4.13.2 - Non Surgical

Conditions

Preferred

Alternative

Comments

 
Neisseria meningitides
Household and close contact
 
Ciprofloxacin 500 mg PO single dose
 
Rifampicin 600 mg PO q12H for 2 days

 
Avoid ciprofloxacin and rifampicin in pregnancy.
Use Ceftriaxone 250 mg IM as single dose.  

Close contacts: have had contact with oropharyngeal secretions (e.g. kissing, sharing toys, beverages, cigarettes, intubating).

 
Upper GI bleeding in cirrhosis

 
Ceftriaxone 1 - 2 gm IV q24h for 2 - 7 days 

 
Ciprofloxacin 500 mg PO q12H 2 - 7 days
 
 
Spontaneous bacterial peritonitis
Indication: Previous proven SBP acsitic protein < 10 g/L

 
Co-trimoxazole (480 mg) 2 tablets PO q24H
 
Norfloxacin 400 mg PO q24H

OR
  
Ciprofloxacin 500 mg PO q24H

 
Only use fluoroquinolone if Co-trimoxazole failed.

Duration: Until liver transplant or liver function improves to a compensated state with resolution of ascites.
 
Asplenia Or Hyposlenia
Pathogen: encapsulated bacteria prophylaxis, recommended for: < 5 year, at least year 3 years post splenectomy, underlying immunocompromised, at least 6 months after an episode of severe sepsis





Emergency supply of antibiotic for self administration when febrile while seeking urgent medication attention






Treatment of post spleenecomised patients (capsulated organisms, gram negative positive, anaerobes; need to cover for capnophagia if contact with animals)








Vaccination recommendation: 
Pneumococcal vaccine 









Meningococcal vaccines 








Hemophilus influenzae type B Influenza



 
Amoxycillin 250 mg PO q12H
or Amoxycillin 500 mg PO q24H

OR
  
Phenoxymethylpenicillin 250 - 500 mg PO q12H



Amoxycillin 1 gm PO STAT, then q8H

OR
  
Co-amoxiclav 625 mg PO STAT, then q8H



Co-amoxiclav 1.2 gm IV q8H

OR

Ampicillin / Sulbactam 3 gm IV q6H

Severe sepsis:
Piperacillin / Tazobactam 4.5 gm IV q6H




13 valent Penumococcal Conjugate vaccine (PCV 13) followed by 23 valent Pneumococcal Polysac vaccine (PPSV23) 8 weeks later. Repeat 5 years later with PPSV23.


Primary immunization:
Meningococcal Quadrivalent conjugate vaccine ACWY 0.5 mL IM and second dose 8 weeks later.
Revaccination every 5 years.


Hib 0.5 mL IM, single dose (no need revaccination)
Influenza vaccine annually
 
Erythromycin Ethyl Succinate 400 mg PO q24H









If taking Erythromycin Ethyl Succinate, increase dose to 800 mg PO q12H 







Cefuroxime 1.5 gm IV q8H
+ Metronidazole 500 mg IV q8H
 




































> 2 weeks before elective surgery
OR 7 - 14 days after emergency splenectomy or prior to discharge.