Drugs for the respiratory tract

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In CF, doses of antibiotics are usually given at a higher dose and for a longer period than in non-CF children, for reasons of pharmacokinetic differences as well as the presence of underlying lung disease. See section 6.2a for antibiotic prescribing policies.

NOTE: od = once daily; bd = twice daily; tds = 3 times daily; qds = 4 times daily

Oral antibiotics - prophylactic doses

Oral antibiotics - prophylactic doses.pdf

Oral antibiotics – treatment doses

See section 6.2a for antibiotic prescribing policies. Decision depends on:

Current clinical state.
Current and past organisms and their antibiotic sensitivities.
Past history of individual.
Known ‘allergies’ or intolerance.

Oral antibiotics – treatment doses.pdf

Inhaled antibiotics

See NHSE Clinical Commissioning Policy for inhaled therapy first published Dec 2014.

Inhaled antibiotics.pdf

Intravenous antibiotics

See section 6.2a for antibiotic prescribing policies. Decision depends on:

Current and past organisms and their antibiotic sensitivities.
Past history of the individual patient.
Known ‘allergies’ or intolerance.

Note

i) Two antipseudomonal antibiotics from different classes are ALWAYS given – consultants only for exceptions.

ii) High dose flucloxacillin is no longer used accompanying IVABs but we add in IV teicoplanin if S aureus has been grown in the past year.

iii) Preferred blind starting combination is meropenem (better Staph cover) or ceftazidime (or aztreonam) plus tobramycin (gentamicin is never used due to increased renal toxicity and less favourable MIC).

iv) Course length is always a minimum two weeks.

v) Take care with first doses as unexpected, severe hypersensitivity does occur.

vi) Antibiotics can impair liver and renal function. Take care with drug dosing with underlying impairment – refer to BNFc or the pharmacy team for more information.

CIVAS (Centralised Intravenous Additives Service)

CIVAS is now outsourced to an external provider so we no longer use banding tables to round off doses.

Since most patients come in for admission during the daytime, the dose for that night and the next morning is made up by the nurses in the usual way on the ward. Admissions from Friday daytime, Saturday & Sunday (and bank holidays) will receive drugs made up on the ward until evening of next midweek working day.

Intravenous antibiotics.pdf