours BEFORE 2nd dose and BEFORE 8th dose. Check creatinine before starting at with tobramycin level. Trough tobramycin level should be <1 mg/litre
To be given before 4pm.
Infuse over 30 mins. 		Used for treatment of M. abscessus ONLY. For more details on dosage and dose adjustment, see BTS guidleines for Management of Non-Tuberculous Pulmonary Disease.