Alternative antibiotic regimes in COVID-19 patients

This section offers guidance on alternative antibiotic regimes that are appropriate for suspected or confirmed COVID-19.

These alternative regimes aim to minimise need for therapeutic drug monitoring to assist in infection prevention and control and also minimise additional nephrotoxicity risks in severely unwell and deteriorating patients.

Dose and frequency adjustments based on renal function may be required. Check with renal drug database or ward pharmacist if any queries.



Alternative to Amoxicillin+Gentamicin for complicated UTI/sepsis:

Amoxicillin 1g IV 8 hourly and Temocillin 2g IV 8 hourly 


Alternative to Amoxicillin+Gentamicin+Metronidazole e.g. for intra-abdominal/biliary infection:

Piperacillin-Tazobactam (Tazocin) 4.5g IV 8 hourly


Alternative to Co-amoxiclav+Gentamicin e.g. for HAP:

Piperacillin-Tazobactam (Tazocin) 4.5g IV 6 hourly


Alternative regime for Vancomycin+Gentamicin+/-Metronidazole:

Ceftriaxone 2g IV daily +/- Metronidazole 400mg PO / 500mg IV 8 hourly

(if anaphylaxis to penicillin - Levofloxacin 500mg PO/IV 12 hourly +/- Metronidazole 400mg PO / 500mg IV 8 hourly)


Alternative for Vancomycin+Ciprofloxacin:

Levofloxacin 500mg PO/IV 12 hourly