Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
B. CATHETER RELATED INFECTIONS Cloxacillin 1-2gm IV q6h If pa
OR *Van
Non- tunneled central venous catheter Cefazolin 1-2gm IV q8h weig
(subclavian, internal jugular) Peripherally
inserted central catheter
Common organisms: If loc
Staphylococcus aureus prev
Streptococcus epidermidis (eg:
Mero
OR
Imip
Tunnel type indwelling venous catheters and Cloxacillin 2gm IV q4-6h If pa
ports (Broviac, Hickman) Haemodialysis OR *Van
catheter Cefazolin 2gm IV q8h weig
PLUS
Common organisms: PLUS Cefta
CoNS, Streptococcus epidermidis, Ceftazidime 2gm IV q8h
Staphylococcus aureus, Gram negative rods
C. TREATMENT OF PACEMAKER INFECTIONS
Pacemaker Infection Refer to Ministry of Health Malaysia’s Clinical Pra
Empirical therapy for superficial post-surgical Cloxacillin 2gm IV q6h *Van
Sternal Wounds OR weig
Cefazolin 1-2gm IV q8h dose
PLUS/MINUS
Gentamicin 5mg/kg IV q24h
4
ment
Comments
Alternative
atient has risk factor for MRSA: Peripheral blood C&S is mandatory when suspecting
ncomycin 15-20mg/kg (actual body CRBSI. If blood C&S negative, consider alternative
ght) IV q8-12h; not to exceed 2gm/dose diagnosis.
cal epidemiology shows high ESBL Antibiotic of choice depends on local epidemiology of
valence AND if patient severely ill CRBSI and guided by antibiogram results.
Hypotension, multiorgan failure): Need to remove catheter as very low cure rates.
openem 2gm IV q8h
penem 1gm IV q8h *Vancomycin loading dose refer to Appendix 1.
atient has risk factor for MRSA: Adjust dose according to renal function.
ncomycin 15-20 mg/kg (actual body *Vancomycin loading dose refer to Appendix 1.
ght) IV q8-12h; not to exceed 2gm/dose
S
azidime 2gm IV q8h
actice Guidelines for the Prevention, Diagnosis & Management of Infective Endocarditis 2017
ncomycin 15-20mg/kg (actual body Duration of treatment: 7-10 days
ght) IV q8-12h; not to exceed 2gm/
e To discuss with Cardiothoracic unit that operated on the
patient if uncertain whether deep sternal wound infection is
present.
*Vancomycin loading dose refer to Appendix 1.
Aim for serum trough level of 15–20 mg/L.
References:
1. Sexton DJ,Tenenbaum MJ, Wilson WR, Steckelberg JM, Tice AD, Gilbert D, et al. Ceftriaxone onc
treatment endocarditis due to penicillin-susceptible Streptococci. Clin Infec Dis. 1998;27(6):1470
2. Francioli P, Etienne J, Hoigné R, Thys J, Gerber A. Treatment of streptococcal endocarditis with a
JAMA. 1992;267(2):264-7.
3. Knoll B, Tleyjeh I, Steckelberg J, Wilson W, Baddour L. Infective endocarditis due to penicillin-res
4. Buchholtz K, Larsen C, Schaadt B, Hassager C, Bruun N. Once versus twice daily gentamicin dosi
5. Giuliano S, Caccese R, Carfagna P, Vena A, Falcone M, Venditti M. Endocarditis caused by nutritio
6. Adam E, Focaccia R, Gualandro D, Calderaro D, Issa V, Rossi F, et al. Case series of infective endo
7. Carugati M, Bayer A, Miró J, Park L, Guimarães A, Skoutells A, et al. High-dose daptomycin thera
Endocarditis. Antimicrob Agents Chemother. 2013;57(12):6213-22.
8. Kullar R, Casapao A, Davis S, Levine D, Zhao J, Crank C, et al. A multicentre evaluation of the effe
Antimicrob Chemother. 2013:68(12):2921-6.
9. Lemonovich T, Haynes K, Latenbach E, Amorosa V. Combination therapy with an aminoglycoside
rate of recurrent bacteremia: a cohort study. Infection. 2011;48(6):549-54.
10. Cosgrove S, Vigliani G, Campion M, Fowler V, Abrutya E, Corey R, et al. Initial low-dose gentamic
2009;48(6):713-21.
11. Korzeniowski O, Sande M. Combination antimicrobial therapy for Staphylococcus aureus endocar
Med. 1982; 97(4):496-503.
12. Fernández-Hidalgo N, lmirante B, Gavaldà J, Gurgui M, Peña C, de Alarcón A, et al. Ampicillin plus
endocarditis. Clin Infect Dis. 2013;56(9):1261-8.
13. Smego RJ, Ahmad H. The role of fluconazole in the treatment of Candida endocarditis. Medicine (
14. Reyes M, Ali A, Mendes R, Biedenbach D. Resurgence of Pseudomonas endocarditis in Detroit, 2
15. Koruk S, Koruk I, Erbay A, Tezer-Tekce Y, Erbay A, Dayan S, et al. Management of Brucella endoca
16. Raoult D, Houpikian P, Dupont H, Riss J, Arditi-Djiane J, Brouqui P. Treatment of Q fever endocard
Intern Med. 1999;159(2):167-73.
17. Raoult D, Fournier P-E, Vandenesch F, Mainardi J-L, Eykyn S, Nash J, et al. Outcome and treatme
18. Rolain J, Brouqui P, Koehler J, Maguina C, Dolan M, Raoult D. Recommendations for treatment o
4
ce daily for four weeks compared with ceftriaxone plus gentamicin once daily for two weeks for
0-4
single daily doseof ceftraxone sodium for 4 weeks. Efficacy and outpatient treatment feasibility.
sistant Viridans group Streptococci. Clin Infect Dis. 2007;44:1585-92.
ing for infective endocarditis: a randomized clinical trial. Cardiology. 2011;119(2):65-71.
onally variant streptococci: a case report and literature review. Infez Med. 2012;20(2):67-74.
ocarditis caused by Granulicatella species. Int J Infect Dis. 2015;31(2015):56-8.
apy for leftsided infective endocarditis: a prospective study from the International Collaboration on
ectiveness and safety of high-dose daptomycin for the treatment of infective endocarditis. J
for Staphylococcus aureus endocarditis and/or persistent bacteremia is associated with a decreased
cin for Staphylococcus aureus bacteremia and endocarditis is nephrotoxic. Clin Infect Dis.
rditis in patients addicted to parenteral drugs and in nonaddicts: a prospective study. Ann Intern
s ceftriaxone is as effective as ampicillin plus gentamicin for treating enterococcus faecalis infective
(Baltimore). 2011;90(4):237-49.
2006-2008. Medicine (Baltimore). 2009;88(5):294-301.
arditis: results of th Gulhane study. Int J Antimicrob Agents. 2012;40(2):145-50.
ditis. Comparison of 2 regimens containing doxycycline and ofloxacin or hydroxychloroquine. Arch
ent of Bartonella endocarditis. Arch Intern Med. 2003;163(Jan 27):226-30.
of human infections caused by Bartonella species. Antimicrob Agents Chemother. 2004;48(6):1921
SECTION A
ADULT
A2 Central Nervous Infections
National Antimicrobial Guideline 2019 45
A2. Central Nervous Infections Preferred Suggested Treatm
Infection/ Condition & Likely Organism Ceftriaxone 2gm IV q12h Chlo
OR Alter
Meningitis (acute) Cefotaxime 2gm IV q6h imm
Empirical treatment on admission: Mero
Common organisms:
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Other organisms:
Gram-negative rods
Causative organism isolated: Ceftriaxone 2gm IV q12h Cefe
OR If org
Haemophilus influenzae Cefotaxime 2gm IV q6h aller
(Gram-negative bacilli) Chlo
50-1
OR
Cipro
4
ment
Alternative Comments
oramphenicol 1gm IV q6h Antibiotic should not be delayed if lumbar puncture is
delayed by radiological investigation.
rnative ONLY for
munocompromised host: If no organism is isolated from CSF C&S but LP is
openem 2gm IV q8h suggestive of bacterial meningitis and patient is
responding, continue antibiotics for 14 days.
Dexamethasone 10mg IV q6h is recommended 15 to 20
minutes before or at the time of first dose of antibiotics.
Continue for 4 days if the Gram stain and/or cultures
consistent with S. pneumoniae. Discontinue if not
Streptococcus pneumonia or if bacterial meningitis is
subsequently thought not to be present.
Incidence of listeriosis increases in people > 60 years of
age, immunosuppressed & pregnancy. Consider empirical
cover for this organism especially if the course of disease is
indolent or there is epidemiological risk (refer section on
treatment of listeriosis).
Duration: 10-14 days
epime 2gm IV q8H Duration: 7-10 days
ganism is susceptible and patient is
rgic to cephalosporins:
oramphenicol
100mg/kg/day IV q6h
ofloxacin 400mg IV q8h
Suggested Treatm
Infection/ Condition & Likely Organism Preferred
Streptococcus pneumoniae
(Gram-positive cocci) Penicillin-sensitive strains (MIC to
Penicillin < 0.12 mcg/ml)
Neisseria meningitidis Benzylpenicillin 4MU IV q4h
(Gram-negative diplococci)
Penicillin resistant strains (MIC to Peni
Penicillin >0.12 mcg/ml) (MIC
Ceftriaxone 2gm IV q12h Cefe
OR OR
Cefotaxime 2gm IV q6h Mero
Cephalosporin resistant strains
(MIC to Cephalosporin ≥2 mcg/ml):
*Vancomycin 25-30mg/kg loading dose
then 15-20mg/kg IV q8-12h; not to
exceed 2gm per dose
OR
Rifampicin 600mg IV/PO q12h
PLUS
Ceftriaxone 2gm IV q12h
OR
Cefotaxime 2gm IV q6h
Benzylpenicillin 4MU IV q4h (if MIC to If org
Penicillin < 0.1 mcg/ml) aller
Chlo
If MIC to penicillin is > 0.1 mcg/ml use: 50-1
Ceftriaxone 2gm IV q12h
OR
Cefotaxime 2gm IV q6h
ment 4
Alternative Comments
icillin resistant strain All attempts should be made to ascertain the MIC of isolated
C to Penicillin >0.12 mcg/ml) pneumococcus. Ceftriaxone or cefotaxime should be de-
epime 2gm IV q8h escalated to benzylpenicillin once the MIC result has been
confirmed.
openem 2gm IV q8h Duration: 10-14 days
*Vancomycin loading dose refer to Appendix 1.
ganism is susceptible and patient is Duration: 5-7 days
rgic to cephalosporins:
oramphenicol
100mg/kg/day IV q6h
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
Prophylaxis for household and close contacts Age > 15 years: Ceftr
of meningococcal meningitis cases Ciprofloxacin 500mg PO as single dose (esp
OR moth
Rifampicin 600mg PO q12h for 2 days OR
(4 doses) [not recommended in pregnant Azith
women]
Children/Adolescent < 15 years:
Refer to Paediatric Non-Surgical Chemoprophylax
Listeriosis Ampicillin 2gm IV q4h Trim
OR 20m
Brain abscess/subdural empyema Benzylpenicillin 4MU IV q4h com
Common organisms: OR
Streptococci PLUS/MINUS Mero
Staphylococcus Gentamicin 5mg/kg/day IV in 3 divided
Gram-negative bacilli doses
Anaerobes
1. Brain abscess/ subdural empyema suspecte
Benzylpenicillin 4MU IV q4-6h
PLUS
Metronidazole 500mg IV q8h
2. Brain abscess/subdural empyema suspecte
source:
Ceftriaxone 2gm IV q12h
OR
Cefotaxime 2gm IV q4-6h
PLUS
Metronidazole 500mg IV q8h
4
ment
Comments
Alternative
riaxone 250mg IM as single dose Close contacts are defined as those individuals who have
pecially in pregnancy and lactating had contact for > 8 hours and within 1 metre of the index
hers) case. Individuals who were in contact with oropharyngeal
secretions of the index case in the last 7 days before onset
hromycin 500mg PO as single dose of symptoms up to 24 hours after appropriate antibiotics
should also receive chemoprophylaxis.
For index case who received only benzylpenicillin as therapy,
xis (Meningococcal Exposure) Section. chemoprophylaxis should also be given upon discharge to
eliminate nasopharyngeal carriage.
methoprim/ sulfamethoxazole 10 to Duration of treatment is 3 weeks depending on clinical
mg/kg/day [based on the TMP response. May be longer in immunocompromised host.
mponent] IV q6-12h
Gentamicin is given until symptoms improve (minimum of 1
openem 2gm IV q8h week).
ed arising from an oral source: Duration to be determined by clinical response (usually 4-8
ed arising from sinus or otogenic weeks with IV therapy for 2 weeks minimum depending on
whether surgical drainage done, clinical and radiological
response).
Third generation cephalosporins are recommended if the
source is from the sinus or otogenic source.
Benzylpenicillin is recommended if the source is from oral
cavity.
Add cloxacillin if suspected hematogenous spread, post-
neurosurgeries or post penetrating injuries. If post
neurosurgery or trauma, consider cover for pseudomonas.
Suggested Treatm
Infection/ Condition & Likely Organism Preferred
Spinal Epidural abscess 3. Brain abscess/subdural empyema arising fr
Common organism: penetrating trauma (community acquired):
Streptococci Ceftriaxone 2gm IV q12h
Staphylococcus OR
Gram-negative bacilli Cefotaxime 2gm IV q4-6h
PLUS
Cloxacillin 2gm IV q4h
PLUS
Metronidazole 500mg IV q8h
4. Brain abscess arising from hematogenous s
neurosurgical operation:
*Vancomycin 25-30mg/kg loading dose then
exceed 2gm per dose
PLUS
Ceftazidime 2gm IV q8h
OR
Cefepime 2gm IV q8h
OR
Meropenem 2 g IV q8h
Cloxacillin 2gm IV q4h
OR
*Vancomycin 25-30mg/kg loading dose
then 15mg/kg IV q8-12h; not to exceed
2gm per dose
PLUS
Gentamicin 4-7mg/kg/day IV in 3 divided
doses
OR
4
ment
Comments
Alternative
rom hematogenous spread or
spread (hospital acquired) or post-
n 15-20mg/kg IV q8-12h; not to
Source control is strongly recommended.
Duration to be determined by clinical response (usually 2-6
weeks with IV therapy for 2 weeks minimum, followed by
oral depending on whether surgical drainage done, clinical
and radiological response).
*Vancomycin loading dose refer to Appendix 1.
Vancomycin is indicated when suspecting MRSA or allergy
to Cloxacillin.
Suggested Treatm
Infection/ Condition & Likely Organism Preferred
Viral encephalitis **Ceftriaxone 2gm IV q12h
Common organisms: OR
Herpes simplex **Cefotaxime 2gm IV q4-6h
Varicella zoster
Meningitis (Chronic) *Acyclovir 10mg/kg IV q8h
Tuberculous meningitis
Mycobacterium tuberculosis Intensive 2 months S/EHRZ and 10 Infec
months HR Reco
Isoniazid (H) 5(4-6)mg/kg/day PO in HI
(max: 300mg/day) thos
PLUS disea
Rifampicin (R) 10(8-12)mg/kg/day PO know
(max: 600mg/day) the f
PLUS
Pyrazinamide (Z) Daily
25 (20-30)mg/kg/day PO inter
(max: 2000mg/day)
PLUS Rifam
com
Streptomycin (S) (PIs)
15 (12-18)mg/kg/day IM PI-ba
(max: 1000mg/day) adult
OR
Ethambutol (E)
15 (15-20)mg/kg/day PO
(max: 1600mg/day)
Pyridoxine 10-50mg PO q24h needs to be
prescribed together with Isoniazid
ment 5
Alternative Comments
**3rd Generation Cephalosporin indicated when Gentamicin
is contraindicated.
*Consider using Ideal Body weight in obese patients.
Duration: 14-21 days
ction in HIV patients: Add dexamethasone 12-16mg daily in divided doses for 6
ommendations for the treatment of TB weeks in tapering doses (intravenously initially, then switch
IV-infected adults are identical to to oral when safe to do so). Alternatively, prednisolone 30-
se for HIV-uninfected adults when the 40mg/day PO in tapering doses for 6 weeks.
ase is caused by organisms that are
wn or presumed to be susceptible to Treatment is continued for 12 months.
first-line drugs.
Refer to Clinical Practice Guidelines on Management of
y dosing is recommended rather than Tuberculosis (3rd edition) MOH/P/PAK/258.12(GU).
rmittent dosing.
mpicin is not recommended in
mbination with all protease inhibitors
) and rifabutin should be used with
ased HAART for HIV-TB co-infected
ts.
Suggested Treatm
Infection/ Condition & Likely Organism Preferred
Cryptococcalmeningitis
Cryptococcus neoformans Induction Therapy: Indu
(non-HIV, non-transplant pt) Amphotericin B 0.7-1.0mg/kg/day IV q24h Fluco
PLUS PLUS
Healthcare-associated ventriculitis and 5-flu
meningitis 5-Flucytosine 100-150mg/kg/day PO q6h
OR
Cranial Trauma Fluconazole 800-1200mg PO q24h
1. Open fracture &
2. Penetrating injuries Consolidation Therapy:
Penetrating craniocerebral injuries Fluconazole 400-800mg PO q24h
Maintenance Therapy:
Fluconazole 200mg PO q24h
Empirical treatment should be decided by the prim
and CSF gram stain result.
If C&S is not available: Mero
Ceftazidime 2gm IV q8h PLUS
PLUS/MINUS *Van
*Vancomycin 25-30mg/kg loading dose then
then 15-20mg/kg IV q8-12h; not to exce
exceed 2gm per dose
Amoxicillin/clavulanate 1.2gm IV q8h Cefu
PLUS
Metr
Ceftriaxone 2gm IV q12h
PLUS
Metronidazole 400mg PO q8h
for 2 weeks initially and then review with
microbiology
5
ment
Comments
Alternative
uction Therapy: Lipid formulations of amphotericin may be used in cases of
onazole 1200mg PO q24h severe nephrotoxicity.
S
ucytosine 100-150mg/kg/day PO q6h Duration of induction therapy: 4-6 weeks
Duration of consolidation therapy: 8 weeks
Duration of maintenance therapy: up to 12 months
mary team based on local antibiogram De-escalate antibiotics to targeted therapy when the culture
results are available.
openem 2gm IV q8h *Vancomycin trough level should be 10-14µmol/L or 15-
S/MINUS 20mcg/L
ncomycin 25-30mg/kg loading dose
n 15-20mg/kg IV q8-12h; not to *Vancomycin loading dose refer to Appendix 1.
eed 2gm per dose
uroxime 1.5gm IV q8H Duration: 5-7 days
S
ronidazole 500mg IV q8H
Suggested Treatm
Infection/ Condition & Likely Organism Preferred
Neurosyphilis
HIV related CNS infection Refer to section (Sexually Transmitted Infections)
Treatment is the same for neurosyphillis in patien
Refer to section (Infections in Immunocompromi
References:
1. Brouwer MC et al. Corticosteroids for acute bacterial meningitis. Cochrane Database of Systemati
2. Pasquale Pagliano et al. Listeria monocytogenes meningitis in the elderly: epidemiological, clinica
3. van de Beek, D. et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Cl
4. McGill, F. et al. The UK joint specialist societies guideline on the diagnosis and management of ac
7, Issue 4, 405 – 438.
5. Solomon, T. et al. Management of suspected viral encephalitis in adults – Association of Brithish
Issue 4 , 347 – 373.
6. Allan R. Tunkel et al. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines fo
6, 15 March 2017,
7. Peter R. Williamson et al. Cryptococcal meningitis: epidemiology, immunology, diagnosis and the
8. The Sanford Guide to Antimicrobial Therapy 2018.
9. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic G
10. R Bayston, J de Louvois, E M Brown, R A Johnston, P Lees, I K Pople, “Infection in Neurosurgery
11. Chaudhuri A. et al. EFNS guideline on the management of community-acquired bacterial meningit
Journal of Neurology 2008, 15: 649–659
12. Allan R. Tunkel et al. Practice Guidelines for the Management of Bacterial Meningitis Clinical Infec
5
ment
Comments
Alternative
)
nts with HIV infection
ised Patients - Human Immunodeficiency Virus)
ic Reviews 2015, Issue 9. Art. No.: CD004405
al and therapeutic findings. Le Infezioni in Medicina, n. 2, 105-111, 2016
linical Microbiology and Infection, Volume 22 , S37 - S62
cute meningitis and meningococcal sepsis in immunocompetent adults.Journal of Infection, Volume
Neurologist and Brithish Infection Association National Guidelines. Journal of Infection, Volume 64,
or Healthcare-Associated Ventriculitis and Meningitis, Clinical Infectious Diseases, Volume 64, Issue
erapy. Nature Reviews Neurologyvolume 13, pages 13–24 (2017)
Guidelines Limited; 2014.
y” Working Party of British Society for Antimicrobial Chemotherapy. Lancet 2000; 355: 1813–17
tis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. European
ctious Diseases 2004; 39:1267–84
SECTION A
ADULT
A3 Chemoprophylaxis
National Antimicrobial Guideline 2019 53
A3. i. Surgical
The goal of antimicrobial prophylaxis is to prevent surgical site infection
by reducing the burden of microorganisms at the surgical site during the
operative procedure.
Single-dose prophylaxis is usually sufficient. If antimicrobial prophylaxis
is continued post-operatively, duration should be less than 24 hours (up
to 48 hours for cardiac surgery), regardless of the presence of intravascular
catheters or indwelling drains.
If presence of pre-existing infections (known or suspected), use
appropriate treatment regimen instead of prophylactic regimen for
procedure. However, re-dosing is required just prior to skin incision.
The optimal time for administration of pre-operative antibiotics is 60
minutes prior to surgical incision. Some agents, such as fluoroquinolones
and vancomycin, require administration over one to two hours; therefore,
the administration of these agents should begin within 120 minutes
before surgical incision.
An additional dose of prophylactic antibiotic during operation is indicated
if:
• Excessive blood loss (>1500 ml)
• Procedures exceed two half-life of the drug
• if there are other factors that may shorten the half-life of the
prophylactic agent (e.g. extensive burns)
Antimicrobial Recommended Redosing Interval in Adults
with Normal Renal Function
Cefazolin
Cefuroxime (From Initiation of Preoperative Dose), (hr)
Ampicillin/Sulbactam
Metronidazole 4
Clindamycin 4
Vancomycin 2
Gentamicin NA
Amoxicillin/Clavulanate 6
Benzylpenicillin NA
NA
3
2
54 National Antimicrobial Guideline 2019
For patients with penicillin allergy, vancomycin or clindamycin is recommended
unless stated otherwise. The dose of Vancomycin is according to patient’s body
weight, as follows:
• <75 kg: 1 gm infused over 60 minutes
• ≥75 kg: 1.5 gm infused over 90 minutes
Administration of cefazolin in obese patients:
• 2 gm if body weight <120 kg
• 3 gm if body weight ≥120 kg
National Antimicrobial Guideline 2019 55
A3.i Surgical Suggested Treatm
Infection/ Condition & Likely Organism Preferred
1. Obstetrics & Gynaecology Surgery Cefazolin 2gm IV (3gm IV for patients Amp
Cesarean Section weighing ≥120 kg)
a. Elective
b. Emergency Cefazolin 2gm IV (3 gm IV for patients Amp
Elective surgery: weighing ≥120 kg) Antib
TAHBSO OR
Hysterectomy (vaginal or abdominal) Cefuroxime 750mg IV
Laparascopy (vagina and/or uterus entered)
PLUS
Laparoscopic surgery Metronidazole 500mg IV
(vagina and/or uterus not entered)
Repair of perineal tear Antibiotic not recommended
e.g. third or fourth degree tears
Cefazolin 2gm IV (3gm IV for patients Amp
Surgical termination of pregnancy weighing ≥120 kg)
PLUS
Emergency laparotomy
Metronidazole 500mg IV
Doxycycline 400mg PO as a single dose
(1 hour prior to procedure)
OR
Azithromycin 1gm PO (1 hour prior to
procedure)
As per elective surgery
5
ment
Comments
Alternative
picillin/sulbactam 3gm IV
picillin/sulbactam 3gm IV Consider second or additional dose for prolonged
procedures.
biotic not recommended Duration: 5- 7days
picillin/sulbactam 3gm IV
No evidence outcomes are improved by including
Metronidazole in prophylactic regimens.2
References:
1. Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis
2. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic G
3. Van Eyk N, van Schalkwyk J, Infectious Diseases Committee. J ObstetGynaecol Can. 2012 Apr; 34
4. Van Schalkwyk J, Van Eyk N et al. No 247 – Antibiotic Prophylaxis in Obstetric Procedures.
5. Journal of Obstetrics and Gynaecology Canada, Volume 39, Issue 9, September 2017, Pages e30
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
2. Otorhinolaryngology Surgery
Head And Neck
Clean Antibiotic not required Antib
Clean with placement of prosthesis (excludes Cefazolin 2gm IV (3gm IV for patients
tympanostomy tubes) weighing ≥120 kg)
Clean-contaminated cancer surgery Cefazolin 2gm IV (3gm IV for patients Cefu
Other clean-contaminated procedures with the weighing ≥120 kg) PLUS
exception of tonsillectomy and functional PLUS Metr
endoscopic sinus procedures.
Metronidazole 500mg IV OR
Amp
References:
1. Simo R, French G. The use of prophylactic antibiotics in head and neck oncological surgery. Curr
3. Oral/ Dental Surgery
Clean Surgery (Class 1) Not indicated for most surgeries.
• Submandibular gland surgery May be indicated
• TMJ surgery i. if the duration of the surgery is
• Excision of benign tumours /cysts
expected to be very long
ii. for open reduction and internal
fixation of facial bone fractures
5
s in surgery. Am J Health-Syst Pharm. 2013; 70:195-283
Guidelines Limited; 2014.
4(4):382-391.
00-e308.
ment
Comments
Alternative
biotic not required
uroxime 1.5gm IV
S
ronidazole 500mg IV
picillin/sulbactam 3gm IV
rOpinOtolaryngolHead Neck Surg. 2006; 14:55-61 88
Prophylaxis is recommended for all patients with an
increased risk of surgical wound infection - i.e. in
immunocompromised patients.
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
Minor Clean-contaminated surgery (Class 2)
• Soft tissue surgery
• Dentoalveolar surgery*
• Periodontal surgery
Minor Clean-contaminated surgery (Class 2) Amoxicillin 1gm PO Amo
• Insertion of dental implants and use of graft OR 1.2g
Clindamycin 600-900mg PO/IV OR
material OR Cefu
• High degree of difficulty / long duration Benzylpenicillin 2MU IV
Major Clean-contaminated surgery (Class 3) Benzylpenicillin 2MU IV Amo
• Orthognathic surgery OR OR
• Excision/ enucleation of large benign Clindamycin 600-900mg IV Cefu
tumours/ cysts
• All oral cancer surgery
• Open reduction and internal fixation of facial
bone fractures
Reference:
1. Oral Health Division Ministry of Health Malaysia. Antibiotic Prophylaxis in Oral Surgery for Preven
Ministry of Health Malaysia; 2015.
4. Plastic Surgery
Not indicated: for the majority of clean procedures*, unless the patient has risk factors for postoperat
antibiotics while waiting for non-infected skin grafts or flaps to epithelialize is not evidence-based.
For clean–contaminated procedures Cefazolin 2gm IV (3gm IV for patients Amo
weighing ≥120 kg)
Reference:
1. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic G
5
ment
Alternative Comments
*In patients with cardiac conditions with increased risk of
Infective Endocarditis, chemoprophylaxis is indicated.
Please refer to Chemoprophylaxis Non-Surgical section.
oxicillin/clavulanate 1.25gm PO or
gm IV
uroxime 500mg PO or 1.5gm IV
oxicillin/clavulanate 1.2gm IV For oral & maxillofacial fractures, antibiotics is
uroxime 1.5gm IV recommended for the immediate post trauma period and
should be discontinued once open reduction and internal
fixation is completed.
ntion of Surgical Site Infection. Putrajaya: Dental Technology Section Oral Health Division (OHD)
tive infection (e.g. implantation of prosthetic material, prior skin irradiation). The continuation of
oxicillin/clavulanate 1.2gm IV
Guidelines Limited; 2014.
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
5. Vascular Surgery Ampicillin/sulbactam 3gm IV Amo
Amputation of ischemic limb
Suspected organism:
Staphylococcus spp. & anaerobic organism
Open and endovascular repair of abdominal Amoxicillin/clavulanate 1.2gm IV Antib
aneurysm. Vanc
patie
Bypass surgery Amoxicillin/clavulanate 1.2gm IV Antib
Vanc
patie
Arteriovenous graft Amoxicillin/clavulanate 1.2gm IV
If High Risk For MRSA:
Vancomycin 1gm IV (1.5gm IV for
patients weighing ≥75 kg)
Reference:
1. Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis
6. General Surgery Cefazolin 2gm IV (3gm IV for patients Cefu
weighing ≥120 kg) Cefu
Procedures involving entry into lumen of
gastroinstestinal tract (bariatric, Cefazolin 2gm IV (3gm IV for patients
pancreaticoduodenectomy) weighing ≥120 kg)
Procedures without entry into gastrointestinal
tract (antireflux, highly selective vagotomy) for
high risk patients
5
ment
Comments
Alternative
oxicillin/clavulanate 1.2gm IV
biotic allergy: Antibiotic allergy refer to Appendix 8.
comycin 1gm IV (1.5gm IV for
ents weighing ≥75 kg) Antibiotic allergy refer to Appendix 8.
biotic allergy: MRSA risk (defined as history of MRSA colonisation or
comycin 1gm IV (1.5gm IV for infection, OR inpatient of high risk hospital or unit (where
ents weighing ≥75 kg) MRSA is endemic).
s in surgery. Am J Health-Syst Pharm.2013; 70:195-283
uroxime 1.5gm IV
uroxime 1.5gm IV
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
Appendectomy for uncomplicated appendicitis Cefazolin 2gm IV (3gm IV for patients Cefu
Colorectal weighing ≥120 kg) PLUS
PLUS Metr
Metronidazole 500mg IV
Antib
OR Clind
Ampicillin/sulbactam 3gm IV PLUS
Gent
Small intestine Non-obstructed:
Cefu
Cefazolin 2gm IV (3gm IV for patients
weighing ≥120 kg) Antib
Clind
Obstructed: PLUS
Gent
Cefazolin 2gm IV (3gm IV for patients
weighing ≥120 kg) Cefu
PLUS PLUS
Metr
Metronidazole 500mg IV
Antib
Hernia repair with mesh Cefazolin 2gm IV (3gm IV for patients Clind
Breast cancer surgery weighing ≥120 kg) PLUS
Gent
Cefazolin 2gm IV (3gm IV for patients
weighing ≥120 kg) Amo
OR
Amp
Amo
OR
Amp
6
ment
Alternative Comments
Antibiotic allergy refer to Appendix 8
uroxime 1.5gm IV
S Antibiotic allergy refer to Appendix 8
ronidazole 500mg IV
Includes laparoscopic repair
biotic allergy: Single / stat dose only.
damycin 600-900mg IV
S The benefits of routine postoperative antibiotic doses in
tamicin 5mg/kg IV reconstruction surgery are uncertain; there may be a
benefit in obese patients or those treated with radiation
uroxime 1.5gm IV therapy. The need for postoperative doses should be
considered on an individual patient basis; if used,
biotic allergy:
damycin 600-900mg IV
S
tamicin 5mg/kg IV
uroxime 1.5gm IV
S
ronidazole 500mg IV
biotic allergy:
damycin 600-900mg IV
S
tamicin 5mg/kg
oxicillin/clavulanate 1.2gm IV
picillin/sulbactam 3gm IV
oxicillin/clavulanate 1.2gm IV
picillin/sulbactam 3gm IV
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
Breast reshaping procedures Cefazolin 2gm IV (3gm IV for patients Amo
weighing ≥120 kg) OR
Amp
Breast surgery with implant (reconstructive or Cefazolin 2gm IV (3gm IV for patients Amo
aesthetic) weighing ≥120 kg) OR
Amp
References:
1. Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis
2. Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic G
7. Orthopaedic Surgery None None
Clean operations involving hand, knee, or foot Cefu
and not involving implantation of foreign Antib
materials Clind
Internal fixation of all closed fracture/ Total Joint Cefazolin 2gm IV (3gm IV for patients
Replacement/ Spine surgery (with and without weighing ≥120 kg)
instrumentation)/ Arthroscopy.
References:
1. Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis
2. T.P Ruedi ,R.GBuckley,C.GMarani,AO principle of fracture management. A.H.R.W Simpson, BMJ 2
ment 6
Alternative Comments
postoperative prophylaxis should not exceed 24 hours.2
oxicillin/clavulanate 1.2gm IV
picillin/sulbactam 3gm IV
oxicillin/ clavulanate 1.2gm IV
picillin/ sulbactam 3gm IV
s in surgery. Am J Health-Syst Pharm.2013; 70:195-283
Guidelines Limited; 2014.
e
uroxime 1.5gm IV The benefits of routine postoperative antibiotic are
uncertain. If used, postoperative prophylaxis should not
biotic allergy: exceed 24 hours.
damycin 600-900mg IV
Antibiotic allergy refer to Appendix 8.
s in surgery. Am J Health-Syst Pharm.2013; 70:195-283
2015
Suggested Treatm
Infection/ Condition & Likely Organism Preferred
8. Urological Surgery Ciprofloxacin 500mg PO q12h for 3 days Targ
A. Diagnostic Procedures (start 24 hours before procedure) pre-o
PLUS/MINUS
Transrectal ultrasound and prostate biopsy Gentamicin 80mg IV single dose given Antib
Common organisms: 30-60 minutes before procedure.
Escherichia coli, Klebsiella, Proteus, Antibiotic not recommended
Enterococcus, Pseudomonas
Cystoscopy/ Urodynamics study
Retrograde pyelogram/Ureteric stenting Cefuroxime 250mg PO stat Cefu
OR
B. Endourology Amoxicillin/ clavulanate 1.2gm IV Cefta
OR Pseu
Endourological surgery Ampicillin/sulbactam 3gm IV
e.g. PCNL, URS, RIRS, TURP
Common organisms:
Escherichia coli, Klebsiella, Proteus,
Enterococcus, Pseudomonas
6
ment
Comments
Alternative
geted antibiotic therapy based on Consider Povidone-iodine bowel preparation to further
operative rectal swab result. decrease infection risk.
biotic not recommended Prophylaxis only for high risk cases (immunocompromised
patients, e.g. debilitated patients on long term catheters,
patient with prosthesis/heart valves, diabetics, transplant
recipients):
Cefuroxime 250mg PO stat.
If heart valve:
Follow recommendation for SBE prophylaxis.
uroxime 1.5gm IV Antibiotic selection to be determined based on patient’s
latest urine culture result.
azidime 2gm IV (if urine grew
udomonas)
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
C. Open Surgery
Clean operations Antibiotic not required Antib
e.g. orchidectomy, orchidopexy, varicocelectomy,
deroofing renal cysts
Clean-contaminated (with opening of urinary Amoxicillin/ clavulanate 1.2gm IV q8h for Cefo
OR
tract) 1 day Cefta
grew
e.g. nephrectomy, prostatectomy, open stone OR
Gent
surgery. Ampicillin/sulbactam 3gm IV q8h for PLUS
Metr
1 day
Common organisms:
Escherichia coli, Klebsiella, Proteus,
Enterococcus, Pseudomonas
Clean-contaminated (with use of bowel segments) Cefoperazone 1gm IV q12h
e.g. Cystectomy with urinary diversion, PLUS
cystoplasty. Metronidazole 500mg IV q8h
Common organisms:
Escherichia coli, Klebsiella, Proteus,
Enterococcus, Pseudomonas, anaerobes
Implant of prosthetic devices Cefuroxime 1.5gm IV q8h for 1 week Amo
e.g. Insertion of penile prosthesis or artificial 1 we
urinary sphincter, artificial slings OR
Amp
Common Organism: 1 we
Staphylococcus aureus
Laparoscopic surgery As for open surgery As fo
or clean– contaminated.
6
ment
Comments
Alternative
biotic not required
operazone 1gm IV q12h for 1 day
azidime 2gm q8h IV for 1 day (if urine
w Pseudomonas)
tamicin 1.5mg/kg IV q8h For duration of catheter presence.
S
ronidazole 500mg IV q8h
oxicillin/ clavulanate 1.2gm IV q8h for
eek
picillin/ sulbactam 3gm IV q8h for
eek
or open surgery Depending on type of procedure performed whether clean
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
Reference:
1. Pickard R., Bartoletti R., Bjerklund-Johansen TE., Bonkat G., Bruyere F., Cek M. et al. members of
SIOG Guidelines on Urological Infections. Edn. presented at the EAU Annual Congress London 20
Netherlands.
9. Neurological Surgery
Clean wounds Cefuroxime 1.5gm IV Vanc
(Uninfected operative wounds in which no (Given as a single IV dose at induction or (Infu
inflammation is encountered and no viscus is within 60 minutes before incision. For befo
entered during the procedures) prolonged procedures, additional is at
intraoperative doses are given at every patie
Elective craniotomy or spinal procedures. 4 hours interval during surgery in patients OR
with normal renal function). *Teic
(Give
Clean wounds with Foreign Body or Cefuroxime 1.5gm IV Vanc
Instrumentation. PLUS OR
CSF shunting procedures, implantation of Metronidazole 500mg IV *Teic
cranial or spinal implants. (Given as a single IV dose at induction or
within 60 minutes before incision. PLUS
Additional redose interval is at every 4 Gent
hours during surgery in patients with (Give
normal renal function). withi
patie
PLUS
Metr
(Give
withi
Addi
durin
rena
6
ment
Comments
Alternative
f the EAU – ESTRO – ESUR –SIOG Urological Infections Guidelines Panel. EAU – ESTRO – ESUR –
017. 978-90-79754-91-5. Publisher: EAU Guidelines Office. Place published: Arnhem, The
comycin 15-20mg/kg IV (max 2gm) Situation where the use of vancomycin is appropriate: -
usion is started within 60-120 min • In hospitals in which MRSA or S.epidermidis are
ore incision. Additional redose interval
frequent causes of postoperative wound infection,
every 12 hours during surgery in • In patients previously colonized with MRSA, or
ents with normal renal function) • Those who are allergic to penicillins or cephalosporins.
Rapid IV administration of Vancomycin may cause
coplanin 400mg IV
en as a single IV dose at induction) hypotension.
*Requires DG's Approval
comycin 15-20mg/kg IV (max 2g) Addition of another drug such as metronidazole and
aminoglycoside is appropriate for procedures in which
coplanin 400mg IV anaerobic and enteric gram negative bacilli or anaerobic are
common pathogens.
S *Requires DG's Approval
tamicin 5mg/kg IV
en as a single IV dose at induction or
in 60 minutes before incision in
ents with normal renal function)
S
ronidazole 500mg IV
en as a single IV dose at induction or
in 60 minutes before incision.
itional redose interval is at 4 hours
ng surgery in patients with normal
al function)
Infection/ Condition & Likely Organism Preferred Suggested Treatm
Clean-contaminated wounds Cefuroxime 1.5gm IV Vanc
(Operative wounds in which a viscus is entered PLUS OR
and without unusual contaminations) Metronidazole 500mg IV *Teic
Procedures that breach air cells or nasal or oral PLUS
cavity. Gent
PLUS
Metr
Contaminated wounds Ceftriaxone 2gm IV Vanc
(Open, fresh accidental wounds, operation with (Given as a single IV dose at induction or OR
major breaks in sterile technique, or gross within 60 minutes before incision. *Teic
spillage from a viscus). Additional redose interval is at every 12
hours during surgery in patients with PLUS
normal renal function) Gent
PLUS PLUS
Metronidazole 500mg IV Metr
Dirty wounds Ceftriaxone 2gm IV Vanc
(Infected CSF shunt, Old traumatic wounds with PLUS OR
retained devitalized tissue, foreign bodies or Metronidazole 500mg IV *Teic
wounds that involve existing clinical infection or
PLUS
perforated viscus) Gent
PLUS
Metr
References:
1. Salford Royal, NHS. Antibiotic Prophylaxis in Cranial Neurosurgery Antibiotic Guidelines, Unique
2. SIGN 104 Antibiotic prophylaxis in surgery. July 2008, updated April 2014
3. Surgical Antimicrobial Prophylaxis Clinical Guideline v2.0. Department for Health and Ageing, Gov
6
ment Comments
*Requires DG's Approval
Alternative
*Requires DG's Approval
comycin 15-20mg/kg IV (max 2g)
Settings where intraventricular antibiotics (vancomycin
coplanin 400mg IV 10mg or gentamycin 5 mg) may be useful:
• Failure to sterilize the CSF with IV therapy
S • Poor respond to IV systemic antibiotics
tamicin 5mg/kg IV • Presence of highly resistant organisms susceptible to
S
ronidazole 500mg IV only antibiotics with poor CSF penetration
• Circumstances in which shunt devices cannot be
comycin 15-20mg/kg IV (max 2g)
removed (including infected Ommaya reservoirs)
coplanin 400mg IV *Requires DG's Approval
S
tamicin 5mg/kg IV
S
ronidazole 500mg IV
comycin 15-20 mg/kg IV (max 2g)
coplanin 400mg IV
S
tamicin 5mg/kg IV
S
ronidazole 500mg IV
ID: 144TD(C)25(F4) Issue number: 6, 2018
vernment of South Australia .October 2017
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
10. Cardiac Surgery Cefazolin 2gm IV ( 3gm IV for patients Cefu
Coronary artery bypass weighing ≥120 kg)
Cardiac device insertion procedures Cefazolin 2gm IV (3gm IV for patients Cefu
(eg. Pacemaker implantation) weighing ≥120 kg)
Reference:
1. Bratzler DW, Dellinger EP, Olsen KM et al. Clinical practice guidelines for antimicrobial prophylaxis
11. Ophthalmology Surgery
The use of povidone iodine 10% to the periorbital skin and 5% to the conjunctival sac as an antise
Intracameral injection of 1mg Cefuroxime in 0.1ml at the end of cataract surgery is recommended
Topical antibiotics at end of surgery.
Reference:
1. Prophylaxis for intraocular surgery-CPG for Management of Post-Operative Endophthalmitis, Min
12. Hepatobiliary Surgery Cefazolin 2 gm (3 gm IV for patients
weighing ≥120 kg)
Laparoscopic procedures
Low risk Cefazolin 2 gm IV (3 gm IV for patients
weighing ≥120 kg)
Laparoscopic procedures PLUS
High risk: Gentamicin 5mg/kg IV (2mg/kg IV single
Stent insertion dose if CrCl< 20)
Biliary obstruction (High direct bilirubin)
6
ment
Comments
Alternative
uroxime 1.5gm IV
uroxime 1.5gm IV
s in surgery. Am J Health-Syst Pharm.2013; 70:195-283
eptic agent for preoperative surgical site preparations are recommended.
d. Careful dilution should be undertaken to prevent potential toxicity.
nistry of Health Malaysia, August 2006
1. Optimum antibiotic timing is to complete intravenous
infusion ≤60min (optimal window 15 to 45 min)
prior to skin incision; to ensure adequate time to reach
bactericidal serum and tissue concentration before skin
is incised.
2. Repeat intraoperative dosing is recommended in:
• Prolonged surgery > 4 hours
• Massive blood loss > 1.5 L
Aminoglycosides should not be re-dosed
Infection/ Condition & Likely Organism Suggested Treatm
Open surgery Preferred
Low risk
Open surgery Cefazolin 2gm IV (3 gm IV for patients
High Risk weighing ≥120 kg)
Multiple ERCP ( ≥ 2) done with stenting
Biliary obstruction Cefazolin 2 gm IV (3 gm IV for patients
Biliary infection or surgery within < 30 days weighing ≥120 kg)
PLUS
Pre-exiting infection before surgery, GB Gentamicin 5mg/kg IV (2mg/kg IV single
empyema, ascending cholangitis dose if CrCl< 20)
If high risk ESBL/Multi-resistant
organisms, eg ESBL in the last 3/12 but
treated
Piperacillin/ tazobactam 4.5gm IV
PLUS
Gentamicin 5mg/kg IV (2mg/kg IV single
dose if CrCl< 20)
Initiate antibiotic according to culture
results, or refer to treatment guidelines
If patient is at risk of infection with
Multi-drug resistant organism, to discuss
with consultant surgeons/ ID physicians
6
ment
Comments
Alternative
A3. ii. Non-Surgical
Table 1: Patients with cardiac conditions are considered as being at increased risk
of developing IE and are indicated for antimicrobial prophylaxis prior to certain
procedures.
Table 1
1. Prosthetic cardiac valves or prosthetic material used for cardiac valve repair
2. Established rheumatic heart disease
3. Previous history of infective endocarditis
4. Unrepaired cyanotic congenital heart disease (CHD), including palliative
shunts and conduits
5. Completely repaired CHD with prosthetic material or device, for first 6
months after the procedure
6. Repaired CHD with residual defects at the site or adjacent to the site of the
prosthetic device (which inhibit endothelisation)
7. Cardiac transplantation recipients who develop cardiac valvulopathy
Dental Procedures
For patients considered as high risk (table 1), antimicrobial prophylaxis is
recommended for invasive dental procedures involve manipulation of gingival
tissue or the periapical region of teeth or perforation of gingival mucosa.
Even with high cardiac risk of infective endocarditis, antibiotic prophylaxis is not
recommended for
• local anaesthetic injections in non-infected tissues
• treatment of superficial caries
• removal of sutures
• dental X-rays
• placement or adjustment of removable prosthodontic or orthodontic
appliances or braces
• following the shedding of deciduous teeth
• trauma to the lips and oral mucosa
68 National Antimicrobial Guideline 2019
Respiratory Tract Procedures:
Antimicrobial prophylaxis is recommended for patients with increased risk of IE
(table 1) who undergo an invasive respiratory tract procedure that involve incision
or biopsy of the respiratory mucosa. Patients who undergo an invasive respiratory
tract procedure to treat an established infection, e.g. biopsy drainage of an abscess,
should receive an antibiotic prophylaxis which contains an anti-staphylococcal
agent.
Gastrointestinal or genitourinary procedures:
Routine pre-procedural antimicrobial prophylaxis is no longer recommended for
patients undergoing genitourinary or gastrointestinal tract procedures. However,
for high risk cardiac patients (table 1) who have an established gastrointestinal or
genitourinary infection, or for those who receive antimicrobial therapy for surgical
reasons, the antimicrobial regimen should include an agent active against
enterococci, such as ampicillin or vancomycin.
Dermatological or musculoskeletal procedures:
For patients described in table 1 undergoing surgical procedures involving infected
skin (including local abscesses), skin structure or musculoskeletal tissue, it is
reasonable that the therapeutic regimen contains an agent active against
staphylococci and beta-hemolytic streptococci. Vancomycin or clindamycin may
be used in patients unable to tolerate a β-lactam antibiotic. If the infection is
known or suspected to be caused by MRSA, vancomycin or another suitable agent
should be administered.
National Antimicrobial Guideline 2019 69
A3.ii Non-Surgical
Suggested Treatm
Infection/ Condition & Likely Organism
Preferred
Prophylactic Regimens For High-Risk Dental Procedures In High-Risk Patients
Prophylactic Regimes Amoxicillin 2gm PO single dose 30 to Cefa
60 minutes before procedure minu
OR Antib
Ampicillin 2gm IV single dose 30 to Clind
60 minutes before procedure. 30 to
Secondary Prevention Of Rheumatic Fever
Secondary Prevention of Rheumatic Fever Parenteral prophylaxis: Antib
Benzathine Penicillin 1.2MU IM Eryth
every 3 to 4 weeks PO q
OR
Phenoxymethylpenicillin (Penicillin V) 10
250mg PO q12h
Type Of Infection
Rheumatic fever with carditis and residual heart disease (persistent valvular disease)
Rheumatic fever with carditis but no residual heart disease (no valvular disease) 10
Rheumatic fever without carditis 5y
References:
1. Ministry of Health Malaysia’s Clinical Practice Guidelines For The Prevention, Diagnosis & Manag
2. ESC Guidelines on Prevention of Infective Endocarditis 2015
3. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and
7
ment
Comments
Alternative
azolin 1gm IV single dose 30 to 60 See above for antibiotic prophylaxis in patients undergoing
utes before procedure. invasive surgical procedure to treat an established
biotic allergy: infection.
damycin 600mg PO or IV single dose
o 60 minutes before procedure. Antibiotic allergy refer to Appendix 8
biotic allergy: Antibiotic allergy refer to Appendix 8
hromycin Ethylsuccinate 800mg
q12h
Duration Of Treatment
years or until 40 years of age, whichever is longer; sometimes lifelong prophylaxis
years or until 21 years of age, whichever is longer
years or until 21 years of age, whichever is longer
gement Of Infective Endocarditis 2017
d rheumatic heart disease (2nd edition)