Antibiotic Policy

ANTIBIOTIC POLICY
FOR
ALL HEALTH CARE FACILITIES
UNDER
DEPT. OF PUBLIC HEALTH &
FAMILY WELFARE,
GOVT. OF
MADHYA PRADESH
LIST OF CONTRIBUTORS
Dr. Debasis Biswas …………......Chairmen

Additional Professor, Department of Microbiology, AIIMS Bhopal
Dr. Ratinder Jhaj…………......Member

Associate Professor, Department of Pharmacology, AIIMS Bhopal
Dr. Girish Bhatt…………......Member

Associate Professor, Department of Pediatrics, AIIMS Bhopal
Dr. U. D. Saxena…………......Member
Surgical Specialist (General), JP Hospital Bhopal
Dr. Parash Kumar Jain …………......Member

Surgical Specialist (Orthopaedics), JP Hospital, Bhopal
Dr. Pankaj Shukla…………......Member

Deputy Director (Quality Assurance), National Health Mission, Bhopal
LIST OF CONTRIBUTORS
Dr. Archana Mishra…………......Member

Deputy Director (Maternal Health), National Health Mission, Bhopal
Dr. Rakesh Shrivastava…………......Member

Medicine Specialist, J P Hospital Bhopal
Dr. Preeti Deopujari…………......Member

Gynecologist, J P Hospital Bhopal
Dr. Anil Chaturvedi…………......Member

ENT-Specialist, J P Hospital Bhopal
Dr. Smita Saxena…………......Member

Pediatrician, Civil Hospital, Bairagarh, Bhopal
Dr. Vivek Mishra…………......Member Secretary

State Consultant Quality, National Health Mission, Bhopal
FOREWORD
Antimicrobial resistance is an issue of growing public health concern that threatens to render many common infections either
difficult-to-treat or completely untreatable. Infections with such resistant bacteria are associated with worse clinical outcomes
like increased mortality, hospital stay and healthcare costs.
Emergence of antibiotic resistance is contributed by the widespread availability of practically all antibiotics across-the-counter
and by their rampant overuse and misuse. Hence, one of the key ways of controlling this menace lies in promoting the prudent
use of antibiotics; which involves the prescription of the right antibiotic at the right dose through the right route and for the
right duration.
In view of this, the present document presents a compilation of antibiotic regimens for common infective syndromes in adult
and pediatric populations. It also includes a section on surgical antimicrobial prophylaxis for common surgical procedures
performed in these two groups of patients.
These evidence-based regimens, largely based on national guidelines, are meant for empirical usage and are expected to be
reviewed by the treating physician after 48-72 hours following the availability of culture-sensitivity reports. Unnecessary
continuation of broad spectrum antibiotics, in the face of evidence suggesting susceptibility with narrow spectrum antibiotics, is
not recommended. Likewise, premature termination and suboptimal dosage of recommended antibiotics are also likely to
worsen antibiotic resistance.
It is also emphasized that the suitability of these regimens for individual patients would need to be evaluated by the treating
physician in view of various patient- specific factors like delayed absorption, hepatic and renal function, drug allergy, etc.
It would also be worthwhile to point out that antibiotic susceptibility profile of bacterial pathogens is an ever-changing
phenomenon which demonstrates significant spatial and temporal variation. As a result, the present document would need to be
revised from time to time, in the light of locally generated antibiotic susceptibility data.
(Dr. Debasis Biswas)

TABLE OF CONTENTS
Sr. No. Topic Page No.

I. Upper Respiratory Tract Infections 01
II. CNS Infections 05
III. Skin and Soft Tissue Infections 08
IV. Genitourinary Infections 10
V. Infective Endocarditis 17
VI. Gastrointestinal & Intra-Abdominal Infections 18
VII. Bone & Joint Infections 21
VIII. Sepsis 23
IX. Pediatric Infections 24
X. Surgical Antimicrobial Prophylaxis 34

I. Upper Respiratory Tract Infections
Condition Most likely organisms Drug Dose Duration
Acute bacterial Streptococcus pneumoniae Amoxicillin- Clavulanate 875/125 mg PO q 12 hours 7 days
rhinosinusitis H. influenzae In case of Penicillin
M. catarrhalis allergy: Azithromycin 500 mg PO q 24 hours 3 days
Acute pharyngitis Streptococcus pyogenes Penicilin V OR 500 mg PO q 12 hours 10 days
Viruses
[Antibiotic administration only for Amoxicillin 500 mg PO q 8 hours 10 days
patients who are most likely to
have S. pyogenes infection: fever, In case of Penicillin
tonsillar exudates, no cough, & allergy: Azithromycin 500 mg PO OD 5 days
tender anterior cervical
lymphadenopathy]
Acute epiglottitis Children: Ceftriaxone OR 50 mg/kg IV 24 hourly
[Airway management H influenzae
essential] Streptococcus pyogenes Cefotaxime OR 50 mg/kg IV 8 hourly
Streptococcus pneumoniae
S. aureus
Adult: Levofloxacin AND 10 mg/kg IV 24 hourly
H influenzae
Streptococcus pyogenes Clindamycin 7.5 mg/kg IV 6 hourly
Malignant otitis externa Pseudomonas aeruginosa in > For early disease : Up to 5 days after signs
(usually diabetic or 90% cases Ciprofloxacin 750 mg PO q 12 hours of inflammation resolve.
immunocompromised) For advanced disease : 6 weeks in case of bone
Debridement usually Ceftazidime OR 2 gm IV q 8 hours involvement.
required. Osteomyelitis Piperacillin-Tazobactum 4.5 gm IV 6 hourly
to be ruled out.
Acute Otitis Media Streptococcus pneumoniae Amoxicillin- Clavulanate 90/6.4 mg/kg/day PO
Treat children <2 years. H. influenzae q 12 hours If age <2 years: 10 days
If >2 years, afebrile & M. catarrhalis If treated in past 1 If age >2 years : 5-7 days
no ear pain: consider month:
analgesics & defer Cefuroxime Axetil 250 mg PO q 12 hours
antibiotics
1. The recommendations listed above are for empirical administration. Antibiotic usage should be de-escalated judiciously following the availability of culture-
sensitivity reports.
2. The duration shown denotes the length of treatment in case the empirical antibiotic is continued.
1
Acute exacerbation of S. pneumoniae OPD patient:
chronic bronchitis H. influenzae Amoxicillin OR 500-1000 mg thrice a day 5-7 days
M. catarrhalis Azithromycin 500 mg once a day 3 days
Viruses Indoor patient:
Chlamydophila Amoxicillin-clavulanic acid OR 625 mg thrice a day 5-7 days
pneumoniae
Cefuroxime OR 500 mg BD 5-7 days
Cefixime 200 mg BD 5-7 days
Bronchiectasis, acute H. influenzae, Amoxicillin-clavulanic acid 625 mg thrice a day 5-7 days
exacerbation P. aeruginosa Long term (in case of repeated exacerbation):
Azithromycin 500 mg thrice a week 1-2 months
Community-acquired No comorbidity Azithromycin OR 500 mg OD 3 days
pneumonia (CAP) M. pneumoniae,
[non-hospitalized S. pneumoniae Amoxicillin 500-1000 mg thrice a day 5 days
patient] Viruses
Community-acquired M. pneumoniae, Amoxicillin-clavulanic acid OR 1.2 gm IV TDS 5-8 days
pneumonia (CAP) S. pneumoniae Cefotaxime OR 2-4 gm OR day IV 7-10 days
[Hospitalized(Non Viruses Ceftriaxone AND 2 gm IV OD 5-8 days
ICU) patient or with
Azithromycin 500 mg IV OD 7-10 days
comorbidities]
CAP in ICU- ( No risk S. pneumoniae, Amoxicillin-clavulanic acid OR 1.2 gm IV TDS 5-8 days
factor for pseudomonas) H. influenzae, Cefotaxime OR 2-4 gm OR day IV 7-10 days
M. catarrhalis, Ceftriaxone AND 2 gm IV OD 5-8 days
Legionella spp. Azithromycin 500 mg IV OD 7-10 days
CAP in ICU (risk Ceftazidime OR 2 gm IV TDS 10-14 days
factor for P. aeruginosa Cefoperazone OR 1-2 gm IV QID 10-14 days
pseudomonas) Piperacillin-Tazobactam OR 4.5 gm IV QID 10-14 days
Imipenem OR 0.5-1 gm IV QID 10-14 days
Meropenem CAN ADD 1-2 gm IV TDS 10-14 days
Gentamicin OR upto 1.6 gm IV per day 10-14 days
2
MDR Acinetobacter
Presence of risk factors for Any of the following drugs according to sensitivity (For 14 days)
multi-drug resistant Carbapenem (Imipenam OR Meropenam), Colistin, Sulbactam PLUS carbapenem, Sulbactam PLUS Colistin, Polymyxin.
bacteria like: Sulbactam should be stopped after 5 days in patients responding to treatment.
i. Antimicrobial therapy
in preceding three
months
ii. Present hospitalization
of ≥5 days
iii. High frequency of
antibiotic resistance in
the community or in
the specific hospital
unit.
iv. Hospitalization for
≥48 hours in
preceding three
months
v. Home infusion
therapy including
antibiotics
vi. Home wound care.
vii. Chronic dialysis within
one month
viii. Family member with
MDR pathogen
ix. Immunosuppressive
drug and/or therapy
3
MDR Pseudomonas
Risk factor: Carbapenam (Iimipenem OR Meropenam) AND Amynoglycoside OR Fluoroquinolone (For 14 days)
Immunocompromised (Ciprofloxacin – Only if TB is ruled out)
state, Chronic respiratory
conditions like COPD,
Asthma, Bronchiectasis;
Enteral tube feeding,
Cerebrovascular accident,
Chronic neurological
conditions.
Methicillin Resistance Empiric Vancomycin OR Teicoplanin (For 14 Days)
Staph Aureus
MRSA is rare in Indian Linezolid should be reserved due to potential Antitubercular effect and should be preferred only if pt is vancomycin
ICU; So if MRSA is intolerant or has concomitant renal failure or vancomycin resistant organism.
strongly suspected in late
onset VAP/HAP in ICU
having documented
MRSA, only then Start
MRSA empiric treatment.
Aspiration pneumonia ± Anaerobes 34%, Ceftriaxone AND 1 gm, IV q 24 hours For aspiration
lung abscess Gram-positive cocci Metronidazole OR 500 mg IV q 8 hours pneumonia- 5 to 7
26%, Clindamycin 1 gm IV q 12 hours days
Strep. milleri 16%, Lung abscess-4 - 6 weeks
Klebsiella pneumoniae
25%,
Nocardia 3%
4
II. CNS Infections:
Condition Situation/Severity Most likely organisms Drug Dose Duration
Meningitis Immunocompetent, S pneumoniae Ceftriaxone OR 2 gm IV q 12 hours 10-14 days
N meningitidis Cefotaxime 2 gm IV q 4-6 hours 10-14 days
H influenzae Chloramphenicol (in case of Penicillin Allergy)
Immunocompromised S pneumoniae Vancomycin AND 1.5 gm IV Loading
N meningitidis 1 gm IV q 12 hours 10-14 days
H influenza
Meropenem 2 gm IV q 8 hours 10-14 days
GNR
Post neurosurgery Staphylococcus Vancomycin AND 1.5g IV Loading
Penetrating head trauma epidermidis, 1 gm IV q 12 hours 10-14 days
Staphylococcus aureus,
Propionibacterium acnes,
Pseudomonas aeruginosa, Meropenem 2g IV q 8 hours 10-14 days
Acinetobacter baumanii
Infected shunt S aureus Vancomycin AND 1 gm IV q 12 hours 10-14 days
GNR (rare) Meropenem 2 gm IV q 8 hours 10-14 days
Meningitis with basilar S pneumonia
skull fractures H. Influenzae Ceftriaxone 2 gm IV q 12 hours 14 days
Dexamethasone
0.15mg/kg IV q6h for 2-4
days (1st dose with or
before first antibiotic dose)
5
Organism specific S pneumoniae Ceftriaxone 2g IV q 12 hours 10-14 days
therapy N meningitidis Ceftriaxone 2g IV q 12 hours 7 days
H influenzae Ceftriaxone 2g IV q 12 hours 7 days
E coli Ceftriaxone 2g IV q 12 hours 21 days
S. aureus-MSSA Oxacillin 2g IV q 4 hours 10-14 days
S. aureus-MRSA Vancomycin 1g IV q 12 hours 10-14 days
Enterococcus Ampicillin AND 2g IV q 4 hours
Gentamicin 5 mg/kg IV q 24 hours
Candida species Amphotericin B 1 mg/kg IV q 24 hours
Cryptococcus Amphotericin B AND 1 mg/kg IV q 24 hours
Flucytocine 25 mg/kg PO q 6 hours
Encephalitis HSV/VZV Acyclovir 10 mg/kg IV q 8 hours 14-21 days
Brain abscess Source unknown Streptococci, Vancomycin AND 1 gm IV q 12 hours Duration
Exclude TB, Bacteroides, Ceftriaxone AND 2 gm IV q 12 hours guided by
Nocardia, Enterobacteriaceae, Metronidazole 500 mg IV q 6 hours response
Aspergillus, S. aureus
Mucor Source : Sinusitis S pneumoniae Ceftriaxone AND 2 gm IV q 12 hours
Anaerobes Metronidazole 500 mg IV q 6 hours
6
If abscess<2.5cm Source : Chronic otitis S pneumonia Ceftriaxone AND 2 gm IV q 12 hours
& patient Anaerobes
neurologically
stable, await Metronidazole 500 mg IV q 6 hours
response to
antibiotics, Source : Post S aureus Vancomycin AND 1 gm IV q 12 hours
Otherwise,
neurosurgery GNR
consider
aspiration/surgical Meropenem 2 gm IV q 8 hours
drainageand
modify antibiotics
Source : Cyanotic Streptococci Ceftriaxone 2 gm IV q 12 hours
as per sensitivity
of aspirated/ heart disease
drained secretions.
Note:
1. Antibiotic therapy must be started within 30 minutes of suspecting a CNS infection.
2. Please give Dexamethasome to all patients with suspected meningitis in the dose of 0.15 mg/kg IV q 6 hours for 2-4 days, ideally first dose
10-20 minutes before an antibiotic.
3. STOP Antibiotic treatment if LP culture obtained prior to antibiotic therapy is negative at 48 hours OR no PMNs on CSF cell count.
7
III. Skin and Soft Tissue Infections
Condition Situation/ Most likely Drug Dose Duration

Severity organisms
Cellulitis Non-suppurative Streptococci Amoxicillin-clavulanic acid OR 625 mg PO q 8 hours 5-7 days
Suppurative cellulitis or S aureus Amoxicillin-clavulanic acid OR 1.2 gm IV q 8 hours 5-7 days
See note 1
below cutaneous abscess Ceftriaxone OR 2 gm IV q 24 hours 5-7 days
Clindamycin 600-900 mg IV q 8 hours 5-7 days
Cat/dog bite P multocida Amoxicillin-clavulanic acid OR 625 mg PO q 8 hours 5-7 days
Diabetic foot Mild infection S aureus Amoxicillin-clavulanic acid OR 875 mg PO q 12 hours 7-10 days
See notes Cephalexin OR 500 mg PO q 6 hours 7-10 days
2,3,4,5,6 as
below Clindamycin 300 mg PO q 8 hours 7-10 days
Moderate infection S aureus Ertapenem OR 1 gm IV q 24 hours 7-10 days

Streptococci Ciprofloxacin AND 500 mg PO q 12 hours 7-10 days
Psuedomonas Metronidazole OR 400 mg PO q 8 hours 7-10 days
Enterobacteriacae Clindamycin 300 mg PO q 8 hours 7-10 days
Severe infection S aureus Piperacillin-Tazobactum OR 4.5 gm IV q 6 hours 7-10days
Streptococci Ciprofloxacin OR 500mg IV q 12 hours 7-10days
Psuedomonas Aztreonam AND 1gm IV q 8 hours 7-10days
Enterobacteriacae Clindamycin 600 mg IV q 8 hours 7-10days
Anaerobes Piperacillin-Tazobactum AND 4.5 gm IV q 6 hours 7-10days
Vancomycin 1 gm q 12 hours 7-10days
8
Condition Situation/ Most likely Drug Dose Duration
Severity organisms
Necrotizing S aureus Piperacillin-Tazobactum AND 4.5 gm IV q 6 hours Duration depends on
fasciitis Clostridia Clindamycin 600-900 mg IV q 8 hours the progress
See note 7 as Anaerobes OR
below Streptococci Imipenem OR 1 gm IV q 8 hours
Meropenem AND 1 gm IV q 8 hours
Clindamycin OR 600-900 mg IV q 8 hours
Linezolid 600 mg IV BD
Note:
1. Incision and drainage is preferred therapy in case of cutaneous abscess. Antibiotics are indicated if infection is severe, assc extensive cellulitis,
septic phlebitis, diabetes, advanced age, or no response to I & D.
2. Uninfected diabetic foot has no purulence or inflamamtaion (erythema, pain, tenderness, warmth, induration).
3. Mild diabetic foot infection : Presence of purulence and one sign of inflammation.
4. Moderate diabetic foot infection : Mild inflammation and >2 cm of cellulitis, lymphangitic streaking, deep tissue abscess, gangrene, involvement
of muscle, tendon, joint, or bone.
5. Ulcer floor should be probed carefully. If bone can be touched with a metal probe then the patient should be treated for osteomyelitis with
antibiotics in addition to surgical debridement.
6. Duration of treatment depends on response. Usually 7-10 days after surgical debridement. Treatment is prolonged with osteomyelitis.
7. In necrotizing fasciitis, antibiotics are only an adjunct to surgical debridement.
9
IV. Genitourinary Infections

N. gonorrhoeae, Chlamydia, Outpatient regimen option 1:
Pelvic Inflammatory Disease
Bacteroides, Doxycycline AND 100 mg PO BID 14 days
(PID), salpingitis, tubo-ovarian
Enterobacteriaceae, Ceftriaxone CAN ADD 250 mg IM OR IV Single dose
abscess
Streptococci Metronidazole 400 mg PO BID 14 days
Outpatient t/t: Pts with temp Gardenella vaginalis Outpatient regimen option 2:
<38°C, WBC <11,000 per mm3, S. aureus Cefoxitin AND 2 gm IM Single dose
minimal evidence of peritonitis, Probenecid AND 1 gm PO Single dose
active bowel sounds & able to . Doxycycline AND 100 mg PO BID 14 days
tolerate oral nourishment Metronidazole 400 mg PO BID 14 days
Initial inpatient Inpatient regimen:
evaluation/therapy suggested for Ceftriaxone AND 250 mg IM single For inpatient regimens,
pts with tubo-ovarian abscess. dose continue treatment until
Drainage of tubo-ovarian abscess Clindamycin 900 mg IV q 8 satisfactory response for

then hours
wherever .indicated. ≥ 24-hr before
switch to outpatient regimen
switching to outpatient
Evaluate and treat sex partner. regimen.
10
Vaginitis Candida albicans 80–90%. Oral azoles:
Candidiasis C. glabrata, C. tropicalis Fluconazole 150 mg PO Single dose
Pruritus, thick cheesy may be increasing—they are Intravaginal
discharge, pH <4.5 less susceptible to azoles azoles:
Clotrimazole OR 200 mg vaginal tabs at bedtime 3 days
1% cream (5 gm) at bedtime 7-14 days
100 mg vaginal tab 7 days
500 mg vaginal tab Single dose
Miconazole 200 mg vaginal suppository at 3 days
bedtime
100 mg vaginal suppository 7 days
q 24 hours
2% cream (5 gm) at bedtime 7 days
Recurrent candidiasis Fluconazole 150 mg PO q week 6 months
(4 or more episodes/ yr) Clotrimazole Vaginal suppositories 500 mg 6 months
q week
Balanitis Candida 40%, Group B Oral or topical
Occurs in 1/4 of male sex Strep, gardnerella azoles as for
partners of women infected with vaginitis
candida.
11
Bacterial vaginosis Etiology unclear: Metronidazole Metro 400 mg PO BID 7 days
Malodorous vaginal Gardnerella vaginalis, OR Metro vaginal gel 1 5 days
discharge, pH >4.5 Mobiluncus, Mycoplasma applicator intravaginally at
hominis,
bedtime
 Reported 50% ↑ in cure rate Prevotella sp., Atopobium
if abstain from sex or use vaginae etc. Tinidazole OR 2 gm PO once daily 2 days
condoms 1 gm PO once daily 5 days
Clindamycin 300 mg PO bid 7 days
 Treatment of male sex 2% vaginal cream 5 gm at 7 days
partner not indicated unless bedtime
balanitis present.
Vaginal Trichomoniasis Trichomonas vaginalis Metronidazole 2 gm PO single dose
Copious foamy discharge, OR 400 mg PO BID 7days
pH >4.5 Tinidazole 2 gm PO single dose
Treat male sexual partners: For treatment failure:
Metronidazole 2 gm as single dose Metronidazole 7 days
400 mg PO BID
2nd failure: Metronidazole
2 gm PO q 24 hours 3-5 days
Urethritis, cervicitis, proctitis N. gonorrhoeae Ceftriaxone AND 250 mg IM Single dose
(uncomplicated) (50% of pts Azithromycin OR 1 gm PO Single dose
with urethritis, cervicitis
have Doxycycline 100 mg PO q 12 hours 7 days
concomitant C.
trachomatis).
Empirical t/t to cover both
pathogens
12
Epididymo-orchitis N. gonorrhoeae, Ceftriaxone AND 250 mg IM Single dose
Age <35 years Chlamydia trachomatis Azithromycin OR 1 gm PO Single dose
Doxycycline 100 mg PO bid 10 days
Enterobacteriaceae Levofloxacin OR 500-750 mg IV/PO once 10-14 days
Age >35 years or homosexual (coliforms) daily
men (insertive partners in anal Ciprofloxacin 500 mg PO OR 400 mg IV 10-14 days
intercourse) twice daily
Acute Prostatitis N. gonorrhoeae, Ceftriaxone AND 250 mg IM Single dose
≤35 years of age C. trachomatis Azithromycin OR 1 gm PO Single dose
Doxycycline 100 mg PO bid 10 days
Enterobacteriaceae Levofloxacin OR 500-750 mg IV/PO once daily 10-14 days
≥35 years of age (coliforms)
Ciprofloxacin OR 500 mg PO OR 400 mg IV 10-14 days
Note: Urine and prostatic massage twice daily x
culture samples to be taken prior
to antibiotics. Sulfamethoxazole- 1 double strength (800 mg – 10-14 days
De-escalate after the availability of Trimethoprim 160 mg) tablet PO BID
culture sensitivity reports.
Acute, uncomplicated cystitis/ E. coli, other members of Nitrofurantoin OR 100 mg PO BD 7 days
urethritis in women Enterobacteriaceae, Ciprofloxacin 250 mg PO q 12 hours 5 days
Staphylococcus
saprophyticus, Enterococci
13
Young woman with typical Chlamydia trachomatis Azithromycin OR 1 gm PO single dose
symptoms, pyuria present, Doxycycline 100 mg PO q 12 hours 7 days
culture-negative
Acute uncomplicated E. coli, other members of Amikacin OR 1 gm OD IM/IV 14 days
pyelonephritis Enterobacteriaceae, Gentamicin 7 mg/kg/day OD IM/IV 14 days
Note: Urine culture samples to be Enterococci
taken prior to initiation of
antibiotic therapy and used to
guide antibiotic regiment once the
report is available.
Monitor renal function
Complicated pyelonephritis Escherichia coli, Klebsiella Piperacillin- 4.5 gm IV q 8 hours 10-14 days
pneumonia, Proteus Tazobactam OR
Note: Urine culture samples to be mirabilis, Pseudomonas
Imipenem OR 1 g, IV q 8 hours 10-14 days
taken prior to antibiotics. aeruginosa, Enterococcus
De-escalate after the availability of Sp. Meropenem OR 1 gm IV q 8 hours 10-14 days
culture sensitivity reports. Frequently multi-drug Amikacin 1 gm OD IM/IV 10-14 days
Monitor renal function if resistant organisms are
aminoglycoside is used. present
Acute pyelonephritis, E. coli, other members of Piperacillin- 4.5 gm IV q 8 hours 14 days
hospitalized, either sex Enterobacteriaceae, Tazobactam OR
Enterococci Imipenem 1 gm IV q 12 hours 14 days
UTI in hospitalized patient on Enterobacteriaceae, Wait for C/S result.
long-term urinary catheter Pseudomonas aeruginosa, If patient is in sepsis,
Acinetobacter spp., start
Enterococci Colistin AND 2 million IU IV q 12 hours
Vancomycin 1 gm IV q 12 hours
until C/S results are
available
14
Chorioamnionitis Group B Streptococcus, Clindamycin OR
Gram negative bacilli, Vancomycin
chlamydiae, ureaplasma and Teicoplanin AND
anaerobes, usually Cefoperazone-
Polymicrobial Sulbactum
If patient is not in
sepsis then IV
Ampicillin
Septic abortion Bacteroides, Prevotella If patient has not taken
bivius, Group B, Group A any prior antibiotic
Streptococcus, (start antibiotic after
Endomyometritis and Septic Enterobactereaceae, C.
sending cultures)
Pelvic Vein Phlebitis trachomatis, Clostridium
perfringens. Ampicillin AND 500 mg QID
Metronidazole 500 mg IV TDS
It patients has been
partially treated with
antibiotics, send blood
cultures and start
Piperacillin-
Tazobactam
OR
Cefoperazone-
sulbactum
till the sensitivity report
is available.
Obstetric Sepsis during Group A beta-haemolytic It patient is in shock
pregnancy Streptococcus, E. coli, and blood culture
anaerobes. reports are pending,
then start
15
Piperacillin-Tazobactam
OR
Cefoperazone-
sulbactam
till the sensitivity report
is available and modify as
per the report.
If patient has only fever,
with no features of
severe sepsis start
Amoxicillin-clavulanate 625 mg TDS PO/
OR 1.2 gm TDS IV
Ceftriaxone AND 2 gm IV OD
Metronidazole 500 mg IV TDS
CAN ADD
Gentamicin 7 mg/kg/day OD
If admission needed.
MRSA cover may be
required if suspected or
colonized
(Vancomycin/
Teicoplanin)
Obstetric Sepsis following S. pyogenes, Same as above

pregnancy E. coli,
S. aureus
Source of sepsis outside Genital S. pneumoniae
tract Mastitis UTI Pneumonia Meticillin-resistant
Skin and soft tissue (IV site, S. aureus (MRSA),
surgical site, drain site etc.) C. septicum &
Morganella morganii.
16
V. Infective Endocarditis
Infective Endocarditis: Viridans Streptococci, other Penicillin G OR 20 MU IV divided doses 4-6 weeks
Native valve (awaiting Streptococci Enterococci 4 hours
cultures) Indolent Ampicillin AND 2 gm IV 4 hours 4-6 weeks
Gentamicin 1 mg/kg IM or IV 8 hours
Infective Endocarditis: S.aureus (MSSA or MRSA) Risk Vancomycin AND 25-30 mg/kg loading followed by 4-6 weeks
Navtive valve (awaiting for gram-negative bacilli 15-20 mg/kg IV 12 hourly
cultures) In Severe (maximum 1gm 12) hourly)
Sepsis Meropenem 1 gm IV 8 hours
Endocarditis Staph Vancomycin AND 25-30 mg/kg loading followed by
(< 2 months); Gram Negative Rods 15-20 mg/kg IV 12 hourly
Prosthetic Valve Diptheroids (maximum 1 gm 12) hourly)
Meropenem OR 1 gm IV 8 hours
Imipenem 500 mg IV q 6 hours
Endocarditis CONS Vancomycin AND 25-30 mg/kg loading followed by
(> 2 months); Enterococcus 15-20 mg/kg IV 12 hourly
Prosthetic Valve S.aureus (maximum 1 gm 12) hourly)
Gentamicin 1 mg/kg body weight IV 8
hourly, modified according to
renal function
17
VI. Gastrointestinal & Intra-Abdominal Infections
Acute Viral, None None None
Gastroenteritis Entero-toxigenic &
Entero-pathogenic
E. Coli
Food poisoning S. aureus,

B. cereus,
C. botulinum
Cholera V. cholerae Doxycycline OR 300 mg Oral Single dose
Azithromycin OR 1 gm Oral 3 days
Ciprofloxacin 500 mg BD 3 days
Bacterial dysentery Shigella sp., Ceftriaxone OR 2 gm IV OD 5 days
Campylobacter, Cefixime OR 10-15 mg/kg/day 5 days
Non-typhoidal
Azithromycin (drug of 1 gm OD 3 days
Salmonellosis
choice for Campylobacter)
Amoebic dysentery E. histolytica Metronidazole OR 400 mg Oral TDS 7-10 days
Tinidazole 2 gm Oral OD 3 days
Giardiasis Giardia lamblia Metronidazole OR 250-500 mg Oral TDS 7-10 days
Tinidazole 2 gm Oral 1 dose
Hospital acquired C. difficile Metronidazole OR 400 mg Oral TDS 10 days
diarrhea Vancomycin 250 mg Oral QDS 10 days
Enteric fever S. Typhi, Cefixime OR 20 mg/kg/day 14 days
(Outpatients) S. Paratyphi A Azithromycin OR 500 mg BD 7 days
Cotrimoxazole OR 960 mg BD 2 weeks
18
Enteric fever S. Thyphi, Ceftriaxone (Ceftriaxone to 2 gm IV BD 2 weeks
(Inpatients) S. Paratyphi A be changed to oral cefixime
when patient is afebrile to
finish total duration of 14
days) OR
Azithromycin 500 mg BD 7 days
Biliary tract infections Enterobacteriaceae Ceftriaxone OR 2 gm IV OD 7-10 days
(cholangitis, (E.coli, Klebsiella sp.) Piperacillin-Tazobactam 4.5 gm IV 8 hourly
cholecystitis)
Biliary tract infections Enterobacteriaceae Imipenem OR 500 mg IV 6 hourly 7-10 days
(cholangitis, (E.coli, Klebsiella sp.) Meropenem 1 gm IV 8 hourly 7-10 days
cholecystitis) (For
serious patients and
documented ESBL
producers)
Spontaneous Bacterial Enterobacteriaceae Cefotaxime OR 1-2 gm IV TDS Duration of treatment
Peritonitis (E.coli, Klebsiella sp.) Piperacillin-Tazobactam 4.5 gm IV 8 hourly is based on source
Spontaneous Bacterial Enterobacteriaceae Imipenem OR 500 mg IV 6 hourly control and clinical
Peritonitis (For serious (E.coli, Klebsiella sp.) improvement
Meropenem 1 gm IV 8 hourly
patients and
documented ESBL
producers)
Secondary Peritonitis, Enterobacteriaceae Piperacillin-Tazobactam 4.5 gm IV 8 hourly Duration of treatment
Intra-abdominal (E.coli, Klebsiella sp.), OR is based on source
abscess/ GI perforation Bacteroides (colonic perforation), Imipenem OR 500 mg IV 6 hourly control and clinical
Anaerobes improvement
In very sickpatients, if required, addition of cover for yeast
(fluconazole iv 800 mg loading dose day 1, followed by 400
mg 2nd day onwards) & and for Enterococcus (vancomycin
OR teicoplanin) may be contemplated
19
Pancreatitis No antibiotics
Mild- moderate
Post necrotizing Entrobacteriaceae, Enterococci, Piperacillin-Tazobactam 4.5 gm IV 8 hourly Duration of treatment is
pancreatitis: infected S. aureus, OR based on source control
pseudocyst; pancreatic S. epidermidis, anaerobes, Imipenem OR 500 mg IV 6 hourly and clinical improvement
abscess Candida sp.
In very sick patients, if required, addition of cover for
yeast (fluconazole iv 800 mg loading dose day 1,
followed by 400 mg 2nd day onwards) & and for
Enterococcus (vancomycin /teicoplanin) may be
contemplated
Diverticulitis- Mild Gram negative rods, Anaerobes Amoxicillin-Clavulanate 625 mg TDS 7 days
(OPD treatment) acid
Diverticulitis- Moderate Gram negative rods, Anaerobes Ceftriaxone AND 2 gm IV OD Duration of treatment is
Metronidazole OR 500 mg IV TDS based on source control
Piperacillin-Tazobactam 4.5 gm IV 8 hourly and clinical improvement
Diverticulitis- Severe Gram negative rods, Anaerobes Imipenem OR 500 mg IV 6 hourly Duration of treatment is
Meropenem 1 gm IV 8 hourly based on source control
and clinical improvement
Liver Abscess Polymicrobial Ceftriaxone AND 2 gm IV OD 2 weeks.
Metronidazole OR 500 mg IV TDS USG-guided drainage
800 mg PO TDS indicated in large
Piperacillin-Tazobactam 4.5gm IV 8 hourly abscesses, signs of
imminent rupture and to
no response to medical
treatment.
20
VII. Bone & Joint Infections
Acute Osteomyelitis/ S. aureus, Streptococcus Ceftriaxone, followed by 2 gm IV OD 4-6 weeks
Septic arthritis pyogenes, Enterobacteriaceae Cloxacillin OR 500 mg PO TDS Surgical debridement to be
Cephalexin 500 mg PO QDS carried out under
Piperacillin-Tazobactam 4.5 gm IV QDS orthopaedic guidance.
OR
Cefoperazone-Sulbactam 3 gm IV BD Therapy to be guided by
AND culture result of
Clindamycin 600-900 mg IV TDS blood/synovial fluid/bone
biopsy.
Prosthetic joint Coagulase negative Ceftriaxone AND 2 gm IV OD 4 weeks
infection Staphylococcus, S. aureus, Vancomycin OR 1 gm IV BD
Streptococci, Enterococcus, Teicoplanin 800 mg X 3 doses, followed
Gram negative rods, Anaerobes by 400mg OD
Piperacillin-Tazobactam
Chronic Osteomyelitis/ No empiric therapy ≥ 6 weeks. Total duration
Chronic synovitis of treatment depends on
joint involved and
organism isolated.
Extensive surgical
debridement.
Therapy to be guided by
culture result of synovial
fluid/bone biopsy.
21
Recommendations for antibiotic therapy in open fracture management
(all drugs to be given intravenously)
Fracture type Antibiotic choice Antibiotic duration
I Cefazolin* Every 8 hours for three doses
Pipercacillin-Tazobactam OR Cefazolin AND Continue for 24 hours after wound
II
Gentamcin OR Amikacin OR Tobramycin closure
Pipercacillin-Tazobactam OR Cefazolin AND
IIIA Gentamcin OR Amikacin OR Tobramycin‡ AND Three days
penicillin for anaerobic bacteria if needed
Continue for three days after wound
IIIB Gentamcin OR Amikacin OR Tobramycin AND
closure
penicillin§ for anaerobic bacteria if needed
Continue for three days after wound
IIIC Gentamcin OR Amikacin OR Tobramycin AND
closure
penicillin for anaerobic bacteria if needed
*1-2 gm intravenously (IV) every 8 hours

†3.375 gm IV every 6 hours
‡5.1 mg/kg IV every 24 hours (recommend pharmacy to assist with monitoring levels)
§2–4 million units IV every 4 hours
22
VIII. Sepsis: The choice of antibiotics depends on the source
1. Lungs : follow pneumonia guidelines

2. SSTI:
a) Extensive inflammation+ SystemicToxicity: GNB, S.aureus: BL + BLI (Piptaz-4.5 gm IV q 8 hours) OR Carbapenem
(Meropenem 1 gm IV q 8 hours/ Imipenem 500 mg IV q 6 hours) + Vancomycin (1 gm IV BD)
b) Necrotizing fasciitis: Streptococci, Anaerobes, GNB, Staph aureus: BL + BLI (Piptaz-4.5 gm IV q 8 hours) OR Carbapenem
(Meropenem 1 gm IV q 8 hours/ Imipenem 500 mg IV q 6 hours) + Clindamycin (600 mg IV q 8 hours).
3. Secondary peritonitis: Enterobacteriacea, Bacteroides, Enterococci, Pseudo: BL / BLI (Piptaz-4.5 gm IV q 8 hours)
4. Primary peritonitis :S pneumoniae, GNB: Ceftriaxone/Cefotaxime (Ceftriaxone 1 gm IV BD)
5. Uncomplicated pyelonephritis: GNB: BL +BLI (Piptaz-4.5 gm IV q 8 hours)
6. Pyelonephritis :GNB (E coli, Pseudomonas): Carbapenem (Meropenem 1 gm IV q 8 hours/ Imipenem 500 mg IV q 6 hours)
7. Severe Pyelonephritis, Perinephric abscess, Emphysematous pyelonephritis: GNB : Carbapenem (Meropenem 1 gm IV q 8
hours/ Imipenem 500 mg IV q 6 hours)
8. Unknown origin: Carbapenem (Meropenem 1 gm IV q 8 hours/ Imipenem 500 mg IV q 6 hours) + Vancomycin/Teicoplanin
(Vancomycin 1 gm IV BD/ Teicoplanin 400 mg IV BD for one day, thereafter 400 mg IV OD for 2 days thereafter as per Cr Cl)
23
IX. Pediatric Infections
IX. A. Pediatric Respiratory Tract Infections

Pharyngotonsillitis Most are caused due to Viruses Viral – no antibiotics needed
30% bacterial If bacterial: Inflamed enlarged - -
-Group A hemolytic tonsils with pus points
streptococci Amoxicillin 50-75 mg/kg/day PO BD/TID 10 days
Group C Streptococcus Penicillin V 50-75 mg/kg/day PO BD/TID 10 days
Arcanobacterium haemolyticum Benzathine Penicillin <30 kg: 6,00,000 units IM Single dose
>30 kg: 1.2 million units IM
If penicillin allergic children:
Erythromycin 20-40 mg/kg/day PO BID/QID 10 days
Azithromycin 12 mg/kg/day 5 days
Diphtheria Corynebacterium diptheriae Erythromycin OR 20-40 mg/kg/day PO BID/QID 14 days
Penicillin G 1.5 lac U/kg/day IV divided 10 days
QID
Acute Otitis Media S. pneumoniae, Amoxicillin 40-50 mg/kg/day PO BD 7-10 days
H. influenzae, In case of severe otalgia OR
M. catarrhalis high grade fever:
Amoxicillin- Clavulanate 40-50 mg/kg/day PO BD 7-10 days
Ceftriaxone 75 mg/kg/day IV BD 7-10 days
For penicillin allergy: Cefidinir 14mg/kg/day in two divided 7-10 days
doses
Acute Sinusitis S. pneumoniae, Amoxicillin OR 40-50 mg/kg/day PO TDS 7-10 days
H. influenzae, Amoxicillin- Clavulanate OR 40-50 mg/kg/day PO BD 7-10 days
M. catarrhalis Ceftriaxone OR 75 mg/kg/day IV BD 7-10 days
Severe cases
24
Ludwig’s Angina S. pyogenes Penicilllin G OR 200000-250000 U/kg/day IV 2-3 weeks
q 6 hours
Staph. aureus Clindamycin 40 mg/kg/day q 8 hours IV 2-3 weeks
Pertussis Bordetella pertussis Azithromycin OR 10 mg/kg/day PO OD 5 days
Clarithromycin OR 15 mg/kg/day PO BD 7 days
Erythromycin OR 40 mg/kg/day PO QID 14 days
Acute Parainfluenza virus Antibiotics not needed - -
laryngotracheobronchitis
Acute Epiglottitis H. influenzae Ceftriaxone 50 mg/kg/day IV OD 7-10 days
S. pneumoniae
Bronchiolitis Respiratory syncytial virus, Antibiotics not needed - -
Metapneumovirus
Pneumonia
Community Acquired 3 mnth- 4 yrs:
Pneumonia S.pneumoniae
S.aureus
S.pyogenes
≥ 5 yrs:
Chlamydophila pneumoniae,
Mycoplasma
25
No Pnumonia mostly viral No antibiotic required
(only cough and no
difficulty in breathing)
Pnumonia > 2 months Amoxicillin 80-90 mg/kg/day QID 7-10 days

Increased breathing
rate(Upto 2 months≥60;
2 months to 1 year≥50;
1-5 years≥40) with lower
chest indrawing
Severe Pnumonia > *Ampicillin AND 50 mg/kg/dose IV 6 hourly 7-10 days
2months Gentamicin OR 7.5 mg/kg/day IV/IM OD 7-10 days
(Those with fast breathing Ceftriaxone OR 50 -75 mg/kg/day IV in two 7-10 days
and danger signs such as divided doses
inability to feed, nasal Cefotaxime 50 mg/kg/dose IV 6 hourly 7-10 days
flaring, head nodding, *Ampicillin can be switched
lower chest wall indrawing, over to amoxicillin once the
respiratory rate >70/min, patient is able to take orally
convulsions, MRSA Add Vancomycin 60 mg/kg/day IV No. of doses 10-14 days
unconsciousness etc. Mycoplasma Azithromycin 10 mg/kg/day Route OD 5 days
Nosocomial pneumonia Staph. aureus Meropenem OR 60 mg/kg/day IV TDS 10-14 days
P. aeruginosa Piperacillin-Tazobactum 240-300 mg/kg/day IV TDS 10-14 days
S. pneumoniae Cefipime CAN ADD 150 mg/kg/day divided 8 hourly 10-14 days
H. influenzae Gentamicin 6 - 7.5 mg/kg/divided 8 hourly 10-14 days
MRSA ADD Vancomycin 60mg/kg/day IV divided 8 10-14 days
hourly
26
With Pleural Staph aureus Cloxacillin AND 50-100 mg/kg IV BD 2-3 week
effusion/empyema Klebsiella Ceftraixone OR 75-100 mg/kg/day in two 2-3 week
S. pneumoniae divided doses
Cefotaxime 50 mg/kg/dose IV 8 hourly 2-3 week
MRSA ADD Vancomycin 60 mg/kg/day IV No. of doses 10-14 days
For severe Pnumonia Inj Cefotaxime OR 50 mg/kg/dose IV 8 hourly 10-14 days
under 2 months of age Ceftriaxone AND 75-100 mg/kg/day in two 10-14 days
divided doses
Gentamicin 7.5 mg/kg/day IV/IM OD 10-14 days
For suspected Inj Cloxacillin OR 50-100 mg/kg IV BD 3-4 weeks
staphylococcus may be added to initial
pneumonia(Presence of regimen
following clinical features:
Rapidly progressive
disease, Pnumatocoele or
pneumothorax or effusion
in CXR, large skin boils or
post measles pneumonia
not responding to initial
treatment within 48 hours
27
IX. B. Pediatric CNS Infections

Meningitis H. influenzae Cefotaxime 200-300 mg/kg/day IV divided 14-21 days
N. meningitidis QID
S. pneumoniae Ceftraixone 100 mg/kg/day IV BD 14-21 days
Neonatal meningitis Group B Streptococcus (GBS), Ampicillin AND 100 mg/kg/dose IV BD/TDS 21 days for gram
E. coli, Gentamicin 5-7.5 mg/kg/day IV OD negative ,
L. monocytogenes, Cefotaxime AND 50 mg/kg/dose IV BD/TDS 14-21 days for
S.pneumoniae, Gentamicin 5-7.5 mg/kg/day IV OD GBS and other
S. aureus gram positive
bacteria
Hospital Acquired Staphylococcus, Cefotaxime AND 50 mg/kg/dose IV BD/TDS 14 days
meningitis CONS, Amikacin 5-7.5 mg/kg/day IV OD 14 days
Enterobacteriaceae, Meropenem AND 40 mg/kg/dose IV TDS 14 days
Pseudomonas Amikacin 5-7.5 mg/kg/day IV OD 14 days
MRSA ADD Vancomycin 60 mg/kg/day IV No. divided 14 days
8 hourly
28
IX. C. Pediatric Gastrointestinal Infections

Dysentery Shigella Ceftriaxone 100 mg/kg/day IV BD 7 days
Campylobacter Cefixime 20 mg/kg/day PO BD 7 days
Cholera Vibrio cholerae Azithromycin 20 mg/kg/day PO OD 5 days
Doxycycline 4 mg/kg/day PO BD 7-10 days
Enteric fever Samonella typhi, Cefixime 20 mg/kg/day PO BD 14 days
Salmonella paratyphi Azithromycin 20 mg/kg/day PO OD 5 days
Ceftriaxone 100 mg/kg/day IV BD 14 days
Cefotaxime 100 mg/kg/day IV TDS 14 days
2nd line drugs:
Chloramphenicol 50-75 mg/kg/day BD 14 days
Amoxicillin 75-100 mg/kg/day BD/TID 14 days
Cotrimoxazole TMP: 8 mg/kg/day 14 days
SMX: 40 mg/kg/day BD
Peritonitis E.coli, Ampicillin OR 100 mg/kg/day IV divided TID 7-10 days
S.pneumoniae, Cefotaxime AND 100 mg/kg/day IV divided BD 7-10 days
S.viridans Gentamicin 5-7.5 mg/kg/day IV OD 7-10 days
Liver abscess
If pyogenic E.coli, Ampicillin OR 100 mg/kg/day IV 2-6 weeks
Klebsiella pneumoniae, Cefotaxime AND 100 mg/kg/day IV 2-6 weeks
Streptococcus sp., Gentamicin OR 5-6 mg/kg/day IV 2-6 weeks
Bacteroides sp. Amikacin 15-20 mg/kg/day IV 2-6 weeks
If amoebic E. histolytica Metronidazole OR 30-50 mg/kg/day IV 10-14 days
Tinidazole 50 mg/kg/day IV 5 days
29
IX. D. Pediatric Urinary Tract Infections

Urinary Tract Infection E. coli, Klebsiella, Parenteral drugs:
Proteus, (if pyelonephritis)
Staphylococcus saprophytius, Ceftriaxone 75-100 mg/kg/day IV BD Switch to oral
Enterococcus following clinical
response
(7-10 days total)
Cefotaxime 100-150 mg/kg/day IV TDS
Amikacin 10-15 mg/kg/day IV OD
If mild cystitis (3-5 days) Gentamicin 5-6 mg/kg/day IV OD

Oral drugs:
Cefixime 8-10 mg/kg/day BD 7-10 days
Ciprofloxacin 10-20 mg/kg/day BD 7-10 days
Coamoxiclav 30-35 mg/kg/day BD 7-10 days
Ofloxacin 15-20 mg/kg/day BD 7-10 days
Prophylaxis for urinary tract infection Cotrimoxazole 1-2 mg/kg/day of trimethoprim
PO
(Prophylaxis should be given in case of recurrent urinary tract
Nitrofurantoin 1-2 mg/kg/day PO
infection till a detailed imaging report is available and child
Cephalexin 10 mg/kg/day PO
sent for expert review to Pediatric nephrologist)
Cefadroxil 5 mg/kg/day PO
30
IX. E. Febrile Neutropenia in children

Febrile Neutropenia Staphylococcus aureus First line:
Pseudomonas aeruginosa Ceftazidime AND 150 mg/kg/day TDS IV
Candida Amikacin OR 15-20 mg/kg/day BD
Enterococcus Second line:
Piperacillin-Tazobactum AND 300 mg/kg/day TDS IV
Vancomycin 40 mg/kg/day IV QID
IX. F. Pediatric Bone & Joint Infections

Osteomyelitis/Septic Staphylococcus aureus, Coamoxyclav AND 100 mg/kg/day IV BD 4-6 weeks
Arthritis Group B Streptococci, Gentamicin 7.5 mg/kg/day OD IV BD 4-6 weeks
Gram negative bacilli 2nd line drugs
Pseudomonas Ceftriaxone OR 100 mg/kg/day IV BD 4-6weeks
Cefotaxime 100 mg/kg/day IV TDS 4-6weeks
CAN ADD Vancomycin 60 mg/kg/day TDS 4-6weeks
31
IX. G. Tetanus in children

Tetanus C. tetani Crystalline Penicillin 1-2 lac unit/kg/day QID IV 10 days
Metronidazole 30 mg/kg/day TDS IV 10 days
IX. H. Acute Infective Endocarditis

Acute Infective Streptococcus viridians, Ceftriaxone AND 100 mg/kg every IV 24 hours
Endocarditis Staph aureus are the leading Gentamicin 7.5 mg/kg/day IV divided 8 4-6 weeks
causative organism hours
Others are group D For B lactam allergy
Streptococcus, Vancomycin AND 40g/kg/day IV divided 8 hourly
Serratia marsecens, Gentamicin 7.5 mg/kg/day IV divided
Pseudomonas aeruginosa, 8 hourly
Acute Rheumatic Fever Group A Streptococcus Benzathine Penicillin 1.2 million units IM Single dose
Penicillin V 250 mg QID PO 10 days
Erythromycin 250 mg QID PO 10 days
Secondary prophylaxis for Acute Rheumtic Fever Benzathine Penicillin >30kg: 1.2 million units IM Every 3 weeks
<30kg: 0.6 million units IM
Penicillin V 250 mg BD PO Every 3 weeks
Erythromycin 250 mg BD PO Every 3 weeks
32
IX. I. Cellulitis

Cellulitis Staphylococcus aureus, Cloxacillin OR 50-100 mg/kg/day IV QID 7-10 days
Streptococcus sp. Cefazolin OR 100 mg/kg/day IV TDS 7-10 days
Clindamycin 30 mg/kg/day IV TDS 7-10 days
IX. J. Neonatal Sepsis

Community Acquired GBS, Ampicillin AND 100 mg/kg/day IV QID 10-14 days
Staph aureus, Gram negative Gentamicin 5- 7.5 mg/kg/day divided BD 10-14 days
bacilli (E. coli, Klebsiella)
 In cases with severe sepsis (Sclerema/Shock/suspicion of meningitis) Inj Cefotaxime 200 mg/kg/day IV in 4 div doses) +
Amikacin (15 mg/kg/day) is recommended.
 If Sepsis is suspected to be health care associated or if there is no response in 48-72 hours of initial therapy or if there is
documented resistance then change to injection Piperacillin-Tazobactum (200-300 mg/kg/day/ IV in 3-4 divided doses) and
Amikacin.
33
X. Surgical Antimicrobial Prophylaxis
 To be administered within 1 hours before the surgical incision.

 Single dose is recommended. Consider for second intra-operative dose in prolong surgery based on the choice of antibiotic
used for prophylaxis.
 Prophylaxis should not be given beyond surgery duration (except for cardiothoracic surgery, up to 48 hours permissible)
 Choice of the prophylaxis should be based on the local antibiogram.
SURGERY MEDICATION
Breast Inj. Cefazolin 2 gm OR Inj. Cefuroxime 1.5 gm IV single dose
Gastroduodenal & biliary Inj. Cefaperazone- Sulbactam 2 gm IV single dose & BD for 24 hours(maximum)
ERCP Inj. Piperacillin-Tazobactum 4.5 gm OR Inj. Cefaperazone- Sulbactam 2 gm IV single dose
Cardiothoracic Inj.Cefuroxime 1.5 gm IV single dose & BD for 48 hours
Colonic surgery Inj. Cefaperazone- Sulbactam 2 gm IV single dose & BD for 24 hours (maximum)
Abdominal surgery (hernia) Inj. Cefazolin 2 gm OR Inj. Cefuroxime 1. 5gm IV single dose
Head & Neck/ ENT Inj. Cefazolin 2 gm IV single dose
Neurosurgery Inj. Cefazolin 2 gm OR Inj. Cefuroxime 1.5 gm IV single dose
Obstetrics& Gynecology Inj. Cefuroxime 1.5 gm IV single dose
Orthopaedic Inj. Cefuroxime 1.5 gm IV single dose & BD for 24 hours (maximum)
OR
Inj. Cefazolin 2 gm IV single dose
Open reduction of closed fracture with internal fixation- Inj. Cefuroxime 1.5 gm IV single dose
and q 12 hours OR Inj. Cefazolin 2 gm IV single dose and q 12 hours for 24 hours
Trauma Inj. Cefuroxime 1.5 gm IV single dose and q 12 hours (for 24 hours)
OR Inj. Ceftriaxone 2 gm IV OD
Urologic procedures Antibiotics only to patients with documented bacteriuria
Trans- rectal prostatic surgery Inj. Cefaperazone- Sulbactam 2 gm IV single dose
34
X. A. Paediatric Surgical Cases
Clean Surgery Clean Surgery likely to be Contaminated/dirty Surgery or Peritonitis

contaminated
Surgeries like Uncomplicated Hernia, cyst For GI surgeries All surgeries under this group
excision, hydrocoele - No Pre-operative
prophylaxis needed Inj Ceftriaxone 50 – 75 mg/kg/day, Inj Ceftriaxone 50 – 75 mg/kg/day IV OR IM 12
IV or I/M 12 hourly doses AND hourly doses
Metronidazole 20 – 30 mg/kg/day Metronidazole 20 – 30 mg/kg/day IV every 8 hourly

IV every 8 hourly AND
Given for 48 hourly only. Gentamicin 7.5mg/kg/day 24 hourly IV OR IM
For all other surgeries under this Urinary tract surgeries 2nd Line
group:
Inj Ceftriaxone 50 – 75 mg/kg/day I.V Inj Ceftriaxone 50 – 75 mg/kg/day Piperacillin + Tazobactam (200-300 mg/kg/day IV in
or I/M single dose half an hour before IV OR IM 12 hourly doses 3-4 divided doses) + Vancomycin (40 mg/kg/day IV
surgery in 4 divided doses)
Do not continue beyond 48 hourly of
surgery
35

Antibiotic Policy - Final GovtMP - 211215 - 121049

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Antibiotic Policy - Final GovtMP - 211215 - 121049

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Dr. Debasis Biswas …………......Chairmen

Dr. Ratinder Jhaj…………......Member

Dr. Girish Bhatt…………......Member

Dr. Parash Kumar Jain …………......Member

Dr. Pankaj Shukla…………......Member

Dr. Archana Mishra…………......Member

Dr. Rakesh Shrivastava…………......Member

Dr. Preeti Deopujari…………......Member

Dr. Anil Chaturvedi…………......Member

Dr. Smita Saxena…………......Member

Dr. Vivek Mishra…………......Member Secretary

(Dr. Debasis Biswas)

Sr. No. Topic Page No.

II. CNS Infections 05

III. Skin and Soft Tissue Infections 08

IV. Genitourinary Infections 10

VI. Gastrointestinal & Intra-Abdominal Infections 18

VII. Bone & Joint Infections 21

IX. Pediatric Infections 24

X. Surgical Antimicrobial Prophylaxis 34

Condition Situation/ Most likely Drug Dose Duration

Moderate infection S aureus Ertapenem OR 1 gm IV q 24 hours 7-10 days

Condition Most likely organisms Drug Dose Duration

Initial inpatient Inpatient regimen:

pts with tubo-ovarian abscess. dose continue treatment until

Drainage of tubo-ovarian abscess Clindamycin 900 mg IV q 8 satisfactory response for

Evaluate and treat sex partner. regimen.

Obstetric Sepsis following S. pyogenes, Same as above

Food poisoning S. aureus,

*1-2 gm intravenously (IV) every 8 hours

1. Lungs : follow pneumonia guidelines

IX. A. Pediatric Respiratory Tract Infections

Condition Most likely organisms Drug Dose Duration

Pnumonia > 2 months Amoxicillin 80-90 mg/kg/day QID 7-10 days

Condition Most likely organisms Drug Dose Duration

Condition Most likely organisms Drug Dose Duration

Condition Most likely organisms Drug Dose Duration

If mild cystitis (3-5 days) Gentamicin 5-6 mg/kg/day IV OD

Condition Most likely organisms Drug Dose Duration

IX. F. Pediatric Bone & Joint Infections

Condition Most likely organisms Drug Dose Duration

Condition Most likely organisms Drug Dose Duration

IX. H. Acute Infective Endocarditis

Condition Most likely organisms Drug Dose Duration

Condition Most likely organisms Drug Dose Duration

IX. J. Neonatal Sepsis

Condition Most likely organisms Drug Dose Duration

 To be administered within 1 hours before the surgical incision.

Clean Surgery Clean Surgery likely to be Contaminated/dirty Surgery or Peritonitis

Metronidazole 20 – 30 mg/kg/day Metronidazole 20 – 30 mg/kg/day IV every 8 hourly

Given for 48 hourly only. Gentamicin 7.5mg/kg/day 24 hourly IV OR IM

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