Beruflich Dokumente
Kultur Dokumente
List of recommendations arranged according to system and diseases
(According to alphabetical order)
Central Nervous system
Community acquired Meningitis (CAM)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: S.I Avoid Imipenem
Pyogenic Meningitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Most of the patient came from different ICU with multiple drugs including
two or more antibiotics with cultural and sensitivity report, so antibiotics choice
mostly depends on c/s report
Dentistry
Acute variceal haemorrhage
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Cleft lippalate, facial cleft, facial deformity correction surgery
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Inj. Ceftriaxone (1 Inj. Meropenem (1
gm) gm)
12 hourly 8 hourly I/V for 7
Tab. Metronidazole days, followed by
(500 mg) Cap. Cephalosporins
8 hourly for 57 Tab. Metronidazole
days followed by or
Cap.
Cephalosporins
Tab. Metronidazole
Dental abscess
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Obligate anaerobes: Cap. Flucloxacillin Cap. Cepholosporins
Prevotella intermedia Tab. Metronidazole Cap. Cefixime
Prevotella nigresub Cap. Cefuroxime
Fusobacterium Tab. metronidazole
periodontices
Phyromonas endodontics
Porphyromonas
gingivalis
Name: For rapidly spreading infections injectable from may be advised
Denture sore mouth
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Denture stomatitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Candida albicans 1 antifungal agents
(eg, Nystatin
powder or cream)
Extraction of tooth surgical/ non surgical
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Cap. Amoxicillin 2 of the other 3rd line
(500 mg) antibiotic*
8 hourly for 7 days
or
Cap. Cefixime (200
mg)
12 hourly for 7
days+
Tab. Metronidazole
(400 mg)
8 hourly for 5 days.
Fungal infections in maxillofacial region like Candidiasis, mucormicosis etc
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Gingivitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Name: Avoidance of Doxycycline, Metronidazole in growing patients and pregnant
women.
Avoidance of antimicrobial drugs in patients having the history of that specific
drug allergy.
Hepatorenal syndrome
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
In case of maxillofacial fracture management like open reduction and fixation
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
3rd generation Inj. Meropenem (1
Ceftriaxone (1 mg gm)
)I/V 8 hourly I/V for 7
12 hourly days, following by
Metronidazole (500 Cap. Cephalosporins
mg) I/V Tab. Metronidazole
8 hourly for 57
days followed by
oral Cephalosporins
Tab. Metronidazole
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In case of oral and maxillofacial lesion with or without reconstruction, like
mendibulectomy, maxillectomy, neck dissection, etc
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Inj. Ceftriaxone (1 Inj. Meropenem (1
mg) 12 hourly gm) 8 hourly for 7
Tab. Metronidazole days, following by
(500 mg) Cap. Cephalosporins
8 hourly for 57 Tab. Metronidazole
days followed by
Cap.
Cephalosporins
Tab. Metronidazole
Jaw osteomyelitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Minor oral surgery like biopsy, excision of mucocele etc
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Cap. Amoxicillin Cap. Amoxicillin
(500 mg) (500 mg) +
8 hourly for 7 days Clavulanic acid (125
or mg)
Cap. Cefixime (200 8 hourly or
mg) Cap. Cefuroxime
12 hourly for 7 days (500 mg) +
+ Clavulanic acid (125
Tab. Metronidazole mg)
(400 mg) 12 hourly for 7 days
8 hourly for 5 days +
Tab. Metronidazole
(400 mg)
8 hourly for 57 days
Oral Candidiasis
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Orofacial space infections
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Peri implantitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Prevotella intermedia Cap.
Pseudomonas Cephalosporins
aeruginosa (200400 mg )
612 hourly for 7
Staphylococcus spp. days
Peptostreptococcus Metronidazole (400
micros mg)
Porphyromonas 57 days
ednodontalis
Name: Safe in pregnancy
Periapical Pathosis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Pericoronitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Periodontitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Primary & secondary prophylaxis for variceal haemorrhage
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Prophylaxis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Cap. Amoxicillin (3 Cap. Clindamycin 3
gm)prior to surgery. gm prior to surgery
Cap. Amoxicillin 3
gm prior to surgery
Pulpits
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Obligate anaerobes: Cap. Amoxicillin Cap. Cefixime
Peptostreptococcus (500 mg)(preferably Cap. Cefuroxime
anaerobius with clavulanic
Veillonella parvula acid)or
Lactobacilus Cap. Cephradine
cateraforme Tab. Metronidazole
Porphylaomonas
endodontic
Facultative anaerobes:
Streptococcus mitis
Streptococcus oralis
Enterococcus faucal
Neisseria
Viral infection in lip/oral cavity like herpes simplex infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Dermatology
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Acne Vulgaris
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Cellulitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Staphylococcal Coamoxiclav (625
Streptococcal or mg)
8 hourly
Combined
Cap. Flucloxacillin
plus Phenoxymethyl
penicillin (500 mg)
6 hourly or
Tab. Gatifloxacin
(400 mg)
24 hourly for 7 days
or
Inj. Ceftriaxone (2
gm) I/V
single or divided
dose
Chancroid
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Cutaneous Anthrax
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Bacillus antharacis Tab. Ciprofloxacin
(500 mg)
12 hourly for14 days
Cap. Doxycycline
(100 mg)
12 hourly for 14
days
Cutaneous Tuberculosis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Gonorrhoeae
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Neisseria gonorrhea Single doses of any of
the following orally:
Cap. Cefixime (300
mg)
Tab. Ciprofloxacin
(500 mg)
Tab. Ofloxacin (400
mg)
Tab. Levofloxacin
(250 mg)
Impetigo contagiosa
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Leprosy
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Syphilis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Endocrine System
Sepsis/ Septicemia
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Skin and soft tissue infection e.g. diabetic foot lesion
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Wound care like debridement, regular drening off loading of presure area
are much important
Supportive Parotitis (Salivary Gland Infection)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Inj. CoAmoxiclav Inj. Clindamycin
(1.2 gm) (900 mg)
8 hourly Oral then: 8 hourly Oral then:
Tab. CoAmoxiclav Tab. Clindamycin
(625 mg) (450 mg)
8 hourly 1014 days 8 hourly
Gastro Intestinal System
Acute gastroenteritis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Pseudomembrenous colities by clostridium difficile is an important cause
of gastroenteritis following use of other antibiotics
Abdominal Sepsis
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Likely causative Antimicrobial of choice
agent
Preferred drug Alternative drug
Cholangitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Gram negative Inj. Meropenem
anaerobes (500 mg)
8 hourly
Gastroenteritis, Typhlitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Candida Inj. Cefepime (500 mg)
Enterococcus faecalis 8 hourly
Aspergillus Piperacillin/Tazobactam
Anaerobes Vancomycin
Itraconazole
Name: Liver function test necessary
Necrotizing Pancreatitis (infected)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Inj. Inj. Meropenem (1
Piperacillin/Tazobactam gm)
(4.5 gm) 8 hourly for 714
68 hourly for 714 days days plus
Plus Inj. Amikacin (500 Inj. Amikacin (500
mg) mg)
12 hourly for 7 days 12 hourly for 7 days
Plus plus
Tab. Metronidazole Inj. Clindamycin
(500 mg) (600 mg)
8 hourly 7 days 8 hourly for 714
days
Peptic ulcer disease
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Duration depending on the nature and severity of the infection
Secondary bacterial peritonitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Inj. Meropenem
Other gut pathogens (500 mg)
8 hourly
Spontaneous bacterial peritonitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Name: Ascitic fluid should be cultured for both aerobic and araerobic organism.
Ascitic fluid should be inculated of blood culture bottle containing 100 ml media
of blood culture bottle containing 100 ml media at bed side.
Hepatobiliary system
Amoebic liver abscess
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Antiviral used in Hepatitis B infection (Chronic Hepatitis B)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Antiviral used in Hepatitis C infection (Chronic Hepatitis C)
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Cholangitis
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Hepatic actinomycosis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Percutaneous liver biopsy relveals suphaur granules with typical organism
Hydatid disease of liver
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: PAIR is as effective as surgery. (WHO guideline 1996)
Leptospirosis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Blood culture during limit 10 days or urine culture during 2nd week
Melioidosis
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Pyogenic liver abscess
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Infectious Disease
Bacterial vaginosis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Febrile Neutropenia
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Name: Culture sensitivity prefered preceded by emperical treatment
Genital Herpes
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Kalaazar
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Malaria
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Neutropenic fever, Cellulitis
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: ANC <500X10L, Hyperemtivity
Pelvic inflammatory disease
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Tab. Azithromycin
(1gm)
post operative stat
followed by
Tab. Ofloxacin (400
mg)
post operative 12
hourly plus
Tab. Metronidazole
(400 mg)
post operative 12
hourly 14 days
Tab. Azithromycin
(1 gm)
post operative stat
followed by
Inj. Clindamycin
(900 mg)
8 hourly plus
Inj. Gentamicin (as
per local protocol)
Tab. Clindamycin
(450 mg)
post operative 6
hourly Plus
Tab. Ofloxacin (400
mg)
post operative 12
hourly to complete
14 days
Post of Infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Post of Infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Secondary fungal infection e.g. oral thrush
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Candida species Fluconazole plus
Locally Nystatin/
Miconazole
Secondary infection in malignant lesion
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Sepsis/ Acute PID
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Gm negative Inj. Cephazolin
(1gm) (if > 80 kg
2gm)
8 hourly+
Inj. Metronidazole
(500 mg)
8 hourly
Inj. Clindamycin
(600 mg)
8 hourly +
Inj. Gentamicin
(2mg /kg)
8 hourly
Sepsis/ Septicemia
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Sepsis uncertain focus
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Inj. Cefepime (1 Inj. Meropenem
gm) (1gm)
8 12 hourly for 7 8 hourly for 714
14 days days plus
Inj. Vancomycin (1 Inj. Metronidazole
gm) (500 mg)
12 hourly 8 hourly for 7 days
Inj. Amikacin (500
mg)
12 hourly for 7 days
Plus
Inj. Metronidazole
(500 mg)
8 hourly for 7 days
Septicemia
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Sick Immunocompromised (febrile neutropenia)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Inj. Meropenem (1 Inj. Linezolid (600 mg)
gm) 12 hourly or/plus
8 hourly for 714 Inj.
days or/plus Piperacillin/Tazobactam
Inj. Meropenem (1 (4.5 gm)
gm) 68 hourly for 714
8 hourly for 714 days
days or/plus
Quinolone
714 days
Trichomoniasis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Uncomplicated Chlamydial Infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
If poor compliance: Inj. Clarithromycin
Tab. Azithromycin or
(1 gm) Tab. Ofloxacin or
post operative stat
dose
If Pregnant:
Tab. Erythromycin
(500 mg)
post operative 6
hourly for 7 days or
Tab. Erythromycin
(500 mg)
post operative 12
hourly for 14 days
Valvovaginal Candidiasis (non regnant)
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Contraindicated in pregnancy
Venous aseptic site of infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Sterelity should be strictly maintained. Personal hygine of the patient as
well as hospital stuff should be maintained
Venous harvesting site wound infection of leg
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Sterelity should be strictly maintained. Personal hygine of the patient as
well as hospital stuff should be maintained
VTI, Septicemia
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Gram positive Inj. Ceftriaxone (1
Staphylococcus aureus gm)
24 hourly
Pseudomonas
Inj. Imipenem (500
mg1gm)
8 hourly
Name: Steroid coverage with antimicrobial therapy may be required
Wound infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Cream Gentamicin
Staphylococcus aureus apply locally 23
times daily Or
Pseudomonas
Cream/ointment
Klebsiella Fusidic acid apply
locally 23 times
daily Or
Cream/ointment
Mupirocin apply
locally 23 times
daily Or
Combination of
Bacitracin and
neomycin apply the
cream locally 23
times daily Fusidic
acid is a steroid
antimicrobial agent
which is used almost
exclusively against β
lactamase producing
staphylococci
Kidney and Urinary System
Acute Pyelonephritis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Name: Complicated pyelorephritis are common in diabetic patient require prolong
therapy
ESWL
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Fluoroquinolones Inj. Aminoglycosides
TMP/SMX Tab. Amoxicillin
1st/2nd generation
Cephalosporins
Lower urinary tract infection (cystitis) in pregnancy UTI
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Non Gonococcal Urethritis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
PCNL
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
1st/2nd generation Aminoglycosides
Cephalosporins or Fluoroquinolones
Inj.
Aminoglycosides
Tab. Metronidazole
or Clindamycin
Prostatitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Prostatic biopsy
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Fluoroquinolones TMP/SMX
1st/2nd generation Aminoglycosides
Cephalosporins
Surgical prophylaxix: Urethrocystoscopy, Urodynamic study, Ureteroscopy,
TURP, TURBT
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Fluoroquinolones Inj. Aminoglycosides
TMP/SMX Inj. Ampicillin
1st/2nd generation
Cephalosporins
CoAmoxiclav
Urinary Tract Infection
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Urinary Tract Infection (acute uncomplicated cystitis)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Urosepsis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Urological Surgery involving intestine e.g.: GI tract, Skin+ intestine
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
2nd/3rd generation Inj. Ampicillin
Cephalosporins Inj. Ticarcillin/ Co
Inj. Amoxiclav
Aminoglycosides Inj. Piperacillin/
Tab. Metronidazole Tazobactam
or Fluoroquinolones
Clindamycin
Musculoskeletal system
Acute and chronic pyogenic Osteomyelitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Deep sternal wound infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Sterctity should be strictly maintained. Personal hygine of the patient as
well as hospital stuff should be maintained superficial and deep
Elective Surgery
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Prophylactic purpose Inj. Ceftriaxone (1
gm)
12 hourly
Inj. Cefuroxime
(750 mg)
12 hourly
Inj. Cefepime(500
mg1000 mg)
8 hourly
Inj. Flucloxacillin
(250 mg 1000 mg)
6 hourly
Inj. Amikacin (500
mg)
12 hourly any one
or two in
combination
Septic arthritis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Staphylococcus aureus Inj. Ceftriaxone (1
Haemophilus influenza gm)
12 hourly
Enterobacter Species
Inj. Flucloxacillin
(250 mg1 gm)
12 hourly
Name: Preferred culture sensitivity report
Skin & Soft tissue infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Superficial sternal wound infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Name: Sterctity should be strictly maintained. Personal hygine of the patient as
well as hospital stuff should be maintained superficial and deep
Tubercular Osteomyelitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Mycobacterium aureus 1st line anti
tubercular drugs
Wound infections
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Streptococcus aureus Inj. Ceftriaxone (1
Pseudomonas pyogenosa gm)
12 hourly
Klebsiella
Inj.Meropenem (500
Enterobacteriaceae mg)
8 hourly
Inj. Amikacin (500
mg)
2 hourly
Inj. Flucloxacillin
Name: According to culture sensitivity report
Obstetrics and Gynaecological Procedure
D&C, endoscopic or other minor procedure
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Anaerobes Not needed
Caesarean section
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Name: Review culture reports
Infected wound Caesar/ Perineal tear and episiotomy
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Gram negative Inj. Flucloxacillin
Staphylococcus (900 mg)
8 hourly+
Escherichia coli
Inj. Metronidazole
Pseudomonas (500 gm)
8 hourly followed by
oral for 7 days
Intra partum pyrexia
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Placenta Removal,4 Degree Tear, Major Surgery, Extensive Oncological Surgery
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
IVsingle dose only
at induction
Post operative Gynaecological Sepsis
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Inj. Gentamicin (as
per local protocol)
plus Inj.
Clindamycin (1.2
gm)
6 hourly
Stop and review if
patient develops
diarrhoea or if
Gentamicin is contra
indicated ( see
GHNHSFT protocol )
consult microbiologist
Duration: 57 days
and then review
Nonsevere penicillin
Allergy:
Inj. Meropenem (1
gm)
8 hourly
Severe penicillin
Allergy:
Inj. Gentamicin (as
per local protocol)
plus
Inj. Clindamycin
(1.2 gm)
6 hourly
Stop and review if
patient develops
diarrhoea or if
Gentamicin is contra
indicated (
GHNHSFT protocol )
consult
microbiologist.
Duration: 57 days
and then review.
Consult
Microbiologist
Prophylaxis Hysterectomy Laparotomy Vaginal Repair
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Inj. Ceftriaxone (2 Inj. Cephazolin
gm) (1gm) (if >80 kg 2
12 hourly at least gm)+
for 710 days Inj. Metronidazole
(500 mg)
8 hourly
Inj. Clindamycin
(600 mg) + Inj.
Gentamicin (2 mg
/kg)
8 hourly
Name: If no penicillin or Blactuse allergy
Surgical Prophylaxis Obstetric & Gynaecological Surgery Hysterectomy
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
IVsingle dose only
at induction
Opthalmology
Antibiotics used in surgical prophylaxis: Cataract surgery, Glaucoma surgery,
Dacryocystitis (Chronic)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Moxifloxacin 0.3% Levofloxacin 0.3%
Gatifloxacin 0.3% 1
drop g.i.d.
Bacterial Uveitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Mycobacterium According to cause
tuberculosis AntiTB
Mycobacterium Bovis AntiSyphilis
Treponema. pallidum (systemic regimen to
be followed)
Name: Aquaus and vitreous sample for culture sensitivity
Conjunctivitis
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Conjunctival culture sensitivity needed
Corneal Ulcer
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Depends on culture sensitivity. Conjunctival sweab and corneal serapping
Dacryocystitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Depending on culture sensitivity
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Endophthalmitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Aquaus vitreous sample for culture sensitivity
Lid infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: To maintain lid hygine
Neonatal conjunctivitis (Opthalmia Neonatorum)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Orbital Cellulitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Name: Pus for culture sensitivity if orbital obsess prerent
Syphilitic eye disease, Syphilitic Uveitis, Optic neuritis, Neuroretinitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Paediatric Central Nervous System
Central venous catheter tip Micro organism isolated: 75%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Pseudomonas 66.66% Imipenem (20
Staphylococcus aureus mg/kg/dose)
33.33% 8 hourly
Tazobactam +
Piperacillin
8 hourly
Meningitis in Children (Bacteria), Young infant
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Septicemia CNS infection
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Paediatric Gastrointestinal System
Bacillary dysentery
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Cholangitis
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Diarrhoea
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Enteric Fever & Severe Enteric Fever
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Giardiasis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Hydatid cyst
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Echinococcus Albendazole (15
Granulosus mg/kg/day)
12 hourly
Intestinal Amoebiasis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Liver Abscess
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Streptococcus aureus Ceftriaxone (50200
Gram negative mg/kg/day)
Anaerobic organism Flucloxacillin (50
100 mg/kg/day)
Metronidazole
Peritonitis (Ascitic Fluid C/S) Micro organism isolated:4%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Streptococcus Ceftazidime (50
Pneumoniae mg/kg/dose)
Acinetobactor 8 hourly
Escherichia coli Ceftriaxone (100
mg/kg/day)
1224 hourly
Amikacin (7.5
mg/kg/dose)
12 hourly
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SBP
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Paediatric Infectious Disease
Abscess 2%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Oral thrush
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Septicemia (Blood C/S) 10%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Name: Febrile Neutropenia in Paediatric Haematology and Oncology is considered
as an entity which is to be addressed ifferently. Here the practised protocol is
1st line 3rd generation of Cephalosporin + Amikacin
2nd line 4th generation of Cephalosporin or Carbapenem + Vancomycin
If febrile neutropenia persists 57 days or more we start intravenous Amphotericin
B
Septicemia (Blood C/S) Micro organism isolated:6%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Cefotaxime (50
Salmonella mg/kg/dose)
812 hourly
Enterococcus
Ampicillin (25
Pseudomonas mg/kg/dose)
Klebsiella 6 hourly
Vancomycin
(15mg/kg/dose)
8 hourly
Ceftazidime (50
mg/kg/dose)
8 hourly
Amikacin (7.5
mg/kg/dose)
12 hourly
Septic Arthritis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Skin infection Cellulitis Osteomyelitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Throat Swab Micro organism isolated: 12%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Streptococcus pyogens Penicillin (2550
82% mg/kg/dose)
Staphylococcus aureus 6 hourly
18% Erythromycin (10
mg/kg/dose)
6 hourly
Amoxicillin (25
mg/kg/dose)
8 hourly
Clindamycin (36
mg/kg/dose)
6 hourly
Wound Swab 2%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Paediatric Surgery
Amniotic band of both leg: release of bank and Zplasty in right leg
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Staphylococci Inj. Ceftriaxone (50
Micrococci 75 mg/kg/day)
Gram positive rods Inj.
Flucloxacillin(50
100 mg/kg/day)
followed by
Flucloxacillin
AVM at the root of nose: Excised
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Inj. Ceftriaxone (50
75 mg/kg)
AVM of left thigh (Aspirated) (Aspirated fluid: no growth)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Staphylococci Inj. Cephradine (50
Micrococci 100 mg/kg/day)
Gram positive rods
Cystic Hygroma (within the abdomen) with sliding hernia: Excision of Cystic
hygroma with herniotomy
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Inj. Ceftriaxone (50
Klebsiella 75 mg/kg/day)
Pseudomonas Inj. Flucloxacillin
aeruginosa (50100 mg/kg/day)
followed by
Enterococci Cefixime (20
mg/kg/day)
Discharging sinus at penoscrotal region: Excision (Pus for C/S: Pseudomonas
spp.)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Escherichia coli Inj. Ceftriaxone (50
Klebsiella 75 mg/kg/day)
Pseudomonas Tab/Inj.
aeruginosa Ciprofloxacin (10
mg/kg/day)
Proteus
Inj. Amikacin (15
20 mg/kg/day)
followed by
Inj. Imipenem (60
100 mg/kg/day)
Name: During change to other group of antibiotic require further urine culture
sensitivity
Eventration of left dome of diaphragm with umbilical hernia: Plication of the
defect and repair of hernia
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Inj. Ceftriaxone (50
Klebsiella Pneumoniae 75 mg/kg/day)
Streptococci Inj. Gentamicin (5
Pseudomonas mg/kg/day)
Enterococci
Growth in lower Esophagus: feeding gastrostomy with biopsy from growth
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Cephradine (50100
Klebsiella pneumonia mg/kg/day)
Streptococcus Inj. Gentamicin (5
pneumonia mg/kg/day)
Enterococci
Hydrocephalus and Meningomyelocele with urinary and fecal incontinence;
Introduction of VP shunt with excision of meningomyelocele
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Encapsulated organism: Inj. Ceftazidime
Streptococcus (1520 mg/kg/day)
Pneumoniae, Nigeria Inj. Amikacin (15
meningitides, 20 mg/kg/day)
Haemophilus influenza.
Non capsulated
organism: Listeria
monocytogenes
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Hypospaedias with rotational deformity of penis: Urethroplasty and correction
of rotation
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Inj. Ceftriaxone (50
Klebsiella 75 mg/kg/day)
followed by
Pseudomonas
aeruginosa Inj. Meropenem
(3040 mg /kg/day)
Proteus
Inj. Flucloxacillin
(50100 mg/kg/day)
Inj. Amikacin
Name: Multidrug use of antibiotic also require specific indication
Hypospaedias: Urethroplasty
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Long segment Hirschsprung’s Disease with Ileostomy: Total colectomy with ileo
anal anaestomosis. On 7th POD patient developed incomplete wound dehiscence
which closed by secondary suture
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Inj. Ceftriaxone (50
Bactericides Fragilis 75 mg/kg/day)
Streptococcus viridians Inj. Metronidazole
group (15 30
mg/kg/day)On 3rd
POD added
Inj. Ciprofloxacin
(10 mg/kg/day) due
to development of
loose diarrhoea. On
26th POD: Changed
to
Inj. Meropenem
(3040 mg/kg/day)
Inj. Amikacin (15
20 mg/kg/day)
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Frequent changes of antibiotic so require wound sweab. Specific indication
should mentioned
Mass in right gluteal region: Incisional biopsy
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Meconium ileus with Ileostomy: Ileostomy closure (Stool culture: no organism)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli, Inj. Ceftriaxone (50
Bactericides Fragilis 75 mg/kg/day)
Streptococcus viridians Inj. Metronidazole
group Inj. Amikacin
Nonoperative case of Choledochal cyst
Likely causative agent Antimicrobial of choice
Inj. Ceftriaxone (50
75 mg/kg)
Penoscrotal hypospaedias: Urethroplasty (Urine c/s: no growth)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Inj. Ceftriaxone (50
Klebsiella pneumonia 75 mg/kg/day)
Pseudomonas Inj. Flucloxacillin
aeruginosa (125250 mg/kg/day)
followed by oral
Proteus Cefixime
Perineal hypospaedias with bilateral undescended testes: Urethroplasty with
bilateral orchiopexy (Urine c/s: no growth)
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli, Inj. Ceftriaxone (50
Klebsiella, Pseudomonas 75 mg/kg/day) for 7
aeruginosa, Proteus days, Then Inj.
Meropenem(3040
mg/kg/day), Inj.
Flucloxacillin (50
100 mg/kg/day) and
Inj. Amikacin (15
20 mg/kg/day) for 8
days followed by
Syrup Cefixime ( 20
mg / kg/day)
for 16 days.
Rectourethral fistula: Perineal hole technique anoplasty (Urine C/S: No. growth)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Inj. Ceftriaxone (50
Bactericides Fragilis 75 mg/kg/day)
Streptococcus viridians Inj. Metronidazole
group (1530 mg/kg/day)
Inj. Ceftazidime
(150 mg/kg/day)
Inj. Gentamicin (5
mg/kg/day)
Residual PUV with Left sided VUR: Fulgaration with left sided ureteric re
reimplantation Ruine R/M/E: Normal finding (Urine C/S: no organism)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Inj. Ceftriaxone (50
Klebsiella 75 mg/kg/day)
followed by
Pseudomonas
aeruginosa Inj. Meropenem
(3040 mg/kg/day)
Proteus
Inj. Amikacin
Thalasseaemia with Hypersplensim: Splenectomy
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Escherichia coli Inj. Ceftriaxone (50
Klebsiella Pneumoniae 75 mg/kg/day)
Streptococci Inj. Phylopen
Pseudomonas Inj. Amikacin (15
Enterococci 20 mg/kg/day)
Paediatric Urinary System
Urinary tract infection Acute cystitis Acute pyelo nephrities
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Urinary tract infection (UTI) Micro organism isolated: 6%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Escherichia coli Cefotaxime (50
Enterococci mg/kg/dose)
812 hourly
Acinatobacter
Ceftazidime (50
Pseudomonas mg/kg dose)
8 hourly
Ceftriaxone (100
mg/kg days)
1224 hourly
Nitrofurantoin (1.75
mg/kg dose) 6
hourly
Amikacin (15 mg/kg
dose)
12 hourly
Gentamicin (2.5
mg/kg/day)
8 hourly
Recurrent UTI prophylaxis
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Cap. Nitrofurantoin
(12 mg/kg/day)
Single dose at bed
time
Tab. Cotrimoxazole
(620 mg/kg/day)
single dose at bed
time
Paediatrics Respiratory System
Otitis Media 2%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Pneumonia
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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RTI 4%
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Respiratory System
Acute Bacterial Rhino sinusitis (severe or persistent symptoms)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Gram positive: 1st line: 1st line:
Staphylococcus aureus Tab. CoAmoxiclav Inj. Clarithromycin (500
Streptococcus (625 mg) mg)
Pneumoniae 8 hourly orally 12 hourly
Haemophilus influenzae 2nd line: 2nd line:
Pseudomonas Doxycycline Cap. Doxycycline (100
aeruginosa oral(100 mg) mg)
12 hourly 10 days 12 hourly
Moraxella catarrhalis
Gram negative:
Pseudomonas
aeruginosa
Escherichia coli
Protease mirabilis
Klebsiella Pneumoniae
Enterobacter
Acute Diffused Otitis Externa (Swimmer's ear)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Staphylococus aureus Milemoderate:
Pseudomonas pyogens Cap.Flucloxacillin
Topical
Escherichia coli Antimicrobial
Often mixed flora Severe (e.g. Cellulitis
or blocked ear canal):
Inj. Ceftriaxone (1
mg)
Tab. Ciprofloxacin
(500mg)
12 hourly for 710
day
Name: Topical drops to be prescribed at the discretion of the ENT consultant
Acute Laryngitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Antibiotics are NOT
Indicated
Acute Localised Otitis Externa (furuncle)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Acute Otitis Media
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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2nd line 2nd line
Tab. CoAmoxiclav Cap. Doxycycline
(625 mg) (100 mg)
8 hourly 10 days 12 hourly and
Tab. Metronidazole
(400 mg)
8 hourly
Name: Most cases are viral and self limiting. Antibiotics should be delayed for 23
days and patient response
Acute Rhino Sinusitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Antibiotics should
be Only prescribed
in SEVERE
infection. Mostly
this condition
caused by viral
Aspiration pneumonia
Likely causative Antimicrobial of choice
agent
Preferred drug Alternative drug
Chronic Otitis Media
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Aerobic: Oral antimicrobial
Pseudomonas may be added if a
aeruginosa susceptible organism
Escherichia coli is cultured 710 days
Streptococcus aureus
Streptococcus
Pyogenes
Proteus mirabilis
Klebsiella species
Anaerobic:
Bacteroides
Peptostreptococcus
Propionibacterium
Community Acquired Pneumonia (CAP)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Epiglottises
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Lung Abscess
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Malignant Otitis Externa
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Ensure sueabs are taken prior to therapy. Switch to orals based on clinical
assesment and microbiological results.
Assess for any bone and intracranial extension
All cases to be discumed with microbiology
Perichondritis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Pseudomonas 1st line
Mixed flora
Tab. Ciprofloxacin
(500mg750mg) for
12 hourly
2nd line:
Cap. Clindamycin
(450mg) 6 hourly
for 46 weeks
Pharyngitis/Tonsillitis
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Pneumonia
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Quinsy (peritonsillar abscess)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Respiratory tract infection e.g. bronchitis Pneumonia
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Name: Nosocomial RTI is common in diabetic patient. Early and agresive
treatment is required
Retropharyngeal Abscess Lateral pharyngeal Abscess
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Inj. Ceftriaxone (2 Inj. Clarithromycin
gm) (900 mg)
24 hourly and 8 hourly and
Inj. Metronidazole Tab. Ciprofloxacin
(500 mg) (500 gm)
4 hourly. Oral then: 12 hourly. Oral then:
Tab. Coamoxiclav Tab. Clindamycin
(625 mg) (450 mg)
8 hourly or 6 hourly and
according to C/S for Tab. Ciprofloxacin
1014 days (500 gm)
12 hourly
Sore Throat
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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Please note that sore
throat can be viral in
nature. These do NOT
require antimicrobial
therapy. Antibiotic
treatment of adult
pharyngitis benefits
only those patients
with GABHS
infection Four clinical
criteria (Centor
criteria **) that
predict infection with
GABHS include:(a)
history of fever (b)
tonsillar exudates (c)
absence of cough (d)
tender anterior
cervical
lymphadenopathy
(lymphadenitis)
Antibiotic therapy is
recommended only
for patients who
fulfill THREE or
FOUR criteria. See
below for antibiotic
recommendations for
pharyngitis.Throat
cultures are not
recommended for the
routine primary
evaluation of adults
with pharyngitis or
for confirmation of
negative results on
rapid antigen tests.
Upper or lower respiratory tract infection (Oncology)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Ventilator associated pneumonia (Early VAP)
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Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
Ventilator associated pneumonia (Late VAP)
Likely causative agent Antimicrobial of choice
Preferred drug Alternative drug
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