Table 1 Choice of antibiotics

EOS

Penicillin + gentamicin

- if Listeria monocytogenes: amoxicillin + gentamicin

- if S.aureus: flucloxacillin + gentamicin

LOS

First line: flucloxacillin + gentamicin

Second line:

- vancomycin + gentamicin (with caution)

- vancomycin + piperacillin/tazobactam (to extend Gram-negative cover)

Third line: meropenem, ciprofloxacin

Meningitis

First line: cefotaxime with amoxicillin ± gentamicin

Second line: meropenem

Gram positive multiresistant bacteria

Currently: glycopeptide antibiotics are the mainstay of therapy, especially vancomycin; if necessary linezolid, clindamycin, rifampicin and daptomycin could be alternative regimens

In the future: novel cephalosporins like ceftaroline and ceftobiprole; novel lipoglycopeptide antibiotics are oritavacin and dalbavancin; telavacin has been approved in the USA in adults

Gram negative multiresistant bacteria

Currently: aminoglycosides and cephalosporins are the antibiotics of choice; carbapenems, colistin, co-trimoxazole, ticarcillin-clavulanic acid could be the an alternative; fluoroquinolone, ciprofloxacin, tigecycline and tetraciclins could only be justified in extreme cases.

In the future: treatment options are extremely limited