We come across a common question when we see our senior doctors writing off antibiotics to the patients for random diseases: “how do they decide what to give?”. It could be amoxycillin, clindamycin, ciprofloxacin or cefotaxime, but how does one decide what to choose? Well, the answer is simple, Antibiotics Protocol Guidelines 2018 have been set up for various diseases in a pdf which are very specific. Bookmark this page just in case you need to re-check what antibiotic to choose for various diseases prevailing in India.
Antibiotics Choice for Common Infections
1. Typhoid Fever
Caused by: Salmonella Typhi, Salmonella Paratyphi A
Initial treatment/preferred treatment:
Oral: Co-trimoxazole (1ds tab bd) or Azithromycin (10mg/kg/day)
Parenteral: Ceftriaxone 2g IV od
Alternatives: Cefixime (20mg/kg/day) or chloramphenicol 500 mg qid or ciprofloxacin 750mg bd
2. Gram Positive Infections
Caused by: Salmonella pneumoniae, Streptococcus pyogenes, Staphylococcus aureus
Initial treatment/preferred treatment: Cefazolin 2g IV q8h or Cloxacillin 2g IV q6h
Alternatives: Amoxicilin-clavulanate 1.2 g IV q8h or Penicillin G 20 laks IV q4h (if S.aureus excluded) or Vancomycin (if anaphylactic penicillin allergy or MRSA clinically possible)
3. Gram Negative Infections
Caused by: E.coli, Klebsiella pneumoniae, anaerobes especially Bacteroides sp in IAI
Initial treatment/preferred treatment: Piperacillin-tazobactam 4.5g IV q6h or Cefoperazone-sulbactam 3g IV q12h
Alternatives: Imipenem 1g IV q8h or Meropenem 1g IV q8h or Ertapenem 1g IV od (carbapenems preferred for more seriously ill patients)
4. Rickettsial infections
Caused by: Orientia tsutsugamushi, Rickettsia conori
Initial treatment/preferred treatment: Doxycycline 100 mg po or IV bd
Alternatives: Azithromycin 500 mg po or IV od, chloramphenicol 500mg qid
5. Leptospirosis
Caused by: Leptospira Sp
Initial treatment/preferred treatment: Penicillin G 20 laks IV q4h or doxycycline 100mg po or IV bd
Alternatives: Ceftriaxone 2g IV od
6. Vivax malaria
Caused by: Plasmodium Vivax
Initial treatment/preferred treatment: Chloroquine 25 mg/kg body weight divided over three days i.e.10 mg/kg on day 1, 10 mg/kg on day 2 and 5mg/kg on day 3
Alternatives: Artemether-lumefantrine (1 tab bd for 3 days)
7. Falciparum Malaria
Caused by: Plasmodium Falciparum
Initial treatment/preferred treatment: Artesunate 4 mg/kg body weight daily for 3 days PlusSulfadoxine (25mg/kg body weight) and Pyrimethamine (1.25mg/kg body weight) on first day
Alternatives: Artemether-lumefantrine (1 tab bd for 3 days)
Antibiotics Drugs of Choice for Upper Respiratory Tract Infections
1. Acute Pharyngitis
Caused by: Commonly viral
Initial treatment/preferred treatment: None required
Alternatives: None required
Caused by: Common bacterial cause is Streptococcus pyogenes
Initial treatment/preferred treatment: Oral Penicillin V 500mg BD or Amoxicillin 500mg Oral TDS for 7 days
Alternatives: In case of penicillin allergy, Azithromycin 500mg OD for 5 days
2. Acute Bacterial Rhinosinusitis
Caused by: Streptococcus pneumoniae, H.influenzae, M. catarrhalis
Initial treatment/preferred treatment: Amoxicillin-clavulanate 1gm oral BD for 7 days
Alternatives: Azithromycin 500mg OD for 5 days or Ciprofloxacin 500mg BD for 7 days
Caused by: Streptococcus pneumoniae, H.influenzae, M. catarrhalis
Initial treatment/preferred treatment: Amoxicillin clavulanate 1gm oral BD for 7 days
Alternatives: Azithromycin 500mg OD for 5 days or Ciprofloxacin 500mg BD for 7 days
4. Acute Bronchitis
Caused by: Viral
Initial treatment/preferred treatment: Antibiotics not required
Alternatives: Antibiotics not required
5. Ludwig’s Angina / Vincent’s Angina
Caused by: Polymicrobial (Cover oral anaerobes)
Initial treatment/preferred treatment: Clindamycin 600mg IV 8 hourly or Amoxicillin clavulanate 1.2gm IV
Alternatives: Piperacillin tazobactam 4.5gm IV 6 hourly
Antibiotics Drugs of Choice for Urinary Tract Infections
1. Acute Cystitis (in absence of cultures)
Caused by: E.coli, Proteus sp, Klebsiella sp
Initial treatment/preferred treatment:
- Nitrofurantoin 100mg BD for 7 days
- Cotrimoxazole 500/125mg BD for 3-5 days
- Ciprofloxacin 500mg BD for 3-5 days
Alternatives:
- Cefuroxime 250mg BD for 3-5 days
- Cefixime 400mg BD for 5 days
2. Acute Pyelonephritis (If blood culture is positive, a carbapenem is preferred)
Caused by: E.coli, Klebsiella sp, Proteus sp, S. aureus
Initial treatment/preferred treatment: Piperacillin tazobactam 4.5gm IV 6 hourly for 10 days
Ertapenem 1g IV OD for 7 day
Alternatives: Imipenem 500mg IV 8 hourly for 10 days or Inj Amikacin 5mg/kg IV once daily x 10 days
3. Acute Prostatitis
Caused by: Enterobacteriaceae (E.coli, Klebsiella sp.)
Initial treatment/preferred treatment:
- Doxycycline 100mg BD for 2-3 wks
- Co-trimoxazole 960mg BD for 2-3 wks
- Ciprofloxacin 500mg BD for 2-3 wks
Alternatives:
- Piperacillin tazobactam 4.5gm IV 6 hourly
- Cefoperazone sulbactam 3gm IV 12 hourly
- Ertapenem 1gm IV OD or Imipenem 1gm IV 8 hourly or Meropenem 1gm IV 8 hourly
Antibiotics Drugs of Choice for CNS Infections in Bone Marrow Transplant Settings
1. Acute Bacterial Meningitis
Caused by: Pneumococcus, Listeria monocytogenes, H.influenzae, Meningococcus
Initial treatment/preferred treatment: Ceftriaxone 2gm IV q12h / Cefotaxime 2gm IV q4-6h + Ampicillin 2gm IV q4h
Alternatives: Moxifloxacin 400mg IV q24h or Meropenem 2gm IV q8h
2. Brain Abscess, Subural Empyema
Caused by: Streptococci, Bacteroides, Enterobacteriaceae, Staph Aureus
Initial treatment/preferred treatment: Ceftriaxone 2 gm IV q12h / Cefotaxime 2gm IV q4-6h + Metronidazole 1gm IV q12h (Duration based upon clinical & radiological response, minimum 8 weeks)
Alternatives: Meropenem 2gm IV q8h
Caused by: Nocardia spp
Initial treatment/preferred treatment: Co-trimoxazole 15 mg/kg/dose (trimethoprim component) IV or PO, plus imipenem-cilastatin 500mg q6h
Alternatives: Linezolid 600mg IV or PO q12h
We will keep adding to the list of diseases and their antibiotics drug of choice and make the post as updated as we can. Meanwhile, you can help us by commenting in any if you know, with the source or book.
