ANTIBIOTICS
ANTIBIOTICS
1. Classification 2. Indications and Dosages for the more commonly used antibiotics during surgery at Basel City Hospital (Kantonsspital Basel) a) Penicillin b) Cephalospirin c) Various 3. Antibiotic Prophylaxis at Basel City Hospital (Kantonsspital Basel) a) Bone Surgery b) Visceral Surgery c) Urology d) Heart- and Thoracic Surgery e) Various 4. Empirical Treatment of an Infection in the Surgical Department of Basel City Hospital (Kantonsspital Basel)
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Classification
Beta-Lactam Antibiotics
Non-Beta-Lactam Antibiotics
Chemotherapeutic Agents for Mycobacteria
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Penicillin
Name Spectrum Side Effects Dosage Q0
iv
Amoxicillin Gram+ Coccal (except for GI, 3 - 4 x 1g 0,06
Clamoxyl® penicillin-building Allergy 3 - 6 x 2g
Staphylococcus)
Neisseria, Spirochaete, 3x 375 mg po
Listeria, Enterococcus, 4x 750 mg po
H.influenza, Gram- Coccal
Benzyl- Gram+ Bakt. (except for GI, according to 0,1
penicillin penicillin -building Allergy, sensitivity
Penicillin G® Staphylococcus, Nocardia, Seizures, and Place of
Listeria) Neutro-, Infection
Neisseria, Gonococcal, Thrombo-
Spirochaete Gram- Rods, Cytopenia
Gram+ Anaerobe
Flucloxacillin for penicillin building GI, 3 x 1 g 0,25
Floxapen® Bacteria, Allergy 3 - 4 x 2 g
Staphylococcus aureus,
coagulase neg. Staph.,
Streptococcus pyogenes 3 - 4 x 500
Strept.pneumoniae mg po
Strept.viridans
Piperacillin Pseudomonas, Eschericheae, GI, 2-4 x 100 - 0,2
Pipril® Klebsiella, Enterobacteria, Allergy, 200 mg/kg
Serratia, E.coli, Increase in
Streptococcus, Pneumococcus, Liverenzymes
Enterococcus
Anaerobe +/-
GI = Gastrointestinal Side Effects
Q0 = Extrarenal Elimination Factor
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Cephalosporin
Name Spectrum Side Dosage Q0
Effects iv
Ceftazidim Gram+: Strept.pyog., St.pneum., GI, 3 x 1 - 2 g 0.03
Strept.Group B, Allergy, Adjust dosage
Fortam® Strept.species Gram-: Eosinophilia, in presence of
Pseudomonas, Klebsiella, Tc.-tose, renal disease!!!
Proteus, E.coli, Enterobacteriaceae,
Serratia, Salmonella, Shigella, Increase in
Neisseriea, H.influenzae (also Liver enzymes,
Ampicillin-resistant germs) Increase in
Anaerobes: Peptoc., creatinine
Peptostreptoc.,
Strept.species, Clostridium,
Fusobacterium
Cefazolin Staph.aureus, GI, 3-4 x 0.5 - 0.06
Kefzol® -hemolytic Streptococcus etc. Allergy, 1 g
Streptococcus family, Tc.-tose, Adjust dosage
Strept.pneum., E.coli, Increase in in presence of
Klebsiella, Proteus mirabilis Liver enzymes, renal disease !!!
Cefamandol Gram+ : Staphylococcus aureus, GI, 3-6 x 0.5 - 0.04
Mandokef® Coagulase neg. Staph., Allergy, 1g
Pneumococcus, Strept.pyogenes, Tc.-tose, Adjust dosage
-hemolytic Streptococcus, Increase in in presence of
Gram- : H.influenza, E.coli, Liver enzymes, renal disease !!!
Kl.pneumoniae, Prot.mirabilis, Increase in
Enterobacteriaceae aerogenes creatinine
Ceftriaxon Gram+ : Streptococcus GI, 1 x 1 - 2 g 0.5
Rocephin® Gram- : E.coli, H.influenza, Allergy, if liver normal
Klebsiella, Enterobacter spp., Tc.-tose, and intact, not
Neisseriea, Proteus, Increase in so essential to
Salmonella, Shigella, Yersinia Liver enzymes, consider kidneys
Anaerobes : Peptococcus, Increase in
Peptostreptoc., Clostridium creatinine
perfringens, Clostr. sporogenes,
Bacteroides.
GI = Gastrointestinal Side Effects Q0 = Extrarenal Elimination Factor
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Name Spectrum Side Effects Dosage Q0
iv
Tobramycin Pseudomonas, Proteus, E.coli, Neurotoxic, 2-3mg/kg/day 0.02
Obracin® Klebsiella, Enteroba. sp., Nephrotoxic, see Compendium
Serratia sp., Escherichia Increase in
Liver enzymes,
Tc.-penie,
Allergy
Amoxicillin Gram+ : Staph. (only methicillin GI, 3 - 4 x 1.2 0.06
with sensitive S.aureus), Streptococcus, Allergy - 2.2 g
Clavulansäure Gram- : Neisseria, 0.55
Augmentin® H.influenza, Moraxella,
E.coli, Salmonella, Shigella,
Klebsiella, Proteus,
Anaerobe : Peptoc.,
Peptostreptoc., Clostridium
perfr., Clostr. sporogenes,
Bacteroides, Fusobacterium
Sulfamethoxazol Gram+ : Staph.aureus, GI, 2 x 10 ml 0.8
mit Staph.epiderm., Streptococcus, Allergy, and
Trimethoprim Listeria Tc.-penie, 0.45
Bactrim® Gram- : E.coli, Proteus, Myelo-Suppre
Klebsiella, Enterobacteria, ssion
Salmonella, Shigella, Yersinia,
H.influenza, Neisseria,
Fusidic acid Gram+ : Staph.aureus, GI 3 x 500 mg
Fucidin® Streptoc., Diplococcus pneumoniae
Gram- : Neisseria, Klebsiella
pneumoniae., E.coli.
Ornidazol Trichomonads, Entamoeba h., GI 2 x 500 mg 0.95
Tiberal® Lambliasis, Bacteroides,
Clostridium und Anaerobe Coccus.
Imipenem Almost all clinically GI, 3-4 x 0.5 - 0.3
Tienam® significant bacteria/organism Allergy, 1 g
(see compendium) Increase in
except : Xanthomonas Liver enzymes,
maltophilia Increase in
creatinine,
Tc.-penie
GI = Gastrointestinal Side Effects Q0 = Extrarenal Elimination Factor
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Antibiotic Prophylaxis at Basel City Hospital (Kantonsspital Basel) bone* Open Fracture 1.° + 2.° : Emergency Station Diagnosis, then Mandokef 2 g iv (Monotrauma) Open Fracture 3.° : Augmentin 3 x 2.2 g iv/day (for ca. 5 days; empirical) Hipsurgery : Mandokef 2 g iv during induction of anaesthesia Amputation : Mandokef 2 g iv during induction of anaesthesia * = If the operation is not completed within 4 hours of the first injection of antibiotic, a repeat injection of the same dosage should be given.
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Antibiotic Prophylaxis at Basel City Hospital (Kantonsspital Basel)
Visceral Surgery*
Bile Ducts : Mandokef 2 g iv during induction of anaesthesia
Colorectostomy
and Appendectomy : Mandokef 2 g iv/Tiberal 500 mg during induction of anaesthesia
* = If the operation is not completed within 4 hours of the first injection of antibiotic, a repeat injection of the same dosage should be given.
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Antibiotic Prophylaxis at Basel City Hospital (Kantonsspital Basel)
Urology
Cystectomy and Ileal Conduit, Ureterosigmoidostomy, Urogenital Trauma (Urethral Tear or Rupture, Rupture of the Bladder) : Mandokef 2 g iv / Tiberal 500 mg during induction of anaesthesia*
Lymphadenectomy, Total Prostatectomy, percutaneous endourology, OP following Marschall- Marchetti : Bactrim forte 2 ampoules in 500 ml NaCl during induction of anaesthesia*
TVP, TURP, TURB, Internal Urethrotomy :
Bactrim forte 2 ampoules in 500 ml NaCl during induction, and continue with 2 x 1 Tiberal forte until Dielectric constant is slight / away.
No prophylaxis should be used during urologic procedures on non-infected kidneys, or ureter, adnexa, and urethra (upper and lower urinary tracts) because of tumors, stones or plastic surgery.
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Antibiotic Prophylaxis at Basel City Hospital (Kantonsspital Basel)
Heart and Thoracic surgery
Heart OP with HLM or Heart OP with artificial implant (without HLM) :
1. Adults
For those allergic to penicillin :
2. Children
Thoracotomy with a lung operation (Pneumonectomy, Lobectomy, Segment resection) :
For TBC patients :
Prophylaxis with Augmentin in addition to specific therapy
No prophylaxis should be used during thoracotomy without bronchial opening (thoracobronchotomy) (pleurectomy, extrapulmonary tumors).
For known/recognised organisms/bacteria (in the case of chronic bronchitis) and also for known resistance, gem. Infekt.-Konsil.
** = if blood pressure falls, lengthen delivery period or even temporarily stop.
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Antibiotic Prophylaxis at Basel City Hospital (Kantonsspital Basel)
Various*
(6 Doses). For those allergic to penicillin : Kefzol 2 x 2 g iv (4 Doses)
* = If the operation is not completed within 4 hours of the first injection of antibiotic, a repeat injection of the same dosage should be given.
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Empirical Treatment of an Infection
As a rule, antibiotic therapy should be introduced specifically against the causing involved (responsible) micro organism. If there is clinical suspicion of septicemia, the therapy should be empirically induced after the necessary bacterial samples (cultures, etc.) have been taken and later specifically adapted.
Augmentin +/- Obracin (v.a. Aspiration, breathing Patient)
Fortam + Obracin (v.a. for Pseudomonas)
! Please notify every nosocomial pneumonia Infekt-Konsil (Study !) !
with suspected septicemia : Clamoxyl + Obracin, or Ciproxin
without suspected septicemia : Bactrim
1. Surgical revision because of suspected aerogenic infection
2. Augmentin +/- Obracin or specific. for Gram+ rods (Clostridial infect.) Penicillin G
Infekt.-Konsil (181-2203) (Rifampicin-Study)
1. Change catheter (make culture from catheter point and swab of catheter entry site)
2. Mandokef or for Cephalos and penicillin allergic : Vancocin +/- Obracin
Augmentin + Obracin or Pipril + Obracin
Proximal until Jejunum : Augmentin + Obracin
Distal (perforated Appendectomy, festering (pussy) Peritonitis, Diverticulitis, Colon tumor etc.) :
Pipril + Obracin or Tienam
!! For any (every) problem or therapy failure 'infektiologisches Konsil' !!
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