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Conditions
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Preferred
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Alternative
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Comments
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Neisseria meningitides
Household and close contact |
Ciprofloxacin 500 mg PO single dose |
Rifampicin 600 mg PO q12H for 2 days
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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).
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Upper GI bleeding in cirrhosis
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Ceftriaxone 1 - 2 gm IV q24h for 2 - 7 days
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Ciprofloxacin 500 mg PO q12H 2 - 7 days |
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Spontaneous bacterial peritonitis
Indication: Previous proven SBP acsitic protein < 10 g/L
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Co-trimoxazole (480 mg) 2 tablets PO q24H |
Norfloxacin 400 mg PO q24H
OR
Ciprofloxacin 500 mg PO q24H
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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
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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. |
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