Cellulitis IV by CIT
CIT Referral Criteria:
- > 16 years old
- Have an acceptable standard of living conditions. (The structure of the accommodation must be permanent in nature, have hot and cold running water and indoor toilet facilities).
- Demonstrate an acceptable understanding of both verbal and written English, or evidence of an equally proficient supportive home translator available at all times.
- Have a contact number
- Fit the CIT Inclusion criteria
OPAT Exclusion Criteria
- Underlying Osteomyelitis, Necrotizing Fasciitis, Septic Joint or Abscess are not excluded from the DDx
- Age <16 years
- History of IVDU, renal impairment or diabetic related infections.
- Renal impairment
- Complex cellulitis (e.g. abscess/bursa/facial)
- SBP <BP 100 mmHg
- History of Clostridium difficile infection
- Admit to CDU under EM for initial labs and IV treatment
- Start Cefazolin 2G IV OD and probenecid 1G PO OD
- Assess for A) Thromboprophylaxis risk and B) CIT suitable
- If improving, CIT available and no contraindications @ 24 hrs (x2 doses), Cefazolin 2g IV OD plus Probenecid 1g OD PO (Prescription 1)
- If the patient has contraindications or intolerance, use Cefazolin 2g BD IV (Prescription 2)
- Confirm adequate doses IVAB and probenecid tolerant
- Patient advice - return CDU SOS
- No work during IV therapy
- Provide patient with pharmacy pack
- Keep medical chart in CDU
Nursing staff checklist
- Arrange medications to be dispensed (pharmacy)
- Phone CIT on 087 9436971 with regard to the referral
- Email referral and prescription to CIT
- Inform GP of discharge arrangement by phone (or fax)
- Arrange appointment for the patient to return
Notes on Cefazolin / Probenecid
- If the patient is unable to tolerate the once daily regimen due to GI upset, then prescribe Cefazolin 2g twice daily iv without the probenecid.
- Check dosing (with pharmacist) in renal impairment.
- For penicillin allergic (OPAT/CIT only) patients, please contact micro. for advice on vancomycin dosing and monitoring.
Probenecid contra-indicated with:
- Sodium phenylbutyrate
- High dose aspirin
Content By Dr Íomhar O' Sullivan 10/05/2019. Last review Dr ÍOS 13/05/19.