(According To Alphabetical Order) : Community Acquired Meningitis (CAM)

List of recommendations arranged according to system and diseases
(According to alphabetical order)

Central Nervous system
Community acquired Meningitis (CAM)
Likely causative agent Antimicrobial of choice
Preferred drug
Alternative drug
Streptococcus Pneumonia Inj. Meropenem (2 gm) Tab. Teicoplanin (400 mg) stat and (200 mg)
Neisseria meningitides 8 hourly for 14 days plus/ or 12 hourly for 14 days plus/ or
Haemophilus influenza
Staphylococcus aureus Inj. Linezolid (600 mg) Inj. Acyclovir (5000 mg)
Herpes simplex 12 hourly 6 hourly for 14 days
Inj. Acyclovir (500 mg)
6 hourly for 14 days if viral infection
Name: S.I Avoid Imipenem

Pyogenic Meningitis
Preferred drug
Alternative drug
Streptococcus Pneumonia Inj. Vancomycin (30-45 mg/kg/day) Inj. Penicillin G
Neisseria meningitides 4-12 hourly interval + Inj. Meropenem
Listeria monocytogenes Inj. Gentamicin
Streptococcus agalactiae Inj. Ceftriaxone (2 gm) Inj. Amikacin
Haemophilus influenza 12 hourly 7-14 days
Escherichia coli
Name: Most of the patient came from different ICU with multiple drugs including two or more antibiotics with cultural and sensitivity report, so antibiotics choice mostly depends on c/s report
Dentistry
Acute variceal haemorrhage
Preferred drug
Alternative drug
Inj. Somatostatin (250 μgm or 500 μgm) A bolus of is given

followed by an infusion of 6 mg/24 hour for 120 hrs
Portal Hypertension due to Cirrhosis of liver or non-cirrhotic portal Inj. Terlipressin (2 mg) 6 hourly for 48 hour. It may be continued for a further 3 days at 1
hypertension mg every 4 – 6 hourly
Inj. Octreotide (5 µgm) A bolus followed by (50 µgm/hour)
for up to 5 days
Cleft lip-palate, facial cleft, facial deformity correction surgery

Preferred drug
Alternative drug
Inj. Ceftriaxone (1 gm) Inj. Meropenem (1 gm)
12 hourly 8 hourly I/V for 7 days, followed by Cap. Cephalosporins
Tab. Metronidazole (500 mg) Tab. Metronidazole
8 hourly for 5-7 days followed by or Cap. Cephalosporins
Tab. Metronidazole
Dental abscess
Preferred drug
Alternative drug
Obligate anaerobes: Cap. Flucloxacillin Cap. Cepholosporins
Prevotella intermedia Tab. Metronidazole Cap. Cefixime

Prevotella nigresub Cap. Cefuroxime
Fusobacterium periodontices Tab. metronidazole
Phyromonas endodontics
Porphyromonas gingivalis
Name: For rapidly spreading infections injectable from may be advised

Denture sore mouth
Preferred drug
Alternative drug
Candida albicans Antifungal agents eg, Nystatin powder or cream Antifungal agents eg, Nystatin powder or cream
Denture stomatitis
Preferred drug
Alternative drug
Candida albicans 1 antifungal agents (eg, Nystatin powder or cream)
Extraction of tooth surgical/ non surgical

Preferred drug
Alternative drug
Cap. Amoxicillin (500 mg)
8 hourly for 7 days or
Cap. Cefixime (200 mg)
2 of the other 3rd line antibiotic*
12 hourly for 7 days+
Tab. Metronidazole (400 mg)
8 hourly for 5 days.
Fungal infections in maxillofacial region like Candidiasis, mucormicosis etc

Preferred drug
Alternative drug
Nystatin oral suspension (5-10 ml) of suspension Nystatin oral suspension (5-10 ml) of suspension
Fungus
for at least 14 days for at least 14 days.
Cap. Fluconazole (100 mg) Cap. Itraconazole (400 mg)
Fungus
daily for 7 – 14 days. 24 hourly for 7-14 days
Cap. Itraconazole (400 mg)
24 hourly for 7-14 days
Inj. Amikacin
Gingivitis
Preferred drug
Alternative drug
Campylobacter rectus Tab. Penicillin V (250-500 mg)
Actinomyces species post operative 6 hourly for 5-7 days
Prevotella inginosus
Streptococcus Tab. Metronidazole (200-400 mg)
Cap. Doxycycline Initial : (200 mg/day) divided twice daily post operative first day then.
8 hourly for 3-5 days Maintenance : (100-200 mg/day) divided 12hrly
Cap. Doxycycline Initial : (200 mg/day)
divided twice daily post operative first day then. Maintenance :

(100-200 mg/day) divided 12 hourly
Name: Avoidance of Doxycycline, Metronidazole in growing patients and pregnant women.
Avoidance of antimicrobial drugs in patients having the history of that specific drug allergy.
Hepatorenal syndrome
Preferred drug
Alternative drug
Inj. Human albumin (1 g/kg/day) bolus on presentation
Inj. Terlipressin (0.5-2.0 mg)
(maximum Dose, 100 gm daily)
Inj. Nor adrenaline (0.5- 3.0 mg/hour) continuous I/V infusion

every 4 – 6 hourly
[Sherlock]
Cirrhosis of liver with ascites with renal impairment
Inj. Octreotide (100-200 μgm)
subcutaneously 8 hourly
Inj. Midodrine (7.5-12.5 mg)
8 hourly
In case of maxillofacial fracture management like open reduction and fixation

Preferred drug
Alternative drug
3rd generation Ceftriaxone (1 mg )I/V Inj. Meropenem (1 gm)
12 hourly 8 hourly I/V for 7 days, following by Cap. Cephalosporins
Metronidazole (500 mg) I/V Tab. Metronidazole
8 hourly for 5-7 days followed by oral Cephalosporins
Tab. Metronidazole
In case of oral and maxillofacial lesion with or without reconstruction, like mendibulectomy, maxillectomy, neck dissection, etc
Likely causative agent
Preferred drug
Alternative drug
Inj. Ceftriaxone (1 mg) 12 hourly Inj. Meropenem (1 gm) 8 hourly for 7 days, following by Cap. Cephalosporins
Tab. Metronidazole (500 mg) Tab. Metronidazole
8 hourly for 5-7 days followed by Cap. Cephalosporins
Tab. Metronidazole
Jaw osteomyelitis
Preferred drug
Alternative drug
Cap. Clindamycin (600 mg) Flucloxacillin (500 mg)
in divided dose for 6 days to 8 weeks ± 6 hourly for 6-8 weeks +
Mixed anaerobic infection. Commonly by staphylococci and enteric

microorganism
Tab. Metronidazole (500 mg) Tab. Secnidazole (2 gm)
8 hourly for 7 days single dose
Minor oral surgery like biopsy, excision of mucocele etc

Preferred drug
Alternative drug
Cap. Amoxicillin (500 mg) Cap. Amoxicillin (500 mg) + Clavulanic acid (125 mg)
8 hourly for 7 days or 8 hourly or
Cap. Cefixime (200 mg) Cap. Cefuroxime (500 mg) + Clavulanic acid (125 mg)
12 hourly for 7 days + 12 hourly for 7 days +
Tab. Metronidazole (400 mg) Tab. Metronidazole (400 mg)
8 hourly for 5 days 8 hourly for 5-7 days
Oral Candidiasis
Preferred drug
Alternative drug
Streptococcus
Antifungal agents eg, Nystatin powder or cream Clotrimazole or Nystatin lozenges

Peptostreptococcus
Bacteroides
Orofacial space infections

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

Polymicrobials of both anaerobic and aerobic
in different dose for 7-14 days
8 hourly 7 days.
Peri implantitis
Preferred drug
Alternative drug
Prevotella intermedia Cap. Cephalosporins (200-400 mg )
Pseudomonas aeruginosa 6-12 hourly for 7 days
Staphylococcus spp.
Peptostreptococcus micros Metronidazole (400 mg)

Porphyromonas ednodontalis 5-7 days
Name: Safe in pregnancy

Periapical Pathosis
Preferred drug
Alternative drug
Prevotella melaninogenica Cap. Cephalosporins (200-400 mg) Tab. Metronidazole (400 mg)
Streptococcus anginosus 6-12 hourly for 7 days. 6 hourly for 7 days
Porphyromonas gingivalis
Peptospreptococus
Microbes
Pericoronitis
Preferred drug
Alternative drug
Porphyromonas gingivalis Tab. Penicillin V (250-500 mg) Tab. Penicillin V (250-500 mg)
Fusobacterium species post operative 6 hourly for 5-7 days post operative 6 hourly for 5-7 days
Peptostreptococcus micros
Fusobacterium nucleatum Cap. Doxycycline Initial: (200 mg/day) Tab. Metronidazole (200-400 mg)
divided twice daily post operative first day then orally 8 hourly for 3-5 days
Cap. Cephalosporins
Periodontitis
Preferred drug
Alternative drug
Prohyromonas gingivalis Tab. Metronidazole (200-400 mg) Cap. Cephalosporins (200-4000 mg)
Bacteroides forsythus 8 hourly for 3-5 days 6-12 hourly for 7 days ±
Antinobacillus actinomycente
Prevotella intermedia Cap. Amoxicillin (500 mg) Metronidazole
Fusobacterium nucleatum 6 hourly 5-7 days Amoxicillin
Peptostreptococcus micros
Prevotella oralis Cap. Doxycycline (200 mg)
24 hourly
Primary & secondary prophylaxis for variceal haemorrhage

Preferred drug
Alternative drug
Tab. Propranolol (20 mg) Tab. Carvedilol (6.25 mg)
Portal Hypertension due to Cirrhosis of liver or non-cirrhotic portal

hypertension
Start at 12 hourly twice a day and titrate up to maximum dose of

24 hourly start with this dose then increase for maintenance up to12.5 mg
320 mg/day.
Prophylaxis
Preferred drug
Alternative drug
Cap. Clindamycin 3 gm prior to surgery
Cap. Amoxicillin (3 gm)prior to surgery.
Cap. Amoxicillin 3 gm prior to surgery
Pulpits
Preferred drug
Alternative drug
Obligate anaerobes: Cap. Amoxicillin (500 mg)(preferably with clavulanic acid)or Cap. Cefixime
Peptostreptococcus anaerobius Cap. Cephradine Cap. Cefuroxime
Veillonella parvula Tab. Metronidazole
Lactobacilus cateraforme
Porphylaomonas endodontic
Facultative anaerobes:
Streptococcus mitis
Streptococcus oralis
Enterococcus faucal
Neisseria
Viral infection in lip/oral cavity like herpes simplex infection

Preferred drug
Alternative drug
Acyclovir (400 mg) Tab.Valacyclovir (1 gm)
orally 8 hourly for 7-10 days 12 hourly for 7-10 days
Herpes viruses
Acyclovir ointment for topical application Acyclovir ointment for topical application
Dermatology
Acne Vulgaris
Preferred drug
Alternative drug
Tab. Azithromycin (500 mg) Cap. Amoxicillin (250-500 mg)
24 hourly 3 days in a week for 12 weeks 8 hourly
Cap. Doxycycline (100 mg) Tab. Trimethoprim-Sulfamethoxazole in double strength

12 hourly for 12 weeks or 12 hourly
Cap. Clindamycin (150 mg)
Propionibacterium Acan 8 hourly and reduced gradually as control is achieved
Cap. Minocycline (50-100 mg)
12 or 24 hourly for 3 months
Cap. Tetracycline (250-500 mg)
6 hourly for 3 months
Erythromycin (250-500 mg)
6 hourly for 3 months
Cellulitis
Preferred drug
Alternative drug
Staphylococcal Co-amoxiclav (625 mg)
Streptococcal or 8 hourly
Combined
Cap. Flucloxacillin plus Phenoxymethyl penicillin (500 mg)
6 hourly or
Tab. Gatifloxacin (400 mg)

24 hourly for 7 days or
Inj. Ceftriaxone (2 gm) I/V
single or divided dose
Chancroid
Preferred drug
Alternative drug
Tab. Azithromycin (1 gm) Inj. Ceftriaxone (1 gm) stat dose with Tab. Ciprofloxacin
Oral single dose Tab. Levofloxacin (750 mg)
24 hourly 7 days
Inj. Ceftriaxone (250 mg)
Haemophilus ducreyi
I/M single dose
Tab. Ciprofloxacin (500 mg)
12 hourly for 2 days
Erythromycin (500 mg)
8 hourly for 7 days
Cutaneous Anthrax
Preferred drug
Alternative drug
12 hourly for14 days
Bacillus antharacis
Cap. Doxycycline (100 mg)
Cutaneous Tuberculosis
Preferred drug
Alternative drug
Cap. Rifampicin (400-600 mg) Inj. Clarithromycin or
single dose Tab. Ofloxacin or
Tab. Ciprofloxacin or
Tab. Isoniazid (300 mg) Inj. Cycloserine or
single dose Inj. Capreomycin or
Tab. Paraaminosalicyclic acid
Tab. Ethambutol (15-25 mg/kg/day) or Tab. Ethionamide.
Inj. Streptomycin (75 mg-1gm)

Mycobacterium Tuberculosis
single dose
Tab. Pyrazinamide (25-35 mg/kg/day)
for 2 months
Tab. Rifampicin (400-600 mg)
single dose
Tab. Isoniazid (300 mg)
single dose for next 4 months
Gonorrhoeae
Preferred drug
Alternative drug
Single doses of any of the following orally:
Neisseria gonorrhea
Cap. Cefixime (300 mg)
Neisseria gonorrhea
Tab. Ofloxacin (400 mg)
Tab. Levofloxacin (250 mg)
Impetigo contagiosa
Preferred drug
Alternative drug
Staphylococcal Cap. Dicloxacillin (250-500 mg) Tab. Clindamycin (30 mg)
Streptococcal or Tab. Co-amoxiclav (625 mg) 8 hourly
Combined 8 hourly
Cap. Cephalexin (250-500 mg) Cap. Erythromycin (250-500 mg)
6 hourly for 7 days 6 hourly for 7 days
Leprosy
Preferred drug
Alternative drug
For paucibacillary: Inj. Clarithromycin (500 mg)
Tab. Dapsone (100 mg) single dose
single dose plus
Cap. Rifampicin (600 mg) Tab. Minocycline (100 mg)
monthly for 6 months single dose
For multibacillary:
Mycobacterium leprae
Tab. Dapsone (100 mg) Tab. Ofloxacin (400 mg)
single dose plus single dose
Tab. Clofazimine (50 mg)

single dose plus Tab. Levofloxacin (500 mg)
Cap. Rifampicin (600 mg) single dose
monthly for 1 year
Syphilis
Preferred drug
Alternative drug
Cap. Doxycycline (100 mg)
12 hourly for 2 weeks
Cap. Erythromycin (500 mg)
Inj. Ceftriaxone (250 mg)
Inj. Benzathin penicillin 12 lac unit I/M in each buttock day one
Treponema pallidum
day eight and day fifteenth according to stages
24 hourly I/M or I/V for 8-10 days
Inj. Azithromycin (2 gm)
single dose
Cap. Tetracycline (500 mg)
Endocrine System
Sepsis/ Septicemia
Preferred drug
Alternative drug
Escherichia coli Inj. Ceftriaxone (2 gm) Inj. Piperacillin+
Klebsiella 12 hourly at least for 7-10 days Inj. Tazobactam
Streptococcus pyogens Inj. Meropenem
Pseudomonas aeruginosa Inj. Amphotericin-B

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

Preferred drug
Alternative drug
Staphylococcus Tab. Co-Amoxiclav (625 mg) Fluoroquinolones
Streptococcus 8 hourly for 7-10 days Ceftibuten
Anaerobes Inj. Ceftriaxone +
Inj. Clindamycin
Name: Wound care like debridement, regular drening off loading of presure area are much important
Supportive Parotitis (Salivary Gland Infection)

Preferred drug
Alternative drug
Inj. Co-Amoxiclav (1.2 gm) Inj. Clindamycin (900 mg)
8 hourly Oral then: 8 hourly Oral then:
Tab. Co-Amoxiclav (625 mg) Tab. Clindamycin (450 mg)
8 hourly 10-14 days 8 hourly
Gastro Intestinal System

Acute gastroenteritis
Preferred drug
Alternative drug
Escherichia coli Tab. Azithromycin (500 mg) Tab. Ciprofloxacin (500 mg)
Campylobacter 2 tab stat then 1 tab for 4 days 12 hourlyfor 7 days
Shigella
Salmonella Tab. Metronidazole (400 mg)
Clostridium difficile 8 hourlyfor 5-7 days
Name: Pseudomembrenous colities by clostridium difficile is an important cause of gastroenteritis following use of other antibiotics
Abdominal Sepsis
Preferred drug
Alternative drug
Acinatobacter Inj. Piperacillin/Tazobactam(4.5 gm) Inj. Meropenem (1 gm)
Enterococci faecalis 6-8 hourly for 7-14 days Plus 8 hourly for 7-14 days plus
Bacteroides fragilis
Inj. Amikacin (500 mg) Inj. Amikacin (500 mg)
12 hourly for 7 days Plus 12 hourly for 7 days.
8 hourly 7 days
Cholangitis
Preferred drug
Alternative drug
Inj. Meropenem (500 mg)
Gram negative anaerobes
8 hourly
Gastroenteritis, Typhlitis
Preferred drug
Alternative drug
Candida Inj. Cefepime (500 mg)
Enterococcus faecalis 8 hourly
Aspergillus
Anaerobes Piperacillin/Tazobactam
Vancomycin
Itraconazole
Name: Liver function test necessary

Necrotizing Pancreatitis (infected)
Preferred drug
Alternative drug
Inj. Piperacillin/Tazobactam (4.5 gm) Inj. Meropenem (1 gm)
6-8 hourly for 7-14 days 8 hourly for 7-14 days plus
Plus Inj. Amikacin (500 mg) Inj. Amikacin (500 mg)
12 hourly for 7 days Plus 12 hourly for 7 days plus
Tab. Metronidazole (500 mg) Inj. Clindamycin (600 mg)
8 hourly 7 days 8 hourly for 7-14 days
Peptic ulcer disease

Preferred drug
Alternative drug
Tab. Levofloxacin (500 mg) Cap. Tetracycline (500 mg)
12 hourly for 14 to 30 days 6 hourly for 14 to 30 days
Helicobacter pylori
Tab. Metronidazole (400-500 mg)
Name: Duration depending on the nature and severity of the infection

Secondary bacterial peritonitis
Preferred drug
Alternative drug
Escherichia coli Inj. Meropenem (500 mg)
Other gut pathogens 8 hourly
Spontaneous bacterial peritonitis

Preferred drug
Alternative drug
Escherichia coli Tab. Levofloxacin (500 mg) Inj. Co-amoxiclav (1 gm/0.2 gm)
Klebsiella 12 hourly for 14 to 30 days 8 hourly for 5 days
Proteus
Tab. Metronidazole (400-500 mg)

Inj. Cefotaxime(2 gm)
Name: Ascitic fluid should be cultured for both aerobic and araerobic organism.
Ascitic fluid should be inculated of blood culture bottle containing 100 ml media of blood culture bottle containing 100 ml media at bed side.
Hepatobiliary system
Amoebic liver abscess
Preferred drug
Alternative drug
Inj. Metronidazole (750 mg) Nitazoxanide (500 mg)
8 hourly for 5-10 days 12 hourly for 3 days
Entamoeba histolytica
Tinidazole, Orrnidazole (2 gm)
Antiviral used in Hepatitis B infection (Chronic Hepatitis B)

Preferred drug
Alternative drug
Hepatitis B Viris Tab. Tenofovir (300 mg) Tab. Lamivudine (100 mg)
Treatment is indicated: HBV-DNA>2000 IU/ml ALT> Upper limit of

normal Histology= moderate to severe necroinflammation & 24 hourly 24 hourly
significant fibrosis
Tab. Entecavir (0.5 mg) Tab. Adefovir (10 mg)
once daily 24 hourly
Tab.Telbivudine (600 mg)
24 hourly
Inj. PEG-IFN-2a (180 µg)
subcutaneously weekly for 12 months
Antiviral used in Hepatitis C infection (Chronic Hepatitis C)

Preferred drug
Alternative drug
Inj. PEG-IFN+ Tab. Simeprevir+ Cap. Ribavirin Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin
for 12 weeks for 12 weeks and
Tab. Sofosbuvir+ Cap. Ledipasvir Inj. PEG-IFN+ Cap. Ribavirin
for 12 weeks for next 12 weeks

HCV Genotype 1
Tab. Sofosbuvir+ Tab. Simeprevir
for 12 weeks
Tab. Sofosbuvir+ Tab. Daclatasvir
for 12 weeks
Tab. Sofosbuvir+ Cap. Ledipasvir Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin

HCV Genotype 2
Tab. Sofosbuvir+ Cap. Daclatasvir
for 12 weeks
Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin Tab. Sofosbuvir+ Cap. Ribavirin
for 12 weeks for 24 weeks
HCV Genotype 3
for 12 weeks
Inj. PEG-IFN+ Tab. Simeprevir+ Cap. Ribavirin Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin
Tab. Sofosbuvir+ Tab. Ledipasvir Inj. PEG-IFN+ Cap. Ribavirin
for 12 weeks for next 12-36 weeks

HCV Genotype 4
Tab. Sofosbuvir+ Tab. Simeprevir
for 12 weeks
for 12 weeks
Inj. PEG-IFN+ Tab. Sofosbuvir+ Cap. Ribavirin Tab. Sofosbuvir+ Tab. Daclatasvir
for 12 weeks for 12 weeks
HCV Genotype 5&6
Tab. Sofosbuvir+ Tab. Ledipasvir
for 12 weeks
Cholangitis
Preferred drug
Alternative drug
Escherichia coli Inj. Piperacillin-Tazobactam (3.375 gm) Inj. Meropenem (1 gm)
Klebsiella Pneumoniae 6 hourly 8 hourly
Pseudomonas
Proteus
Hepatic actinomycosis
Preferred drug
Alternative drug
Actinomyces israelii Benzy1 Penicillin Doxycycline and Clindamycin

Actinomyces israelii Benzy1 Penicillin Doxycycline and Clindamycin
Name: Percutaneous liver biopsy relveals suphaur granules with typical organism
Hydatid disease of liver

Preferred drug
Alternative drug
Surgery followed by Tab. Albendazole (400 mg) PAIR followedby Tab. Albendazole (400 mg)
12 hourly for 1 month 12 hourly for 1 month
Echinococcus granulosus
Tab. Albendazole (400 mg)
for 1 month then 14 days interval, total 3-6 cycles
Name: PAIR is as effective as surgery. (WHO guideline- 1996)

Leptospirosis
Preferred drug
Alternative drug
Inj. Benzyl Penicillin (900 mg) Inj. Ceftriaxone (1 gm)
Leptospira icterohaemorrhagiae
1.5 million unit 6 hourly for 1 week 24 hourly for 1 week
Name: Blood culture- during limit 10 days or urine culture during 2nd week
Melioidosis
Preferred drug
Alternative drug
Inj. Ceftazidime (2 gm) Inj. Meropenem (0.5-1 gm)
8 hourly for 2-3 weeks followed by 8 hourly for 2-3 weeks followed by
Burkholderia pseudomallei
Cap. Doxycycline (200 mg) Cap. Doxycycline (200 mg)
24 hourly plus 24 hourly plus
Tab. Co-trimoxazole (80/400 mg) Co-trimoxazole
Pyogenic liver abscess

Preferred drug
Alternative drug
Escherichia coli Inj. Ciprofloxacin (500 mg) Piperacillin/ Tazobactam
Klebsiella Pneumoniae 12 hourly Imipenem/ Cilastatin
Viridans streptococci Meropenem
Streptococcus Pneumoniae Inj. Ceftriaxone (1 gm) Co-amoxiclav
plus 12 hourly
Inj. Metronidazole for 2 weeks and then oral for 4 weeks.
Infectious Disease
Bacterial vaginosis
Preferred drug
Alternative drug
Tab. Metronidazole (500 mg) Tab. Metronidazole (500 mg)
8 hourly 8 hourly
Anaerobes
Tab. Clindamycin (80 mg) Tab. Clindamycin (80 mg)
8 hourly 8 hourly
Febrile Neutropenia
Preferred drug
Alternative drug
Staphylococcus Inj. Meropenem (1 gm) Inj. Meropenem (1 gm)
Pseudomonas 8 hourly for 7-10 days 8 hourly for 7-10 days
Streptococcus
Escherichia coli
Klebsiella
Name: Culture sensitivity prefered preceded by emperical treatment

Genital Herpes
Preferred drug
Alternative drug
Tab. Acyclovir (400 mg) Tab. Famcyclovir (250 mg)
Herpes simplex type I or type II

8 hourly for 7-10 days orally 8 hourly for 7-10 days
Herpes simplex type I or type II
Tab. Valacyclovir (1 gm)
Kala-azar
Preferred drug
Alternative drug
Inj. Liposomal Amphotericin B (10 mg/kg) Miltefosine (2.5mg/kg/day)
not less than in 2 hours single dose. in 2 divided doses for 28 days
Paromomycin (15mg/kg/day)
Leishmania
alternate buttock once daily for 21 days
Amphotericin B Deoxycholate (1mg/kg/day)
alternate day total 15 doses
Malaria
Preferred drug
Alternative drug
Chloroquine
Tab. Artemether-Lumefantrine- Quinine (10 mg/kg) 8 hourly for 7 Doxycycline

Plasmodium sepsis
days
Tetracycline
Neutropenic fever, Cellulitis

Preferred drug
Alternative drug
Mostly Unknown Inj. Meropenem (500 mg) Ceftazidime
Gram negative Escherichia coli 8 hourly plusInj Cefepime

Amikacin (500 mg)
I/V 12 hourly for 7 days
Name: ANC <500X10L, Hyperemtivity

Pelvic inflammatory disease
Preferred drug
Alternative drug
Tab. Azithromycin (1gm)
post operative stat followed by
post operative 12 hourly plus
post operative 12 hourly 14 days
Tab. Azithromycin (1 gm)
post operative stat followed by
Inj. Clindamycin (900 mg)
8 hourly plus
Inj. Gentamicin (as per local protocol)
Tab. Clindamycin (450 mg)
post operative 6 hourly Plus

post operative 12 hourly to complete 14 days
Post of Infection
Preferred drug
Alternative drug
Inj. Amikacin (500 mg)
Pseudomonas Netlimicin
12 hourly
Post of Infection
Preferred drug
Alternative drug
Ceftriaxone (1 gm)
Escherichia coli Meropenem
24 hourly
Secondary fungal infection e.g. oral thrush

Preferred drug
Alternative drug
Candida species Fluconazole plus Locally Nystatin/ Miconazole
Secondary infection in malignant lesion

Preferred drug
Alternative drug
Pseudomonas
Staphylococcus
3rd generation Cephalosporins plus Metronidazole 2nd Generation Cephalosporins or Quinolone derivatives
Streptococcus
Sepsis/ Acute PID

Preferred drug
Alternative drug
Inj. Cephazolin (1gm) (if > 80 kg 2gm)
8 hourly+
Inj. Metronidazole (500 mg)
Gm negative 8 hourly
Inj. Clindamycin (600 mg)
8 hourly +
Inj. Gentamicin (2mg /kg)
8 hourly
Sepsis/ Septicemia
Preferred drug
Alternative drug
Escherichia coli, Klebsiella Inj. Ceftriaxone (2 gm) Inj. Piperacillin + Inj. Tazobactam
Streptococcus pyogens 12 hourly at least for 7-10 days Inj. Meropenem
Pseudomonas aeruginosa Inj. Amphotericin-B
Sepsis uncertain focus

Preferred drug
Alternative drug
Inj. Cefepime (1 gm) Inj. Meropenem (1gm)
8- 12 hourly for 7-14 days 8 hourly for 7-14 days plus
Inj. Vancomycin (1 gm) Inj. Metronidazole (500 mg)
12 hourly 8 hourly for 7 days
12 hourly for 7 days Plus
8 hourly for 7 days
Septicemia
Preferred drug
Alternative drug
Inj. Meropenem (1 gm) Inj. Piperacillin/ Tazobactam (4.5 gm)
According to source of infection
6 hourly 8 hourly
Sick Immunocompromised (febrile neutropenia)

Preferred drug
Alternative drug
Inj. Meropenem (1 gm) Inj. Linezolid (600 mg)

8 hourly for 7-14 days or/plus 12 hourly or/plus
Inj. Meropenem (1 gm) Inj. Piperacillin/Tazobactam (4.5 gm)
8 hourly for 7-14 days or/plus 6-8 hourly for 7-14 days
Quinolone
7-14 days
Trichomoniasis
Preferred drug
Alternative drug
Metronidazole (2 gm) as a single oral dose or (400 mg) Tab. Metronidazole (2 gm) as a single oral dose or (400 mg)
12 hourly for 7 days. Or 12 hourly for 7 days. Or
Trichomoniasis vaginalis Tinidazole (2 gm) Tab. Tinidazole (2 gm)
as a single oral dose Or as a single oral dose Or
Secnidazole (2 gm) Tab. Secnidazole (2 gm)
single dose for both partners single dose for both partners
Uncomplicated Chlamydial Infection

Preferred drug
Alternative drug
If poor compliance: Inj. Clarithromycin or
Tab. Azithromycin (1 gm) Tab. Ofloxacin or
post operative stat dose
If Pregnant:
Tab. Erythromycin (500 mg)
post operative 6 hourly for 7 days or
Tab. Erythromycin (500 mg)
post operative 12 hourly for 14 days
Valvovaginal Candidiasis (non regnant)

Preferred drug
Alternative drug
Tab. Clotrimazole (500 mg) aginal tab once Or Two (100 mg)
Tab. Clotrimazole (500 mg) vaginal tablet once Or Two (100 mg) vaginal tablet topically
vaginal tablet topically
Candida Albicans
for 3 nights Or Vaginal 1% cream topically for 6 nights for 3 nights Or Vaginal 1% cream topically for 6 nights
Cap. Fluconazole (150 mg) Cap. Fluconazole (150 mg)
as a single dose oral as a single dose
Name: Contraindicated in pregnancy

Venous aseptic site of infection
Preferred drug
Alternative drug
Staphylococcus epidermises Inj. Ceftriaxone (1-2 gm) <
Staphylococcus aureus 12 hourly Inj. Cephalosporins
Pseudomonas Inj. Amikacin
Inj. Amikacin (500 mg) Tab. Linezolid
12 hourly Cap. Flucloxacillin

Tab. Ciprofloxacin
Name: Sterelity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained
Venous harvesting site wound infection of leg

Preferred drug
Alternative drug
Streptococcus aureus Inj. Ceftriaxone (1-2 gm) Inj. Cephalosporins
Streptococcus pyogens 12 hourly Inj. Amikacin
Pseudomonas Tab. Linezolid
Escherichia coli Inj. Amikacin (500 mg) Cap. Flucloxacillin
12 hourly Tab. Ciprofloxacin
Name: Sterelity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained
VTI, Septicemia
Preferred drug
Alternative drug
Gram positive Inj. Ceftriaxone (1 gm)
Staphylococcus aureus 24 hourly
Pseudomonas
Inj. Imipenem (500 mg-1gm)
8 hourly
Name: Steroid coverage with antimicrobial therapy may be required

Wound infection
Preferred drug
Alternative drug
Escherichia coli Cream Gentamicin apply locally 2-3 times daily Or
Staphylococcus aureus Cream/ointment Fusidic acid apply locally 2-3 times daily Or
Pseudomonas Cream/ointment Mupirocin apply locally 2-3 times daily Or
Combination of Bacitracin and neomycin apply the cream locally 2-

3 times daily Fusidic acid is a steroid antimicrobial agent which is
Klebsiella
used almost exclusively against β lactamase producing
staphylococci
Kidney and Urinary System

Acute Pyelonephritis
Preferred drug
Alternative drug
Escherichia coli Tab. Ciprofloxacin (500 mg) Inj. Ceftriaxone (1 gm)
Streptococcus saprophyticus 12 hourly for 7 days stat dose with oral Ciprofloxacin
Klebsiella
Tab. Trimethoprim- Sulfamethoxazole 1 double strength tablet

Pseudomonas aeruginosa Inj. Levofloxacin (750 mg)
(160/800 mg)
Enterococci 12 hourly for 3 days 24 hourly for 7 days
Name: Complicated pyelorephritis are common in diabetic patient require prolong therapy
ESWL
Preferred drug
Alternative drug
Fluoroquinolones Inj. Aminoglycosides
TMP/SMX Tab. Amoxicillin
1st/2nd generation Cephalosporins
Lower urinary tract infection (cystitis) in pregnancy UTI

Preferred drug
Alternative drug
Escherichia coli Cap. Nitrofurantoin (100 mg) Cap. Cephalexin (500 mg)
Klebsiella 6 hourly for 7 days 8 hourly for 7 days
Pseudomonas
Enterococcus Tab. Pivmecillinam (400 mg) stat & (200 mg)
8 hourly for 7 days
Non Gonococcal Urethritis

Preferred drug
Alternative drug
Chlamydia trachomatis Cap. Doxycycline (100 mg) Cap. Erythromycin (500 mg)
Ureplasma urealyticum 12 hourly for 7 days 6 hourly for 7 days or 12 hourly for 2 weeks or
Mycoplasma
Genetalium Tab. Azithromycin (1 gm) Tab. Ofloxacin (200 mg)
single dose 12 hourly for 7 days
PCNL
Preferred drug
Alternative drug
1st/2nd generation Cephalosporins or Aminoglycosides
Inj. Aminoglycosides Fluoroquinolones
Tab. Metronidazole or Clindamycin
Prostatitis
Preferred drug
Alternative drug
Escherichia coli
Enterobacteriaceae
TMP/SMX for 4 weeks Fluoroquinolones

Pseudomonas
TMP/SMX for 4 weeks Fluoroquinolones
Enterococci
Enterococcus
Prostatic biopsy
Preferred drug
Alternative drug
Fluoroquinolones TMP/SMX
1st/2nd generation Cephalosporins Aminoglycosides
Surgical prophylaxix: Urethrocystoscopy, Urodynamic study, Ureteroscopy, TURP, TURBT

Preferred drug
Alternative drug
Fluoroquinolones Inj. Aminoglycosides
TMP/SMX Inj. Ampicillin
1st/2nd generation Cephalosporins
Co-Amoxiclav
Urinary Tract Infection

Preferred drug
Alternative drug
Escherichia coli Tab. Ciprofloxacin (500 mg) Co-amoxiclav
Klebsiella 12 hourly for 7-10 days Cefuroxime+Clindamycin
Pseudomonas
Candida albicans
Urinary Tract Infection (acute uncomplicated cystitis)

Preferred drug
Alternative drug
Escherichia coli Tab. Nitrofurantoin (100 mg) Fluoroquinolones
Streptococcus saprophyticus 12 hourly for 5 days Tab. Ofloxacin (400 mg)
Klebsiella 12 hourly for 3 days

Tab. Trimethoprim- Sulfamethoxazole 1 double strength tablet
Pseudomonas aeruginosa Tab. Ciprofloxacin (250 mg)
(160/800 mg)
12 hourly for 3 days 12 hourly for 3 days
Tab. Levofloxacin (500 mg)
Fosfomycin trometamol (3 gm) 24 hourly for 3 days
A sachet orally a single dose β-Lactams
Co-amoxiclav
Pivmecillinam (400 mg) Cefdinir
12 hourly for 3-7 days Cefaclor
Cefpodoxime-Proxetil (100mg)
12 hourly 3 days
Urosepsis
Preferred drug
Alternative drug
Escherichia coli Inj. Amikacin (500 mg) Inj. Cefepime (1 gm)
Proteus 12 hourly for 7 days 8-12 hourly for 7-14 days
Klebsiella
Enterococci Inj. Meropenem (1 gm) Inj. Meropenem (1 gm)
Candia 8 hourly for 7-14 days plus 8 hourly for 7-14 days or plus
Cap. Fluconazole (500-100 mg/day) if fungal infection Cap. Fluconazole (500-100 mg/day)
Urological Surgery involving intestine e.g.: GI tract, Skin+ intestine
Preferred drug
Alternative drug
2nd/3rd generation Cephalosporins Inj. Ampicillin
Inj. Aminoglycosides Inj. Ticarcillin/ Co-Amoxiclav
Tab. Metronidazole or Inj. Piperacillin/ Tazobactam
Clindamycin Fluoroquinolones
Musculoskeletal system
Acute and chronic pyogenic Osteomyelitis
Preferred drug
Alternative drug
Staphylococcus aureus Inj. Ceftriaxone (1 gm) Inj. Cefuroxime (750 mg)
Staphylococcus pyogens 12 hourly 12 hourly
Inj. Flucloxacillin (250 mg-1 gm)
6 hourly
Deep sternal wound infection

Preferred drug
Alternative drug
Streptococcus pyogens Inj.Meropenem (500 mg-1 gm) Inj. Ceftriaxone
Streptococcus aureus 18 hourly Inj. Amikacin
Pseudomonas Inj. Flucloxacillin
Escherichia coli Inj. Amikacin (500 mg) Inj. Linezolid
Fungal 12 hourly Inj. Ciprofloxacin
Name: Sterctity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained superficial and deep
Elective Surgery
Preferred drug
Alternative drug
Inj. Ceftriaxone (1 gm)
12 hourly
Inj. Cefuroxime (750 mg)
12 hourly
Inj. Cefepime(500 mg-1000 mg)
8 hourly
Prophylactic purpose
Inj. Flucloxacillin (250 mg -1000 mg)
6 hourly
12 hourly any one or two in combination
Septic arthritis
Preferred drug
Alternative drug
Staphylococcus aureus Inj. Ceftriaxone (1 gm)
Haemophilus influenza 12 hourly
Enterobacter Species
Inj. Flucloxacillin (250 mg-1 gm)
12 hourly
Name: Preferred culture sensitivity report

Skin & Soft tissue infection
Preferred drug
Alternative drug
Streptococcus pyogens
Cap. Flucloxacillin (500mg) 6 hourly Tab. Clarithromycin (500mg) 12 hourly and Cap. Clindamycin (450-60mg) 6 hourly
Superficial sternal wound infection

Preferred drug
Alternative drug
Staphylococcus aureus Inj. Ceftriaxone (1-2 gm) Inj. Cephalosporins

Streptococcus pyogens 12 hourly Inj. Amikacin
Escherichia coli Inj. Flucloxacillin
Pseudomonas Inj. Amikacin (500 mg) Inj. Linezolid
12 hourly Inj. Ciprofloxacin
Name: Sterctity should be strictly maintained. Personal hygine of the patient as well as hospital stuff should be maintained superficial and deep
Tubercular Osteomyelitis
Preferred drug
Alternative drug
Mycobacterium aureus 1st line anti-tubercular drugs
Wound infections
Preferred drug
Alternative drug
Streptococcus aureus Inj. Ceftriaxone (1 gm)
Pseudomonas pyogenosa 12 hourly
Klebsiella
Enterobacteriaceae Inj.Meropenem (500 mg)
8 hourly
2 hourly
Inj. Flucloxacillin
Name: According to culture sensitivity report

Obstetrics and Gynaecological Procedure
D&C, endoscopic or other minor procedure
Preferred drug
Alternative drug
Anaerobes Not needed

Caesarean section
Preferred drug
Alternative drug
Inj. Amoxiclav (1.2 gm) Inj. Clindamycin (900 mg)
Prophylaxis
8 hourly 8 hourly
Name: Review culture reports

Infected wound Caesar/ Perineal tear and episiotomy
Preferred drug
Alternative drug
Gram negative Inj. Flucloxacillin (900 mg)

Staphylococcus 8 hourly+
Escherichia coli
Pseudomonas Inj. Metronidazole (500 gm)
8 hourly followed by oral for 7 days
Intra partum pyrexia

Preferred drug
Alternative drug
Inj. Amoxicillin (2 gm) + Inj. Metronidazole (500 mg) initially

followed by
Inj. Amoxicillin (500 mg)
8 hourly +
Prophylaxis Inj. Clindamycin in penicillin allergy group

8 hourly till delivery
Inj. Gentamicin if severe sepsis 5 days for oral antibiotics after

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

Preferred drug
Alternative drug
IV-single dose only at induction
Post operative Gynaecological Sepsis

Preferred drug
Alternative drug
Inj. Gentamicin (as per local protocol) plus Inj. Clindamycin (1.2
gm)
6 hourly
Stop and review if patient develops diarrhoea or if Gentamicin is
contra-indicated ( see GHNHSFT protocol ) consult microbiologist
Duration: 5-7 days and then review
Non-severe penicillin Allergy:
Inj. Meropenem (1 gm)
8 hourly
Severe penicillin Allergy:
Inj. Gentamicin (as per local protocol) plus
Inj. Clindamycin (1.2 gm)
6 hourly
Stop and review if patient develops diarrhoea or if Gentamicin is

contra-indicated ( GHNHSFT protocol ) consult microbiologist.
Duration: 5-7 days and then review. Consult Microbiologist
Prophylaxis Hysterectomy Laparotomy Vaginal Repair

Preferred drug
Alternative drug
Inj. Ceftriaxone (2 gm) Inj. Cephazolin (1gm) (if >80 kg 2 gm)+
12 hourly at least for 7-10 days Inj. Metronidazole (500 mg)
8 hourly
Inj. Clindamycin (600 mg) + Inj. Gentamicin (2 mg /kg)

8 hourly
Name: If no penicillin or B-lactuse allergy

Surgical Prophylaxis Obstetric & Gynaecological Surgery Hysterectomy
Preferred drug
Alternative drug
IV-single dose only at induction
Opthalmology
Antibiotics used in surgical prophylaxis: Cataract surgery, Glaucoma surgery, Dacryocystitis (Chronic)
Preferred drug
Alternative drug
Moxifloxacin 0.3%
Levofloxacin 0.3%
Gatifloxacin 0.3% 1 drop g.i.d.
Bacterial Uveitis

Preferred drug
Alternative drug
Mycobacterium tuberculosis According to cause
Mycobacterium Bovis Anti-TB
Treponema. pallidum Anti-Syphilis (systemic regimen to be followed)
Name: Aquaus and vitreous sample for culture sensitivity

Conjunctivitis
Preferred drug
Alternative drug
Streptococcus Pneumonia Chloramphenicol Tetracycline
Staphylococcus aureus Aminoglycosides (Gentamicin, Neomycin) Fusidic acid
Haemophilus influenzae Quinolones (Ciprofloxacin Ofloxacin) Doxycycline
Moraxella catarrhalis Levofloxacin Erythromycin
Neisseria gonorrhea Lomefloxacin Bacitracin
Neisseria meningitides Gatifloxacin

Chlamydia trachomatis Moxifloxacin
Polymyxin B
Fusidic acid dose (g.i.d. for 1 week)
Name: Conjunctival culture sensitivity needed

Corneal Ulcer
Preferred drug
Alternative drug
Pseudomonas Ciprofloxacin 0.3% Moxifloxacin
Staphylococcus aureus Ofloxacin 03.% Gatifloxacin
Streptococcus Fortified Gentamicin Doxycycline
Neisseria Gonorrhoeae Fortified Cephalosporins Tetracycline
Procaine Penicillin (g.i.d. for 1 week or according to severity of the

Meningitis Erythromycin
disease)
Coronibacterium diphtheria Sub conjunctival antibiotics
Haemophilus influenzae
Treponema pallidum
Name: Depends on culture sensitivity. Conjunctival sweab and corneal serapping

Dacryocystitis
Preferred drug
Alternative drug
Staphylococcus aureus Flucloxacillin (oral) Co-amoxiclav
Epidermidis for 1 week Cephalosporins
Streptococcus viridians Cefixime
Pneumoniae pyogens Cephradine

Escherichia coli
Name: Depending on culture sensitivity

Endophthalmitis
Preferred drug
Alternative drug
Staphylococcus species. Ceftazidime (2 mg in 0.1 ml) Amikacin (0.4 mg in 0.1 ml)
Bacillus species Vancomycin (2 mg in 0.1 ml) Gentamicin (0.2 mg in 0.1 ml)
12 hourly or
Moxifloxacin (400 mg)
24 hourly
Name: Aquaus vitreous sample for culture sensitivity

Lid infection
Preferred drug
Alternative drug
Staphylococcus aureus Ciprofloxacin 0.3% 1 drop g.i.d Moxifloxacin
Pyogenes for 7 days (dose can be readjusted according to severity) Flucloxacillin
Epidermidis
Streptococcus viridans
Pneumonia
Pyogenes
Name: To maintain lid hygine

Neonatal conjunctivitis (Opthalmia Neonatorum)
Preferred drug
Alternative drug
Chlamydia trachomatis Penicillin G Topical 1,00,000-3,33,000 units/ml
Silver nitrate 1% solution
Neisseria Gonorrhoeae Paediatric 10,000 to 20,000 IU
Orbital Cellulitis
Preferred drug
Alternative drug
Streptococcus Pneumoniae Ceftazidime I/V (2mg in 0.1ml)
Oral Metronidazole (antibiotic continued) till the patient free

from fever
Vancomycin (if penicillin allergy) 1 mg in 0.1 ml
Streptococcus viridans for 4 days.
Haemophilus influenzas
Name: Pus for culture sensitivity if orbital obsess prerent

Syphilitic eye disease, Syphilitic Uveitis, Optic neuritis, Neuroretinitis
Preferred drug
Alternative drug
3 to 4 million unit Penicillin G is administered every Alternative procaine Penicillin G IM 2.4 million IU daily plus Probenecid (500 mg)
Treponema pallidum
4 hourly for 10 to 14 days. oral g.i.d for 10 to 14 days.
Paediatric Central Nervous System

Central venous catheter tip Micro organism isolated: 75%
Preferred drug
Alternative drug
Pseudomonas 66.66% Imipenem (20 mg/kg/dose)
Staphylococcus aureus 33.33% 8 hourly
Tazobactam + Piperacillin
8 hourly
Meningitis in Children (Bacteria), Young infant

Preferred drug
Alternative drug
Neisseria meningitides Inj. Ceftriaxone (100 mg/kg/day) Meropenem (40 mg/kg/day)
Streptococcus pneumonia 12 hourly + 8 hourly+
Haemophilus influenjae
Inj. Dexamethasone (0.15 mg/kg/day) Amino glycosides (if pseudomonas)
every 6 hourly for 48 hours started at least 20 minutes before

antibiotic therapy
Inj. Cefotaxime (200 mg/kg/day)
Inj. Vancomycin (45-60 mg/kg/day)
Ampicillin (200-400 mg/kg/day)
Septicemia CNS infection

Preferred drug
Alternative drug
Inj. Vancomycin (45-60 mg/kg/day) Inj. Vancomycin (45-60 mg/kg/day)
12 hourly for 10-14 days+ 12 hourly for 10- 14 days+
Organism of unknown susceptibility

Inj. Meropenem (30-40 mg/kg/day) Inj. Meropenem (30-40 mg/kg/day)
8 hourly for 10-14 days 8 hourly
Paediatric Gastrointestinal System

Bacillary dysentery

Preferred drug
Alternative drug
Cap. Cefixime (8-10 mg/kg/day) Cefixime12 hourly
12 hourly for 5 days Ceftriaxone (50-75 mg/kg/day)
Shigella species, Shigella dysentery, Shigella flexnari

12 hourly
Pivmecillinam (50 mg/kg/day)
6 hourly for 5 days
Cholangitis
Preferred drug
Alternative drug
Escherichia coli Ceftazidime (150 mg/kg/day)
Meropenem (30-40 mg/kg/day)
Staphylococcus aureus Amikacin (15-20 mg/kg/day)
Diarrhoea
Preferred drug
Alternative drug
Escherichia coli Azithromycin (10 mg/kg/day)
Ceftriaxone (50-200 mg/kg/day)

Shigella Ciprofloxacin (15-30 mg/kg/day)
Vibrio cholerae Pivrnecillinam
Enteric Fever & Severe Enteric Fever

Preferred drug
Alternative drug
Salmonella typhi Cap. Cefixime (20 mg / kg/day) Azithromycin (20 mg/kg/day)

Salmonella paraphyphi A 12 hourly for 10 to 14 days 24 hourly 7 days
Salmonella paratyphi B
Inj. Ceftriaxone (50-75 mg/kg/day) Ciprofloxacin (20-30 mg/kg/day)
12 hourly at least 5 days after a febrile period 12 hourly 7-10 days
Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Dexamethasone (3mg/kg)initial flowed by (1 mg/kg)
6 hourly for 48 hours
Giardiasis
Preferred drug
Alternative drug
Metronidazole (15 mg/kg/day)
Giardia Secnidazole
8 hourly for 5–7 days
Hydatid cyst
Preferred drug
Alternative drug
Echinococcus Albendazole (15 mg/kg/day)
Granulosus 12 hourly
Intestinal Amoebiasis
Preferred drug
Alternative drug
Entamoeba Metronidazole (15 mg/kg/day)
Secnidazole
Secnidazole
Histolytica 8 hourly for 5–7 days
Liver Abscess
Preferred drug
Alternative drug
Streptococcus aureus Ceftriaxone (50-200 mg/kg/day)
Gram negative Flucloxacillin (50-100 mg/kg/day)
Anaerobic organism Metronidazole
Peritonitis (Ascitic Fluid C/S) Micro organism isolated:4%

Preferred drug
Alternative drug
Streptococcus Pneumoniae Ceftazidime (50 mg/kg/dose)
Acinetobactor 8 hourly
Escherichia coli
Ceftriaxone (100 mg/kg/day)
12-24 hourly
Amikacin (7.5 mg/kg/dose)
12 hourly
SBP
Preferred drug
Alternative drug
Escherichia coli Cefotaxime (50-200 mg/kg/day)
Staphylococcus aureus Flucloxacillin (50-100 mg/kg/day)
Paediatric Infectious Disease

Abscess 2%
Preferred drug
Alternative drug
Flucloxacillin (25-250 mg) Inj. Vancomycin (45-60 mg/kg/day)
Enterobacter Spesis
6 hourly 12 hourly for 10-14 days+
Enterobacter Spesis
Vancomycin (45-60 mg/kg/day) Inj. Meropenem (30-40 mg/kg/day)
Tazobactam 8 hourly
Oral thrush
Preferred drug
Alternative drug
Nystatin (4-6 lakhs) Inj. Vancomycin (45-60)
unit for 6 hourly 8 hourly for 2-4 weeks
Candida albicans
Miconazole 2% apply
12 hourly
Septicemia (Blood C/S) 10%

Preferred drug
Alternative drug
Klebsiella Inj. Amikacin (15-20 mg/kg/day) Gentamicin
Acinatobacter Inj. Meropenem (30-40 mg/kg/day) Amikacin
Coagulase negative staph Inj. Ceftazidime (150 mg/kg/day) Imipenem
Escherichia coli Colistin
Ciprofloxacin
Cotrimoxazole
Vancomycin
Netlimicin
Name: Febrile Neutropenia in Paediatric Haematology and Oncology is considered as an entity which is to be addressed ifferently. Here the practised protocol is-
1st line- 3rd generation of Cephalosporin + Amikacin

2nd line- 4th generation of Cephalosporin or Carbapenem + Vancomycin
If febrile neutropenia persists 5-7 days or more we start intravenous Amphotericin B

Septicemia (Blood C/S) Micro organism isolated:6%
Preferred drug
Alternative drug
Escherichia coli Cefotaxime (50 mg/kg/dose)
Salmonella 8-12 hourly
Enterococcus
Pseudomonas Ampicillin (25 mg/kg/dose)
Klebsiella 6 hourly
Vancomycin (15mg/kg/dose)
8 hourly
Ceftazidime (50 mg/kg/dose)
8 hourly
Amikacin (7.5 mg/kg/dose)
12 hourly
Septic Arthritis
Preferred drug
Alternative drug
Haemophilus influenza Inj. Ceftriaxone (50-75 mg/kg/day) Inj. Clindarnycin (10-40 g/kg/day)
Streptococcus aureus 12 hourly for 4 weeks 8 hourly
Streptococcus pneumoniae
Cefotaxime (20 mg/kg/day) Vancomycin (45-60 mg/kg/day)
8 hourly for 4 weeks+ 8 hourly
Clindamycin (10-40 mg/kg/day) Meropenem (40 mg/kg/day)
8 hourly for 4 weeks 8 hourly
Skin infection Cellulitis Osteomyelitis

Preferred drug
Alternative drug
Cloxacillin (50-100 mg/kg) Inj. Vancomycin (45-60)
6 hourly for 7-10 days 8 hourly for 2-4 weeks
Inj. Clindamycin (10-40 mg/kg/day)
8 hourly for 2-4 weeks
Throat Swab Micro organism isolated: 12%

Preferred drug
Alternative drug
Streptococcus pyogens 82% Penicillin (25-50 mg/kg/dose)
Staphylococcus aureus 18% 6 hourly
Erythromycin (10 mg/kg/dose)
6 hourly
Amoxicillin (25 mg/kg/dose)
8 hourly
Clindamycin (3-6 mg/kg/dose)
6 hourly
Wound Swab 2%
Preferred drug
Alternative drug
Flucloxacillin (125-250 mg) Imipenem
6 hourly Amikacin
Colistin
Amikacin (15-20 mg/kg/day) Ticarcillin
Pseudomonas

Pseudomonas
Vancomycin (45-60 mg/kg/day)
Paediatric Surgery
Amniotic band of both leg: release of bank and Z-plasty in right leg
Preferred drug
Alternative drug
Staphylococci Inj. Ceftriaxone (50-75 mg/kg/day)
Micrococci Inj. Flucloxacillin(50-100 mg/kg/day) followed by Flucloxacillin
Gram positive rods
AVM at the root of nose: Excised

Preferred drug
Alternative drug
Inj. Ceftriaxone (50-75 mg/kg)
AVM of left thigh (Aspirated) (Aspirated fluid: no growth)

Preferred drug
Alternative drug
Staphylococci
Micrococci Inj. Cephradine (50-100 mg/kg/day)
Gram positive rods
Cystic Hygroma (within the abdomen) with sliding hernia: Excision of Cystic hygroma with herniotomy
Preferred drug
Alternative drug
Escherichia coli Inj. Ceftriaxone (50-75 mg/kg/day)
Inj. Flucloxacillin (50-100 mg/kg/day) followed by Cefixime (20

Klebsiella
mg/kg/day)
Pseudomonas aeruginosa
Enterococci
Discharging sinus at penoscrotal region: Excision (Pus for C/S: Pseudomonas spp.)
Preferred drug
Alternative drug
Klebsiella Tab/Inj. Ciprofloxacin (10 mg/kg/day)
Pseudomonas aeruginosa Inj. Amikacin (15-20 mg/kg/day) followed by
Proteus Inj. Imipenem (60-100 mg/kg/day)
Name: During change to other group of antibiotic require further urine culture sensitivity
Eventration of left dome of diaphragm with umbilical hernia: Plication of the defect and repair of hernia
Preferred drug
Alternative drug
Klebsiella Pneumoniae Inj. Gentamicin (5 mg/kg/day)
Streptococci Pseudomonas
Enterococci
Growth in lower Esophagus: feeding gastrostomy with biopsy from growth

Preferred drug
Alternative drug
Escherichia coli Cephradine (50-100 mg/kg/day)
Klebsiella pneumonia Inj. Gentamicin (5 mg/kg/day)
Streptococcus pneumonia
Enterococci
Hydrocephalus and Meningomyelocele with urinary and fecal incontinence; Introduction of V-P shunt with excision of meningomyelocele
Preferred drug
Alternative drug
Inj. Ceftazidime (15-20 mg/kg/day)
Encapsulated organism: Streptococcus Pneumoniae, Nigeria

meningitides, Haemophilus influenza. Non capsulated organism:
Listeria monocytogenes
Encapsulated organism: Streptococcus Pneumoniae, Nigeria
meningitides, Haemophilus influenza. Non capsulated organism:
Listeria monocytogenes
Inj. Amikacin (15-20 mg/kg/day)
Hypospaedias with rotational deformity of penis: Urethroplasty and correction of rotation

Preferred drug
Alternative drug
Escherichia coli Inj. Ceftriaxone (50-75 mg/kg/day) followed by
Klebsiella Inj. Meropenem (30-40 mg /kg/day)
Pseudomonas aeruginosa Inj. Flucloxacillin (50-100 mg/kg/day)
Proteus Inj. Amikacin
Name: Multidrug use of antibiotic also require specific indication

Hypospaedias: Urethroplasty
Preferred drug
Alternative drug
Inj. Ceftriaxone (50-75 mg/kg/day) Streptococcus pyogens 82%
Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus
Inj. Flucloxacillin (50-100 mg/kg/day) followed by Cefixime ( 20 mg

Staphylococcus aureus 18%
/ kg/day)
Long segment Hirschsprung’s Disease with Ileostomy: Total colectomy with ileo-anal anaestomosis. On 7th POD patient developed incomplete wound dehiscence which closed by secondary suture
Preferred drug
Alternative drug
Bactericides Fragilis Inj. Metronidazole (15- 30 mg/kg/day)On 3rd POD added

Inj. Ciprofloxacin (10 mg/kg/day) due to development of loose
Streptococcus viridians group
diarrhoea. On 26th POD: Changed to
Inj. Meropenem (30-40 mg/kg/day)
Name: Frequent changes of antibiotic so require wound sweab. Specific indication should mentioned
Mass in right gluteal region: Incisional biopsy

Preferred drug
Alternative drug
Streptococcus pyogens 82%
Staphylococci, Micrococci, Gram positive rods Inj. Ceftriaxone (50-75 mg/kg/day) followed by oral Cefixime
Staphylococcus aureus 18%
Meconium ileus with Ileostomy: Ileostomy closure (Stool culture: no organism)

Preferred drug
Alternative drug
Escherichia coli, Bactericides Fragilis Inj. Ceftriaxone (50-75 mg/kg/day)
Streptococcus viridians group Inj. Metronidazole
Inj. Amikacin
Non-operative case of Choledochal cyst

Inj. Ceftriaxone (50-75 mg/kg)
Penoscrotal hypospaedias: Urethroplasty (Urine c/s: no growth)

Preferred drug
Alternative drug

Klebsiella pneumonia Inj. Flucloxacillin (125-250 mg/kg/day) followed by oral Cefixime
Proteus
Perineal hypospaedias with bilateral undescended testes: Urethroplasty with bilateral orchiopexy (Urine c/s: no growth)
Preferred drug
Alternative drug
Inj. Ceftriaxone (50-75 mg/kg/day) for 7 days, Then Inj.

Meropenem(30-40 mg/kg/day), Inj. Flucloxacillin (50-100
mg/kg/day) and Inj. Amikacin (15-20 mg/kg/day) for 8 days
followed by Syrup Cefixime ( 20 mg / kg/day)
Escherichia coli, Klebsiella, Pseudomonas aeruginosa, Proteus
for 16 days.
Rectourethral fistula: Perineal hole technique anoplasty (Urine C/S: No. growth)
Preferred drug
Alternative drug
Bactericides Fragilis Inj. Metronidazole (15-30 mg/kg/day)
Streptococcus viridians group Inj. Ceftazidime (150 mg/kg/day)
Inj. Gentamicin (5 mg/kg/day)
Residual PUV with Left sided VUR: Fulgaration with left sided ureteric re-reimplantation Ruine R/M/E: Normal finding (Urine C/S: no organism)
Preferred drug
Alternative drug
Escherichia coli Inj. Ceftriaxone (50-75 mg/kg/day) followed by
Klebsiella Inj. Meropenem (30-40 mg/kg/day)

Pseudomonas aeruginosa Inj. Amikacin
Proteus
Thalasseaemia with Hypersplensim: Splenectomy
Preferred drug
Alternative drug
Klebsiella Pneumoniae Inj. Phylopen
Streptococci Pseudomonas Inj. Amikacin (15-20 mg/kg/day)
Enterococci
Paediatric Urinary System

Urinary tract infection Acute cystitis Acute pyelo nephrities
Preferred drug
Alternative drug
Escherichia coli Cap. Cefixime (8-10 mg/kg/day) Inj. Amikacin (15-20 mg/kg/day)
Klebsiella 12 hourly for 7-10 days Inj. Gentamicin (5 mg/kg/day)
Proteus Cap. Nitrofurantoin (5-7 mg/kg/day)
Tab. Ciprofloxacin (8-30 mg/kg/day) Tab. Co-trimoxazole
Inj. Gentamicin (5 mg/kg/day)
Ceftazidime (150 mg/kg/day)
Urinary tract infection (UTI) Micro organism isolated: 6%

Preferred drug
Alternative drug
Escherichia coli Cefotaxime (50 mg/kg/dose)
Enterococci 8-12 hourly
Acinatobacter
Pseudomonas Ceftazidime (50 mg/kg dose)
8 hourly
Ceftriaxone (100 mg/kg days)
12-24 hourly
Nitrofurantoin (1.75 mg/kg dose) 6 hourly
Amikacin (15 mg/kg dose)
12 hourly
Gentamicin (2.5 mg/kg/day)
8 hourly
Recurrent UTI prophylaxis

Preferred drug
Alternative drug
Cap. Nitrofurantoin (1-2 mg/kg/day)
Single dose at bed time
Tab. Co-trimoxazole (6-20 mg/kg/day)
single dose at bed time
Paediatrics Respiratory System

Otitis Media 2%
Preferred drug
Alternative drug
Ceftriaxone (50-75 mg/kg/day) Ceftazidime
Cefuroxime Ciprofloxacin
Pseudomonas
Ceftazidime (150 mg/kg/day) Imipenem
Meropenem
Netlimicin
Pneumonia
Preferred drug
Alternative drug
Haemophilus influenjae Inj. Ceftriaxone (50-75 mg/kg/day) Inj. Ceftriaxone (50-75mg/kg/day)
Staphylococcus aureus 7-10 days according to clinical response 12 hourly
Nosocomial:
Escherichia coli Cap. Flucloxacillin (125-250 mg) Inj. Gentamicin (5 mg/kg/day)
Streptococcus Pneumoniae 6 hourly.(in staphylococcus aureus) 3 hourly
Haemophilus influenjae
Pseudomonas Inj. Azithromycin (10 mg/kg/day) Inj. Clarithromycin (15 mg/kg/day)
Klebsiella Inj. Erythromycin (30-50 g/kg/day) 8 hourly
Community acquired: Inj. Clindamycin (10-40 g/kg/day)
≥5 years: Mycoplasma Chlarnydia 8 hourly for 14 days

Inj. Vancomycin (45-60 g/kg/day)
8 hourly
Inj. Imipenem (15-25 mg/kg/day)
8 hourly
Inj. Clarithromycin (15 mg/kg/day)
RTI 4%
Preferred drug
Alternative drug
Klebsiella Penicillin (125-250 mg) Imipenem
Acinatobacter orally every 6-8 hourly Ciprofloxacin
Colistin
Erythromycin (30-50 mg/kg/day) Tazobactam
Clarithromycin (15 mg/kg/day) Piperacillin
Respiratory System
Acute Bacterial Rhino sinusitis (severe or persistent symptoms)
Preferred drug
Alternative drug
Gram positive: 1st line: 1st line:
Staphylococcus aureus Tab. Co-Amoxiclav (625 mg) Inj. Clarithromycin (500 mg)
Streptococcus Pneumoniae 8 hourly orally 12 hourly
Haemophilus influenzae 2nd line: 2nd line:
Pseudomonas aeruginosa Doxycycline oral(100 mg) Cap. Doxycycline (100 mg)

Moraxella catarrhalis 12 hourly 10 days 12 hourly
Gram negative:
Escherichia coli
Protease mirabilis
Klebsiella Pneumoniae
Enterobacter
Acute Diffused Otitis Externa (Swimmer's ear)

Preferred drug
Alternative drug
Staphylococus aureus Mile-moderate:
Pseudomonas pyogens Cap.Flucloxacillin Topical Antimicrobial
Escherichia coli Severe (e.g. Cellulitis or blocked ear canal):
Often mixed flora Inj. Ceftriaxone (1 mg)
Tab. Ciprofloxacin (500mg)
12 hourly for 7-10 day
Name: Topical drops to be prescribed at the discretion of the ENT consultant

Acute Laryngitis
Preferred drug
Alternative drug
Antibiotics are NOT Indicated
Acute Localised Otitis Externa (furuncle)

Preferred drug
Alternative drug
Cap. Flucloxacillin (1 gm) Clarithromycin (500 mg)
Staphylococcal 6 hourly for 7 days plus 12 hourly

Staphylococcal
Topical steroids
Acute Otitis Media

Preferred drug
Alternative drug
Antibiotics should not be routinely prescribed for uncomplicated Antibiotics should not be routinely prescribed for uncomplicated AOM. For severe
Streptococcus Pneumoniae
AOM. For severe disease or when risk of complications: disease or when risk of complications:
Haemophilus influenzae 1st Line 1st Line
Micrococcus Catarrhalis (Necrotizing)
B Haemolytic streptococcus Cap. Amoxicillin (500 mg) Clarithromycin (500 mg)
8 hourly 12 hourly
2nd line 2nd line
Tab. Co-Amoxiclav (625 mg) Cap. Doxycycline (100 mg)
8 hourly 10 days 12 hourly and
8 hourly
Name: Most cases are viral and self limiting. Antibiotics should be delayed for 2-3 days and patient response
Acute Rhino Sinusitis

Preferred drug
Alternative drug
Antibiotics should be Only prescribed in SEVERE infection. Mostly

this condition caused by viral
Aspiration pneumonia
Preferred drug
Alternative drug
Pseudomonas Inj. Piperacillin/Tazobactam(4.5 gm) Inj. Meropenem (1gm)

Acinatobacter 6-8 hourly for 7-14 days plus 8 hourly for 7-14 days
Enterococci faecalis
Bacteroides fragilis Inj. Amikacin (500 mg) Inj. Amikacin (500 mg)
12 hourly for 7 days Plus 12 hourly for 7 days plus
Tab. Metronidazole (500 mg) Tab. Clindamycin (600 mg)
8 hourly for 7 days 8 hourly for 7-14 days
Chronic Otitis Media

Preferred drug
Alternative drug
Aerobic:
Escherichia coli
Streptococcus aureus
Streptococcus Pyogenes
Oral antimicrobial may be added if a susceptible organism is

cultured 7-10 days
Proteus mirabilis
Klebsiella species
Anaerobic:
Bacteroides
Peptostreptococcus
Propionibacterium
Community Acquired Pneumonia (CAP)

Preferred drug
Alternative drug
Streptococcus Pneumoniae Inj. Azithromycin (500 mg) I/V OD Inj. Ceftazidine (1 gm)
Staphylococcus aureus 5 days, or 8 hourly for 7-14 days, plus/ or
Candia
Inj. Clarithromycin (500 mg) Inj. Clindamycin (600 mg)I/V
12 hourly for 7-14 days 8 hourly for 7-14 days
Inj. Quinolone Inj. Piperacillin/ Tazobactam (4.5 gm)
7-14 days or 6-8 hourly for 7-14 days
Inj. Linezolid (600 mg) Inj. Vancomycin (1 gm) I/V
12 hourly 7-14 days (if gram positive infection), or 12 hourly 7-14 days (if gram positive infection)
Inj. Ticoplzmin (400 mg) stat and (200 mg) Inj. Amphotericin-B if fungal infection
12 hourly for 7-14 days, or
Cap. Fluclonazole (50-100 mg/day) if fungal infection
Epiglottises
Preferred drug
Alternative drug
Inj. Ceftriaxone (2 gm) Inj. Clarithromycin (900 mg)
24 hourly. Oral then: 8 hourly and
Tab. Co-amoxiclav (625 mg) Tab. Ciprofloxacin (500 gm)
Haemophilus influenzae (25%), followed by Haemophilus 8 hourly for 7-10 days 12 hourly. Oral then:
parainfluenzae, Streptococcus Pneumoniae, and group A
streptococci
Tab. Clindamycin (450 mg)

Haemophilus influenzae (25%), followed by Haemophilus
parainfluenzae, Streptococcus Pneumoniae, and group A
streptococci
6 hourly and
Tab. Ciprofloxacin (500 gm)
12 hourly
Lung Abscess
Preferred drug
Alternative drug
Co-amoxiclav
Staphylococus Clindamycin, Vancomycin, Daptomycin, Linezolid

Metronidazole
Malignant Otitis Externa

Preferred drug
Alternative drug
3rd Generation Cepholosporins- Piperacillin hourly plus Topical

Inj. Clindamycin (900 mg) and (750 mg)
Treatment oral Stop down:
Pseudomonas
Tab. Ciprofloxacin (500 mg-750 mg) 8 hourly and 12 hourly
12 hourly for 4-6 weeks
Name: Ensure sueabs are taken prior to therapy. Switch to orals based on clinical assesment and microbiological results.
Assess for any bone and intracranial extension

All cases to be discumed with microbiology
Perichondritis
Preferred drug
Alternative drug
Pseudomonas 1st line
Mixed flora
Tab. Ciprofloxacin (500mg-750mg) for 12 hourly
2nd line:
Cap. Clindamycin (450mg) 6 hourly for 4-6 weeks
Pharyngitis/Tonsillitis
Preferred drug
Alternative drug
GABHS (common) Mild: Mild:
Arcanobacterium hemolytic (7% or adolescents and adults with

Tab. Phenoxymethy1 penicillin (500 mg) Tab. Clarithromycin (500 mg)
pharyngitis)
Group C Streptococci (uncommon) 6 hourly 12 hourly
Group G Streptococci (uncommon)) Severe: Severe:
Neisseria Gonorrhoeae (uncommon) Inj. Benzy1 penicillin (1.2 gm) Inj. Clarithromycin (900 mg)
Coronibacterium diphtheria (rare) 6 hourly and 8 hourly. Oral then
Inj. Metronidazole (500 mg) Tab. Clindamycin (450 mg)
8 hourly. Oral then 8 hourly
Tab. Co-amoxiclav (625 mg)
8 hourly for 7-10 days.
Pneumonia
Preferred drug
Alternative drug
Mostly unknown Inj. Meropenem (500 mg) Ceftazidime
Gram-ve Escherichia coli 8 hourly plus Cefepime
Inj.Amikacin (500 mg) I/V
Quinsy (peritonsillar abscess)

Preferred drug
Alternative drug
Inj. Benzy1penicillin (1.2 gm) Inj. Clarithromycin (900 mg)
6 hourly and 8 hourly. Oral then
Inj. Metronidazole (500 mg) Tab. Clindamycin (450 mg)
Aerobic bacteria are Streptococcus group A (GAS), B-hemolytic

Streptococci group C and G, and Staphylococcus aureus Anaerobic
bacteria isolated form PTA aspirates is Fusobacterium necrophorum
8 hourly. Oral then 8 hourly
Respiratory tract infection e.g. bronchitis Pneumonia

Preferred drug
Alternative drug
Streptococcus Pneumoniae 3rd / 4th generation Cephalosporins Fluoroquinolones
Legionella pneumophetin Macrolide Macrolide
Mycoplasma
Haemophilus influenza
Name: Nosocomial RTI is common in diabetic patient. Early and agresive treatment is required
Retropharyngeal Abscess Lateral pharyngeal Abscess

Preferred drug
Alternative drug
Inj. Ceftriaxone (2 gm) Inj. Clarithromycin (900 mg)
24 hourly and 8 hourly and
Inj. Metronidazole (500 mg) Tab. Ciprofloxacin (500 gm)
4 hourly. Oral then: 12 hourly. Oral then:
Tab. Co-amoxiclav (625 mg) Tab. Clindamycin (450 mg)

8 hourly or according to C/S for 10-14 days 6 hourly and
Tab. Ciprofloxacin (500 gm)
12 hourly
Sore Throat
Preferred drug
Alternative drug
Please note that sore throat can be viral in nature. These do NOT
require antimicrobial therapy. Antibiotic treatment of adult
pharyngitis benefits only those patients with GABHS infection
Four clinical criteria (Centor criteria **) that predict infection with
GABHS include:(a) history of fever (b) tonsillar exudates (c)
absence of cough (d) tender anterior cervical lymphadenopathy
(lymphadenitis) Antibiotic therapy is recommended only for
patients who fulfill THREE or FOUR criteria. See below for
antibiotic recommendations for pharyngitis.Throat cultures are
not recommended for the routine primary evaluation of adults
with pharyngitis or for confirmation of negative results on rapid
antigen tests.
Upper or lower respiratory tract infection (Oncology)

Preferred drug
Alternative drug
Pneumococcus Inj. Azithromycin (500 mg-1 gm)
Streptococcus 24 or 12 hourly for 3 days or
Staphylococcus
Tab. Azithromycin (500 mg)
3rd generation Cephalosporins or Quinolone derivatives

3rd generation Cephalosporins or Quinolone derivatives
orally 24 or 12 hourly for 3 days or
orally 8 hourly for 7 days
Ventilator associated pneumonia (Early VAP)

Preferred drug
Alternative drug
Pseudomonas Inj. Piperacillin/Tazobactam (4.5 gm) Inj. Meropenem (1 gm)
Acinatobacter 6-8 hourly for 7-14 days plus 8 hourly for 7-14 days or
Proteus Inj. Vancomycin (1 gm)
Klebsiella Inj. Amikacin (500 mg) 12 hourly or
Staphylococcus aureus 12 hourly for 7 days Inj. Colistin Sulphate (1-2 MU)
Quinolone
for 7-14 days
Ventilator associated pneumonia (Late VAP)

Preferred drug
Alternative drug
Pseudomonas Inj. Meropenem (1 gm) Inj. Cefepime (1 gm)
Acinatobacter 8 hourly plus 8-12 hourly
Proteus
Klebsiella Inj. Amikacin (500 mg) Inj. Vancomycin (1 gm)
Staphylococcus aureus 12 hourly for 7 days 12 hourly
Inj. Colistin Sulphate (1-2 MU) Inj. Colistin Sulphate (1-2 MU)
8 hourly for 7-14 days 8 hourly for 7-14 days

(According To Alphabetical Order) : Community Acquired Meningitis (CAM)

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(According To Alphabetical Order) : Community Acquired Meningitis (CAM)

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List of recommendations arranged according to system and diseases

(According to alphabetical order)

Herpes simplex 12 hourly 6 hourly for 14 days

Inj. Acyclovir (500 mg)

6 hourly for 14 days if viral infection

Name: S.I Avoid Imipenem

Streptococcus Pneumonia Inj. Vancomycin (30-45 mg/kg/day) Inj. Penicillin G

Neisseria meningitides 4-12 hourly interval + Inj. Meropenem

Listeria monocytogenes Inj. Gentamicin

Streptococcus agalactiae Inj. Ceftriaxone (2 gm) Inj. Amikacin

Haemophilus influenza 12 hourly 7-14 days

Inj. Somatostatin (250 μgm or 500 μgm) A bolus of is given

Inj. Octreotide (5 µgm) A bolus followed by (50 µgm/hour)

Cleft lip-palate, facial cleft, facial deformity correction surgery

Inj. Ceftriaxone (1 gm) Inj. Meropenem (1 gm)

12 hourly 8 hourly I/V for 7 days, followed by Cap. Cephalosporins

Tab. Metronidazole (500 mg) Tab. Metronidazole

8 hourly for 5-7 days followed by or Cap. Cephalosporins

Obligate anaerobes: Cap. Flucloxacillin Cap. Cepholosporins

Prevotella intermedia Tab. Metronidazole Cap. Cefixime

Fusobacterium periodontices Tab. metronidazole

Name: For rapidly spreading infections injectable from may be advised

Candida albicans 1 antifungal agents (eg, Nystatin powder or cream)

Extraction of tooth surgical/ non surgical

Cap. Amoxicillin (500 mg)

8 hourly for 7 days or

Cap. Cefixime (200 mg)

2 of the other 3rd line antibiotic*

12 hourly for 7 days+

Tab. Metronidazole (400 mg)

8 hourly for 5 days.

Fungal infections in maxillofacial region like Candidiasis, mucormicosis etc

Cap. Fluconazole (100 mg) Cap. Itraconazole (400 mg)

daily for 7 – 14 days. 24 hourly for 7-14 days

Cap. Itraconazole (400 mg)

24 hourly for 7-14 days

Campylobacter rectus Tab. Penicillin V (250-500 mg)

Actinomyces species post operative 6 hourly for 5-7 days

Streptococcus Tab. Metronidazole (200-400 mg)

Cap. Doxycycline Initial : (200 mg/day)

divided twice daily post operative first day then. Maintenance :

Name: Avoidance of Doxycycline, Metronidazole in growing patients and pregnant women.

Inj. Nor adrenaline (0.5- 3.0 mg/hour) continuous I/V infusion

Cirrhosis of liver with ascites with renal impairment

Inj. Octreotide (100-200 μgm)

Inj. Midodrine (7.5-12.5 mg)

In case of maxillofacial fracture management like open reduction and fixation

3rd generation Ceftriaxone (1 mg )I/V Inj. Meropenem (1 gm)

12 hourly 8 hourly I/V for 7 days, following by Cap. Cephalosporins

Metronidazole (500 mg) I/V Tab. Metronidazole

8 hourly for 5-7 days followed by oral Cephalosporins

Tab. Metronidazole (500 mg) Tab. Metronidazole

8 hourly for 5-7 days followed by Cap. Cephalosporins

Cap. Clindamycin (600 mg) Flucloxacillin (500 mg)

in divided dose for 6 days to 8 weeks ± 6 hourly for 6-8 weeks +

Mixed anaerobic infection. Commonly by staphylococci and enteric

Tab. Metronidazole (500 mg) Tab. Secnidazole (2 gm)

8 hourly for 7 days single dose

Minor oral surgery like biopsy, excision of mucocele etc

8 hourly for 7 days or 8 hourly or

Tab. Metronidazole (400 mg) Tab. Metronidazole (400 mg)

8 hourly for 5 days 8 hourly for 5-7 days

Antifungal agents eg, Nystatin powder or cream Clotrimazole or Nystatin lozenges