This document provides guidelines for rational antibiotic therapy. It discusses the importance of rational antibiotic use to better care for patients, combat antimicrobial resistance, and reduce costs. It outlines strategies for choosing the appropriate antibiotic based on diagnosis, likely pathogens, sensitivity patterns, and patient factors. Specific antibiotic recommendations are provided for common bacterial infections affecting various body systems like skin, ENT, respiratory, GI, urinary, CNS, and cardiovascular. It also discusses approaches for antibiotic prophylaxis and strategies to prevent antibiotic resistance.

1. DR SANDIP GUPTA
PGT,PEDIATRICS
B.S.M.C.H.
RATIONAL ANTIBIOTIC THERAPYRATIONAL ANTIBIOTIC THERAPY

2. Why Rational Antibiotic Therapy ?
• Better care of patients.
• Combating antimicrobial resistance.
• Prevent misuse of antibiotics.
• Reduce cost of treatment.

3. Misuse of antibiotics
• Lack of awareness & evidence based practice.
• Fear of secondary infection.
• False sense of security.
• Fear of losing patients.
• Parental anxiety & pressure.

4. • Is an antibiotic really necessary?
• Must have a provisional diagnosis.
• Predict the organisms.
• Consider stensitivity pattern.
• Narrowest spectrum, least toxic, less costly.
• Host factors.
• Co existing medical problem.
HOW TO CHOOSE ANTIBIOTICS

5. • Skin & soft tissue infections
• ENT infections
• LRTI
• GI infections
• UTI
• CNS infections
• CVS infections
• Osteoarticular infections
Common bacterial infections

6. • This includes impetigo, pyoderma, abscesses,
lymphadenitis, pyomyositis & bites.
• Common organism responsible : GrA
streptococcus,staphylococcus.
• 1st generation cephalosporins
(cephalexin,cefadroxil) amoxyclav, cloxacillin.
• Duration of therapy is 5-10 days.
Skin & soft tissue infection

7. ENT INFECTIONS
Otitis media & sinusitis:
cover pseudomonas, H influenze &
moraxella.
(a) 1st line: Amoxycillin for 5 to 10 days.
(b) 2nd line: coamoxyclav/inj
ceftriaxone/macrolide.
(c) for sinusitis complete at least 14-21 days
of therapy

8. LOWER RESPIRATORY TRACT
INFECTIONS
Community acquired:
Cover for Gp A streptococcus, pneumococcus, &
staph aureus in infants& toddlers . Atypical
agents in school age & adolescent.
(a) Outpatient– consider in less severe illness.
(i) Amoxycillin.
(ii)coamoxyclav/cefpodoxime/cefuroxime axetil.
(iii) Add macrolide if atypical pneumonia
suspected.

9. Cont.
(b) Hospitalized:
 1st line:inj cetriaxone/inj cefotaxime/inj cefuroxime for 10 to 14 days
 if staph is suspected (rapid evolution,empyema,pneumatocele)
initial antibiotic should include vancomycin or clindamycin.
 Add macrolides if atypical pneumonia is suspected.
 Respiratory floroquinolones are alternative in adolescence
 Reassess choice of antibiotic after 48 -96 hrs if no response/modify as
per results of cultures, look for other factors.

10. GASTROINTESTINAL INFECTIONS
1.Cholera: Doxycycline 4mg/kg/day bid for 3d cotrimoxazole,
erythromycin, furazolidone.
2. Enteric fever:
3rd gen cephalosporin (14 days), azithromycin.
3. Acute dysentery: ciprofloxacin 30mg /kg for 5d.
4. Peritonitis:
(a) SBP– inj cetriaxone/inj cefotaxime.
(b) Secondary to bowel pathology– inj meropenem/inj
imipenem/inj ampicillin+inj gentamycin+inj clindamycin

11. URINARY TRACT INFECTIONS
1. Uncomplicated UTI:
oral:cefixime,amoxyclav,cephalexin,floroquinolones
for 7-10 days.
2. Complicated UTI:
inj ceftriaxone,amikacin,amoxyclav for 10-14
days.
3. Prophylaxis:
Nitrofurantoin/cotrimoxazole,cephalexin,cefadroxil.

12. CNS INFECTIONS
Meningitis:
Empirical– inj vancomycin + inj ceftriaxone/inj
cefotaxime .
H influenza-ceftriaxone/cefotaxime for 7-10 d
Pneumococcus– If penicillin susceptible inj penicillin G
or 3rd gen cephalosporin . If resistant continue on
inj ceftriaxone+ inj vancomycin for 10-14 days.
N.Meningitidis-inj penicillinG 4lacU/kg/d for 5-7 d.
Gm –ve organism t/t for 3 wks with 3rd gen
cephalosporin (ceftazidime for pseudomonas).
Brain abcess t/t for 4-6 wks with 3rd gen cephalosporin
+ inj vancomycin + metronidazole.
2nd Line: meropenem+ vancomycin

13. CARDIOVASCULAR INFECTIONS
Endocarditis:
inj vancomycin & inj gentamycin to start with. Modify as per
c/s report.
(a) inj penicillin G / inj ceftriaxone & inj gentamycin/ inj
vancomycin in case of S Viridans.
(b) Enterococcus– Ampicillin/vancomycin & inj gentamycin.
(c)S aureus/ Epidermidis– inj vancomycin/ inj cloxacillin & inj
gentamycin for 6wks.
(d) Pneumococcus/ Gonococcus/ Gp A streptococcus– inj
penicillin G/ inj ceftriaxone/ inj vancomycin.
HACEKorganisms: inj ceftriaxone & inj gentamycin for 6wks
Gm-veorganisms:piperacillin/ceftazidime+gentamycin 6wks

14. OSTEOARTICULAR INFECTIONS
1. Bacterial arthritis/ osteomyelitis:
Cover S aureus & Gp A streptococcus;
Pneumococcus & H influenze in infancy. Modify
therpy according to c/s reports.
(a) 1st line: inj cloxacillin iv for 21 days followed by
oral therapy for a total of 4-6 weeks+ceftriaxone.
(b) 2nd line: inj vancomycin or inj clindamycin for
21 days followed by oral therapy for a total
period of 4-6 weeks. Use as first line if MRSA is
suspected.
.

15. Antibiotic prophylaxis
• UTI: in infants waiting imaging, VUR,
Frequent febrile UTI(30 or more/yr).
• Rheumatic fever
• Tuberculosis
• IE prophylaxis
• Pertussis contacts

16. Stratergies to prevent antibiotic
resistance
• Optimal use of antimicrobials.
• National protocol .
• Restriction policy.
• Antibiotic cycling.
• Combination therapy.
• Surveillance for resistant bacterial pathogen.

17. Non antimicrobial prevention
stratergies
Primary prevention programme for specific
infections
a. Adoption of WHO stratergies, e.g.DOTS.
b. Vaccines & immunoglobins.
c. Reducing length of hospital admission.
d. Avoiding invasive procedures.
Prevention of horizonital transmission
a. Hand washing
b. Gloves & gowns
Health education