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CHEMOPROPHYLAXIS<br />Dr Sangeetha P<br />
CHEMOPROPHYLAXIS<br /> Definition <br />The Practice of administering an antimicrobial agent for preventing an infection  ...
Influencing factors<br />
.<br />Prophylaxis effective when<br /> Single pathogen<br /> Acute exposure<br /> Short duration prophylaxis<br /> Suitab...
Ineffective prophylaxis leads to<br /><ul><li>Overuse of antibiotics
Resistant organisms
 Economic waste
 Risk of side effects</li></li></ul><li>The ideal antibiotic <br />Narrow spectrum<br />Cheap<br />Minimum toxicity<br />S...
Types of prophylaxis <br />
Classification <br />
Disease targeted prophylaxis<br /><ul><li>Rheumatic fever
Endocarditis
Malaria
Cholera
Plague
Influenza </li></li></ul><li>Host targeted<br /><ul><li>HIV
Neutropenia
Asplenia
Haemoglobinopathy</li></li></ul><li>Post exposure<br />Tuberculosis<br />Pertussis<br />HIV <br />Meningococcal meningitis...
Surgical prophylaxis<br />To prevent Surgical Site Infection (SSI); not all infections  occuring  in  the  post-op  period...
Rheumatic fever<br /><ul><li>Primary</li></ul>  Treating streptococcal pharyngitis<br /><ul><li>Secondary</li></ul>    Pre...
Streptococcal pharyngitis<br /><ul><li>Oral Penicillin V for 10 days
Oral Erythromycin for 10 days</li></ul>Inj Benzathine Penicillin 6L IM single dose<br />
Secondary <br /><ul><li>Oral Penicillin V 250mg BD daily
Sulfadiazine 500mg OD
Erythromycin 250mg BD</li></ul>Inj.Benzathine Penicillin 1.2L IM 4 weekly<br />
Endocarditis <br />High morbidity<br />Dental /Surgical procedures with bleeding from mucosa..<br />2007 AHA guidelines<br...
Endocarditis<br />.<br />Upper GIT<br />Alpha hemolytic streptococci<br />Ampicillin/Amox/<br />clindamycin<br />
Endocarditis <br />.<br />Lower GIT<br />ENTEROCOCCI<br />Ampi+Genta<br />Vanco+Genta<br />Ampi/Amox<br />
Antibiotic Regimens for Prophylaxis of Endocarditis in Adults with High-Risk Cardiac Lesions<br />A. Standard oral regimen...
Malaria <br />Chloroquine sensitive<br /><ul><li>Tab.Chloroquine 500mg base once weekly.</li></ul>    Start 2 weeks prior ...
Malaria <br />Chloroquine resistant<br /><ul><li>Atovaquone+Proguanil (Malarone) daily
Mefloquine 250mg weekly
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Chemoprophylaxis

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Chemoprophylaxis

  1. 1. CHEMOPROPHYLAXIS<br />Dr Sangeetha P<br />
  2. 2. CHEMOPROPHYLAXIS<br /> Definition <br />The Practice of administering an antimicrobial agent for preventing an infection or for suppressing contacted infection before the clinical manifestations.<br />
  3. 3. Influencing factors<br />
  4. 4. .<br />Prophylaxis effective when<br /> Single pathogen<br /> Acute exposure<br /> Short duration prophylaxis<br /> Suitable drug<br /> Lethal disease<br />
  5. 5. Ineffective prophylaxis leads to<br /><ul><li>Overuse of antibiotics
  6. 6. Resistant organisms
  7. 7. Economic waste
  8. 8. Risk of side effects</li></li></ul><li>The ideal antibiotic <br />Narrow spectrum<br />Cheap<br />Minimum toxicity<br />Single dose.. <br />
  9. 9. Types of prophylaxis <br />
  10. 10. Classification <br />
  11. 11. Disease targeted prophylaxis<br /><ul><li>Rheumatic fever
  12. 12. Endocarditis
  13. 13. Malaria
  14. 14. Cholera
  15. 15. Plague
  16. 16. Influenza </li></li></ul><li>Host targeted<br /><ul><li>HIV
  17. 17. Neutropenia
  18. 18. Asplenia
  19. 19. Haemoglobinopathy</li></li></ul><li>Post exposure<br />Tuberculosis<br />Pertussis<br />HIV <br />Meningococcal meningitis<br />
  20. 20. Surgical prophylaxis<br />To prevent Surgical Site Infection (SSI); not all infections occuring in the post-op period.. <br />Staphylococcus - Cefazolin<br />
  21. 21. Rheumatic fever<br /><ul><li>Primary</li></ul> Treating streptococcal pharyngitis<br /><ul><li>Secondary</li></ul> Preventing a second episode of pharyngitis<br />
  22. 22. Streptococcal pharyngitis<br /><ul><li>Oral Penicillin V for 10 days
  23. 23. Oral Erythromycin for 10 days</li></ul>Inj Benzathine Penicillin 6L IM single dose<br />
  24. 24. Secondary <br /><ul><li>Oral Penicillin V 250mg BD daily
  25. 25. Sulfadiazine 500mg OD
  26. 26. Erythromycin 250mg BD</li></ul>Inj.Benzathine Penicillin 1.2L IM 4 weekly<br />
  27. 27. Endocarditis <br />High morbidity<br />Dental /Surgical procedures with bleeding from mucosa..<br />2007 AHA guidelines<br />Choice of drug depend on the flora..<br />
  28. 28. Endocarditis<br />.<br />Upper GIT<br />Alpha hemolytic streptococci<br />Ampicillin/Amox/<br />clindamycin<br />
  29. 29. Endocarditis <br />.<br />Lower GIT<br />ENTEROCOCCI<br />Ampi+Genta<br />Vanco+Genta<br />Ampi/Amox<br />
  30. 30. Antibiotic Regimens for Prophylaxis of Endocarditis in Adults with High-Risk Cardiac Lesions<br />A. Standard oral regimen<br />  1. Amoxicillin 2.0 g PO 1 h before procedure<br />B. Inability to take oral medication<br />  1. Ampicillin 2.0 g IV or IM within 1 h before procedure<br />C. Penicillin allergy<br />  1. Clarithromycin or azithromycin 500 mg PO 1 h before procedure<br />  2. Cephalexin 2.0 g PO 1 h before procedure<br />  3. Clindamycin 600 mg PO 1 h before procedure<br />D. Penicillin allergy, inability to take oral medication<br />  1. Cefazolinor ceftriaxone1.0 g IV or IM 30 min before procedure<br />  2. Clindamycin 600 mg IV or IM 1 h before procedure<br />
  31. 31. Malaria <br />Chloroquine sensitive<br /><ul><li>Tab.Chloroquine 500mg base once weekly.</li></ul> Start 2 weeks prior & continue for 4weeks after travel..<br />
  32. 32. Malaria <br />Chloroquine resistant<br /><ul><li>Atovaquone+Proguanil (Malarone) daily
  33. 33. Mefloquine 250mg weekly
  34. 34. Doxycycline 100mg daily</li></li></ul><li>Tuberculosis <br /> Treatment of latent infection..<br />
  35. 35. Regimens <br /><ul><li>INH 300mg daily for 9 months</li></ul> or<br /><ul><li> INH +Rifampicin daily for 6months</li></ul> or<br /><ul><li>Rifampicin for 4 months
  36. 36. Rifampicin +Pyrazinamide for 2 months. </li></li></ul><li>HIV-Post exposure prophylaxis<br />Two drug regime for low risk<br />Zidovudine +Lamivudine<br />Zidovudine+Lamivudine+Indinavir<br />Three drug regime for high risk<br />
  37. 37. HIV<br />Prophylaxis against opportunistic infections: <br />primary<br />
  38. 38. Secondary or c/c suppressive Rx<br />.<br />
  39. 39. OTHERS<br />
  40. 40. Surgical prophylaxis<br />Maintain peak concentration of antibiotic at time of wound closure<br />To prevent Surgical Site Infection<br />(SSI)<br />
  41. 41. Surgical prophylaxis <br /> Principles <br /><ul><li>Give antibiotics 1 hour before surgery
  42. 42. Continue for 24 hours only
  43. 43. Most commonly cephalosporins</li></li></ul><li>Types of surgical wounds<br />.<br />
  44. 44.
  45. 45. Drugs used<br />
  46. 46. High risk when<br />Surgery >2hours<br />Prosthesis<br />Immunosuppressed patient<br />Extremes of age..<br />
  47. 47. …<br />Thank you <br />

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