Surgical Prophylaxis

An#bio#cs Before Surgery:

• Any an#bio#cs
o 60 minutes before making a cut
• If quinolone of vancomycin (Because intolerance at high dose)
o 120 minutes before making a cut
An#bio#cs During Surgery
• + Addi#onal doses if longer than 4 hours
An#bio#cs aFer surgery
• D/C within 24 hours
Periopera2ve An2bio2c Selec2on
• Surgery involving the skin (such as cuJng into the body)
• Surgery involving the abdomen GI
• Surgery is inpa#ent therefore all treatment is IV

Surgery type Pathogens Treatment Reasoning if needed

Skin MSSA IV: 1st genera#on Cefazolin

Alterna(ve if beta lactam allergy:

Clindamycin or Vancomycin IV
Abdominal Infec#ons MSSA IV: 1st gen Cefazolin Does not include 2nd
gen cefuroxime because
Anaerobes IV: Metronidazole ??

Gram - IV: Ampicillin Sulbactam, or

IV: 2nd gen Cefotetan
IV: 2nd gen Cefoxi#n

Meningi2s
• Symptoms including:
o fever, headache, s#ff neck, altered mental status
• Diagnosis:
o Lumbar puncture
• Treatment: Must administer dexamethasone prior to 1st abx dose to prevent neuro complica#ons.

Disease Bacteria Treatment Age

Meningi#s Listeria Gram + IV: Ampicillin < 1 month
Aerobe
IV: 3rd gen Cefotaxime
Neisseria Gram - Alterna(ve:gentamicin
Cocci
IV: Vancomycin
1-50 yrs
IV: 3rd gen: Cefotaxime or CeFriaxone

IV: Ampicillin + Vancomycin +50 or immunocom

IV 3rd gen: Cefotaxime or CeFriaxone

Acute o22s media:
• 1st Observe for 2-3 days if the pa#ent meets the following:
o Less than 48 hours
o Less than 102.2 Degree fever
o + 6months: only 1 ear
o + 2 years: 1 or 2 ears
• All treatments will be outpa#ent: PO

Disease Bacteria Treatment Allergic to PCN?

Acute o##s media Strep Pneumoniae: PO: Amoxicillin: 80-90 mg/kg Cephalosporins
Gram + Cocci PO: Amoxicillin/Clavunate” 2nd gen
H.Influen 90mg/kg/day • Cefuroxime
Gram – Anaerobes • Cefotetan
Moraxella • Cefoxi#n
Gram – Cocci/Bacilli 3rd
• CeFriaxone
• Cefdinir
• CeFazidime
If no improvement: ceFriaxone 50mg/kg IM daily for 3 days

Other Condi2ons of Cough/Cold

Common Cold Sneezing OTC

Runny Nose
Mild sore
throat/cough
Influenza Fever OTC
Chills
Fa#gue
Pharyngi#s Sore throat Strep.Pyogenes Penicillin Cephalosporins
Fever Gram + Cocci (because it 2nd gen
Swollen lymph covers strep) • Cefuroxime
nodes or • Cefotetan
White Patches Amoxicillin • Cefoxi#n
*Must be posi#ve 3rd
with rapid an#gen • CeFriaxone
test* • Cefdinir
Acute sinusi#s Nasal conges#on Strep Pneumon: Amoxicillin with • CeFazidime
Discharge Gram + Cocci clavunate
Face/Ear/dental pain H.Influen If severe PCN:
*Treatment test if Gram – Anaerobes MACS or Clindamycin
for more than 10 Moraxella
days or 3 days Gram –
severe w/(fever)* Cocci/Bacilli
 Lower Resp Tract infec2on:
Bronchi2s
• Symptoms
o Cough with or without stuff las#ng 1-3 weeks LONG TIME
• Diagnose
o Chest X-ray= Normal
• Bacteria
o VIRAL
• Treatment: Cough suppressants, and expectorants

Pertussis: Whooping cough

• Symptoms:
o Whooping cough noise, and its contagious EWW
• Diagnose:
o Swab culture/PCR test
• Bacteria involved:
o Bordetella Gram – Cocci/Rod
• Treatment: Macrolides??????

Acute COPD exacerba2on

• Symptoms (3 cardinal symtpoms) From GOLD guidelines
o Dyspnea (Labored breathing)
o Sputum Volume ­
o Sputum Purulence ­

Disease Bacteria Treatment An#bio#c of choice

Acute COPD Strep Pneumoniae 1st suppor#ve treatment Amoxicillin with clavunate
exacerba#on Gram + Cocci - Oxygen
H.Influen - Saba
Gram – Anaerobes - IV/PO steroids
Moraxella ABX if
Gram - Cocci/Bacilli - All 3 sx’s
- Sputum yellow/green +
Dyspnea or Sputum
volume
- Mechanical ven#lated
Community Acquired Pneumonia
• Symptoms
o SOB, Fever, Cough, Purulent Sputum, Tachypnea, Rales,
• Diagnose: Posi#ve Chest X-Ray GOLD STANDARD with opaci#es, infiltrates, consolida#ons
• *No#ce: You cant use fluoquinolones such as ciprofloxacin because although they cover atypical, they
don’t cover strep.pneumoniae that well*

Disease Bacteria Treatment How to chose which one

If you’re healthy Strep. Pneumoniae Amoxicillin (1 g TID) Do not chose if PCN if:
Gram + Cocci or - PCN Allergy
H. Influenzae Doxycycline - Probenecid DDI
Gram – Anaerobes or - Schizo
Mycobacterum. Macrolides: only (Azi/Clari) - Doesn’t cover atypical
Pneumo and if local resistance <25% Do not chose Doxy
Atypical - Pregnant/child
- DDI: Antacids
- Polyvalent IONS
- Sucralfate bismuth
Do not chose Macrolides.
- QT interval
If Beta Lactam + Doxy or MAC
- Heart - Amoxicillin
- Lung - Cephalosporins
- Liver
- Kidney *Resp Fluoroquinolone*
- Diabetes -Moxi
- Alcohol -Levo
- Cancer -Gemi
- No spleen

Inpa2ent CAP (5-7 days)

- Based on severity and is IV ABX ini#ally
- Non severe: CAP

Non-severe Strep. Pneumoniae Beta Lactam + Doxy or MAC

Gram + Cocci - Ampicillin
H. Influenzae - Cephalosporins
Gram – Anaerobes or
Mycobacterum. Pneumo *Resp Fluoroquinolone*
Atypical -Moxi
-Levo
-Gemi
Severe ICU Beta lactam + Macrolide
Or
Beta lactam + Resp fluroquinolones
Addi#onal Risk factors to Consider
Pa#ent had to be Pa#ent had to be isolated due to Pa#ent in the hospital prior and had to use
isolated for MRSA or pseudomonas PN therapy in 90 days
+ Nasal Swab

Add vanco or Pip/tazo Abx coverage against MRSA + Pseduo

linezolid Cefepime
Meropenam