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 |
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