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.

Contents

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

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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

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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

3. Acute Otitis Media

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
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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.

2 COMMENTS

  1. Thank you for reserving quinolones for resistant cases. It’s concerning that Cipro and Levaquin are VERY frequently used first line in UTIs and other infections and C&S is not ordered.

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