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Bahan Untuk Penyusunan Pedomam Antibiotik 2011 RSU TIDAR MAGELAG
1! Da"i Uni#e"sitas Pensi$#ania Ame"ika Se"ikat
B%E AD &%IT I'E(TI%S($ini)a$
Settin* Em+i"i)
T"eatment Like$y Patho*ens De,initi#e
T"eatment Dosa*e
Re*imen Du"ation
%steomye$itis1
Normal
Host
na,)i$$in2 o"
)e,a-o$in2 S. aureus
nafcillin2 or
cefazolin2
2gm IV q 4-6
hour
500mg IV q 8hour
6 weesminimum!
then
continueuntil "#$
normal%!4"ntero&acteriaceae
'occasionall() *+,#+.
8-
10mgg/a(
*+, IV, in%-4 /ii/e/
/oses
Intraenous
rug 3ser
#an)omy)in .
*entami)in
same as a&oe
methicillin resistantS. aureus
same as
emiric 'if
culture /atanot
aaila&le)
gentamicin5 -see this lin
2 wees
ancom(cin -see this lin
6 wees
minimum!
thencontinue
until "#$
normal4
,ost-
oeratieTMP/SM S. aureus
nafcillin2 or
cefazolin2
2gm IV q 4-6hour
500mg IV q 8
hour6 weesminimum!
then
continueuntil "#$
normal%!4
coagulase negatiestah(lococcus
ancom(cin see this lin
"ntero&acteriaceae *+,#+.
8-
10mgg/a(
*+, IV in %-4/ii/e/ /oses
P. aeruginosa
ieracillin
gentamicin
4 gm IV q 6
hour
see this lin
,ost-
traumatic
amicillin
sul&actam6
same as a&oe!
inclu/ing7
same as
a&oe
same as a&oe 6 wees
minimum!
http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htm
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then
continue
until "#$normal%!4
anaero&es 'eseciall(
lostri/ia s9) enicillin :
2mu IV q 4
hour
ontiguouswith
/ecu&itusulcer
/ia&etic foot
TMP/SM met"onida-o$e34
ol(micro&ial same asemiric
*+,#+. 8-10mgg/a(
*+, IV in %-4/ii/e/ /oses
metroni/azole
500mg IV,q 12 hour
6 weesminimum!
thencontinue
until "#$
normal%!4
1'o" o+tima$ t"eatment3 mi)"oo"*anism5s6 shou$d be identi,ied by as+i"ation o" bone bio+sy7
deb"idement 8i$$ enhan)e )u"e "ate
2I, beta9$a)tam a$$e"*y use )$indamy)in o" t"imetho+"im su$,ametho:a-o$e7 i, MRSA9use #an)omy)in
;Shou$d s8it)h to o"a$ the"a+y on)e )$ini)a$ im+"o#ement o))u"s
(an s8it)h to $e#o,$o:a)in >00m* P% ? 2< hou" in )ombination 8ith I@ #an)omy)in
=Am+i)i$$in/su$ba)tam dose1!>*m I@ ? = hou"s
Met"onida-o$e use i, ,ou$ odo" +"esent
4ot ,o" a**"essi#e anae"obi) in,e)tions in diabeti) hosts
B%E AD &%IT I'E(TI%S9(ontCd!
($ini)a$
Settin* Em+i"i)
T"eatment Like$y Patho*ens De,initi#e
T"eatment Dosa*e
Re*imen Du"ation
Se+ti) A"th"itis1
Normal
Host
na,)i$$in2 o"
)e,a-o$in
2
S. aureus nafcillin2 or
cefazolin
2
2gm IV q 4-6
hour
500mg IV q8 hour
4-6
wees%
"ntero&acteriaceae *+,#+. 8-
10mgg/a(
*+, IV in %-4 /ii/e/
/oses
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grou ; stretococcus enicillin :
8-12mu/ IV
in 4-6
/ii/e/ /oses
#e(e,i:ime is a non9,o"mu$a"y a*ent a non,o"mu$a"y "e?uest ,o"m must be )om+$eted
=Remo#a$ o, +"osthesis may be "e?ui"ed
May "e?ui"e subse?uent o"a$ the"a+y to e"adi)ate in,e)tion
http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/vanco.htmhttp://www.uphs.upenn.edu/bugdrug/antibiotic_manual/amino.htm
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(ETRAL ER@%US SSTEM I'E(TI%S
Re)ommendations a"e ,o" em+i"i) the"a+y!
Di"e)ted the"a+y shou$d be based u+on )u$tu"e and sensiti#ity "esu$ts!
($ini)a$
Settin*Like$y Patho*ens
Em+i"i) T"eatment
%+tionsDu"ation/(omments
+eningitis
ommunit(-
acquire/
meningitis!age 18-50
S. pneumoniae
N. meningitidis
H. influenzae
ceftria
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10mg once /ail( eer( 1-%
/a(s until clinical an/
micro&iologic imroement
occurs9 *he gentamicin must &e reseratie free9
';miacin can &e use/ in
lace of gentamicin at thesame /osage9)
>rain ;&scess
ommunit(-
acquire/ &rain
a&scess
uer resirator( flora ceftria
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ain!*+,#+.
failure)
H. influenzae
*+,#+.
160800mg'1 /ou&le
strengthta&let) ,>I
M.catarrhalis
oral anaero&es
Tonsi$$itis/ Pha"yn*itis
+il/ +eni)i$$in @4grou ;stretococcus
enicillin V
250mg ,
q 6 hour-10 /a(s
+o/erate5ben-athine +eni)i$$in
G to 2>
0 m* +o ?id7 i, a$$e"*y se#e"e 5u"ti)a"ia3 an*ioedema3 o" ana+hy$a:is6 then ey"th"omy)in 2>0 m* +o ?id 5)he)k sus)e+tibi$ity 9
"esistan)e "ate >9106
> I, mu$ti+$e o" "e)u""ent e+isodes3 )onside" )$indamy)in 1>0 m* +o ?id 5)he)k sus)e+t 9 >910
"esistan)e63 amo:i)i$$in/)$a#u$ani) a)id >00 m* +o bid o" ben-athine +eni)i$$in 1!2 mu IM on)e!
Ri,am+in )an be added to e"adi)ate st"e+to)o))i ,"om the +ha"yn: 5=00 m* +o ?d : < d6
=Abs)ess shou$d be d"ained
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UI@ERSIT %' PESL@AIA MEDI(AL (ETER GUIDELIES '%R
ATIBI%TI( USE
GASTR%ITESTIAL I'E(TI%S
Re)ommendations a"e ,o" em+i"i) the"a+y!
Di"e)ted the"a+y shou$d be based u+on )u$tu"e and sensiti#ity "esu$ts!
($ini)a$ Settin* Like$y Patho*ens
Em+i"i) T"eatment %+tions
5no"ma$ "ena$ ,un)tion 9 see
dosin* in "ena$ im+ai"ment
+a*e ,o" adHustments ,o"
"ena$ insu,,i)ien)y6
Du"ation/(omments
Un)om+$i)ated int"a9abdomina$ in,e)tions 'e9g9 communit(-
acquire/ infections such
as /ierticulitis! eritonitis! an/
cholec(stitischolangitis
without a&scess)
"ntero&acteriaceae
"nterococcus s9
anaero&es
tion 1
cefazolin 500mg IV q8h
metroni/azole 500mg IV or ,q12h
tion 2
amicillinsul&actam 195g IV
q6h
B-lactam allerg( otion 1
trimethorimsulfametho
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with a&scess or recent
&iliar( instrumentation!
secon/ar( eritonitis!immunocomromise/
atients)
"nterococcus s9
anaero&es
tion 2
cefeime 1g IV q12h
metroni/azole 500mg IV q12h
B-lactam allerg(
leoflo
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If not tolerating oral
me/ications
metroni/azole 500mg IV q8h
N* &e as effectie as
oral thera(9
#eere C. difficile
• F> G 25!000uA
• H(otension
• I3 atients
• #eere a&/ominal ain
• #econ/ recurrence
• No imroement after 5 /a(s of
metroni/azole
ancom(cin 125mg , q6h Du"ation 10 days
or mare/l( seerecases! consi/er
com&ination thera(!
surger( consult! an/ Iconsult9
Vancom(cin IV is
ineffectie for the
treatment of C. difficile9
Ba)te"ia$
*ast"oente"itis and/o"
t"a#e$e"Cs dia""hea
Salmonella s9
Shigella s9
Campylobacter
s9
E. coli
;nti&iotics shoul/ not &e rescri&e/ routinel( as
anti&acterial treatment ma(
worsen outcomes9
*reatment shoul/ &e consi/ere/
in7
19 $eturning traelers with
mo/erate to seere/iarrhea
29 Immunocomromise/
atients
%9 eer an/ signs ofinasie /isease
tion 1
azithrom(cin 500mg , q24h
tion 2 'for traelers
/iarrhea)
rifaacteremic salmonella
infections requirelonger treatment
/uration9 I consult
shoul/ &e consi/ere/9
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Cryptosporidium
parvum
nitazo days
S+ontaneous ba)te"ia$ +e"itonitis 5SBP6
#>, without recent
anti&iotic e
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295 mg/A9
H. pylori 9asso)iated
disease
H. pylori clarithrom(cin 500mg , q12h
amo
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;cute
,rostatitis ;> yea"s o$d
ceftria
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function)
3ncomlicate/
3*I 'a/mitte/ M
48 hrs)
cefazolin
o"
cehale
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a&normalities!flan ain!
eleate/ s(stemic
F>)
o"
cefeime2
q24h
Enterococcus s9%
amicillin
gentamicin
1 gram IV
q6h
see /osinggui/elines
,seu/omonasaeruginosa
ieracillin
.
gentamicin
o"
cefeime
% grams
IV q6h
see /osinggui/elines
1 gram IV
q12h
an/i/a al&icans fluconazole 100 mg, q24h
,elic
Inflammator(isease
clin/am(cin
gentamicin
N. gonorrhoeae" C.
trachomatis!"ntero&acteriaceae!
#acteroides s9!Streptococcus s9
clin/am(cin
gentamicin
00 mg IV
q8h
see /osinggui/elines
14 /a(
total4
"n/om(ometritis clin/am(cin
gentamicin
amicillin
+i
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1 If seere enicillin allerg( 'urticaria! angioe/ema! anah(la
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S. aureus
nafcillin5 or
cefazolin5
2gm IV q 4-6 hr
500mg IV q 8 hr
$. baumanii reiew susceti&ilit( /ata
T"a)heob"on)hitis
;cute TMP/SM S. pneumoniae amo
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