Antibiotic Guidelines by BSMMU

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The chosen antibiotics must be active against the most common expected pathogens. g. patients with j aundice or diabetes, or identified at the time of the operation. Timing of antibiotic prophylaxis Current recommendations are that the parenteral antibiotics used in prophylaxis should be given in sufficient dosage (according to weight of the patient) within 30 minutes preceding incision. This results in near maximum drug levels in the wound and the surrounding tissues during the operation. This can be facilitated by administer the bile, ets for culture and sensitivity).

Patic dysfunction including jaundice reported Co-amoxiclav Cholestatic jaundice reported, mon�or liver function in liver disease (mmolll) 1 50-350 >500 USE OF ANTIBIOTICS IN LIVER DISEASE Aminoglycosides 1 50-300 I ncrease dosing interval; avoid if possible Amoxicillin >500 I ncrease dosing interval Azathioprine >500 Decrease dose/ increase dosing interval Benzylpenicillin >500 Halve the dose Ceftazidine >1 50-300 Increase dosing interval Cefuroxime >500 Increase dosing interval Cefalexin >500 Increase dosing interval Ceftriaxone >500 No adjustment if hepatic function is normal Chloramphenicol >700 Avoid Co-trimoxazole Avoid in severe liver disease Chloroquine 1 50-300 300-500 Maximum 75 mg/day Maximum 50 mg/day Doxycycline Use with caution Ciprofloxacin 150-300 Halve the dose Erythromycin May cause idiosyncratic hepatotoxicity Cisplatin 150-300 I ncrease dosing interval Co-trimoxazole >500 Maximum 960 mg/day Flucloxacillin Cholestatic jaundice Cyclophosphamide 300-500 Fluconazole Monitor liver function, discontinue if liver function impaired Fusidic acid Impair biliary excretion; increased risk of hepatotoxicity; avoid or reduce dose Griseofulvin Avoid in sevEll'e liver disease Isoniazid Avoid if possible; idiosyncratic hepatotoxicity more common; monitor liver function regularly Itraconazole Half-life prolonged; dose reduction may be necessary Ketoconaiole Avoid Mefloquine Avoid for prophylaxis in severe liver disease Metronidazole Reduce the dose in severe liver disease Norfloxacin Hepatitis with necrosis; use in spontaneous bacterial peritonitis Ofloxacin Reduce dose Rifampicin Avoid in liver disease Decrease dose Decrease dose if GFR falls Cyclosporine Doxycycline 1 50-300 I ncrease dosing interval Ethumbutol 150-300 Increase dosing interval Fluconazole 1 50-300 Increase dosing interval Isoniazid >500 Maximum 200 mg/day Ketoconazole 1 50-300 Unchanged Methotrexate 300-500 I ncrease dosing interval Nalidixic acid 300-500 Avoid Neomycin 150-300 Avoid Nitrofurantoin 1 50-300 Avoid Sulfadiazine >500 Avoid Sulfasalazine >500 Ensure increase fluid intake Tetracycline 150-300 Avoid Vancomycin 1 50-300 Avoid Vincristine 1 50-300 Unchanged 66 67 ANTIBIOTIC GUIDELINE ANTIBIOTIC G U IDELI N E Drugs ANTIBIOTICS IN PREGNANCY Drugs Amikacin Use only when potential benefit outweighs risk 2, 3 alternatives are not available least 1 month after administration Use only i n life-threatening situations (toxicity at Ceftriaxone Not known to be harmful Chloramphenicol Neonatal 'Grey syndrome' 1 , 2, 3 Avoid- arthropathy in alternatives available animal studies; safer Not known to be harmful but use only if adequate alternatives are not available Clindamycin Not known to be harmful Co-amoxiclav 3 menstrual period 3 Mefloquine 1 1 Fansidar 3 Metronidazole Nitrofurantoin 3 Theoretical teratogenic risk (trimethoprim a folate antagonist) Norfloxacin 1 , 2, 3 Neonatal hemolysis and methemoglobinemia; fear of increased risk of kernicterus in neonates Ofloxacin 1 , 2, 3 Effects on skeletal development in animal studies Pentamidine Dental discoloration; maternal hepatotoxicity with Primaquine 3 Pyrimethamine 1 large parenteral doses Gentamicin 68 arthropathy in animal studies; safer alternatives available May produce neonatal hemolysis if use at term Avoid- arthropathy in animal studies; safer in animal studies; safer alternatives available Avoid- arthropathy alternatives available Avoid unless essential Neonatal hemolysis and methemoglobinemia antagonist); adequate folate supplements should be given to mother Possible teratogenic risk (trimethoprim a folate antagonist) Neonatal hemolysis and methemoglobinemi a; fear of increased risk of kernicterus in neonates appears to be unfounded Quinine Streptomycin Tetracyclines Teratogenic in animal studies; use only when potential benefit outweighs risk 2, 3 Avoid- Theoretical teratogenic risk (trimethoprim a folate May be teratogenic with long-term high doses Flucytosine Teratogenic in animal studies Avoid high-dose regimen essential Avoid- multiple congenital abnormalities reported Fluconazole Toxicity in animal studies 1 1 , 2, 3 Not known to be harmful Erythromycin warning to avoid in pregnancy Mebendazole appears to be unfounded 1 Teratogenic in animal studies; packs carry a Nalidixic acid No evidence of teratogenicity but avoid unless 1 Ethionamide contraception during treatment and until the next Ketoconazole Clarithromycin Doxycycline high doses in animal studies); ensure effective Itraconazole Not known to be harmful but use only if adequate alternatives are not available Co-trimoxazole effective contraception required during and for at Auditory or vestibular nerve damage Azithromycin Ciprofloxacin Griseofulvin Not known to be harmful but use only if adequate Amphotericin B Co mment Avoid (fetotoxicity and teratogenicity in animals); Comment Trimester Acyclovir Trimester Auditory or vestibular nerve damage Zidovudine 1 2, 3 1 3 Teratogenic at high doses; but in malaria benefit of treatment outweighs risk Auditory or vestibular nerve damage Effects on skeletal development in animal studies Dental discoloration; maternal hepatotoxicity with large parenteral doses Limited information available; use only if clearly indicated 69 ANTIBIOTIC G U I DELI N E ANTIBIOTIC GUI DELINE DRUGS PRESENT IN BREAST MILK Comment Drugs MANAGEMENT OF ANAPHYLACTIC SHOCK Management consists of stopping the offending drug, treating the acute reaction, and making a determination concerning futures use of Aciclovir Significant amount is found in milk after systemic administration the drug.

The American Society for GI Endoscopy recommends prophylaxis for known or suspected biliary obstruction. The value of prophylaxis for ERCP is controversial. Note that cephalosporins are not active against the enterococci, yet' are clinically effective as prophylaxis in biliary surgery. With cholangitis, treat as infection, not prophylaxis. High risk patients include those >70 years of age, acute cholecystitis, non-functioning gall-bladder, obstructive jaundice or common duct stones. a. 500 mg intravenously 8 hourly for 3 days.

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