General List of Recommended Antibiotics

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Antibiotics Recommendations Medical Department Acute Bacterial Meningitis Organism(s) Empirical N. meningitidis H. influnenzae S. pneumoniae First line Alternative IV Ceftriaxone 2g bd IV Cefotaxime 2g tds for 2 weeks or IV Meropenem 2g (elderly/ malignancy, tds for 2 weeks to add IV Ampicilin, 2g bd to cover for L. monocytogenes) Acute Dysentary First line Alternative IV/PO Metronidazole for 10days IV/PO Ciprofloxacin for 3days Aspiration pneumonia First line IV Augmentin 1.2g tds Alternative IV cefotaxime 1g tds Plus IV Metronidazole 500mg tds notes

Organism(s) E. histolytica Shigella

notes

Organism(s) S. pneumoniae Oral anaerobes H. influnenzae M. catarrhalis

notes

Community acquired pneumonia Organism(s) S. pneumoniae Oral anaerobes H. influnenzae M. catarrhalis First line Alternative IV Augmentin 1.2g tds IV Cefuroxime 1.5g or tds for 1-2 weeks IV Cefotaxime 1g tds or IV Unasyn 1.5g tds For 1-2 weeks Plus either Erythromycin ES 800mg bd or doxycycline 100mg bd or Azithromycin 500mg od for 2 weeks notes

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Diabetic related ulcer Organism(s) P. aeruginosa E. coli First line IV Ampiciln + Sulbactam (Unasyn) 1.5g tds Or IV Amoxicillin + Clavulanic acid (Augmentin) 1-2g tds For 1-2 weeks. Alternative notes

Organism(s)

Double lumen catheter related sepsis 1 line Alternative IV Ceftazidime 1g od plus IV Cloxacillin 500 mg qid for 2 weeks
st

Notes

Organism(s) E.coli Camphylobacter Salmonella Vibrio Yersinia Clostridium difficile colitis

Gastrointestinal tract 1st line Alternative IV / PO Ciprofloxacin Cap Doxycycline 500 mg bd for 5 days 100 bd for 5 days

Notes

IV Metronidazole 500 bd or 1g od till diarrhea cured IV Ceftriaxone 2g od for 5 days Gonorrhea 1 line Alternative IM Ceftrixone 125 mg IM 3rd generation * 1 dose Cephalosporin 250 500 mg * 1 dose
st

Salmonella thypi

Organism(s) N. Gonorrhea

Notes

Organism(s) P.auruginosa E.coli K. pneumonia

Hospital acquired pneumonia 1st line Alternative IV Cefotaxime 1g tds IV Meropenem 1 g or IV Sulperezone 1g tds or bd for 1-2 weeks IV Tazosin 4.5 g tds IV Vancomycin 1 g

Notes

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Staph aureus (MRSA)

tds for 1 week

Organism(s) Strep viridan Gp B,C, G Streptococci

Infective Endocarditis 1st line Alternative IV C Penincillin 2 MU 4 hourly plus IV Gentamycin 3.5 5 mg per kg in 3 divided doses 4 minimum of 2 weeks. Intravenous drug abuser First line Alternative IV Cloxacillin 2g 4hrly plus IV Gentamicin 3.5-5mg in 3 divided doses Liver abscess First line Alternative IV Ciprofloxacin plus IV Metronidazole 500mg tds till Abscess reduce in size IV Ceftazidime 2g tds for 2 weeks plus Cap Doxycycline 100mg bd and Co-trimoxazole 2 tad bd for 18 weeks Miscellaneous First line Alternative IV C Penicillin IV Ceftriaxone 1g 2MU qid plus od for 1 week Doxycycline 100mg bd for 1 week

Notes

Organism (s) S. pneumoniae

Notes

Organism (s) Enterobacteriacea Enterococcus B. flagilis

Notes

Burkholderia pseudomallei

Organism (s) Leptospira spp

Notes

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Syphilis Organism (s) Primary/secondary (<1 year) First line IM Benzathine penicillin 2.4MU single dose or Doxycycline 100mg bd for 2 weeks IM Benzathine penicillin 2.4MU weekly for 2 weeks or Doxycycline 100mg bd for 3 weeks Alternative Notes

Latent syphilis (duration >1 year)

Urinary tract a) Pyelonephritis

Organism(s) Empirical enterobacteriacea 1 line IV Ceftriaxone 1g od for 1 to 2 weeks Or IV / PO Ciprofloxacin 500 mg bd for 1 to 2 weeks 1 line IV Ceftriaxone 1g OD or ( till abscess resolved) 1 line IV Ceftriaxone 1g od Or IV Ciprofloxacin 500 mg bd for 1 to 2 weeks IV Augmentin 1.2g tds for 1-2 weeks
st st st

Alternative IV Cefuroxime 1.5 g tds

Notes

b) Renal Abscess
Organism(s) Empirical S. pneumonia Alternative Notes

C) Urosepsis
Organism(s) Gram (-ve) Alternative Notes

Gram (+ve)

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MALARIA Diagnosis Plasmodium vivax Suggested treatment 1st line Altenative Chloroquine(base) 600 mg ( 4 tabs immediately, then 300 mg (2tabs) 6 hours later and on days 2 & 3. + Primaquine 15 mg daily for 14 days + Pyrimethamine + Sulfadoxine ( Fansidar) 3tabs Notes G6PD deficiency should be excluded prior to the use of Primaquine If fails to respond to standard Chloroquine treatment Quinine or Mefloquine are alternative therapies. Chloroquine resistant is widespread along Malaysia,Thai border, Sabah and in some areas with illegal immigrant village. Fansidar is contraindicated in pregnancy and infant.

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Antibiotics Recommendations Surgery Department Breast Abscess 1 line Alternatives Cloxacillin Erythromycin 1st generation Cephalosporins
st

Organism(s) Staphylococci aureus and epidermidis Streptococci

Notes Recommended duration: 1week Proper I&D and dressings are necessary

Organism(s) Staphylococci Streptococci Pseudomonas

Burns (burn wound sepsis) 1st line Alternatives Cloxacillin Metronidazole Gentamicin

Notes Recommended duration: depends on response

Organism(s) E.coli Klebsiella Enterococci Proteus

Diverticulitis Perirectal Abscess 1st line Alternatives 2nd / 3rd generation Gentamicin of Cephalosporins Amikacin Metronidazole

Notes Recommended duration: 1week

Organism(s) H.pylori

Duodenal / Gastric Ulcer 1st line Alternatives PO Clarithromycin PO Tetracyclin PO Amoxycillin PO Metronidazole PO Lansoprazole PO Omiprazole

Notes Recommended duration: 1week Urease test positive

Gastrointestinal (Gallbladder, Cholecystitis, Cholangitis Biliary Sepsis,Appendicitis) Organism(s) 1st line Alternatives Notes E.coli Amoxycillin Gentamicin Recommended Kleabsiella 2nd / 3rd generation Amikacin duration: 1week Proteus of Cephalosporins Enterococci Metronidazole Anaerobes Kidney (Perinephric abscess, UTI, Pyelonephritis) 1st line Alternatives Notes Gentamicin Recommended Bactrim Amikacin duration: 1week 2nd / 3rd generation of Cephalosporins Metronidazole

Organism(s) Coliforms anaerobes Staphylococci

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Organism(s) Coliforms anaerobes

Liver (Hepatic Abscess) 1st line Alternatives 2nd / 3rd generation Gentamicin of Cephalosporins Amikacin Metronidazole

Notes Recommended duration: 1 week

Organism(s) Clostridium perfringens

Muscle (Gas gangrene) 1st line Alternatives Benzylpenicillin Metronidazole Cephalosporins Muscle (Pyomyocitis) 1st line Alternatives Beta-lactams Cephalosporins Cloxacillin Necrotizing fascilitis 1st line Alternatives Cloxacillin Metronidazole Gentamici Unasyn Pancreas Necrotizing pancreatitis 1st line Alternatives 2nd / 3rd generation Gentamicin of Cephalosporins Amikacin Metronidazole Pancreatic abcess, Infected pseudocyst 1st line Alternatives nd rd 2 / 3 generation of Cephalosporins Metronidazole

Notes Recommended duration: 1week

Organism(s) Staphylococci Clostridium

Notes Recommended duration: 1week

Organism(s) Staphylococci Streptococci Pseudomonas

Notes Recommended duration: 1week

Organism(s)

Notes Recommended duration: 1week

Organism(s) Coliforms anaerobs

Notes Recommended duration: 1week

Organism(s)

Pancreatitis, Acute alcoholic pancreatitis 1st line Alternatives Notes nd rd 2 / 3 generation Recommended of Cephalosporins duration: 1week Metronidazole

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Peritonium Primary Peritonitis Organism(s) Coliforms anaerobs 1st line 2nd / 3rd generation of Cephalosporins Metronidazole Alternatives Gentamicin Amikacin Notes Recommended duration: dependant on respond

Prevention of SPB (cirrhosis & ascites) 1st line Alternatives Notes nd rd 2 / 3 generation Gentamicin Recommended of Cephalosporins Amikacin duration: 1week Metronidazole Secondary peritonitis (bowel perforation, ruptured appendix/diverticula) Organism(s) 1st line Alternatives Notes Coliforms 2nd / 3rd generation Gentamicin Recommended anaerobs of Cephalosporins Amikacin duration: Metronidazole dependant on respond Organism(s) Coliforms anaerobs

ANTIBIOTIC PROPHYLAXIS FOR SURGERY Type Of Surgery Prophylaxis Agent/Dose/Route/Duration AAA repair and vascular bypass surgery IV Ampicillin/Sulbactam 1.5gm TDS x 1week IV Cloxacillin 1gm on induction and 500mg QID x 1 week IV Cefoperazone 1g BD x 1 week IV Metronidazole 500mg TDS x 1 week May continue with oral antibiotics Notes

Biliary Laparoscopic cholecyctectomy (high risk)

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Breast

IV Cefuroxime 1.5g on induction

May be extended in presence of skin infection IV Gentamicin Or Amikacin may be used if indicated

Colorectal Elective Emergency

IV Cefoperazone 1g BD x 1 week IV Metronidazole 500mg TDS x 1 week

Gastrointestinal tract Appendicitis Herniorraphy

IV Cefoperazone 1g BD x 1 week IV Metronidazole 500mg TDS x 1 week

IV Cefuroxime 1.5g on induction

May be extended in presence of skin infection

Vascular access

IV Ampicillin/Sulbactam 1.5gm IV Cloxacilin 1g

May continue with oral antibiotics

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