Antibiotics table - ACEM Fellowship Notes

#infectious_diseases #tables > thanks *Laura G* for making this! | INFECTION | ORGANISMS | INITIAL ANTIMICROBIALS | DURATION/ OTHER COMMENTS | | ------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------- | | **CNS** | | | | | [[Meningitis]] <2 months | GBS E.coli Listeria monocytogenes | Benzylpenicillin 60mg/kg + Cefotaxime 50mg/kg IV Q12H | | | Meningitis Over 2 months | S.pneumoniae N. meningitidis H. influenzae Type B | Ceftriaxone 2g Q12H IV+ Dexamethasone 10mg Q6H for 4 days+ Benzylpenicillin 2.4g (60mg/kg child) IV Q4H | -Benpen for listeria cover -Bactrim 480/2400mg IV Q8H for penicillin hypersensivity -Moxifloxacin for Cephalosporin allergy | | Encephalitis | HSV Enteroviruses M. pneumoniae | Aciclovir 10mg/kg IV Q8H+ Benzylpenicillin 2.4g Q4H IV for patients at risk of listeria | Listeria Risk factors: -Neonates, >50yo, immunocompromised, pregnant, ETOH abuse | | **EYE** | | | | | [[Eye infections#Periorbital and orbital cellulitis\|orbital cellulitis]] | S. aureus H. influenzae spp S. pneumoniae M. catarrhalis Anaerobes | Flucloxacillin 2g (50mg/kg child) IV Q6H PLUS Ceftriaxone 2g (50mg/kg child) IV daily if severe infection | Depends on severity Downgrade to AugDF Vancomycin + cipro 400mg BD IV if penicillin allergy | | Periorbital Cellulitis | Group A Strep S. aureus H. influenzae | Mild: Cefalexin or flucloxacillin 500mg Q6H PO for 7 days Mod-severe: Flucloxacillin 2g IV Q6H PLUS Ceftriaxone 2g IV daily if severe | Depends on severity often due to sinus infection | | **Cardio** | | | | | Infective [[Endocarditis]] Native valve | Strep. Viridians S. aureus Strep. Epidermidis Enterococcus sp. | Benzylpenicillin 60mg/kg (max 2g) IV Q6H + Flucloxacillin 50mg/kg (max 2g) Q6H | Likely for 4-6 weeks | | IE Artificial valve of MRSA | Above + S. epidermidis | Vancomycin 15mg/kg IV Q6H + Flucloxacillin 50mg/kg IV Q6H+ Gentamicin 6mg/kg IV daily | | | Endocarditis Prophylaxis (dental) | | Amoxicillin 50mg/kg (2g) | | | Acute [[Rheumatic fever]] | Group A Strep. | Benzathine benzylpenicillin IM single dose -1.2 million units adult; 0.6million units if <20kg | | | **Gastro / abdo** | | | | | Diarrhoea | Salmonella spp. Campylobacter spp. | Ceftriaxone 2g IV daily if oral not tolerated OR Ciprofloxacin 500mg (12.5mg/kg child) PO Q12H for 3 days | -Indicated for severe disease, immunocompromised, returned travellers | | C.diff Diarrhoea | C. difficile | Vancomycin 125mg (10mg/kg child) PO Q6H for 10 days | | | Peritonitis or Ascending Cholangitis | Gram negative coliforms Enterococcus spp | Tazocin 4.5g IV Q8H | | | Acute cholecystitis | | Augmenin IV 1.2g Q8H IV or Ceftriaxone 2g IV daily | | | Acute Diverticulitis | | Uncomplicated : -Augmentin DF BD for 5 dayw Complicated: -Ceftriaxone 2g IV daily + Metronidazole 500mg IV BD | | | Spontaneous Bacterial Peritonitis | Enterobacter spp. | Ceftriaxone 2g (50mg/kg child) IV daily | | | **GENITOURINARY** | | | | | Acute Cystitis | | Trimethoprim 300mg daily for 3 days for women, 7 days for men | | | UTI in Pregnant women | | Cefalexin 500mg PO BD for 5 days | | | Acute Pyelonephritis | | Mild: AugDF 875/125mg BD for 14 days; Severe or Pregnant: Gentamicin + amoxicillin 2g IV Q6H | | | Prostatitis | E. coli Klebsiella spp Proteus spp. | Mild: Trimethoprim 300mg daily for 14 days Severe: Gentamicin + Amoxicillin 2g Q6H IV | | | Epididymo-orchitis | | STI pathogen: Ceftriaxone 500mg IV/IM + doxycycline 100mg BD for 14 days Urinary pathogen: Trimethoprim 300mg daily for 14 days | | | **ENT** | | | | | Epiglottitis | H. influenzae | Ceftriaxone 1g (50mg/kg child) IV daily or Q12H pending severity | ICU= 12 hourly | | Tonsillitis | Group A Strep | Phenoxymethylpenicillin 500mg BD for 10 days OR Benzathine benzylpenicillin 900mg IM single dose | Immunosuppressed, ATSI, hx of rheumatic heart disease/ fever | | Peritonsillar abscess | Group A Strep | Benzylpenicillin 1.2g (50mg/kg child) IV Q6H | -Continue IV for 1-2 days post I+D, then downgrade to PO phenoxymethylpenicillin | | Retropharyngeal Abscess | S. aureus Group A Strep | Augmentin DF 1g Q8H IV | Switch to PO AugDF after 3-5 days IV therapy | | Otitis Externa | S. Aureus Group A Strep | Dexamethasone + framycetin + gramicidin 3 drops in ear TDS for 7 days OR Ciprofloxacin + hydrocortisone 3 drops BD for 7 days | Cipro if concern for TM perforation or tympanostomy | | [[Acute Otitis Media]] | S. pneumoniae H. Influenzae M. catarrhalis | Amoxicillin 1g (30mg/kg) PO Q12H for 5 days OR Augmentin DF 875/125mg Q12H for 5 days -Ciprofloxacin 0.3% 5x drops Q12hourly into ear until discharge fee for 3 days | -AugDF for H. influenzae, M catarrhalis or inadequate amoxicillin response -Cipro for chronic otorrhoea + PO | | **Resp** | | | | | Influenza | | Oseltamivir 75mg BD orally | 5 days | | CAP- mild pneumonia | | Amoxicillin 1g TDS, for between 5-7 days if showing improvement Doxycycline 100mg BD 507 days if penicillin hypersensitivity | | | CAP- Moderate | | Benzylpenicillin 1.2g Q6H IV + Doxycycline 100mg BD | Switch to oral amoxicillin once clinically improving | | CAP- Severe | | Ceftriaxone 2g IV daily + Azithromycin 500mg IV daily + Tazocin 4.5g IV Q6H if pseudomonas concern | | | **Bone / soft tissue** | | | | | Bites (animal and human) | Strep. Viridians S. aureus Group A Strep Pasteurella spp. | Augmentin DF 875/400mg BD PO, or IV 1g Q12H IV if severe | 5 days | | Cellulitis- Mild | S.aureus S. pyogenes | Flucloxacillin 500mg (12.5mg/kg child) PO Q6H for 5 days | | | Cellulitis-Mod/severe | | Flucloxacillin 2g (50mg/kg child) IV Q6H OR Benzylpenicillin 1.2g (50mg/kg child) IV Q6H OR Vancomycin if MRSA | Fluclox for S. aureus, Benpen for s. pyogenes | | Necrotising Fasciitis | Group A Strep Clostridium E.coli S. aureus | Vancomycin 15mg/kg IV Q6H + Meropenum 1g IV Q8H+ Clindamycin 600mg IV Q8H | | | Dental abscess | | Amoxicillin 500mg PO TDS 7 days | | | Impetigo | Group A Streptococcal S. aureus | Mupirocin 2% ointment Q8H topical OR Cefalexin 500mg PO TDS | 5 days | | [[Osteomyelitis]] | S. aureus Group A Streptococci | Flucloxacillin 2g IV Q6H | | | Septic Arthritis | | Flucloxacillin 2g IV Q6H | | | Shingles | Herpes Zoster | Valaciclovir 1g Q8H PO for 7 days | Indicated if present within 72 hours of rash onset | | Lactational [[mastitis]] | S. aureus | Flucloxacillin 500mg Q6H PO Upgrade to IV is concern about abscess formation | Clindamycin 450mg Q8H for 5 days if penicillin allergy | | **STIs** | | | | | Chlamydia | | Azithromycin 1g PO as single dose | | | N. Gonorrhoea | | Ceftriaxone 500mg IM or IV Once only + Azithromycin 1g PO orally once only | | | [[Pelvic inflammatory disease\|PID]] | | Ceftriaxone 500mg IV/IM Once only + Metronidazole 400mg Q12H PO for 14 days + Doxycycline 100mg BD for 14 days or 1g azithromycin PO, 2x doses 1 week apart SEVERE -Ceftriaxone 2g daily IV + Metronidazole 500mg IV Q12H + Azithromycin 500mg IV daily | Consider gentamicin if penicillin/ cefalosporin hypersensitivity | | Primary Syphillis | | Benzathine benzylpenicillin 2.4 million units IM as single dose | | | **haem-onc** | | | | | Febrile Neutropenia | Needs Gram negative cover | Tazocin 4.5g IV Q6H +Gentamicin up to 7mg/kg IV if needing ICU + Meropenum 1g Q8H IV if known MDR organisms previously | Also consider Vancomycin if MRSA suspicion |