3.13.2 - Non Surgical [updated]

Conditions

Preferred

Alternative

Comments
 
Neisseria meningitides
Household and close contact		  

Ciprofloxacin 500 mg PO single dose

OR

Rifampicin 600 mg PO q12H for 2 days (not recommended in pregnant women)		  

Ceftriaxone 250mg IV single dose (for pregnant and lactating mothers)

Or

Azithromycin 500mg PO single dose		  

Avoid ciprofloxacin in pregnancy.


Close contacts:

Include individual who had >8 hours contact while in close proximity to the patient (within 1 meter of the index case) or who have been directly exposed to the patient's oral secretions during the seven days before the onset of the patient's symptoms and until 24 hours after initiation of appropriate antibiotic.

 

Exposure through:

·         Contact with oropharyngeal secretions (e.g. kissing, sharing toys, beverages, cigarettes, intubating).

·         Household members, roommates, intimate contacts, contacts at a childcare center, young adults exposed in dormitories, military recruits exposed in training centers

Travellers who had direct contact with respiratory secretions from an index patient or who were seated directly next to an index patient on a prolonged flight (ie, one lasting ≥8 hours)
 
Upper GI bleeding in cirrhosis

  

Ceftriaxone 1 - 2 gm IV q24h for 7 days.

Change to

Ciprofloxacin 500mg PO q12H if patient discharge before completing 7 days

  

Ciprofloxacin 500 mg PO q12H 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



  

Phenoxymethylpenicilin (Penicillin V) 125mg-250mg PO q12H











Amoxycillin 500mg PO STAT, then q8H

OR
  
Co-amoxiclav 625 mg PO STAT, then q8H

 

If patient is on  Erythromycin Ethyl Succinate for prophylaxis, increase dose to 800 mg PO q12H 





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		  


Amoxicillin 250-500mg PO q12H

 

or(if penicillin allergy) Erythromycin Ethyl Succinate 400 mg PO q12H 


erythromycin Ethylsuccinate 15-20mg/kg/dose PO q12H (peadiatric)


















Cefuroxime 1.5 gm IV q8H
+ Metronidazole 500 mg IV q8H		  

Duration: Minimum 2 years post splenectomy but preferably lifelong. However, antibacterial prophylaxis may be discontinued in those over 5 years of age with sickle-cell disease who have received pneumococcal immunisation and who do not have a history of severe pneumococcal infection




































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

Upper Gastrointestinal scopes for obstructive lesion

All endoscopic procedures with *high risk of bacteremia, including procedures not listed above (eg, routine endoscopy with oesophageal stricture dilation or endoscopic sclerotherapy)

 
Ampicillin 2 gm IV or IM within 60 minutes prior to procedure 		 

If penicillin hypersensitivity:

Clindamycin 600 mg PO

within 60 minutes before procedure or

Clindamycin 900 mg IV

Within 60 minutes prior to procedure.

 

*high risk of bacteremia-

Immunocompromised patients (eg. Severe neutropenia (absolute neutrophil count <500cells/mm3), advanced hematologic malignancy

Patients at high risk for post-procedural infections may also include those with decreased gastric acidity and motility resulting from malignancy or acid suppression