Antibiotics by Aj Wisanu Siriraj PDF

Thailand AMR Containment and Prevention Program
(.)
(.)
International Development Research Center (IDRC), Canada

70
(miracle drug wonder drug)

2 1)

2)

40

100
.. 2536
(Post-Antibiotic Era)
(Pre-Antibiotic Era)

100,000
30,000
40,000 0.6
(Gross Domestic Product,GDP)

3 1)

2) 3)
(Hygiene & Sanitation)
(Infection Prevention & Control Practices)

3
(
)

(.)
(.)
International Development Research Center (IDRC)

.
.

.. 2558

1

9

16
1 17

25

28
2
29

38

48
3
49

50

52
4
53

59

61

66

66

69

72

75

79

81

82

83

86

88

89

90

90
Sepsis/ Severe Sepsis

91
5 Sepsis/ Severe Sepsis

93

95
6
103

105

106

( Lactobacillus spp.
)
( Pseudomonas
aeruginosa)
(Cocci) (Bacilli,
Rods), (Aerobes)
(Anaerobes) (Gram Positive)
(Gram Negative)

- Gram Positive Aerobic Cocci : Staphylococcus aureus, Streptococcus pneumoniae,
Streptococcus pyogenes, Streptococcus
agalactiae, viridans streptococci, Streptococcus suis, Enterococcus spp.

- Gram Positive Anaerobic Cocci : Peptostreptococcus spp.

- Gram Positive Aerobic Bacilli : Listeria
monocytogenes, Corynebacterium diphtheriae,
Bacillus spp.

- Gram Positive Anaerobic Bacilli :
Clostridium tetani, Clostridium difficile

- Gram Negative Aerobic Cocci :
Neisseria gonorrhoeae, Neisseria meningitidis,
Moraxella catarrhalis

- Gram Negative Anaerobic Cocci :
Veillonella spp.

- Gram Negative Aerobic Bacilli :
Escherichia coli, Klebsiella pneumoniae,
Proteus spp., Enterobacter spp., Salmonella
spp., Shigella spp., Aeromonas spp., Vibrio
spp., Campylobacter spp., Helicobacter pylori,
Pseudomonas aeruginosa, Acinetobacter
spp., Hemophilus influenzae, Burkholderia
pseudomallei, Stenotrophomonas maltophilia,
Pasteurella multocida

- Gram Negative Anaerobic Bacilli :
Bacteroides fragilis, Fusobacterium spp.
Treponema pallidum, Nocardia

asteroides, Rickettsia spp., Mycobacterium spp.

( E.coli
)
( E.coli
)

(
)
(
)
(Antimicrobial Agent)
(Antibiotic)
(Bacteriostatic) (Bactericidal)

1.
(Intrinsic Resistance)

( E.coli Vancomycin
E.coli Vancomycin

E.coli Vancomycin
E.coli Vancomycin Vancomycin
E.coli )

2.
(Acquired Resistance)

E.coli
Ceftriaxone E.coli Ceftriaxone
( Fluoroquinolones) E.coli Ceftriaxone

1 5
(Emerging Infectious Diseases)

3

. (MultidrugResistant, MDR)
1 3

. (Extensively Drug-Resistant, XDR)
1
1-2

. (PandrugResistant, PDR)

Acinetobacter
baumannii

A.baumannii
Aminoglycosides
Gentamicin, Tobramycin, Amikacin, Netilmicin
Antipseudomonal Carbapenems
Imipenem, Meropenem, Doripenem
Antipseudomonal Fluoroquinolones
Ciprofloxacin, Levofloxacin
Antipseudomonal Penicillins
+ Beta-Lactamase Inhibitors
Extended-Spectrum Cephalosporins
Piperacillin-Tazobactam, Ticarcillin-Clavulanic Acid
Folate Pathway Inhibitors
Cotrimoxazole
Penicillins + Beta-Lactamase Inhibitors
Ampicillin-Sulbactam
Polymyxins
Colistin, Polymyxin B
Tetracyclines
Tetracycline, Doxycycline, Minocycline, Tigecycline
Cefotaxime, Ceftriaxone, Ceftazidime, Cefepime

MDR A.baumannii A.baumannii
Amikacin, Ciprofloxacin, Ceftazidime
Imipenem, Colistin, Tigecycline

XDR A.baumannii A.baumannii
Amikacin, Imipenem, Ciprofloxacin,
Piperacillin-Tazobactam, Ceftazidime, Cotrimoxazole, Ampicillin-Sulbactam Colistin,
Tigecycline

PDR A.baumannii A.baumannii

A.baumannii
A.baumannii Imipenem
MDR, A.baumannii Imipenem
Colistin XDR A.baumannii
Imipenem Colistin PDR

- Drug-Resistant Streptococcus pneumoniae (DRSP)

- Macrolide-Resistant Streptococcus pyogenes

- Methicillin-Resistant S.aureus (MRSA)

- Vancomycin-Resistant Enterococci (VRE)

- Fluoroquinolone-Resistant Neisseria
gonorrhoeae

- Fluoroquinolone-Resistant Enteric
Bacteria ( Shigella spp., Campylobacter spp.,
Salmonella spp.)

- Extended-Spectrum Beta-Lactamase
(ESBL) Producuing Enterobacteriaceae (
E.coli, Klebsiella spp.)

- Carbapenem-Resistant Enterobacteriaceae (CRE)

- Carbapenem-Resistant Pseudomonas
aeruginosa

- Carbapenem-Resistant Acinetobacter
baumannii

- Colistin-Resistant A.baumannii

- Cotrimoxazole-Resistant Stenotrophomonas maltophilia

MRSA, ESBLProducuing Enterobacteriaceae, CRE, CarbapenemResistant P.aeruginosa & A.baumannii
2

1.

-
( Shigella spp.)
( N.gonorrhoeae)

-
( ESBL-producing E.coli)

(
) ESBL-producing E.coli

- (
Fluoroquinolone, Cephalosporin)
( E.coli)
(ESBL-producing
E.coli)
( )
ESBL-producing E.coli

- (
E.coli)
( Norfloxacin
)
(ESBL-producing E.coli)

2.

- ( Acute Pyelonephritis E.coli)

( Ciprofloxacin
) ESBLproducing E.coli

- ( Acute Pyelonephritis E.coli)

ESBL-producing E.coli

-

(
)

-

(
24 )

(
)

0.4 1.6
(Gross Domestic Product, GDP)

100,000 30,000
3
6,000

40,000 0.6 GDP
2
2 1)

2)
( )

2
6
4

(Responsible Use of Antibiotics)
)
( )

(

)

( -)

(

)

(
)

( -)

( ) (
)

()

5
1)
2)
3)
4)
5)

(
Acute
Pyelonephritis E.coli)

( Acute
Pyelonephritis E.coli Ceftriaxone
2 )

2 1)
2)

(
Cellulitis)
( Acute Otitis
Media, Acute Cholecystitis)
(
Acute Cystitis
)

- ( )

- (
Sepsis, Infective Endocarditis, Meningitis)

- ( Complicated Urinary Tract Infection, Prosthetic Joint
Infection)

-
( Ventilator-Associated
Pneumonia)

-
( Acute Pyelonephritis
Ofloxacin )

- ( Recurrent Acute Pyelonephritis)

-
( Cellulitis

S.aureus S.pyogenes)

2

1.

10

1.1.

-

-
2% Chlorhexidine 70% Alcohol (
Chlorhexidine Povidone
Iodine Alcohol )

-
1:5
1:10 5-10 . 0.5 5 . ( 1%
)

- 70% Alcohol

-

- 2

2

1.2.

-
2-3

Saline Nebulizer

-

1.3.

-

labia

-

70% Alcohol Syringe

5-10 .

-

1.4.

-

( Vibrio cholerae, Shigella spp.)

- Rectal Swab
Rectal Swab
Swab Swab
12 Swab
Swab Transport Medium ( Cary-Blair

Transport Medium)

- Clostridium
difficile Toxin

1.5. /

-
Swab

Swab
Swab Transport
Medium Swab
Swab

- 6

1.6.

-

Continuous Ambulatory Peritoneal Dialysis
(CAPD)

-
2% Chlorhexidine 70% Alcohol
( Chlorhexidine
Povidone Iodine Alcohol )

-

( )

11

2.
( )

-

Gram Positive Diplococci
Streptococcus
pneumoniae

-

Gram
Positive Cocci S.aureus
MRSA (
Vancomycin)

( Anaerobes, N.gonorrhoeae, H.influenzae)

Squamous Epithelial
Cells 10-25 /Low Power Filed

12

(
Streptococci Alpha Hemolysis
Viridans Streptococci
Streptococcus suis
Non-Fermentative Gram-Negative Rods
Burkholderia pseudomallei )

( )
(
)
( Severe Sepsis)
( Acinetobacter
baumannii)

(
Contact Precautions)
( Anaerobes)

-

(
) (
Coagulase Negative Staphylococci
)

-
(
)

-
( E.coli )
E.coli 100,000 .
Streptococci
Alpha Hemolysis Viridans Streptococci

Streptococcus suis Non-Fermentative
Gram-Negative Rods
Burkholderia pseudomallei

-
(
3
Coagulase-Negative Staphylococci,
Corynebacterium spp., Diphtheroid, Bacillus
spp. 1 2-3
)

E.coli Vancomycin E.coli
Vancomycin
13
14
-hemolytic Streptococci Penicillins

-hemolytic Streptococci
Penicillins

-

Clinical and Laboratory Standards
Institute (CLSI)

2

1) Disk Diffusion

(Antimicrobial
Disk)

Inhibition Zone
Inhibition Zone

6

2) Etest

(Minimum Inhibitory Concentration, MIC)
7
Disk Diffusion

MIC
Disk Diffusion
Inhibition Zone
Disk Diffusion
6
Disk Diffusion
7
Etest

Beta-Lactamase
Beta-Lactams,
Extended-Spectrum
Beta-Lactamase (ESBL) Combination Disk
Disk 2 ( Ceftazidime
Disk Ceftazidime-Clavulanic Acid Disk
Cefotaxime Disk Cefotaxime-Clavulanic Acid
Disk)
ESBL
E.coli ESBL
Cephalosporins ESBL

( CLSI)

( CLSI)

( Oxacillin Disk,
Cefoxitin Disk)

( MIC
)

Disk Diffusion
1

E.coli ESBL
Gentamicin Ceftrixone
Amikacin Imipenem

( )
(
)
( )
( Carbapenem-Resistant
E.coli)
15

(.)
MRSA S.aureus, Imipenem
E.coli, K.pneumoniae, P.aeruginosa, A.baumannii

Enterobacteriaceae
ESBL, Enterobacteriaceae
Cephalosporins 3, P.aeruginosa
A.baumannii Colistin, Stenotrophomonasmaltophilia Cotrimoxazole,
Enterococci Vancomycin (VRE)
1.
2.
3.
4.
5.
16
S.aureus
( Disk)

*S
*I
*R

(Inhibition Zone Diameter, .)
Cefoxitin (30g)

22
-
21
(Surrogate Test for Oxacillin)

( MSSA)

( MRSA)
Erythromycin (15g)

23 14-22 13
Clindamycin (2g)

21 15-20 14
Trimethoprim/Sulfamethoxazole (1.25/23.75g) 16 11-15 10
Fosfomycin (50g) 15 12-14 11
Fusidic Acid (10g) 22 15-21 14
Vancomycin (MIC, g/ml) 2 4-8 16

1. S.aureus Cefoxitin Disk (30g) S.aureus MRSA

- Inhibition Zone 22 . MSSA Cloxacillin,
Dicloxacillin, Cefazolin, Cephalexin ( Erythromycin) Disk
Diffusion

- Inhibition Zone 21 . MRSA
( Cotrimoxazole, Fosfomycin, Fusidic Acid) Disk Diffusion
MRSA Vancomycin MIC MIC
MRSA Vancomycin
Vancomycin MIC Vancomycin

3. Erythromycin Clindamycin D-Shape
Clindamycin
* MSSA Methicillin-Susceptible S.aureus

* MRSA Methicillin-Resistant S.aureus
* S Susceptible
* I Intermediate Susceptible
* R Resistant
17
Streptococcus pneumoniae
( Disk)

S
I
R

Oxacillin (1g)

20

( Penicillin)
Inhibition Zone 19 . MIC Penicillin, Cefotaxime, Ceftriaxone
Erythromycin (15g)

21 1620
15
Levofloxacin (5g)

17 1416
13
Trimethoprim/sulfamethoxazole (1.25/23.75g) 19 1618
15
Clindamycin (2g)

19 1618
15
Vancomycin (30g)

17
( Vancomycin)

1. Penicillin S.pneumoniae Oxacillin Disk (1 g)

1.1 Inhibition Zone 20 . ( Penicillin MIC 0.06 ./.) S.pneumoniae
Beta-Lactams Penicillin Penicillin G,
Ampicillin, Amoxicillin, Ceftriaxone, Cefotaxime

1.2 Inhibition Zone 19 . Penicillin Ceftriaxone
MIC Penicillin, Cefotaxime Ceftriaxone,
Meropenem MIC

1.2.1 Meningitis

- Inhibition Zone (6 .) Penicillin (MIC >0.06) 100%
Penicillin Penicillin

- Inhibition Zone (6 .) Ceftriaxone (MIC >0.5)
92% Ceftriaxone Vancomycin
Vancomycin + Ceftriaxone ( Cefotaxime)

- Inhibition Zone 7-19 . Penicillin (MIC >0.06) 71%

- Inhibition Zone 7-19 . Ceftriaxone (MIC >0.5) 1%
Ceftriaxone Ceftriaxone Cefotaxime

1.2.2 Meningitis

- Inhibition Zone (6 .) Penicillin (MIC >2) 12%
Ceftriaxone ( Cefotaxime) Vancomycin

- Inhibition Zone (6 .) Ceftriaxone (MIC >1) 22%
Ceftriaxone Levofloxacin
Vancomycin
18

- Inhibition Zone 7-19 . Penicillin (MIC >2) 0%

- Inhibition Zone 7-19 . Ceftriaxone (MIC >1) 1%
Ceftriaxone Ceftriaxone Penicillin

2. Erythromycin Clindamycin D-Shape
Clindamycin

3. S.pneumoniae Vancomycin
Streptococcus spp. -Hemolytic Group
( Disk)

S
I
R

Penicillin (10 units)

24
( -Hemolytic Streptococci
Penicillin)
Erythromycin (15g)

21 16-20
15
Clindamycin (2g)

19 16-18
15
Vancomycin (30g)

17
( -Hemolytic Streptococci
Vancomycin)

Erythromycin Clindamycin D-Shape
Clindamycin
Enterococcus spp.
( Disk)

S
I
R


15 -

14
Ampicillin (10g)

17
-

16
Vancomycin (30g)

17 15-16
14
Gentamicin (120g)

10 7-9
6
Nitrofurantoin (300g)

17 15-16
14
(Urine)
Ciprofloxacin (5g)

21 16-20
15
(Urine)

Gentamicin (120g Disk) Gentamicin (Synergy)
Penicillin, Ampicillin, Vancomycin Gentamicin

Gentamicin (120g Disk) Gentamicin (NonSynergy) Penicillin, Ampicillin, Vancomycin
19
Streptococcus spp. viridans group

( Disk)

S
I
R

Penicillin (MIC, g/ml)
0.12 0.25-2
4
Ampicillin (MIC, g/ml) 0.25 0.5-4
8
Cefotaxime (30g)

28 26-27
25
Ceftriaxone (30g)

27 25-26
24
Erythromycin (15g)

21 16-20
15
Clindamycin (2g)

19 16-18
15
Vancomycin (30g)

17 --- --
Penicillin Ampicillin MIC MIC Disk
Diffusion
20
Enterobacteriaceae (E.coli, Klebsiella spp., Proteus spp., Enterobacter spp.)

( Disk)

S
I
R

Ampicillin (10g)

17 14-16
13
Amoxicillin-Clavulanate (20/10g)

18 14-17
13
Ampicillin-Sulbactam (10/10g)

15 12-14
11
Piperacillin-Tazobactam (100/10g)

21 18-20
17
Cefazolin (30g) (Parenteral)

23 20-22
19
Cefazolin (30g) (Oral)

15 -

14
(surrogate test for uncomplicated UTI
Cephalosporins )
Cefotaxime (30g)

26 23-25
22
Ceftriaxone (30g)

23 20-22
19
Ceftazidime (30g)

21 18-20
17
Ertapenem (10g)

22 19-21
18
Imipenem (10g)

23 20-22
19
Meropenem (10g)

23 20-22
19
Gentamicin (10g)

15 13-14
12
Amikacin (30g)

17 15-16
14
Trimethoprim/Sulfamethoxazole (1.25/23.75g) 16 11-15
10
Fosfomycin (200g)

16 13-15
12
(Oral/Urine)
Ciprofloxacin (5g)

21 16-20
15
Ofloxacin (5g)

16 13-15
12
(Urine)
Enterobacteriaceae (E.coli, Klebsiella spp., Proteus spp., Enterobacter spp.)

( Disk)

S
I
R

Norfloxacin (10g)

17 13-16
12
(Urine)
Nitrofurantoin (300g)

17 15-16
14
(Urine)

1. Beta-Lactams
ESBL ESBL

2. ESBL ESBL
ESBL

3. Carbapenem (Ertapenem, Imipenem, Meropenem)
Colistin, Fosfomycin
Salmonella spp.
( Disk)

S
I
R

Ampicillin (10g) 17 14-16
13
10
Ciprofloxacin (5g) 31 21-30
20
Ceftriaxone (30g) 23 20-22
19
Shigella spp.
( Disk)

S
I
R

13
10
15
Norfloxacin (10g) 17 13-16
12
Aeromonas spp.
( Disk)

S
I
R

Amoxicillin-Clavulanate (20/10g) 18 14-17
13
Ceftriaxone (30g) 23 20-22
19
15
10
21
Vibrio spp.
( Disk)

S
I
R

13
Amoxicillin-Clavulanate (20/10g) 18 14-17
13
Tetracycline (30g) 15 12-14
11
10
15
Cefotaxime (30g) 26 23-25
22
Gentamicin (10g) 15 13-14
12
Pseudomonas aeruginosa
( Disk)

S
I
R


21 15-20
14
Ceftazidime (30g)

18 15-17
14
Imipenem (10g)

19 16-18
15
Meropenem (10g)

19 16-18
15
Colistin (10g)

11
-
10
Gentamicin (10g)

15 13-14
12
Amikacin (30g)

17 15-16
14
Netilmicin (30g)

15 13-14
12
Ciprofloxacin (5g)

21 16-20
15
Ofloxacin (5g)

16 13-15
12
(Urine)
Norfloxacin (10g)

17 13-16
12
(Urine)
Acinetobacter spp.
( Disk)

S
I
R

Ampicillin-Sulbactam (10/10g)

15 12-14
11

21 18-20
17
Cefotaxime (30g)

23 15-22
14
Ceftriaxone (30g)

21 14-20
13
Ceftazidime (30g)

18 15-17
14
Imipenem (10g)

22 19-21
18
Meropenem (10g)

18 15-17
14
22
Acinetobacter spp.
( Disk)

S
I
R

Ciprofloxacin (5g)

21 16-20
15
10

Acinetobacter spp. Extensively Drug-Resistant (XDR) Imipenem/
Meropenem 50 Colistin
MIC Colistin

MIC Disk Diffusion

- Inhibition Zone 10 . Colistin
- Inhibition Zone 11 . Colistin 95%

MIC Cotrimoxazole (Trimethoprim/Sulfamethoxazole), Coamoxiclav,
Ceftazidime, Imipenem, Tetracycline Doxycycline MIC
Disk Diffusion

- Ceftazidime, Imipenem, Coamoxiclav Enterobacteriaceae

- B.pseudomallei Ceftazidime Imipenem

- Inhibition Zone Diameter Cotrimoxazole (Trimethoprim/Sulfamethoxazole 1.25/23.75g) ( 16 .) Intermediate (11-15 .)
Cotrimoxazole Inhibition Zone Diameter ( 10 .)
Cotrimoxazole 88%
Stenotrophomonas maltophilia
( Disk)

S
I
R

10
Levofloxacin (5g)

17 14-16
13
Haemophilus influenzae
( Disk)

S
I
R

Ampicillin (10g)

22 19-21
18

20 ---
19
Trimethoprim/Sulfamethoxazole (1.25/ 23.75g) 16 11-15
10
Azithromycin (15g)

12 ---
---
Clarithromycin (15g)

13 11-12
10
23
Haemophilus influenzae
( Disk)

S
I
R

Ciprofloxacin (5g)

21
---
--Cefriaxone (30g)

26
---
---

1. Haemophilus Test Medium (HTM)

2. -Lactamase Test -Lactamase
Ampicillin -Lactamase Ampicillin
N.gonorrhoeae
( Disk)

S
I
R


47 27-46
26
Ciprofloxacin (5g)

41 28-40
27
Cefixime (5g)

31
---
---
Cefriaxone (30g)

35
---
--

GC Agar with 1% defined growth
supplement
Moraxella catarrhalis
( Disk)

S
I
R


24
-
23
10
Erythromycin (15g) 21
-
-
Azithromycin (15g) 26
-
-
Clarithromycin (15g) 24
-
-
Ciprofloxacin (MIC, g/ml) 1

Cefriaxone (MIC, g/ml) 2
24
1)
2)

(
)

1)
(Ventilator-Associated Pneumonia, VAP)
2)
(Catheter-Associated Urinary Tract Infection,
CAUTI) 3)
(Central Line-Associated
Blood Stream Infection, CLABSI) 4)
(Surgical Site Infection, SSI)

25
26
2 )

:

:

(Pulmonary Infiltration, Consolidation, Cavitation)

2
(Ventilator-Associated
Pneumonia, VAP)

Hospital-Acquired Pneumonia, HAP)

(Tracheobronchitis)

:

100,000 .

2

(Catheter-Associated Urinary Tract
Infection, CAUTI)

Asymptomatic Significant
Bacteriuria

:

(Primary Bacteremia)

(Central
Line-Associated Blood Stream Infection, CLABSI)

( )

(Secondary Bacteremia)

:

:

/

(Decubitus Ulcer Infection)

( )

:

, Sepsis/Severe Sepsis
Clostridium difficile

:

(Episiotomy Wound Infection)

Abnormal
Discharge/

(Infectious
Endometritis)

(Infectious Mastitis/ Breast

Abscess)

Abnormal Discharge/
(Infectious
Omphalitis)

1.
(Prevalence Survey)

(Point Prevalence
Survey) (Period Prevalence
Survey)

2

2.
(Targeted Surveillance)

Clean Surgery
1

-

-
(
)

-
27

(Infection Control Nurse, ICN)

(Infection
Control Ward Nurse, ICWN)
( )

30-40

( )

MRSA, VRE,
ESBL-producing E.coli & K.pneumoniae, Third
Generation Cephalosporin Resistant E.coli &
K.pneumoniae, CRE, Carbapenem-Resistant
P.aeruginosa & A.baumannii, Colistin-Resistant
P.aeruginosa & A.baumannii, CotrimoxazoleResistant S.maltophilia
1.
2. (Prevalence Survey)
3.
4. (Targeted Surveillance)
5. ( 3 )
6.
28
29
30
No.
ATB
Urinary cath.
C
IV line
Ventilator
NI
Nosocomial infection (NI)

Site Org. Org. Site Org. Org. Site Org. Org.
1 1.1 1.2 2 2.1 2.2 3 3.1 3.2
1. 1 1 2. 3. (NI) ()
HN
Adm.
date
.......................................................... .................................................................................... ...................................................................

/ ICU.... () ......................................................
(Nosocomial Infection Point Prevalence Survey)
No. = 1
Adm. Date =
ATB = Antibiotic
C = Central IV line, P = Peripheral IV line C P
Ventilator ET Ventilator
Site : 01 = VAP, 02 = UTI, 03 = CLABSI, 04 = SSI Site
Org. : 01 = MSSA, 02 = MRSA, 03 = Enterococci, 04 = E.coli, 05 = K.pneumoniae/Klebsiella spp., 06 = Enterobacter spp.,
07 = Providencia/Serratia/Citrobacter spp., 08 = P.aeruginisa, 09 = A.baumannii/Acinetobacter spp.,
10 = S.maltophilia, 11 = other
(NI)
Antibiotic
Penicillin
Ampicillin/Amoxicillin
Cloxacillin/Dicloxacillin
Oxacillin
Amoxicillin-Clavulanate
Piperacillin-Tazobactam
Cefoperazone-Sulbactam
Gentamicin
Amikacin
Norfloxacin
Ofloxacin
No HN ..........
Org
Org
S I/R S I/R
No HN ..........
Org
Org
S I/R S I/R
No HN ..........
Org
Org
S I/R S I/R
No HN ..........
Org
Org
S I/R S I/R
Ciprofloxacin
Erythromycin
Cefazolin
Cefoxitin
Ceftriaxone
Cefotaxime
Ceftazidime
Imipenem
Meropenem
Fosfomycin
Vancomycin
Cotrimoxazole
Colistin
...............................
...............................
...............................
...............................
...............................
31

24

No.
HN
Adm. Date
ATB
Urinary cath.
IV line
Ventilator
(Respirator)
32
()
()

Antibiotic Y N
Admit
1 = Clean Surgery

2 = Clean Contaminated Surgery

3 = Contaminated Wound 4-6

4 = Dirty Wound 4-6
/
( Nephrostomy)
N
C ( Cut down, Jugular,
Subclavian Vein) P C
P
(Endotracheal Tube, ET)
Ventilator ET Ventilator
NI
Site

2
NI (Site) (Org.)

01 Ventilator-Associated Pneumonia (VAP)
- / 2
- ( >38C)
- / / /
- / /
- Crepitations/ Rhonchi/ Bronchial Breath Sounds
- Infiltration/ Consolidation/ Cavitaty

011 Hospital-Acquired Pneumonia (HAP)
-
- 01
012 Tracheobronchitis
- 01 011
02 Urinary Tract Infection (UTI)

- ( >38C) /
/ / /

- >105 /. U/A >10 cells/mm3
021 Catheter-Associated Urinary Tract Infection, CAUTI
- 02 2
2
022 Asymptomatic Significant Bacteriuria
- >105 /. 02
03 Bacteremia
- ( >38C)
-
33
34
031 CLABSI
-
- 03
032 Primary Bacteremia
- 03
- Bacteremia
032 Secondary Bacteremia
- 03
- Bacteremia
04 Surgical Site Infection (SSI)
041 Superficial SSI
- 30
-
042 Deep SSI
- / 30
-
-
- /
- /
043 Organ/Space SSI
- 30
-
-
-
-
05 Diarrhea
- 3 24 1

06 Skin Infection
-
- Drainage
( Coagulase Negative Staphylococci,
Micrococci, Diphtheroid) (Pure Culture)
07 Post-partum Infection
071 Episiotomy Wound Infection
- (Episiotomy Wound) Abnormal Discharge/
072 Endometritis
- ( >38C)
- Abnormal Discharge/
- Abnormal Discharge,
08 Omphalitis
- <30
- /
-
1. /
2. NI NI
Site

Org.
01 = MSSA, 02 = MRSA, 03 = Enterococci, 04 = E.coli, 05 = K.pneumoniae/

Klebsiella spp., 06 = Enterobacter spp., 07 = Providencia/ Serratia/
Citrobacter spp., 08 = P.aeruginisa, 09 = A.baumannii/ Acinetobacter spp.,
10 = S.maltophilia, 11 = other
35
(Targeted NI Surveillance)
............................................................HN ...... ..
....../........./......... ....../........./......... .
ICU.... () ....................
..
..
// //
Clean Clean-Cont.
Cont. Dirty
..
..

1 VAP CAUTI CLABSI SSI .................................

1..... 2.. 3. 4....

1..... 2.. 3. 4....

1..... 2.. 3. 4....

. ..

NI /
1.
2.
3. : 01 = MSSA, 02 = MRSA, 03 =Enterococci, 04 = E.coli, 05 = K.pneumoniae/ Klebsiella spp.,
06 = Enterobacter spp., 07 = Providencia/ Serratia/ Citrobacter spp., 08 = P.aeruginisa,
09 = A.baumannii/ Acinetobacter spp., 10 = S.maltophilia, 11 = other
4. ()
36

Antibiotic
Penicillin
Ampicillin/Amoxicillin
Cloxacillin/Dicloxacillin
Oxacillin
Amoxicillin-Clavulanate
Gentamicin
Amikacin
Norfloxacin
Ofloxacin
Ciprofloxacin
Erythromycin
Cefazolin
Cefoxitin
Ceftriaxone
Cefotaxime
Ceftazidime
Imipenem
Meropenem
Fosfomycin
Vancomycin
Cotrimoxazole
Colistin
...................................
...................................
...................................
...................................
...................................
Org.........
S
I/R
Org.........
S
I/R
Org.........
S
I/R
Org.........
S
I/R
37

30-40

(
)

(Infection
Control Committee) -

(Infection Control Nurse, ICN)
ICN 1 100-250
38
(
, Alcohol Gel
)

(Hand Hygiene)

(Barrier Precautions)
(Environmental Decontamination)

1.
Standard Precautions

-

Body Fluid

- ( )
Body Fluid

2.
(Infection)
(Colonization)
( , Conjunctivitis,
Viral Hemorrhagic Infections, --
)
Standard Precautions
Contact Precautions

-

Contact Precautions

-

-
Body
Fluid

-

3.

(
(SARS)
) Standard
Precautions Airborne Precautions

-

Airborne Precautions

- - N 95

-

- -

- -

-
-
4.

3
(

) Standard Precautions
Droplet Precautions
-

39
Droplet Precautions

- -

(
) - N 95

-

- -

- -

-
-

Contact Precautions Airborne Precautions
Droplet Precautions

3 1)
(Hand Hygiene) 2)
(Personal Protective Equipment, PPE)
3) (Antiseptic)
40
(Hand Hygiene)

(

, Stethoscope,
) (

)

-

Body Fluid
Alcohol Gel

http://www.nejm.org/doi/full/10.1056/
NEJMvcm0903599
Alcohol Gel
1. Alcohol Gel 60%-95% 3-5 ( Alcohol Gel
3-4 )
2. Alcohol Gel
3.

4.

5.

6.
7.

8.
2 7 20-30
41
42

Alcohol Gel

- Alcohol Gel
(

)

-

Alcohol Gel

- Alcohol Gel

Alcohol Gel

-
Alcohol Gel
Alcohol

-
Alcohol ( Clostridium diffcile,
Non-Enveloped Viruses)

( 4% Chlorhexidine)

- Alcohol Gel
Alcohol Alcohol
Gel 30 Alcohol
Gel Alcohol
Gel Alcohol Gel

- Alcohol Gel
Alcohol

( Clostridium difficile)
( NonEnveloped Viruses) -
Alcohol Gel
40-60

/
( 4 % Chlorhexidine
Gluconate 7.5% Povidone Iodine) 2-6

Alcohol 10
3
(Personal Protective
Equipment, PPE)

-
(Sterile Gloves) -

- (NonSterile Gloves)

- (mask)

- -
(Surgical Mask)
---
-
-

- -
-

-
- N95 N100
Airborne Precautions
Droplet Precautions
(Protective eyeware)

-
Body Fluid
/

- /

/Body Fluid

- /
/Body
Fluid

-
( )

-

Body Fluid
(Antiseptic)

- Chlorhexidine Gluconate sol. (aqueous)
( 2%, 4% 5%), sol./sol. (hosp.) (
2%, 4% in 70% alcohol) 5%
ChlorhexIdine Gluconate

- Ethyl Alcohol sol., sol. (hosp.), gel
(hosp.)

- Gentian Violet sol. (paint)

- Hydrogen Peroxide sol.

- Potassium Permanganate pwdr. (hosp.)

- Povidone-Iodine sol., sol. (hosp.)

- Silver Sulfadiazine Cream

43
Body Fluid
Perineum
()
44
70% Alcohol
( 10% Povidone Iodine)
60%-95% Alcohol Gel
4% Chlorhexidine 7.5% Povidone
Iodine
4% Chlorhexidine 7.5% Povidone
Iodine
( 10% povidone iodine)
10% Povidone Iodine
0.5% Chlorhexidine
10% Povidone Iodine

0.5% Chlorhexidine
1% Silver Sulfadiazine Cream
0.12% Chlorhexidine
0.12% Chlorhexidine

2% Chlorhexidine
4% Chlorhexidine

-

-

-
30-45

-
30 . 8

-

-
Histamine Receptor 2 (H2)Blocking Agent
Proton Pump Inhibitor

- Alcohol Gel

-

3
2% Chlorhexidine

- /

-
70% Alcohol

- -

15-20 .

- 150 .
(50-120 . )
15 ( 5-10 )

-

-
70% Alcohol
70% Alcohol
1

-

- (Humidifier)
(Nebulizer)

Ventilator Circuit

- Ventilator Circuit InLine Suction Catheter 7

- Resuscitation Bag 1
Resuscitation Bag
70% Alcohol Resuscitation Bag

-

(Detergent)

8
45
46

-

( Condom Catheter )

-

Alcohol Gel

-
10-20 .

-

70% Alcohol

-
2

-

-

-
1

-

-

Alcohol Gel
-
2%
Chlorhexidine 70% Alcohol

-
2 Discharge

- 24

-
3-4

- hub 70%
Alcohol

-

4

-

-
( Chlorhexidine)
()

-

- 4% Chlorhexidine Gluconate 7.5% Povidone Iodine

- 2% Chlorhexidine 70% Alcohol 10% Povidone
Iodine

-
-
( 4% Chlorhexidine Gluconate 7.5%
Povidone Iodine)
2-6

-
200 ./.

-
35.5

-

- 24-48
/ Discharge

- Alcohol Gel

-

- (
Stethoscope,
)

70% alcohol

-
(
, Oxygen Pipeline,
Overbed, )
( 70% Alcohol)

-

-
(

//

) ( 70%
Alcohol)
47

-
(
)
( 0.5% Sodium Hypochlorite)
1. (Infection Control Committee)
2.
3.
4. 80
5.

5.1. Point Prevalence 2
4 6

5.2. (Ventilator-Associated Pneumonia, VAP)
6 1,000

5.3. (Catheter-Associated Urinary Tract
Infection, CAUTI) 3 1,000

5.4. (Central Line-Associated Blood
Stream Infection, CLABSI) 3 1,000

5.5. Clean Surgery 1 100 Clean Surgery
6.
48
......................... // ............................. .............................
1.
2.
3.
4. .
5. .
6. ...............
Invasive
1.
2.
3.
4. peripheral vein
5. central line
6.
7. Suction
8.
9.
10.
11. .
Non Invasive
1.
2. BP
3.
4.
5. NG tube
6.
7.
8. /
9.
10.
11.
12. NG tube
13.
1. /
2.
3.
4. /
( monitor, infusion
pump, respirator)
5. ..........................
1.
2. Alcohol Gel
3.
4. .........................
49

(World Health Organization, WHO) Defined Daily Dose (DDD)
DDD
(WHO-Assigned DDD) WHO-Assigned DDD
http://www.whocc.no/atc_ddd_index/
Name Search WHO-Assigned DDD

WHO-Assigned DDD Meropenem 2

WHO-Assigned DDD Vancomycin 2

DDD
DDD Number of Days of
Therapy (DOT) DOT

1 DDD DOT

DDD DOT
Meropenem 1 8 . 2
Meropenem 500 . 24 2
Meropenem 1 8 . 2
Vancomycin 1 12 . 7
50
3 x 2 = 6
0.5 x 2 = 1
3 x 2 = 6
2 x 7 = 14
DDD
6/2 = 3
1/2 = 0.5
(6/2 = 3) + (14/2 = 7) = 10
DOT
2
2
2+7=9

DDD DOT

DDD DOT
DDD DOT

- DDD 1,000

- DDD 100 1,000

2

1) (Drug Use Evaluation, DUE)
(Controlled Antibiotics)

2) (Preauthorization) (Restricted
Antibiotics)

(Restricted Antibiotics)

. .

Cefoperazone-Sulbactam,
Piperacillin-Tazobactam, Cefepime, Cefpirome, Cefixime, Ertapenem, Imipenem, Meropenem,
Doripenem, Levofloxacin, Sitafloxacin, Colistin, Vancomycin, Teicoplanin, Daptomycin, Linezolid,
Tigecycline
51

1. (Pharmaceuticals and Therapeutics Committee)
2.
3.
4. (Restricted Antibiotics) / (Controlled

Antibiotics)
5. /
6.
( 6 )
7.
52
1. (Controlled Antibiotics)
1.1.
Piperacillin-Tazobactam (.)
Cefoperazone-Sulbactam (.)
Meropenem (.) ImipenemCilastatin (.)
Ertapenem (.)
- P.aeruginosa
- Neutropenia (Absolute Neutrophil <500)
- Cephalosporins,
Aminoglycosides Fluoroquinolones
- () ...........................................
- . (Nosocomial Infection)
Cephalosporins,
Aminoglycosides, Fluoroquinolones, Beta-Lactam BetaLactamase Inhibitors
- Neutropenia (Absolute Neutrophil <500)
Cephalosporins, Aminoglycosides,
Fluoroquinolones, Beta-Lactam Beta-Lactamase Inhibitors
-
Cephalosporins, Aminoglycosides, Fluoroquinolones, BetaLactam Beta-Lactamase Inhibitors
- ExtendedSpectrum Beta-Lactamase (ESBL) Ceftriaxone
Ertapenem Pipearcillin-Tazobactam
()
-
................................................................................................
..........................................................................................................
- () ....................................................................................
- ESBL
Ceftriaxone
- () ....................................................................................
53

Levofloxacin (.)
Cefixime (.)
Vancomycin (.)
-

- Streptococcus pneumoniae
Penicillin Cephalosporin
- Mycobacteria

- () ....................................................................................
- Third Generation Cephalosporins
-
- () ....................................................................................
-
( ) .
- () ....................................................................................
1.2

1.2.1
( 48-72 )
()

1.2.2 (
)

1.2.3
( )

1.2.4 ( 48-72 )

-

- ( 3 )

-

-

- ...

1.2.5
1.2.4

1.2.6 ( 6 )

DUE
54
2. (Restricted Antibiotics)
2.1
(Restrictled Antibiotics)
Doripenem ()
Linezolid Tablet (2)
Linezolid Injection ()
Daptomycin ()
Tigecycline ()
Sitafloxacin ()
Colistin (.)
Polymyxin B ()
- Imipenem
Meropenem Doripenem
- () ....................................................................................
- Vancomycin-Resistant Enterococci (VRE)
( Vancomycin) .....................
- MRSA
Glycopeptides ( Vancomycin)
Glycopeptides
- () ....................................................................................
- Colistin
Tigecycline
- Carbapenems,
Cephalosporins, Aminoglycosides, Beta-Lactam BetaLactamase Inhibitors Fluoroquinolones
Tigecycline Colistin ( )
- () ....................................................................................
- ESBL
Ceftriaxone Sitafloxacin
- Carbapenems (Ertapenem,
Meropenem, Imipenem Doripenem)
Sitafloxacin
- () ....................................................................................
- Carbapenems,
Cephalosporins, Aminoglycosides, Beta-Lactam BetaLactamase Inhibitors Fluoroquinolones
Colistin Polymyxin B
-
Carbapenems
- () ....................................................................................
1 2
55
2.2

2.2.1

2.2.2

-

- ( 3 )

- ........................................................

-

- .................( )..........................................................................................

2.2.3 2.2.2

2.2.4 ( 6 )

56
1
HN..AN....
- .....

. ....
2 :
( 1).... ( 1) ..............................
........... ( 1) ..............................
..... ( 1) ..............................
( 2).... ( 2) ..............................
........... ( 2) ..............................
..... ( 2) ..............................
( 3).... ( 3) ..............................
........... ( 3) ..............................
..... ( 3) ..............................
Blood Sputum Pus Urine Other
S.aureus P.aeruginosa A.baumannii
ESBL-ve E.coli or K.pneumoniae ESBL+ve E.coli or K.pneumoniae Other....
3
4
.... ( 3 ) ..........................
....................... .........................
(..........................) . .................. (..........................) . .........................
5 ()

.. .....
.. .......... .. .......
.. .......... .. .......
.. .......... .. .......

...................................................
.....................................................
........ (..............................) . ..........
........ (..............................) . ...........................
57
(Restricted Antibiotics)
1
- .....

. ....
HN..AN....
2 :
( 1).... ( 1) ..............................
........... ( 1) ..............................
..... ( 1) ..............................
( 2).... ( 2) ..............................
........... ( 2) ..............................
..... ( 2) ..............................
( 3).... ( 3) ..............................
........... ( 3) ..............................
..... ( 3) ..............................
Blood Sputum Pus Urine Other
S.aureus P.aeruginosa A.baumannii
ESBL-ve E.coli or K.pneumoniae ESBL+ve E.coli or K.pneumoniae Other....
3
4
..........................
........................................................
........................ .........................
(..........................) . ................... (..........................) . .........................
5 ()

.. .....
.. .......... .. .......
.. .......... .. .......

...................................................
.....................................................
........ (..............................) . ..........
........ (..............................) . ...........................
58

(Responsible Use of Antibiotics)

.. 2556
., .,
., . .
.
Penicillin V, Penicillin G, Amoxicillin, Ampicillin (IV), Cloxacillin (IV), Dicloxacillin, Cephalexin, Cefazolin,
Doxycycline, Tetracycline, Neomycin, Gentamicin, Erythromycin estolate (PO syr.), Erythromycin
stearate or succinate (PO syr.), Roxithromycin ( 100 150 mg), Norfloxacin, Metronidazole,
Sulfadiazine, Cotrimoxazole
59
.
Cefuroxime Axetil, Amikacin, Ofloxacin ( 100, 200 mg), Clindamycin, Lincomycin, Nitrofurantoin,
Trimethoprim
.
Co-amoxiclav (Tab. 500/125, 875/125 . dry syr 200/28.5, 400/57 .), Co-amoxiclav
(IV), Ampicillin-Sulbactam (IV), Cefotaxime, Ceftriaxone, Ceftazidime, Chloramphenicol (IV)
.
Piperacillin-Tazobactam, Cefoperazone-Sulbactam, Cefoxitin, Ertapenem, Imipenem, Meropenem,
Netilmicin, Cefixime, Azithromycin PO (, dry syrup ), Azithromycin
(IV), Clarithromycin (PO), Ciprofloxacin, Levofloxacin (PO 500 mg), Levofloxacin (IV), Colistin
(IV), Fosfomycin (IV), Sodium Fusidate, Vancomycin (IV)
. (2)
Linezolid (PO)
.
/ - Boric Acid (eye wash sol), Chloramphenicol (eye drop, eye oint), Tetracycline
Hydrochloride (eye oint), Gentamicin Sulfate (eye drop, eye oint)
/ - Chloramphenicol (ear drop)
- Sulfadiazine Silver (Silver Sulfadiazine) Cream
.
- Fusidic Acid Cream, Sodium Fusidate oint, Mupirocin oint
.
/ - Polymyxin B Sulfate + Neomycin Sulfate + Gramicidin (eye drop), Dexamethasone
Sodium Phosphate + Neomycin Sulfate (eye drop), Dexamethasone Sodium Phosphate +
Chloramphenicol + Tetrahydrozoline Hydrochloride (eye drop), Dexamethasone + Neomycin
Sulfate + Polymyxin B Sulfate (eye oint)
/ - Dexamethasone + Framycetin Sulfate + Gramicidin (ear drop/ear oint), Hydrocortisone +
Neomycin Sulfate + Polymyxin B Sulfate (ear drop)
.
/ - Fusidic Acid eye drop (in gel base)
60
/

/
1

/
2

1. Clean Surgery
()

/
)
(
) )

2. Clean Contaminated Surgery

(Normal Flora)
/

/
(Contaminated Wound) ( Open Fracture)

(Dirty Wound)
( )

1 /
/
Clean Clean-Contaminated
Contaminated Dirty
61

2 4

- ) ) )
/

-
-
/
24

- /
60 ( Vancomycin Cefazolin
60 120 ) 30 ./. 2 .

- / 60
) /
2 /
( Cefazolin 2
2 /

- Cefazolin
- Penicillin Clindamycin Vancomycin
- Cefazolin Ampicillin-Sulbactam
- Penicillin Clindamycin
-
/
- Cefazolin

-/ -
-/ - Cefazolin + Metronidazole Ampicillin-Sulbactam
- Cefazolin Ceftriaxone Ampicillin-Sulbactam

- Penicillin Clindamycin ( Metronidazole)
+ Gentamicin
Laparoscopic Cholecystectomy
-
60 Colic
30 Jaundice, Acute Cholecystitis Cholangitis
(Uncomplicated
- Cefazolin + Metronidazole
Appendicitis)
+ Gentamicin
- Cefazolin
- Penicillin Clindamycin + Gentamicin
- Penicillin Metronidazole + Gentamicin
62

Duodenum
- Cefazolin + Metronidazole Ampicillin-Sulbactam

Ceftriaxone + Metronidazole
+ Gentamicin
- Cefazolin
-
- 3
4 (Forceps/Vacuum)
Cefazolin Ampicillin-Sulbactam Clindamycin
- Cefazolin
- Cefazolin Ampicillin-Sulbactam
+ Gentamicin
- Cefazolin
- Cefazolin + Gentamicin Ciprofloxacin
- Penicillin Metronidazole ( Clindamycin)
+ Gentamicin
- Cefazolin
- Cefazolin
(Percutaneous
Endoscopic Gastrostomy, PEG)
- Ampicillin + Gentamicin Ampicillin-Sulbactam

Endoscopic Retrograde
- Penicillin Vancomycin + Gentamicin
Cholangiopancreatography (ERCP)

(Endoscopy)
-
( Ascites) Amoxicillin 2 .
Ampicillin 2 . IV
Penicillin Clindamycin 600 . IV
63
(
6 .)

-
-
-
-
-

- /
-
(
6 .)
/

-
- 5
-
-
- >65

64
- ( 5%-10% Povidone Iodine)
-
( Cefazolin, Cefuroxime) Subconjunctival
Intracameral
- 1%
- Dicloxacillin
: 25-50 ././ 4
2
: 250-500 . 4
2
Penicillin
- Erythromycin susp/dry syr
: 20-50 ././ 3-4
2
- Roxithromycin
40 . 5-8 ././ 2
2
>40 . 300 .
2 2
- Clindamycin
: 10-25 ././ 3-4
: 300 . 3
- Tetanus Toxoid

(
6 .)

- /
-
-
-

- Co-amoxiclav
( Amoxicillin) : 25-50 ././
3 2
: 375 . 3 625 .
2 2
- Penicillin
: Co-trimoxazole ( Trimethoprim) 8-10
././ 2 2 Clindamycin
10-25 ././ 3-4
Metronidazole 20-30 ././ 3
2
: Ciprofloxacin 500 . 2 2
Clindamycin 300 . 3 2
Metronidazole 400-500 . 3 2
- / 3-5
- Tetanus Toxoid
- Rabies Vaccine, Rabies Immunoglobulin
- Amoxicillin 2 . Ampicillin 2 . Cefazolin

1-2 . 30-60
Amoxicillin 50 ./.
30-60
- Penicillin Clindamycin 600-900 .

1.
E.coli Cefazolin Ceftriaxone Ceftriaxone
Cefazolin

2. Penicillin (Anaphylaxis, Urticaria) Beta-Lactams
( Roxithromycin, Clindamycin, Vancomycin) Penicillin (Maculopapular
Rash) Cephalosporins ( Cefazolin)

2 3
65
Cefazolin IV/IM
Clindamycin IV
Clindamycin PO
Vancomycin IV
Ampicillin-Sulbactam IV
Coamoxiclav PO
Metronidazole IV
Gentamicin IV
Ceftriaxone IV
Amoxicillin PO
Ampicillin IV
Dicloxacillin PO
2 ., 30 ./., 4 .
600-900 ., 10 ./., 6 .
600 ., 20 ./.
15 ./. ( 60 )
3 . (Ampicillin 2 ./ Sulbactam 1 .) 50 ./. (Ampicillin),
2 .
1 . (875/125), 10-20 ./. ( Amoxicillin)
500 ., 15 ./.
5 ./., 2.5 ./.
2 ., 50-75 ./.
2 ., 50 ./.
2 ., 50 ./. 2 .
250-500 ., 5-20 ./.

( E.coli
Ceftriaxone Pseudomonas aeruginosa
Ceftriaxone)
( E.coli
Ceftriaxone
E.coli )

(
66
)
( Complete Blood Count, CBC)

-
Cellulitis
Streptococcus pyogenes S.aureus

-

Acute Cystitis E.coli (
Proteus spp., Staphylococcus saprophyticus)

- Exudates

Pharyngotonsillitis Streptococcus pyogenes
(
)

(

)

(
)

( Acute Cystitis
)
( Acute Otitis Media,

Acute Cholecystitis)
(
Cellulitis, )

(
)

( Severe Sepsis, Febrile
Neutropenia, Meningitis)

( )
( Streptococcal Pharyngotonsillitis
Rheumatic Fever)
(
)
( )
(
Meropenem Ceftriaxone E.coli
Ceftriaxone)
67

1.

2.
-

()

3.

(
)
(

)

(Escalation Therapy)

-

(Deescalation
Therapy)

4.
3

/
4, 5 6

5.

68

6. 1
) 1
( )
)
( Severe Sepsis) )
2 ( Ampicillin +
Gentamicin Enterococci)
)
( Rifampicin
S.aureus)

7.

(Broad Spectrum)
48

-
Heart Failure

-
Meropenem
Vancomycin
MRSA
Vancomycin

-

Meropenem
Ceftriaxone
Ceftriaxone, Cotrimoxazole

CarbapenemResistant A.baumannii Colistin
Colistin

-

E.coli ESBL
Ceftriaxone Ertapenem

-

Ceftazidime Amikacin
Meropenem

8.

(
Vasoactive Drugs Severe Sepsis/ Septic
Shock,
)

9.
24

-

(Contamination)
(Normal Flora/ Colonization)

(Infection) ( , Discharge
)
Disk Diffusion
(
MRSA Vancomycin)
MIC
MIC (
Etest, Broth Dilution, Agar Dilution)

Disk Diffusion
1
69

-

Gentamicin
Salmonella spp.

-
Erythromycin
S.pneumoniae

-
Moxifloxacin

Ciprofloxacin
Levofloxacin Fluoroquinolones

-

E.coli ESBL
Beta-Lactams Carbapenems
Cephalosporins

ESBL
Cephalosporins

Streptococcus spp.
Pen G, Pen V, Ampicillin,
(S.pyogenes, S.pneumoniae, Amoxicillin
S.suis, Streptococci other
than Enterococci)
Enterococcus spp.
Pen G (Ampicillin) +/- Gentamicin
S.aureus (MSSA)
Cloxacillin, Dicloxacillin
S.aureus (MRSA)
Vancomycin
Clostridium spp. other than Pen G

C.difficile
Corynebacterium
Pen G
diphtheriae
70
Roxithromycin, Erythromycin,
Lincomycin, Cefazolin,
Ceftriaxone, Cefotaxime,
Clindamycin, Vancomycin
Vancomycin +/- Gentamicin,
Linezolid
Cefazolin, Cephalexin,
Clindamycin, Vancomycin
Cotrimoxazole, Fusidic Acid,
Fosfomycin, Clindamycin,
Linezolid
Clindamycin
Clindamycin

Neisseria gonorrhoeae
(Non PPNG)
(PPNG)
Neisseria meningitidis
Enterobacteriaceae (E.coli,
Klebsiella spp., Proteus
spp., Enterobacter spp.)
- Non-ESBL producer
Pen G
Ceftriaxone
Pen G
Ceftriaxone, Spectinomycin,
Ofloxacin
Cefixime, Azithromycin
Chloramphenicol
Ceftriaxone, Cefotaxime, Ofloxacin,

Ciprofloxacin, Gentamicin,
Cotrimoxazole
Ertapenem
Coamoxiclav, AmpicillinSulbactam, Levofloxacin,

Amikacin
- ESBL producer
Imipenem, Meropenem,
Piperacillin-Tazobacctam
- CRE
Colistin, Polymyxin B
Tigecycline, Fosfomycin
Salmonella spp.
Norfloxacin, Ofloxacin,
Ciprofloxacin, Chloramphenicol,
Cotrimoxazole
Ceftriaxone
Shigella spp.
Norfloxacin
Cotrimoxazole
Vibrio spp.
Norfloxacin
Tetracycline, Ceftriaxone,
Gentamicin
Aeromonas spp.
Norfloxacin, Ciprofloxacin,
Coamoxiclav, AmpicillinGentamicin, Cotrimoxazole
Sulbactam, Ceftriaxone
Pseudomonas aeruginosa Ceftazidime, Amikacin, Piperacillin- Ciprofloxacin, Imipenem,
Tazobactam, CefoperazoneMeropenem, Doripenem,
Sulbactam
Netilmicin, Colistin
Burkholderia pseudomallei Ceftazidime, Cotrimoxazole
Coamoxiclav, Doxycycline,
Acinetobacter spp.
Ceftazidime, CefoperazoneColistin, Polymyxin B,
Sulbactam, Ampicillin-Sulbactam, Tigecycline
Amikacin
Stenotrophomonas
Cotrimoxazole
Levofloxacin
maltophilia
PPNG = Penicillinase Producing Neisseria gonorrhoeae
ESBL = Extended-Spectrum Beta-Lactamase
CRE = Carbapenem-Resistant Enterobacteriaceae
71
( )
( Anaerobes) (
Hemophilus influenzae)

(
)

(
Gram Positive
Dipplococci
S.pneumoniae)
( )

-

(Clinical Specimen)
Gram Positive Diplococci, -
- Pen G, Ampicillin, Amoxicillin,
Lancet Shape
(S.pneumoniae)
Vancomycin
Gram Positive Cocci -
- Pen G Ampicillin (
(Streptococci)
Gentamicin
Infective Endocarditis
Enterococcus spp.), Vancomycin
+/- Gentamicin, Roxithromycin,
Erythromycin, Clindamycin
Gram Positive Cocci -
- Cloxacillin, Dicloxacillin,
(Staphylococci)
Cefazolin, Cephalexin,
Clindamycin, Vancomycin,
Fosfomycin, Cotrimoxazole,
Linezolid
72

Gram Positive Branching
Filament
- Modified AFB
(Actinomyces spp.)
- Modified AFB
(Nocardia spp.)
Gram Negative Diplococci,
Kidney Shape (Neisseria
spp., Moraxella spp.)
Gram Negative Rods
- (Hemophilus
spp.)
(Clinical Specimen)
-
-
-
-
-
-
-
- Pen G, Clindamycin,
Tetracycline
- Cotrimoxazole, Amikacin,
Imipenem
- Ceftriaxone, Cefixime
- Ceftriaxone
- Coamoxiclav, Ceftriaxone
- Pen G, Ceftriaxone
- Ceftriaxone
- , Empyema
- Ampicillin, Amoxicillin,
Coamoxiclav, Ceftriaxone,
Cefotaxime, Cotrimoxazole
- - - Clindamycin, Metronidazole,
(Bacteroides spp.)
Coamoxiclav, AmpicillinSulbactam
- (Aeromonas spp., -
- Ceftriaxone, Ciprofloxacin,
Vibrio spp.)
Gentamicin
-
-
- Azithromycin
(Campylobacter spp.)
- - ( - - Ceftazidime, Cotrimoxazole,
B.pseudomallei)
-
Coamoxiclav, Doxycycline
- - -
- Ceftazidime, Cefoperazone( Acinetobacter spp.)
Sulbactam, AmpicillinSulbactam, Amikacin, Colistin
- (
-
- Ceftazidime, Amikacin,
P.aeruginosa)
Doripenem, PiperacillinTazobactam, CefoperazoneSulbactam, Ciprofloxacin,
Colistin
73
(Clinical Specimen)
- - ( Salmonella
(Enterobacteriaceae) spp.)
-
-
- Ceftriaxone, Ciprofloxacin
- Ceftriaxone, Cefotaxime,
Meropenem
- Gentamicin, Amikacin,
Coamoxiclav, Ceftriaxone,
Ofloxacin, Ciprofloxacin
- Ertapenem, Imipenem,
Meropenem, PiperacillinTazobactam, Amikacin,
Ciprofloxacin
1

Empiric

(

) /
( )
(
S.pneumoniae, Klebsiella
pneumoniae, Pseudomonas aeruginosa)
/

(
74

(
)
24

-

Severe Sepsis
2
, Bacterial Meningitis

-
( Cholecystitis)

-

Chronic Ulcer

-

(
Cellulitis,
Acute Cystitis
)

/
6

(Acute Nasopharyngitis, Common Cold, Acute Upper Respiratory Infection-Unspecified)

- - 3-4 4-5

5-7 7-14
-
-
/ (Acute Pharyngitis, Acute Tonsillitis)

- - 80
- Penicillin V Amoxicillin
- (Injected Pharynx)
Roxithromycin Erythromycin 10
- (>80%) Streptococcus group A
3 1) ( >38 C), 2) Exudate/

Pustule / 3) (Anterior
Cervical Lymph Nodes) / 4)
75
-
(
)
- (Diphtheria) (Gonorrhea)
(Candidiasis)
-
() (Acute Rhinosinusitis)
- - 7

- ( /)
-
7
- X-Ray
Amoxicillin
- Roxithromycin/ Erythromycin 5-14
S.pneumoniae, H.influenzae - Coamoxiclav Clarithromycin/
Azithromycin
Amoxicillin
- (Mucor)
, Gram Negative Bacteria/Anaerobes Nasogastric Tube
(Acute Otitis Media)
-
-
3
- Tympanic Membrane , / - ( )
Otorrhea
Tympanic Membrane Otorrhea
-
3 Amoxicillin
S.pneumoniae,
Roxithromycin/ Erythromycin 5-14
H.influenzae
- Coamoxiclav Clarithromycin/
Azithromycin
Amoxicillin
(Acute Otitis Externa)
- - Acetic Acid,
Chloramphenicol, Dexamethasone-Framycetin/
Gramicidin
- S.aureus - Dicloxacillin Roxithromycin
P.aeruginosa
- P.aeruginosa Polymyxin B
+ Neomycin Ofloxacin Ciprofloxacin
76
(Acute Bronchitis)
- -
18
-
-
- X-Ray
-
- (Pertussis)
Roxithromycin/ Erythromycin
14 (Post-Exposure Prophylaxis)
- (COPD) (
-) Amoxicillin
Roxithromycin Coamoxiclav
(Influenza)
- -
- Oseltamivir 5
- /

-
( 2 )
( )
( )
(Community-Acquired Pneumonia)
- -
1) >65 , 2) Confusion, 3) Respiration >30/,
4) Systolic BP <90 Diastolic BP60 mm.Hg

- (
0-1
Crepitations)
Roxithromycin ( Erythromycin) +/- Amoxicillin
-
Levofloxacin
- Atypical Agents
1
(Chlamydophila & Mycoplasma
Coamoxiclav ( Ampicillinpneumoniae), S.pneumoniae,
Sulbactam Ceftriaxone) + Roxithromycin
H.influenzae, Virus ( Influenza)
Levofloxacin
- - Penicillin G Coamoxiclav AmpicillinSulbactam Clindamycin
- Ceftriaxone + Roxithromycin
-
Klebsiella
pneumoniae
- Ceftazidime + Roxithromycin
-
B.pseudomallei
77
- - Piperacillin-Tazobactam Ceftazidime +
Gram Negative Rods
Amikacin ( Ciprofloxacin)
P.aeruginosa
- interstitial - Cotrimoxazole
Pneumocystis jiroveci
-
- Oseltamivir
-

Gram Positive Dipplococci S.pneumoniae
Peinicillin Penicillin G Ampicillin
- 5-14 B.pseudomallei,
- ( S.aureus, Mycobacteria, )
-- ( Scrub Typhus, Infective Endocarditis)

(Hospital-Acquired Pneumonia, HAP)
- 48 - HAP

-
Ceftazidime + Amikacin ( Ciprofloxacin)
- Cephalosporins
- Meropenem ( Imipenem Cefoperazone- Gram Negative Rods ( Sulbactam) +/- Amikacin ( Ciprofloxacin)
A.baumannii, P.aeruginosa, K.pneumoniae) - Cephalosporins/ Carbapenems
S.aureus (MRSA)
Gram Negative Rods
A.baumannii
Carbapenem Colistin
- MRSA Gram
Positive Cocci (Clusters)
Gram Negative Bacteria Vancomycin
- (Aspergillus)

-
-
2-3
- 8-14
78

(Acute Diarrhea, Gastroenteritis)
- 3 - 95% 3-5
1
- Sepsis
7
Ciprofloxacin Ceftriaxone

- / Shigellosis -
- (S.aureus,
Norfloxacin 3
E.coli, Bacillus spp., C.difficile)
-
(E.coli, Salmonella spp., Shigella, spp.,
Doxycycline 300 .
Vibrio spp., Campylbacter spp.,
Norfloxacin 3
Aeromonas spp.,), ,
- C.difficile
- Metronidazole
- Entameoba histolytica
Metronidazole
- ( )
- C.difficile Broad Spectrum Antibiotics
C.difficile
- Norfloxacin Campylobacter spp. Azithromycin
- Furazolidone, Neomycin, Colistin
(Biliary Tract Infection)
- - Ceftriaxone ( Gentamicin Ciprofloxacin) +/-
Metronidazole Ampicillin-Sulbactam
Jaundice
- Alkaline Phosphatase Bilirubin
- Ultrasonography Gall Stone,

, Fluid, Debris

Ultrasonography
(Sonographic Murphys Sign)
- K.pneumoniae, E.coli
Anaerobes
-
- /
(Liver Abscess)
-
- Metronidazole Amoebic Abscess
-
- Ceftazidime Pyogenic Abscess
- Alkaline Phosphatase
B.pseudomallei (Melioidosis)
79
- Ultrasonography
- Ceftriaxone ( Gentamicin Ciprofloxacin)
Amoebic Abscess,
+/- Metronidazole Ampicillin-Sulbactam
Pyogenic Abscess, Pyogenic Abscess
B.pseudomallei
(Melioidodis)
- Antibody E.histolytica Amoebic
Abscess
-
Amoeba
- Entameoba histolytica,
K.pneumoniae, E.coli, B.pseudomallei
Anaerobes
- ()
- Infective Endocarditis
-
(Primary Peritonitis Spontaneous Bacterial Peritonitis, SBP)
- (Ascites) - Ceftriaxone Ciprofloxacin Amikacin
(Cirrhosis)
Gentamicin
-
- Bowel Sound
-
250 /..
- E.coli
- ()
(Secondary Peritonitis)
- / - Ceftriaxone ( Gentamicin Ciprofloxacin) +
Metronidazole ( Clindamycin) Ampicillin
Sulbactam
-
- Cephalosporins
- , Bowel Sound Fluoroquinolones
- ( Meropenem Imipenem)
/, Ultrasonography, CT
- /
250 /..
- E.coli, Enterococci
Anaerobes Candida
80
- /
- /
(Peritonitis Related to Continuous
Ambulatory Peritoneal Dialysis, CAPD)
- (Dialysate) -

Dialysate
- Dialysate >100/.. -
>50%
Cefazolin 15 ./. + Gentamicin 0.6
- Staphylococci, Gram Negative ./. ( Amikacin 2 ./. Ceftazidime 1
Rods, Enterococci, Candida spp.
.) 1 6
Vancomycin Cefazolin
Vancomycin 15-30 ./. 5-7
-
- 10-14
-
- Dialysate Dialysate >50 .
- CAPD Discharge/Pus
Discharge/Pus Dicloxacillin
Cephalexin
Complicated Skin/ Soft Tissue Infection
- CAPD
( , Mycobacterium spp.)
Helicobacter pylori
- Helicobacter pylori - Clarithromycin 500 . 2 + Amoxicillin 1
Duodenum
. 2 Clarithromycin 250 . 2
Positive Urea Breath Test, + Metronidazole 400 . 2 7
- Proton Pump Inhibitor (PPI)

(Dental Caries, Periodontal Diseases)
(Dental Caries, Periodontal Diseases)
- / -
/ (

) (
- Chlorhexidine)
81
-
( )
(
)
( )

- Penicillin V Amoxicillin
Penicillin Roxithromycin
Erythromycin Clindamycin
Metronidazole
Coamoxiclav
-
82
(Urinary Tract Infection, UTI)

(Lower Urinary Tract Infection, Acute Cystitis)
- - Ofloxacin Ciprofloxacin Coamoxiclav

3
-
- E.coli
-
Complicated UTI ( )
- 100,000 (105) / 1 .
- Fluoroquinolones Cephalosporins E.coli
ESBL Nitrofurantoin 100 . 4 5
Fosfomycin Tromethamine 3 .
(Upper Urinary Tract Infection, Acute Pyelonephritis)
-
-
- Ofloxacin Ciprofloxacin Coamoxiclav
- E.coli
7-14
- ( Sepsis)
Amikacin Gentamicin
Ceftriaxone Ciprofloxacin
7-14
- E.coli ESBL
Ertapenem Piperacillin-Tazobactam Meropenem Imipenem Amikacin
- (
)
- Complicated UTI UTI (
, Neurogenic Bladder, Vesicoureteral Reflux)
()
(Asymptomatic Bacteriuria)
-
-
- 100,000 / Transurethral Resection (TUR)
.

Mucosa
-
Transurethral Resection (TUR)
Mucosa
(Bacterial Sexually Transmitted Diseases)
(Gonorrhea)
-

- Gram-Negative
Dipplococci

-
-

-
Bartholins Abscess, Posterior Urethritis,
Epididymitis, Epididymo-Orchitis,
Paraurethral Abscess, Periurethral
Abscess, Cowpers Gland Abscess
-
Ceftriaxone 250 . IM Cefixime 400
. Cephalosporin
Azithromycin 2 .
- Ceftriaxone 250 IM
-
2
83
- Sepsis,
Petechiae Pustule , Arthritis,
Tenosynovitis
- Ceftriaxone 1 . IV/IM 1 7
- Meningitis Ceftriaxone 1-2 . IV 12
. 10-28
- Endocarditis Ceftriaxone 1-2 . IV
12 4
- Doxycycline 100 . Roxithromycin
150 . 2 14 Ofloxacin 300 . 2 7
- HIV
(Syphilis)
-
- Benzathine Penicillin G 2.4
- IM (
/ 1.2 ) Penicillin
2 Doxycycline 100 . 2 Erythromycin
500 . 4 14
-
- Benzathine Penicillin G 2.4
/ IM 1 3
(Aorta) Penicillin Doxycycline 100 .

2 Erythromycin 500 . 4
28-30
- Penicillin G 2-4
IV 4 14 14
Benzathine Penicillin G 2.4 IM
1 3
Penicillin Doxycycline 200
. 2 30
-
-
- HIV
(Chancroid)
- - Ceftriaxone 250 . IM Ofloxacin
400 . Ciprofloxacin 500 .

- Haemophilus ducreyi
-
- Ciprofloxacin 500 . 2 3
Erythromycin 500 . 4 14
-
-
- HIV
84
/ (Lymphogranuloma Venereum, LGV, Bubo)

- - Doxycycline 100 . 2
Erythromycin 500 . 4 14-21

- Chlamydia trachomatis
-
-
- HIV
(Bacterial Vaginosis)
- - Bacterial Vaginosis Metronidazole
- 500 . 2 Clindamycin 300 .

2 Tinidazole 500 . 2
- 7

, pH>4.5, clue cells (
)
20 Lactobacillus
KOH
- (Candida spp.) (Trichomonas Vaginilis)
Bacterial Vaginosis
(Acute Pelvic Inflammatory Disease, PID)

-
- Ceftriaxone + Doxycycline + Metronidazole
-
Gentamicin ( Ciprofloxacin) + Metronidazole
/ Discharge/
Pus/Blood
- Discharge/
Pus
- N.gonorrhoeae,
Chlamydia trachomatis
E.coli, Streptococci, Anaerobes
- Transvaginal Ultrasonography Collection/Abscess
- Collection/Abscess
85
(Postpartum Endometritis)
- - Ampicillin + Gentamicin + Metronidazole

( Clindamycin) Ampicillin-Sulbactam
- E.coli, Streptococci, Anaerobes
- Urinary Tract Infection, Mastitis
(Septic Abortion)
- / - Penicillin G + Gentamicin + Metronidazole

( Clindamycin)
/ Discharge/Pus/
Blood
-
- E.coli, Streptococci,
Bacteroides spp., Clostridium spp.
- Tetanus Immunoglobulin Tetanus Toxoid
(Skin and Soft Tissue Infection, SSI)
(Uncomplicated SSI) Impetigo, Folliculitis,
Erysipelas, Furunculosis, Cellulitis, Abscess, Wound
- -

(Antiseptic)
- S.aureus
Streptococcus pyogenes (group A

-
Streptococci)
Dicloxacillin Cephalexin
Cloxacillin Cefazolin Clindamycin
- Penicillin Roxithromycin
Erythromycin Clindamycin
- 1 Bacteremia
-
-
- / ( Tetanus Vaccine, Rabies Vaccine)
- 5-7
- ( 6 )
2
86
(Complicated SSI) - Necrotizing Infections, Bite

Wound Infections, Surgical Site Infections
- (/)
- Toxic Shock Syndrome
(
Penicillin G + Clindamycin + Gentamicin
)
- / Coamoxiclav
- Ampicillin-Sulbactam
Bleb, -
Crepitus Ceftriaxone + Metronidazole ( Clindamycin)
Sepsis/Severe Coamoxiclav Ampicillin-Sulbactam
Sepsis
-
- Discharge/ PiperacillinTazobactam Meropenem ( Imipenem) +/Pus
- Streptococcus Vancomycin
-
pyogenes (group A streptococci)
S.aureus Pasturella multocida ( ( ) Ceftriaxone +/- Gentamicin
- Ceftazidime
/) Aeromonas spp.,
Piperacillin-Tazobactam Meropenem
Vibrio vulnificus
- Gram Negative Imipenem +/- Vancomycin
Rods + Anaerobes
(
)
- (
Burns,
)
P.aeruginosa, MRSA, ESBL+
Enterobacteriaceae, A.baumannii)
- Bacteremia ( V.vulnificus )
Toxin ( Toxic Shock Syndrome)
-
- Sepsis/Severe Sepsis
- , Necrotizing Fasciitis, Myonecrosis
- ( Tetanus Vaccine, Rabies Vaccine)

- 7-14
87
(Acute Septic Arthritis)

- -
Cloxacillin Cefazolin
Clindamycin
- (>50,000/
-
..)
Ceftriaxone
-
( ) -
Salmonella spp. Ceftriaxone
S.aureus
- -
- Vancomycin +/- Ceftazidime (
( Piperacillin-Tazobactam Meropenem
)
Imipenem)
-
-
- 3 7
(Infective Endocarditis)
-
-

-
- (Murmurs)
(Emboli)
( Petichae
Penicillin G ( Ampicillin Vancomycin) +
)
Gentamicin

Cloxacillin ( Vancomycin) + Gentamicin

- Vegetation
Vancomycin + Rifampicin
Echocardiography,
+ Gentamicin
(Right-Sided Infective Endocarditis)
-
Viridans Streptococci
Enterococci
-
S.aureus Gram
Negative Rods ( P.aeruginosa)
- Coagulase
Negative Staphylococci
88
- 2-6
- Vegetation
(Acute Bacterial Meningitis)

- (Stiff Neck)
- Ceftriaxone Cefotaxime
- 1,000/
S.pneumoniae Penicillin, N.meningitidis,
.. ()
H.influenzae, E.coli, Salmonella spp., Streptococci

- S.pneumoniae
- S.pneumoniae, N.meningitidis, Vancomycin + Ceftriaxone (
S.suis H.influenzae
Cefotaxime)
- (
- L.monocytogenes
Lymphoma, Corticosteroid ) Ampicillin Cotrimoxazole
Listeria monocytogenes
- Vancomycin +
-
Ceftazidime ( Meropenem)
S.aureus Gram
Negative Rods P.aeruginosa,
Acinetobacter spp.
- / group B
Streptococci, E.coli, Salmonella spp.,
Listeria spp.
- Ceftriaxone 2 . 12 ., Meropenem 2 . 8 .
- ( Carbapenem-Resistant Acinetobacter spp.)
( Colistin)
- 7-21
- S.pneumoniae Dexamethasone 0.15 ./. IV
6 2-4 Dexamethasone
- N.meningitidis Rifampin Ciprofloxacin
- ( Mycobacterium
tubercolosis, Cryptococcus neoformans, Angiostrongylus cantonensis, Viruses)
89

(Bacteremia)
- (Primary -
Bacteremia)

( Infective
Endocarditis, Central Line-Associated
Bacteremia)

- Infection Contamination
- Infection
- Bacteremia Bacteremia Uncomplicated
Acute Pyelonephritis 7-14 Bacteremia Infective Endocarditis 2-6
- / ( )
/
(Acute Fever, Acute Febrile Illness)

- 2 -

- (

)
-
-
/
- -
(
)
/ - (
Atypical Lymphocytes )
( ,
Influenza, Acute Retroviral Syndrome)

-

- Leptospirosis
Rickettsia ( Scrub Typhus) Doxycycline Penicillin G Ceftriaxone
Leptospirosis
- Scrub Typhus
Enteric Fever
Doxycycline
Bacteremia ( S.aureus, E.coli,
-
B.pseudomallei)
( Leptospirosis,
Rickettsia)
Doxycycline +/- Ceftriaxone

90
- Neutropenia (Absolute Neutrophil <500

<1,000 <500 )
Gram Negative Rods Ceftazidime + Amikacin

Coamoxiclav +
Ciprofloxacin
- Sepsis Systemic
Inflammatory Response Syndrome (SIRS)
2 4 1) T >38 C
<36 C, 2) P >90/, 3) R >20/,
4) WBC >12,000 <4,000/ ..
SIRS
- Severe Sepsis Sepsis
Hypoxemia Organ Dysfunction
1 1) Systolic BP <90
Mean Arterial Pressure (MAP) <65
., 2) /, 3) <0.5
././. Creatinine >2 ./.,
4) , 5) Capillary Filling
Time 3 , 6) Lactate >2
/., 7) PaO2/FiO2 <300, 8)
( Platelets <100,000,
INR>1.5)
- Sepsis/ Severe Sepsis
2

(
)
-
Enterobacteriaceae ( E.coli,
Klebsiella spp.), Non-Fermentative Gram
Negative Rods (P.aeruginosa, A.baumannii,
B.pseudomallei), S.aureus, Streptococci
(S.pyogenes, S.agalactiae, S.suis)
-
, , Scrub Typhus,

- Severe Sepsis
1
Severe Sepsis
-
/
- /

Ceftriaxone+Amikacin ( Gentamicin)
Rickettsia
Doxycycline
B.pseudomallei
( )
Ceftazidime Ceftriaxone

( )
( Cephalosporins
Fluoroquinolones 3 )
Piperacillin-Tazobactam ( Meropenem
Imipenem) +/- Amikacin +/- Vancomycin
/
Carbapenems Colistin +/Cotrimoxazole ( Levofloxacin) +/- Vancomycin
- 1
Sepsis/Severe Sepsis
- /
Beta-Lactams ( Cephalosporins, Carbapenems)
4
Aminoglycosides, Fluoroquinolones, Vancomycin, Colistin (loading dose)
91
- Toxic Shock Syndrome (TSS) T >38.9 C, Systolic BP <90 .

- 1-2 /
( ) Toxin ( S.aureus,
Streptococci)
- Severe Sepsis

SIRS
Vancomycin MRSA

Meropenem Ceftriaxone
Meropenem Ceftriaxone

- Sepsis/Severe Sepsis
Sepsis/Severe Sepsis 5
92
5
1. Sepsis/ Severe Sepsis

Sepsis/
Severe Sepsis ()
(ICU)
(Triage)
Systemic Inflammatory Response

Syndrome (SIRS) 2 4
1) T >38 C <36 C, 2) P >90/, 3) R >20/,
4) WBC >12,000 <4,000/.. Sepsis

Sepsis
2 4 SIRS
SIRS

Sepsis
(Hypoxemia)
(Organ Dysfunction)
1 1) Systolic BP <90 Mean
Arterial Pressure (MAP) <65 ., 2) /
, 3) <0.5 ././. Creatinine
>2 ./., 4) , 5) Capillary
Filling Time 3 , 6) Lactate >2
/., 7) PaO2/FiO2 <300, 8)
( Platelets <100,000, INR>1.5)
Severe Sepsis
2. Sepsis/ Severe Sepsis


2.1
()
()

- Oxygen
Oxygen Canula, Mask, Ventilator

- 2

(
)

- CBC, Blood Sugar,
Electrolytes, BUN, Creatinine, Lactate ()

- ( 6)
1 Sepsis/ Severe Sepsis

Beta-Lactams (
Cephalosporins, Carbapenems)
4
Aminoglycosides, Fluoroquinolones,
Vancomycin, Colistin (loading
dose)

- Normal Saline (NSS) 500 .
30 (P, R, BP)
(
)
Systolic BP <90 MAP <65 .
Fluid Overload (
Crepitations,
5 .) NSS
30 NSS 30-60 ./
. ( 2-3 ) 2-3
MAP 65

(
)
93

- Systolic BP <90
MAP <65
(
) Septic Shock
Norepinephrine 0.02 /./
NSS MAP
<65 Norepinephrine 0.02
/./
MAP 65 (
>0.5 ././.,
Lactate ) 6

(
)

- Norepinephrine 2
/./ MAP <65

Hemodynamics
94

Hematocrit <30%
Hct >30%

Hydrocortisone 100 . IV
8 . 7

Sodium Bicarbonate
Arterial pH <7.15

Epinephrine 0.05 -1 /
./

(
)

- MAP 65
., >0.5 ././., CVP 8-12
. (6-10 . ), Central Venous Oxygen
Saturation (SvO2) 70%, Lactate , PaO2/
FiO2 >300, Blood Glucose <150 ./.,
Hct 30%
Penicillin V
Penicillin G
Ampicillin
Amoxicillin
Cloxacillin
Dicloxacillin
Ampicillin/Sulbactam
AM:
Ampicillin
SB:
Sulbactam
AmoxicillinClavulanate
AX:
Amoxicillin
CV:
Clavulanate
PO 250-500 . 3-4 25-50 ././

3-4
IV 0.5-4 50,000-400,000 /
4 .
./
4
IV 50-200 ././ 100-400 ././
4-6 6 .
.
PO 250 . - 1 .
25-50 ././
2-4
2-3
80-90 ././
2-3
Drug-resistant
S.pneumoniae
(DRSP)
IV 1-2 . 4-6 . 100-200 ././
6 .
PO 125-500 .
25-200 ././
4
4
IV 2 . AM + 1.0 . 100-400 ././

SB 6 .
AM 6-8 .
PO 375-750 .
BW30 .:
2

BW<30 .: 25-50
.// AM
2
IV 1,000 . AX+200 BW40 .:
. CV 8 .
BW<40 .: 3
.: 25 . AX/ 5 .
CV/. 8 .
<3 . BW <4
.: 25 . AX/ 5 .
CV/. 12 .
CrCl (./)
>50-90
10-50
<10

4 .
8 .
12 .
6 .
6-12 .
12-24 .
8 .
8-12 .
24 .
6 .
8-12 .
24 .
CrCl<30: 500
. /100 .
CV 12 .
BW <40 . 25
. AX /5 .
CV/. 12
.
500 . AX/
100 . CV
24 .
BW <40 .
25 . AX/
5 . CV/.
24 .
95
PO
AX-CV (500/125)
3
AX-CV (875/125)
2
PiperacillinTazobactam
IV
4.5 . IV 6-8
.
Cefoperazone (CP)
-Sulbactam
(SB) 1:1-CP
500 ./ SB
500 ., 2:1CP 1,000 ./
SB 500 .
Cefazolin
IV
1-2 . (1:1) 12 75-100 ././

.
8-12 .
1.5-3 . (2:1)
12 .
SB
4 ./
IV
1-2 . 8 .
Cephalexin
PO
Cefuroxime
PO
50-150 ././
8 .
250-1,000 . 25-100 ././
4
3-4
250-500 . 20-30 ././
12 .
2-3
750 . 8 . 100-200 ././
8 .
2 . 6-8 .
75-150 ././
6-8 .
1-2 . 12-24 50-100 ././
.
12-24 .
250 . IM 1
Gonococcal
Urethritis
IV
96
Cefoxitin
IV
Ceftriaxone
IV
CrCl (./)
>50-90
10-50
<10
250-500 .
250-500 .
AX 2 AX
BW40 .:

BW<40 .: 45
90 . AX/./
2
(90 . AX/./
Drug-resistant
S.pneumoniae
(DRSP)
BW 40 .:
BW<40 .: 100 ./
. 6 .
CrCl 20-50:
2.25 . 6
.
CrCl 10-20:
2.25 . 8
.
CrCl 15-30: SB
2
./
12 .
2.25 . 8
.
1-2 .
12 .
500 .
2
1-2 .
24-48 .
250 .
2
500 .
24 .
2 . 8
.
8-12 .
24 .
CrCl <15: SB
1 ./
12
.
2 . 8-12 2 .
.
24-48 .

Cefotaxime
IV
Ceftazidime
IV
Cefepime
IV
1-2 . 4-12 . 50-300 ././

6-8 .
1-2 . 8-12 . 100-150 ././
40 ./.
6-8 .
8 .
Melioidosis
1-2 . 8-12 . 100-150 ././
8-12 .
CrCl (./)
>50-90
10-50
<10
2 .
2 .
2 .
8-12 . 12-24 .
24 .
2 .
2 .
2 .
8-12 . 12-24 .
24-48 .
CrCl 30-60:
2 . 12 .
CrCl 11-29:
2 . 24 .
Cefixime
PO 400 ./
8 ././ 400 .
300 .
1-2
1-2

Cefdinir
PO 300 . 2 14 ././ 300 .
300 .
600 . 1-2 ( 2 2
600 ./)
Cefditoren
PO 250-400 . 9-18 ././ CrCl 30-50
2
2-3
200 .
2
Ertapenem
IV/IM 1 . 24 .
15 ./. 12 . 1 .
CrCl < 30:
( 1 ./)
24 .
0.5 . 24 .
Imipenem
IV 0.5-1 . 6 . 60-100 ././
250-500
250 .
6 .
. 6-8 8-12 .
.
Meropenem
IV 1-2 . 8 .
60-120 ././
1 .
CrCl 25-50:
6-8 .
8 .
1 . 12 .
CrCl 10-24:
0.5 . 12
.
Doripenem
IV 500 . 8 .
500 .
CrCl 30-50:
8 . 250 .
8 .
CrCl 10-29:
250 .
12 .
Roxithromycin PO 150 . 2 6-10 ././
300 . 2
2 .
8 .
CrCl < 11:

1 . 24
.
200 .
300
CrCl <30
200 .
0.5 .
24 .
125-250 .
12 .
0.5 .
24 .
CrCl <15:
97
Erythromycin
PO
Azithromycin
PO
IV
Clarithromycin
PO
IV
Clindamycin
PO
IV
Lincomycin
IM
Gentamicin
IV
MDD: Multiple
Daily Dose
OD: Once
Daily Dose
98
CrCl (./)
>50-90
10-50
<10
Base: 250-500 . 30-50 ././
2-4
4
Ester: 400-800 .
2-4
250-500 .
5-12 ././

1 . ( 500 ./)
Chancroid &
C.trachomatis
2 .
N.gonorrhoeae
500 . 24 . 5-12 ././
( 500 ./)
250-500 .
15 ././
2
1-2 ( 1
./)
500 . 12 . 12 :

<12 :
150-450 .
20-40 ././
3-4
3-4
600-900 . 20-40 ././
8 .
6-8 .
0.6-1 . 8-12 10-30 ././
.
12 .
MDD: 2 ./. 5-7.5 ././
1.7 8-12 .
./. 8 .
500 . 500 .
500 .
2 1-2
CrCl 10-30:
250 .
250-500 .
12 .
12 .

1.7 ./. 1.7 ./.

8 . 12-24 .
1.7 ./.
48 .
OD: 5-7 ./.

24 .
Amikacin
MDD: Multiple
Daily Dose
OD: Once
Daily Dose
Netilmicin
MDD: Multiple
Daily Dose
OD: Once
Daily Dose
Norfloxacin
IV
IV
MDD: 2 ./.
8 .
OD: 6.5 ./.
24 .
3-7.5 ././
8-12 .
2 ./.
8 .
2 ./.
12-24 .
2 ./.
48 .
PO
400 .
2
CrCl <30:
24 .
24 .
Ofloxacin
PO
15-20 ././
2 (
400-800 ./)
10-20 ././
2
20-30 ././
2
20-30 ././
12 .
6 . < 5 :
10 ./. 12 .
5 : 10 ./.
24 .
200-400 .
250-500 .
2
400 . 24
.
CrCl 20-49:
750 . 48
.
CrCl <20: 750
.
500 . 48
.
200 .
250 .
400 .
24 .
750 .
500
. 48
.
Ciprofloxacin
Levofloxacin
Moxifloxacin
CrCl (./)
>50-90
10-50
<10
MDD: 7.5 ./. 15-25 ././ 7.5 ./. 7.5 ./.
7.5 ./.
12 .
8 . ( 1.5 12 . 24 .
48 .
OD: 15 ./.
./)
24 .
200-400 .
2
PO 500-750 .
2
IV 400 . 8-12
.
PO/IV 250-750 .
24 .
PO/IV 400 . 24 .
Sitafloxacin
PO
Prulifloxacin
Cotrimoxazole
Trimethoprim
(TMP)
Sulfamethoxazole (SMX)
PO
PO
50-100 .
2
600 .
1-2 DS 1224 .
6-12 ././ TMP 5-20 ./

2
./
TMP
6-12
Melioidosis
.
(maintenance
phase):
CrCl 30-50:
5-7.5 ././
TMP
8 .
CrCl 10-29:
5-10 ././
TMP
12 .
5-10
././
TMP 24
.
99

Singlestrength
(SS): 80
TMP/400
SMX, Doublestrength (DS):
160TMP/
800 SMX
CrCl (./)
>50-90
10-50
<10
BW < 40 :
2 SS 2 ,
BW 40-60 :
3 SS 2
,
BW >60 : 4 SS
2 ,
IV
5-20 ././ 6-12 ././ TMP

TMP
12 .
6-12 .
20 ././
TMP
6-12 .
Listeria Meningitis
5-20 ./
./
TMP
6-12
.
Doxycycline
PO
Vancomycin
IV
100 . 12 . >8 : 2-5 ./

./ 2
( 200 ./
)
1 . 12 .
40 ././
6-8 .
(Critically ill)
60 ././
25-30 ./ 6-8 .
. Meningitis
15-20 ./.
8-12 .
125 . 6
40 ././
.
6 . (
C.difficile Colitis 2 ./)
4-12 ./ 100-200 ././
12 .
12 .
PO
Fosfomycin
100
IV
CrCl 30-50:
5-7.5 ././
TMP
8 .
CrCl 10-29:
5-10 ././
TMP
12 .
5-10
././
TMP 24
.
15-30 ./ 15 ./. 7.5 ./.

. 12 24-96 .
2-3
.
2-4 .
CrCl 40-50: 1
12 . . 12 .
CrCl 20-30: 0.5
. 12 .
PO
3 .
Uncomplicated
UTI
300 .
150 . 12 .
100 .
8 .
2 .
Uncomplicated UTI
Colistin
IV
Tigecycline
IV
CrCl (./)
>50-90
10-50
<10
CrCl < 20:
CrCl 41-50:
300 .
150 .
12 .
75-100 .
8 .
CrCl 31-40:
300 .
75-100 .
12 .
CrCl 21-30:
300 .
75 . 12
. 150
. 24 .
CrCl 11-20:
300 .
100 . 24
.
CrCl<10: 150
. 75
. 24 .

CrCl <50:
2.5-5 ././
2-4
100 .
50 . 12 . 18
Linezolid
PO/IV 600 . 12 . 30 ././
8 .
Nitrofurantoin PO
50-100 .
>12 :
4
>1 .: 5-7 ./
./
4
1 .
101
Sodium
Fusidate
PO
500 . 3
Chloramphenicol
IV
Metronidazole
PO
50-100 ././
6 .
( 4 ./)
7.5 ./. 6
. ( 4 ./)
Anaerobic
Infection
500 .
2
Bacterial Vaginosis
500 .
3
C.difficile Colitis
7.5 ./. 6
. Brain
Abscess
IV
CrCl (./)
>50-90
10-50
<10
6-12 : 250-500
. 3
1-5 : 250 .
3
<1 : 50 ./
./
3
50-100 ././

6-8 .
30-50 ././ 7.5 ./. 7.5 ./. 3.75 ./.

3 ( 6 . 6 .
6 .
2.25 ./)
30 ././
7.5 ./. 7.5 ./. 3.75 ./.
6 . (
6 . 6 .
6 .
1 ./)
Anaerobic Infection
* 28
102
1.
/

/

/

/ (
)

/

/

/
103
2.
/
/

/ 3-5 , 4-5 , 5-7
, 7-14
18

/
. /

/
/

/
104
1. (Defined Daily Dose, DDD 100 visits)

2.
3.

3.1 20

3.2 20

3.3 95

3.4 40

3.5 10
1. (DDD 1,000 patient-days)

2.
3. 10
4. 24 10
5.
80
105

Danchaivijitr S, Chokloikaew S. A national prevalence study on nosocomial infections 1988. J Med Assoc
Thai 1989;72 Suppl 2:1-6.
Thamlikitkul V, Chokloikaew S, Tangtrakul T, Siripoonkiat P, Wongpreedee N, Danchaivijitr. Blood culture:
Comparison of outcomes between switch-needle and no-switch techniques. Am J Infect Control
1992;20:122-5.
Cummings P, Del Beccaro MA. Antibiotics to prevent infection of simple wounds: a meta analysis of
randomized studies. Am J Emerg Med 1995;13:396-400.
Danchaivijitr S, Tangtrakool T, Waitayapiches S, Chokloikaew S. Efficacy of hospital infection control in
Thailand 1988-1992. J Hosp Infect 1996;32:147-53.
Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic lacerations. N Engl J Med
1997;337:1142-8.
Thamlikitkul V, Danchaivijitr S, Kongpatanakul S, Chokloikaew S. The impact of an educational program
on antibiotic use in a tertiary care hospital in a developing country. J Clin Epidemiology 1998;51:773-8.
Jett LP, Sinave C. Use of an oxacillin disk screening test for detection of penicillin- and ceftriaxoneresistant pneumococci. J Clin Microbiol 1999;37:1178-81.
Leelarasamee A, Leowattana W, Tobunluepop P, Chub-upakarn S, Artavetakun W, Jarupoonphol V,
Varangphongsri K, et al. Amoxicillin for fever and sore throat due to non-exudative pharyngotonsillitis:
beneficial or harmful? Int J Infect Dis 2000;4:70-4.
Thamlikitkul V, Jintanothaitavorn D, Sathitmathakul R, Vaithayapiches S, Trakulsomboon S, Danchaivijitr S.
Bacterial infections in hospitalized patients in Thailand 1997 & 2000. J Med Assoc Thailand 2001;84:
666-72.
Guerrant RL, Van Gilder T, Steiner TS, Thielman NM, Slutsker L, Tauxe RV, et al. Practice guidelines for the
management of infectious diarrhea. Clin Infect Dis 2001; 32: 331-51.
Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections. Ann Intern
Med2001;134:479-529.
Manatsathit S, Dupont HL, Farthing M, Kositchaiwat C, Leelakusolvong S, Ramakrishna BS, et al. Guideline
for the management of acute diarrhea in adults. J Gastroenterol Hepatol 2002;17 Suppl: S54-71.
Chastre J, Wolff M, Fagon JY, Chevret S, Thomas F, Wermert D, Clementi E, et al. Comparison of 8 vs. 15
days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA 2003
19;290:2588-98.
106
Tribuddharat C, Tiensasitorn C, Techachaiwiwat W, Rugdeekha S, Dhiraputra C, Thamlikitkul V. In Vitro

Activity of Polymyxin B and Polymyxin E against Multi-Drug Resistant Pseudomonas aeruginosa and
Acinetobacter baumannii. J Infect Antimicrob Agents 2003;20:135-7.
Keerasuntonpong A, Thearawiboon W, Panthawanan A, Judaeng T, Kachintorn K, Jintanotaitavorn,
Suddhisanont L, et al. Incidence of urinary tract infection in short term indwelling urethral catheter
in hospitalized patients : A comparison between a 3-day urinary drainage bag change and no change
regimen. Am J Infect Control 2003;31:9-12.
Thamlikitkul V, Apisitwittaya W. Implementation of clinical practice guidelines for upper respiratory
infection in Thailand. Int J Infect Dis 2004;8:47-51.
Thielman NM, Guerrant RL. Clinical practice. Acute infectious diarrhea. N Engl J Med 2004;350:38-47.
Chayakulkeeree M, Junsriwong P, Keerasuntonpong A, Tribuddharat C, Thamlikitkul V. Epidemiology of
extended-spectrum beta-lactamase producing Gram-negative bacilli at Siriraj Hospital, Thailand, 2003.
Southeast Asian J Trop Med Public Health 2005;36:1503-9.
Patarakul K, Tan-Khum A, Kanha S, Padungpean D, Jaichaiyapum O. Cross-sectional survey of handhygiene compliance and attitudes of health care workers and visitors in the intensive care units
at King Chulalongkorn Memorial Hospital. J Med Assoc Thai 2005;88 Suppl 4:S287-93.
Danchaivijitr S, Dhiraputra C, Santiprasitkul S, Judaeng T. Prevalence and impacts of nosocomial infection
in Thailand 2001. J Med Assoc Thai 2005;88 Suppl 10:S1-9.
Danchaivijitr S, Pichiensatian W, Apisarnthanarak A, Kachintorn K, Cherdrungsi R. Strategies to Improve
Hand Hygiene Practices in Two University Hospitals. J Med Assoc Thai 2005;88 Suppl 10:S155-60.
Wuthiekanun V, Cheng AC, Chierakul W, Amornchai P, Limmathurotsakul D, Chaowagul W, Simpson AJ,
Short JM, Wongsuvan G, Maharjan B, White NJ, Peacock SJ. Trimethoprim/ sulfamethoxazole resistance in
clinical isolates of Burkholderia pseudomallei. J Antimicrob Chemother 2005;55:1029-31.
Keerasuntonpong A, Samakeenich C, Tribuddharat C, Thamlikitkul. Epidemiology of Acinetobacter
baumannii infections in Siriraj Hospital 2002. Siriraj Med J 2006;58:951-4.
Maenthaisong R, Chaiyakunapruk N, Thammalikitkul V. Cost Effectiveness Analysis of Chlorhexidine
Gluconate Compared with Povidone-Iodine Solution for Catheter-Site Care in Siriraj Hospital, Thailand. J
Med Assoc Thai 2006;89 suppl 11:S94-S101.
Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens persist on inanimate surfaces?
A systematic review. BMC Infectious Diseases 2006,6:130.
107
Koomanachai P, Tiengrim S, Kiratisin P, Thamlikitkul V. Efficacy and safety of colistin (colistimethate

sodium) for therapy of infections caused by multidrug-resistant Pseudomonas aeruginosa and
Acinetobacter baumannii in Siriraj Hospital, Bangkok, Thailand. Int J Infect Dis 2007;11:402-6.
Balamongkhon B, Thamlikitkul V. Implementation of chlorhexidine gluconate for central venous catheter
site care at Siriraj Hospital, Bangkok, Thailand. Am J Infect Control 2007;35:585-8.
Zehtabchi S. The role of antibiotic prophylaxis for prevention of infection in patients with simple hand
lacerations. Ann Emerg Med 2007;49:682-9.
Danchaivijitr S, Judaeng T, Sripalakij S, Naksawas K, Plipat T. Prevalence of nosocomial infection in
Thailand 2006. J Med Assoc Thai 2007;90:1524-9.
, , , .
2550.
Sridermma S, Limtangturakool S, Wongsurakiat P, Thamlikitkul V. Development of appropriate procedures
for inflation of endotracheal tube cuff in intubated patients. J Med Assoc Thai 2007;90 Suppl 2:74-8.
Apisarnthanarak A, Pinitchai U, Thongphubeth K, Yuekyen C, Warren DK, Fraser VJ. A multifaceted
intervention to reduce pandrug-resistant Acinetobacter baumannii colonization and infection in
3 intensive care units in a Thai tertiary care center: a 3-year study. Clin Infect Dis 2008;15;47:760-7.
Tantipong H, Morkchareonpong C, Jaiyindee S, Thamlikitkul V. Randomized Controlled Trial and Metaanalysis of Oral Decontamination with 2% Chlorhexidine Solution for the Prevention of VentilatorAssociated Pneumonia. Infect Control Hosp Epidemiol 2008;29:131-6.
Duggal N, Mercado C, Daniels K, Bujor A, Caughey AB, El-Sayed YY. Antibiotic prophylaxis for prevention of
postpartum perineal wound complications: a randomized controlled trial. Obstet Gynecol
2008;111:1268-73.
Suankratay C, Jutivorakool K, Jirajariyavej S. A prospective study of ceftriaxone treatment in acute
pyelonephritis caused by extended-spectrum beta-lactamase-producing bacteria. J Med Assoc Thai
2008;91:1172-81.
Picheansathian W, Pearson A, Suchaxaya P. The effectiveness of a promotion programme on hand hygiene
compliance and nosocomial infections in a neonatal intensive care unit. Int J Nurs Pract 2008;14:315-21.
DuPont HL. Clinical practice. Bacterial diarrhea. N Engl J Med 2009;361:1560-9.
Angkasekwinai N, Rattanaumpawan P, Thamlikitkul V. Epidemiology of sepsis in Siriraj Hospital 2007.
J Med Assoc Thai 2009;92 Suppl 2:S68-78.
108
Apisarnthanarak A, Buppunharun W, Tiengrim S, Sawanpanyalert P, Aswapokee N. An overview of

antimicrobial susceptibility patterns for gram-negative bacteria from the National Antimicrobial
Resistance Surveillance Thailand (NARST) program from 2000 to 2005. J Med Assoc Thai 2009;92 Suppl
4:S91-4.
Allegranzi B, Pittet D. Role of hand hygiene in healthcare-associated infection prevention. J Hosp Infect
2009;73:305-15.
Rattanaumpawan P, Sutha P, Thamlikitkul V. Effectiveness of drug use evaluation and antibiotic
authorization on patients clinical outcomes, antibiotic consumption, and antibiotic expenditures.
Am J Infect Control 2010;38:38-43.
Werarak P, Kiratisin P, Thamlikitkul V. Hospital-acquired pneumonia and ventilator-associated pneumonia
in adults at Siriraj Hospital: etiology, clinical outcomes, and impact of antimicrobial resistance. J Med
Assoc Thai 2010;93 Suppl 1:S126-38.
Rattanaumpawan P, Lorsutthitham J, Ungprasert P, Angkasekwinai N, Thamlikitkul V. Randomized
controlled trial of nebulized colistimethate sodium as adjunctive therapy of ventilator-associated
pneumonia caused by Gram-negative bacteria. J Antimicrob Chemother 2010;65:2645-9.
Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on
antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096.
Van Schalkwyk J, Van Eyk N. Antibiotic prophylaxis in obstetric procedures. J Obstet Gynaecol Can
2010;32:878-92.
Seto WH, Otaza F, Pessoa-Silva CL; World Health Organization Infection Prevention and Control Network.
Core components for infection prevention and control programs: a World Health Organization network
report. Infect Control Hosp Epidemiol 2010;31:948-50.
. . .
2553.
Korbkitjaroen M, Vaithayapichet S, Kachintorn K, Jintanothaitavorn D, Wiruchkul N, Thamlikitkul V.
Effectiveness of comprehensive implementation of individualized bundling infection control
measures for prevention of health care-associated infections in general medical wards. Am J Infect
Control 2011;39:471-6.
Song JH, Hsueh PR, Chung DR, Ko KS, Kang CI, Peck KR, Yeom JS et al. Spread of methicillin-resistant
Staphylococcus aureus between the community and the hospitals in Asian countries: an ANSORP study.
J Antimicrob Chemother 2011;66:1061-9.
109
Garonzik SM, Li J, Thamlikitkul V, Paterson DL, Shoham S, Jacob J, Silveira FP, Forrest A, Nation RL.
Population pharmacokinetics of colistin methanesulfonate and formed colistin in critically ill
patients from a multicenter study provide dosing suggestions for various categories of patients.
Antimicrob Agents Chemother 2011;55:3284-94.
Chung DR, Song JH, Kim SH, Thamlikitkul V, Huang SG, Wang H, So TM, et al. High Prevalence of
Multidrug-Resistant Non-Fermenters in Hospital-Acquired Pneumonia in Asia. Am J Respir Crit Care Med
2011;184:1409-17.
Cowell DL, Harvey M, Cave G. Antibiotic prophylaxis at triage for simple traumatic wounds: A pilot study.
Euro J Emerg Med 2011;18:27981.
Enzler MJ, Berbari E, Osmon DR. Antimicrobial prophylaxis in adults. Mayo Clin Proc 2011;86:686-701.
Leekha S, Terrell CL, Edson RS. General principles of antimicrobial therapy. Mayo Clin Proc 2011;86:15667.
Doron S, Davidson LE. Antimicrobial stewardship. Mayo Clin Proc 2011;86:1113-23.
Enzler MJ, Berbari E, Osmon DR. Antimicrobial prophylaxis in adults. Mayo Clin Proc 2011;86:686-701.
Yan RC, Shen SQ, Chen ZB, Lin FS, Riley J. The role of prophylactic antibiotics in laparoscopic
cholecystectomy in preventing postoperative infection: a meta-analysis. Laparoendosc Adv Surg Tech A
2011;21:301-6.
Clinical and Laboratory Standards Institute. Methods for Antimicrobial Dilution and Disk Susceptibility
Testing of Infrequently Isolated or Fastidious Bacteria; Approved Guideline- Second Edition 2011
M45-A2. Wayne, Pennsylvania, U.S.A.
Jenkins SG, Schuetz AN. Current concepts in laboratory testing to guide antimicrobial therapy. Mayo Clin
Proc 2012;87:290-308.
Werarak P, Waiwarawut J, Tharavichitkul P, Pothirat C, Rungruanghiranya S, Geater SL, Chongthaleong A,
et al. Acinetobacter baumannii nosocomial pneumonia in tertiary care hospitals in Thailand. J Med Assoc
Thai2012;95 Suppl 2:S23-33.
Siriboon S, Tiengrim S, Taweemongkongsup T,Thamlikitkul V, Chayakulkeeree M. Prevalence of antibiotic
resistance in fecal flora of patients undergoing transrectal ultrasound-guided prostate biopsy in Thailand.
Urol Int2012;88:187-93.
Ghafouri HB, Bagheri-Behzad B, Yasinzadeh MR, Modirian E, Divsalar D, Farahmand S. Prophylactic
Antibiotic Therapy in Contaminated Traumatic Wounds: Two Days versus Five Days Treatment. Bioimpacts
2012;2:33-7.
110
Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, et al. Infectious Diseases
Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults.
Clin Infect Dis 2012;54:e72-e112.
Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G, Martin JM, Van Beneden C. Clinical
practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update
by the Infectious Diseases Society of America. Clin Infect Dis 2012;55:1279-82.
Pumart P, Phodha T, Thamlikitkul V, Riewpaiboon A, Prakongsai P, Limwattananon S. Health and
economic impacts of antimicrobial resistant infections in Thailand: a preliminary study. J Health Syst Res.
2012;6:352-60.
Apisarnthanarak A, Kiratisin P, Khawcharoenporn T, Warren DK. Using an intensified infection prevention
intervention to control carbapenemase-producing Enterobacteriaceae at a Thai center. Infect Control
Hosp Epidemiol 2012;33:960-1.
Derde LP, Dautzenberg MJ, Bonten MJ. Chlorhexidine body washing to control antimicrobial-resistant
bacteria in intensive care units: a systematic review. Intensive Care Med 2012;38:931-9.
Pincock T, Bernstein P, Warthman S, Holst E. Bundling hand hygiene interventions and measurement to
decrease healthcare-associated infections. Am J Infect Control 2012;40 4 Suppl 1:S18-27.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, et al. Multidrugresistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert
proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268-81.
Nottinghamshire Guidelines on Management of Common Infections and Infestations in Primary Care2012.
http://www.nottsapc.nhs.uk/attachments/article/3/antimicrobial%20guidelines.pdf
Gonzales R, Anderer T, McCulloch CR, Maselli JH, Bloom FJ, Graf TR, Stahl M, et al. A Cluster Randomized
Trial of Decision Support Strategies for Reducing Antibiotic Use in Acute Bronchitis. JAMA Intern Med
2013;173:267-273.
Llor C, Moragas A, Bayona C, Morros R, Pera H, Plana-Ripoll O, Cots JM, Miravitlles M. Efficacy of antiinflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured
sputum: randomised placebo controlled trial. BMJ 2013;347:f5762.
, , , , .
. R2R .
2556.
111
Waterbrook AL, Hiller K, Hays DP, Berkman M. Do topical antibiotics help prevent infection in minor
traumatic uncomplicated soft tissue wounds? Ann Emerg Med 2013;61:86-8.
Farthing M1, Salam MA, Lindberg G, Dite P, Khalif I, Salazar-Lindo E, et al; WGO. Acute diarrhea in adults
and children: a global perspective. J Clin Gastroenterol 2013;47:12-20.
Kanoksil M, Jatapai A, Peacock SJ, Limmathurotsakul D. Epidemiology, microbiology and mortality
associated with community-acquired bacteremia in northeast Thailand: a multicenter surveillance study.
PLoS One 2013;8:e54714.
Eiamsitrakoon T, Apisarnthanarak A, Nuallaong W, Khawcharoenporn T, Mundy LM. Hand hygiene
behavior: translating behavioral research into infection control practice. Infect Control Hosp Epidemiol
2013;34:1137-45.
Chlebicki MP, Safdar N, OHoro JC, Maki DG. Preoperative chlorhexidine shower or bath for prevention of
surgical site infection: a meta-analysis. Am J Infect Control 2013;41:167-73.
Dimopoulos G, Poulakou G, Pneumatikos IA, et al. Short- vs. long duration antibiotic regimens for
ventilator-associated pneumonia: a systematic review and meta-analysis. Chest 2013;144:1759-67.
Woerther PL, Burdet C, Chachaty E, Andremont A. Trends in human fecal carriage of extended-spectrum
-lactamases in the community: toward the globalization of CTX-M. Clin Microbiol Rev 2013;26:744-58.
Antibiotic choices for common infections 2013. www.bpac.org.nz/antibiotics
CDC/NHSN Surveillance Definition of Healthcare-Associated Infection and Criteria for Specific Types of
Infections in the Acute Care Setting 2013.
http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf
Bratzler DW, Dellinger EP, Olsen KM, Perl TM, Auwaerter PG, Bolon MK, Fish DN, et al. Clinical practice
guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013;70:195-283.
, . .
. 2556.
Chawla S, DeMuro JP. Current controversies in the support of sepsis. Curr Opin Crit Care 2014;20:681-4.
Cosgrove SE, Avdic E, Dzintars K. Treatment Recommendations for Adult Inpatients. John Hopkins
Medicine Antibiotic Guidelines 2014-2015.
Yokoe DS, Anderson DJ, Berenholtz SM, Calfee DP, Dubberke ER, et al. A Compendium of Strategies to
Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates. Am J Infect Control
2014;42:820-8.
112
Boonyasiri A, Thamlikitkul V. Effectiveness of multifaceted interventions on rational use of antibiotics

for patients with upper respiratory tract infections and acute diarrhea. J Med Assoc Thai 2014;97 Suppl
3:S13-9.
Sirijatuphat R, Siritongtaworn P, Sripojtham V, Boonyasiri A, Thamlikitkul V. Bacterial contamination of
fresh traumatic wounds at Trauma Center, Siriraj Hospital, Bangkok, Thailand. J Med Assoc Thai 2014;97
Suppl 3:S20-5.
Lai CC, Lee K, Xiao Y, Ahmad N, Veeraraghavan B, Thamlikitkul V, Tambyah PA, et al. High burden of
antimicrobial drug resistance in Asia. J Glob Antimicrob Resist 2014;2:141-7.
Thamlikitkul V. STOP Antimicrobial Resistance: Everybodys Business. Siriraj Med J 2014;66:234-40.
Boonyasiri A, Tangkoskul T, Seenama C, Saiyarin J, Tiengrim S, Thamlikitkul V. Prevalence of antibiotic
resistant bacteria in healthy adults, foods, food animals, and the environment in selected areas
in Thailand. Pathog Glob Health 2014;108:235-45.
Svanstrm H, Pasternak B, Hviid A. Use of clarithromycin and roxithromycin and risk of cardiac death:
cohort study. BMJ 2014;349:g4930.
Liabsuetrakul T, Choobun T, Peeyananjarassri K, Islam QM. Antibiotic prophylaxis for operative vaginal
delivery. Cochrane Database Syst Rev 2014;10:CD004455.
Pichichero ME. Treatment and prevention of streptococcal tonsillopharyngitis. In: UpToDate 2014.
Guarino A, Ashkenazi S, Gendrel D, Lo Vecchio A, Shamir R, Szajewska H. European Society for Pediatric
Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases
evidence-based guidelines for the management of acute gastroenteritis in children in Europe:
update 2014. J Pediatr Gastroenterol Nutr 2014;59:132-52.
Buppasiri P, Lumbiganon P, Thinkhamrop J, Thinkhamrop B. Antibiotic prophylaxis for third- and fourthdegree perineal tear during vaginal birth. Cochrane Database Syst Rev 2014;10:CD005125.
Chaisathaphol T, Chayakulkeeree M. Epidemiology of infections caused by multidrug-resistant gramnegative bacteria in adult hospitalized patients at Siriraj Hospital. J Med Assoc Thai 2014;97 Suppl
3:S35-45.
Zuccotti G, Pflomm JM. Drugs for Urinary Tract Infections. JAMA 2014;311:855-6.
Grigoryan L, Trautner BW, Gupta K. Diagnosis and Management of Urinary Tract Infections in the Outpatient
Setting: A Review. JAMA 2014;312:1677-84.
113
Dance DA, Davong V, Soeng S, Phetsouvanh R, Newton PN, Turner P. Trimethoprim/sulfamethoxazole

resistance in Burkholderia pseudomallei. Int J Antimicrob Agents 2014;44:368-9.
Piewngam P, Kiratisin P. Comparative assessment of antimicrobial susceptibility testing for tigecycline
and colistin against Acinetobacter baumannii clinical isolates, including multidrug-resistant
isolates. Int J Antimicrob Agents 2014;44:396-401.
Eccles S, Pincus C, Higgins B, Woodhead M. Diagnosis and management of community and hospital
acquired pneumonia in adults: summary of NICE guidance. BMJ 2014;349:g6722.
Fokkens WJ, Hoffmans R, Thomas M. Avoid prescribing antibiotics in acute rhinosinusitis. BMJ
2014;349:g5703.
..2557.
http://www.thaipediatrics.org/attchfile/CPG1.pdf
Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility
Testing; Twenty-Fourth Information Supplement (January 2014) M100-S24. Wayne, Pennsylvania,
U.S.A.
Peripheral Hospital Antimicrobial Guidelines(Quick Reference Guide) 2014.
http://www.torbaycaretrust.nhs.uk/publications/TSDHC/Peripheral%20Hospital%20Antimicrobial%20
Guidelines.pdf
HSE South East Hospitals Antimicrobial Stewardship Group. Guidelines for the empiric use of antimicrobials
in adults 2014.
Management of infection guidance for primary care for consultation and local adaptation 2014.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/377509/PHE_Primary_
Care_guidance_14_11_14.pdf
Sanford Guide to Anitmicrobial Therapy 2014.
Rosenfeld R, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. Clinical Practice
Guideline (Update): Adult Sinusitis. Otolaryngol Head Neck Surg 2015;152 (2S):S1S39.
Sirijatuphat R, Choochan T, Siritongtaworn P, Sripojtham V, Thamlikitkul V. Implementation of Antibiotic
Use Guidelines for Fresh Traumatic Wound at Siriraj Hospital. J Med Assoc Thai 2015;98:245-52.
Taketomo CK, Hodding JH, Kraus DM. Pediatric and Neonatal dosage handbook with international trade
nemes index. A universal resource for clinicians treating pediatric and neonatal patients. American
Pharmacists Association 21st Edition 2014-2015.
114
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Thailand AMR Containment and Prevention Program

International Development Research Center (IDRC), Canada

Treponema pallidum, Nocardia

Gentamicin, Tobramycin, Amikacin, Netilmicin

Imipenem, Meropenem, Doripenem

Piperacillin-Tazobactam, Ticarcillin-Clavulanic Acid

Folate Pathway Inhibitors

Penicillins + Beta-Lactamase Inhibitors

Tetracycline, Doxycycline, Minocycline, Tigecycline

Cefotaxime, Ceftriaxone, Ceftazidime, Cefepime

MRSA, ESBLProducuing Enterobacteriaceae, CRE, CarbapenemResistant P.aeruginosa & A.baumannii

70% Alcohol Syringe

Swab Transport Medium ( Cary-Blair

-hemolytic Streptococci Penicillins

* MSSA Methicillin-Susceptible S.aureus

Streptococcus spp. viridans group

Enterobacteriaceae (E.coli, Klebsiella spp., Proteus spp., Enterobacter spp.)

Enterobacteriaceae (E.coli, Klebsiella spp., Proteus spp., Enterobacter spp.)

(Infectious Mastitis/ Breast

Nosocomial infection (NI)

.......................................................... .................................................................................... ...................................................................

(Nosocomial Infection Point Prevalence Survey)

02 Urinary Tract Infection (UTI)

01 = MSSA, 02 = MRSA, 03 = Enterococci, 04 = E.coli, 05 = K.pneumoniae/

1. (Infection Control Committee)

......................... // ............................. .............................

4. (Restricted Antibiotics) / (Controlled

Meropenem (.) ImipenemCilastatin (.)

- Neutropenia (Absolute Neutrophil <500)

(Contaminated Wound) ( Open Fracture)

- Penicillin Clindamycin Vancomycin

- Cefazolin Ceftriaxone Ampicillin-Sulbactam

- Cefazolin + Metronidazole Ampicillin-Sulbactam

- Ampicillin + Gentamicin Ampicillin-Sulbactam

- ( 5%-10% Povidone Iodine)

- Amoxicillin 2 . Ampicillin 2 . Cefazolin

( Acute Otitis Media,

(Normal Flora/ Colonization)

Clostridium spp. other than Pen G

Ceftriaxone, Cefotaxime, Ofloxacin,

Coamoxiclav, AmpicillinSulbactam, Levofloxacin,

(Acute Nasopharyngitis, Common Cold, Acute Upper Respiratory Infection-Unspecified)

/ (Acute Pharyngitis, Acute Tonsillitis)

3 1) ( >38 C), 2) Exudate/

4) Systolic BP <90 Diastolic BP60 mm.Hg

-- ( Scrub Typhus, Infective Endocarditis)

- Ultrasonography Gall Stone,

- Dialysate Dialysate >50 .

- Proton Pump Inhibitor (PPI)

(Urinary Tract Infection, UTI)

400 . Ciprofloxacin 500 .

/ (Lymphogranuloma Venereum, LGV, Bubo)

Streptococcus pyogenes (group A

(Complicated SSI) - Necrotizing Infections, Bite

- ( Tetanus Vaccine, Rabies Vaccine)

(Acute Septic Arthritis)

Cloxacillin ( Vancomycin) + Gentamicin

(Acute Bacterial Meningitis)

(Acute Fever, Acute Febrile Illness)

Influenza, Acute Retroviral Syndrome)

Doxycycline +/- Ceftriaxone

- Neutropenia (Absolute Neutrophil <500

Gram Negative Rods Ceftazidime + Amikacin