The resident's electronic handbook ...

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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Various


   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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Prophylaxis


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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Prophylaxis


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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Prophylaxis

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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Prophylaxis


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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Prophylaxis


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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1996 kaufmannm@ubaclu.unibas.ch