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Antibiotic guideline by bsmmu

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Ashraful Islam
Ashraful Islam

THIS PDF DESCRIBES DETAILS OF ANTIBIOTIC GUIDELINE IN BANGLADESH.

Health & Medicine
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12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 1/66 List of recommendations arranged according to system and diseases (According to alphabetical order) Central Nervous system Community acquired Meningitis (CAM) Pyogenic Meningitis Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Pneumonia Neisseria meningitides Haemophilus influenza Staphylococcus aureus Herpes simplex Inj. Meropenem (2 gm) 8 hourly for 14 days plus/ or Inj. Linezolid (600 mg) 12 hourly Inj. Acyclovir (500 mg) 6 hourly for 14 days if viral infection Tab. Teicoplanin (400 mg) stat and (200 mg) 12 hourly for 14 days plus/ or Inj. Acyclovir (5000 mg) 6 hourly for 14 days Name: S.I Avoid Imipenem  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Pneumonia Neisseria meningitides Listeria monocytogenes Streptococcus agalactiae Haemophilus influenza Escherichia coli Inj. Vancomycin (30­45 mg/kg/day) 4­12 hourly interval + Inj. Ceftriaxone (2 gm) 12 hourly 7­14 days Inj. Penicillin G Inj. Meropenem Inj. Gentamicin Inj. Amikacin 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 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 2/66 Dentistry Acute variceal haemorrhage Cleft lip­palate, facial cleft, facial deformity correction surgery Dental abscess Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Portal Hypertension due to Cirrhosis of liver or non­cirrhotic portal hypertension Inj. Somatostatin (250 μgm or 500 μgm) A bolus of is given followed by an infusion of 6 mg/24 hour for 120 hrs Inj. Octreotide (5 µgm) A bolus followed by (50 µgm/hour) for up to 5 days Inj. Terlipressin (2 mg) 6 hourly for 48 hour. It may be continued for a further 3 days at 1 mg every 4 – 6 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Ceftriaxone (1 gm) 12 hourly Tab. Metronidazole (500 mg) 8 hourly for 5­7 days followed by or Cap. Cephalosporins Tab. Metronidazole Inj. Meropenem (1 gm)  8 hourly I/V for 7 days, followed by Cap. Cephalosporins Tab. Metronidazole  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Obligate anaerobes: Prevotella intermedia Prevotella nigresub Cap. Flucloxacillin Tab. Metronidazole Cap. Cepholosporins Cap. Cefixime Cap. Cefuroxime 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 3/66 Denture sore mouth Denture stomatitis Extraction of tooth surgical/ non surgical Fusobacterium periodontices Phyromonas endodontics Porphyromonas gingivalis Tab. metronidazole Name: For rapidly spreading infections injectable from may be advised Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Candida albicans Antifungal agents eg, Nystatin powder or cream Antifungal agents eg, Nystatin powder or cream  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Candida albicans 1 antifungal agents (eg, Nystatin powder or cream)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Cap. Amoxicillin (500 mg) 8 hourly for 7 days or Cap. Cefixime (200 mg) 12 hourly for 7 days+ Tab. Metronidazole (400 mg) 8 hourly for 5 days. 2 of the other 3rd line antibiotic* 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 4/66 Fungal infections in maxillofacial region like Candidiasis, mucormicosis etc Gingivitis Hepatorenal syndrome Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Fungus Nystatin oral suspension (5­10 ml) of suspension  for at least 14 days Cap. Fluconazole (100 mg) daily for 7 – 14 days. Cap. Itraconazole (400 mg) 24 hourly for 7­14 days Inj. Amikacin Nystatin oral suspension (5­10 ml) of suspension  for at least 14 days. Cap. Itraconazole (400 mg) 24 hourly for 7­14 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Campylobacter rectus Actinomyces species Prevotella inginosus Streptococcus Tab. Penicillin V (250­500 mg) post operative 6 hourly for 5­7 days Tab. Metronidazole (200­400 mg) 8 hourly for 3­5 days Cap. Doxycycline Initial : (200 mg/day) divided twice daily post operative first day then. Maintenance : (100­200 mg/day) divided 12 hourly Cap. Doxycycline Initial : (200 mg/day) divided twice daily post operative first day then. Maintenance : (100­200 mg/day) divided 12hrly 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. 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 5/66 In case of maxillofacial fracture management like open reduction and fixation 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 Cirrhosis of liver with ascites with renal impairment Inj. Human albumin (1 g/kg/day) bolus on presentation (maximum Dose, 100 gm daily) Inj. Nor adrenaline (0.5­ 3.0 mg/hour) continuous I/V infusion [Sherlock] Inj. Terlipressin (0.5­2.0 mg) every 4 – 6 hourly Inj. Octreotide (100­ 200 μgm) subcutaneously 8 hourly Inj. Midodrine (7.5­ 12.5 mg) 8 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 3rd generation Ceftriaxone (1 mg )I/V  12 hourly Metronidazole (500 mg) I/V  8 hourly for 5­7 days followed by oral Cephalosporins Tab. Metronidazole Inj. Meropenem (1 gm) 8 hourly I/V for 7 days, following by Cap. Cephalosporins Tab. Metronidazole  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Ceftriaxone (1 mg) 12 hourly Tab. Metronidazole (500 mg) 8 hourly for 5­7 days followed by Cap. Inj. Meropenem (1 gm) 8 hourly for 7 days, following by Cap. Cephalosporins Tab. Metronidazole 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 6/66 Jaw osteomyelitis Minor oral surgery like biopsy, excision of mucocele etc Oral Candidiasis Cephalosporins Tab. Metronidazole Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Mixed anaerobic infection. Commonly by staphylococci and enteric microorganism Cap. Clindamycin (600 mg) in divided dose for 6 days to 8 weeks ± Tab. Metronidazole (500 mg) 8 hourly for 7 days Flucloxacillin (500 mg) 6 hourly for 6­8 weeks + Tab. Secnidazole (2 gm) single dose  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Cap. Amoxicillin (500 mg) 8 hourly for 7 days or Cap. Cefixime (200 mg) 12 hourly for 7 days + Tab. Metronidazole (400 mg) 8 hourly for 5 days Cap. Amoxicillin (500 mg) + Clavulanic acid (125 mg) 8 hourly or Cap. Cefuroxime (500 mg) + Clavulanic acid (125 mg) 12 hourly for 7 days + Tab. Metronidazole (400 mg) 8 hourly for 5­7 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Peptostreptococcus Antifungal agents eg, Nystatin powder or cream Clotrimazole or Nystatin lozenges 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 7/66 Orofacial space infections Peri implantitis Periapical Pathosis Bacteroides Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Polymicrobials of both anaerobic and aerobic Cap. Amoxicillin or Cap. Cephalosporins (Cephradine, Cefixime, Cefuroxime) (500 mg­1gm) in different dose for 7 ­14 days+ Tab. Metronidazole (500 mg) 8 hourly 7 days. Cap. Amoxicillin or Cap. Cephalosporins with Clavulanic acid + Tab. Secnidazole (2 gm) single dose. Cefuroxime (500 mg to 1 gm) in different dose for 7­14 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Prevotella intermedia Pseudomonas aeruginosa Staphylococcus spp. Peptostreptococcus micros Porphyromonas ednodontalis Cap. Cephalosporins (200­400 mg ) 6­12 hourly for 7 days Metronidazole (400 mg) 5­7 days Name: Safe in pregnancy  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Prevotella melaninogenica Streptococcus anginosus Cap. Cephalosporins (200­400 mg) 6­12 hourly for 7 days. Tab. Metronidazole (400 mg) 6 hourly for 7 days 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 8/66 Pericoronitis Periodontitis Primary & secondary prophylaxis for variceal haemorrhage Porphyromonas gingivalis Peptospreptococus Microbes Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Porphyromonas gingivalis Fusobacterium species Peptostreptococcus micros Fusobacterium nucleatum Tab. Penicillin V (250­500 mg) post operative 6 hourly for 5­7 days Cap. Doxycycline Initial: (200 mg/day) divided twice daily post operative first day then Cap. Cephalosporins Tab. Penicillin V (250­500 mg) post operative 6 hourly for 5­7 days Tab. Metronidazole (200­400 mg) orally 8 hourly for 3­5 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Prohyromonas gingivalis Bacteroides forsythus Antinobacillus actinomycente Prevotella intermedia Fusobacterium nucleatum Peptostreptococcus micros Prevotella oralis Tab. Metronidazole (200­400 mg) 8 hourly for 3­5 days Cap. Amoxicillin (500 mg) 6 hourly 5­7 days Cap. Doxycycline (200 mg) 24 hourly Cap. Cephalosporins (200­4000 mg) 6­12 hourly for 7 days ± Metronidazole Amoxicillin  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 9/66 Prophylaxis Pulpits Viral infection in lip/oral cavity like herpes simplex infection Portal Hypertension due to Cirrhosis of liver or non­cirrhotic portal hypertension Tab. Propranolol (20 mg) Start at 12 hourly twice a day and titrate up to maximum dose of 320 mg/day. Tab. Carvedilol (6.25 mg) 24 hourly start with this dose then increase for maintenance up to12.5 mg Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Cap. Amoxicillin (3 gm)prior to surgery. Cap. Clindamycin 3 gm prior to surgery Cap. Amoxicillin 3 gm prior to surgery  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Obligate anaerobes: Peptostreptococcus anaerobius Veillonella parvula Lactobacilus cateraforme Porphylaomonas endodontic Facultative anaerobes: Streptococcus mitis Streptococcus oralis Enterococcus faucal Neisseria Cap. Amoxicillin (500 mg) (preferably with clavulanic acid)or Cap. Cephradine Tab. Metronidazole Cap. Cefixime Cap. Cefuroxime  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Herpes viruses Acyclovir (400 mg) orally 8 hourly for 7­10 days Tab.Valacyclovir (1 gm) 12 hourly for 7­10 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 10/66 Dermatology Acne Vulgaris Cellulitis Acyclovir ointment for topical application days Acyclovir ointment for topical application Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Propionibacterium Acan Tab. Azithromycin (500 mg) 24 hourly 3 days in a week for 12 weeks Cap. Doxycycline (100 mg) 12 hourly for 12 weeks or Cap. Clindamycin (150 mg) 8 hourly and reduced gradually as control is achieved Cap. Minocycline (50­100 mg) 12 or 24 hourly for 3 months Cap. Tetracycline (250­500 mg) 6 hourly for 3 months Erythromycin (250­500 mg) 6 hourly for 3 months Cap. Amoxicillin (250­500 mg) 8 hourly Tab. Trimethoprim­ Sulfamethoxazole in double strength 12 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcal Streptococcal or Co­amoxiclav (625 mg) 8 hourly 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 11/66 Chancroid Cutaneous Anthrax Cutaneous Tuberculosis 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 Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Haemophilus ducreyi Tab. Azithromycin (1 gm) Oral single dose Inj. Ceftriaxone (250 mg) I/M single dose Tab. Ciprofloxacin (500 mg) 12 hourly for 2 days Erythromycin (500 mg) 8 hourly for 7 days Inj. Ceftriaxone (1 gm) stat dose with Tab. Ciprofloxacin Tab. Levofloxacin (750 mg) 24 hourly 7 days  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 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 12/66 Gonorrhoeae Impetigo contagiosa Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Mycobacterium Tuberculosis Cap. Rifampicin (400­600 mg) single dose Tab. Isoniazid (300 mg) single dose Tab. Ethambutol (15­25 mg/kg/day) or Inj. Streptomycin (75 mg­1gm) single dose Tab. Pyrazinamide (25­35 mg/kg/day) for 2 months Tab. Rifampicin (400­600 mg)  single dose Tab. Isoniazid (300 mg) single dose for next 4 months Inj. Clarithromycin or Tab. Ofloxacin or Tab. Ciprofloxacin or Inj. Cycloserine or Inj. Capreomycin or Tab. Paraaminosalicyclic acid Tab. Ethionamide.  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)  Likely causative agent Antimicrobial of choice 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 13/66 Leprosy Syphilis Preferred drug Alternative drug Staphylococcal Streptococcal or Combined Cap. Dicloxacillin (250­500 mg) Tab. Co­amoxiclav (625 mg) 8 hourly Cap. Cephalexin (250­500 mg) 6 hourly for 7 days Tab. Clindamycin (30 mg) 8 hourly Cap. Erythromycin (250­500 mg) 6 hourly for 7 days Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Mycobacterium leprae For paucibacillary: Tab. Dapsone (100 mg) single dose plus Cap. Rifampicin (600 mg) monthly for 6 months For multibacillary: Tab. Dapsone (100 mg) single dose plus Tab. Clofazimine (50 mg) single dose plus Cap. Rifampicin (600 mg) monthly for 1 year Inj. Clarithromycin (500 mg) single dose Tab. Minocycline (100 mg) single dose Tab. Ofloxacin (400 mg) single dose Tab. Levofloxacin (500 mg) single dose  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Treponema pallidum Inj. Benzathin penicillin 12 lac unit I/M in each buttock day one day eight and day fifteenth according to stages Cap. Doxycycline (100 mg) 12 hourly for 2 weeks Cap. Erythromycin (500 mg) 6 hourly for 14 days Inj. Ceftriaxone 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 14/66 Endocrine System Sepsis/ Septicemia Skin and soft tissue infection e.g. diabetic foot lesion Supportive Parotitis (Salivary Gland Infection) (250 mg) 24 hourly I/M or I/V for 8­10 days Inj. Azithromycin (2 gm) single dose Cap. Tetracycline (500 mg) 6 hourly for 14 days Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Streptococcus pyogens Pseudomonas aeruginosa Staphylococcus aureus Inj. Ceftriaxone (2 gm) 12 hourly at least for 7­10 days Inj. Piperacillin+ Inj. Tazobactam Inj. Meropenem Inj. Amphotericin­B  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcus Streptococcus Anaerobes Tab. Co­Amoxiclav (625 mg) 8 hourly for 7­10 days Fluoroquinolones Ceftibuten Inj. Ceftriaxone + Inj. Clindamycin Name: Wound care like debridement, regular drening off loading of presure area are much important  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Co­Amoxiclav (1.2 gm) Inj. Clindamycin (900 mg) 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 15/66 Gastro Intestinal System Acute gastroenteritis Abdominal Sepsis Cholangitis 8 hourly Oral then: Tab. Co­Amoxiclav (625 mg) 8 hourly 10­14 days 8 hourly Oral then: Tab. Clindamycin (450 mg) 8 hourly Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Campylobacter Shigella Salmonella Clostridium difficile Tab. Azithromycin (500 mg) 2 tab stat then 1 tab for 4 days Tab. Ciprofloxacin (500 mg) 12 hourlyfor 7 days Tab. Metronidazole (400 mg) 8 hourlyfor 5­7 days Name: Pseudomembrenous colities by clostridium difficile is an important cause of gastroenteritis following use of other antibiotics  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Acinatobacter Enterococci faecalis Bacteroides fragilis Inj. Piperacillin/Tazobactam(4.5 gm) 6­8 hourly for 7­14 days Plus Inj. Amikacin (500 mg) 12 hourly for 7 days Plus Tab. Metronidazole (500 mg) 8 hourly 7 days Inj. Meropenem (1 gm) 8 hourly for 7­ 14 days plus Inj. Amikacin (500 mg) 12 hourly for 7 days.  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Gram negative Inj. Meropenem 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 16/66 Gastroenteritis, Typhlitis Necrotizing Pancreatitis (infected) Peptic ulcer disease anaerobes (500 mg) 8 hourly Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Candida Enterococcus faecalis Aspergillus Anaerobes Inj. Cefepime (500 mg) 8 hourly Piperacillin/Tazobactam Vancomycin Itraconazole Name: Liver function test necessary  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Piperacillin/Tazobactam (4.5 gm) 6­8 hourly for 7­14 days Plus Inj. Amikacin (500 mg) 12 hourly for 7 days Plus Tab. Metronidazole (500 mg) 8 hourly 7 days Inj. Meropenem (1 gm) 8 hourly for 7­14 days plus Inj. Amikacin (500 mg) 12 hourly for 7 days plus Inj. Clindamycin (600 mg) 8 hourly for 7­14 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Helicobacter pylori Tab. Levofloxacin (500 mg) 12 hourly for 14 to 30 days Tab. Metronidazole (400­500 mg) Cap. Tetracycline (500 mg) 6 hourly for 14 to 30 days 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 17/66 Secondary bacterial peritonitis Spontaneous bacterial peritonitis Hepatobiliary system Amoebic liver abscess 8 hourly for 14­30 days Name: Duration depending on the nature and severity of the infection Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Other gut pathogens Inj. Meropenem (500 mg) 8 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Proteus Tab. Levofloxacin (500 mg) 12 hourly for 14 to 30 days Tab. Metronidazole (400­500 mg) 8 hourly for 14­30 days Inj. Cefotaxime(2 gm) 12 hourly for 5 days Inj. Co­amoxiclav (1 gm/0.2 gm) 8 hourly for 5 days 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.  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Entamoeba histolytica Inj. Metronidazole (750 mg) Nitazoxanide (500 mg) 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 18/66 Antiviral used in Hepatitis B infection (Chronic Hepatitis B) Antiviral used in Hepatitis C infection (Chronic Hepatitis C) 8 hourly for 5­10 days 12 hourly for 3 days Tinidazole, Orrnidazole (2 gm) 24 hourly for 3 days Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Hepatitis B Viris Treatment is indicated: HBV­DNA>2000 IU/ml ALT> Upper limit of normal Histology= moderate to severe necroinflammation & significant fibrosis Tab. Tenofovir (300 mg) 24 hourly Tab. Entecavir (0.5 mg) once daily Tab. Lamivudine (100 mg) 24 hourly Tab. Adefovir (10 mg) 24 hourly Tab.Telbivudine (600 mg) 24 hourly Inj. PEG­IFN­2a (180 µg) subcutaneously weekly for 12 months  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug HCV Genotype 1 Inj. PEG­IFN+ Tab. Simeprevir+ Cap. Ribavirin  for 12 weeks Tab. Sofosbuvir+ Cap. Ledipasvir for 12 weeks Inj. PEG­IFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks and Inj. PEG­IFN+ Cap. Ribavirin for next 12 weeks Tab. Sofosbuvir+ Tab. Simeprevir for 12 weeks Tab. Sofosbuvir+ Tab. Daclatasvir for 12 weeks HCV Genotype 2 Tab. Sofosbuvir+ Cap. Ledipasvir for 12 weeks Inj. PEG­IFN+ Tab. Sofosbuvir+ Cap. Ribavirin  for 12 weeks and 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 19/66 Cholangitis Hepatic actinomycosis Tab. Sofosbuvir+ Cap. Daclatasvir  for 12 weeks HCV Genotype 3 Inj. PEG­IFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks Tab. Sofosbuvir+ Cap. Ribavirin for 24 weeks Tab. Sofosbuvir+ Tab. Daclatasvir for 12 weeks HCV Genotype 4 Inj. PEG­IFN+ Tab. Simeprevir+ Cap. Ribavirin  for 12 weeks Tab. Sofosbuvir+ Tab. Ledipasvir  for 12 weeks Inj. PEG­IFN+ Tab. Sofosbuvir+ Cap. Ribavirin  for 12 weeks and Inj. PEG­IFN+ Cap. Ribavirin  for next 12­36 weeks Tab. Sofosbuvir+ Tab. Simeprevir  for 12 weeks Tab. Sofosbuvir+ Tab. Daclatasvir  for 12 weeks HCV Genotype 5&6 Inj. PEG­IFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks Tab. Sofosbuvir+ Tab. Ledipasvir  for 12 weeks Tab. Sofosbuvir+ Tab. Daclatasvir  for 12 weeks Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pneumoniae Pseudomonas Proteus Inj. Piperacillin­ Tazobactam (3.375 gm) 6 hourly Inj. Meropenem (1 gm) 8 hourly  Likely causative agent Antimicrobial of choice 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 20/66 Hydatid disease of liver Leptospirosis Melioidosis Preferred drug Alternative drug Actinomyces israelii Benzy1 Penicillin Doxycycline and Clindamycin Name: Percutaneous liver biopsy relveals suphaur granules with typical organism Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Echinococcus granulosus Surgery followed by Tab. Albendazole (400 mg) 12 hourly for 1 month Tab. Albendazole (400 mg) for 1 month then 14 days interval, total 3­6 cycles PAIR followedby Tab. Albendazole (400 mg) 12 hourly for 1 month Name: PAIR is as effective as surgery. (WHO guideline­ 1996)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Leptospira icterohaemorrhagiae Inj. Benzyl Penicillin (900 mg) 1.5 million unit 6 hourly for 1 week Inj. Ceftriaxone (1 gm) 24 hourly for 1 week Name: Blood culture­ during limit 10 days or urine culture during 2nd week  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Burkholderia pseudomallei Inj. Ceftazidime (2 gm) 8 hourly for 2­3 weeks followed by Inj. Meropenem (0.5­1 gm) 8 hourly for 2­3 weeks followed by 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 21/66 Pyogenic liver abscess Infectious Disease Bacterial vaginosis Febrile Neutropenia Cap. Doxycycline (200 mg) 24 hourly plus Tab. Co­ trimoxazole (80/400 mg) Cap. Doxycycline (200 mg) 24 hourly plus Co­trimoxazole Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pneumoniae Viridans streptococci Streptococcus Pneumoniae Inj. Ciprofloxacin (500 mg) 12 hourly Inj. Ceftriaxone (1 gm) plus 12 hourly Inj. Metronidazole for 2 weeks and then oral for 4 weeks. Piperacillin/ Tazobactam Imipenem/ Cilastatin Meropenem Co­amoxiclav  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Anaerobes Tab. Metronidazole (500 mg) 8 hourly Tab. Clindamycin (80 mg) 8 hourly Tab. Metronidazole (500 mg) 8 hourly Tab. Clindamycin (80 mg) 8 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcus Pseudomonas Inj. Meropenem (1 gm) 8 hourly for 7­10 Inj. Meropenem (1 gm) 8 hourly for 7­10 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 22/66 Genital Herpes Kala­azar Malaria Streptococcus Escherichia coli Klebsiella days days Name: Culture sensitivity prefered preceded by emperical treatment Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Herpes simplex type I or type II Tab. Acyclovir (400 mg) 8 hourly for 7­10 days Tab. Famcyclovir (250 mg) orally 8 hourly for 7­10 days Tab. Valacyclovir (1 gm) 12 hourly for 7­10 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Leishmania Inj. Liposomal Amphotericin B (10 mg/kg) not less than in 2 hours single dose. Miltefosine (2.5mg/kg/day) in 2 divided doses for 28 days Paromomycin (15mg/kg/day) alternate buttock once daily for 21 days Amphotericin B Deoxycholate (1mg/kg/day) alternate day total 15 doses  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Plasmodium sepsis Tab. Artemether­ Lumefantrine­ Chloroquine 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 23/66 Neutropenic fever, Cellulitis Pelvic inflammatory disease Quinine (10 mg/kg) 8 hourly for 7 days Doxycycline Tetracycline Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Mostly Unknown Gram negative Escherichia coli Inj. Meropenem (500 mg) 8 hourly plusInj Amikacin (500 mg) I/V 12 hourly for 7 days Ceftazidime Cefepime Name: ANC <500X10L, Hyperemtivity  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 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 24/66 Post of Infection Post of Infection Secondary fungal infection e.g. oral thrush Secondary infection in malignant lesion Sepsis/ Acute PID Tab. Ofloxacin (400 mg) post operative 12 hourly to complete 14 days Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pseudomonas Inj. Amikacin (500 mg) 12 hourly Netlimicin  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Ceftriaxone (1 gm) 24 hourly Meropenem  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Candida species Fluconazole plus Locally Nystatin/ Miconazole  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pseudomonas Staphylococcus Streptococcus 3rd generation Cephalosporins plus Metronidazole 2nd Generation Cephalosporins or Quinolone derivatives 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 25/66 Sepsis/ Septicemia Sepsis uncertain focus 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  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli, Klebsiella Streptococcus pyogens Pseudomonas aeruginosa Staphylococcus aureus Inj. Ceftriaxone (2 gm) 12 hourly at least for 7­10 days Inj. Piperacillin + Inj. Tazobactam Inj. Meropenem Inj. Amphotericin­B  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Cefepime (1 gm) 8­ 12 hourly for 7­ 14 days Inj. Vancomycin (1 gm) 12 hourly Inj. Amikacin (500 mg) 12 hourly for 7 days Plus Inj. Metronidazole Inj. Meropenem (1gm) 8 hourly for 7­14 days plus Inj. Metronidazole (500 mg) 8 hourly for 7 days 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 26/66 Septicemia Sick Immunocompromised (febrile neutropenia) Trichomoniasis (500 mg) 8 hourly for 7 days Likely causative agent Antimicrobial of choice Preferred drug Alternative drug According to source of infection Inj. Meropenem (1 gm) 6 hourly Inj. Piperacillin/ Tazobactam (4.5 gm) 8 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Meropenem (1 gm) 8 hourly for 7­14 days or/plus Inj. Meropenem (1 gm) 8 hourly for 7­14 days or/plus Quinolone 7­14 days Inj. Linezolid (600 mg) 12 hourly or/plus Inj. Piperacillin/Tazobactam (4.5 gm)  6­8 hourly for 7­14 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Trichomoniasis vaginalis Metronidazole (2 gm) as a single oral dose or (400 mg) 12 hourly for 7 days. Or Tinidazole (2 gm) as a single oral dose Or Secnidazole (2 gm) single dose for both partners Tab. Metronidazole (2 gm) as a single oral dose or (400 mg) 12 hourly for 7 days. Or Tab. Tinidazole (2 gm) as a single oral dose Or Tab. Secnidazole (2 gm) single dose for both 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 27/66 Uncomplicated Chlamydial Infection Valvovaginal Candidiasis (non regnant) Venous aseptic site of infection partners Likely causative agent Antimicrobial of choice Preferred drug Alternative drug If poor compliance: Tab. Azithromycin (1 gm) 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 Inj. Clarithromycin or Tab. Ofloxacin or  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Candida Albicans Tab. Clotrimazole (500 mg) aginal tab once Or Two (100 mg) vaginal tablet topically for 3 nights Or Vaginal 1% cream topically for 6 nights Cap. Fluconazole (150 mg) as a single dose Tab. Clotrimazole (500 mg) vaginal tablet once Or Two (100 mg) vaginal tablet topically for 3 nights Or Vaginal 1% cream topically for 6 nights Cap. Fluconazole (150 mg) oral as a single dose Name: Contraindicated in pregnancy  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 28/66 Venous harvesting site wound infection of leg VTI, Septicemia Wound infection Staphylococcus epidermises Staphylococcus aureus Pseudomonas Inj. Ceftriaxone (1­ 2 gm) 12 hourly Inj. Amikacin (500 mg) 12 hourly < Inj. Cephalosporins Inj. Amikacin Tab. Linezolid Cap. Flucloxacillin Tab. Ciprofloxacin Name: Sterelity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus aureus Streptococcus pyogens Pseudomonas Escherichia coli Inj. Ceftriaxone (1­ 2 gm) 12 hourly Inj. Amikacin (500 mg) 12 hourly Inj. Cephalosporins Inj. Amikacin Tab. Linezolid Cap. Flucloxacillin Tab. Ciprofloxacin Name: Sterelity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Gram positive Staphylococcus aureus Pseudomonas Inj. Ceftriaxone (1 gm) 24 hourly Inj. Imipenem (500 mg­1gm) 8 hourly Name: Steroid coverage with antimicrobial therapy may be required  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Staphylococcus aureus Cream Gentamicin apply locally 2­3 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 29/66 Kidney and Urinary System Acute Pyelonephritis ESWL Pseudomonas Klebsiella times daily Or Cream/ointment 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 Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Streptococcus saprophyticus Klebsiella Pseudomonas aeruginosa Enterococci Tab. Ciprofloxacin (500 mg) 12 hourly for 7 days Tab. Trimethoprim­ Sulfamethoxazole 1 double strength tablet (160/800 mg) 12 hourly for 3 days Inj. Ceftriaxone (1 gm) stat dose with oral Ciprofloxacin Inj. Levofloxacin (750 mg) 24 hourly for 7 days Name: Complicated pyelorephritis are common in diabetic patient require prolong therapy  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 30/66 Lower urinary tract infection (cystitis) in pregnancy UTI Non Gonococcal Urethritis PCNL Fluoroquinolones TMP/SMX Inj. Aminoglycosides Tab. Amoxicillin 1st/2nd generation Cephalosporins Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pseudomonas Enterococcus Cap. Nitrofurantoin (100 mg) 6 hourly for 7 days Tab. Pivmecillinam (400 mg) stat & (200 mg) 8 hourly for 7 days Cap. Cephalexin (500 mg) 8 hourly for 7 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Chlamydia trachomatis Ureplasma urealyticum Mycoplasma Genetalium Cap. Doxycycline (100 mg) 12 hourly for 7 days Tab. Azithromycin (1 gm) single dose Cap. Erythromycin (500 mg) 6 hourly for 7 days or 12 hourly for 2 weeks or Tab. Ofloxacin (200 mg) 12 hourly for 7 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 1st/2nd generation Cephalosporins or Inj. Aminoglycosides Tab. Aminoglycosides Fluoroquinolones 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 31/66 Prostatitis Prostatic biopsy Surgical prophylaxix: Urethrocystoscopy, Urodynamic study, Ureteroscopy, TURP, TURBT Urinary Tract Infection Metronidazole or Clindamycin Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Enterobacteriaceae Pseudomonas Enterococci Enterococcus TMP/SMX for 4 weeks Fluoroquinolones  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Fluoroquinolones 1st/2nd generation Cephalosporins TMP/SMX Aminoglycosides  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Fluoroquinolones TMP/SMX Inj. Aminoglycosides Inj. Ampicillin 1st/2nd generation Cephalosporins Co­Amoxiclav  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Tab. Co­amoxiclav 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 32/66 Urinary Tract Infection (acute uncomplicated cystitis) Urosepsis Klebsiella Pseudomonas Staphylococcus aureus Candida albicans Ciprofloxacin (500 mg)  12 hourly for 7­ 10 days Cefuroxime+Clindamycin Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Streptococcus saprophyticus Klebsiella Pseudomonas aeruginosa Tab. Nitrofurantoin (100 mg) 12 hourly for 5 days Tab. Trimethoprim­ Sulfamethoxazole 1 double strength tablet (160/800 mg) 12 hourly for 3 days Fosfomycin trometamol (3 gm) A sachet orally a single dose Pivmecillinam (400 mg) 12 hourly for 3­7 days Fluoroquinolones Tab. Ofloxacin (400 mg) 12 hourly for 3 days Tab. Ciprofloxacin (250 mg) 12 hourly for 3 days Tab. Levofloxacin (500 mg) 24 hourly for 3 days β­Lactams Co­amoxiclav Cefdinir Cefaclor Cefpodoxime­ Proxetil (100mg) 12 hourly 3 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Proteus Klebsiella Enterococci Candia Inj. Amikacin (500 mg) 12 hourly for 7 days Inj. Meropenem (1 gm) 8 hourly for 7­14 days plus Cap. Fluconazole (500­100 mg/day) if fungal infection Inj. Cefepime (1 gm) 8­12 hourly for 7­14 days Inj. Meropenem (1 gm) 8 hourly for 7­14 days or plus Cap. Fluconazole (500­100 mg/day) 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 33/66 Urological Surgery involving intestine e.g.: GI tract, Skin+ intestine Musculoskeletal system Acute and chronic pyogenic Osteomyelitis Deep sternal wound infection Elective Surgery Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 2nd/3rd generation Cephalosporins Inj. Aminoglycosides Tab. Metronidazole or Clindamycin Inj. Ampicillin Inj. Ticarcillin/ Co­ Amoxiclav Inj. Piperacillin/ Tazobactam Fluoroquinolones  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcus aureus Staphylococcus pyogens Inj. Ceftriaxone (1 gm) 12 hourly Inj. Flucloxacillin (250 mg­1 gm) 6 hourly Inj. Cefuroxime (750 mg) 12 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus pyogens Streptococcus aureus Pseudomonas Escherichia coli Fungal Inj.Meropenem (500 mg­1 gm) 18 hourly Inj. Amikacin (500 mg) 12 hourly Inj. Ceftriaxone Inj. Amikacin Inj. Flucloxacillin Inj. Linezolid Inj. Ciprofloxacin Name: Sterctity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained superficial and deep  
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 34/66 Septic arthritis Skin & Soft tissue infection Superficial sternal wound infection Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 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 Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcus aureus Haemophilus influenza Enterobacter Species Inj. Ceftriaxone (1 gm) 12 hourly Inj. Flucloxacillin (250 mg­1 gm) 12 hourly Name: Preferred culture sensitivity report  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus pyogens Staphylococcus aureus Cap. Flucloxacillin (500mg) 6 hourly Tab. Clarithromycin (500mg) 12 hourly and Cap. Clindamycin (450­ 60mg) 6 hourly  
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 35/66 Tubercular Osteomyelitis Wound infections Obstetrics and Gynaecological Procedure D&C, endoscopic or other minor procedure Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcus aureus Streptococcus pyogens Escherichia coli Pseudomonas Inj. Ceftriaxone (1­ 2 gm) 12 hourly Inj. Amikacin (500 mg) 12 hourly Inj. Cephalosporins Inj. Amikacin Inj. Flucloxacillin Inj. Linezolid Inj. Ciprofloxacin Name: Sterctity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained superficial and deep Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Mycobacterium aureus 1st line anti­ tubercular drugs  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus aureus Pseudomonas pyogenosa Klebsiella Enterobacteriaceae Inj. Ceftriaxone (1 gm) 12 hourly Inj.Meropenem (500 mg) 8 hourly Inj. Amikacin (500 mg) 2 hourly Inj. Flucloxacillin Name: According to culture sensitivity report  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 36/66 Caesarean section Infected wound Caesar/ Perineal tear and episiotomy Intra partum pyrexia Anaerobes Not needed Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Prophylaxis Inj. Amoxiclav (1.2 gm) 8 hourly Inj. Clindamycin (900 mg) 8 hourly Name: Review culture reports  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Gram negative Staphylococcus Escherichia coli Pseudomonas Inj. Flucloxacillin (900 mg) 8 hourly+ Inj. Metronidazole (500 gm) 8 hourly followed by oral for 7 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Prophylaxis Inj. Amoxicillin (2 gm) + Inj. Metronidazole (500 mg) initially followed by Inj. Amoxicillin (500 mg) 8 hourly + Inj. Metronidazole (500 mg) 8 hourly till delivery Inj. Gentamicin if severe sepsis 5 days for oral antibiotics Inj. Clindamycin in penicillin allergy group 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 37/66 Placenta Removal,4 Degree Tear, Major Surgery, Extensive Oncological Surgery Post operative Gynaecological Sepsis after delivery Likely causative agent Antimicrobial of choice Preferred drug Alternative drug IV­single dose only at induction  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 contra­indicated ( 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 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 38/66 Prophylaxis Hysterectomy Laparotomy Vaginal Repair Surgical Prophylaxis Obstetric & Gynaecological Surgery Hysterectomy Opthalmology Antibiotics used in surgical prophylaxis: Cataract surgery, Glaucoma surgery, Dacryocystitis (Chronic) diarrhoea or if Gentamicin is contra­indicated ( GHNHSFT protocol ) consult microbiologist. Duration: 5­7 days and then review. Consult Microbiologist Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Ceftriaxone (2 gm) 12 hourly at least for 7­10 days Inj. Cephazolin (1gm) (if >80 kg 2 gm)+ Inj. Metronidazole (500 mg) 8 hourly Inj. Clindamycin (600 mg) + Inj. Gentamicin (2 mg /kg) 8 hourly Name: If no penicillin or B­lactuse allergy  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug IV­single dose only at induction  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 39/66 Bacterial Uveitis Conjunctivitis Corneal Ulcer Moxifloxacin 0.3% Gatifloxacin 0.3% 1 drop g.i.d. Levofloxacin 0.3% Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Mycobacterium tuberculosis Mycobacterium Bovis Treponema. pallidum According to cause Anti­TB Anti­Syphilis (systemic regimen to be followed) Name: Aquaus and vitreous sample for culture sensitivity  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Pneumonia Staphylococcus aureus Haemophilus influenzae Moraxella catarrhalis Neisseria gonorrhea Neisseria meningitides Chlamydia trachomatis Chloramphenicol Aminoglycosides (Gentamicin, Neomycin) Quinolones (Ciprofloxacin Ofloxacin) Levofloxacin Lomefloxacin Gatifloxacin Moxifloxacin Polymyxin B Fusidic acid dose (g.i.d. for 1 week) Tetracycline Fusidic acid Doxycycline Erythromycin Bacitracin Name: Conjunctival culture sensitivity needed  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 40/66 Dacryocystitis Endophthalmitis Pseudomonas Staphylococcus aureus Streptococcus Neisseria Gonorrhoeae Meningitis Coronibacterium diphtheria Haemophilus influenzae Treponema pallidum Ciprofloxacin 0.3% Ofloxacin 03.% Fortified Gentamicin Fortified Cephalosporins Procaine Penicillin (g.i.d. for 1 week or according to severity of the disease) Moxifloxacin Gatifloxacin Doxycycline Tetracycline Erythromycin Sub conjunctival antibiotics Name: Depends on culture sensitivity. Conjunctival sweab and corneal serapping Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcus aureus Epidermidis Streptococcus viridians Pneumoniae pyogens Escherichia coli Flucloxacillin (oral) for 1 week Cephradine Co­amoxiclav Cephalosporins Cefixime Name: Depending on culture sensitivity  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcus species. Bacillus species Ceftazidime (2 mg in 0.1 ml) Vancomycin (2 mg in 0.1 ml) Tab. Ciprofloxacin (750 mg) 12 hourly or Moxifloxacin (400 mg) 24 hourly Amikacin (0.4 mg in 0.1 ml) Gentamicin (0.2 mg in 0.1 ml) Name: Aquaus vitreous sample for culture sensitivity 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 41/66 Lid infection Neonatal conjunctivitis (Opthalmia Neonatorum) Orbital Cellulitis Syphilitic eye disease, Syphilitic Uveitis, Optic neuritis, Neuroretinitis Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcus aureus Pyogenes Epidermidis Streptococcus viridans Pneumonia Pyogenes Ciprofloxacin 0.3% 1 drop g.i.d for 7 days (dose can be readjusted according to severity) Moxifloxacin Flucloxacillin Name: To maintain lid hygine  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Chlamydia trachomatis Neisseria Gonorrhoeae Penicillin G Topical 1,00,000­ 3,33,000 units/ml Paediatric 10,000 to 20,000 IU Silver nitrate 1% solution  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Pneumoniae Staphylococcus aureus Streptococcus viridans Haemophilus influenzas Ceftazidime I/V (2mg in 0.1ml) Oral Metronidazole (antibiotic continued) till the patient free from fever for 4 days. Vancomycin (if penicillin allergy) 1 mg in 0.1 ml Name: Pus for culture sensitivity if orbital obsess prerent  Likely causative agent Antimicrobial of choice 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 42/66 Paediatric Central Nervous System Central venous catheter tip Micro organism isolated: 75% Meningitis in Children (Bacteria), Young infant Preferred drug Alternative drug Treponema pallidum 3 to 4 million unit Penicillin G is administered every 4 hourly for 10 to 14 days. Alternative procaine Penicillin G IM 2.4 million IU daily plus Probenecid (500 mg) oral g.i.d for 10 to 14 days. Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pseudomonas 66.66% Staphylococcus aureus 33.33% Imipenem (20 mg/kg/dose) 8 hourly Tazobactam + Piperacillin  8 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Neisseria meningitides Streptococcus pneumonia Haemophilus influenjae Inj. Ceftriaxone (100 mg/kg/day) 12 hourly + Inj. Dexamethasone (0.15 mg/kg/day) every 6 hourly for 48 hours started at least 20 minutes before antibiotic therapy Inj. Cefotaxime (200 mg/kg/day) 8 hourly for 10 days+ Inj. Vancomycin (45­60 mg/kg/day) 8 hourly for 10 days+ Meropenem (40 mg/kg/day) 8 hourly+ Amino glycosides (if pseudomonas) 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 43/66 Septicemia CNS infection Paediatric Gastrointestinal System Bacillary dysentery Cholangitis Ampicillin (200­ 400 mg/kg/day) 6 hourly for 10 days Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Organism of unknown susceptibility Inj. Vancomycin (45­60 mg/kg/day) 12 hourly for 10­14 days+ Inj. Meropenem (30­40 mg/kg/day) 8 hourly for 10­14 days Inj. Vancomycin (45­60 mg/kg/day) 12 hourly for 10­ 14 days+ Inj. Meropenem (30­40 mg/kg/day) 8 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Shigella species, Shigella dysentery, Shigella flexnari Cap. Cefixime (8­ 10 mg/kg/day) 12 hourly for 5 days Pivmecillinam (50 mg/kg/day) 6 hourly for 5 days Cefixime12 hourly Ceftriaxone (50­75 mg/kg/day) 12 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Staphylococcus aureus Ceftazidime (150 mg/kg/day) Amikacin (15­20 mg/kg/day) Meropenem (30­40 mg/kg/day) 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 44/66 Diarrhoea Enteric Fever & Severe Enteric Fever Giardiasis Hydatid cyst Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Shigella Vibrio cholerae Azithromycin (10 mg/kg/day) Ciprofloxacin (15­ 30 mg/kg/day) Pivrnecillinam Ceftriaxone (50­200 mg/kg/day)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Salmonella typhi Salmonella paraphyphi A Salmonella paratyphi B Cap. Cefixime (20 mg / kg/day) 12 hourly for 10 to 14 days Inj. Ceftriaxone (50­75 mg/kg/day) 12 hourly at least 5 days after a febrile period Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Dexamethasone (3mg/kg)initial flowed by (1 mg/kg) 6 hourly for 48 hours Azithromycin (20 mg/kg/day) 24 hourly 7 days Ciprofloxacin (20­ 30 mg/kg/day) 12 hourly 7­10 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Giardia Metronidazole (15 mg/kg/day) 8 hourly for 5–7 days Secnidazole 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 45/66 Intestinal Amoebiasis Liver Abscess Peritonitis (Ascitic Fluid C/S) Micro organism isolated:4% Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Echinococcus Granulosus Albendazole (15 mg/kg/day) 12 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Entamoeba Histolytica Metronidazole (15 mg/kg/day) 8 hourly for 5–7 days Secnidazole  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus aureus Gram negative Anaerobic organism Ceftriaxone (50­ 200 mg/kg/day) Flucloxacillin (50­ 100 mg/kg/day) Metronidazole  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Pneumoniae Acinetobactor Escherichia coli Ceftazidime (50 mg/kg/dose) 8 hourly Ceftriaxone (100 mg/kg/day) 12­24 hourly Amikacin (7.5 mg/kg/dose) 12 hourly 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 46/66 SBP Paediatric Infectious Disease Abscess 2% Oral thrush Septicemia (Blood C/S) 10% Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Staphylococcus aureus Cefotaxime (50­200 mg/kg/day) Flucloxacillin (50­ 100 mg/kg/day) Meropenem (30­40 mg/kg/day)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Enterobacter Spesis Flucloxacillin (25­ 250 mg) 6 hourly Vancomycin (45­60 mg/kg/day) Tazobactam Meropenem (30­40 mg/kg/day) Inj. Vancomycin (45­60 mg/kg/day) 12 hourly for 10­14 days+ Inj. Meropenem (30­40 mg/kg/day) 8 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Candida albicans Nystatin (4­6 lakhs) unit for 6 hourly Miconazole 2% apply 12 hourly Inj. Vancomycin (45­60) 8 hourly for 2­4 weeks  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 47/66 Septicemia (Blood C/S) Micro organism isolated:6% Septic Arthritis Klebsiella Acinatobacter Coagulase negative staph Escherichia coli Inj. Amikacin (15­ 20 mg/kg/day) Inj. Meropenem (30­40 mg/kg/day) Inj. Ceftazidime (150 mg/kg/day) Gentamicin Amikacin Imipenem Colistin Ciprofloxacin Cotrimoxazole Vancomycin Netlimicin 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 Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Salmonella Enterococcus Pseudomonas Klebsiella Cefotaxime (50 mg/kg/dose) 8­12 hourly Ampicillin (25 mg/kg/dose) 6 hourly Vancomycin (15mg/kg/dose) 8 hourly Ceftazidime (50 mg/kg/dose) 8 hourly Amikacin (7.5 mg/kg/dose) 12 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Haemophilus influenza Streptococcus aureus Streptococcus pneumoniae Inj. Ceftriaxone (50­75 mg/kg/day) 12 hourly for 4 weeks Inj. Clindarnycin (10­40 g/kg/day) 8 hourly Vancomycin (45­60 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 48/66 Skin infection Cellulitis Osteomyelitis Throat Swab Micro organism isolated: 12% Wound Swab 2% Cefotaxime (20 mg/kg/day) 8 hourly for 4 weeks+ Clindamycin (10­ 40 mg/kg/day) 8 hourly for 4 weeks mg/kg/day) 8 hourly Meropenem (40 mg/kg/day) 8 hourly Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Organism of unknown susceptibility Cloxacillin (50­100 mg/kg) 6 hourly for 7­10 days Inj. Clindamycin (10­40 mg/kg/day) 8 hourly for 2­4 weeks Inj. Vancomycin (45­60) 8 hourly for 2­4 weeks  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus pyogens 82% Staphylococcus aureus 18% Penicillin (25­50 mg/kg/dose) 6 hourly Erythromycin (10 mg/kg/dose) 6 hourly Amoxicillin (25 mg/kg/dose) 8 hourly Clindamycin (3­6 mg/kg/dose) 6 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 49/66 Paediatric Surgery Amniotic band of both leg: release of bank and Z­plasty in right leg AVM at the root of nose: Excised AVM of left thigh (Aspirated) (Aspirated fluid: no growth) Cystic Hygroma (within the abdomen) with sliding hernia: Excision of Cystic hygroma with herniotomy Pseudomonas Flucloxacillin (125­ 250 mg) 6 hourly Amikacin (15­20 mg/kg/day) Meropenem (30­40 mg/kg/day) Vancomycin (45­60 mg/kg/day) Imipenem Amikacin Colistin Ticarcillin Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococci Micrococci Gram positive rods Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Flucloxacillin(50­ 100 mg/kg/day) followed by Flucloxacillin  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Ceftriaxone (50­75 mg/kg)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococci Micrococci Gram positive rods Inj. Cephradine (50­100 mg/kg/day) 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 50/66 Discharging sinus at penoscrotal region: Excision (Pus for C/S: Pseudomonas spp.) Eventration of left dome of diaphragm with umbilical hernia: Plication of the defect and repair of hernia Growth in lower Esophagus: feeding gastrostomy with biopsy from growth Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pseudomonas aeruginosa Enterococci Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Flucloxacillin (50­100 mg/kg/day) followed by Cefixime (20 mg/kg/day)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus Inj. Ceftriaxone (50­75 mg/kg/day) Tab/Inj. Ciprofloxacin (10 mg/kg/day) 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  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pneumoniae Streptococci Pseudomonas Enterococci Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Gentamicin (5 mg/kg/day)  
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 51/66 Hydrocephalus and Meningomyelocele with urinary and fecal incontinence; Introduction of V­P shunt with excision of meningomyelocele Hypospaedias with rotational deformity of penis: Urethroplasty and correction of rotation Hypospaedias: Urethroplasty Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella pneumonia Streptococcus pneumonia Enterococci Cephradine (50­ 100 mg/kg/day) Inj. Gentamicin (5 mg/kg/day) Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Encapsulated organism: Streptococcus Pneumoniae, Nigeria meningitides, Haemophilus influenza. Non capsulated organism: Listeria monocytogenes Inj. Ceftazidime (15­20 mg/kg/day) Inj. Amikacin (15­ 20 mg/kg/day)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus Inj. Ceftriaxone (50­75 mg/kg/day) followed by Inj. Meropenem (30­40 mg /kg/day) Inj. Flucloxacillin (50­100 mg/kg/day) Inj. Amikacin Name: Multidrug use of antibiotic also require specific indication  Likely causative agent Antimicrobial of choice 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 52/66 Long segment Hirschsprung’s Disease with Ileostomy: Total colectomy with ileo­anal anaestomosis. On 7th POD patient developed incomplete wound dehiscence which closed by secondary suture Mass in right gluteal region: Incisional biopsy Meconium ileus with Ileostomy: Ileostomy closure (Stool culture: no Preferred drug Alternative drug Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Flucloxacillin (50­100 mg/kg/day) followed by Cefixime ( 20 mg / kg/day) Streptococcus pyogens 82% Staphylococcus aureus 18% Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Bactericides Fragilis Streptococcus viridians group Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Metronidazole (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) Name: Frequent changes of antibiotic so require wound sweab. Specific indication should mentioned  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococci, Micrococci, Gram positive rods Inj. Ceftriaxone (50­75 mg/kg/day) followed by oral Cefixime Streptococcus pyogens 82% Staphylococcus aureus 18% 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 53/66 organism) Non­operative case of Choledochal cyst Penoscrotal hypospaedias: Urethroplasty (Urine c/s: no growth) Perineal hypospaedias with bilateral undescended testes: Urethroplasty with bilateral orchiopexy (Urine c/s: no growth) Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli, Bactericides Fragilis Streptococcus viridians group Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Metronidazole Inj. Amikacin  Likely causative agent Antimicrobial of choice Inj. Ceftriaxone (50­75 mg/kg)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella pneumonia Pseudomonas aeruginosa Proteus Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Flucloxacillin (125­250 mg/kg/day) followed by oral Cefixime  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus Inj. Ceftriaxone (50­75 mg/kg/day) for 7 days, Then Inj. Meropenem(30­40 mg/kg/day), Inj. Flucloxacillin (50­ 100 mg/kg/day) and Inj. Amikacin 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 54/66 Rectourethral fistula: Perineal hole technique anoplasty (Urine C/S: No. growth) Residual PUV with Left sided VUR: Fulgaration with left sided ureteric re­ reimplantation Ruine R/M/E: Normal finding (Urine C/S: no organism) Thalasseaemia with Hypersplensim: Splenectomy (15­20 mg/kg/day) for 8 days followed by Syrup Cefixime ( 20 mg / kg/day) for 16 days. Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Bactericides Fragilis Streptococcus viridians group Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Metronidazole (15­30 mg/kg/day) Inj. Ceftazidime (150 mg/kg/day) Inj. Gentamicin (5 mg/kg/day)  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus Inj. Ceftriaxone (50­75 mg/kg/day) followed by Inj. Meropenem (30­40 mg/kg/day) Inj. Amikacin  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Pneumoniae Streptococci Pseudomonas Enterococci Inj. Ceftriaxone (50­75 mg/kg/day) Inj. Phylopen Inj. Amikacin (15­ 20 mg/kg/day) 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 55/66 Paediatric Urinary System Urinary tract infection Acute cystitis Acute pyelo nephrities Urinary tract infection (UTI) Micro organism isolated: 6% Recurrent UTI prophylaxis Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Klebsiella Proteus Cap. Cefixime (8­ 10 mg/kg/day) 12 hourly for 7­10 days Tab. Ciprofloxacin (8­30 mg/kg/day) 12 hourly for 7­10 days Inj. Amikacin (15­ 20 mg/kg/day) Inj. Gentamicin (5 mg/kg/day) Ceftazidime (150 mg/kg/day) Inj. Amikacin (15­ 20 mg/kg/day) Inj. Gentamicin (5 mg/kg/day) Cap. Nitrofurantoin (5­7 mg/kg/day) Tab. Co­trimoxazole  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Escherichia coli Enterococci Acinatobacter Pseudomonas Cefotaxime (50 mg/kg/dose) 8­12 hourly Ceftazidime (50 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 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 56/66 Paediatrics Respiratory System Otitis Media 2% Pneumonia Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Cap. Nitrofurantoin (1­2 mg/kg/day) Single dose at bed time Tab. Co­ trimoxazole (6­20 mg/kg/day) single dose at bed time  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pseudomonas Ceftriaxone (50­75 mg/kg/day) Cefuroxime Ceftazidime (150 mg/kg/day) Ceftazidime Ciprofloxacin Imipenem Meropenem Netlimicin  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Haemophilus influenjae Staphylococcus aureus Nosocomial: Escherichia coli Streptococcus Pneumoniae Haemophilus influenjae Pseudomonas Klebsiella Staphylococcus aureus Community acquired: Inj. Ceftriaxone (50­75 mg/kg/day) 7­10 days according to clinical response Cap. Flucloxacillin (125­250 mg) 6 hourly.(in staphylococcus aureus) Inj. Azithromycin (10 mg/kg/day) Inj. Erythromycin Inj. Ceftriaxone (50­ 75mg/kg/day) 12 hourly Inj. Gentamicin (5 mg/kg/day) 3 hourly Inj. Clarithromycin (15 mg/kg/day) 8 hourly Inj. Clindamycin (10­40 g/kg/day) 8 hourly for 14 days 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 57/66 RTI 4% Respiratory System Acute Bacterial Rhino sinusitis (severe or persistent symptoms) ≥5 years: Mycoplasma Chlarnydia (30­50 g/kg/day) Inj. Vancomycin (45­60 g/kg/day) 8 hourly Inj. Imipenem (15­ 25 mg/kg/day) 8 hourly Inj. Clarithromycin (15 mg/kg/day) Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Klebsiella Acinatobacter Penicillin (125­250 mg) orally every 6­8 hourly Erythromycin (30­ 50 mg/kg/day) Clarithromycin (15 mg/kg/day) Meropenem (30­40 mg/kg/day) Imipenem Ciprofloxacin Colistin Tazobactam Piperacillin  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Gram positive: Staphylococcus aureus Streptococcus Pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Moraxella catarrhalis Gram negative: Pseudomonas aeruginosa Escherichia coli Protease mirabilis 1st line: Tab. Co­Amoxiclav (625 mg) 8 hourly orally 2nd line: Doxycycline oral(100 mg) 12 hourly 10 days 1st line: Inj. Clarithromycin (500 mg) 12 hourly 2nd line: Cap. Doxycycline (100 mg) 12 hourly 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 58/66 Acute Diffused Otitis Externa (Swimmer's ear) Acute Laryngitis Acute Localised Otitis Externa (furuncle) Acute Otitis Media Klebsiella Pneumoniae Enterobacter Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococus aureus Pseudomonas pyogens Escherichia coli Often mixed flora Mile­moderate: Cap.Flucloxacillin Topical Antimicrobial 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  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Antibiotics are NOT Indicated  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococcal Cap. Flucloxacillin (1 gm) 6 hourly for 7 days plus Topical steroids Clarithromycin (500 mg) 12 hourly  
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 59/66 Acute Rhino Sinusitis Aspiration pneumonia Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Pneumoniae Staphylococcus aureus Haemophilus influenzae Micrococcus Catarrhalis (Necrotizing) B Haemolytic streptococcus Antibiotics should not be routinely prescribed for uncomplicated AOM. For severe disease or when risk of complications: 1st Line Cap. Amoxicillin (500 mg) 8 hourly 2nd line Tab. Co­Amoxiclav (625 mg) 8 hourly 10 days Antibiotics should not be routinely prescribed for uncomplicated AOM. For severe disease or when risk of complications: 1st Line Clarithromycin (500 mg) 12 hourly 2nd line Cap. Doxycycline (100 mg) 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 Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Antibiotics should be Only prescribed in SEVERE infection. Mostly this condition caused by viral  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pseudomonas Acinatobacter Enterococci faecalis Inj. Piperacillin/Tazobactam(4.5 gm) 6­8 hourly for 7­14 days plus Inj. Meropenem (1gm) 8 hourly for 7­ 14 days 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 60/66 Chronic Otitis Media Community Acquired Pneumonia (CAP) Bacteroides fragilis Inj. Amikacin (500 mg) 12 hourly for 7 days Plus Tab. Metronidazole (500 mg) 8 hourly for 7 days Inj. Amikacin (500 mg) 12 hourly for 7 days plus Tab. Clindamycin (600 mg) 8 hourly for 7­ 14 days Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Aerobic: Pseudomonas aeruginosa Escherichia coli Streptococcus aureus Streptococcus Pyogenes Proteus mirabilis Klebsiella species Anaerobic: Bacteroides Peptostreptococcus Propionibacterium Oral antimicrobial may be added if a susceptible organism is cultured 7­10 days  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Pneumoniae Staphylococcus aureus Candia Inj. Azithromycin (500 mg) I/V OD 5 days, or Inj. Clarithromycin (500 mg) 12 hourly for 7­14 days Inj. Quinolone 7­14 days or Inj. Linezolid (600 mg) 12 hourly 7­14 Inj. Ceftazidine (1 gm) 8 hourly for 7­14 days, plus/ or Inj. Clindamycin (600 mg)I/V 8 hourly for 7­14 days Inj. Piperacillin/ Tazobactam (4.5 gm) 6­8 hourly for 7­14 days 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 61/66 Epiglottises Lung Abscess Malignant Otitis Externa days (if gram positive infection), or Inj. Ticoplzmin (400 mg) stat and (200 mg) 12 hourly for 7­14 days, or Cap. Fluclonazole (50­100 mg/day) if fungal infection Inj. Vancomycin (1 gm) I/V 12 hourly 7­14 days (if gram positive infection) Inj. Amphotericin­B if fungal infection Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Haemophilus influenzae (25%), followed by Haemophilus parainfluenzae, Streptococcus Pneumoniae, and group A streptococci Inj. Ceftriaxone (2 gm) 24 hourly. Oral then: Tab. Co­amoxiclav (625 mg) 8 hourly for 7­10 days Inj. Clarithromycin (900 mg) 8 hourly and Tab. Ciprofloxacin (500 gm) 12 hourly. Oral then: Tab. Clindamycin (450 mg) 6 hourly and Tab. Ciprofloxacin (500 gm) 12 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Staphylococus Co­amoxiclav Metronidazole Clindamycin, Vancomycin, Daptomycin, Linezolid  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 62/66 Perichondritis Pharyngitis/Tonsillitis Pseudomonas 3rd Generation Cepholosporins­ Piperacillin hourly plus Topical Treatment oral Stop down: Tab. Ciprofloxacin (500 mg­750 mg) 12 hourly for 4­6 weeks Inj. Clindamycin (900 mg) and (750 mg) 8 hourly and 12 hourly 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 Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pseudomonas Mixed flora 1st line Tab. Ciprofloxacin (500mg­750mg) for 12 hourly 2nd line: Cap. Clindamycin (450mg) 6 hourly for 4­6 weeks  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug GABHS (common) Arcanobacterium hemolytic (7% or adolescents and adults with pharyngitis) Group C Streptococci (uncommon) Group G Streptococci (uncommon)) Neisseria Gonorrhoeae (uncommon) Mild: Tab. Phenoxymethy1 penicillin (500 mg) 6 hourly Severe: Inj. Benzy1 penicillin (1.2 gm) 6 hourly and Inj. Metronidazole (500 mg) 8 hourly. Oral then Mild: Tab. Clarithromycin (500 mg) 12 hourly Severe: Inj. Clarithromycin (900 mg) 8 hourly. Oral then Tab. Clindamycin (450 mg) 8 hourly 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 63/66 Pneumonia Quinsy (peritonsillar abscess) Respiratory tract infection e.g. bronchitis Pneumonia Coronibacterium diphtheria (rare) Tab. Co­amoxiclav (625 mg) 8 hourly for 7­10 days. Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Mostly unknown Gram­ve Escherichia coli Inj. Meropenem (500 mg) 8 hourly plus Inj.Amikacin (500 mg) I/V 12 hourly for 7 days Ceftazidime Cefepime  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Aerobic bacteria are Streptococcus group A (GAS), B­hemolytic Streptococci group C and G, and Staphylococcus aureus Anaerobic bacteria isolated form PTA aspirates is Fusobacterium necrophorum Inj. Benzy1penicillin (1.2 gm) 6 hourly and Inj. Metronidazole (500 mg) 8 hourly. Oral then Tab. Co­amoxiclav (625 mg) 8 hourly for 7­10 days Inj. Clarithromycin (900 mg) 8 hourly. Oral then Tab. Clindamycin (450 mg) 8 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Streptococcus Pneumoniae Legionella pneumophetin Mycoplasma Haemophilus influenza 3rd / 4th generation Cephalosporins Macrolide Fluoroquinolones Macrolide 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 64/66 Retropharyngeal Abscess Lateral pharyngeal Abscess Sore Throat Staphylococcus aureus Name: Nosocomial RTI is common in diabetic patient. Early and agresive treatment is required Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Inj. Ceftriaxone (2 gm) 24 hourly and Inj. Metronidazole (500 mg) 4 hourly. Oral then: Tab. Co­amoxiclav (625 mg) 8 hourly or according to C/S for 10­14 days Inj. Clarithromycin (900 mg) 8 hourly and Tab. Ciprofloxacin (500 gm) 12 hourly. Oral then: Tab. Clindamycin (450 mg) 6 hourly and Tab. Ciprofloxacin (500 gm) 12 hourly  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug 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 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 65/66 Upper or lower respiratory tract infection (Oncology) Ventilator associated pneumonia (Early VAP) (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. Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pneumococcus Streptococcus Staphylococcus Inj. Azithromycin (500 mg­1 gm) 24 or 12 hourly for 3 days or Tab. Azithromycin (500 mg) orally 24 or 12 hourly for 3 days or Tab. Co­amoxiclav (625 mg) orally 8 hourly for 7 days 3rd generation Cephalosporins or Quinolone derivatives  Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pseudomonas Acinatobacter Proteus Klebsiella Staphylococcus aureus Inj. Piperacillin/Tazobactam (4.5 gm) 6­8 hourly for 7­14 days plus Inj. Amikacin (500 mg) 12 hourly for 7 days Inj. Meropenem (1 gm) 8 hourly for 7­14 days or Inj. Vancomycin (1 gm) 12 hourly or 
12/19/2015 Antibiotic Guideline http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html 66/66 Ventilator associated pneumonia (Late VAP) Quinolone for 7­14 days Inj. Colistin Sulphate (1­2 MU) 8 hourly for 7­14 days Likely causative agent Antimicrobial of choice Preferred drug Alternative drug Pseudomonas Acinatobacter Proteus Klebsiella Staphylococcus aureus Inj. Meropenem (1 gm) 8 hourly plus Inj. Amikacin (500 mg) 12 hourly for 7 days Inj. Colistin Sulphate (1­2 MU) 8 hourly for 7­14 days Inj. Cefepime (1 gm) 8­12 hourly Inj. Vancomycin (1 gm) 12 hourly Inj. Colistin Sulphate (1­2 MU) 8 hourly for 7­14 days 

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