Preamble

DISCLAIMER: This information has been developed specifically for the IWK Health Centre. It is provided for informational purposes for qualified health care professionals. This material is not intended as a substitute for consulting qualified health care professionals. Patient situations will vary and some information may have become outdated as a result of more recent evidence or practice changes. While efforts are made to maintain the accuracy/currency of this information, the IWK Health Centre will not assume responsibility for the continued currency of the information, any errors or omissions, and/or any consequences arising from the use of the information outside of the IWK.

PURPOSE: These guidelines were developed by the Antimicrobial Stewardship Program in collaboration with multiple clinical groups. They represent consensus based on evidence-based guidelines and local microbiology and susceptibility patterns. The purpose of these guidelines is to inform initial selection of empiric antimicrobial therapy, to optimize antimicrobial use and as such, provide better patient outcomes including fewer adverse events and development of resistance related to antimicrobials. These guidelines apply to previously healthy, immunized infants and children greater than 1 month of age that are not immunocompromised unless otherwise indicated and to patients in our women’s health program.
For neonates being cared for in the NICU, please refer to NICU guidelines.

These guidelines are not meant to replace clinical judgment. Each patient’s response should be assessed by clinical evaluation. A thorough clinical assessment is required to identify any complicating factors which may necessitate alternative or additional therapy.

When considering starting or modifying therapy, useful questions pertaining to the use of antimicrobials include:

  •  Have I made a presumptive clinical diagnosis based on the clinical history, physical exam and available laboratory investigations?
  •  Have I considered taking, blood/urine/CSF and/or other relevant samples for culture wherever possible before starting anti‐microbial therapy?
  •  Have I selected empiric therapy based on the presumptive clinical diagnosis, local antibiogram and the most probable pathogens?
  •  Is there evidence that supports the prescribing of broad spectrum antimicrobials or more than one antimicrobial; or, is just one antimicrobial sufficient in this clinical situation?
  •  Am I “treating” colonization (from chronic wounds or tracheostomy sites) or contamination rather than a true infection?
  •  Do I have the appropriate dose ?
  •  Have I considered the need for dose adjustment (e.g., renal impairment)?
  •  When can I shorten the duration or stop antimicrobial therapy?

Review Antimicrobials Daily

Adjust treatment according to microbiologic results as soon as they are available

Consult ID and/or relevant subspeciality team(s) if required.

Note, guidelines exclude neonates (unless otherwise indicated) and immunocompromised patients. For neonates being cared for in the NICU, please refer to NICU guidelines.