• Starship Clinical Guidance
  • Te Toka Tumai Intranet
  • NZ Formulary
  • Auckland Regional Health Pathways
  • Antibiotic Prescribing Guidelines
  • My Shortlist

Useful information about working in Infectious Diseases

Essential resources

RESOURCES Antibiotic guidelines for management of sepsis, meningitis, pneumonia and many other infections can be found in the Antibiotic Prescribing Guidelines

Auckland DHB Antimicrobial Stewardship Guidelines – under A on the intranet or Health Professionals on the internet site: https://www.adhb.health.nz/health-professionals/resources/ams/

Who to call

You can contact ID in a number of ways depending on what you need

  1. ID referrals (see below) are best made through email

  2. Urgent clinical advice or antibiotic approvals

  3. OPAT team (see below)

  4. HIV team

There is an ID RMO on-call until 10pm Monday to Friday and a SMO on-call at all times.

General principles

  • Where feasible, collect appropriate specimens, ideally at least two sets of blood cultures before starting antimicrobial agents.

  • If an organism which fits the clinical picture has been isolated from an appropriate specimen, adjust the patient’s therapy accordingly.

  • Try to prescribe the most narrow spectrum regimen e.g. penicillin rather than amoxicillin for a penicillin-sensitive organism.

  • Document the indication for an antimicrobial on the drug chart. If you’re unsure – why are you prescribing something?

  • Prescribe short courses of antimicrobial agents and always specify the duration – in most cases 5 days will be enough.

  • Always review allergies when prescribing antimicrobials. Many are actually side effects or expected symptoms of illness and should not stop you using first line therapies.

  • All fever is not infection. Resolution of fever with antimicrobial treatment does not necessarily imply a microbial diagnosis; likewise, a persistent fever does not necessarily mean that the antimicrobial regimen is wrong.

ID referrals

The ID Service is available to provide advice on patients with known or suspected infection. There are 3 different services provided so please follow up with the team or clinician who has reviewed your patient.

Referrals (like the following conditions) are split between the 2 inpatient referral teams (General and Bone/Renal/Urology):

  • Septic shock

  • Infections due to multi-resistant organisms e.g. ESBL, MRSA, VRE

  • Invasive fungal infections

  • Infections of implanted prosthetic devices e.g. central lines, pacemakers, CSF shunts

  • Meningitis, encephalitis or brain abscess

  • Meningococcal disease

  • Infective endocarditis

  • Tuberculosis other than those patients under the care of the Respiratory team

  • Diabetic foot infections

  • Prosthetic joint infections

  • Septic arthritis or osteomyelitis

The Bacteraemia Service will automatically see patients with positive blood cultures every day; you do not need to refer unless the blood culture was taken in a different hospital (please refer these patients).

Information to have when referring to Infectious Diseases

  1. It is expected that you will have assessed your patient and discussed management with your team first

  2. Name, NHI and location of your patient

  3. Knowledge of your patient’s problems

  4. Relevant microbiology results, including colonisation with multi-resistant organisms

  5. Current and/or recent antimicrobial therapy, including a clear understanding of antibiotic allergies

OPAT – Outpatient IV Antibiotic Service

All patients being considered for OPAT first require referral to Adult Infectious Diseases.

More information about OPAT and the referral process can be found on HIPPO https://adhb.hanz.health.nz/Pages/OPIVA.aspx