Meningitis (acute)
-strep pneu. (G+ cocci)
-ness mening. (G- diplococci)
-haem influe. (G- bacilli)
-Gram neg bacilli
Meningitis (chronic)
-mycobact tuberculosis
-cryptococcus neoformans (non HIV, non
transplat pt)
Spontaneous bact peritonitis
-Primary: enterobacteriacea (e coli, kleb
pneumoniae, strep sp)
-cirrhotic with UGIB
LRTI
Community acquired neumonia
Viral pneumonia
-influenza
-varicella zoster
Lung abscess & empyema
-Staph aureus (G+ cocci)
Infective exacerbation of COPD
-Abx needed only in increase purulence
+increase sputum vol/increase SOB or pt
intubated (GOLD 2019)
-G-ve aerobic rods
Risks: frequent exacerb, severe airflow
limitation, exacerb reqd mech ventilation
Hosp acquired pneumonia (HAP/VAP)
Risks: use of abx w/in 90days, >5days hosp
in high risk ward (ICU, HDU), prev
colonization w MDR pathogens
-early onset 2-4 days
-late onset 5 days or more
Aspiration pneumonia
Cellulitis
-staph aureus
-strep pyogenes (G+ in pairs/chains)
>severity
>G-ve coverage: relation cellulitis to
decubitus ulcer, crepitant cellulitis,
prominent necrosis/gangrene,
perioral/perirectal, in septicaemic
shock/suspect NF, immunocompromised
Neutropenic pt
-pseudomonas aeruginosa, other G-ve
Methicillin-resistant Staph aureus (MRSA)
Empirical: IV ceftriaxone 2g BD
Prophylaxis: T rifampicin 600mg BD x2/7 or IM ceftriaxone
250mg
Immunocompromised: Meropenem 2g TDS
-2/12 of S/EHRZ and 10/12 of HR
-amphotericin B + 5flucytosine or amphotericin B +
fluconazole
-IV ceftriaxone 1g BD or IV cefotaxime 2g TDS
-IV ceftriaxone 1g BD or IV cefotaxime 2g TDS
Outpt: Amoxicillin 500mg TDS x5-7/7 or Augmentin 625mg
TD x5-7/7 or doxycycline 100mg BD x7/7
Inpt CURB>2: IV Augmentin 1.2g TDS + T/IV azithromycin
OD x3-5/7
-C oseltamivir 75mg BD x5/7
-IV acyclovir 10mg/kg TDS x7/7
Empirical: IV Augmentin 1.2g TDS/QID or ceftriaxone 2g
OD + IV metronidazole 500mg TDS (aspiration suspected)
*drained- need 2-4 weeks *undrained- need 4-6 weeks
-Staph aureus: IV cloxacillin 2g 4-6hourly or IV cefazolin 2g
TDS
*Metronidazole to cover anaerobes
Outpt: Augmentin 625mg TDS x5-7/7 or cefuroxime 500mg
BD or doxycycline 100mg BD
Inpt: IV augmentin 1.2g TDS +/ T/IV azithromycin 500mg
x3-5/7 or IV ceftriaxone 500mg BD x5-7/7 +/ IV/T
azithromycin x3-5/7
Suspect pseudomonas: [IV Tazocin 4.5g TDS/QID or IV
cefepime 2g TDS] +/ IV/T azithromycin OR Iv ceftazidime
2g TDS +/ IV/T azithromycin
*Tazocin if given TDS, to be given as extended infusion, over
3-4hours
Early: IV augmentin 1.2g TDS x5-7/7 or IV ceftriaxone 2g
OD x5-7/7
Late:[ Tazocin 4.5g TDS/QID x77 or IV cefepime 2g TDS
x7/7] OR [IV imipenem/cilastatin 500mg QID or IV
meropenem 1g TDS x7/7]
IV augmentin 1.2g TDS or IV ceftriaxone 2g OD + IV
metronidazole 500mg TDS
Mild: T cephalexin 500mg QID or [T cefuroxime 250-500mg
BD or T augmentin 625mg TDS]
Moderate: IV cloxacillin 1-2g QID or IV cefazolin 1-2g TDS
Severe: [IV Unasyn 3g TDS/QID +/ IV clindamycin 600mg
QID] or [Iv tazocin 4.5g TDS/QID +/ Iv clindamycin 600mg
QID]
*duration 5-10 days according to clinical response, change to
oral when improves
*deescalate once culture available/necrotizing fasciitis ruled
out
[IV Tazocin 4.5g TDS/QID] or [IV ceftazidime 2g TDS or IV
cefepime]
[IV vancomycin 15-20mg/kg TDS/BD
Severe: load with IV vanco 25-30mg/kg, followed by 15-
20mg/kg TDS/BD, not exceeding 2g per dose]
Or IV/T linezolid 600mg BD
 Catheter-related bloodstream infection
(CRBSI)
-coagulase neg staph (CoNS)
Methicillin sensitive (MSCoNS)
Methiclllin resistant (MRCoNS)
-coagulase pos staph
Methicillin sensitive (MSSA)
Methiclllin resistant (MRSA)
G-ve bacilli enterobacteriacea (enteric G-)
PEEKSSS –Proteus, E coli, Enterobacter, Klebsiella, Salmonella, Shigella, Serratia
Extended spectrum beta lactamases
ESBL neg
ESBL pos
Pseudomonas aeruginosa
*not all is drug resistant, if ceftazidime
remains susceptible, use it + aminoglycoside
Cystitis
-uncomplicated: E coli, staph saprophyticus, cephalexin 500mg BD] or [T cefuroxime 250mg BD or T
enterobacteriaceae: klebsiella, proteus
Pyelonephritis
-uncomplicated: enterobacteriacea,
enterococci
-in pregnancy: treat as inpt rx for
uncomplicated pyelonephritis
Complicated UTIs
-enterobacteriacea
-enterococci
-pseudomonas sp
*UTIs in men OR presence of
structural/functional abnormality
(obstruction, CKD, poorly controlled
T2DM, immunosuppression, CBD insitu,
neurogenic bladder, postmenopausal wmen,
hx recurrent UTIs, nephrolithiasis)
SOURCE: NATIONAL ANTIBIOTIC GUIDELINE 2019 3RD EDITION
*paired blood C&S from catheters & peripheral
*remove catheters
*duration 10-14 days after culture clearance
*for CoNS, need to decide whether isolates from blood C&S
is colonizers/true pathogens
IV cloxacillin 200mg/kg/d in 4-6 divided doses or IV
cefazolin 100mg/kg/d in 3 divided doses
IV vancomycin 60mg/kg/d in 2-3 divided doses
IV cloxacillin 200mg/kg/d in 4-6 divided doses or IV
cefazolin 100mg/kg/d in 3 divided doses
IV vancomycin 60mg/kg/d in 2-3 divided doses
IV tazocin 300mg/kg/d in 3-4 divided doses *empiric, follow
thru with culture
[IV Ertapenem 30mg/kg/d in 2 divided doses] or [imipenem
60-100mg/kg/d in 4 divided doses or Meropenem 60-
120mg/kg/d in 3 divided doses]
IV tazocin 300mg/kg/d in 3-4 divided doses or IV cefepime
50mg/kg/d TDS
*deescalate abx to preserve abx for future use
[T nitrofurantoin 50-100mg QID or 100mg BD or T
augmentin 625mg TDS or T unasyn 375-750mg BD or
fosfomycin 3g x1 dose] duration 5-7/7
*nitrofurantoin contraindicated if GFR<30
*fosfomycin: MDR G-ve
Outpt: T augmentin 625mg TDS x2/52 or T unasyn 375-
750mg BD x2/52
Inpt: [IV augmentin 1.2g TDS or IV cefuroxime 750mg TDS
or IV unasyn 1.5-3g TDS] or IV ceftriaxone 1g OD
*urine culture before start abx
*USG KUB exclude obstructive pyelonephritis
*step down by C&S & allow orally if afebrile >48hours
Oral: T augmentin 625mg TDS x7/7 or T cephalexin 500mg
QID x7/7
Parenteral: [IV augmentin 1.2g TDS or IV Unasyn 1.5-3g
TDS or IV cefuroxime 750mg TDS] or [IV ceftriaxone 1g
OD] +/ aminoglycoside