Guidelines
Severe Illness

Severe Illness

Preferred Treatment

  • Dose adjustment required in renal impairment

If True Immediate Penicillin Allergy

  • Immediate, IgE mediated allergies include, but are not limited to, anaphylaxis, urticaria, angioedema, hypotension, bronchospasm, stridor, and pruritic rash
  • Refer to the NB-ASC Beta-Lactam Allergy guidelines to determine which beta-lactams share similar side chains (see link below)
  • Dose adjustment required in renal impairment

If Severe Delayed Reaction to a Beta-lactam

  • Severe delayed hypersensitivity reactions to beta-lactams are caused by mechanisms that are not well known and require that subsequent use of beta-lactams be avoided.
  • Severe delayed hypersensitivity reactions can include interstitial nephritis, immune hepatitis, hemolytic anemia, serum sickness, severe cutaneous reactions such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms (DRESS).

levoFLOXacin 750 mg IV q24h

  • Dose adjustment required in renal impairment

PLUS

metroNIDAZOLE 500 mg IV q12h

If MRSA Suspected, ADD to Above Regimens

  • History of MRSA infection or colonization
  • Household contact with a MRSA colonized individual
  • Injection drug use
  • Crowded living conditions (e.g. homelessness, incarcerated persons)
  • Recent travel to or residing in an MRSA endemic region or community
  • Adjust dose to a trough target of 10 to 15 mg/L
  • Dose adjustment required in renal impairment
  • See risk factors below
  • Stop vancomycin if MRSA not found on screening swabs or culture

Duration of Therapy

5-7 days (if good clinical response)

  • Recommend consultation to Infectious Diseases, Respirology OR Thoracic Surgery
  • Employ source control if appropriate
  • Treat with IV antibiotics for 3 – 6 weeks depending on clinical response and radiographic resolution

Treatment Considerations

If initially started on IV therapy convert to the PO route of administration when: 

  • clinically improving,
  • hemodynamically stable,
  • able to take PO medications, and 
  • have a normally functioning gastrointestinal tract