Combination Regimens
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This guidance only applies if there are no previous culture results indicating resistance to the proposed oral agent and no positive cultures are available for the current infective episode.
If the current agents are available in an oral formulation, a direct conversion is possible with the exception of PO Vancomycin; it is not absorbed from the GI tract and the PO formulation is therefore only indicated for treatment of C. difficile infection.
In pregnant patients, ciprofloxacin and co-trimoxazole are contraindicated.
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IV regimen |
PO regimen |
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Amoxicillin + Gentamicin + Metronidazole or Vancomycin + Gentamicin + Metronidazole |
Co-trimoxazole 960mg every 12 hours + Metronidazole 400mg every 8 hours Co-trimoxazole contains trimethoprim and sulfamethoxazole. Do not use this agent in pregnancy. Trimethoprim is contraindicated in the first trimester of pregnancy due to a risk of neural tube defects; sulfamethoxazole can cause neonatal haemolysis and methaemoglobinaemia in the last trimester. In pregnancy, use Co-amoxiclav 625mg every 8 hours. If penicillin allergic, discuss with an infection specialist. |
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Gentamicin +/- Amoxicillin for biliary sepsis or Gentamicin +/- Vancomycin for biliary sepsis |
Co-trimoxazole 960mg every 12 hours Co-trimoxazole contains trimethoprim and sulfamethoxazole. Do not use this agent in pregnancy. Trimethoprim is contraindicated in the first trimester of pregnancy due to a risk of neural tube defects; sulfamethoxazole can cause neonatal haemolysis and methaemoglobinaemia in the last trimester. In pregnancy, use Co-amoxiclav 625mg every 8 hours. If penicillin allergic, discuss with an infection specialist. |
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Temocillin + Amoxicillin for SBP |
Co-trimoxazole 960mg every 12 hrs If on SBP prophylaxis with co-trimoxazole use: Co-Amoxiclav 625mg every 8 hours |
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Gentamicin +/- Amoxicillin for urosepsis or Gentamicin +/- Vancomycin for urosepsis |
Co-trimoxazole 960mg every 12 hours Co-trimoxazole contains trimethoprim and sulfamethoxazole. Do not use this agent in pregnancy. Trimethoprim is contraindicated in the first trimester of pregnancy due to a risk of neural tube defects; sulfamethoxazole can cause neonatal haemolysis and methaemoglobinaemia in the last trimester. Only if low risk of C.difficile infection and suitable for early IVOS and discharge: Ciprofloxacin 500mg every 12hrs Nitrofurantoin does not achieve therapeutic serum or tissue levels and is only used for treatment of uncomplicated lower UTI. It is not an appropriate agent for upper or bacteraemic UTI. Do not use as IV-to-oral switch in urosepsis. In pregnancy, use Co-amoxiclav 625mg every 8 hours. If penicillin allergic, discuss with an infection specialist. |
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Co-trimoxazole + Gentamicin for HAP |
Co-trimoxazole 960mg every 12 hours; stop Gentamicin after 72hrs or at time of IVOS whichever is earlier Co-trimoxazole contains trimethoprim and sulfamethoxazole. Do not use this agent in pregnancy. Trimethoprim is contraindicated in the first trimester of pregnancy due to a risk of neural tube defects; sulfamethoxazole can cause neonatal haemolysis and methaemoglobinaemia in the last trimester. |
| Vancomycin + Ciprofloxacin for neutropenic sepsis |
Ciprofloxacin 500mg every 12 hours |