Hospital Antibiotic Policy Date of Issue :

22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

ANTIBIOTIC POLICY
POLICY & PROCEDURE

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 1 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

INTRODUCTION
Antibiotics are essential treatments for serious infections. They are one of the most
important and valuable discoveries of modern medicine. However administration of antibiotics
can lead to the selection of antibiotic-resistant organisms. These organisms can give rise to
healthcare-associated infections which are associated with increased morbidity and mortality.
Therefore it is important to ensure that antibiotics are prescribed in a way which
minimizes the risk of healthcare-associated infections. Hospital Antibiotic Guidelines have been
designed to treat common infections effectively and with the minimum risk of healthcare-
associated infections. The current antibiotic policy describes the procedures to encourage the use
of the Antibiotic Guidelines and to ensure that antibiotics are not prescribed in a way which is
likely to lead to healthcare-associated infections.
This policy deals with the processes by which recommendations for specific antibiotic
treatments are made and the procedures to support these recommendations. It does not provide
specific advice on which antibiotics should be used in specific infections as this is covered in the
Drug Formulary Antibiotic Guidelines. This policy also does not provide information on which
antibiotics are regarded as having the highest risk of causing healthcare-associated infections nor
on which antibiotics can only be used following advice from a microbiologist or infectious
diseases physician. This is because this will vary between clinical areas depending on recent
infection surveillance data.

PURPOSE OF THIS POLICY

The aim of implementing this policy throughout the hospital is to ensure that antibiotics are used
appropriately. This should result in more effective treatment of infections so that patient
outcomes are optimized. In addition appropriate antibiotic use should minimize the risk of
healthcare-associated infections occurring and this produces benefits for patients and staff and
for service delivery and clinical outcomes.

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 2 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

1. Anti-Microbial Pre-Operative Prophylaxis Guidelines

Ideally, an antimicrobial agent for surgical prophylaxis should (1) prevent SSI, (2) prevent SSI-
related morbidity and mortality, (3) reduce the duration and cost of health care (when the costs
associated with the management of SSI are considered, the cost-effectiveness of prophylaxis
becomes evident), (4) produce no adverse effects, and (5) have no adverse consequences for the
microbial flora of the patient or the hospital.53
To achieve these goals, an antimicrobial agent should be (1) active against the pathogens most
likely to contaminate the surgical site, (2) given in an appropriate dosage and at a time that
ensures adequate serum and tissue concentrations during the period of potential contamination,
(3) safe, and (4) administered for the shortest effective period to minimize adverse effects, the
development of resistance, and costs
These Recommendations are provided for adult (age 19 years or older) and pediatric (age 1–
18years) patients. These guidelines do not specifically address newborn(premature and full-term)
infants.
While the guidelines do not address all concerns for patients with renal or hepatic dysfunction,
antimicrobial prophylaxis often does not need to be modified for these patients when given as a
single preoperative dose before surgical incision.
The recommendations herein may not be appropriate for use in all clinical situations. Decisions
to follow these recommendations must be based on the judgment of the clinician and
consideration of individual patient circumstances and available resources.

a. Preoperative-dose timing:
Successful prophylaxis requires the delivery of the antimicrobial to the operative site before
contamination occurs. Thus, the antimicrobial agent should be administered at such a time to
provide serum and tissue concentrations exceeding the minimum inhibitory concentration (MIC)
for the probable organisms associated with the procedure, at the time of incision, and for the
duration of the procedure.

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 3 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Overall, administration of the first dose of antimicrobial beginning within 60 minutes before
surgical incision is recommended.
Administration of vancomycin and fluoroquinolones should begin within 120 minutes before
surgical incision because of the prolonged infusion times required for these drugs. Because these
drugs have long half-lives, this early administration should not compromise serum levels of these
agents during most surgical procedures.

b. Selection and dosing:

To ensure that adequate serum and tissue concentrations of antimicrobial agents for prophylaxis
of SSIs are achieved, antimicrobial specific pharmacokinetic and pharmacodynamics properties
and patient factors must be considered when selecting a dose.
It seems advisable to administer prophylactic agents in a manner that will ensure adequate levels
of drug in serum and tissue for the interval during which the surgical site is open.

Weight-based dosing: The dosing of most antimicrobials in pediatric patients is based on body
weight, but the dosing of many antimicrobials in adults is not based on body weight, because it is
safe, effective, and convenient to use standardized doses for most of the adult patient population.
However, in obese patients, especially those who are morbidly obese, serum and tissue
concentrations of some drugs may differ from those in normal-weight patients because of
pharmacokinetic alterations that depend on the lipophilicity of the drug and other factors.
Obesity has been recognized as a risk factor for SSI; therefore, optimal dosing of antimicrobial
prophylaxis is needed in these patients.

c. Redosing.
Intraoperative redosing is needed to ensure adequate serum and tissue concentrations of the
antimicrobial if the duration of the procedure exceeds two half-lives of the antimicrobial or there
is excessive blood loss (i.e., >1500 mL)

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 4 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

The redosing interval should be measured from the time of administration of the preoperative
dose, not from the beginning of the procedure.
Redosing may also be warranted if there are factors that shorten the half-life of the antimicrobial
agent (e.g., extensive burns)
Redosing may not be warranted in patients in whom the half-life of the antimicrobial agent is
prolonged (e.g., patients with renal insufficiency or renal failure)

d. Duration.:
The duration of antimicrobial prophylaxis should be less than 24 hours for most procedures.
A cardiothoracic procedure for which prophylaxis duration of up to 48 hours has been accepted
without evidence to support the practice is an area that remains controversial.
Moreover, prolonged prophylaxis was associated with an increased risk of acquired antimicrobial
resistance compared with short-term prophylaxis
There are no data to support the continuation of antimicrobial prophylaxis until all indwelling
drains and intravascular catheters are removed

e. Drug administration
The preferred route of administration varies with the type of procedure, but for a majority of
procedures, i.v. administration is ideal because it produces rapid, reliable, and predictable serum
and tissue concentrations.

f. Patients with prosthetic implants.

For patients with existing prosthetic implants who undergo an invasive procedure, there is no
evidence that antimicrobial prophylaxis prevents infections of the implant. However, updated
guidelines from the American Heart Association (AHA) suggest that prophylaxis may be
justified in a limited subset of patients for the prevention of endocarditis.

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 5 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

g. Drug of choice:
For most procedures, cefazolin is the drug of choice for prophylaxis because it is the most widely
studied antimicrobial agent, with proven efficacy. It has a desirable duration of action, spectrum
of activity against organisms commonly encountered in surgery, reasonable safety, and low cost.
Routine use of vancomycin prophylaxis is not recommended for any procedure.8 Vancomycin
may be included in the regimen of choice when a cluster of
MRSA cases (e.g., mediastinitis after cardiac procedures) or methicillinresistant coagulase-
negative staphylococci SSIs have been detected at an institution. Vancomycin prophylaxis
should be considered for patients with known MRSA colonization or at high risk for MRSA
colonization in the absence of surveillance data (e.g., patients with recent hospitalization,
nursing-home residents, hemodialysis patients).
In institutions with SSIs attributable to communityassociated MRSA, antimicrobial agents with
known in vitro activity against this pathogen may be considered as an alternative to vancomycin.
The use of vancomycin for MRSA prophylaxis does not supplant the need for routine surgical
prophylaxis appropriate for the type of procedure.
When vancomycin is used, it can almost always be used as a single dose due to its long half-life.
Patients receiving therapeutic antimicrobials for a remote infection before surgery should also be
given antimicrobial prophylaxis before surgery to ensure adequate serum and tissue levels of
antimicrobials with activity against likely pathogens for the duration of the operation.
If the agents used therapeutically are appropriate for surgical prophylaxis, administering an extra
dose within 60 minutes before surgical incision is sufficient. Otherwise, the antimicrobial
prophylaxis recommended for the planned procedure should be used.
For patients with indwelling tubes or drains, consideration may be given to using prophylactic
agents active against pathogens found in these devices before the procedure, even though
therapeutic treatment for pathogens in drains is not indicated at other times.
For patients with chronic renal failure receiving vancomycin, a preoperative dose of cefazolin
should be considered instead of an extra dose of vancomycin, particularly if the probable

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 6 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

pathogens associated with the procedure are gram-negative. In most circumstances, elective
surgery should be postponed when the patient has an infection at a remote site.
h. Allergy to b-lactam antimicrobials.
Allergy to b-lactam antimicrobials may be a consideration in the selection of surgical
prophylaxis. The b-lactam antimicrobials, including cephalosporins, are the mainstay of surgical
antimicrobial prophylaxis and are also the most commonly implicated drugs when allergic
reactions occur. Because the predominant organisms in SSIs after clean procedures are gram-
positive, the inclusion of vancomycin may be appropriate for a patient with a life-threatening
allergy to b-lactam antimicrobials.
Although true Type 1 (immunoglobulin E [IgE]-mediated) crossallergic reactions between
penicillins, cephalosporins, and carbapenems are uncommon, cephalosporins and carbapenems
should not be used for surgical prophylaxis in patients with documented or presumed
IgEmediated penicillin allergy.
Refer
Annexure 1: Recommended doses and redosing intervals for commonly used antimicrobials
Annexure 2: Recommendations for surgical antimicrobial prophylaxis

Antibiotic timing
Duration of prophylaxis
Infusion of the first antimicrobial dose should begin within 60 min
before the surgical incision except for vancomycin and quinolones.
When fluroquinolones or vancomycins are indicated, infusions of
the 1st antimicrobial dose should begin within 120 min before the
incision.
Prophylactic antimicrobials should be discontinued within 24 h
after the end of surgery. Patients who have documented infection
at the time of surgery or within 24 hrs of surgery are excluded
from 24 hrs rule. Additionally post CT surgery patient allowed
upto 48 hrs of treatment.

Screening for b-lactam For those operations for which cephalosporins represent the most
allergy appropriate antimicrobials for prophylaxis, the medical history
should be adequate to determine whether the patient has a history
of allergy or serious adverse antibiotic reaction. Alternative testing
strategies (e.g., skin testing) may be useful for patients with
reported allergy.

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 7 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

2. EMPERICAL TREATMENT FOR INFECTION

2.1.INFECTIVE ENDOCARDITIS ( Follow the Empirical Treatment)

Native valves Ampicillin(12g/d)+Cloxacillin(12g/d) OR
Ceftriaxone 2gm IV Q24H + Gentamycin
3mg/Kg IV /IM 1dose.
In Pt’s allergic to Penicillin Vancomycin 15mg/kg IV Q12H+ Gentamycin.
Prosthetic valves Vancomycin 15mg/kg IV Q12H + Gentamycin
3mg/kg IV 1 dose +Rifampicin 900mg in 2-3
divideddoses.

2.2.URINARY TRACT INFECTIONS

Uncomplicated Cystitis Nitrofurantoin Monohydrate 100mg PO Q12H
for 5 days or
Trimethoprim – Sulphamethoxazole (160/800)
PO Q12H for 3 days
Complicated Cystitis Nitrofurantoin Monohydrate 100mg PO Q12H
for 7 days OR
(For Men and Women)
Cefaperazonesulbactum 1.5 gmsBD .
Complicated Cystitis Nitrofurantoin Monohydrate 100mg Q12H for
7 days or
(For Pregnant Women)
Trimethoprim – Sulphamethoxazole (160/800)
PO Q12H for 3 days
Uncomplicated Pyelonephritis Cefaperazone-Sulbactum 1.5 to 3gm IV Q12H
or Aztreonam 1.5 to 2gm IV Q8H (if Pt’s
allergic to penicillin)

Complicated Pyelonephritis Cefaperazone-Sulbactum 1.5 to 3gm IV Q12H

or Aztreonam 1.5 to 2gm IV Q8H (if Pt’s

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 8 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

allergic to penicillin) or Meropenem 1gm IV

Q8Hly or Imipenem-cilastin 500mg Q6H (if pt.
in septic shock)
Asymptomatic Bacteriuria* No Role for Antibiotic usage

* To be treated with antibiotics in Pregnant women and Pt’s who underwent urogenital
surgery.
2.3.CATHETER RELATED BLOOD STREAM INFECTIONS: ( Follow the Empirical
Treatment)

Cefaperazone + Sulbactum + Vancomycin (30mg/kg/d)

Or
Piperacillin + Tazobactum
OR
Imipenem+cilastatin OR Meropenem ( in shock)

2.4.CNS INFECTIONS
2.4.a. Brain abscess – Follow guidelines
Simple Complex (Following surgical procedure, Head
trauma, Inf. Endocarditis)
1. Ceftriaxone 2gms / BD 1. Ceftriaxone 2gms / BD or Ceftazidime
+ / TDS 2gms
Metronidazole 500mg / TDS +
Metronidazole 500mg / TDS +
Vancomycin 30mg / kg / day
1. Ceftazidime 2gms / IV TDS (in
immunosuppressed)
+
Metronidazole 500mg / TDS

2.4.b. Meningitis:

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 9 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Neonates Cefotaxime (12g / day) + ampicillin (150mg / kg / day)

4 – 12 weeks Ceftriaxone (100mg / kg / day) + ampicillin (150mg / kg / day)
3m – 18 years Ceftriaxone (100mg /kg/day) + Vancomycin 30mg / kg / day
18 – 50 years Ceftriaxone 2gm IV Q12H + Vancomycin 30mg/kg/day
Above 50 years Ceftriaxone 2gm IV Q12H + Vancomycin 30mg/kg/day
Immunocompromised Ceftazidime 2gms / IV Q8H+ Amikacin (15mg / kg / day) +
Vancomycin 30mg / kg / day
Basilar skull fracture Ceftriaxone (2gm IV Q12H + Vancomycin 30mg / kg / day
Head injury Ceftazidime 2gm IV Q8H + Vancomycin 30mg / kg / day
CSF Shunt Ceftazidime 2gm IV Q8H + Vancomycin 30mg / kg / day
Penicillin allergy Vancomycin 30mg / kg / day + Carbapenem (Meropenem 1gm IV Q8H)

2.5.PNEUMONIA
Community acquired pneumonia
2.5.a. OUT PATIENT

No antibiotics used in the last 3 Azithromycin 500mg PO Q24H or

Months
* Comorbidities present and no use of
antibiotics in last 3 months
Antibiotics used in the last 3 months
Comorbidities present and recent use of Pipericillin tazobactum or Cefeperazone
antibiotics in last 3 months
Comorbidities present and recent use of
antibiotics in last 3 months
Clarithromycin 500mg PO Q12H or
Doxycycline 100mg PO Q12H
Macrolides(Azithromycin, Clarithromycin) +
Amoxicillin-clavulunate 625mg PO Q8H
Azithromycin 500mg PO Q24H or/
Clarithromycin 500mg PO Q12H + IV
Sulbactum PO Q8HQ12H
Macrolides(Azithromycin/ Clarithromycin) +
Amoxyclav.

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 10 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

2.5.b. IN PATIENT

Non ICU Admission/in ward Pipericillin tazobactum/ Cefeperazone

Influenza with bacterial superinfection with
comorbidities
ICU admission * With risk factors of
pseudomonas
ICU admission without risk factors of
pseudomonas
ICU admission with * Risk factors for CA –
MRSA
If Patient’s allergic to Penicillin’s
Early Health-care Associated
Pneumonia/VAP ,LateHAP
Sulbactum + Azithromycin (Macrolides) 500mg
IV Q24H
Linezolid 600mg PO Q12H +Cefaperazone-
sulbactum. + Antiviral ( Flivir/tamiflu)
Pipericillin-tazobactum4.5gm Q6H or
Cefaperazone -sulbactum. OR Imipenem-
Cilastin& Levofloxacin.
Cefaperazone-SulbactumORPipericillin-
tazobactum 4.5gm Q6H ORImipenem-Cilastin
(shock) &Meropenem + Azithromycin 500 mg
OD
Piperacillin-Tazobactum 4.5 gm IV Q6H +
Azithromycin 500mg IV Q24H + Linezolid
600mg IV Q12H
Aztreonam +Azithromycin
Piperacillin-Tazobactum 4.5gm Q6H
+Cefaperazone-sulbactum or Meropenem 1gm
Q8H or Imipenem-cilastin + Levofloxacin
+Linezolid600mg IV Q12H.

Risk factors for pseudomonas:

1. Structural lung disease. (bronchiectasis), Cystic Fibrosis

2. Repeated exacerbation of COPD with recent steroids (10 mg/ d) + antibiotics usage.

3. Prior antibiotic therapy.( > 7 days in last 1 month)

4. Sputum / Blood – Consistent on gram stain.

5. Malnutrition

6. Immunocompromised state

7. Parenteral feeding

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 11 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Risk factors for CA – MRSA

1. End stage Renal Disease, Pt. on Hemodialysis
2. Drug (IV) abuse
3. Prior influenza
4. Prior antibiotic treatment – fluoroquinolones.
8. 5. Presence of cavitating infiltration without risk for aspiration.

2.6.Surgical site infections

2.6.a. Clean wound of trunk, head, neck or extremities
Cefazolin 1gm 8th hourly or Clindamycin 600mg 8th hourly till culture is available.
2.6.b. Wound of perineum, operation of GI, genitourinary tract
Cefaperazone-sulbactum +Metronidazole
If MRSA risk-Vancomycin / Linezolid in discretion of clinician.

If patient sepsis send culture & prescribe IV linezolid & Piperecillin Tazobactum
Stable – Augmentin (Amoxicillin-clavulanate)

2.7.Skin & Soft tissue infections (SSTI)

Impetigo Amoxicillin-clavulanate 1gm BD or
Cloxacillin 250 QID
MSSA STI Clindamycin 600mg TDS or
Cloxacillin 500mg QID or
Cefazolin 1gm 8th hourly
MRSA Vancomycin or linezolid
Necrotizing STI: PiperacillinTazobactum + Clindamycin or
Clindamycin +Meropenem

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 12 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

2.8.Gastro intestinal & Abdominal & Infections

Acute Gastroenteritis No Antibiotics needed

Amoebic Dysentery Metronidazole 400mg PO Q8H

Enteric Fever Ceftriaxone 2gm IV BD

Acute Cholecystitis Piperacillin-Tazobactum 4.5 gm IV Q6H

Acute Cholecystitis with shock/advanced Imipenem-cilastin.

age
Spontaneous Bacterial Peritonitis Piperacillin-Tazobactum 4.5 gm IV Q6H

Secondary Peritonitis(community acquired) loading dose followed by 50mg IV Q12H or

Piperacillin-Tazobactum 4.5 gm IV
Q6H/Carbapenems (if in shock)
Secondary Peritonitis(If patient in Imipenem-cilastin +Meropenem + Metronidazole
shock/sick
Ameobic Liver Abscess Metronidazole 750mg IV Q8H for 10 days

If evidence of infection for distal small Add Metronidazole.

bowel,appendix,colon, proximal GI
perforation
Health care associated intra abdominal Piperacillin-Tazobactum 4.5 gm IV
infections. Q8H+Metronidazole.

3. ANTIBIOTIC POLICY FOR PEDIATRIC AND PEDIATRIC CARDIOLOGY

DEPARTMENT

3.1.EMPIRICAL ANTIBIOTICS
1. CARDIAC CATHETERISATION

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 13 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

2. All Pediatric Surgery – Inj.Magnex Forte 60 mg/kg/dose/8th hourly

 Only for cath- Cefazolin - 50 mg /kg/ dose 8thhrly

3. PRE-OPERATIVE PNEUMONIAS

A. Community acquired
 1st line - Amoxicillin & clavulanic acid (100 mg/kg/day in 3 divided doses)
 2nd line – (Magnex,Cefeperazone Sulbactum)_+Amikacin to be added if required
 2nd line- Meropenum,cilaneum+ Amikacin+/- Linezolid
 3rd line- Meropenum,cilaneum+ Linezolid +/- Amikacin

3.2.Nosocomial
 Cefaperazone-sulbactum _+ Amikacin (15 mg/kg/ day in 3 divided doses

 2nd line- Meropenum/Cilanem+Linezolid+/- Amikacin

If gram positive infection is suspected Cloxacillin to be added

Later up gradation depends on throat secretions and blood culture reports as per sensitivity
pattern.

3.3.POST OPERATIVE

 Cefazolin& amkacin (15 mg/kg/day) OD

Duration 48 hrs only
If signs of infection are present, septic screening is done and antibiotics up graded as per culture,
sensitivity reports.
Methicillin resistant steptococcal pneumonia (MRSA)
 Vancomycin (10 mg/kg/dose 6th hourly

Vancomycin if culture sensitivity reports suggest

Second line antibiotics- Cilanem+ Amikacin+/- Linezolid until culture report available.
Prepared by: Infection control committee Reviewed by: Consultants
chairperson

Approved by: Medical Director Signature:

Page 14 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

3.4. LRTI (LOWER RESP: TRACT INFECTION)

3.4.a. COMMUNITY ACQUIRED PNEUMONIA (CAP) – OPD

AGE I LINE ALTERNATIVES

3 Months – 5 Months Amoxicillin Coamoxiclav
30 – 50 mg/kg/day (40mg/kg/day)
> 5 years Amoxicillin Coamoxiclav
30 – 50 mg/kg/day (10 – 20 mg/kg/day)

3.4.b. COMMUNITY ACQUIRED PNEUMONIA (CAP) – IPD

AGE I LINE ALTERNATIVES

3 Months Amoxicillin ceftriaxone
30 – 50 mg/kg/day (50 – 80 mg/kg/day)
Aminoglycosides
>5 year Coamoxyclav Ceftriaxone +

>5 year Coamoxiclav Ceftriaxone

& clarithromycin
(15mg/kg/day)
Azithromycin
(10mg/kg/day)
Suspected staphylococcal pneumoniacefriaxone& cloxacillin, ceftriaxone and
linezolid+cloxacillin
st
Afebrile 1 line- Azithromycin
Febrile- 2nd line Cefperazone sulbactum + Clarithromycin

NOTE: Duration----7 to 14 days (Switch to oral therapy after 48 to 72 hrs)

3.5. (HAP) HEALTH CARE ASSOCIATED PNEUMONIA

EARLY ONSET HAP WITH NO PRIOR ANTIBIOTIC USE:

 Coamoxiclav

EARLY ONSET HAP WITH PRIOR ANTIBIOTIC USE / LATE ONSET HAP
 Amikacin + Cefaperazone
 If ESBL rates are high - Start piperacillintazobactum / cefaperazoneSulbactum
 If child is sick - meropenem
 If MRSA ---- linezolid
Prepared by: Infection control committee Reviewed by: Consultants
chairperson

Approved by: Medical Director Signature:

Page 15 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

3.6. SEPTICEMIA

AGENT Dose (mg/kg/day)

Neonates Ampicillin 100
<7 days Amikacin 5
>7 day Ampicillin & Amikacin 100 + 5
If CNS infection is suspected Vancomycin 40

INFANTS AND CHILDREN

 Ceftriaxone 50
 If CNS infection or resistant streptococcus
pneumonia suspected Vancomycin added 40
 Metronidazole
If intra-abdominal infection suspected - Clindamycin 30

IMMUNO COMPROMISED

 Piperacillin & Tazobactum 300 – 400 mg/kg/day

 Vancomycin to be added if skin or mucus membrane infection present

INFECTIVE ENDOCARDITIS

Prophylaxis Before Surgery

 Ampicilin – 50 mg/kg 1 hr before surgery
 Amikacin– 2.5 mg/kg 1 hr before surgery

Long Term Prophylaxis (for valvularlesson )

 Benzathinepencillin
>28 kg – 1.2 million international units (i.m)
<28 kg – 0.6 million international units (i.m)
4. EMPERICAL ANTIBIOTICS IN INFECTION

Penicillin - G - 2,00,000 kg/day in 4 divided doses

+
Gentamicin—5 mg/kg/day once a day

Antibiotics are up graded as per culture sensitivity pattern

Prepared by: Infection control committee Reviewed by: Consultants
chairperson

Approved by: Medical Director Signature:

Page 16 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

If cultures are negative, empirical antibiotics are upgraded depending on the type of valve lesion
and the suspected organism according to IAP 2007 guidelines

URINARY TRACT INFECTION

A. FOR CHEMOPROPHYLAXIS
 Cephalexin,Cefuroxime – 10 mg/kg/day in 3-4 divided doses for 6 months

B. TREATMENT (PARENTERAL)
 Cefotaxim – 100 – 150 mg/kg/day in 2-3 divided doses

 Amikacin – 15 mg/kg/day in once day doses

C. TREATMENT (ORAL)
 Cephalexim – 10 mg/kg/day in 2 divided doses

Up gradation depending upon the cultures sensitivity patterns

If culture negative, quinolones are added if infection strongly suspected

5. Infusion of Higher Antibiotic:

S. Antibiotics Infusion Rate Test Dose

No
1 Inj. Vancomycin Dilute in 100 ml NS No test dose
over 2hrs
2 Inj. Amphoterecin Dilute in 100ml of 5% As per doctor
dextrose over 2hrs. instruction
3 Inj. Colistin One half of the total No test dose
daily dose given by
direct IV injection
over3-5min and the
remaining half diluted
in 500 ml of 5%
dextrose/ NS and given
over 23 hrs.
4 All cephalosporins(Cefotaxime, Dilute in 100 ml NS Take 0.5ml & give
Cefepime- Tazobactum, Ceftriaxone, over 30min. intradermal
Cefazoline, Cefepime, Cefaperazone+
Sulbactum)
Prepared by: Infection control committee Reviewed by: Consultants
chairperson

Approved by: Medical Director Signature:

Page 17 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

5 Meropenem, Imipenem, Aztreonam, Dilute in 100 ml NS Take 0.5ml & give

Tigecycline, Teicoplanin over 30min. intradermal

6 Pipercillin-tazobactum, Ticarcilline- Dilute in 100 ml NS Take 0.5ml & give

clavulanic acid, amoxycylin- over 30min. intradermal
Clavulanic acid

6 Linezolid 300 ml over 2hrs No test dose

7 Azithromycin , Clarithromycin, 100 ml NS over 1hr. No test dose

8 Ofloxacin, Ciprofloxacin, 100ml NS over 1hr. No test dose

Levoflaxacin, Metronidazole

9 Caspofungin, Anidulafungin 100 ml NS over 1hr. No test dose

10 Cardarone
a) Infusion a) Dilute in 500
ml 5% dextrose
over 24 hrs
b) Bolous b) in 100 ml NS
over 1/2hrs.
11 Amikacin 100 ml NS over 1hr. No test dose

Annexure 1:

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 18 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 19 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 20 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Annexure 2:

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 21 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 22 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 23 of 24
 Hospital Antibiotic Policy Date of Issue :
22/02/2017
Document No : Date of Revision:
SH/AP /M/ 01 08/02/2017

Prepared by: Infection control committee Reviewed by: Consultants

chairperson

Approved by: Medical Director Signature:

Page 24 of 24