General list of recommended antibiotic malaysia
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This document provides guidelines for recommended antibiotic treatments for various bacterial infections and medical conditions. It lists the typical first-line antibiotic options and occasional alternative treatments. The conditions covered include acute bacterial meningitis, acute dysentery, aspiration pneumonia, community acquired pneumonia, diabetic foot ulcers, catheter-related sepsis, gastrointestinal infections, gonorrhea, hospital-acquired pneumonia, infections in intravenous drug users, liver abscesses, infectious endocarditis, syphilis, urinary tract infections, malaria, and various surgical site infections. For each condition, it recommends the most common causative organisms and preferred antibiotic regimens.
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General list of recommended antibiotic malaysia
- 1. Edited by CSMU HOW Medical Team Page 1 General List of Recommended Antibiotics Disclaimer: The authors do not accept any responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work.
- 2. Edited by CSMU HOW Medical Team Page 2 Antibiotics Recommendations Medical Department Acute Bacterial Meningitis Organism(s) First line Alternative notes Empirical N. meningitidis H. influnenzae S. pneumoniae IV Ceftriaxone 2g bd for 2 weeks (elderly/ malignancy, to add IV Ampicilin, 2g bd to cover for L. monocytogenes) IV Cefotaxime 2g tds or IV Meropenem 2g tds for 2 weeks Acute Dysentary Organism(s) First line Alternative notes E. histolytica Shigella IV/PO Metronidazole for 10days IV/PO Ciprofloxacin for 3days Aspiration pneumonia Organism(s) First line Alternative notes S. pneumoniae Oral anaerobes H. influnenzae M. catarrhalis IV Augmentin 1.2g tds IV cefotaxime 1g tds Plus IV Metronidazole 500mg tds Community acquired pneumonia Organism(s) First line Alternative notes S. pneumoniae Oral anaerobes H. influnenzae M. catarrhalis IV Augmentin 1.2g tds or IV Cefotaxime 1g tds or IV Unasyn 1.5g tds For 1-2 weeks Plus either Erythromycin ES 800mg bd or doxycycline 100mg bd or Azithromycin 500mg od for 2 weeks IV Cefuroxime 1.5g tds for 1-2 weeks
- 3. Edited by CSMU HOW Medical Team Page 3 Diabetic related ulcer Organism(s) First line Alternative notes P. aeruginosa E. coli IV Ampiciln + Sulbactam (Unasyn) 1.5g tds Or IV Amoxicillin + Clavulanic acid (Augmentin) 1-2g tds For 1-2 weeks. Double lumen catheter related sepsis Organism(s) 1st line Alternative Notes IV Ceftazidime 1g od plus IV Cloxacillin 500 mg qid for 2 weeks Gastrointestinal tract Organism(s) 1st line Alternative Notes E.coli Camphylobacter Salmonella Vibrio Yersinia Clostridium difficile colitis Salmonella thypi IV / PO Ciprofloxacin 500 mg bd for 5 days IV Metronidazole 500 bd or 1g od till diarrhea cured IV Ceftriaxone 2g od for 5 days Cap Doxycycline 100 bd for 5 days Gonorrhea Organism(s) 1st line Alternative Notes N. Gonorrhea IM Ceftrixone 125 mg * 1 dose IM 3rd generation Cephalosporin 250 – 500 mg * 1 dose Hospital acquired pneumonia Organism(s) 1st line Alternative Notes P.auruginosa E.coli K. pneumonia IV Cefotaxime 1g tds or IV Sulperezone 1g bd for 1-2 weeks IV Vancomycin 1 g IV Meropenem 1 g tds or IV Tazosin 4.5 g tds
- 4. Edited by CSMU HOW Medical Team Page 4 Intravenous drug abuser Organism (s) First line Alternative Notes S. pneumoniae IV Cloxacillin 2g 4hrly plus IV Gentamicin 3.5-5mg in 3 divided doses Liver abscess Organism (s) First line Alternative Notes Enterobacteriacea Enterococcus B. flagilis Burkholderia pseudomallei IV Ciprofloxacin plus IV Metronidazole 500mg tds till Abscess reduce in size IV Ceftazidime 2g tds for 2 weeks plus Cap Doxycycline 100mg bd and Co-trimoxazole 2 tad bd for 18 weeks Miscellaneous Organism (s) First line Alternative Notes Leptospira spp IV C Penicillin 2MU qid plus Doxycycline 100mg bd for 1 week IV Ceftriaxone 1g od for 1 week Staph aureus (MRSA) tds for 1 week Infective Endocarditis Organism(s) 1st line Alternative Notes Strep viridan Gp B,C, G Streptococci IV C Penincillin 2 MU 4 hourly plus IV Gentamycin 3.5 – 5 mg per kg in 3 divided doses 4 minimum of 2 weeks.
- 5. Edited by CSMU HOW Medical Team Page 5 Syphilis Organism (s) First line Alternative Notes Primary/secondary (<1 year) Latent syphilis (duration >1 year) IM Benzathine penicillin 2.4MU single dose or Doxycycline 100mg bd for 2 weeks IM Benzathine penicillin 2.4MU weekly for 2 weeks or Doxycycline 100mg bd for 3 weeks Urinary tract a) Pyelonephritis Organism(s) 1 st line Alternative Notes Empirical enterobacteriacea IV Ceftriaxone 1g od for 1 to 2 weeks Or IV / PO Ciprofloxacin 500 mg bd for 1 to 2 weeks IV Cefuroxime 1.5 g tds b) Renal Abscess Organism(s) 1 st line Alternative Notes Empirical S. pneumonia IV Ceftriaxone 1g OD or ( till abscess resolved) C) Urosepsis Organism(s) 1 st line Alternative Notes Gram (-ve) IV Ceftriaxone 1g od Or IV Ciprofloxacin 500 mg bd for 1 to 2 weeks Gram (+ve) IV Augmentin 1.2g tds for 1-2 weeks
- 6. Edited by CSMU HOW Medical Team Page 6 MALARIA Diagnosis Suggested treatment Notes 1st line Altenative Plasmodium vivax Chloroquine(base) 600 mg ( 4 tabs immediately, then 300 mg (2tabs) 6 hours later and on days 2 & 3. + Primaquine 15 mg daily for 14 days + Pyrimethamine + Sulfadoxine ( Fansidar) 3tabs G6PD deficiency should be excluded prior to the use of Primaquine If fails to respond to standard Chloroquine treatment Quinine or Mefloquine are alternative therapies. Chloroquine resistant is widespread along Malaysia,Thai border, Sabah and in some areas with illegal immigrant village. Fansidar is contraindicated in pregnancy and infant.
- 7. Edited by CSMU HOW Medical Team Page 7 Antibiotics Recommendations Surgery Department Breast Abscess Organism(s) 1st line Alternatives Notes Staphylococci aureus and epidermidis Streptococci Cloxacillin 1st generation Cephalosporins Erythromycin Recommended duration: 1week Proper I&D and dressings are necessary Burns (burn wound sepsis) Organism(s) 1st line Alternatives Notes Staphylococci Streptococci Pseudomonas Cloxacillin Gentamicin Metronidazole Recommended duration: depends on response Diverticulitis Perirectal Abscess Organism(s) 1st line Alternatives Notes E.coli Klebsiella Enterococci Proteus 2nd / 3rd generation of Cephalosporins Metronidazole Gentamicin Amikacin Recommended duration: 1week Duodenal / Gastric Ulcer Organism(s) 1st line Alternatives Notes H.pylori PO Clarithromycin PO Amoxycillin PO Lansoprazole PO Tetracyclin PO Metronidazole PO Omiprazole Recommended duration: 1week Urease test positive Gastrointestinal (Gallbladder, Cholecystitis, Cholangitis Biliary Sepsis,Appendicitis) Organism(s) 1st line Alternatives Notes E.coli Kleabsiella Proteus Enterococci Anaerobes Amoxycillin 2nd / 3rd generation of Cephalosporins Metronidazole Gentamicin Amikacin Recommended duration: 1week Kidney (Perinephric abscess, UTI, Pyelonephritis) Organism(s) 1st line Alternatives Notes Coliforms anaerobes Staphylococci Bactrim 2nd / 3rd generation of Cephalosporins Metronidazole Gentamicin Amikacin Recommended duration: 1week
- 8. Edited by CSMU HOW Medical Team Page 8 Liver (Hepatic Abscess) Organism(s) 1st line Alternatives Notes Coliforms anaerobes 2nd / 3rd generation of Cephalosporins Metronidazole Gentamicin Amikacin Recommended duration: 1 week Muscle (Gas gangrene) Organism(s) 1st line Alternatives Notes Clostridium perfringens Benzylpenicillin Cephalosporins Metronidazole Recommended duration: 1week Muscle (Pyomyocitis) Organism(s) 1st line Alternatives Notes Staphylococci Clostridium Beta-lactams Cloxacillin Cephalosporins Recommended duration: 1week Necrotizing fascilitis Organism(s) 1st line Alternatives Notes Staphylococci Streptococci Pseudomonas Cloxacillin Gentamici Unasyn Metronidazole Recommended duration: 1week Pancreas Necrotizing pancreatitis Organism(s) 1st line Alternatives Notes 2nd / 3rd generation of Cephalosporins Metronidazole Gentamicin Amikacin Recommended duration: 1week Pancreatic abcess, Infected pseudocyst Organism(s) 1st line Alternatives Notes Coliforms anaerobs 2nd / 3rd generation of Cephalosporins Metronidazole Recommended duration: 1week Pancreatitis, Acute alcoholic pancreatitis Organism(s) 1st line Alternatives Notes 2nd / 3rd generation of Cephalosporins Metronidazole Recommended duration: 1week
- 9. Edited by CSMU HOW Medical Team Page 9 Peritonium Primary Peritonitis Organism(s) 1st line Alternatives Notes Coliforms anaerobs 2nd / 3rd generation of Cephalosporins Metronidazole Gentamicin Amikacin Recommended duration: dependant on respond Prevention of SPB (cirrhosis & ascites) Organism(s) 1st line Alternatives Notes Coliforms anaerobs 2nd / 3rd generation of Cephalosporins Metronidazole Gentamicin Amikacin Recommended duration: 1week Secondary peritonitis (bowel perforation, ruptured appendix/diverticula) Organism(s) 1st line Alternatives Notes Coliforms anaerobs 2nd / 3rd generation of Cephalosporins Metronidazole Gentamicin Amikacin Recommended duration: dependant on respond ANTIBIOTIC PROPHYLAXIS FOR SURGERY Type Of Surgery Prophylaxis Agent/Dose/Route/Duration Notes AAA repair and vascular bypass surgery IV Ampicillin/Sulbactam 1.5gm TDS x 1week IV Cloxacillin 1gm on induction and 500mg QID x 1 week May continue with oral antibiotics Biliary Laparoscopic cholecyctectomy (high risk) IV Cefoperazone 1g BD x 1 week IV Metronidazole 500mg TDS x 1 week
- 10. Edited by CSMU HOW Medical Team Page 10 Breast IV Cefuroxime 1.5g on induction May be extended in presence of skin infection Colorectal Elective Emergency IV Cefoperazone 1g BD x 1 week IV Metronidazole 500mg TDS x 1 week IV Gentamicin Or Amikacin may be used if indicated Gastrointestinal tract Appendicitis IV Cefoperazone 1g BD x 1 week IV Metronidazole 500mg TDS x 1 week Herniorraphy IV Cefuroxime 1.5g on induction May be extended in presence of skin infection Vascular access IV Ampicillin/Sulbactam 1.5gm IV Cloxacilin 1g May continue with oral antibiotics