3.13.2 - Non Surgical





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

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

Phenoxymethylpenicillin 250 - 500 mg PO q12H

Amoxycillin 1 gm PO STAT, then q8H

Co-amoxiclav 625 mg PO STAT, then q8H

Co-amoxiclav 1.2 gm IV q8H


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.