Antibiotics of choice for common pathogen

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Antibiotics of choice for common pathogen
Pathogen Antibiotics of first choice
Staphylococcus aureus or S. epidermidis Non-penicillinase producing Penicillinase producing Methicillin-resistant Streptococci Group A,C,G Group B Enterococcus Penicillin Oxacillin or Nafcillin Vancomycin Penicillin Penicillin Penicillin( or ampicillin)

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Antibiotics of choice for common pathogen
Pathogen Antibiotics of first choice
Neiseria gonorhoeae Neiseria meningitides Moraxella Listeria monocytogenes Bacteroides spp. B. fragilis strain Enterobacter spp E.coli Ceftriaxone or cefixime or ciprofloxacin Penicillin G TMP-SMX Amipcillin with or without gentamycin Penicillin G or clindamycin Metronidazole Imipenem or meropenem TMP-SMX or ciprofloxacin
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Diagnosis Duration of Therapy
Meningococcal meningitis Pneumoncoccal meningitis H. Influenzae type B meningitis Streptococcal group A pharyngitis Otitis media Bacterial sinusistis Pneumococcal pneumonia Gram-negative pneumonia Mycoplasma pneumonia Legionella pneumonia Endocarditis Viridans streptococci Staphylococcal Peritonitis Eptic arthritis osteomyelitis 7-10 10-14 10-14 10 7-10 10-14 ? optimal ? 21 14 21 28 28-42 10-14 14-21 28-42
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Differentiating features of pharyngitis caused
by group A streptococci and viruses
Classic Streptocccal Pharyngitis Viral Pharyngitis
Season Age Symptoms Sign Later winter or early spring 5-11 yr Sudden onset Sore throat, may be severe Headache Abdominal pain, nausea, Vomiting Pharyngeal erythema and exudates Tender, enlarged ant cervical nodes Palatal petechiae Tonsillar hypertrophy Scarlet fever rash Absence of cough, rhinitis, Hoarseness, conjunctivitis, and diarrhea All seasons All ages Onset varies Sore throat, often mild Fever varies Myalgia, arthralgia Abd pain Characteristic enanthems Often have cough, rhinitis, hoarseness, conjunctivitis, or diarrhea
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Clinical Practice Guidelines Compendium
Illness/pathogen Indication for antibiotic treatment Treatment Antibiotic
Acute bacterial sinusitis Streptococcus pneumoniae, nontypeable Hemophilus influenza, Moraxella catarrhalis, mainly viral pathogens When not to treat with an antibiotic nearly all cases resolve without antibiotics. Antibiotic use should be reserved for moderate symptoms that are not improve after 10 days or that worsen after 5 to 7 days, and sever symptoms Antibiotic duration 10 days Failure to respond after 72 hours of antibiotics reevaluate patient and switch to alternate antibiotics First-line therapy amoxicillin Alternative therapy Agmentin, gatigloxacin levofloxacin, moxifloxacin
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Clinical Practice Guidelines Compendium
Illness/pathogen Indication for antibiotic treatment Treatment Antibiotic
Acute bacterial sinusitis Streptococcus pneumoniae, nontypeable Hemophilus influenza, Moraxella catarrhalis, mainly viral pathogens When to treat with an antibioc diagnosis may be made in adults with symptoms of a viral upper respiratory infection that have not improved after 10 days or that worsen after five to seven days. Diagnosis may include nasal drainage, facial pressure or pain, Postnasal discharge, hyposmia anosmia, fever, cough, fatigue, maxillary dental pain, ear pressure or fullness Antibiotic duration 10 days Failure to respond after 72 hours of antibiotics reevaluate patient and switch to alternate antibiotics First-line therapy amoxicillin Alternative therapy Augmentin, gatifloxacin levofloxacin, moxifloxacin
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Clinical Practice Guidelines Compendium
Illness/pathogen Indication for antibiotic treatment Treatment Antibiotic
Pharyngitis Streptococcus pyogenes, routine respiratory viruses When not to treat with an antibiotic most pharyngitis cases are viral in origin. The presence of the following is uncommon with group A streptococcal infection conjunctivitis, cough, rhinorrhea, diarrhea and absence of fever
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Clinical Practice Guidelines Compendium
Illness/pathogen Indication for antibiotic treatment Treatment Antibiotic
Pharyngitis Streptococcus pyogenes, routine respiratory viruses When to treat with an antibioc S. pyogenes. Symptoms of sore throat, fever, headache, Physical finding include fever, tonsillopharyngeal erythema and exudates palatal petechiae, tender and enlarged anterior cervical lymph nodes and absence of cough. Group A streptococcal infection, antibiotic duration 10 days Failure to respond after 72 hours of antibiotics reevaluate patient and switch to alternate antibiotics First-line therapy Penicillin V Penicillin G benzathine Alternative therapy amoxicillin, macrolides, oral cephalosporins, clindamycin
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Clinical Practice Guidelines Compendium
Illness/pathogen Indication for antibiotic treatment Treatment Antibiotic
Acute bronchitis Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae When not to treat with an antibiotic 90 of cases are nonbacterial. Literature fails to support use of antibiotics in adults without history of chronic bronchitis or other comorbid condition Uncomplicated Not indicated
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Clinical Practice Guidelines Compendium
Illness/pathogen Indication for antibiotic treatment Treatment Antibiotic
Acute bronchitis Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae When to treat with an antibioc antibiotics not indicated in patients with uncomplicated acute bacterial bronchitis. Sputum characteristics not helpful in determining need for antibiotics. Treatment is reserved for patients with acute bacterial exacerbation of chronic bronchitis and COPD Uncomplicated Not indicated Chronic bronchitis and COPD amoxicillin, TMP-SMX, doxycycline Other erythromycin or doxycycline
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Clinical Practice Guidelines Compendium
Illness/pathogen Indication for antibiotic treatment Treatment Antibiotic
Nonspecific upper respiratory infection Viral When not to treat with an antibiotic Antibiotics not indicted. However nonspecific upper respiratory infection is a major etiologic cause of acute respiratory illnesses presenting to primary care physicians. Patients often expect treatment Not indicated None
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Clinical Practice Guidelines Compendium
Illness/pathogen Indication for antibiotic treatment Treatment Antibiotic
Influenza Influenza virus When not to treat with an antibiotic Antibiotics not indicted. for acute treatment. Supportive and symptomatic care is the standard. Characterized by abrupt onset of constitutional and respiratory signs and symptoms such as fever, myalgia, headache, rhinitis, severe malaise, nonproductive cough and sore throat Antibiotic not indicated, but patients often expect treatment Antiviral medications available for acute relief of symptoms and for prevention in some cases
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Biliary tract surgery High risk gt 60 years Obstructive jaundice Acute cholecystitis Cholangitis Common duct stone Previous biliary surgery Nonfunctioning gall bladder Low risk Cefazolin 1-2 g IV x 1 dose or gentamicin 1.7 mg/kg iv q8h x 1 or 2 doses Not recommended
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Elective colorectal Nonelective colorectal Neomycin 1g po and erythromycin base 1 g po given at 1 PM, 2 PM, 11 PM on day prior to surgery with or without cefoxitin 2 g IV x 1 dose or metronidazole 500 mg IV and gentamicin 1.7 mg/kg IV q8h x 1 or 2 doses Cefoxitin or cefotetan or metronidazole and gentamicin
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Gastroduodenal procedures High risk GI bleeding, gastric ulcer or malignancy, decreased gastric acidity, obesity, obstruction Low risk Cefazolin 1-2 g IV x 1dose Not recommended
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Appendectomy Cefoxitin 2 g IV q6h x 1-3 doses or cefotetan 2 g IV q12h x1 or 2 doses or metronidazole 500mg IV q8h and gentamicin 1.7 mg/kg IV q8h x 1-3 doses
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Hysterectomy ( abdominal or vaginal) Cesarean section High-risk patient Low risk Therapeutic abortion Cefazolin 1-2 g IV x 1dose or doxycycline 200mg IVx1 or clindamycin 900 mg IV x 1 Cefazolin 1-2 g IV x 1dose or metronidazole 500mg IV x 1 dose Not recommended Cefazolin 1-2 g IV x 1dose
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Head and neck surgery Incision through oral or pharyngeal mucosa Uncomtaminated Clindamycin 600 mg IV x 1 and gentamicin 1.7 mg/kg IV x 1 dose or ampicillin-sulbactam Not recommended
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Neurosurgery CSF shunt Craniotomy Not recommended Cefazolin 1 g IV x 1dose or Vancomycin
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Orthopedics Closed reduction of fracture Open reduction of a fracture Prosthetic joint replacement Amputation Laminectomy spinal fusion Hardware implantation No hardware implantation Not recommended Cefazolin 1-2 g IV x 1dose Cefazolin 1-2 g IV q6h or Vancomycin IV up to 24h Cefoxitin 2 g IV x 1dose Cefazolin 1-2 g IV x 1dose Not recommended
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Recommended antimicrobial regimens
Surgical Procedure Recommended Regimen
Urologic surgery If the urine is sterile If the urine is infected Transrectal prostate biopsy Not recommended Sterilize urine before surgery Ciprofloxacin 500mg po or 400 mg IV to 48h
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Denatl procedures and endocarditis prophylaxis
Endocarditis Prophylaxis Recommended
Dental extractions Periodontal procedures including surgery, scaling and root planning Dental implant placement and reimplantation of avusled teeth Endodontic instrumentation or surgery only beyond the apex Subgingival placement of antibiotic fibers or strips Intraligmentary local anesthetic injections Prophylactic cleaning of teeth or implants where bleeding is anticipated
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Other procedures and endocarditis prophylaxis
Endocarditis Prophylaxis Recommended
Respiratory tract Tonsillectomy and/or adenoidectomy Surgical operation that involve respiratory mucosa Bronchoscopy with a rigid bronchoscope Gastrointestinal tract Sclerotherapy for esophageal varices Esophageal stricture dilatation Endoscopic retrograde cholangiography with biliary obstruction Biliary tract surgery Surgical operation that involve intestinal mucosa Genitourinary tract Prostatic surgery Cystoscopy Urethral dilation
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Recommended chemoprophylaxis for high-risk
contacts and index cases of invasive
meningococcal meningitis
Infants, children and adult Dose Duration Efficacy()
Rifampin ? 1mo ? 1mo Ceftriaxone ? 12 yr ? 12 yr Ciprofloxacin ? 18 yr 5mg/kg PO q12h 10mg/kg PO q12h 20mg/kg PO q24h 125 mg IM 250 mg IM 500 mg PO 2 days 2 days 4 days Single dose Single dose Single dose 72-90 97 90-95
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