{"id":765,"date":"2016-08-22T12:04:37","date_gmt":"2016-08-22T12:04:37","guid":{"rendered":"http:\/\/emedsa.org.au\/CoreMed\/?p=765"},"modified":"2017-11-11T23:59:34","modified_gmt":"2017-11-11T23:59:34","slug":"antibiotics","status":"publish","type":"post","link":"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/22\/antibiotics\/","title":{"rendered":"Antibiotics"},"content":{"rendered":"<p><a href=\"http:\/\/twitter.com\/share?url=http%3A%2F%2Femedsa.org.au%2FCoreMed%2F2016%2F08%2F22%2Fantibiotics%2F&amp;count=none&amp;text=Antibiotics - CoreMed\" class=\"twitter-share-button\">Tweet<\/a><\/p><p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-767\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Penicillin.jpg\" alt=\"Penicillin\" width=\"768\" height=\"759\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Penicillin.jpg 768w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Penicillin-300x296.jpg 300w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Penicillin-624x617.jpg 624w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Penicillin-60x60.jpg 60w\" sizes=\"auto, (max-width: 768px) 100vw, 768px\" \/><\/p>\n<ul>\n<li>Antibiotics are commonly prescribed medications in the acute setting<\/li>\n<li>It is useful to commit to memory the regimes for common infections e.g. pneumonia, urinary tract infections and cellulitis<\/li>\n<li>For more unusual infections, returned travellers and recent immigrants consult a microbiologist<\/li>\n<li>The relationship between site of infection, likely organism(s) and effective empirical antibiotic has some loose patterns but some regimes have to be memorised by rote<\/li>\n<li>A delay in administering antibiotics increases the mortality from <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/25\/sepsis-pathology\/\">sepsis<\/a><\/li>\n<li>Ongoing treatment may need to be modified after subsequent culture results and sensitivities are returned<\/li>\n<\/ul>\n<p><strong>ANTIBIOTIC REGIMES BY SITE OF INFECTION<\/strong><\/p>\n<ul>\n<li>The following table is a simplified account for community acquired <em>bacterial<\/em> infections &#8211; outpatient and inpatient based on <a href=\"https:\/\/www.tg.org.au\">Australian Therapeutic Guidelines<\/a><\/li>\n<li>Hospital-in-the home regimes may have alternative or modified regimes to standard inpatient treatments.<\/li>\n<li>Post-op prophylaxis and post-surgical infections are not included.<\/li>\n<\/ul>\n<p>The choice is based on first line empiric prescribing on known sensitivities in Metropolitan areas\u00a0before culture results are available. (Do not follow this in indigenous populations or Far North Australia)<\/p>\n<p>Unless specified the antibiotic chosen is appropriate also for <i>pregnancy<\/i> and <i>children<\/i>.<\/p>\n<p>Use caution in amino-glycoside dosing in patients with renal failure<\/p>\n<p>There may be cheaper or simpler options if the above considerations are not required.<\/p>\n<p>An alternative is suggested for true beta lactam allergy (severe reactions are actually rare and cross-reactivity between penicillins and cephalosporins even less so particularly for the third generation variants).<\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"middle\"><b>Clinical condition<\/b><\/td>\n<td valign=\"middle\"><b>Outpatient (oral)<\/b><\/td>\n<td valign=\"middle\"><b>In-patient (IV)<\/b><\/td>\n<td valign=\"middle\"><b>Pencillin ADR<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Meningitis<\/b><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Ceftriaxone<\/td>\n<td valign=\"middle\">Vancomycin<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Periorbital cellulitis<\/b><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Flucloxacillin<\/p>\n<p>Ceftriaxone<\/td>\n<td valign=\"middle\">Cephazolin<\/p>\n<p>Ceftriaxone<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Bacterial URTI (tonsillitis)<\/b><\/td>\n<td valign=\"middle\">Penicillin<\/td>\n<td valign=\"middle\">Penicillin<\/td>\n<td valign=\"middle\">Roxithromycin<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>LRTI\u00a0<\/b><\/td>\n<td valign=\"middle\">Roxithromycin<\/td>\n<td valign=\"middle\">Ampicillin +<\/p>\n<p>Doxcyline<\/p>\n<p>(mild moderate)<\/p>\n<p>Ceftriaxone +<\/p>\n<p>Azithromycin<\/p>\n<p>(severe cases)<\/td>\n<td valign=\"middle\">1st gen cephalopsporin +<\/p>\n<p>Doxcycline<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Endocarditis<\/b><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Ampicillin +<\/p>\n<p>Gentamicin<\/p>\n<p>(SBE)<\/p>\n<p>Flucloxacillin<\/p>\n<p>(BE)<\/td>\n<td valign=\"middle\">Vancomycin<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Intra-abdominal infections<\/b><\/td>\n<td valign=\"middle\">Augmentin<\/td>\n<td valign=\"middle\">Ampicillin +<\/p>\n<p>Gentamicin +<\/p>\n<p>Metronidazole<\/p>\n<p>(&#8216;triple antibiotics&#8217;)<\/td>\n<td valign=\"middle\">Cephazolin + Gentamicin +<\/p>\n<p>Metronidazole<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>UTI<\/b><\/td>\n<td valign=\"middle\">Ampicilllin<\/td>\n<td valign=\"middle\">Ampicillin +<\/p>\n<p>Gentamicin<\/td>\n<td valign=\"middle\">Cephalexin (mild)<\/p>\n<p>Ceftriaxone (severe)<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>PID (STD)<\/b><\/td>\n<td valign=\"middle\">Cetriaxone IM once stat +<\/p>\n<p>Azithromycin<\/td>\n<td valign=\"middle\">Ceftriaxone +<\/p>\n<p>Azithromycin<\/td>\n<td valign=\"middle\"><\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Skin \/ MSK<\/b><\/td>\n<td valign=\"middle\">Flucloxacillin<\/td>\n<td valign=\"middle\">Flucloxacillin<\/td>\n<td valign=\"middle\">1st gen cephalosporin<\/p>\n<p>OR<\/p>\n<p>Clindamycin<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><b>Antibiotic spectra &#8211; simplified<\/b><\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"middle\"><b>BACTERIAL CLASS<\/b><\/td>\n<td valign=\"middle\"><b>TYPICAL ORGANISM<\/b><\/td>\n<td valign=\"middle\"><b>TYPICAL ANTIBIOTIC<\/b><\/td>\n<td valign=\"middle\"><b>OTHER ORGANISM<\/b><\/td>\n<td valign=\"middle\"><b>SPECIAL ANTIBIOTIC<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Gram +ve<\/b><\/td>\n<td valign=\"middle\">Strep<\/p>\n<p>Staph<\/td>\n<td valign=\"middle\">1st\u00a0 gen cephalosporin<\/p>\n<p>Flucloxacillin<\/td>\n<td valign=\"middle\">&#8216;Enterococcus&#8217; &#8211; Strep faecalis<\/p>\n<p>MRSA<\/td>\n<td valign=\"middle\">Ampicillin<\/p>\n<p>Vancomycin<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Gram -ve<\/b><\/td>\n<td valign=\"middle\">Various<\/td>\n<td valign=\"middle\">Gentamicin<\/td>\n<td valign=\"middle\">Pseudomonas<\/td>\n<td valign=\"middle\">Piperacillin<\/p>\n<p>Ciprofloxacin<\/p>\n<p>Cefotaxime<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Anaerobe<\/b><\/td>\n<td valign=\"middle\">Various<\/td>\n<td valign=\"middle\">Metronidazole<\/p>\n<p>Clindamycin<\/td>\n<td valign=\"middle\">Clostridia<\/td>\n<td valign=\"middle\">Penicillin<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><b>Pencillin classification<\/b> &#8211; simplified<\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"middle\"><b>\u00a0<\/b><\/td>\n<td valign=\"middle\"><b>Examples<\/b><\/td>\n<td valign=\"middle\"><b>Spectra<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Standard<\/b><\/td>\n<td valign=\"middle\">Phenoxypenicillin (Pen G) PO<\/p>\n<p>Benzylpenicillin (Pen V) IV<\/td>\n<td valign=\"middle\">Gram +ve<\/p>\n<p>(some Gram -ve)<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Extended cover<\/b><\/td>\n<td valign=\"middle\">Ampicillin \/ Amoxycillin \/Augmentin<\/td>\n<td valign=\"middle\">More Gram -ve<\/p>\n<p>Enterococcus<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Anti-staph<\/b><\/td>\n<td valign=\"middle\">Flucloxacillin<\/td>\n<td valign=\"middle\">Staph. aureus<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Anti-pseudomonal<\/b><\/td>\n<td valign=\"middle\">Ticarcillin<\/p>\n<p>Piperacillin<\/td>\n<td valign=\"middle\">Pseudomonas<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><b>Cephalosporin classification<\/b> &#8211; simplified<\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"middle\"><b>Generation<\/b><\/td>\n<td valign=\"middle\"><b>Examples<\/b><\/td>\n<td valign=\"middle\"><b>Spectra<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>1st<\/b><\/td>\n<td valign=\"middle\">Cephalexin PO<\/p>\n<p>Cephazolin IV<\/td>\n<td valign=\"middle\">Gram +ve<\/p>\n<p>(some Gram -ve)<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>2nd<\/b><\/td>\n<td valign=\"middle\">Cefaclor PO<\/p>\n<p>Cefotetan IV<\/td>\n<td valign=\"middle\">More Gram -ve<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>3rd<\/b><\/td>\n<td valign=\"middle\">Ceftriaxone<\/td>\n<td valign=\"middle\">Extended Gram -ve<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Antipseudomonal<\/b><\/td>\n<td valign=\"middle\">Cefepime<\/td>\n<td valign=\"middle\">Pseudomonas<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>* No cephalosporin is active against enterococcus<\/p>\n<p><b>Adult Antibiotic doses<\/b> (typical &#8211; consult Therapeutic guidelines)<\/p>\n<table cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td valign=\"middle\"><b>\u00a0<\/b><\/td>\n<td valign=\"middle\"><b>250MG<\/b><\/td>\n<td valign=\"middle\"><b>300mg<\/b><\/td>\n<td valign=\"middle\"><b>500mg<\/b><\/td>\n<td valign=\"middle\"><b>1g<\/b><\/td>\n<td valign=\"middle\"><b>1.2g<\/b><\/td>\n<td valign=\"middle\"><b>1.5g<\/b><\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>Daily<\/b><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Trimethoprim<\/p>\n<p>Roxithromycin<\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Ceftriaxone<\/p>\n<p>(2g bd in meningitis)<\/p>\n<p>Azithromycin<\/p>\n<p>&nbsp;<\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\"><\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>BD<\/b><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Cephalexin\u00a0 (for UTI)<\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Vancomycin<\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>TDS<\/b><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Ampicillin PO\/IV<\/p>\n<p>Erythtromycin IV<\/p>\n<p>Metronidazole IV<\/td>\n<td valign=\"middle\">Cephazolin<\/p>\n<p>Cefotaxime<\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\"><\/td>\n<\/tr>\n<tr>\n<td valign=\"middle\"><b>QID<\/b><\/td>\n<td valign=\"middle\">Erythromycin PO<\/td>\n<td valign=\"middle\"><\/td>\n<td valign=\"middle\">Cephalexin<\/p>\n<p>Pencillin\/Flucloxacillin PO<\/td>\n<td valign=\"middle\">Flucloxacillin PO<\/td>\n<td valign=\"middle\">Pencillin IV<\/td>\n<td valign=\"middle\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tweet Antibiotics are commonly prescribed medications in the acute setting It is useful to commit to memory the regimes for common infections e.g. pneumonia, urinary tract infections and cellulitis For&#8230; 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