Late Onset (> 5 days)

Micro-organism

Pseudomonas spp. more likely

First line

Piperacillin/tazobactam IV for 5-10 days

Add gentamicin IV if severe Pseudomonal infection

Add vancomycin IV if MRSA suspected or confirmed

Consider IV to oral switch when afebrile > 24 hours and clinically improving

Second line: mild intolerance or mild skin reaction

Ceftazadime IV for 5-10 days

Add gentamicin IV if severe Pseudomonal infection

Add vancomycin IV if MRSA suspected or confirmed

Consider IV to oral switch when afebrile > 24 hours and clinically improving

Anaphylaxis (including severe skin reaction) to penicillin / cephalosporins

Vancomycin IV + Ciprofloxacin IV (use higher dosing as per BNFC)