Empirical treatment

Start IV antibiotics to provide broad spectrum cover. Stop prophylactic ciprofloxacin. Follow local protocol if available.

First line: Tazocin 4.5g tds plus gentamicin 6mg/kg/day.

If patient has history of penicillin allergy use ceftazidime 2g tds instead of tazocin; if anaphylaxis with penicillin discuss with microbiologist.

If suspected line infection (exit site inflammation) add vancomycin 1g bd and consider line removal. Vancomycin dose should be split and administered through each lumen. May be locked in the line for 1h then flushed.

If there are signs of perianal sepsis, mucositis or intra-abdominal infection or if C difficile is suspected add metronidazole 500mg tds IV.

1. Patients on od gentamicin should have pre-dose level checked 24h after first dose then twice weekly if satisfactory.

2. Patients on vancomycin should have pre-dose levels checked immediately before 3rd or 4th dose (2nd if renal impairment) then twice weekly if satisfactory.

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