Antibiotic Guideline By Bsmmu 2016 5m5c15
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12/19/2015
Antibiotic Guideline
List of recommendations arranged according to system and diseases (According to alphabetical order)
Central Nervous system Community acquired Meningitis (CAM) Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumonia
Inj. Meropenem (2 gm) 8 hourly for 14 days plus/ or
Neisseria meningitides Haemophilus influenza Staphylococcus aureus
Inj. Linezolid (600 mg) 12 hourly
Herpes simplex
Inj. Acyclovir (500 mg) 6 hourly for 14 days if viral infection
Alternative drug 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
Pyogenic Meningitis Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Dentistry Acute variceal haemorrhage Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Cleft lippalate, facial cleft, facial deformity correction surgery Likely causative agent
Antimicrobial of choice Preferred drug Inj. Ceftriaxone (1 gm) 12 hourly Tab. Metronidazole (500 mg) 8 hourly for 57 days followed by or Cap. Cephalosporins Tab. Metronidazole
Alternative drug Inj. Meropenem (1 gm) 8 hourly I/V for 7 days, followed by Cap. Cephalosporins Tab. Metronidazole
Dental abscess Likely causative agent
Antimicrobial of choice Preferred drug
Obligate anaerobes: Prevotella intermedia Prevotella nigresub http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Cap. Flucloxacillin Tab. Metronidazole
Alternative drug Cap. Cepholosporins Cap. Cefixime Cap. Cefuroxime 2/66
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Fusobacterium periodontices Phyromonas endodontics Porphyromonas gingivalis
Tab. metronidazole
Name: For rapidly spreading infections injectable from may be advised
Denture sore mouth Likely causative agent
Antimicrobial of choice Preferred drug
Candida albicans
Antifungal agents eg, Nystatin powder or cream
Alternative drug Antifungal agents eg, Nystatin powder or cream
Denture stomatitis Likely causative agent
Antimicrobial of choice Preferred drug
Candida albicans
Alternative drug
1 antifungal agents (eg, Nystatin powder or cream)
Extraction of tooth surgical/ non surgical Likely causative agent
Antimicrobial of choice Preferred drug Cap. Amoxicillin (500 mg) 8 hourly for 7 days or
Alternative drug 2 of the other 3rd line antibiotic*
Cap. Cefixime (200 mg) 12 hourly for 7 days+ Tab. Metronidazole (400 mg) 8 hourly for 5 days.
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Fungal infections in maxillofacial region like Candidiasis, mucormicosis etc Likely causative agent
Antimicrobial of choice Preferred drug
Fungus
Alternative drug
Nystatin oral suspension (510 ml) of suspension for at least 14 days
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
Cap. Itraconazole (400 mg) 24 hourly for 714 days
Gingivitis Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Cap. Doxycycline Initial : (200 mg/day) divided twice daily post operative first day then. Maintenance : (100200 mg/day) divided 12hrly
Cap. Doxycycline Initial : (200 mg/day) divided twice daily post operative first day then. Maintenance : (100200 mg/day) divided 12 hourly 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.
Hepatorenal syndrome http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred 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]
Alternative drug 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
In case of maxillofacial fracture management like open reduction and fixation Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Meropenem (1 gm) 8 hourly I/V for 7 days, following by Cap. Cephalosporins Tab. Metronidazole
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 Inj. Ceftriaxone (1 mg) 12 hourly Tab. Metronidazole (500 mg) 8 hourly for 57 days followed by Cap.
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug Inj. Meropenem (1 gm) 8 hourly for 7 days, following by Cap. Cephalosporins Tab. Metronidazole
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Cephalosporins Tab. Metronidazole
Jaw osteomyelitis Likely causative agent
Antimicrobial of choice Preferred drug
Mixed anaerobic infection. Commonly by staphylococci and enteric microorganism
Alternative drug
Cap. Clindamycin (600 mg) in divided dose for 6 days to 8 weeks ±
Flucloxacillin (500 mg) 6 hourly for 68 weeks +
Tab. Metronidazole (500 mg) 8 hourly for 7 days
Tab. Secnidazole (2 gm) single dose
Minor oral surgery like biopsy, excision of mucocele etc Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Oral Candidiasis Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Peptostreptococcus http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antifungal agents eg, Nystatin powder or cream
Alternative drug Clotrimazole or Nystatin lozenges 6/66
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Bacteroides
Orofacial space infections Likely causative agent
Antimicrobial of choice Preferred 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.
Alternative drug 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
Peri implantitis Likely causative agent
Antimicrobial of choice Preferred drug
Prevotella intermedia Pseudomonas aeruginosa Staphylococcus spp. Peptostreptococcus micros Porphyromonas ednodontalis
Alternative drug
Cap. Cephalosporins (200400 mg ) 612 hourly for 7 days Metronidazole (400 mg) 57 days
Name: Safe in pregnancy
Periapical Pathosis Likely causative agent
Antimicrobial of choice Preferred drug
Prevotella melaninogenica Streptococcus anginosus http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Cap. Cephalosporins (200400 mg) 612 hourly for 7 days.
Alternative drug Tab. Metronidazole (400 mg) 6 hourly for 7 days
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Porphyromonas gingivalis Peptospreptococus Microbes
Pericoronitis Likely causative agent
Antimicrobial of choice Preferred drug
Porphyromonas gingivalis Fusobacterium species Peptostreptococcus micros Fusobacterium nucleatum
Alternative drug
Tab. Penicillin V (250500 mg) post operative 6 hourly for 57 days
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
Tab. Metronidazole (200400 mg) orally 8 hourly for 35 days
Cap. Cephalosporins
Periodontitis Likely causative agent
Antimicrobial of choice Preferred drug
Prohyromonas gingivalis Bacteroides forsythus Antinobacillus actinomycente Prevotella intermedia Fusobacterium nucleatum Peptostreptococcus micros
Alternative drug
Tab. Metronidazole (200400 mg) 8 hourly for 35 days
Cap. Cephalosporins (2004000 mg) 612 hourly for 7 days ± Metronidazole
Cap. Amoxicillin (500 mg) 6 hourly 57 days Cap. Doxycycline (200 mg) 24 hourly
Amoxicillin
Prevotella oralis
Primary & secondary prophylaxis for variceal haemorrhage Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 8/66
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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
Prophylaxis Likely causative agent
Antimicrobial of choice Preferred drug Cap. Amoxicillin (3 gm)prior to surgery.
Alternative drug Cap. Clindamycin 3 gm prior to surgery Cap. Amoxicillin 3 gm prior to surgery
Pulpits Likely causative agent
Antimicrobial of choice Preferred drug
Obligate anaerobes: Peptostreptococcus anaerobius Veillonella parvula Lactobacilus cateraforme Porphylaomonas endodontic
Cap. Amoxicillin (500 mg) (preferably with clavulanic acid)or
Alternative drug Cap. Cefixime Cap. Cefuroxime
Cap. Cephradine Tab. Metronidazole
Facultative anaerobes: Streptococcus mitis Streptococcus oralis Enterococcus faucal Neisseria
Viral infection in lip/oral cavity like herpes simplex infection Likely causative agent
Antimicrobial of choice Preferred drug
Herpes viruses
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Acyclovir (400 mg) orally 8 hourly for 710 days
Alternative drug Tab.Valacyclovir (1 gm) 12 hourly for 710 9/66
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Acyclovir ointment for topical application
days Acyclovir ointment for topical application
Dermatology Acne Vulgaris Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Cap. Amoxicillin (250500 mg) 8 hourly Tab. Trimethoprim Sulfamethoxazole in double strength 12 hourly
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
Cellulitis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcal Streptococcal or http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Coamoxiclav (625 mg) 8 hourly 10/66
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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
Chancroid Likely causative agent
Antimicrobial of choice Preferred drug
Haemophilus ducreyi
Alternative drug
Tab. Azithromycin (1 gm) Oral single dose
Inj. Ceftriaxone (1 gm) stat dose with Tab. Ciprofloxacin
Inj. Ceftriaxone (250 mg) I/M single dose
Tab. Levofloxacin (750 mg) 24 hourly 7 days
Tab. Ciprofloxacin (500 mg) 12 hourly for 2 days Erythromycin (500 mg) 8 hourly for 7 days
Cutaneous Anthrax Likely causative agent
Antimicrobial of choice Preferred drug
Bacillus antharacis
Alternative drug
Tab. Ciprofloxacin (500 mg) 12 hourly for14 days Cap. Doxycycline (100 mg) 12 hourly for 14 days
Cutaneous Tuberculosis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Mycobacterium Tuberculosis
Alternative drug
Cap. Rifampicin (400600 mg) single dose
Inj. Clarithromycin or Tab. Ofloxacin or
Tab. Isoniazid (300 mg) single dose
Tab. Ciprofloxacin or
Tab. Ethambutol (1525 mg/kg/day) or
Inj. Capreomycin or
Inj. Streptomycin (75 mg1gm) single dose
Inj. Cycloserine or Tab. Paraaminosalicyclic acid Tab. Ethionamide.
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
Gonorrhoeae Likely causative agent
Antimicrobial of choice Preferred drug
Neisseria gonorrhea
Alternative drug
Single doses of any of the following orally: Cap. Cefixime (300 mg) Tab. Ciprofloxacin (500 mg) Tab. Ofloxacin (400 mg) Tab. Levofloxacin (250 mg)
Impetigo contagiosa Likely causative agent http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice 12/66
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Preferred drug Staphylococcal Streptococcal or
Cap. Dicloxacillin (250500 mg)
Combined
Tab. Coamoxiclav (625 mg) 8 hourly Cap. Cephalexin (250500 mg) 6 hourly for 7 days
Alternative drug Tab. Clindamycin (30 mg) 8 hourly Cap. Erythromycin (250500 mg) 6 hourly for 7 days
Leprosy Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Clarithromycin (500 mg) single dose Tab. Minocycline (100 mg) single dose Tab. Ofloxacin (400 mg) single dose Tab. Levofloxacin (500 mg) single dose
Tab. Clofazimine (50 mg) single dose plus Cap. Rifampicin (600 mg) monthly for 1 year
Syphilis Likely causative agent
Antimicrobial of choice Preferred drug
Treponema pallidum
Inj. Benzathin penicillin 12 lac unit I/M in each buttock day one day eight and day fifteenth according to stages
Alternative drug Cap. Doxycycline (100 mg) 12 hourly for 2 weeks Cap. Erythromycin (500 mg) 6 hourly for 14 days Inj. Ceftriaxone
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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(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
Endocrine System Sepsis/ Septicemia Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Streptococcus pyogens Pseudomonas aeruginosa
Alternative drug
Inj. Ceftriaxone (2 gm) 12 hourly at least for 710 days
Inj. Piperacillin+ Inj. Tazobactam Inj. Meropenem Inj. AmphotericinB
Staphylococcus aureus
Skin and soft tissue infection e.g. diabetic foot lesion Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus Streptococcus Anaerobes
Alternative drug
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
ive Parotitis (Salivary Gland Infection) Likely causative agent
Antimicrobial of choice Preferred drug Inj. CoAmoxiclav (1.2 gm)
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug Inj. Clindamycin (900 mg) 14/66
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8 hourly Oral then: Tab. CoAmoxiclav (625 mg) 8 hourly 1014 days
8 hourly Oral then: Tab. Clindamycin (450 mg) 8 hourly
Gastro Intestinal System Acute gastroenteritis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli
Alternative drug
Tab. Azithromycin (500 mg) 2 tab stat then 1 tab for 4 days
Campylobacter Shigella Salmonella
Tab. Ciprofloxacin (500 mg) 12 hourlyfor 7 days Tab. Metronidazole (400 mg) 8 hourlyfor 57 days
Clostridium difficile
Name: Pseudomembrenous colities by clostridium difficile is an important cause of gastroenteritis following use of other antibiotics
Abdominal Sepsis Likely causative agent
Antimicrobial of choice Preferred drug
Acinatobacter Enterococci faecalis Bacteroides fragilis
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 7 14 days plus Inj. Amikacin (500 mg) 12 hourly for 7 days.
Cholangitis Likely causative agent
Antimicrobial of choice Preferred drug
Gram negative http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Inj. Meropenem 15/66
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anaerobes
(500 mg) 8 hourly
Gastroenteritis, Typhlitis Likely causative agent
Antimicrobial of choice Preferred drug
Candida
Alternative drug
Enterococcus faecalis
Inj. Cefepime (500 mg) 8 hourly
Aspergillus
Piperacillin/Tazobactam
Anaerobes
Vancomycin Itraconazole
Name: Liver function test necessary
Necrotizing Pancreatitis (infected) Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Inj. Piperacillin/Tazobactam (4.5 gm) 68 hourly for 714 days
Inj. Meropenem (1 gm) 8 hourly for 714 days plus
Plus Inj. Amikacin (500 mg) 12 hourly for 7 days Plus
Inj. Amikacin (500 mg) 12 hourly for 7 days plus
Tab. Metronidazole (500 mg) 8 hourly 7 days
Inj. Clindamycin (600 mg) 8 hourly for 714 days
Peptic ulcer disease Likely causative agent
Antimicrobial of choice Preferred drug
Helicobacter pylori
Tab. Levofloxacin (500 mg) 12 hourly for 14 to 30 days
Alternative drug Cap. Tetracycline (500 mg) 6 hourly for 14 to 30 days
Tab. Metronidazole (400500 mg) http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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8 hourly for 1430 days Name: Duration depending on the nature and severity of the infection
Secondary bacterial peritonitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Other gut pathogens
Alternative drug
Inj. Meropenem (500 mg) 8 hourly
Spontaneous bacterial peritonitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Proteus
Tab. Levofloxacin (500 mg) 12 hourly for 14 to 30 days
Alternative drug Inj. Coamoxiclav (1 gm/0.2 gm) 8 hourly for 5 days
Tab. Metronidazole (400500 mg) 8 hourly for 1430 days Inj. Cefotaxime(2 gm) 12 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.
Hepatobiliary system Amoebic liver abscess Likely causative agent
Antimicrobial of choice Preferred drug
Entamoeba histolytica http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Inj. Metronidazole (750 mg)
Alternative drug Nitazoxanide (500 mg) 17/66
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8 hourly for 510 days
12 hourly for 3 days Tinidazole, Orrnidazole (2 gm) 24 hourly for 3 days
Antiviral used in Hepatitis B infection (Chronic Hepatitis B) Likely causative agent
Antimicrobial of choice Preferred drug
Hepatitis B Viris Treatment is indicated: HBVDNA>2000 IU/ml ALT> Upper limit of normal Histology= moderate to severe necroinflammation & significant fibrosis
Alternative drug
Tab. Tenofovir (300 mg) 24 hourly
Tab. Lamivudine (100 mg) 24 hourly
Tab. Entecavir (0.5 mg) once daily
Tab. Adefovir (10 mg) 24 hourly Tab.Telbivudine (600 mg) 24 hourly Inj. PEGIFN2a (180 µg) subcutaneously weekly for 12 months
Antiviral used in Hepatitis C infection (Chronic Hepatitis C) Likely causative agent
Antimicrobial of choice Preferred drug
HCV Genotype 1
Alternative drug
Inj. PEGIFN+ Tab. Simeprevir+ Cap. Ribavirin for 12 weeks
Inj. PEGIFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks and
Tab. Sofosbuvir+ Cap. Ledipasvir for 12 weeks
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
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Tab. Sofosbuvir+ Cap. Ledipasvir for 12 weeks
Inj. PEGIFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks and 18/66
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Tab. Sofosbuvir+ Cap. Daclatasvir for 12 weeks HCV Genotype 3
HCV Genotype 4
Inj. PEGIFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks
Tab. Sofosbuvir+ Cap. Ribavirin for 24 weeks
Inj. PEGIFN+ Tab. Simeprevir+ Cap. Ribavirin for 12 weeks
Inj. PEGIFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks and
Tab. Sofosbuvir+ Tab. Ledipasvir for 12 weeks
Inj. PEGIFN+ Cap. Ribavirin for next 1236 weeks
Tab. Sofosbuvir+ Tab. Daclatasvir for 12 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
Cholangitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pneumoniae Pseudomonas Proteus
Inj. Piperacillin Tazobactam (3.375 gm) 6 hourly
Alternative drug Inj. Meropenem (1 gm) 8 hourly
Hepatic actinomycosis Likely causative agent http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice 19/66
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Preferred drug Actinomyces israelii
Benzy1 Penicillin
Alternative drug Doxycycline and Clindamycin
Name: Percutaneous liver biopsy relveals suphaur granules with typical organism
Hydatid disease of liver Likely causative agent
Antimicrobial of choice Preferred drug
Echinococcus granulosus
Surgery followed by Tab. Albendazole (400 mg) 12 hourly for 1 month
Alternative drug PAIR followedby Tab. Albendazole (400 mg) 12 hourly for 1 month
Tab. Albendazole (400 mg) for 1 month then 14 days interval, total 36 cycles Name: PAIR is as effective as surgery. (WHO guideline 1996)
Leptospirosis Likely causative agent
Antimicrobial of choice Preferred drug
Leptospira icterohaemorrhagiae
Inj. Benzyl Penicillin (900 mg) 1.5 million unit 6 hourly for 1 week
Alternative drug Inj. Ceftriaxone (1 gm) 24 hourly for 1 week
Name: Blood culture during limit 10 days or urine culture during 2nd week
Melioidosis Likely causative agent
Antimicrobial of choice Preferred drug
Burkholderia pseudomallei
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Inj. Ceftazidime (2 gm) 8 hourly for 23 weeks followed by
Alternative drug Inj. Meropenem (0.51 gm) 8 hourly for 23 weeks followed by 20/66
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Cap. Doxycycline (200 mg) 24 hourly plus
Cap. Doxycycline (200 mg) 24 hourly plus
Tab. Co trimoxazole (80/400 mg)
Cotrimoxazole
Pyogenic liver abscess Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pneumoniae Viridans streptococci Streptococcus Pneumoniae
Alternative drug
Inj. Ciprofloxacin (500 mg) 12 hourly
Piperacillin/ Tazobactam
Inj. Ceftriaxone (1 gm) plus 12 hourly
Meropenem
Imipenem/ Cilastatin Coamoxiclav
Inj. Metronidazole for 2 weeks and then oral for 4 weeks.
Infectious Disease Bacterial vaginosis Likely causative agent
Antimicrobial of choice Preferred drug
Anaerobes
Tab. Metronidazole (500 mg) 8 hourly Tab. Clindamycin (80 mg) 8 hourly
Alternative drug Tab. Metronidazole (500 mg) 8 hourly Tab. Clindamycin (80 mg) 8 hourly
Febrile Neutropenia Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus Pseudomonas http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Inj. Meropenem (1 gm) 8 hourly for 710
Alternative drug Inj. Meropenem (1 gm) 8 hourly for 710 21/66
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Streptococcus
days
days
Escherichia coli Klebsiella Name: Culture sensitivity prefered preceded by emperical treatment
Genital Herpes Likely causative agent
Antimicrobial of choice Preferred drug
Herpes simplex type I or type II
Tab. Acyclovir (400 mg) 8 hourly for 710 days
Alternative drug Tab. Famcyclovir (250 mg) orally 8 hourly for 710 days Tab. Valacyclovir (1 gm) 12 hourly for 710 days
Kalaazar Likely causative agent
Antimicrobial of choice Preferred drug
Leishmania
Inj. Liposomal Amphotericin B (10 mg/kg) not less than in 2 hours single dose.
Alternative drug 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
Malaria Likely causative agent
Antimicrobial of choice Preferred drug
Plasmodium sepsis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Tab. Artemether Lumefantrine
Alternative drug Chloroquine 22/66
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Quinine (10 mg/kg) 8 hourly for 7 days
Doxycycline Tetracycline
Neutropenic fever, Cellulitis Likely causative agent
Antimicrobial of choice Preferred drug
Mostly Unknown Gram negative Escherichia coli
Inj. Meropenem (500 mg) 8 hourly plusInj
Alternative drug Ceftazidime Cefepime
Amikacin (500 mg) I/V 12 hourly for 7 days Name: ANC <500X10L, Hyperemtivity
Pelvic inflammatory disease 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 http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Tab. Ofloxacin (400 mg) post operative 12 hourly to complete 14 days
Post of Infection Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas
Inj. Amikacin (500 mg) 12 hourly
Alternative drug Netlimicin
Post of Infection Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli
Ceftriaxone (1 gm) 24 hourly
Alternative drug Meropenem
Secondary fungal infection e.g. oral thrush Likely causative agent
Antimicrobial of choice Preferred drug
Candida species
Alternative drug
Fluconazole plus Locally Nystatin/ Miconazole
Secondary infection in malignant lesion Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas Staphylococcus Streptococcus
3rd generation Cephalosporins plus Metronidazole
Alternative drug 2nd Generation Cephalosporins or Quinolone derivatives
Sepsis/ Acute PID http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Gm negative
Alternative drug
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
Sepsis/ Septicemia Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli, Klebsiella
Inj. Ceftriaxone (2 gm) 12 hourly at least for 710 days
Streptococcus pyogens Pseudomonas aeruginosa Staphylococcus aureus
Alternative drug Inj. Piperacillin + Inj. Tazobactam Inj. Meropenem Inj. AmphotericinB
Sepsis uncertain focus Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Inj. Cefepime (1 gm) 8 12 hourly for 7 14 days
Inj. Meropenem (1gm) 8 hourly for 714 days plus
Inj. Vancomycin (1 gm) 12 hourly
Inj. Metronidazole (500 mg) 8 hourly for 7 days
Inj. Amikacin (500 mg) 12 hourly for 7 days Plus Inj. Metronidazole http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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(500 mg) 8 hourly for 7 days
Septicemia Likely causative agent
Antimicrobial of choice Preferred drug
According to source of infection
Inj. Meropenem (1 gm) 6 hourly
Alternative drug Inj. Piperacillin/ Tazobactam (4.5 gm) 8 hourly
Sick Immunocompromised (febrile neutropenia) Likely causative agent
Antimicrobial of choice Preferred drug Inj. Meropenem (1 gm) 8 hourly for 714 days or/plus Inj. Meropenem (1 gm) 8 hourly for 714 days or/plus
Alternative drug Inj. Linezolid (600 mg) 12 hourly or/plus Inj. Piperacillin/Tazobactam (4.5 gm) 68 hourly for 714 days
Quinolone 714 days
Trichomoniasis Likely causative agent
Antimicrobial of choice Preferred 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
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 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 26/66
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partners
Uncomplicated Chlamydial Infection Likely causative agent
Antimicrobial of choice Preferred drug If poor compliance: Tab. Azithromycin (1 gm) post operative stat dose If Pregnant:
Alternative drug Inj. Clarithromycin or Tab. Ofloxacin or
Tab. Erythromycin (500 mg) post operative 6 hourly for 7 days or Tab. Erythromycin (500 mg) post operative 12 hourly for 14 days
Valvovaginal Candidiasis (non regnant) Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Venous aseptic site of infection Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 27/66
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Staphylococcus epidermises Staphylococcus aureus Pseudomonas
< Inj. Cephalosporins
Inj. Ceftriaxone (1 2 gm) 12 hourly
Inj. Amikacin Tab. Linezolid Cap. Flucloxacillin
Inj. Amikacin (500 mg) 12 hourly
Tab. Ciprofloxacin
Name: Sterelity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained
Venous harvesting site wound infection of leg Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus aureus Streptococcus pyogens Pseudomonas Escherichia coli
Inj. Ceftriaxone (1 2 gm) 12 hourly Inj. Amikacin (500 mg) 12 hourly
Alternative drug 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
VTI, Septicemia Likely causative agent
Antimicrobial of choice Preferred drug
Gram positive Staphylococcus aureus Pseudomonas
Alternative drug
Inj. Ceftriaxone (1 gm) 24 hourly Inj. Imipenem (500 mg1gm) 8 hourly
Name: Steroid coverage with antimicrobial therapy may be required
Wound infection Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Staphylococcus aureus http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Cream Gentamicin apply locally 23 28/66
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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
Kidney and Urinary System Acute Pyelonephritis Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
ESWL Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 29/66
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Fluoroquinolones TMP/SMX
Inj. Aminoglycosides Tab. Amoxicillin 1st/2nd generation Cephalosporins
Lower urinary tract infection (cystitis) in pregnancy UTI Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas Enterococcus
Cap. Nitrofurantoin (100 mg) 6 hourly for 7 days
Alternative drug Cap. Cephalexin (500 mg) 8 hourly for 7 days
Tab. Pivmecillinam (400 mg) stat & (200 mg) 8 hourly for 7 days
Non Gonococcal Urethritis Likely causative agent
Antimicrobial of choice Preferred drug
Chlamydia trachomatis Ureplasma urealyticum Mycoplasma Genetalium
Cap. Doxycycline (100 mg) 12 hourly for 7 days Tab. Azithromycin (1 gm) single dose
Alternative drug 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
PCNL Likely causative agent
Antimicrobial of choice Preferred drug 1st/2nd generation Cephalosporins or
Alternative drug Aminoglycosides Fluoroquinolones
Inj. Aminoglycosides Tab. http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Metronidazole or Clindamycin
Prostatitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli
TMP/SMX for 4 weeks
Enterobacteriaceae Pseudomonas
Alternative drug Fluoroquinolones
Enterococci Enterococcus
Prostatic biopsy Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Fluoroquinolones
TMP/SMX
1st/2nd generation Cephalosporins
Aminoglycosides
Surgical prophylaxix: Urethrocystoscopy, Urodynamic study, Ureteroscopy, TURP, TURBT Likely causative agent
Antimicrobial of choice Preferred drug Fluoroquinolones TMP/SMX
Alternative drug Inj. Aminoglycosides Inj. Ampicillin 1st/2nd generation Cephalosporins CoAmoxiclav
Urinary Tract Infection Likely causative agent Escherichia coli http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice Preferred drug Tab.
Alternative drug Coamoxiclav 31/66
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Klebsiella Pseudomonas Staphylococcus aureus Candida albicans
Ciprofloxacin (500 mg) 12 hourly for 7 10 days
Cefuroxime+Clindamycin
Urinary Tract Infection (acute uncomplicated cystitis) Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Urosepsis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Proteus Klebsiella Enterococci Candia
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Alternative drug 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) 32/66
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Urological Surgery involving intestine e.g.: GI tract, Skin+ intestine Likely causative agent
Antimicrobial of choice Preferred drug 2nd/3rd generation Cephalosporins Inj. Aminoglycosides Tab. Metronidazole or
Alternative drug Inj. Ampicillin Inj. Ticarcillin/ Co Amoxiclav Inj. Piperacillin/ Tazobactam Fluoroquinolones
Clindamycin
Musculoskeletal system Acute and chronic pyogenic Osteomyelitis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus Staphylococcus pyogens
Inj. Ceftriaxone (1 gm) 12 hourly Inj. Flucloxacillin (250 mg1 gm) 6 hourly
Alternative drug Inj. Cefuroxime (750 mg) 12 hourly
Deep sternal wound infection Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus pyogens Streptococcus aureus Pseudomonas Escherichia coli Fungal
Inj.Meropenem (500 mg1 gm) 18 hourly Inj. Amikacin (500 mg) 12 hourly
Alternative drug 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
Elective Surgery http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Prophylactic purpose
Alternative drug
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
Septic arthritis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus Haemophilus influenza Enterobacter Species
Alternative drug
Inj. Ceftriaxone (1 gm) 12 hourly Inj. Flucloxacillin (250 mg1 gm) 12 hourly
Name: Preferred culture sensitivity report
Skin & Soft tissue infection Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus pyogens Staphylococcus aureus
Cap. Flucloxacillin (500mg) 6 hourly
Alternative drug Tab. Clarithromycin (500mg) 12 hourly and Cap. Clindamycin (450 60mg) 6 hourly
Superficial sternal wound infection http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus Streptococcus pyogens Escherichia coli Pseudomonas
Inj. Ceftriaxone (1 2 gm) 12 hourly Inj. Amikacin (500 mg) 12 hourly
Alternative drug 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
Tubercular Osteomyelitis Likely causative agent
Antimicrobial of choice Preferred drug
Mycobacterium aureus
Alternative drug
1st line anti tubercular drugs
Wound infections Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus aureus Pseudomonas pyogenosa Klebsiella Enterobacteriaceae
Alternative drug
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
Obstetrics and Gynaecological Procedure D&C, endoscopic or other minor procedure Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 35/66
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Anaerobes
Not needed
Caesarean section Likely causative agent
Antimicrobial of choice Preferred drug
Prophylaxis
Inj. Amoxiclav (1.2 gm) 8 hourly
Alternative drug Inj. Clindamycin (900 mg) 8 hourly
Name: Review culture reports
Infected wound Caesar/ Perineal tear and episiotomy Likely causative agent
Antimicrobial of choice Preferred drug
Gram negative Staphylococcus Escherichia coli Pseudomonas
Alternative drug
Inj. Flucloxacillin (900 mg) 8 hourly+ Inj. Metronidazole (500 gm) 8 hourly followed by oral for 7 days
Intra partum pyrexia Likely causative agent
Antimicrobial of choice Preferred drug
Prophylaxis
Inj. Amoxicillin (2 gm) + Inj. Metronidazole (500 mg) initially followed by
Alternative drug Inj. Clindamycin in penicillin allergy group
Inj. Amoxicillin (500 mg) 8 hourly + Inj. Metronidazole (500 mg) 8 hourly till delivery Inj. Gentamicin if severe sepsis 5 days for oral antibiotics http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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after delivery
Placenta Removal,4 Degree Tear, Major Surgery, Extensive Oncological Surgery Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
IVsingle dose only at induction
Post operative Gynaecological Sepsis 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 http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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diarrhoea or if Gentamicin is contraindicated ( GHNHSFT protocol ) consult microbiologist. Duration: 57 days and then review. Consult Microbiologist
Prophylaxis Hysterectomy Laparotomy Vaginal Repair Likely causative agent
Antimicrobial of choice Preferred drug Inj. Ceftriaxone (2 gm) 12 hourly at least for 710 days
Alternative drug 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
Surgical Prophylaxis Obstetric & Gynaecological Surgery Hysterectomy Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
IVsingle dose only at induction
Opthalmology Antibiotics used in surgical prophylaxis: Cataract surgery, Glaucoma surgery, Dacryocystitis (Chronic) Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 38/66
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Moxifloxacin 0.3% Gatifloxacin 0.3% 1 drop g.i.d.
Levofloxacin 0.3%
Bacterial Uveitis Likely causative agent
Antimicrobial of choice Preferred drug
Mycobacterium tuberculosis Mycobacterium Bovis Treponema. pallidum
Alternative drug
According to cause AntiTB AntiSyphilis (systemic regimen to be followed)
Name: Aquaus and vitreous sample for culture sensitivity
Conjunctivitis Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumonia Staphylococcus aureus Haemophilus influenzae Moraxella catarrhalis Neisseria gonorrhea Neisseria meningitides Chlamydia trachomatis
Chloramphenicol Aminoglycosides (Gentamicin, Neomycin) Quinolones (Ciprofloxacin Ofloxacin)
Alternative drug Tetracycline Fusidic acid Doxycycline Erythromycin Bacitracin
Levofloxacin Lomefloxacin Gatifloxacin Moxifloxacin Polymyxin B Fusidic acid dose (g.i.d. for 1 week)
Name: Conjunctival culture sensitivity needed
Corneal Ulcer Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Pseudomonas Staphylococcus aureus
Ciprofloxacin 0.3%
Moxifloxacin Gatifloxacin
Streptococcus Neisseria Gonorrhoeae
Ofloxacin 03.% Fortified Gentamicin
Doxycycline Tetracycline
Meningitis Coronibacterium diphtheria Haemophilus influenzae Treponema pallidum
Fortified Cephalosporins Procaine Penicillin (g.i.d. for 1 week or according to severity of the disease)
Erythromycin Sub conjunctival antibiotics
Name: Depends on culture sensitivity. Conjunctival sweab and corneal serapping
Dacryocystitis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus Epidermidis Streptococcus viridians Pneumoniae pyogens Escherichia coli
Flucloxacillin (oral) for 1 week Cephradine
Alternative drug Coamoxiclav Cephalosporins Cefixime
Name: Depending on culture sensitivity
Endophthalmitis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus species. Bacillus species
Alternative drug
Ceftazidime (2 mg in 0.1 ml)
Amikacin (0.4 mg in 0.1 ml)
Vancomycin (2 mg in 0.1 ml)
Gentamicin (0.2 mg in 0.1 ml)
Tab. Ciprofloxacin (750 mg) 12 hourly or Moxifloxacin (400 mg) 24 hourly Name: Aquaus vitreous sample for culture sensitivity
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Lid infection Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus
Alternative drug
Ciprofloxacin 0.3% 1 drop g.i.d for 7 days (dose can be readjusted according to severity)
Pyogenes Epidermidis Streptococcus viridans Pneumonia
Moxifloxacin Flucloxacillin
Pyogenes Name: To maintain lid hygine
Neonatal conjunctivitis (Opthalmia Neonatorum) Likely causative agent
Antimicrobial of choice Preferred drug
Chlamydia trachomatis Neisseria Gonorrhoeae
Alternative drug
Penicillin G Topical 1,00,000 3,33,000 units/ml Paediatric 10,000 to 20,000 IU
Silver nitrate 1% solution
Orbital Cellulitis Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Staphylococcus aureus Streptococcus viridans Haemophilus influenzas
Alternative drug
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
Syphilitic eye disease, Syphilitic Uveitis, Optic neuritis, Neuroretinitis Likely causative agent http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice 41/66
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Preferred drug Treponema pallidum
3 to 4 million unit Penicillin G is istered every 4 hourly for 10 to 14 days.
Alternative drug Alternative procaine Penicillin G IM 2.4 million IU daily plus Probenecid (500 mg) oral g.i.d for 10 to 14 days.
Paediatric Central Nervous System Central venous catheter tip Micro organism isolated: 75% Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas 66.66% Staphylococcus aureus 33.33%
Alternative drug
Imipenem (20 mg/kg/dose) 8 hourly Tazobactam + Piperacillin 8 hourly
Meningitis in Children (Bacteria), Young infant Likely causative agent
Antimicrobial of choice Preferred drug
Neisseria meningitides Streptococcus pneumonia Haemophilus influenjae
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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+
Alternative drug Meropenem (40 mg/kg/day) 8 hourly+ Amino glycosides (if pseudomonas)
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Ampicillin (200 400 mg/kg/day) 6 hourly for 10 days
Septicemia CNS infection Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Vancomycin (4560 mg/kg/day) 12 hourly for 10 14 days+ Inj. Meropenem (3040 mg/kg/day) 8 hourly
Paediatric Gastrointestinal System Bacillary dysentery Likely causative agent
Antimicrobial of choice Preferred drug
Shigella species, Shigella dysentery, Shigella flexnari
Cap. Cefixime (8 10 mg/kg/day) 12 hourly for 5 days
Alternative drug Cefixime12 hourly Ceftriaxone (5075 mg/kg/day) 12 hourly
Pivmecillinam (50 mg/kg/day) 6 hourly for 5 days
Cholangitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Staphylococcus aureus
Ceftazidime (150 mg/kg/day)
Alternative drug Meropenem (3040 mg/kg/day)
Amikacin (1520 mg/kg/day)
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Diarrhoea Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Shigella Vibrio cholerae
Azithromycin (10 mg/kg/day)
Alternative drug Ceftriaxone (50200 mg/kg/day)
Ciprofloxacin (15 30 mg/kg/day) Pivrnecillinam
Enteric Fever & Severe Enteric Fever Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Azithromycin (20 mg/kg/day) 24 hourly 7 days Ciprofloxacin (20 30 mg/kg/day) 12 hourly 710 days
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Dexamethasone (3mg/kg)initial flowed by (1 mg/kg) 6 hourly for 48 hours
Giardiasis Likely causative agent
Antimicrobial of choice Preferred drug
Giardia
Metronidazole (15 mg/kg/day) 8 hourly for 5–7 days
Alternative drug Secnidazole
Hydatid cyst http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Echinococcus Granulosus
Alternative drug
Albendazole (15 mg/kg/day) 12 hourly
Intestinal Amoebiasis Likely causative agent
Antimicrobial of choice Preferred drug
Entamoeba Histolytica
Metronidazole (15 mg/kg/day) 8 hourly for 5–7 days
Alternative drug Secnidazole
Liver Abscess Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus aureus Gram negative Anaerobic organism
Alternative drug
Ceftriaxone (50 200 mg/kg/day) Flucloxacillin (50 100 mg/kg/day) Metronidazole
Peritonitis (Ascitic Fluid C/S) Micro organism isolated:4% Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Acinetobactor Escherichia coli
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Ceftazidime (50 mg/kg/dose) 8 hourly Ceftriaxone (100 mg/kg/day) 1224 hourly Amikacin (7.5 mg/kg/dose) 12 hourly
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SBP Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Staphylococcus aureus
Cefotaxime (50200 mg/kg/day) Flucloxacillin (50 100 mg/kg/day)
Alternative drug Meropenem (3040 mg/kg/day)
Paediatric Infectious Disease Abscess 2% Likely causative agent
Antimicrobial of choice Preferred drug
Enterobacter Spesis
Flucloxacillin (25 250 mg) 6 hourly Vancomycin (4560 mg/kg/day) Tazobactam Meropenem (3040 mg/kg/day)
Alternative drug Inj. Vancomycin (4560 mg/kg/day) 12 hourly for 1014 days+ Inj. Meropenem (3040 mg/kg/day) 8 hourly
Oral thrush Likely causative agent
Antimicrobial of choice Preferred drug
Candida albicans
Nystatin (46 lakhs) unit for 6 hourly Miconazole 2% apply 12 hourly
Alternative drug Inj. Vancomycin (4560) 8 hourly for 24 weeks
Septicemia (Blood C/S) 10% Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 46/66
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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
Septicemia (Blood C/S) Micro organism isolated:6% Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Salmonella Enterococcus Pseudomonas Klebsiella
Alternative drug
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
Septic Arthritis Likely causative agent
Antimicrobial of choice Preferred drug
Haemophilus influenza Streptococcus aureus Streptococcus pneumoniae http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Inj. Ceftriaxone (5075 mg/kg/day) 12 hourly for 4 weeks
Alternative drug Inj. Clindarnycin (1040 g/kg/day) 8 hourly Vancomycin (4560 47/66
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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
Skin infection Cellulitis Osteomyelitis Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Vancomycin (4560) 8 hourly for 24 weeks
Throat Swab Micro organism isolated: 12% Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus pyogens 82% Staphylococcus aureus 18%
Alternative drug
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
Wound Swab 2% Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 48/66
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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
Paediatric Surgery Amniotic band of both leg: release of bank and Zplasty in right leg Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococci Micrococci Gram positive rods
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Flucloxacillin(50 100 mg/kg/day) followed by Flucloxacillin
AVM at the root of nose: Excised Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Inj. Ceftriaxone (5075 mg/kg)
AVM of left thigh (Aspirated) (Aspirated fluid: no growth) Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococci Micrococci Gram positive rods
Alternative drug
Inj. Cephradine (50100 mg/kg/day)
Cystic Hygroma (within the abdomen) with sliding hernia: Excision of Cystic hygroma with herniotomy http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas aeruginosa Enterococci
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Flucloxacillin (50100 mg/kg/day) followed by Cefixime (20 mg/kg/day)
Discharging sinus at penoscrotal region: Excision (Pus for C/S: Pseudomonas spp.) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus
Alternative drug
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
Eventration of left dome of diaphragm with umbilical hernia: Plication of the defect and repair of hernia Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pneumoniae Streptococci Pseudomonas Enterococci
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Gentamicin (5 mg/kg/day)
Growth in lower Esophagus: feeding gastrostomy with biopsy from growth http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella pneumonia Streptococcus pneumonia Enterococci
Alternative drug
Cephradine (50 100 mg/kg/day) Inj. Gentamicin (5 mg/kg/day)
Hydrocephalus and Meningomyelocele with urinary and fecal incontinence; Introduction of VP shunt with excision of meningomyelocele Likely causative agent
Antimicrobial of choice Preferred drug
Encapsulated organism: Streptococcus Pneumoniae, Nigeria meningitides, Haemophilus influenza. Non capsulated organism: Listeria monocytogenes
Alternative drug
Inj. Ceftazidime (1520 mg/kg/day) Inj. Amikacin (15 20 mg/kg/day)
Hypospaedias with rotational deformity of penis: Urethroplasty and correction of rotation Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus
Alternative drug
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
Hypospaedias: Urethroplasty Likely causative agent http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice 51/66
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Preferred drug Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus
Alternative drug
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%
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 Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Bactericides Fragilis Streptococcus viridians group
Alternative drug
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
Mass in right gluteal region: Incisional biopsy Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococci, Micrococci, Gram positive rods
Inj. Ceftriaxone (5075 mg/kg/day) followed by oral Cefixime
Alternative drug Streptococcus pyogens 82% Staphylococcus aureus 18%
Meconium ileus with Ileostomy: Ileostomy closure (Stool culture: no http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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organism) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli, Bactericides Fragilis Streptococcus viridians group
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Metronidazole Inj. Amikacin
Nonoperative case of Choledochal cyst Likely causative agent
Antimicrobial of choice Inj. Ceftriaxone (5075 mg/kg)
Penoscrotal hypospaedias: Urethroplasty (Urine c/s: no growth) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella pneumonia Pseudomonas aeruginosa Proteus
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Flucloxacillin (125250 mg/kg/day) followed by oral Cefixime
Perineal hypospaedias with bilateral undescended testes: Urethroplasty with bilateral orchiopexy (Urine c/s: no growth) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
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 53/66
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(1520 mg/kg/day) for 8 days followed by Syrup Cefixime ( 20 mg / kg/day) for 16 days.
Rectourethral fistula: Perineal hole technique anoplasty (Urine C/S: No. growth) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Bactericides Fragilis Streptococcus viridians group
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Metronidazole (1530 mg/kg/day) Inj. Ceftazidime (150 mg/kg/day) Inj. Gentamicin (5 mg/kg/day)
Residual PUV with Left sided VUR: Fulgaration with left sided ureteric re reimplantation Ruine R/M/E: Normal finding (Urine C/S: no organism) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) followed by Inj. Meropenem (3040 mg/kg/day) Inj. Amikacin
Thalasseaemia with Hypersplensim: Splenectomy Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pneumoniae Streptococci Pseudomonas Enterococci http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Phylopen Inj. Amikacin (15 20 mg/kg/day) 54/66
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Paediatric Urinary System Urinary tract infection Acute cystitis Acute pyelo nephrities Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Amikacin (15 20 mg/kg/day) Inj. Gentamicin (5 mg/kg/day) Cap. Nitrofurantoin (57 mg/kg/day) Tab. Cotrimoxazole
Inj. Amikacin (15 20 mg/kg/day) Inj. Gentamicin (5 mg/kg/day) Ceftazidime (150 mg/kg/day)
Urinary tract infection (UTI) Micro organism isolated: 6% Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Enterococci Acinatobacter Pseudomonas
Alternative drug
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
Recurrent UTI prophylaxis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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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
Paediatrics Respiratory System Otitis Media 2% Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas
Ceftriaxone (5075 mg/kg/day) Cefuroxime Ceftazidime (150 mg/kg/day)
Alternative drug Ceftazidime Ciprofloxacin Imipenem Meropenem Netlimicin
Pneumonia Likely causative agent
Antimicrobial of choice Preferred drug
Haemophilus influenjae Staphylococcus aureus Nosocomial: Escherichia coli Streptococcus Pneumoniae Haemophilus influenjae Pseudomonas Klebsiella Staphylococcus aureus Community acquired: http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Alternative drug 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 56/66
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≥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)
RTI 4% Likely causative agent
Antimicrobial of choice Preferred 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)
Alternative drug Imipenem Ciprofloxacin Colistin Tazobactam Piperacillin
Respiratory System Acute Bacterial Rhino sinusitis (severe or persistent symptoms) Likely causative agent
Antimicrobial of choice Preferred drug
Gram positive: Staphylococcus aureus Streptococcus Pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Moraxella catarrhalis Gram negative:
Alternative drug
1st line:
1st line:
Tab. CoAmoxiclav (625 mg) 8 hourly orally 2nd line: Doxycycline oral(100 mg) 12 hourly 10 days
Inj. Clarithromycin (500 mg) 12 hourly 2nd line: Cap. Doxycycline (100 mg) 12 hourly
Pseudomonas aeruginosa Escherichia coli Protease mirabilis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Klebsiella Pneumoniae Enterobacter
Acute Diffused Otitis Externa (Swimmer's ear) Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococus aureus Pseudomonas pyogens Escherichia coli Often mixed flora
Alternative drug
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
Acute Laryngitis Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Antibiotics are NOT Indicated
Acute Localised Otitis Externa (furuncle) Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcal
Cap. Flucloxacillin (1 gm) 6 hourly for 7 days plus Topical steroids
Alternative drug Clarithromycin (500 mg) 12 hourly
Acute Otitis Media http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Staphylococcus aureus Haemophilus influenzae Micrococcus Catarrhalis (Necrotizing) B Haemolytic streptococcus
Alternative drug
Antibiotics should not be routinely prescribed for uncomplicated AOM. For severe disease or when risk of complications:
Antibiotics should not be routinely prescribed for uncomplicated AOM. For severe disease or when risk of complications:
1st Line
1st Line
Cap. Amoxicillin (500 mg) 8 hourly
Clarithromycin (500 mg) 12 hourly
2nd line
2nd line
Tab. CoAmoxiclav (625 mg) 8 hourly 10 days
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
Acute Rhino Sinusitis Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Antibiotics should be Only prescribed in SEVERE infection. Mostly this condition caused by viral
Aspiration pneumonia Likely causative agent Pseudomonas Acinatobacter Enterococci faecalis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice Preferred drug
Alternative drug
Inj. Piperacillin/Tazobactam(4.5 gm) 68 hourly for 714 days plus
Inj. Meropenem (1gm) 8 hourly for 7 14 days 59/66
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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
Chronic Otitis Media Likely causative agent
Antimicrobial of choice Preferred drug
Aerobic: Pseudomonas aeruginosa Escherichia coli Streptococcus aureus Streptococcus Pyogenes Proteus mirabilis Klebsiella species Anaerobic:
Alternative drug
Oral antimicrobial may be added if a susceptible organism is cultured 710 days
Bacteroides Peptostreptococcus Propionibacterium
Community Acquired Pneumonia (CAP) Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Staphylococcus aureus Candia
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Alternative drug 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 60/66
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days (if gram positive infection), or Inj. Ticoplzmin (400 mg) stat and (200 mg) 12 hourly for 714 days, or
Inj. Vancomycin (1 gm) I/V 12 hourly 714 days (if gram positive infection) Inj. AmphotericinB if fungal infection
Cap. Fluclonazole (50100 mg/day) if fungal infection
Epiglottises Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Lung Abscess Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococus
Coamoxiclav Metronidazole
Alternative drug Clindamycin, Vancomycin, Daptomycin, Linezolid
Malignant Otitis Externa Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 61/66
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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
Perichondritis Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas Mixed flora
Alternative drug
1st line Tab. Ciprofloxacin (500mg750mg) for 12 hourly 2nd line: Cap. Clindamycin (450mg) 6 hourly for 46 weeks
Pharyngitis/Tonsillitis Likely causative agent
Antimicrobial of choice Preferred drug
GABHS (common) Arcanobacterium hemolytic (7% or adolescents and adults with pharyngitis) Group C Streptococci (uncommon) Group G Streptococci (uncommon)) Neisseria Gonorrhoeae (uncommon) http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Alternative drug Mild: Tab. Clarithromycin (500 mg) 12 hourly Severe: Inj. Clarithromycin (900 mg) 8 hourly. Oral then Tab. Clindamycin (450 mg) 8 hourly 62/66
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Coronibacterium diphtheria (rare)
Tab. Coamoxiclav (625 mg) 8 hourly for 710 days.
Pneumonia Likely causative agent
Antimicrobial of choice Preferred drug
Mostly unknown Gramve Escherichia coli
Inj. Meropenem (500 mg) 8 hourly plus Inj.Amikacin (500 mg) I/V 12 hourly for 7 days
Alternative drug Ceftazidime Cefepime
Quinsy (peritonsillar abscess) Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Clarithromycin (900 mg) 8 hourly. Oral then Tab. Clindamycin (450 mg) 8 hourly
Respiratory tract infection e.g. bronchitis Pneumonia Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Legionella pneumophetin
3rd / 4th generation Cephalosporins Macrolide
Alternative drug Fluoroquinolones Macrolide
Mycoplasma Haemophilus influenza http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Staphylococcus aureus Name: Nosocomial RTI is common in diabetic patient. Early and agresive treatment is required
Retropharyngeal Abscess Lateral pharyngeal Abscess Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Sore Throat 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 http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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(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.
Upper or lower respiratory tract infection (Oncology) Likely causative agent
Antimicrobial of choice Preferred drug
Pneumococcus Streptococcus Staphylococcus
Alternative drug
Inj. Azithromycin (500 mg1 gm) 24 or 12 hourly for 3 days or
3rd generation Cephalosporins or Quinolone derivatives
Tab. Azithromycin (500 mg) orally 24 or 12 hourly for 3 days or Tab. Coamoxiclav (625 mg) orally 8 hourly for 7 days
Ventilator associated pneumonia (Early VAP) Likely causative agent Pseudomonas Acinatobacter Proteus Klebsiella Staphylococcus aureus http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Inj. Meropenem (1 gm) 8 hourly for 714 days or Inj. Vancomycin (1 gm) 12 hourly or 65/66
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Quinolone for 714 days
Inj. Colistin Sulphate (12 MU) 8 hourly for 714 days
Ventilator associated pneumonia (Late VAP) Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas Acinatobacter Proteus Klebsiella Staphylococcus aureus
Inj. Meropenem (1 gm) 8 hourly plus
Inj. Cefepime (1 gm) 812 hourly
Inj. Amikacin (500 mg) 12 hourly for 7 days
Inj. Vancomycin (1 gm) 12 hourly Inj. Colistin Sulphate (12 MU) 8 hourly for 714 days
Inj. Colistin Sulphate (12 MU) 8 hourly for 714 days
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
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List of recommendations arranged according to system and diseases (According to alphabetical order)
Central Nervous system Community acquired Meningitis (CAM) Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumonia
Inj. Meropenem (2 gm) 8 hourly for 14 days plus/ or
Neisseria meningitides Haemophilus influenza Staphylococcus aureus
Inj. Linezolid (600 mg) 12 hourly
Herpes simplex
Inj. Acyclovir (500 mg) 6 hourly for 14 days if viral infection
Alternative drug 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
Pyogenic Meningitis Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Dentistry Acute variceal haemorrhage Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Cleft lippalate, facial cleft, facial deformity correction surgery Likely causative agent
Antimicrobial of choice Preferred drug Inj. Ceftriaxone (1 gm) 12 hourly Tab. Metronidazole (500 mg) 8 hourly for 57 days followed by or Cap. Cephalosporins Tab. Metronidazole
Alternative drug Inj. Meropenem (1 gm) 8 hourly I/V for 7 days, followed by Cap. Cephalosporins Tab. Metronidazole
Dental abscess Likely causative agent
Antimicrobial of choice Preferred drug
Obligate anaerobes: Prevotella intermedia Prevotella nigresub http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Cap. Flucloxacillin Tab. Metronidazole
Alternative drug Cap. Cepholosporins Cap. Cefixime Cap. Cefuroxime 2/66
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Fusobacterium periodontices Phyromonas endodontics Porphyromonas gingivalis
Tab. metronidazole
Name: For rapidly spreading infections injectable from may be advised
Denture sore mouth Likely causative agent
Antimicrobial of choice Preferred drug
Candida albicans
Antifungal agents eg, Nystatin powder or cream
Alternative drug Antifungal agents eg, Nystatin powder or cream
Denture stomatitis Likely causative agent
Antimicrobial of choice Preferred drug
Candida albicans
Alternative drug
1 antifungal agents (eg, Nystatin powder or cream)
Extraction of tooth surgical/ non surgical Likely causative agent
Antimicrobial of choice Preferred drug Cap. Amoxicillin (500 mg) 8 hourly for 7 days or
Alternative drug 2 of the other 3rd line antibiotic*
Cap. Cefixime (200 mg) 12 hourly for 7 days+ Tab. Metronidazole (400 mg) 8 hourly for 5 days.
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Fungal infections in maxillofacial region like Candidiasis, mucormicosis etc Likely causative agent
Antimicrobial of choice Preferred drug
Fungus
Alternative drug
Nystatin oral suspension (510 ml) of suspension for at least 14 days
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
Cap. Itraconazole (400 mg) 24 hourly for 714 days
Gingivitis Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Cap. Doxycycline Initial : (200 mg/day) divided twice daily post operative first day then. Maintenance : (100200 mg/day) divided 12hrly
Cap. Doxycycline Initial : (200 mg/day) divided twice daily post operative first day then. Maintenance : (100200 mg/day) divided 12 hourly 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.
Hepatorenal syndrome http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred 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]
Alternative drug 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
In case of maxillofacial fracture management like open reduction and fixation Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Meropenem (1 gm) 8 hourly I/V for 7 days, following by Cap. Cephalosporins Tab. Metronidazole
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 Inj. Ceftriaxone (1 mg) 12 hourly Tab. Metronidazole (500 mg) 8 hourly for 57 days followed by Cap.
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug Inj. Meropenem (1 gm) 8 hourly for 7 days, following by Cap. Cephalosporins Tab. Metronidazole
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Cephalosporins Tab. Metronidazole
Jaw osteomyelitis Likely causative agent
Antimicrobial of choice Preferred drug
Mixed anaerobic infection. Commonly by staphylococci and enteric microorganism
Alternative drug
Cap. Clindamycin (600 mg) in divided dose for 6 days to 8 weeks ±
Flucloxacillin (500 mg) 6 hourly for 68 weeks +
Tab. Metronidazole (500 mg) 8 hourly for 7 days
Tab. Secnidazole (2 gm) single dose
Minor oral surgery like biopsy, excision of mucocele etc Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Oral Candidiasis Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Peptostreptococcus http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antifungal agents eg, Nystatin powder or cream
Alternative drug Clotrimazole or Nystatin lozenges 6/66
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Antibiotic Guideline
Bacteroides
Orofacial space infections Likely causative agent
Antimicrobial of choice Preferred 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.
Alternative drug 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
Peri implantitis Likely causative agent
Antimicrobial of choice Preferred drug
Prevotella intermedia Pseudomonas aeruginosa Staphylococcus spp. Peptostreptococcus micros Porphyromonas ednodontalis
Alternative drug
Cap. Cephalosporins (200400 mg ) 612 hourly for 7 days Metronidazole (400 mg) 57 days
Name: Safe in pregnancy
Periapical Pathosis Likely causative agent
Antimicrobial of choice Preferred drug
Prevotella melaninogenica Streptococcus anginosus http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Cap. Cephalosporins (200400 mg) 612 hourly for 7 days.
Alternative drug Tab. Metronidazole (400 mg) 6 hourly for 7 days
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Porphyromonas gingivalis Peptospreptococus Microbes
Pericoronitis Likely causative agent
Antimicrobial of choice Preferred drug
Porphyromonas gingivalis Fusobacterium species Peptostreptococcus micros Fusobacterium nucleatum
Alternative drug
Tab. Penicillin V (250500 mg) post operative 6 hourly for 57 days
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
Tab. Metronidazole (200400 mg) orally 8 hourly for 35 days
Cap. Cephalosporins
Periodontitis Likely causative agent
Antimicrobial of choice Preferred drug
Prohyromonas gingivalis Bacteroides forsythus Antinobacillus actinomycente Prevotella intermedia Fusobacterium nucleatum Peptostreptococcus micros
Alternative drug
Tab. Metronidazole (200400 mg) 8 hourly for 35 days
Cap. Cephalosporins (2004000 mg) 612 hourly for 7 days ± Metronidazole
Cap. Amoxicillin (500 mg) 6 hourly 57 days Cap. Doxycycline (200 mg) 24 hourly
Amoxicillin
Prevotella oralis
Primary & secondary prophylaxis for variceal haemorrhage Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 8/66
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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
Prophylaxis Likely causative agent
Antimicrobial of choice Preferred drug Cap. Amoxicillin (3 gm)prior to surgery.
Alternative drug Cap. Clindamycin 3 gm prior to surgery Cap. Amoxicillin 3 gm prior to surgery
Pulpits Likely causative agent
Antimicrobial of choice Preferred drug
Obligate anaerobes: Peptostreptococcus anaerobius Veillonella parvula Lactobacilus cateraforme Porphylaomonas endodontic
Cap. Amoxicillin (500 mg) (preferably with clavulanic acid)or
Alternative drug Cap. Cefixime Cap. Cefuroxime
Cap. Cephradine Tab. Metronidazole
Facultative anaerobes: Streptococcus mitis Streptococcus oralis Enterococcus faucal Neisseria
Viral infection in lip/oral cavity like herpes simplex infection Likely causative agent
Antimicrobial of choice Preferred drug
Herpes viruses
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Acyclovir (400 mg) orally 8 hourly for 710 days
Alternative drug Tab.Valacyclovir (1 gm) 12 hourly for 710 9/66
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Acyclovir ointment for topical application
days Acyclovir ointment for topical application
Dermatology Acne Vulgaris Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Cap. Amoxicillin (250500 mg) 8 hourly Tab. Trimethoprim Sulfamethoxazole in double strength 12 hourly
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
Cellulitis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcal Streptococcal or http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Coamoxiclav (625 mg) 8 hourly 10/66
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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
Chancroid Likely causative agent
Antimicrobial of choice Preferred drug
Haemophilus ducreyi
Alternative drug
Tab. Azithromycin (1 gm) Oral single dose
Inj. Ceftriaxone (1 gm) stat dose with Tab. Ciprofloxacin
Inj. Ceftriaxone (250 mg) I/M single dose
Tab. Levofloxacin (750 mg) 24 hourly 7 days
Tab. Ciprofloxacin (500 mg) 12 hourly for 2 days Erythromycin (500 mg) 8 hourly for 7 days
Cutaneous Anthrax Likely causative agent
Antimicrobial of choice Preferred drug
Bacillus antharacis
Alternative drug
Tab. Ciprofloxacin (500 mg) 12 hourly for14 days Cap. Doxycycline (100 mg) 12 hourly for 14 days
Cutaneous Tuberculosis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Mycobacterium Tuberculosis
Alternative drug
Cap. Rifampicin (400600 mg) single dose
Inj. Clarithromycin or Tab. Ofloxacin or
Tab. Isoniazid (300 mg) single dose
Tab. Ciprofloxacin or
Tab. Ethambutol (1525 mg/kg/day) or
Inj. Capreomycin or
Inj. Streptomycin (75 mg1gm) single dose
Inj. Cycloserine or Tab. Paraaminosalicyclic acid Tab. Ethionamide.
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
Gonorrhoeae Likely causative agent
Antimicrobial of choice Preferred drug
Neisseria gonorrhea
Alternative drug
Single doses of any of the following orally: Cap. Cefixime (300 mg) Tab. Ciprofloxacin (500 mg) Tab. Ofloxacin (400 mg) Tab. Levofloxacin (250 mg)
Impetigo contagiosa Likely causative agent http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice 12/66
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Preferred drug Staphylococcal Streptococcal or
Cap. Dicloxacillin (250500 mg)
Combined
Tab. Coamoxiclav (625 mg) 8 hourly Cap. Cephalexin (250500 mg) 6 hourly for 7 days
Alternative drug Tab. Clindamycin (30 mg) 8 hourly Cap. Erythromycin (250500 mg) 6 hourly for 7 days
Leprosy Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Clarithromycin (500 mg) single dose Tab. Minocycline (100 mg) single dose Tab. Ofloxacin (400 mg) single dose Tab. Levofloxacin (500 mg) single dose
Tab. Clofazimine (50 mg) single dose plus Cap. Rifampicin (600 mg) monthly for 1 year
Syphilis Likely causative agent
Antimicrobial of choice Preferred drug
Treponema pallidum
Inj. Benzathin penicillin 12 lac unit I/M in each buttock day one day eight and day fifteenth according to stages
Alternative drug Cap. Doxycycline (100 mg) 12 hourly for 2 weeks Cap. Erythromycin (500 mg) 6 hourly for 14 days Inj. Ceftriaxone
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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(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
Endocrine System Sepsis/ Septicemia Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Streptococcus pyogens Pseudomonas aeruginosa
Alternative drug
Inj. Ceftriaxone (2 gm) 12 hourly at least for 710 days
Inj. Piperacillin+ Inj. Tazobactam Inj. Meropenem Inj. AmphotericinB
Staphylococcus aureus
Skin and soft tissue infection e.g. diabetic foot lesion Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus Streptococcus Anaerobes
Alternative drug
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
ive Parotitis (Salivary Gland Infection) Likely causative agent
Antimicrobial of choice Preferred drug Inj. CoAmoxiclav (1.2 gm)
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug Inj. Clindamycin (900 mg) 14/66
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8 hourly Oral then: Tab. CoAmoxiclav (625 mg) 8 hourly 1014 days
8 hourly Oral then: Tab. Clindamycin (450 mg) 8 hourly
Gastro Intestinal System Acute gastroenteritis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli
Alternative drug
Tab. Azithromycin (500 mg) 2 tab stat then 1 tab for 4 days
Campylobacter Shigella Salmonella
Tab. Ciprofloxacin (500 mg) 12 hourlyfor 7 days Tab. Metronidazole (400 mg) 8 hourlyfor 57 days
Clostridium difficile
Name: Pseudomembrenous colities by clostridium difficile is an important cause of gastroenteritis following use of other antibiotics
Abdominal Sepsis Likely causative agent
Antimicrobial of choice Preferred drug
Acinatobacter Enterococci faecalis Bacteroides fragilis
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 7 14 days plus Inj. Amikacin (500 mg) 12 hourly for 7 days.
Cholangitis Likely causative agent
Antimicrobial of choice Preferred drug
Gram negative http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Inj. Meropenem 15/66
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anaerobes
(500 mg) 8 hourly
Gastroenteritis, Typhlitis Likely causative agent
Antimicrobial of choice Preferred drug
Candida
Alternative drug
Enterococcus faecalis
Inj. Cefepime (500 mg) 8 hourly
Aspergillus
Piperacillin/Tazobactam
Anaerobes
Vancomycin Itraconazole
Name: Liver function test necessary
Necrotizing Pancreatitis (infected) Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Inj. Piperacillin/Tazobactam (4.5 gm) 68 hourly for 714 days
Inj. Meropenem (1 gm) 8 hourly for 714 days plus
Plus Inj. Amikacin (500 mg) 12 hourly for 7 days Plus
Inj. Amikacin (500 mg) 12 hourly for 7 days plus
Tab. Metronidazole (500 mg) 8 hourly 7 days
Inj. Clindamycin (600 mg) 8 hourly for 714 days
Peptic ulcer disease Likely causative agent
Antimicrobial of choice Preferred drug
Helicobacter pylori
Tab. Levofloxacin (500 mg) 12 hourly for 14 to 30 days
Alternative drug Cap. Tetracycline (500 mg) 6 hourly for 14 to 30 days
Tab. Metronidazole (400500 mg) http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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8 hourly for 1430 days Name: Duration depending on the nature and severity of the infection
Secondary bacterial peritonitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Other gut pathogens
Alternative drug
Inj. Meropenem (500 mg) 8 hourly
Spontaneous bacterial peritonitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Proteus
Tab. Levofloxacin (500 mg) 12 hourly for 14 to 30 days
Alternative drug Inj. Coamoxiclav (1 gm/0.2 gm) 8 hourly for 5 days
Tab. Metronidazole (400500 mg) 8 hourly for 1430 days Inj. Cefotaxime(2 gm) 12 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.
Hepatobiliary system Amoebic liver abscess Likely causative agent
Antimicrobial of choice Preferred drug
Entamoeba histolytica http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Inj. Metronidazole (750 mg)
Alternative drug Nitazoxanide (500 mg) 17/66
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8 hourly for 510 days
12 hourly for 3 days Tinidazole, Orrnidazole (2 gm) 24 hourly for 3 days
Antiviral used in Hepatitis B infection (Chronic Hepatitis B) Likely causative agent
Antimicrobial of choice Preferred drug
Hepatitis B Viris Treatment is indicated: HBVDNA>2000 IU/ml ALT> Upper limit of normal Histology= moderate to severe necroinflammation & significant fibrosis
Alternative drug
Tab. Tenofovir (300 mg) 24 hourly
Tab. Lamivudine (100 mg) 24 hourly
Tab. Entecavir (0.5 mg) once daily
Tab. Adefovir (10 mg) 24 hourly Tab.Telbivudine (600 mg) 24 hourly Inj. PEGIFN2a (180 µg) subcutaneously weekly for 12 months
Antiviral used in Hepatitis C infection (Chronic Hepatitis C) Likely causative agent
Antimicrobial of choice Preferred drug
HCV Genotype 1
Alternative drug
Inj. PEGIFN+ Tab. Simeprevir+ Cap. Ribavirin for 12 weeks
Inj. PEGIFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks and
Tab. Sofosbuvir+ Cap. Ledipasvir for 12 weeks
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
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Tab. Sofosbuvir+ Cap. Ledipasvir for 12 weeks
Inj. PEGIFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks and 18/66
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Antibiotic Guideline
Tab. Sofosbuvir+ Cap. Daclatasvir for 12 weeks HCV Genotype 3
HCV Genotype 4
Inj. PEGIFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks
Tab. Sofosbuvir+ Cap. Ribavirin for 24 weeks
Inj. PEGIFN+ Tab. Simeprevir+ Cap. Ribavirin for 12 weeks
Inj. PEGIFN+ Tab. Sofosbuvir+ Cap. Ribavirin for 12 weeks and
Tab. Sofosbuvir+ Tab. Ledipasvir for 12 weeks
Inj. PEGIFN+ Cap. Ribavirin for next 1236 weeks
Tab. Sofosbuvir+ Tab. Daclatasvir for 12 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
Cholangitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pneumoniae Pseudomonas Proteus
Inj. Piperacillin Tazobactam (3.375 gm) 6 hourly
Alternative drug Inj. Meropenem (1 gm) 8 hourly
Hepatic actinomycosis Likely causative agent http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice 19/66
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Preferred drug Actinomyces israelii
Benzy1 Penicillin
Alternative drug Doxycycline and Clindamycin
Name: Percutaneous liver biopsy relveals suphaur granules with typical organism
Hydatid disease of liver Likely causative agent
Antimicrobial of choice Preferred drug
Echinococcus granulosus
Surgery followed by Tab. Albendazole (400 mg) 12 hourly for 1 month
Alternative drug PAIR followedby Tab. Albendazole (400 mg) 12 hourly for 1 month
Tab. Albendazole (400 mg) for 1 month then 14 days interval, total 36 cycles Name: PAIR is as effective as surgery. (WHO guideline 1996)
Leptospirosis Likely causative agent
Antimicrobial of choice Preferred drug
Leptospira icterohaemorrhagiae
Inj. Benzyl Penicillin (900 mg) 1.5 million unit 6 hourly for 1 week
Alternative drug Inj. Ceftriaxone (1 gm) 24 hourly for 1 week
Name: Blood culture during limit 10 days or urine culture during 2nd week
Melioidosis Likely causative agent
Antimicrobial of choice Preferred drug
Burkholderia pseudomallei
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Inj. Ceftazidime (2 gm) 8 hourly for 23 weeks followed by
Alternative drug Inj. Meropenem (0.51 gm) 8 hourly for 23 weeks followed by 20/66
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Cap. Doxycycline (200 mg) 24 hourly plus
Cap. Doxycycline (200 mg) 24 hourly plus
Tab. Co trimoxazole (80/400 mg)
Cotrimoxazole
Pyogenic liver abscess Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pneumoniae Viridans streptococci Streptococcus Pneumoniae
Alternative drug
Inj. Ciprofloxacin (500 mg) 12 hourly
Piperacillin/ Tazobactam
Inj. Ceftriaxone (1 gm) plus 12 hourly
Meropenem
Imipenem/ Cilastatin Coamoxiclav
Inj. Metronidazole for 2 weeks and then oral for 4 weeks.
Infectious Disease Bacterial vaginosis Likely causative agent
Antimicrobial of choice Preferred drug
Anaerobes
Tab. Metronidazole (500 mg) 8 hourly Tab. Clindamycin (80 mg) 8 hourly
Alternative drug Tab. Metronidazole (500 mg) 8 hourly Tab. Clindamycin (80 mg) 8 hourly
Febrile Neutropenia Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus Pseudomonas http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Inj. Meropenem (1 gm) 8 hourly for 710
Alternative drug Inj. Meropenem (1 gm) 8 hourly for 710 21/66
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Streptococcus
days
days
Escherichia coli Klebsiella Name: Culture sensitivity prefered preceded by emperical treatment
Genital Herpes Likely causative agent
Antimicrobial of choice Preferred drug
Herpes simplex type I or type II
Tab. Acyclovir (400 mg) 8 hourly for 710 days
Alternative drug Tab. Famcyclovir (250 mg) orally 8 hourly for 710 days Tab. Valacyclovir (1 gm) 12 hourly for 710 days
Kalaazar Likely causative agent
Antimicrobial of choice Preferred drug
Leishmania
Inj. Liposomal Amphotericin B (10 mg/kg) not less than in 2 hours single dose.
Alternative drug 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
Malaria Likely causative agent
Antimicrobial of choice Preferred drug
Plasmodium sepsis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Tab. Artemether Lumefantrine
Alternative drug Chloroquine 22/66
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Quinine (10 mg/kg) 8 hourly for 7 days
Doxycycline Tetracycline
Neutropenic fever, Cellulitis Likely causative agent
Antimicrobial of choice Preferred drug
Mostly Unknown Gram negative Escherichia coli
Inj. Meropenem (500 mg) 8 hourly plusInj
Alternative drug Ceftazidime Cefepime
Amikacin (500 mg) I/V 12 hourly for 7 days Name: ANC <500X10L, Hyperemtivity
Pelvic inflammatory disease 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 http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Tab. Ofloxacin (400 mg) post operative 12 hourly to complete 14 days
Post of Infection Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas
Inj. Amikacin (500 mg) 12 hourly
Alternative drug Netlimicin
Post of Infection Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli
Ceftriaxone (1 gm) 24 hourly
Alternative drug Meropenem
Secondary fungal infection e.g. oral thrush Likely causative agent
Antimicrobial of choice Preferred drug
Candida species
Alternative drug
Fluconazole plus Locally Nystatin/ Miconazole
Secondary infection in malignant lesion Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas Staphylococcus Streptococcus
3rd generation Cephalosporins plus Metronidazole
Alternative drug 2nd Generation Cephalosporins or Quinolone derivatives
Sepsis/ Acute PID http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Gm negative
Alternative drug
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
Sepsis/ Septicemia Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli, Klebsiella
Inj. Ceftriaxone (2 gm) 12 hourly at least for 710 days
Streptococcus pyogens Pseudomonas aeruginosa Staphylococcus aureus
Alternative drug Inj. Piperacillin + Inj. Tazobactam Inj. Meropenem Inj. AmphotericinB
Sepsis uncertain focus Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Inj. Cefepime (1 gm) 8 12 hourly for 7 14 days
Inj. Meropenem (1gm) 8 hourly for 714 days plus
Inj. Vancomycin (1 gm) 12 hourly
Inj. Metronidazole (500 mg) 8 hourly for 7 days
Inj. Amikacin (500 mg) 12 hourly for 7 days Plus Inj. Metronidazole http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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(500 mg) 8 hourly for 7 days
Septicemia Likely causative agent
Antimicrobial of choice Preferred drug
According to source of infection
Inj. Meropenem (1 gm) 6 hourly
Alternative drug Inj. Piperacillin/ Tazobactam (4.5 gm) 8 hourly
Sick Immunocompromised (febrile neutropenia) Likely causative agent
Antimicrobial of choice Preferred drug Inj. Meropenem (1 gm) 8 hourly for 714 days or/plus Inj. Meropenem (1 gm) 8 hourly for 714 days or/plus
Alternative drug Inj. Linezolid (600 mg) 12 hourly or/plus Inj. Piperacillin/Tazobactam (4.5 gm) 68 hourly for 714 days
Quinolone 714 days
Trichomoniasis Likely causative agent
Antimicrobial of choice Preferred 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
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 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 26/66
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partners
Uncomplicated Chlamydial Infection Likely causative agent
Antimicrobial of choice Preferred drug If poor compliance: Tab. Azithromycin (1 gm) post operative stat dose If Pregnant:
Alternative drug Inj. Clarithromycin or Tab. Ofloxacin or
Tab. Erythromycin (500 mg) post operative 6 hourly for 7 days or Tab. Erythromycin (500 mg) post operative 12 hourly for 14 days
Valvovaginal Candidiasis (non regnant) Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Venous aseptic site of infection Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Staphylococcus epidermises Staphylococcus aureus Pseudomonas
< Inj. Cephalosporins
Inj. Ceftriaxone (1 2 gm) 12 hourly
Inj. Amikacin Tab. Linezolid Cap. Flucloxacillin
Inj. Amikacin (500 mg) 12 hourly
Tab. Ciprofloxacin
Name: Sterelity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained
Venous harvesting site wound infection of leg Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus aureus Streptococcus pyogens Pseudomonas Escherichia coli
Inj. Ceftriaxone (1 2 gm) 12 hourly Inj. Amikacin (500 mg) 12 hourly
Alternative drug 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
VTI, Septicemia Likely causative agent
Antimicrobial of choice Preferred drug
Gram positive Staphylococcus aureus Pseudomonas
Alternative drug
Inj. Ceftriaxone (1 gm) 24 hourly Inj. Imipenem (500 mg1gm) 8 hourly
Name: Steroid coverage with antimicrobial therapy may be required
Wound infection Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Staphylococcus aureus http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Cream Gentamicin apply locally 23 28/66
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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
Kidney and Urinary System Acute Pyelonephritis Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
ESWL Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Fluoroquinolones TMP/SMX
Inj. Aminoglycosides Tab. Amoxicillin 1st/2nd generation Cephalosporins
Lower urinary tract infection (cystitis) in pregnancy UTI Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas Enterococcus
Cap. Nitrofurantoin (100 mg) 6 hourly for 7 days
Alternative drug Cap. Cephalexin (500 mg) 8 hourly for 7 days
Tab. Pivmecillinam (400 mg) stat & (200 mg) 8 hourly for 7 days
Non Gonococcal Urethritis Likely causative agent
Antimicrobial of choice Preferred drug
Chlamydia trachomatis Ureplasma urealyticum Mycoplasma Genetalium
Cap. Doxycycline (100 mg) 12 hourly for 7 days Tab. Azithromycin (1 gm) single dose
Alternative drug 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
PCNL Likely causative agent
Antimicrobial of choice Preferred drug 1st/2nd generation Cephalosporins or
Alternative drug Aminoglycosides Fluoroquinolones
Inj. Aminoglycosides Tab. http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Metronidazole or Clindamycin
Prostatitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli
TMP/SMX for 4 weeks
Enterobacteriaceae Pseudomonas
Alternative drug Fluoroquinolones
Enterococci Enterococcus
Prostatic biopsy Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Fluoroquinolones
TMP/SMX
1st/2nd generation Cephalosporins
Aminoglycosides
Surgical prophylaxix: Urethrocystoscopy, Urodynamic study, Ureteroscopy, TURP, TURBT Likely causative agent
Antimicrobial of choice Preferred drug Fluoroquinolones TMP/SMX
Alternative drug Inj. Aminoglycosides Inj. Ampicillin 1st/2nd generation Cephalosporins CoAmoxiclav
Urinary Tract Infection Likely causative agent Escherichia coli http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice Preferred drug Tab.
Alternative drug Coamoxiclav 31/66
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Klebsiella Pseudomonas Staphylococcus aureus Candida albicans
Ciprofloxacin (500 mg) 12 hourly for 7 10 days
Cefuroxime+Clindamycin
Urinary Tract Infection (acute uncomplicated cystitis) Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Urosepsis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Proteus Klebsiella Enterococci Candia
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Alternative drug 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) 32/66
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Urological Surgery involving intestine e.g.: GI tract, Skin+ intestine Likely causative agent
Antimicrobial of choice Preferred drug 2nd/3rd generation Cephalosporins Inj. Aminoglycosides Tab. Metronidazole or
Alternative drug Inj. Ampicillin Inj. Ticarcillin/ Co Amoxiclav Inj. Piperacillin/ Tazobactam Fluoroquinolones
Clindamycin
Musculoskeletal system Acute and chronic pyogenic Osteomyelitis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus Staphylococcus pyogens
Inj. Ceftriaxone (1 gm) 12 hourly Inj. Flucloxacillin (250 mg1 gm) 6 hourly
Alternative drug Inj. Cefuroxime (750 mg) 12 hourly
Deep sternal wound infection Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus pyogens Streptococcus aureus Pseudomonas Escherichia coli Fungal
Inj.Meropenem (500 mg1 gm) 18 hourly Inj. Amikacin (500 mg) 12 hourly
Alternative drug 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
Elective Surgery http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Prophylactic purpose
Alternative drug
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
Septic arthritis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus Haemophilus influenza Enterobacter Species
Alternative drug
Inj. Ceftriaxone (1 gm) 12 hourly Inj. Flucloxacillin (250 mg1 gm) 12 hourly
Name: Preferred culture sensitivity report
Skin & Soft tissue infection Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus pyogens Staphylococcus aureus
Cap. Flucloxacillin (500mg) 6 hourly
Alternative drug Tab. Clarithromycin (500mg) 12 hourly and Cap. Clindamycin (450 60mg) 6 hourly
Superficial sternal wound infection http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus Streptococcus pyogens Escherichia coli Pseudomonas
Inj. Ceftriaxone (1 2 gm) 12 hourly Inj. Amikacin (500 mg) 12 hourly
Alternative drug 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
Tubercular Osteomyelitis Likely causative agent
Antimicrobial of choice Preferred drug
Mycobacterium aureus
Alternative drug
1st line anti tubercular drugs
Wound infections Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus aureus Pseudomonas pyogenosa Klebsiella Enterobacteriaceae
Alternative drug
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
Obstetrics and Gynaecological Procedure D&C, endoscopic or other minor procedure Likely causative agent
Antimicrobial of choice Preferred drug
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Alternative drug 35/66
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Anaerobes
Not needed
Caesarean section Likely causative agent
Antimicrobial of choice Preferred drug
Prophylaxis
Inj. Amoxiclav (1.2 gm) 8 hourly
Alternative drug Inj. Clindamycin (900 mg) 8 hourly
Name: Review culture reports
Infected wound Caesar/ Perineal tear and episiotomy Likely causative agent
Antimicrobial of choice Preferred drug
Gram negative Staphylococcus Escherichia coli Pseudomonas
Alternative drug
Inj. Flucloxacillin (900 mg) 8 hourly+ Inj. Metronidazole (500 gm) 8 hourly followed by oral for 7 days
Intra partum pyrexia Likely causative agent
Antimicrobial of choice Preferred drug
Prophylaxis
Inj. Amoxicillin (2 gm) + Inj. Metronidazole (500 mg) initially followed by
Alternative drug Inj. Clindamycin in penicillin allergy group
Inj. Amoxicillin (500 mg) 8 hourly + Inj. Metronidazole (500 mg) 8 hourly till delivery Inj. Gentamicin if severe sepsis 5 days for oral antibiotics http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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after delivery
Placenta Removal,4 Degree Tear, Major Surgery, Extensive Oncological Surgery Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
IVsingle dose only at induction
Post operative Gynaecological Sepsis 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 http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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diarrhoea or if Gentamicin is contraindicated ( GHNHSFT protocol ) consult microbiologist. Duration: 57 days and then review. Consult Microbiologist
Prophylaxis Hysterectomy Laparotomy Vaginal Repair Likely causative agent
Antimicrobial of choice Preferred drug Inj. Ceftriaxone (2 gm) 12 hourly at least for 710 days
Alternative drug 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
Surgical Prophylaxis Obstetric & Gynaecological Surgery Hysterectomy Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
IVsingle dose only at induction
Opthalmology Antibiotics used in surgical prophylaxis: Cataract surgery, Glaucoma surgery, Dacryocystitis (Chronic) Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 38/66
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Moxifloxacin 0.3% Gatifloxacin 0.3% 1 drop g.i.d.
Levofloxacin 0.3%
Bacterial Uveitis Likely causative agent
Antimicrobial of choice Preferred drug
Mycobacterium tuberculosis Mycobacterium Bovis Treponema. pallidum
Alternative drug
According to cause AntiTB AntiSyphilis (systemic regimen to be followed)
Name: Aquaus and vitreous sample for culture sensitivity
Conjunctivitis Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumonia Staphylococcus aureus Haemophilus influenzae Moraxella catarrhalis Neisseria gonorrhea Neisseria meningitides Chlamydia trachomatis
Chloramphenicol Aminoglycosides (Gentamicin, Neomycin) Quinolones (Ciprofloxacin Ofloxacin)
Alternative drug Tetracycline Fusidic acid Doxycycline Erythromycin Bacitracin
Levofloxacin Lomefloxacin Gatifloxacin Moxifloxacin Polymyxin B Fusidic acid dose (g.i.d. for 1 week)
Name: Conjunctival culture sensitivity needed
Corneal Ulcer Likely causative agent
Antimicrobial of choice Preferred drug
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Alternative drug 39/66
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Pseudomonas Staphylococcus aureus
Ciprofloxacin 0.3%
Moxifloxacin Gatifloxacin
Streptococcus Neisseria Gonorrhoeae
Ofloxacin 03.% Fortified Gentamicin
Doxycycline Tetracycline
Meningitis Coronibacterium diphtheria Haemophilus influenzae Treponema pallidum
Fortified Cephalosporins Procaine Penicillin (g.i.d. for 1 week or according to severity of the disease)
Erythromycin Sub conjunctival antibiotics
Name: Depends on culture sensitivity. Conjunctival sweab and corneal serapping
Dacryocystitis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus Epidermidis Streptococcus viridians Pneumoniae pyogens Escherichia coli
Flucloxacillin (oral) for 1 week Cephradine
Alternative drug Coamoxiclav Cephalosporins Cefixime
Name: Depending on culture sensitivity
Endophthalmitis Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus species. Bacillus species
Alternative drug
Ceftazidime (2 mg in 0.1 ml)
Amikacin (0.4 mg in 0.1 ml)
Vancomycin (2 mg in 0.1 ml)
Gentamicin (0.2 mg in 0.1 ml)
Tab. Ciprofloxacin (750 mg) 12 hourly or Moxifloxacin (400 mg) 24 hourly Name: Aquaus vitreous sample for culture sensitivity
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Lid infection Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcus aureus
Alternative drug
Ciprofloxacin 0.3% 1 drop g.i.d for 7 days (dose can be readjusted according to severity)
Pyogenes Epidermidis Streptococcus viridans Pneumonia
Moxifloxacin Flucloxacillin
Pyogenes Name: To maintain lid hygine
Neonatal conjunctivitis (Opthalmia Neonatorum) Likely causative agent
Antimicrobial of choice Preferred drug
Chlamydia trachomatis Neisseria Gonorrhoeae
Alternative drug
Penicillin G Topical 1,00,000 3,33,000 units/ml Paediatric 10,000 to 20,000 IU
Silver nitrate 1% solution
Orbital Cellulitis Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Staphylococcus aureus Streptococcus viridans Haemophilus influenzas
Alternative drug
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
Syphilitic eye disease, Syphilitic Uveitis, Optic neuritis, Neuroretinitis Likely causative agent http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Preferred drug Treponema pallidum
3 to 4 million unit Penicillin G is istered every 4 hourly for 10 to 14 days.
Alternative drug Alternative procaine Penicillin G IM 2.4 million IU daily plus Probenecid (500 mg) oral g.i.d for 10 to 14 days.
Paediatric Central Nervous System Central venous catheter tip Micro organism isolated: 75% Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas 66.66% Staphylococcus aureus 33.33%
Alternative drug
Imipenem (20 mg/kg/dose) 8 hourly Tazobactam + Piperacillin 8 hourly
Meningitis in Children (Bacteria), Young infant Likely causative agent
Antimicrobial of choice Preferred drug
Neisseria meningitides Streptococcus pneumonia Haemophilus influenjae
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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+
Alternative drug Meropenem (40 mg/kg/day) 8 hourly+ Amino glycosides (if pseudomonas)
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Ampicillin (200 400 mg/kg/day) 6 hourly for 10 days
Septicemia CNS infection Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Vancomycin (4560 mg/kg/day) 12 hourly for 10 14 days+ Inj. Meropenem (3040 mg/kg/day) 8 hourly
Paediatric Gastrointestinal System Bacillary dysentery Likely causative agent
Antimicrobial of choice Preferred drug
Shigella species, Shigella dysentery, Shigella flexnari
Cap. Cefixime (8 10 mg/kg/day) 12 hourly for 5 days
Alternative drug Cefixime12 hourly Ceftriaxone (5075 mg/kg/day) 12 hourly
Pivmecillinam (50 mg/kg/day) 6 hourly for 5 days
Cholangitis Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Staphylococcus aureus
Ceftazidime (150 mg/kg/day)
Alternative drug Meropenem (3040 mg/kg/day)
Amikacin (1520 mg/kg/day)
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Diarrhoea Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Shigella Vibrio cholerae
Azithromycin (10 mg/kg/day)
Alternative drug Ceftriaxone (50200 mg/kg/day)
Ciprofloxacin (15 30 mg/kg/day) Pivrnecillinam
Enteric Fever & Severe Enteric Fever Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Azithromycin (20 mg/kg/day) 24 hourly 7 days Ciprofloxacin (20 30 mg/kg/day) 12 hourly 710 days
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Dexamethasone (3mg/kg)initial flowed by (1 mg/kg) 6 hourly for 48 hours
Giardiasis Likely causative agent
Antimicrobial of choice Preferred drug
Giardia
Metronidazole (15 mg/kg/day) 8 hourly for 5–7 days
Alternative drug Secnidazole
Hydatid cyst http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Echinococcus Granulosus
Alternative drug
Albendazole (15 mg/kg/day) 12 hourly
Intestinal Amoebiasis Likely causative agent
Antimicrobial of choice Preferred drug
Entamoeba Histolytica
Metronidazole (15 mg/kg/day) 8 hourly for 5–7 days
Alternative drug Secnidazole
Liver Abscess Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus aureus Gram negative Anaerobic organism
Alternative drug
Ceftriaxone (50 200 mg/kg/day) Flucloxacillin (50 100 mg/kg/day) Metronidazole
Peritonitis (Ascitic Fluid C/S) Micro organism isolated:4% Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Acinetobactor Escherichia coli
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Ceftazidime (50 mg/kg/dose) 8 hourly Ceftriaxone (100 mg/kg/day) 1224 hourly Amikacin (7.5 mg/kg/dose) 12 hourly
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SBP Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Staphylococcus aureus
Cefotaxime (50200 mg/kg/day) Flucloxacillin (50 100 mg/kg/day)
Alternative drug Meropenem (3040 mg/kg/day)
Paediatric Infectious Disease Abscess 2% Likely causative agent
Antimicrobial of choice Preferred drug
Enterobacter Spesis
Flucloxacillin (25 250 mg) 6 hourly Vancomycin (4560 mg/kg/day) Tazobactam Meropenem (3040 mg/kg/day)
Alternative drug Inj. Vancomycin (4560 mg/kg/day) 12 hourly for 1014 days+ Inj. Meropenem (3040 mg/kg/day) 8 hourly
Oral thrush Likely causative agent
Antimicrobial of choice Preferred drug
Candida albicans
Nystatin (46 lakhs) unit for 6 hourly Miconazole 2% apply 12 hourly
Alternative drug Inj. Vancomycin (4560) 8 hourly for 24 weeks
Septicemia (Blood C/S) 10% Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 46/66
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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
Septicemia (Blood C/S) Micro organism isolated:6% Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Salmonella Enterococcus Pseudomonas Klebsiella
Alternative drug
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
Septic Arthritis Likely causative agent
Antimicrobial of choice Preferred drug
Haemophilus influenza Streptococcus aureus Streptococcus pneumoniae http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Inj. Ceftriaxone (5075 mg/kg/day) 12 hourly for 4 weeks
Alternative drug Inj. Clindarnycin (1040 g/kg/day) 8 hourly Vancomycin (4560 47/66
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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
Skin infection Cellulitis Osteomyelitis Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Vancomycin (4560) 8 hourly for 24 weeks
Throat Swab Micro organism isolated: 12% Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus pyogens 82% Staphylococcus aureus 18%
Alternative drug
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
Wound Swab 2% Likely causative agent
Antimicrobial of choice Preferred drug
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Alternative drug 48/66
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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
Paediatric Surgery Amniotic band of both leg: release of bank and Zplasty in right leg Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococci Micrococci Gram positive rods
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Flucloxacillin(50 100 mg/kg/day) followed by Flucloxacillin
AVM at the root of nose: Excised Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Inj. Ceftriaxone (5075 mg/kg)
AVM of left thigh (Aspirated) (Aspirated fluid: no growth) Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococci Micrococci Gram positive rods
Alternative drug
Inj. Cephradine (50100 mg/kg/day)
Cystic Hygroma (within the abdomen) with sliding hernia: Excision of Cystic hygroma with herniotomy http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas aeruginosa Enterococci
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Flucloxacillin (50100 mg/kg/day) followed by Cefixime (20 mg/kg/day)
Discharging sinus at penoscrotal region: Excision (Pus for C/S: Pseudomonas spp.) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus
Alternative drug
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
Eventration of left dome of diaphragm with umbilical hernia: Plication of the defect and repair of hernia Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pneumoniae Streptococci Pseudomonas Enterococci
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Gentamicin (5 mg/kg/day)
Growth in lower Esophagus: feeding gastrostomy with biopsy from growth http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella pneumonia Streptococcus pneumonia Enterococci
Alternative drug
Cephradine (50 100 mg/kg/day) Inj. Gentamicin (5 mg/kg/day)
Hydrocephalus and Meningomyelocele with urinary and fecal incontinence; Introduction of VP shunt with excision of meningomyelocele Likely causative agent
Antimicrobial of choice Preferred drug
Encapsulated organism: Streptococcus Pneumoniae, Nigeria meningitides, Haemophilus influenza. Non capsulated organism: Listeria monocytogenes
Alternative drug
Inj. Ceftazidime (1520 mg/kg/day) Inj. Amikacin (15 20 mg/kg/day)
Hypospaedias with rotational deformity of penis: Urethroplasty and correction of rotation Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus
Alternative drug
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
Hypospaedias: Urethroplasty Likely causative agent http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice 51/66
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Preferred drug Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus
Alternative drug
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%
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 Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Bactericides Fragilis Streptococcus viridians group
Alternative drug
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
Mass in right gluteal region: Incisional biopsy Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococci, Micrococci, Gram positive rods
Inj. Ceftriaxone (5075 mg/kg/day) followed by oral Cefixime
Alternative drug Streptococcus pyogens 82% Staphylococcus aureus 18%
Meconium ileus with Ileostomy: Ileostomy closure (Stool culture: no http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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organism) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli, Bactericides Fragilis Streptococcus viridians group
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Metronidazole Inj. Amikacin
Nonoperative case of Choledochal cyst Likely causative agent
Antimicrobial of choice Inj. Ceftriaxone (5075 mg/kg)
Penoscrotal hypospaedias: Urethroplasty (Urine c/s: no growth) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella pneumonia Pseudomonas aeruginosa Proteus
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Flucloxacillin (125250 mg/kg/day) followed by oral Cefixime
Perineal hypospaedias with bilateral undescended testes: Urethroplasty with bilateral orchiopexy (Urine c/s: no growth) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
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 53/66
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(1520 mg/kg/day) for 8 days followed by Syrup Cefixime ( 20 mg / kg/day) for 16 days.
Rectourethral fistula: Perineal hole technique anoplasty (Urine C/S: No. growth) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Bactericides Fragilis Streptococcus viridians group
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Metronidazole (1530 mg/kg/day) Inj. Ceftazidime (150 mg/kg/day) Inj. Gentamicin (5 mg/kg/day)
Residual PUV with Left sided VUR: Fulgaration with left sided ureteric re reimplantation Ruine R/M/E: Normal finding (Urine C/S: no organism) Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pseudomonas aeruginosa Proteus
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) followed by Inj. Meropenem (3040 mg/kg/day) Inj. Amikacin
Thalasseaemia with Hypersplensim: Splenectomy Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Klebsiella Pneumoniae Streptococci Pseudomonas Enterococci http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
Inj. Ceftriaxone (5075 mg/kg/day) Inj. Phylopen Inj. Amikacin (15 20 mg/kg/day) 54/66
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Paediatric Urinary System Urinary tract infection Acute cystitis Acute pyelo nephrities Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Amikacin (15 20 mg/kg/day) Inj. Gentamicin (5 mg/kg/day) Cap. Nitrofurantoin (57 mg/kg/day) Tab. Cotrimoxazole
Inj. Amikacin (15 20 mg/kg/day) Inj. Gentamicin (5 mg/kg/day) Ceftazidime (150 mg/kg/day)
Urinary tract infection (UTI) Micro organism isolated: 6% Likely causative agent
Antimicrobial of choice Preferred drug
Escherichia coli Enterococci Acinatobacter Pseudomonas
Alternative drug
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
Recurrent UTI prophylaxis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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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
Paediatrics Respiratory System Otitis Media 2% Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas
Ceftriaxone (5075 mg/kg/day) Cefuroxime Ceftazidime (150 mg/kg/day)
Alternative drug Ceftazidime Ciprofloxacin Imipenem Meropenem Netlimicin
Pneumonia Likely causative agent
Antimicrobial of choice Preferred drug
Haemophilus influenjae Staphylococcus aureus Nosocomial: Escherichia coli Streptococcus Pneumoniae Haemophilus influenjae Pseudomonas Klebsiella Staphylococcus aureus Community acquired: http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Alternative drug 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 56/66
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≥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)
RTI 4% Likely causative agent
Antimicrobial of choice Preferred 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)
Alternative drug Imipenem Ciprofloxacin Colistin Tazobactam Piperacillin
Respiratory System Acute Bacterial Rhino sinusitis (severe or persistent symptoms) Likely causative agent
Antimicrobial of choice Preferred drug
Gram positive: Staphylococcus aureus Streptococcus Pneumoniae Haemophilus influenzae Pseudomonas aeruginosa Moraxella catarrhalis Gram negative:
Alternative drug
1st line:
1st line:
Tab. CoAmoxiclav (625 mg) 8 hourly orally 2nd line: Doxycycline oral(100 mg) 12 hourly 10 days
Inj. Clarithromycin (500 mg) 12 hourly 2nd line: Cap. Doxycycline (100 mg) 12 hourly
Pseudomonas aeruginosa Escherichia coli Protease mirabilis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Klebsiella Pneumoniae Enterobacter
Acute Diffused Otitis Externa (Swimmer's ear) Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococus aureus Pseudomonas pyogens Escherichia coli Often mixed flora
Alternative drug
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
Acute Laryngitis Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Antibiotics are NOT Indicated
Acute Localised Otitis Externa (furuncle) Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococcal
Cap. Flucloxacillin (1 gm) 6 hourly for 7 days plus Topical steroids
Alternative drug Clarithromycin (500 mg) 12 hourly
Acute Otitis Media http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Staphylococcus aureus Haemophilus influenzae Micrococcus Catarrhalis (Necrotizing) B Haemolytic streptococcus
Alternative drug
Antibiotics should not be routinely prescribed for uncomplicated AOM. For severe disease or when risk of complications:
Antibiotics should not be routinely prescribed for uncomplicated AOM. For severe disease or when risk of complications:
1st Line
1st Line
Cap. Amoxicillin (500 mg) 8 hourly
Clarithromycin (500 mg) 12 hourly
2nd line
2nd line
Tab. CoAmoxiclav (625 mg) 8 hourly 10 days
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
Acute Rhino Sinusitis Likely causative agent
Antimicrobial of choice Preferred drug
Alternative drug
Antibiotics should be Only prescribed in SEVERE infection. Mostly this condition caused by viral
Aspiration pneumonia Likely causative agent Pseudomonas Acinatobacter Enterococci faecalis http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Antimicrobial of choice Preferred drug
Alternative drug
Inj. Piperacillin/Tazobactam(4.5 gm) 68 hourly for 714 days plus
Inj. Meropenem (1gm) 8 hourly for 7 14 days 59/66
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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
Chronic Otitis Media Likely causative agent
Antimicrobial of choice Preferred drug
Aerobic: Pseudomonas aeruginosa Escherichia coli Streptococcus aureus Streptococcus Pyogenes Proteus mirabilis Klebsiella species Anaerobic:
Alternative drug
Oral antimicrobial may be added if a susceptible organism is cultured 710 days
Bacteroides Peptostreptococcus Propionibacterium
Community Acquired Pneumonia (CAP) Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Staphylococcus aureus Candia
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Alternative drug 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 60/66
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days (if gram positive infection), or Inj. Ticoplzmin (400 mg) stat and (200 mg) 12 hourly for 714 days, or
Inj. Vancomycin (1 gm) I/V 12 hourly 714 days (if gram positive infection) Inj. AmphotericinB if fungal infection
Cap. Fluclonazole (50100 mg/day) if fungal infection
Epiglottises Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Lung Abscess Likely causative agent
Antimicrobial of choice Preferred drug
Staphylococus
Coamoxiclav Metronidazole
Alternative drug Clindamycin, Vancomycin, Daptomycin, Linezolid
Malignant Otitis Externa Likely causative agent
Antimicrobial of choice Preferred drug
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug 61/66
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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
Perichondritis Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas Mixed flora
Alternative drug
1st line Tab. Ciprofloxacin (500mg750mg) for 12 hourly 2nd line: Cap. Clindamycin (450mg) 6 hourly for 46 weeks
Pharyngitis/Tonsillitis Likely causative agent
Antimicrobial of choice Preferred drug
GABHS (common) Arcanobacterium hemolytic (7% or adolescents and adults with pharyngitis) Group C Streptococci (uncommon) Group G Streptococci (uncommon)) Neisseria Gonorrhoeae (uncommon) http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Alternative drug Mild: Tab. Clarithromycin (500 mg) 12 hourly Severe: Inj. Clarithromycin (900 mg) 8 hourly. Oral then Tab. Clindamycin (450 mg) 8 hourly 62/66
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Coronibacterium diphtheria (rare)
Tab. Coamoxiclav (625 mg) 8 hourly for 710 days.
Pneumonia Likely causative agent
Antimicrobial of choice Preferred drug
Mostly unknown Gramve Escherichia coli
Inj. Meropenem (500 mg) 8 hourly plus Inj.Amikacin (500 mg) I/V 12 hourly for 7 days
Alternative drug Ceftazidime Cefepime
Quinsy (peritonsillar abscess) Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug Inj. Clarithromycin (900 mg) 8 hourly. Oral then Tab. Clindamycin (450 mg) 8 hourly
Respiratory tract infection e.g. bronchitis Pneumonia Likely causative agent
Antimicrobial of choice Preferred drug
Streptococcus Pneumoniae Legionella pneumophetin
3rd / 4th generation Cephalosporins Macrolide
Alternative drug Fluoroquinolones Macrolide
Mycoplasma Haemophilus influenza http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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Staphylococcus aureus Name: Nosocomial RTI is common in diabetic patient. Early and agresive treatment is required
Retropharyngeal Abscess Lateral pharyngeal Abscess Likely causative agent
Antimicrobial of choice Preferred 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
Alternative drug 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
Sore Throat 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 http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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(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.
Upper or lower respiratory tract infection (Oncology) Likely causative agent
Antimicrobial of choice Preferred drug
Pneumococcus Streptococcus Staphylococcus
Alternative drug
Inj. Azithromycin (500 mg1 gm) 24 or 12 hourly for 3 days or
3rd generation Cephalosporins or Quinolone derivatives
Tab. Azithromycin (500 mg) orally 24 or 12 hourly for 3 days or Tab. Coamoxiclav (625 mg) orally 8 hourly for 7 days
Ventilator associated pneumonia (Early VAP) Likely causative agent Pseudomonas Acinatobacter Proteus Klebsiella Staphylococcus aureus http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
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
Inj. Meropenem (1 gm) 8 hourly for 714 days or Inj. Vancomycin (1 gm) 12 hourly or 65/66
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Quinolone for 714 days
Inj. Colistin Sulphate (12 MU) 8 hourly for 714 days
Ventilator associated pneumonia (Late VAP) Likely causative agent
Antimicrobial of choice Preferred drug
Pseudomonas Acinatobacter Proteus Klebsiella Staphylococcus aureus
Inj. Meropenem (1 gm) 8 hourly plus
Inj. Cefepime (1 gm) 812 hourly
Inj. Amikacin (500 mg) 12 hourly for 7 days
Inj. Vancomycin (1 gm) 12 hourly Inj. Colistin Sulphate (12 MU) 8 hourly for 714 days
Inj. Colistin Sulphate (12 MU) 8 hourly for 714 days
http://exam.bsmmu.edu.bd/antibiotic_guideline/list.html
Alternative drug
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