ANTIOBIOTIC POLICY

INHS ASVINI
INTRODUCTION

1. Hospital acquired infection is the worst curse for the patient and nightmare for the
clinician. That is why more and more hospitals all over the world are switching over to
the OPD services or day care surgery rather than in-patient services. That has put the in-
patients even more vulnerable to nosocomial infections. This infection is not only costly
in terms of suffering and death but posses a tremendous financial burden on the hospitals,
loss of man-hour and legal liability. Each year 2 millions of hospital acquired infections
result in 1,50,000 deaths in USA. It adds an average of 1.5 to 16.6 days to the hospital
stay for patients with various types of infections. The total cost is estimated to be several
billions dollars. The bulk of the cost is spent on antibiotics, alone which has helped
Pharmaceutical Companies to thrive and survive well. Since the era of Penicillin, many
antibiotics has been produced and so also so many antibiotics resistant organisms.
Vancomycin which was supposed to be the highest in the list of antibiotics against MRSA
(methicillin resistant Staph aureus) also known as the “silver bullet” has developed the
latest strain – known as VRE or VRSA – Vancomycin Resistant Enterococci or
Vancomycin resistant Staph aureus which is threatening most of the hospitals of Europe
and USA today. The process is never ending and the problem continues. The magnitude
of problem is in no way less than the environmental problem faced by the world today. It
therefore calls for all out efforts by everybody in the hospital, the clinician in particular to
help and reduce this menace as minimum as possible. Various hospitals have therefore
have set up their Hospital Infection Control Committee (HICC) whose role is to study the
microbiological flora of the hospital environment and formulate measures and guidelines
to reduce the hospital acquired infections. One of the major contributors to this problem is
the abuse and misuses of various antibiotics resulting in production of multi-drug resistant
organisms in the hospital environment. Besides various measures suggested by HICC, it
also advocates regulated use of antibiotics in the hospital rather than its indiscriminate use.
Individualistic or discipline wise approach for antibiotic use must be discouraged. Hence,
it is necessary to formulate an antibiotic policy of the hospital to be used by all discipline
in the hospital.

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2. INHS Asvini spends almost 35% of its total allocated budget of Local Purchase on
higher antibiotics over and above 60 odd varieties of antibiotics available in the PVMS.
The antibiotic policy of INHS Asvini is given in succeeding paragraphs. They are broad
based guidelines and should not be misconstrued as orders. Each case has to be managed
on its merits, under the discretion of the treating clinicians.

AIMS & OBJECTIVE

The aim of the antibiotic policy of the hospital is to
(a) Minimise Hospital Acquired Infection.
(b) To preserve hospital ecology and avoid development of multi-drug resistant
strains and difficult to treat infections.
(c) To keep abreast with latest and older antibiotics and their toxic/side effects
To achieve this aim, Hospital Antibiotic Policy Committee has been liaising with HICC,
Clinicians and Administration. They will be meeting every three months to review and
revise policy from time to time.

PROPHYLACTIC THERAPY
Antibiotic prophylaxis is recommended in cases planned for both cold and emergency
surgery. However, it must not be forgotten that antibiotics are no substitute to “Clean
and neat Surgery”. Strict adherence to aseptic measures, meticulous haemostasis and
clean surgical procedures are the best method of preventing postoperative infection.
Antibiotics are only adjunct to this policy and philosophy. Nevertheless while selecting
antibiotics for prophylaxis therapy following principles should be considered: -
(a) Should be effective against pathogens most likely to be encountered
(b) Should have less toxicity
(c) Antibiotics must be in the tissue before the bacteria are introduced i.e.
antibiotics must be given IV shortly before surgery to ensure high blood/ tissue
levels

(d) Should be given in a single full therapeutic dose through intravenous route, 30
– 60 minutes before surgery.
(e) Second dose should be given if surgery lasts longer than 4 hrs. Post-operatively
only 2/3 doses should be given.
(f) In established infections full and adequate doses must be used.

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Discipline wise recommended Antibiotics Prophylaxis are as follows: -

SURGICAL DISCIPLINE CASES:

(a) General Surgery & GI Surgery cases

i) Clean minor cases –

E.g. Hernia, Hydrocele, Vasectomy, Varicose Veins, Excision of
Cysts
No antibiotics are recommended.
ii) Clean major cases –
E.g. Thyroidectomy, Cholecystectomy, Interval Appendicectomy
3 doses of Inj Ampicilin 500mg each
Ist dose - 2 hrs before surgery
2nd dose - Intra Operative
3rd dose - 6 hrs Post Operative
iii) Clean contaminated cases –
E.g. GI Anastomosis, Emergency Appendicectomy,
Cholecystectomy in acute Cholecystitis, Intestinal resection &
anastomosis. Recommend Prophylaxis
Inj Ampicillin 500 mg IV 6 hrly
Inj Gentamycin 60 mg IM/IV 8 hrly
Inj Metronidazole 500 mg IV 8 hrly
1 day prior to surgery followed till 2nd PO day
Further continuation or discontinuation of antibiotics is as per the antibiotic
sensitivity of isolated organisms.

IV Contaminated and Infected cases-

Initially start as above then change as and when culture and
antibiotic sensitivity test are available. Otherwise
2nd line prophylaxis can be given
Inj Cipro floxacine 250 mg IV BD or Cefoxitin 2 Gm IV
Inj Metronidazole 500 mg IV 8 hrly

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 3rd line prophylaxis
Inj Omnatax 1 gm IV BD
Inj Metronidazole 500 mg IV 8 hrly

GI SURGERY
Gastro-duodenal surgery: Cefuroxime 1.5 gm + Metronidazole 500 mg + second dose if
procedure > 3 hrs / Ciprofloxacin 200 mg + Metronidazole 500 mg + second dose if
procedure > 3hrs.

Biliary tract surgery: At risk patients Ceftriaxone 1 Gm IV

Common bile duct surgery: Augmentin 1.2 gm IV / Ciprofloxacin + Metronidazole

Colo-rectal: Ceftriaxone 1 Gm or Gentamicin 80 mg + Metronidazole 500 mg

Emergency procedures : Cefotaxime 2 Gm + Metronidazole 500 mg continue 8th hrly for
24 hrs / Gentamicin 1.5 Mg / Kg + Clindamycin 600 Mg IV continue 8th hrly for 24 hrs.

Appendicectomy: Metronidazole 500 Mg rectally

If appendix gangrenous: Augmentin 1.2 gm IV 8th hrly for 48 hrs / Gentamicin 1.5 mg /
Kg + Clindamycin 600 mg IV 8th hrly for 48 hrs.

Ruptured gangrenous viscus suspected before surgery: Augmentin 1.2 gm + Gentamicin

1.5 mg/kg 8th hrly for 2 days / Gentamicin 1.5 mg / kg + Clindamycin 600 mg 8th hrly for 2
days.

Laparotomy: Augmentin 1.2 gm + Gentamicin 1.5 mg/kg/ Cefuroxime 1.5 gm +

Metronidazole 500 mg / Gentamicin 1.5 Mg/kg + Clindamycin 600 Mg all 8th hrly for 24
hrs.
V Special Cases
Gas Gangrene: Inj Sodium Penicillin 1-2 mega unit IV 4 hrly
In all diabetic patients with infections a combination of Ampicillin,
Gentamicin and Metronidazole in recommended doses can be given.

All old people above the age of 65 yrs must get antibiotic prophylaxis
irrespective of the procedures.

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 In the absence of any specific indications antibiotics should be stopped
automatically on day 3, 5 or 7 depending upon the severity of the cases.

(b). Urological cases

1. In short procedures like prostate biopsy; Urethral dilatation
etc one single dose of Inj Gentamicin 80 mg IV prior to the
procedure is enough.

2. For various endoscopic procedure – Inj Gentamicin 80 mg

IV an hour prior to procedure followed by oral Tab Norflox
or Tab Cifran for 24 hrs or till removal of catheter

3. Open surgical procedure on Ureter

Inj Gentamicin 80 mg IV starting 2 hrs prior to Surgery
till 24 hrs of drain removal.
Open procedure on Kidney
Inj Ampicillin/Inj Cloxacillin 500 mg IV 6 hrly
Inj Gentamicin 60 mgs IV 8 hrly (wef 2 hrs prior to
surgery till 24 hrs after drain removal).
RENAL TRANSPLANT
Ceftriaxone 1 gm IV single dose or Ticoplanin 400 mg IV single dose.

Urinary Tract Infection

Antibiotics as per Culture & ABST to be given
In pediatric cases doses should be adjusted as per body
weight. In renal-failure cases non-Nephrotoxic antibiotics to
be given.

Cardio-vascular Surgery:
Inj Cefazoline 1 gm Iv x 5 days
Inj Cloxacillin 500 mg IV 6 hrly x 5 days
Inj Amikacin 250 mg IV 12 hrly x 5 days

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(c) Paediatric Surgery Cases
1. Neonatal cases: -
Hospital delivery – Inj Ampicillin100 mg /kg/day &
Inj Gentamicin 5 mg/kg/day for 5 – 7 days.

Neonatal Surgery – Bowel surgery/Thoracotomy

Inj Cephalosporin 100mg/kg/day , Inj Gentamicin 5mg
/kg/day & Inj Mectronidazole 7.5 mg.kg/day for 7 to 10
days.
2nd line Inj Fortum 50 mg/kg/day
2. Other paediatric cases –
Minor procedures – Circumcision, LN biopsy
Inj Ampicillin at induction then 24 hr post operative
Major procedures - Inj Ampicillin & Inj Gentamycin
Bowel resection & anastomosis - Inj Ampicillin, Inj
Gentamycin & Inj Metronidazole during induction till 5 to 7
days post operatively
Septicemia - Inj Omnatax, Inj Metronidazole & Inj
Gentamycin
(d) Neurosurgical cases
1. Clean Cranial/spinal cases
Extra dural - Inj Chloromycetin 500 mg IV one hour
prior to surgery till 48 hrs postoperatively
Intradural - Same as above but continued 5 days post
operatively
VP/TP Shunts - Adult-Inj Sod Penicillin1500 –2000units IV

Inj Chloromycetin 5-10mg/kg one

hour before surgery till 5 days post
operatively

Children – Inj Cefotaxime 40-50mg/kg/day

Inj Gentamycin 0.5-07 mg/kg/day
One hr before surgery to 5 days
Post Op continued 6 hrly IV 24 – 48 hrs

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 2. Infected /Potentially infected cases –
Inj Penicillin 1500-5000units/kg/QID
Inj Chloromycetin 10 mg/kg/QID
Inj Metronidazole 30 – 50 mg/kg/BD
3. Emergency Surgery
Inj Penicillin 1-2 mega units IV
Inj Chloromycetin 500-1000mg IV
for 5 days
Inj Metronidazole 500 mg IV 8 hr
(e) Burns & Reconstructive Surgery cases -
Burns - Fresh cases (within 6 hrs)
Inj Sod Penicillin – initially, later as
per culture and ABST.
Arriving after 6 hrs

Inj Omnatax + Inj Gentamycin

+ Inj Metronidazole

Elective surgery- Cleft palate & Cleft lips

Inj Sod penicillin IV 6hrly
Other planned Surgery
Inj Cloxacillin + Inj Gentamycin

f) Orthopaedic Surgery cases:

1. Compound fractures
Inj. Cloxacillin 500 mg IV 6 hrly x 5 days
Inj Gentamicin 80mg 8 hrly x 5 days
In contaminated cases – Inj Flagyl to be added
In grossly contaminated wounds a combination of Inj
Omnatax, Cloxacillin, and Gentamicin & Flagyl to
be started
2. ORIF - Pre operatively Inj Cloxacillin & Inj
Gentamicin and post operatively x 5 days.
3. Implants - Inj Cloxacillin & Inj Gentamicin

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 4. Joint replacement (THR & TKR) – A combination of
Inj Teicoplanin 400 mg IV and Inj Amikacin 500 mg
8 hrly for 5 days pre-operatively and for 7 days post-
operatively
5. Arthroscopy – Inj Cloxacillin & Inj Gentamycin
single dose 2 days prior to surgery.

(g) Gynaecology and Obstetrics cases:

1. Normal full term delivery with or without episiotomies

No Antibiotics prophylaxis

2. Laparascopic Tubal ligation

No Antibiotics prophylaxis

3. MTP with or without tubectomy

Cap Doxycyclin –1BD x 1 day followed by

1 OD for 4 days and
Tab Tiniba 500 mg – BD x 5 days

4. Diagnostic Laparoscopy
Cap Doxycyclin –1BD first day followed by
1 OD 4 days &
Tab Tiniba 500 mg – BD x 5 days

5. LSCS
Inj. Ampicillin 500 mg IV – 8 hrly x 3 doses &
Inj Gentamycin 60 mg IV – 12 hrly x 3 doses
OR
Inj Omnatax 1 gm – single dose Pre Operatively
Immediate pre-operatively

6. Vaginal or Abdominal Hysterectomy

Inj. Ampicillin 500 mg IV – 8 hrly x 3 doses &
Inj Gentamycin 60 mg IV – 12 hrly x 3 doses
Inj Flagyl 500 mg IV – 8 hourly x 3 doses

7. Premature Rupture of membranes

Inj Ampicillin 500 mg IV – 8 hrly; till delivery and 48 hrs thereafter.

Opthalmological cases:

1. In High risk cases 2nd /3rd generation cephalosporin are used as under .
a) Inj Omnatax 1gm IV BD x 5 days
b) Inj Ceftazidime 1gm IM/IV 8 hrly

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 2. In cases of suspected Endophthalmitis
a) Inj Vancomycin 500 mg 6hrly x 5 days
b) Inj Amikacin 15mg/Kg body weight x 5 days
c) Local application of Vancomycin subconjuctiva/ subtenous and intravetreal
Amikacin.

ENT cases :

(a) Acute Tonsillitis:

Children, Syp Erythromycin 20-40 mg/kg/day x four divided doses x 7days

or
Syp Roxid 5-10 mg /kg/day x two divided doses x 5 days

If no relief 2nd Line Therapy

Syp Amoxicillin-Clavulanate 75 mg/kg/day x three divided doses x 7 days

Syp Clarithromycin 50 mg/kg/day x three divided doses x 7 days
Syp Cefachlor 20-40 mg/kg/day x three divided doses x 5 days

(b) Acute Peritonsillitis:

Inj Ampicillin (1gm), 100mg/kg/day x three divided doses

Inj Gentamycin 4 mg/kg/day x 3 divided doses
Inj Flagyl 15-20 mg/kg/day x three divided doses

(c) Acute Otitis Media:

Children:- Syp Amoxycillin 75mg/kg/day in three divided doses x 10 days

or Syp Erythromycin 30mg/kg/day x four divided dose x 10 days

If no relief 2nd Line Therapy,

Syp Cefachlor 20-40 mg/kg/day X three divided doses x 5 days or Syp
Amoxicillin-Clavulanate Potassium 75-100mg/kg/day x divided four days
x 5 days.

Adults Cap Amoxycillin 500mg 8hrly x 7days or Cap Azithromycin 250

mg 1OD x 5 days or Tab Ciprofloxacin 500 mg BD x 7 days

Cap Amoxicillin-Clavulanate 1000 mg BD x 5 days or Cap Cefachlor 750

mg BD x 5 days.

(d) Chronic Otitis Media:

Cap Amoxycillin 500mg 8hrly x 7days or Tab Ciprofloxacin 500 mg BD x

7 days or Tab Erythromycin 500 mg QID x 7 days.
Supplemented by aural toilet and cleansing and symptomatic therapy.

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(e) Acute Mastoiditis:-

(a) Inj Ampicillin (1gm), 100mg/kg/day x 8 hrly

(b) Inj Gentamycin 4 mg/kg/day x 3 divided doses
(c) Inj Flagyl 15-20 mg/kg/day x 8 hrly

If no relief 2nd Line Therapy

Inj Fortum 100-150 mg/kg/day x 8 hrly
Inj Amikacin 15-20 mg/kg/day x 12 hrly
Inj Flagyl 15-20 mg/kg/day x 8 hrly

(f) Acute Pan sinusitis Uncomplicated:-

Cap Doxycycline (100 mg) 1 BD x 10 days or Cap Minocycline (100 mg) 1 BD x

10 days or Tab Ciprofloxacin (500 mg) 1 BD x 10 days and Tab Tinidazole (300
mg) 1 BD x 5 days

(g) Acute Pan sinusitis (complicated):-

Cap Augmentin 625 mg 1 TDS x 7-10 days or Tab Cefotaxime 500 mg BD x 10

days

(i) Acute Supraglottis:-

Inj Ampicillin (1gm), 100mg/kg/day x 8 hrly

Inj Chloramphenicol 500 mg 6 hrly

If no relief 2nd Line Therapy

Inj Amoxicillin-Clavulanate 1 gm 12 hrly

MEDICAL DISCIPLINE CASES:

Chemoprophylaxis for conditions like

(a) Rheumatic fever - Inj Benzathine Penicillin 1.2 Mega Units once in 3
weeks

(b) Infective Endocarditis - Oral Amoxycillin 3 gm before any procedure

and 1.5 gms after 6 hrs or Erythromycin 1 gm before the procedure or
Clindamycin 300 mgm before the procedure

(c) Meningococcal meningitis - Cap Rifampicin 10 mgm/kg twice a

day for two days and Tab Erythromycin steorate 1g, 2 hrs before the
procedure, then 0.5 gm, 6hrs after the first dose.

(d)High risk cases for genito-urinary / gastrointestinal procedures.

Inj Ampicillin 2 g IV and Inj Gentamicin 1.5 mg/kg (up to 80 mg) IV 30
min before the procedure, which is, repeated 8 hrs after first dose.
OR
Inj Vancomycin 1 g IV single dose 1 hour and Inj Gentamicin 1.5 mg /kg
IV, 1 hour before the procedure, repeated 8 hour after first dose.

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Paediatric & Neonatal cases:
1. Newborn (High Risk) – No prophylaxis
2. Newborn with positive sepsis screen: Inj Ampicillin and Inj
Gentamicin as the first line and Inj Cefotaxime and Inj Amikacin as
the second line.

ANTIBIOTIC THERAPY
Dermatological cases :
S.No. Drugs Remarks
a) Cap Amoxycillin Routinely used for infected lesions
b) Cap Doxycyclin Routinely used for Acne & Pyoderma
c) Tab Erythromycin Routinely used for Infected eczemas
d) Tab Septran Routinely used for S T Diseases
e) Cap Ofloxacin Hansen’s disease
f) Tab Clarithromycin) Sparingly to be used
g) Tab Cefexime) Treatment of Genococcal urethritis
h) Tab Cefuroxime) (occasional)
i) Cap Azithromycin Chancroid, Syphilis

Medical Emergencies :

(a) Septicemia : Is the most common medical emergency when the

antibiotics are to be used. A fair idea of organism causing septicaemia
can be obtained if primary site of infection is known e.g. UTI, Pneumonias
etc and the appropriate antibiotic for these infection should be used.
In most cases when primary site can not be identified, pending culture
reports, broad spectrum antibiotics should be started.
Following combination of antibiotics to be started in life threatening
situations

- Inj Cloxacillin (1-2 gm IV x 6 hrly ) and

- Inj Fortum 2 gm IV bd and
- Inj Metronidazole (5-8 mgm/Kg/8 hrly IV)

Where Pseudomonas septicaemia is suspected following combination

should be used :-
Inj Piperacillin in combination with Tazobactam 4.2 gm IV three times a
day
In Staphylococcal septicemia - Injection Vancomycin 2 gm IV once a day

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 (b) Meningitis : Bacterial meningitis in adults pending culture report :

- Inj Sodium Penicillin 20-24 Mega units IV/day

(2 MU IV x 2 hrly) after sensitivity test and
- Inj Cefotaxime 1-2 gm IV x 8 hrly
OR Ceftriaxone 2 -4gm IV OD

(c ) Common Infections :

Bacterimia due to Gram-ve organism and Coagulase negative Staph

aureus (CON) or Candida antibiotics of choice are
Inj Gentamicin (3-5 mgm/kg/ day) IV in three-divided doses

(d) Urinary tract Infection :

Pattern of Hospital isolates in INHS Asvini are
E.coli: 56%
Klebsiella: 10%
Pseudomonas: 10%
Strepto faecalis:8%
Coagulase -ve Staphylococci
For Non Hospital acquired infection, 1st generation cephalosporin
-Cefazoline is recommended.
For hospital acquired infection: (1) Quinolones
- Norfloxacin 400 mgm bd orally
- Ciprofloxacin 500mgm bd orally
200 mgm bd iv for 10-14days
(2) Inj Amikacin 15 mg/kg per day iv-

Note: It is better to avoid Ciprofloxacin & Norfloxacin for next six months as
the sensitivity is less than 50%. These drugs will be reused after six months
depending the pattern of sensitivity.

(e) Community Acquired pneumonia:

Lobar Pneumonia- Inj sodium penicillin 10 lakh units im/iv 6 hrly after
AST if sensitive to penicillin tab erythromycin 500mgm 8 hrly
In complicated pneumonia and older patients- Inj Ampicillin 500 mgm IV
6 hrly along with Inj. Gentamycin 3-5 mgm/kg/ day

(g) Hospital acquired pneumonia:

Hospital flora not yet identified.
Common organisms are- P aeruginosa
K pneumoniae
Staph aureus
Recommended treatment
Inj Cefotaxime 1-2 gm iv 8hrly

(g) Malaria:
Hospital acquired malaria is on the increase due to prolonged
hospitalization.

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 BT Malaria -Tab Chloroquine - 4 OD x 2 days
2 OD x 1 day
-Tab Primaquine - 7.5 mgm BD x 5 days

MT Malaria - Quinine (IV/ Oral)

10 mg / kg iv/oral- TDS x 7 Days + Cap Doxycycline 2 stat. 1

OD x 7 days and Tab Primaquine 45 mgm stat if quinine is
contraindicated - Inj Falcigo 120 mgm IV stat, 60 mgm OD x 4
Days and Tab Primaquine 45 mgm stat.

Complicated MT Malaria Inj quinine 20 mgm / kg IV loading

dose followed by 10 mgm / kg x 10 days and Cap Doxycycline in
same dose along with prophylactic antibiotic therapy for associated
infections

(h) Enteric fever: Pending culture reports - Inj Ceftriaxone 2- 4 gm iv once a

day dissolved in 100 ml of saline over 30 min, for at least three days
after the fever subsides.

(j) URI: Mostly Viral .No antibiotics should be used.

If bacterial infection suspected - Tab erythromycin 500 mgm TDS
or Roxythromicin 1 tab BD
Paediatric cases
(a) Pneumonia: Inj Ampicillin and Inj Gentamicin or Inj Cefotaxime and
Inj Amikacin.
In infants (1month – 2 years) combination of Inj Ampicillin,
Inj Gentamicin and Inj Cefotaxime
In Children (< 7 years) combination of Inj Ampicillin and
Inj Cefotaxime
(b) Meningitis: Combination of Inj Ceftriaxone, Inj Gentamicin
Inj Ceftriaxone and Inj Amikacin or Inj Vancomycin
In infants (1month – 2 years) combination of Inj
Ceftriaxone, Inj Piperacillin and Inj Amikacin
In Children (< 7 years) combination of Inj Ceftriaxone or
Piperacillin and Amikacin.
(c) Staph Infection: Combination of Inj Cloxacillin, Inj Vancomycin and Inj
Amikacin
(d) Enteric Fever: Ciprofloxacin and Ceftriaxone

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Conclusion:

The antibiotic policy is not just a document but the record of a dynamic process of
microbial prevalence and their sensitivity to various antibiotics in different patient
populations. It should not be too rigid but at the same time the treating physicians should
follow reasoning for the benefit of the patient and utilizing effectively the scarce
resources. The physician should decide whether an antibiotic is required for a particular
ailment at all; if so, which drug, dosage, route of administration and duration of treatment.
Senior staff should review the requirement of antibiotics after 48-72 hrs of initiation of
treatment. If laboratory data suggests a non-infective cause, treatment with antibiotics
should be stopped. In the end it may be said that antibiotic policies can definitely improve
the quality of prescribing and may be used to limit prescribing costs. Limiting
superinfection and antibiotic resistance should be viewed as additional potential benefits.

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 ANTIBIOTIC POLICY FOR
INHS ASVINI

AIM: The aim of the antibiotic policy is to encourage rational prescribing which is
based on a knowledge of pharmacology, efficacy, safety & cost. Prescribe
antibiotics, only if it is definitely required. It may be the cause of adverse drug
reactions, alteration of microflora, super-infection with Clostridium difficile,
besides chance of increasing resistance.

After deliberation with the Heads of the Departments, members of the antibiotic
policy committee, taking the antibiotic sensitivity pattern of the isolated organisms
from the laboratory and availability of the antibiotics in the inventory of the
hospital the following recommendations are made for use of the antibiotics at
various levels. For detail information full document on antibiotic policy may be
referred.
MI ROOM / STAFF SURGEON / FAMILY CLINIC
Inj Sodium and Benzathine penicillin
Amoxycillin Cloxacillin
Co-trimoxazole Erythromycin
Azithromycin Doxycycline
Nitrofurantoin (for UTI only)
Note: It is better to avoid Ciprofloxacin & Norfloxacin for next six months as the
sensitivity is less than 50%. These drugs will be reused after six months.
WARDS, INTENSIVE CARE UNITS
Drugs used in OPDs may also be used. In addition, the following drugs may be
used when indicated orally/ parenterally
Cefexime Cefotaxime
Streptomycin Gentamycin
Amikacin Chloramphenicol
Rifampicin Azithromycin
Clarithromycin Ciprofloxacin
Norfloxacin Gatifloxacin
Levofloxacin

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 DRUGS TO BE PRESCRIBED OR RATIFIED BY
SENIOR ADVISOR/ HOD OF DEPT

(1) Amoxycillin + Clavulanic acid (Augmentin)

(2) Piperacillin + Tazobactam
(3) Ticarcillin + Clavulanic acid
(4) Ceftriaxone
(5) Cefoperazone + Sulbactam
(6) Ceftazidime
(7) Clindamycin
(8) Vancomycin
(9) Ticoplanin
(10)Meropenem
(11)Linezolid
(12)Aztreonam

Sd:
Commodore Academics

Distribution :
1) Department of Medicine
3) Department of Obst & Gyaneac
5) Department of ENT
7) Department of Dermatology
9) MI Room
11) Family Clinic (Officers & Sailors)
13) Medical Stores
2) Department of Surgery
4) Department of Ophthalmology
6) Department of Paediatrics
8) Department of Psychiatry
10) Staff Surgeon
12) Department of Pathology

Info :
Executive Officer
Senior Registrar

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