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	Alternative drug

Streptococcus Pneumonia
Neisseria meningitides
Haemophilus influenza
Staphylococcus aureus
Herpes simplex

Inj. Meropenem (2 gm)
8 hourly for 14 days plus/ or
Inj. Linezolid (600 mg)
12 hourly
Inj. Acyclovir (500 mg)
6 hourly for 14 days if viral infection

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	Alternative drug

Streptococcus Pneumonia
Neisseria meningitides
Listeria monocytogenes
Streptococcus agalactiae
Haemophilus influenza
Escherichia coli

Inj. Vancomycin (30-45 mg/kg/day)
4-12 hourly interval +
Inj. Ceftriaxone (2 gm)
12 hourly 7-14 days

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

Dentistry

Acute variceal haemorrhage

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Portal Hypertension due to Cirrhosis of liver or non-cirrhotic 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

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 lip-palate, facial cleft, facial deformity correction surgery

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Inj. Ceftriaxone (1 gm)
12 hourly
Tab. Metronidazole (500 mg)
8 hourly for 5-7 days followed by or Cap. Cephalosporins
Tab. Metronidazole

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	Alternative drug

Prevotella intermedia
Prevotella nigresub
Fusobacterium periodontices
Phyromonas endodontics
Porphyromonas gingivalis

Cap. Flucloxacillin
Tab. Metronidazole

Cap. Cepholosporins
Cap. Cefixime
Cap. Cefuroxime
Tab. metronidazole

Name: For rapidly spreading infections injectable from may be advised

Denture sore mouth

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Candida albicans

Antifungal agents eg, Nystatin powder or cream

Antifungal agents eg, Nystatin powder or cream

Denture stomatitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Candida albicans

1 antifungal agents (eg, Nystatin powder or cream)

Extraction of tooth surgical/ non surgical

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative 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.

2 of the other 3rd line antibiotic*

Fungal infections in maxillofacial region like Candidiasis, mucormicosis etc

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Fungus

Nystatin oral suspension (5-10 ml) of suspension
for at least 14 days
Cap. Fluconazole (100 mg)
daily for 7 – 14 days.
Cap. Itraconazole (400 mg)
24 hourly for 7-14 days
Inj. Amikacin

Nystatin oral suspension (5-10 ml) of suspension
for at least 14 days.
Cap. Itraconazole (400 mg)
24 hourly for 7-14 days

Gingivitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Campylobacter rectus
Actinomyces species
Prevotella inginosus
Streptococcus

Tab. Penicillin V (250-500 mg)
post operative 6 hourly for 5-7 days
Tab. Metronidazole (200-400 mg)
8 hourly for 3-5 days
Cap. Doxycycline Initial : (200 mg/day)
divided twice daily post operative first day then. Maintenance : (100-200 mg/day) divided 12 hourly

Cap. Doxycycline Initial : (200 mg/day) divided twice daily post operative first day then. Maintenance : (100-200 mg/day) divided 12hrly

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

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative 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]

Inj. Terlipressin (0.5-2.0 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	Alternative drug

3rd generation Ceftriaxone (1 mg )I/V
12 hourly
Metronidazole (500 mg) I/V
8 hourly for 5-7 days followed by oral Cephalosporins
Tab. Metronidazole

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	Alternative drug

Inj. Ceftriaxone (1 mg) 12 hourly
Tab. Metronidazole (500 mg)
8 hourly for 5-7 days followed by Cap. Cephalosporins
Tab. Metronidazole

Inj. Meropenem (1 gm) 8 hourly for 7 days, following by Cap. Cephalosporins
Tab. Metronidazole

Jaw osteomyelitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Mixed anaerobic infection. Commonly by staphylococci and enteric microorganism

Cap. Clindamycin (600 mg)
in divided dose for 6 days to 8 weeks ±
Tab. Metronidazole (500 mg)
8 hourly for 7 days

Flucloxacillin (500 mg)
6 hourly for 6-8 weeks +
Tab. Secnidazole (2 gm)
single dose

Minor oral surgery like biopsy, excision of mucocele etc

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative 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

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 5-7 days

Oral Candidiasis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus
Peptostreptococcus
Bacteroides

Antifungal agents eg, Nystatin powder or cream

Clotrimazole or Nystatin lozenges

Orofacial space infections

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Polymicrobials of both anaerobic and aerobic

Cap. Amoxicillin or Cap. Cephalosporins (Cephradine, Cefixime, Cefuroxime) (500 mg-1gm) in different dose
for 7 -14 days+
Tab. Metronidazole (500 mg)
8 hourly 7 days.

Cap. Amoxicillin or Cap. Cephalosporins with Clavulanic acid + Tab. Secnidazole (2 gm) single dose.
Cefuroxime (500 mg to 1 gm)
in different dose for 7-14 days

Peri implantitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Prevotella intermedia
Pseudomonas aeruginosa
Staphylococcus spp.
Peptostreptococcus micros
Porphyromonas ednodontalis

Cap. Cephalosporins (200-400 mg )
6-12 hourly for 7 days
Metronidazole (400 mg)
5-7 days

Name: Safe in pregnancy

Periapical Pathosis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Prevotella melaninogenica
Streptococcus anginosus
Porphyromonas gingivalis
Peptospreptococus
Microbes

Cap. Cephalosporins (200-400 mg)
6-12 hourly for 7 days.

Tab. Metronidazole (400 mg)
6 hourly for 7 days

Pericoronitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Porphyromonas gingivalis
Fusobacterium species
Peptostreptococcus micros
Fusobacterium nucleatum

Tab. Penicillin V (250-500 mg)
post operative 6 hourly for 5-7 days
Cap. Doxycycline Initial: (200 mg/day)
divided twice daily post operative first day then
Cap. Cephalosporins

Tab. Penicillin V (250-500 mg)
post operative 6 hourly for 5-7 days
Tab. Metronidazole (200-400 mg)
orally 8 hourly for 3-5 days

Periodontitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Prohyromonas gingivalis
Bacteroides forsythus
Antinobacillus actinomycente
Prevotella intermedia
Fusobacterium nucleatum
Peptostreptococcus micros
Prevotella oralis

Tab. Metronidazole (200-400 mg)
8 hourly for 3-5 days
Cap. Amoxicillin (500 mg)
6 hourly 5-7 days
Cap. Doxycycline (200 mg)
24 hourly

Cap. Cephalosporins (200-4000 mg)
6-12 hourly for 7 days ±
Metronidazole
Amoxicillin

Primary & secondary prophylaxis for variceal haemorrhage

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Portal Hypertension due to Cirrhosis of liver or non-cirrhotic 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	Alternative drug

Cap. Amoxicillin (3 gm)prior to surgery.

Cap. Clindamycin 3 gm prior to surgery
Cap. Amoxicillin 3 gm prior to surgery

Pulpits

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Obligate anaerobes:

Peptostreptococcus anaerobius
Veillonella parvula
Lactobacilus cateraforme
Porphylaomonas endodontic

Facultative anaerobes:

Streptococcus mitis
Streptococcus oralis
Enterococcus faucal
Neisseria

Cap. Amoxicillin (500 mg)(preferably with clavulanic acid)or
Cap. Cephradine
Tab. Metronidazole

Cap. Cefixime
Cap. Cefuroxime

Viral infection in lip/oral cavity like herpes simplex infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Herpes viruses

Acyclovir (400 mg)
orally 8 hourly for 7-10 days
Acyclovir ointment for topical application

Tab.Valacyclovir (1 gm)
12 hourly for 7-10 days
Acyclovir ointment for topical application

Dermatology

Acne Vulgaris

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative 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
Cap. Clindamycin (150 mg)
8 hourly and reduced gradually as control is achieved
Cap. Minocycline (50-100 mg)
12 or 24 hourly for 3 months
Cap. Tetracycline (250-500 mg)
6 hourly for 3 months
Erythromycin (250-500 mg)
6 hourly for 3 months

Cap. Amoxicillin (250-500 mg)
8 hourly
Tab. Trimethoprim-Sulfamethoxazole in double strength
12 hourly

Cellulitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcal
Streptococcal or
Combined

Co-amoxiclav (625 mg)
8 hourly
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	Alternative drug

Haemophilus ducreyi

Tab. Azithromycin (1 gm)
Oral single dose
Inj. Ceftriaxone (250 mg)
I/M single dose
Tab. Ciprofloxacin (500 mg)
12 hourly for 2 days
Erythromycin (500 mg)
8 hourly for 7 days

Inj. Ceftriaxone (1 gm) stat dose with Tab. Ciprofloxacin
Tab. Levofloxacin (750 mg)
24 hourly 7 days

Cutaneous Anthrax

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Bacillus antharacis

Tab. Ciprofloxacin (500 mg)
12 hourly for14 days
Cap. Doxycycline (100 mg)
12 hourly for 14 days

Cutaneous Tuberculosis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Mycobacterium Tuberculosis

Cap. Rifampicin (400-600 mg)
single dose
Tab. Isoniazid (300 mg)
single dose
Tab. Ethambutol (15-25 mg/kg/day) or
Inj. Streptomycin (75 mg-1gm)
single dose
Tab. Pyrazinamide (25-35 mg/kg/day)
for 2 months
Tab. Rifampicin (400-600 mg)
single dose
Tab. Isoniazid (300 mg)
single dose for next 4 months

Inj. Clarithromycin or
Tab. Ofloxacin or
Tab. Ciprofloxacin or
Inj. Cycloserine or
Inj. Capreomycin or
Tab. Paraaminosalicyclic acid
Tab. Ethionamide.

Gonorrhoeae

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Neisseria gonorrhea

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

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcal
Streptococcal or
Combined

Cap. Dicloxacillin (250-500 mg)
Tab. Co-amoxiclav (625 mg)
8 hourly
Cap. Cephalexin (250-500 mg)
6 hourly for 7 days

Tab. Clindamycin (30 mg)
8 hourly
Cap. Erythromycin (250-500 mg)
6 hourly for 7 days

Leprosy

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative 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
Tab. Clofazimine (50 mg)
single dose plus
Cap. Rifampicin (600 mg)
monthly for 1 year

Inj. Clarithromycin (500 mg)
single dose
Tab. Minocycline (100 mg)
single dose
Tab. Ofloxacin (400 mg)
single dose
Tab. Levofloxacin (500 mg)
single dose

Syphilis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Treponema pallidum

Inj. Benzathin penicillin 12 lac unit I/M in each buttock day one day eight and day fifteenth according to stages

Cap. Doxycycline (100 mg)
12 hourly for 2 weeks
Cap. Erythromycin (500 mg)
6 hourly for 14 days
Inj. Ceftriaxone (250 mg)
24 hourly I/M or I/V for 8-10 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	Alternative drug

Escherichia coli
Klebsiella
Streptococcus pyogens
Pseudomonas aeruginosa
Staphylococcus aureus

Inj. Ceftriaxone (2 gm)
12 hourly at least for 7-10 days

Inj. Piperacillin+
Inj. Tazobactam
Inj. Meropenem
Inj. Amphotericin-B

Skin and soft tissue infection e.g. diabetic foot lesion

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcus
Streptococcus
Anaerobes

Tab. Co-Amoxiclav (625 mg)
8 hourly for 7-10 days

Fluoroquinolones
Ceftibuten
Inj. Ceftriaxone +
Inj. Clindamycin

Name: Wound care like debridement, regular drening off loading of presure area are much important

Supportive Parotitis (Salivary Gland Infection)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Inj. Co-Amoxiclav (1.2 gm)
8 hourly Oral then:
Tab. Co-Amoxiclav (625 mg)
8 hourly 10-14 days

Inj. Clindamycin (900 mg)
8 hourly Oral then:
Tab. Clindamycin (450 mg)
8 hourly

Gastro Intestinal System

Acute gastroenteritis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Campylobacter
Shigella
Salmonella
Clostridium difficile

Tab. Azithromycin (500 mg)
2 tab stat then 1 tab for 4 days

Tab. Ciprofloxacin (500 mg)
12 hourlyfor 7 days
Tab. Metronidazole (400 mg)
8 hourlyfor 5-7 days

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	Alternative drug

Acinatobacter
Enterococci faecalis
Bacteroides fragilis

Inj. Piperacillin/Tazobactam(4.5 gm)
6-8 hourly for 7-14 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	Alternative drug

Gram negative anaerobes

Inj. Meropenem (500 mg)
8 hourly

Gastroenteritis, Typhlitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Candida
Enterococcus faecalis
Aspergillus
Anaerobes

Inj. Cefepime (500 mg)
8 hourly
Piperacillin/Tazobactam
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)
6-8 hourly for 7-14 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 plus
Inj. Clindamycin (600 mg)
8 hourly for 7-14 days

Peptic ulcer disease

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Helicobacter pylori

Tab. Levofloxacin (500 mg)
12 hourly for 14 to 30 days
Tab. Metronidazole (400-500 mg)
8 hourly for 14-30 days

Cap. Tetracycline (500 mg)
6 hourly for 14 to 30 days

Name: Duration depending on the nature and severity of the infection

Secondary bacterial peritonitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Other gut pathogens

Inj. Meropenem (500 mg)
8 hourly

Spontaneous bacterial peritonitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Klebsiella
Proteus

Tab. Levofloxacin (500 mg)
12 hourly for 14 to 30 days
Tab. Metronidazole (400-500 mg)
8 hourly for 14-30 days
Inj. Cefotaxime(2 gm)
12 hourly for 5 days

Inj. Co-amoxiclav (1 gm/0.2 gm)
8 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	Alternative drug

Entamoeba histolytica

Inj. Metronidazole (750 mg)
8 hourly for 5-10 days

Nitazoxanide (500 mg)
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	Alternative drug

Hepatitis B Viris
Treatment is indicated: HBV-DNA>2000 IU/ml ALT> Upper limit of normal Histology= moderate to severe necroinflammation & significant fibrosis

Tab. Tenofovir (300 mg)
24 hourly
Tab. Entecavir (0.5 mg)
once daily

Tab. Lamivudine (100 mg)
24 hourly
Tab. Adefovir (10 mg)
24 hourly
Tab.Telbivudine (600 mg)
24 hourly
Inj. PEG-IFN-2a (180 µg)
subcutaneously weekly for 12 months

Antiviral used in Hepatitis C infection (Chronic Hepatitis C)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

HCV Genotype 1

Inj. PEG-IFN+ Tab. Simeprevir+ Cap. Ribavirin
for 12 weeks
Tab. Sofosbuvir+ Cap. Ledipasvir
for 12 weeks

Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin
for 12 weeks and
Inj. PEG-IFN+ Cap. Ribavirin
for next 12 weeks
Tab. Sofosbuvir+ Tab. Simeprevir
for 12 weeks
Tab. Sofosbuvir+ Tab. Daclatasvir
for 12 weeks

HCV Genotype 2

Tab. Sofosbuvir+ Cap. Ledipasvir
for 12 weeks

Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin
for 12 weeks and
Tab. Sofosbuvir+ Cap. Daclatasvir
for 12 weeks

HCV Genotype 3

Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin
for 12 weeks

Tab. Sofosbuvir+ Cap. Ribavirin
for 24 weeks
Tab. Sofosbuvir+ Tab. Daclatasvir
for 12 weeks

HCV Genotype 4

Inj. PEG-IFN+ Tab. Simeprevir+ Cap. Ribavirin
for 12 weeks
Tab. Sofosbuvir+ Tab. Ledipasvir
for 12 weeks

Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin
for 12 weeks and
Inj. PEG-IFN+ Cap. Ribavirin
for next 12-36 weeks
Tab. Sofosbuvir+ Tab. Simeprevir
for 12 weeks
Tab. Sofosbuvir+ Tab. Daclatasvir
for 12 weeks

HCV Genotype 5&6

Inj. PEG-IFN+ 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	Alternative drug

Escherichia coli
Klebsiella Pneumoniae
Pseudomonas
Proteus

Inj. Piperacillin-Tazobactam (3.375 gm)
6 hourly

Inj. Meropenem (1 gm)
8 hourly

Hepatic actinomycosis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Actinomyces israelii

Benzy1 Penicillin

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	Alternative drug

Echinococcus granulosus

Surgery followed by Tab. Albendazole (400 mg)
12 hourly for 1 month
Tab. Albendazole (400 mg)
for 1 month then 14 days interval, total 3-6 cycles

PAIR followedby Tab. Albendazole (400 mg)
12 hourly for 1 month

Name: PAIR is as effective as surgery. (WHO guideline- 1996)

Leptospirosis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Leptospira icterohaemorrhagiae

Inj. Benzyl Penicillin (900 mg)
1.5 million unit 6 hourly for 1 week

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	Alternative drug

Burkholderia pseudomallei

Inj. Ceftazidime (2 gm)
8 hourly for 2-3 weeks followed by
Cap. Doxycycline (200 mg)
24 hourly plus
Tab. Co-trimoxazole (80/400 mg)

Inj. Meropenem (0.5-1 gm)
8 hourly for 2-3 weeks followed by
Cap. Doxycycline (200 mg)
24 hourly plus
Co-trimoxazole

Pyogenic liver abscess

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Klebsiella Pneumoniae
Viridans streptococci
Streptococcus Pneumoniae

Inj. Ciprofloxacin (500 mg)
12 hourly
Inj. Ceftriaxone (1 gm)
plus 12 hourly
Inj. Metronidazole for 2 weeks and then oral for 4 weeks.

Piperacillin/ Tazobactam
Imipenem/ Cilastatin
Meropenem
Co-amoxiclav

Infectious Disease

Bacterial vaginosis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Anaerobes

Tab. Metronidazole (500 mg)
8 hourly
Tab. Clindamycin (80 mg)
8 hourly

Tab. Metronidazole (500 mg)
8 hourly
Tab. Clindamycin (80 mg)
8 hourly

Febrile Neutropenia

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcus
Pseudomonas
Streptococcus
Escherichia coli
Klebsiella

Inj. Meropenem (1 gm)
8 hourly for 7-10 days

Inj. Meropenem (1 gm)
8 hourly for 7-10 days

Name: Culture sensitivity prefered preceded by emperical treatment

Genital Herpes

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Herpes simplex type I or type II

Tab. Acyclovir (400 mg)
8 hourly for 7-10 days

Tab. Famcyclovir (250 mg)
orally 8 hourly for 7-10 days
Tab. Valacyclovir (1 gm)
12 hourly for 7-10 days

Kala-azar

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Leishmania

Inj. Liposomal Amphotericin B (10 mg/kg)
not less than in 2 hours single dose.

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	Alternative drug

Plasmodium sepsis

Tab. Artemether-Lumefantrine- Quinine (10 mg/kg) 8 hourly for 7 days

Chloroquine
Doxycycline
Tetracycline

Neutropenic fever, Cellulitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Mostly Unknown
Gram negative Escherichia coli

Inj. Meropenem (500 mg)
8 hourly plusInj
Amikacin (500 mg)
I/V 12 hourly for 7 days

Ceftazidime
Cefepime

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
Tab. Ofloxacin (400 mg)
post operative 12 hourly to complete 14 days

Post of Infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas

Inj. Amikacin (500 mg)
12 hourly

Netlimicin

Post of Infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli

Ceftriaxone (1 gm)
24 hourly

Meropenem

Secondary fungal infection e.g. oral thrush

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Candida species

Fluconazole plus Locally Nystatin/ Miconazole

Secondary infection in malignant lesion

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas
Staphylococcus
Streptococcus

3rd generation Cephalosporins plus Metronidazole

2nd Generation Cephalosporins or Quinolone derivatives

Sepsis/ Acute PID

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Gm negative

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	Alternative drug

Escherichia coli, Klebsiella
Streptococcus pyogens
Pseudomonas aeruginosa
Staphylococcus aureus

Inj. Ceftriaxone (2 gm)
12 hourly at least for 7-10 days

Inj. Piperacillin + Inj. Tazobactam
Inj. Meropenem
Inj. Amphotericin-B

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. Vancomycin (1 gm)
12 hourly
Inj. Amikacin (500 mg)
12 hourly for 7 days Plus
Inj. Metronidazole (500 mg)
8 hourly for 7 days

Inj. Meropenem (1gm)
8 hourly for 7-14 days plus
Inj. Metronidazole (500 mg)
8 hourly for 7 days

Septicemia

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

According to source of infection

Inj. Meropenem (1 gm)
6 hourly

Inj. Piperacillin/ Tazobactam (4.5 gm)
8 hourly

Sick Immunocompromised (febrile neutropenia)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Inj. Meropenem (1 gm)
8 hourly for 7-14 days or/plus
Inj. Meropenem (1 gm)
8 hourly for 7-14 days or/plus
Quinolone
7-14 days

Inj. Linezolid (600 mg)
12 hourly or/plus
Inj. Piperacillin/Tazobactam (4.5 gm)
6-8 hourly for 7-14 days

Trichomoniasis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative 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

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 partners

Uncomplicated Chlamydial Infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

If poor compliance:

Tab. Azithromycin (1 gm)
post operative stat dose

If Pregnant:

Tab. Erythromycin (500 mg)
post operative 6 hourly for 7 days or
Tab. Erythromycin (500 mg)
post operative 12 hourly for 14 days

Inj. Clarithromycin or
Tab. Ofloxacin or

Valvovaginal Candidiasis (non regnant)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative 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

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	Alternative drug

Staphylococcus epidermises
Staphylococcus aureus
Pseudomonas

Inj. Ceftriaxone (1-2 gm)
12 hourly
Inj. Amikacin (500 mg)
12 hourly

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

Venous harvesting site wound infection of leg

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus aureus
Streptococcus pyogens
Pseudomonas
Escherichia coli

Inj. Ceftriaxone (1-2 gm)
12 hourly
Inj. Amikacin (500 mg)
12 hourly

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	Alternative drug

Gram positive
Staphylococcus aureus
Pseudomonas

Inj. Ceftriaxone (1 gm)
24 hourly
Inj. Imipenem (500 mg-1gm)
8 hourly

Name: Steroid coverage with antimicrobial therapy may be required

Wound infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Staphylococcus aureus
Pseudomonas
Klebsiella

Cream Gentamicin apply locally 2-3 times daily Or
Cream/ointment Fusidic acid apply locally 2-3 times daily Or
Cream/ointment Mupirocin apply locally 2-3 times daily Or
Combination of Bacitracin and neomycin apply the cream locally 2-3 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	Alternative 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

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	Alternative drug

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	Alternative drug

Escherichia coli
Klebsiella
Pseudomonas
Enterococcus

Cap. Nitrofurantoin (100 mg)
6 hourly for 7 days
Tab. Pivmecillinam (400 mg) stat & (200 mg)
8 hourly for 7 days

Cap. Cephalexin (500 mg)
8 hourly for 7 days

Non Gonococcal Urethritis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Chlamydia trachomatis
Ureplasma urealyticum
Mycoplasma
Genetalium

Cap. Doxycycline (100 mg)
12 hourly for 7 days
Tab. Azithromycin (1 gm)
single dose

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	Alternative drug

1st/2nd generation Cephalosporins or
Inj. Aminoglycosides
Tab. Metronidazole or Clindamycin

Aminoglycosides
Fluoroquinolones

Prostatitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Enterobacteriaceae
Pseudomonas
Enterococci
Enterococcus

TMP/SMX for 4 weeks

Fluoroquinolones

Prostatic biopsy

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Fluoroquinolones
1st/2nd generation Cephalosporins

TMP/SMX
Aminoglycosides

Surgical prophylaxix: Urethrocystoscopy, Urodynamic study, Ureteroscopy, TURP, TURBT

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Fluoroquinolones
TMP/SMX

Inj. Aminoglycosides
Inj. Ampicillin
1st/2nd generation Cephalosporins
Co-Amoxiclav

Urinary Tract Infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Klebsiella
Pseudomonas
Staphylococcus aureus
Candida albicans

Tab. Ciprofloxacin (500 mg)
12 hourly for 7-10 days

Co-amoxiclav
Cefuroxime+Clindamycin

Urinary Tract Infection (acute uncomplicated cystitis)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative 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 3-7 days

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

β-Lactams

Co-amoxiclav
Cefdinir
Cefaclor
Cefpodoxime-Proxetil (100mg)
12 hourly 3 days

Urosepsis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Proteus
Klebsiella
Enterococci
Candia

Inj. Amikacin (500 mg)
12 hourly for 7 days
Inj. Meropenem (1 gm)
8 hourly for 7-14 days plus
Cap. Fluconazole (500-100 mg/day) if fungal infection

Inj. Cefepime (1 gm)
8-12 hourly for 7-14 days
Inj. Meropenem (1 gm)
8 hourly for 7-14 days or plus
Cap. Fluconazole (500-100 mg/day)

Urological Surgery involving intestine e.g.: GI tract, Skin+ intestine

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

2nd/3rd generation Cephalosporins
Inj. Aminoglycosides
Tab. Metronidazole or
Clindamycin

Inj. Ampicillin
Inj. Ticarcillin/ Co-Amoxiclav
Inj. Piperacillin/ Tazobactam
Fluoroquinolones

Musculoskeletal system

Acute and chronic pyogenic Osteomyelitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcus aureus
Staphylococcus pyogens

Inj. Ceftriaxone (1 gm)
12 hourly
Inj. Flucloxacillin (250 mg-1 gm)
6 hourly

Inj. Cefuroxime (750 mg)
12 hourly

Deep sternal wound infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus pyogens
Streptococcus aureus
Pseudomonas
Escherichia coli
Fungal

Inj.Meropenem (500 mg-1 gm)
18 hourly
Inj. Amikacin (500 mg)
12 hourly

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

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Prophylactic purpose

Inj. Ceftriaxone (1 gm)
12 hourly
Inj. Cefuroxime (750 mg)
12 hourly
Inj. Cefepime(500 mg-1000 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	Alternative drug

Staphylococcus aureus
Haemophilus influenza
Enterobacter Species

Inj. Ceftriaxone (1 gm)
12 hourly
Inj. Flucloxacillin (250 mg-1 gm)
12 hourly

Name: Preferred culture sensitivity report

Skin & Soft tissue infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus pyogens
Staphylococcus aureus

Cap. Flucloxacillin (500mg) 6 hourly

Tab. Clarithromycin (500mg) 12 hourly and Cap. Clindamycin (450-60mg) 6 hourly

Superficial sternal wound infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcus aureus
Streptococcus pyogens
Escherichia coli
Pseudomonas

Inj. Ceftriaxone (1-2 gm)
12 hourly
Inj. Amikacin (500 mg)
12 hourly

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	Alternative drug

Mycobacterium aureus

1st line anti-tubercular drugs

Wound infections

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus aureus
Pseudomonas pyogenosa
Klebsiella
Enterobacteriaceae

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	Alternative drug

Anaerobes

Not needed

Caesarean section

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Prophylaxis

Inj. Amoxiclav (1.2 gm)
8 hourly

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	Alternative drug

Gram negative
Staphylococcus
Escherichia coli
Pseudomonas

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	Alternative drug

Prophylaxis

Inj. Amoxicillin (2 gm) + Inj. Metronidazole (500 mg) initially followed by
Inj. Amoxicillin (500 mg)
8 hourly +
Inj. Metronidazole (500 mg)
8 hourly till delivery
Inj. Gentamicin if severe sepsis 5 days for oral antibiotics after delivery

Inj. Clindamycin in penicillin allergy group

Placenta Removal,4 Degree Tear, Major Surgery, Extensive Oncological Surgery

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

IV-single 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 contra-indicated ( see GHNHSFT protocol ) consult microbiologist Duration: 5-7 days and then review

Non-severe 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 diarrhoea or if Gentamicin is contra-indicated ( GHNHSFT protocol ) consult microbiologist. Duration: 5-7 days and then review. Consult Microbiologist

Prophylaxis Hysterectomy Laparotomy Vaginal Repair

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Inj. Ceftriaxone (2 gm)
12 hourly at least for 7-10 days

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 B-lactuse allergy

Surgical Prophylaxis Obstetric & Gynaecological Surgery Hysterectomy

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

IV-single dose only at induction

Opthalmology

Antibiotics used in surgical prophylaxis: Cataract surgery, Glaucoma surgery, Dacryocystitis (Chronic)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Moxifloxacin 0.3%
Gatifloxacin 0.3% 1 drop g.i.d.

Levofloxacin 0.3%

Bacterial Uveitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Mycobacterium tuberculosis
Mycobacterium Bovis
Treponema. pallidum

According to cause
Anti-TB
Anti-Syphilis (systemic regimen to be followed)

Name: Aquaus and vitreous sample for culture sensitivity

Conjunctivitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus Pneumonia
Staphylococcus aureus
Haemophilus influenzae
Moraxella catarrhalis
Neisseria gonorrhea
Neisseria meningitides
Chlamydia trachomatis

Chloramphenicol
Aminoglycosides (Gentamicin, Neomycin)
Quinolones (Ciprofloxacin Ofloxacin)
Levofloxacin
Lomefloxacin
Gatifloxacin
Moxifloxacin
Polymyxin B
Fusidic acid dose (g.i.d. for 1 week)

Tetracycline
Fusidic acid
Doxycycline
Erythromycin
Bacitracin

Name: Conjunctival culture sensitivity needed

Corneal Ulcer

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas
Staphylococcus aureus
Streptococcus
Neisseria Gonorrhoeae
Meningitis
Coronibacterium diphtheria
Haemophilus influenzae
Treponema pallidum

Ciprofloxacin 0.3%
Ofloxacin 03.%
Fortified Gentamicin
Fortified Cephalosporins
Procaine Penicillin (g.i.d. for 1 week or according to severity of the disease)

Moxifloxacin
Gatifloxacin
Doxycycline
Tetracycline
Erythromycin
Sub conjunctival antibiotics

Name: Depends on culture sensitivity. Conjunctival sweab and corneal serapping

Dacryocystitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcus aureus
Epidermidis
Streptococcus viridians
Pneumoniae pyogens
Escherichia coli

Flucloxacillin (oral)
for 1 week
Cephradine

Co-amoxiclav
Cephalosporins
Cefixime

Name: Depending on culture sensitivity

Endophthalmitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcus species.
Bacillus species

Ceftazidime (2 mg in 0.1 ml)
Vancomycin (2 mg in 0.1 ml)
Tab. Ciprofloxacin (750 mg)
12 hourly or
Moxifloxacin (400 mg)
24 hourly

Amikacin (0.4 mg in 0.1 ml)
Gentamicin (0.2 mg in 0.1 ml)

Name: Aquaus vitreous sample for culture sensitivity

Lid infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococcus aureus
Pyogenes
Epidermidis
Streptococcus viridans
Pneumonia
Pyogenes

Ciprofloxacin 0.3% 1 drop g.i.d
for 7 days (dose can be readjusted according to severity)

Moxifloxacin
Flucloxacillin

Name: To maintain lid hygine

Neonatal conjunctivitis (Opthalmia Neonatorum)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Chlamydia trachomatis
Neisseria Gonorrhoeae

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	Alternative drug

Streptococcus Pneumoniae
Staphylococcus aureus
Streptococcus viridans
Haemophilus influenzas

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

Antimicrobial of choice
Preferred drug	Alternative drug

Treponema pallidum

3 to 4 million unit Penicillin G is administered every
4 hourly for 10 to 14 days.

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	Alternative drug

Pseudomonas 66.66%
Staphylococcus aureus 33.33%

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	Alternative drug

Neisseria meningitides
Streptococcus pneumonia
Haemophilus influenjae

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 (45-60 mg/kg/day)
8 hourly for 10 days+
Ampicillin (200-400 mg/kg/day)
6 hourly for 10 days

Meropenem (40 mg/kg/day)
8 hourly+
Amino glycosides (if pseudomonas)

Septicemia CNS infection

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Organism of unknown susceptibility

Inj. Vancomycin (45-60 mg/kg/day)
12 hourly for 10-14 days+
Inj. Meropenem (30-40 mg/kg/day)
8 hourly for 10-14 days

Inj. Vancomycin (45-60 mg/kg/day)
12 hourly for 10- 14 days+
Inj. Meropenem (30-40 mg/kg/day)
8 hourly

Paediatric Gastrointestinal System

Bacillary dysentery

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Shigella species, Shigella dysentery, Shigella flexnari

Cap. Cefixime (8-10 mg/kg/day)
12 hourly for 5 days
Pivmecillinam (50 mg/kg/day)
6 hourly for 5 days

Cefixime12 hourly
Ceftriaxone (50-75 mg/kg/day)
12 hourly

Cholangitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Staphylococcus aureus

Ceftazidime (150 mg/kg/day)
Amikacin (15-20 mg/kg/day)

Meropenem (30-40 mg/kg/day)

Diarrhoea

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Shigella
Vibrio cholerae

Azithromycin (10 mg/kg/day)
Ciprofloxacin (15-30 mg/kg/day)
Pivrnecillinam

Ceftriaxone (50-200 mg/kg/day)

Enteric Fever & Severe Enteric Fever

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Salmonella typhi
Salmonella paraphyphi A
Salmonella paratyphi B

Cap. Cefixime (20 mg / kg/day)
12 hourly for 10 to 14 days
Inj. Ceftriaxone (50-75 mg/kg/day)
12 hourly at least 5 days after a febrile period
Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Dexamethasone (3mg/kg)initial flowed by (1 mg/kg)
6 hourly for 48 hours

Azithromycin (20 mg/kg/day)
24 hourly 7 days
Ciprofloxacin (20-30 mg/kg/day)
12 hourly 7-10 days

Giardiasis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Giardia

Metronidazole (15 mg/kg/day)
8 hourly for 5–7 days

Secnidazole

Hydatid cyst

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Echinococcus
Granulosus

Albendazole (15 mg/kg/day)
12 hourly

Intestinal Amoebiasis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Entamoeba
Histolytica

Metronidazole (15 mg/kg/day)
8 hourly for 5–7 days

Secnidazole

Liver Abscess

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus aureus
Gram negative
Anaerobic organism

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	Alternative drug

Streptococcus Pneumoniae
Acinetobactor
Escherichia coli

Ceftazidime (50 mg/kg/dose)
8 hourly
Ceftriaxone (100 mg/kg/day)
12-24 hourly
Amikacin (7.5 mg/kg/dose)
12 hourly

SBP

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Staphylococcus aureus

Cefotaxime (50-200 mg/kg/day)
Flucloxacillin (50-100 mg/kg/day)

Meropenem (30-40 mg/kg/day)

Paediatric Infectious Disease

Abscess 2%

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Enterobacter Spesis

Flucloxacillin (25-250 mg)
6 hourly
Vancomycin (45-60 mg/kg/day)
Tazobactam
Meropenem (30-40 mg/kg/day)

Inj. Vancomycin (45-60 mg/kg/day)
12 hourly for 10-14 days+
Inj. Meropenem (30-40 mg/kg/day)
8 hourly

Oral thrush

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Candida albicans

Nystatin (4-6 lakhs)
unit for 6 hourly
Miconazole 2% apply
12 hourly

Inj. Vancomycin (45-60)
8 hourly for 2-4 weeks

Septicemia (Blood C/S) 10%

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Klebsiella
Acinatobacter
Coagulase negative staph
Escherichia coli

Inj. Amikacin (15-20 mg/kg/day)
Inj. Meropenem (30-40 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 5-7 days or more we start intravenous Amphotericin B

Septicemia (Blood C/S) Micro organism isolated:6%

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Salmonella
Enterococcus
Pseudomonas
Klebsiella

Cefotaxime (50 mg/kg/dose)
8-12 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	Alternative drug

Haemophilus influenza
Streptococcus aureus
Streptococcus pneumoniae

Inj. Ceftriaxone (50-75 mg/kg/day)
12 hourly for 4 weeks
Cefotaxime (20 mg/kg/day)
8 hourly for 4 weeks+
Clindamycin (10-40 mg/kg/day)
8 hourly for 4 weeks

Inj. Clindarnycin (10-40 g/kg/day)
8 hourly
Vancomycin (45-60 mg/kg/day)
8 hourly
Meropenem (40 mg/kg/day)
8 hourly

Skin infection Cellulitis Osteomyelitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Organism of unknown susceptibility

Cloxacillin (50-100 mg/kg)
6 hourly for 7-10 days
Inj. Clindamycin (10-40 mg/kg/day)
8 hourly for 2-4 weeks

Inj. Vancomycin (45-60)
8 hourly for 2-4 weeks

Throat Swab Micro organism isolated: 12%

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus pyogens 82%
Staphylococcus aureus 18%

Penicillin (25-50 mg/kg/dose)
6 hourly
Erythromycin (10 mg/kg/dose)
6 hourly
Amoxicillin (25 mg/kg/dose)
8 hourly
Clindamycin (3-6 mg/kg/dose)
6 hourly

Wound Swab 2%

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas

Flucloxacillin (125-250 mg)
6 hourly
Amikacin (15-20 mg/kg/day)
Meropenem (30-40 mg/kg/day)
Vancomycin (45-60 mg/kg/day)

Imipenem
Amikacin
Colistin
Ticarcillin

Paediatric Surgery

Amniotic band of both leg: release of bank and Z-plasty in right leg

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococci
Micrococci
Gram positive rods

Inj. Ceftriaxone (50-75 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 (50-75 mg/kg)

AVM of left thigh (Aspirated) (Aspirated fluid: no growth)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococci
Micrococci
Gram positive rods

Inj. Cephradine (50-100 mg/kg/day)

Cystic Hygroma (within the abdomen) with sliding hernia: Excision of Cystic hygroma with herniotomy

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Klebsiella
Pseudomonas aeruginosa
Enterococci

Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Flucloxacillin (50-100 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	Alternative drug

Escherichia coli
Klebsiella
Pseudomonas aeruginosa
Proteus

Inj. Ceftriaxone (50-75 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	Alternative drug

Escherichia coli
Klebsiella Pneumoniae
Streptococci Pseudomonas
Enterococci

Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Gentamicin (5 mg/kg/day)

Growth in lower Esophagus: feeding gastrostomy with biopsy from growth

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Klebsiella pneumonia
Streptococcus pneumonia
Enterococci

Cephradine (50-100 mg/kg/day)
Inj. Gentamicin (5 mg/kg/day)

Hydrocephalus and Meningomyelocele with urinary and fecal incontinence; Introduction of V-P shunt with excision of meningomyelocele

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Encapsulated organism: Streptococcus Pneumoniae, Nigeria meningitides, Haemophilus influenza. Non capsulated organism: Listeria monocytogenes

Inj. Ceftazidime (15-20 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	Alternative drug

Escherichia coli
Klebsiella
Pseudomonas aeruginosa
Proteus

Inj. Ceftriaxone (50-75 mg/kg/day) followed by
Inj. Meropenem (30-40 mg /kg/day)
Inj. Flucloxacillin (50-100 mg/kg/day)
Inj. Amikacin

Name: Multidrug use of antibiotic also require specific indication

Hypospaedias: Urethroplasty

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus

Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Flucloxacillin (50-100 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 ileo-anal anaestomosis. On 7th POD patient developed incomplete wound dehiscence which closed by secondary suture

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Bactericides Fragilis
Streptococcus viridians group

Inj. Ceftriaxone (50-75 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 (30-40 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	Alternative drug

Staphylococci, Micrococci, Gram positive rods

Inj. Ceftriaxone (50-75 mg/kg/day) followed by oral Cefixime

Streptococcus pyogens 82%
Staphylococcus aureus 18%

Meconium ileus with Ileostomy: Ileostomy closure (Stool culture: no organism)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli, Bactericides Fragilis
Streptococcus viridians group

Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Metronidazole
Inj. Amikacin

Non-operative case of Choledochal cyst

Likely causative agent

Antimicrobial of choice

Inj. Ceftriaxone (50-75 mg/kg)

Penoscrotal hypospaedias: Urethroplasty (Urine c/s: no growth)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Klebsiella pneumonia
Pseudomonas aeruginosa
Proteus

Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Flucloxacillin (125-250 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	Alternative drug

Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus

Inj. Ceftriaxone (50-75 mg/kg/day) for 7 days, Then Inj. Meropenem(30-40 mg/kg/day), Inj. Flucloxacillin (50-100 mg/kg/day) and Inj. Amikacin (15-20 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	Alternative drug

Escherichia coli
Bactericides Fragilis
Streptococcus viridians group

Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Metronidazole (15-30 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	Alternative drug

Escherichia coli
Klebsiella
Pseudomonas aeruginosa
Proteus

Inj. Ceftriaxone (50-75 mg/kg/day) followed by
Inj. Meropenem (30-40 mg/kg/day)
Inj. Amikacin

Thalasseaemia with Hypersplensim: Splenectomy

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Klebsiella Pneumoniae
Streptococci Pseudomonas
Enterococci

Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Phylopen
Inj. Amikacin (15-20 mg/kg/day)

Paediatric Urinary System

Urinary tract infection Acute cystitis Acute pyelo nephrities

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Klebsiella
Proteus

Cap. Cefixime (8-10 mg/kg/day)
12 hourly for 7-10 days
Tab. Ciprofloxacin (8-30 mg/kg/day)
12 hourly for 7-10 days
Inj. Amikacin (15-20 mg/kg/day)
Inj. Gentamicin (5 mg/kg/day)
Ceftazidime (150 mg/kg/day)

Inj. Amikacin (15-20 mg/kg/day)
Inj. Gentamicin (5 mg/kg/day)
Cap. Nitrofurantoin (5-7 mg/kg/day)
Tab. Co-trimoxazole

Urinary tract infection (UTI) Micro organism isolated: 6%

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Escherichia coli
Enterococci
Acinatobacter
Pseudomonas

Cefotaxime (50 mg/kg/dose)
8-12 hourly
Ceftazidime (50 mg/kg dose)
8 hourly
Ceftriaxone (100 mg/kg days)
12-24 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

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Cap. Nitrofurantoin (1-2 mg/kg/day)
Single dose at bed time
Tab. Co-trimoxazole (6-20 mg/kg/day)
single dose at bed time

Paediatrics Respiratory System

Otitis Media 2%

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas

Ceftriaxone (50-75 mg/kg/day)
Cefuroxime
Ceftazidime (150 mg/kg/day)

Ceftazidime
Ciprofloxacin
Imipenem
Meropenem
Netlimicin

Pneumonia

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Haemophilus influenjae
Staphylococcus aureus

Nosocomial:

Escherichia coli
Streptococcus Pneumoniae
Haemophilus influenjae
Pseudomonas
Klebsiella
Staphylococcus aureus

Community acquired:

≥5 years: Mycoplasma Chlarnydia

Inj. Ceftriaxone (50-75 mg/kg/day)
7-10 days according to clinical response
Cap. Flucloxacillin (125-250 mg)
6 hourly.(in staphylococcus aureus)
Inj. Azithromycin (10 mg/kg/day)
Inj. Erythromycin (30-50 g/kg/day)

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 (10-40 g/kg/day)
8 hourly for 14 days
Inj. Vancomycin (45-60 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	Alternative drug

Klebsiella
Acinatobacter

Penicillin (125-250 mg)
orally every 6-8 hourly
Erythromycin (30-50 mg/kg/day)
Clarithromycin (15 mg/kg/day)
Meropenem (30-40 mg/kg/day)

Imipenem
Ciprofloxacin
Colistin
Tazobactam
Piperacillin

Respiratory System

Acute Bacterial Rhino sinusitis (severe or persistent symptoms)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Gram positive:

Staphylococcus aureus
Streptococcus Pneumoniae
Haemophilus influenzae
Pseudomonas aeruginosa
Moraxella catarrhalis

Gram negative:

Pseudomonas aeruginosa
Escherichia coli
Protease mirabilis
Klebsiella Pneumoniae
Enterobacter

1st line:

Tab. Co-Amoxiclav (625 mg)
8 hourly orally

2nd line:

Doxycycline oral(100 mg)
12 hourly 10 days

1st line:

Inj. Clarithromycin (500 mg)
12 hourly

2nd line:

Cap. Doxycycline (100 mg)
12 hourly

Acute Diffused Otitis Externa (Swimmer's ear)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Staphylococus aureus
Pseudomonas pyogens
Escherichia coli
Often mixed flora

Mile-moderate:

Cap.Flucloxacillin Topical Antimicrobial

Severe (e.g. Cellulitis or blocked ear canal):

Inj. Ceftriaxone (1 mg)
Tab. Ciprofloxacin (500mg)
12 hourly for 7-10 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	Alternative drug

Staphylococcal

Cap. Flucloxacillin (1 gm)
6 hourly for 7 days plus
Topical steroids

Clarithromycin (500 mg)
12 hourly

Acute Otitis Media

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus Pneumoniae
Staphylococcus aureus
Haemophilus influenzae
Micrococcus Catarrhalis (Necrotizing)
B Haemolytic streptococcus

1st Line

Cap. Amoxicillin (500 mg)
8 hourly

2nd line

Tab. Co-Amoxiclav (625 mg)
8 hourly 10 days

Antibiotics should not be routinely prescribed for uncomplicated AOM. For severe disease or when risk of complications:

1st Line

Clarithromycin (500 mg)
12 hourly

2nd line

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 2-3 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

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas
Acinatobacter
Enterococci faecalis
Bacteroides fragilis

Inj. Piperacillin/Tazobactam(4.5 gm)
6-8 hourly for 7-14 days plus
Inj. Amikacin (500 mg)
12 hourly for 7 days Plus
Tab. Metronidazole (500 mg)
8 hourly for 7 days

Inj. Meropenem (1gm)
8 hourly for 7-14 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	Alternative drug

Aerobic:

Pseudomonas aeruginosa
Escherichia coli
Streptococcus aureus
Streptococcus Pyogenes
Proteus mirabilis
Klebsiella species

Anaerobic:

Bacteroides
Peptostreptococcus
Propionibacterium

Oral antimicrobial may be added if a susceptible organism is cultured 7-10 days

Community Acquired Pneumonia (CAP)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Streptococcus Pneumoniae
Staphylococcus aureus
Candia

Inj. Azithromycin (500 mg) I/V OD
5 days, or
Inj. Clarithromycin (500 mg)
12 hourly for 7-14 days
Inj. Quinolone
7-14 days or
Inj. Linezolid (600 mg)
12 hourly 7-14 days (if gram positive infection), or
Inj. Ticoplzmin (400 mg) stat and (200 mg)
12 hourly for 7-14 days, or
Cap. Fluclonazole (50-100 mg/day) if fungal infection

Inj. Ceftazidine (1 gm)
8 hourly for 7-14 days, plus/ or
Inj. Clindamycin (600 mg)I/V
8 hourly for 7-14 days
Inj. Piperacillin/ Tazobactam (4.5 gm)
6-8 hourly for 7-14 days
Inj. Vancomycin (1 gm) I/V
12 hourly 7-14 days (if gram positive infection)
Inj. Amphotericin-B if fungal infection

Epiglottises

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Haemophilus influenzae (25%), followed by Haemophilus parainfluenzae, Streptococcus Pneumoniae, and group A streptococci

Inj. Ceftriaxone (2 gm)
24 hourly. Oral then:
Tab. Co-amoxiclav (625 mg)
8 hourly for 7-10 days

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	Alternative drug

Staphylococus

Co-amoxiclav
Metronidazole

Clindamycin, Vancomycin, Daptomycin, Linezolid

Malignant Otitis Externa

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas

Tab. Ciprofloxacin (500 mg-750 mg)
12 hourly for 4-6 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	Alternative drug

Pseudomonas
Mixed flora

1st line
Tab. Ciprofloxacin (500mg-750mg) for 12 hourly
2nd line:
Cap. Clindamycin (450mg) 6 hourly for 4-6 weeks

Pharyngitis/Tonsillitis

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

GABHS (common)
Arcanobacterium hemolytic (7% or adolescents and adults with pharyngitis)
Group C Streptococci (uncommon)
Group G Streptococci (uncommon))
Neisseria Gonorrhoeae (uncommon)
Coronibacterium diphtheria (rare)

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
Tab. Co-amoxiclav (625 mg)
8 hourly for 7-10 days.

Mild:

Tab. Clarithromycin (500 mg)
12 hourly

Severe:

Inj. Clarithromycin (900 mg)
8 hourly. Oral then
Tab. Clindamycin (450 mg)
8 hourly

Pneumonia

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Mostly unknown
Gram-ve Escherichia coli

Inj. Meropenem (500 mg)
8 hourly plus
Inj.Amikacin (500 mg) I/V
12 hourly for 7 days

Ceftazidime
Cefepime

Quinsy (peritonsillar abscess)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Aerobic bacteria are Streptococcus group A (GAS), B-hemolytic 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. Co-amoxiclav (625 mg)
8 hourly for 7-10 days

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	Alternative drug

Streptococcus Pneumoniae
Legionella pneumophetin
Mycoplasma
Haemophilus influenza
Staphylococcus aureus

3rd / 4th generation Cephalosporins
Macrolide

Fluoroquinolones
Macrolide

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	Alternative drug

Inj. Ceftriaxone (2 gm)
24 hourly and
Inj. Metronidazole (500 mg)
4 hourly. Oral then:
Tab. Co-amoxiclav (625 mg)
8 hourly or according to C/S for 10-14 days

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 (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	Alternative drug

Pneumococcus
Streptococcus
Staphylococcus

Inj. Azithromycin (500 mg-1 gm)
24 or 12 hourly for 3 days or
Tab. Azithromycin (500 mg)
orally 24 or 12 hourly for 3 days or
Tab. Co-amoxiclav (625 mg)
orally 8 hourly for 7 days

3rd generation Cephalosporins or Quinolone derivatives

Ventilator associated pneumonia (Early VAP)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas
Acinatobacter
Proteus
Klebsiella
Staphylococcus aureus

Inj. Piperacillin/Tazobactam (4.5 gm)
6-8 hourly for 7-14 days plus
Inj. Amikacin (500 mg)
12 hourly for 7 days
Quinolone
for 7-14 days

Inj. Meropenem (1 gm)
Inj. Vancomycin (1 gm)
Inj. Colistin Sulphate (1-2 MU)

Ventilator associated pneumonia (Late VAP)

Likely causative agent

Antimicrobial of choice
Preferred drug	Alternative drug

Pseudomonas
Acinatobacter
Proteus
Klebsiella
Staphylococcus aureus

Inj. Meropenem (1 gm)
8 hourly plus
Inj. Amikacin (500 mg)
12 hourly for 7 days
Inj. Colistin Sulphate (1-2 MU)
8 hourly for 7-14 days

Inj. Cefepime (1 gm)
8-12 hourly
Inj. Vancomycin (1 gm)
12 hourly
Inj. Colistin Sulphate (1-2 MU)
8 hourly for 7-14 days