ID

ID

Antibiotics

ID Meds

Meningitis & Encephalitis

Antibiotics

Pneumonia

1. Community-Acquired, discharge: Augmentin 625mg TDS, Clarithromycin 500mg BD 7-10d

2. Community-Acquired, admit: Augmentin 1.2g IV, or Clarithromycin 500mg PO or Azithromycin 500mg IV

3. suspected Malleidosis: PenG 4MU, Ceftazidime 2g IV, Clarithromycin

4. Nosocomial (Pseudomonas + Staph):

a. Pip-Tazo 4.5g IV +/- Amikacin 15mg/kg once daily if clinically sick

b. Imipenem is only 75% sensitive! (so, stay away from Carbapenems)

5. Healthcare-associated (3 months in nursing home or dialysis centre)

- same as nosocomial

*1st dose of antibiotics usually doesn't matter if renally impaired

UTI

- criteria: >= 60 WBC/dL

significant bacteriuria >10(4)

no pyuria = no UTI

1. CA, discharge: Augmentin 625mg TDS or Amoxicillin 1g TDS or Ciprofloxacin 750mg BD, female 5 days, male 10-14 days

2. CA, admit:

>= 60 GFR: Gentamycin 5mg/kg q24hrs

40-59: Gentamycin 5mg/kg q36hrs

<40: Augmentin 1.2g IV q 12hrs

- if sick: Augmentin + Gentamycin

3. HCA:

>= 60 GFR: Amikacin 15mg/kg q24hrs

40-59: Amikacin 15mg/kg q 36hrs

<40: Ceftazidime 2g q8hrs

if sick: Imipinem + Amikacin

Sepsis, Unknown source

1. CA: Ceftriaxone 2g IV

2. HCA: Amikacin

3. suspected Intraabdominal sepsis: Pip-Tazo

Bronchitis, discharge: Clarithromycin

Cellulitis: Cephalexin 1g TDS

Note:

CA - Community acquired

HCA - Healthcare associated

Meningitis & Encephalitis

Empiric Treatment

Meningitis: Fever + Neck stiffness (Jolt test 100% Sn)

1. Ceftriaxone 2g IV

2. Dexamethasone 0.15mg/kg Q6hr x4d (10mg max): before or with antibiotics

- not to neonates <6 weeks

Encephalitis: Fever + AMS

1. Acyclovir 10mg/kg over 1 hour: 250mg/10mL vial

-Q8h x10d (if 65kg, then 650mg Q8H)

(precipitates in renal tubules if given bolus; adjust if renal failure)

ID Meds

• Penicillin-allergy will cross-react 10% to cephalosporins is a MYTH (link 1) (link 2)

Faget's sign - Pulse Temperature Dissocation

• Typhoid fever, malaria, Leptospirosis
• Atypical Pneumonia (CML Chlamydia, Mycoplasma, Legionnaire’s disease)
• viral infections such as dengue fever, yellow fever, and viral hemorrhagic fevers
• babesiosis, Q fever, infection with Rickettsia sp., Tularemia, Colorado tick fever

* increase in the pulse of 8 beats per minute for each Centigrade degree of fever (Liebermeister's rule)

*the axillary temperature averages about 1 degree Fahrenheit lower than the oral temperature. A higher axillary temperature than oral temperature suggests hyperthyroidism (Lucatello's sign).