antibiotic[1] - DONE EDITING.pptx

Presented by Group 4
• Lavenytharan A/L M.Arivazhkan
• Kalimah Binti Nazari
• Halimatul Azreen Binti Abdul Halliim

A drug or chemical used
to treat infections caused
by bacteria and other
microorganisms.

 Broad spectrum: antibiotics that were effective against both gram
+ve and gram –ve. ( ex. aisoniazide)
 Narrow spectrum : antibiotic that is only able to kill or inhibit
limited species of bacteria. They can act on either gram +ve or gram
–ve but not both. ( Ex. Tetracycline & chloramphenicol)

Kills the bacteria ( bacteriocidal)
- Damages the bacterial cells wall
-interfere with the chemical activity in bacteria
Slows down bacterial growth (Bacteriostatic)
-interferes with the reproduction of bacteria

Bactericidal Bacteriostatic
Antibiotic that kills bacteria Antibiotic that prevent the growth of
bacteria
Action is irreversible Action is reversible
Inhibit the cell wall formation of
bacteria
Inhibit DNA replication and protein
synthesis of bacteria
Do not work with the immune
system of the host
Work with immune system of the host
to prevent the growth and
reproduction of bacteria
MBC refers to the concentration of
the drug required to kill 99.99% of
bacterial population
MIC is the minimum drug
concentration which inhibits the
bacterial growth
Examples include beta-lactam
antibiotic , cephalosporins and
vancomycin
Examples include tetracyclines,
spectinomycin, chloramphenicol,
sulfonamides, etc.

Must be taken according to the prescribed dose and
duration.
Time frame: usually 7 days - 10days
Infection in the respiratory system: 2-6 weeks ( set
by the doctor according to patient condition)
TB disease : 4-6 months

Using antibiotic to treat infection not cause by
bacteria
Self medication by using antibiotic
Using antibiotics in the wrong dose and duration
can result in multidrug- RESISTANT

Hypersensitivity effects (anaphylactic shock,Bronchial
asthma , etc)
Allergic reaction (Urticaria)
Intestinal disorder ( gastric,diarrhea , etc)
Eliminate normal flora in the mouth and intestine
Disturbances/damages the liver and kidney ( if prolonged
use)

Resistance due to inappropriate use of
antibiotic.
Direct toxicity ( aminoglycosides –
ototoxicity)
Super infection ( Multidrug- RESISTANT)

Infection / condition
& likely organism
Suggested Treatment
Comments
Preferred Alternative
• Abdominal
trauma
• Stab wound
• Suspected bowel
or solid organ
injury
 Common
organisms:
-Gram negative
enteric aerobes and
anaerobed
Amoxicillin/clavulana
te (augmentin) 1.2 gm
IV TDS
Cefuroxime (zinacef)1.5gm
IV TDS
PLUS
Metronidazole (flagyl)500gm
IV TDS
Duration : 4-7 days ( if
adequate source control, no
delay in surgical
intervention and patient
has rapid clinical recovery)
*piperacillin/tazobactam: if
given as q8h, to be given as
extended infusion ( over 3-
4 hours)
Severe /infected
wound:
-cefazolin 2gm IV
TDS
PLUS
-
Metronidazole(flagyl)50
0gm IV TDS
OR
*piperacillin/tazobactam
(zosyn)4.5gm IV QID -
Severe/infected wound:
Ciprofloxacin (ciprobay)
400mg IV BD
PLUS
Clindamycin 450-600mg IV
TDS

& likely organism
Suggested Treatment
Comments
Ichemic limb ulcer
with infection
Ampicillin/sulbactam
1.5-3gm IV QID-TDS
for 7 days
( to continue until
C&S available)
Amoxicillin/clavulanate
1.2gm IV TDS for 7day
( to continue until C&S
available
Duration : depends on the
extend of the infection (
longer if bone involved)
• Acute osteomyelitis
 Common
organisms:
-Staphylococcus aereus
(80%)
Group A streptococcus
pyogenes
Rarely gram negative
bacilli
Empirical coverage:
Cloxacillin 2gm IV QID
To tailor antibiotics
according to definitive
cultures.
Antibiotic allergy:
Cefazolin 2gm IV QID-TDS
Duration : Initial IV therapy
for 2-4 weeks followed by oral
therapy. Minimum 6 weeks.
Modify according to clinical
response.
A shorter duration of
antibiotics can be considered if
the osteomyelitis is fully
resected (e.g. amputation with
a clear margin):
• No surrounding soft tissue
infection : 5days.
• Evidence of soft tissue
infection: 10-14 days.

Infection / condition &
likely organism
Suggested Treatment
Comments
• Chronic Osteomyelitis
1. Relapsing infection
despite adequate
duration of
appropriate antibiotic
2. Chronic
pain/swelling/bone
tenderness associated
with tissue necrosis,
increased drainage or
persistent sinus tracts
3. Presence of bone
destruction and
presence of sequestra
on imaging
Empirical
treatment before
taking cultures is
not recommended
Choice of
antibiotic depends
on C&S results
from tissue/Bone
as swab culture
NOT reliable
Thorough surgical
debridement
required ( removal
of deadbone/
orthopaedic
hardware)
Streptococcus aureus:
Cont cloxacillin 2gm IV QID
Pseudomonas;
Tazocin 4.5mg IV QID
Multiple-resistant
staphloccus aureus (MRSA):
Vancomycin 15-20mg/kg IV
TDS-BD: not to exceed
2gm/dose
Duration : 6 weeks but
usually > 3 months
Treat until inflammatory
parameter are normal.

& likely organism
Suggested Treatment
Comments
• Vertebral
osteomyelitis
• Epidural abcess
 Common
organism:
-Staphylococcus
aureus( main)
-Brucella
-salmonella
-Gram –ve Bacilli
Empirical should be
withheld unless
patient is septic or in
patient with
neurologic
compromise.
Cloxacillin 2gm IV 4
hourly
To tailor according to
definitive cultures.
Cefazolin 2gm IV QID-TDS Empiric gram negative
should be covered if
patient had:
 Recent spinal hardware
inserted or surgery
 Intraabdominal
infections
 HIV infection
Surgical therapy is
necessary in:
 Spinal cord
compression/instability
 Persistence of epidural
abscess despite
adequate antibiotic
 Consediring TB
spine/MDR organism
Duration:
Minimum 6 weeks.
Minimum 8weeks if undrained paravertebral abcess
and/or infection due to drug-resistant organism.
Up to 12 weeks if extensive bone destruction.

& likely organism
Suggested Treatment
Comments
Septic arthritis
• Acute
monoarticular
(in person who do
not have any risk
factors for STD (
staphylococcus/strep
tococcus)
Cloxacillin 2gm IV 4
hourly- QID
Duration:
-Parental therapy 2-4
weeks
-Oral therapy to
complete total 4-6
weeks
Antibiotic allergy:
- Cefazolin 2gm IV QID-TDS
OR
-Clindamycin 600mg IV
QID,followed by oral therapy
( same dose)
OR
-Vancomycin 15-20mg/kg IV
TDS-BD: not to exceed
2gm/dose
Duration:
-parental therapy 2-4weeks
-Oral therapy to complete
total 4-6 weeks
Drainage ,debridement and
washout of infected joint is
important to limit further
damage
therapy is possible in
immunocompetent patients
who have had adequate
surgical drainage.
Vancomycin : if
suspected/confirm
MRSA.consider loading
dose 25-30mg/kg for
critically ill/septic patient to
achieve faster steady state.

Infection /
condition & likely
organism
Suggested Treatment
Comments
Septic arthritis
• Acute
monoarticular[
in person who
have risk of
STD(gonorrhea/
streptococcus/sta
phylococcus/Gra
m –ve bacilli)]
Cetriaxone 2gm IV
OD for 1-2 weeks
PLUS
azithromycin 1gm PO
stat
OR
Doxycycline 100mg
PO BD for 7days
Cefotaxime 2gm IV TDS for
1-2 weeks
PLUS
azithromycin 1gm PO stat
OR
Doxycycline 100mg PO BD
for 7days
• Polyarticular
Gonorrhoea
Ceftriaxone 2gm IV
OD for 7days

& likely organism
Suggested Treatment
Comments
Definitive Prosthetic
joint infection
treatment
• Methicillin-
sensitive
staphylococcus
aureus (MSSA)
Initial treatment:
Cloxacillin 2gm IV
4hourly-QID
OR
Cefazolin 2gm IV QID-
TDS
PLUS
Rifampicin 600mg PO
OD or 450mg PO BD
Duration: 2-6 weeks (
according to treatment
strategy)
Followed by an oral
combination therapy
according to
susceptibility.
Rifampicin should be
included if implant is
insitu.
• Methicillin-
resistant
staphylococcus
aureus (MRSA)
Initial treatment :
-vancomycin 15-
20mg/kg ( actual body
weight) IV TDS-BD
;not to exced 2gm/dose
PLUS
Rifampicin 300mg-
450mg PO BD
Duration: same as above

Infection /
condition & likely
organism
Suggested Treatment
Comments
Diabetic foot
infection
• Mild infection
a) Local infection
involving skin &
SC tissues
b) Erythema,less
than 2cm
around the ulcer
c) No systemic
signs of
infection
Amoxicillin/clavulana
te 625mg PO TDS
OR
Ampicillin/sulbactam
375-750mg PO BD
Cephalexin 500mg PO QID
PLUS
Metronidazole 400mg PO
TDS
Duration : 5-7 days

Infection /
condition & likely
organism
Suggested Treatment
Comments
Diabetic foot
infection
• Moderate
infections:
a) Deep tissue
infection
b) Erythema more
than 2 cm
around ulcer
c) No SIRS
(Systemic
inflammatory
response
syndrome)
Ampicillin/sulbactam(
unasyn) 3gm IV QID-
TDS
If pseudomonas is
suspected:
Piperacillin/tazobacta
m 4.5gm IV QID-TDS
Cefazolin 2gm IV TDS
PLUS
Metronidazole(flagyl)
500mg PO TDS
Antibiotic allergy:
Ciprofloxacin 400mg IV
TDS-BD
PLUS
Clindamycin 600mg IV TDS
Duration : 7-14days
Modify according to
clinical response.
If proven osteomyelitis or
margin of resection in
inadequate: at least 4-6
weeks.
Piperacillin/tazobactam : if
given q8h, to be given as
extended infusion ( over 3-
4hour)

likely organism
Suggested Treatment
Comments
Diabetic foot infection
• Severe infections:
a) All of the above
b) 2 or more SIRS
-history of previous
antibiotics exposure
-Recurrent admission
-Risk of pseudomonas
has infection
-Immunocompromised
Piperacillin/tazobactam
4.5gm IV QID-TDS
If given as TDS, to be
given as extended
infusion (over 3-4hours)
Cefepime 2gm IV TDS
PLUS
Metronidazole 500mg IV
TDS
Surgical debridement is
URGENT.
Based on intra-operative
C&S, antibiotic should be
streamlined.
Duration : 7-14 days (
subjected to clinical
improvement)
If proven osteomyelitis or
margin of resection is
inadequate at least 4-6
weeks.
antibiotics can be considered
if the osteomyelitis is fully
resected( i.e., amputation
with a clear margin):
 No surrounding soft tissue
infection : 5days
 Evidence of soft tissue: 10-
14 days

likely organism
Suggested Treatment
Comments
Necrotizing fascitis
• Type 1 (
polymicrobial
infection)
Primarily occurs in
patients who are
immunocompromised
or have certain
chronic disease such
as diabetes
Piperacillin/tazobactam
4.5gm IV QID-TDS
PLUS/MINUS
Clindamycin 600-900mg
IV TDS
Cefotaxime 2gm IV TDS
PLUS
Metronidazole 500mg IV
TDS
OR
TDS
OR
Ampicillinn/sulbactam 3gm
IV QID-TDS
PLUS/MINUS
TDS
Piperacillin/tazobactam : if given
as q8h, to be given as extended
infusion (over 3-4hour)
Clindamycin
Only necessary if risk of group A
streptococcus/ presence of gas
crepitus.
Immediate aggresive surgical
Debridement is the primary
treatment modality.
Repeated surgical debridemenet
for source control are normally
necessary.
Based on intra-operative C&S
,antibiotic should be
streamlined.

& likely organism
Suggested Treatment
Comments
Necrotizing fascitis
• Type 2 (
monomicrobial
infection)
Group A
streptococcus ( most
common)
Benzylpenicillin 2-
4MU IV 4hourly
PLUS
Clindamycin 600-
900mg IV TDS
Clindamycin
Only necessary if risk of
group A streptococcus/
presence of gas crepitus.
Duration: 7-14days
(subjected clinical
assessment)
Fournier Gangrene
Common organism:
-E.coli
-Klebsiella
-Proteus
-Enterococcus
-Pseudomonas
-anaerobes
Piperacillin/tazobac
tam 4.5gm IV QID-
TDS
OR
Ceftriaxone 2gm IV
OD
PLUS
Metronidazole
500mg IV TDS
Ampicillin/sulbactam 3gm
IV QID-TDS
Aggressive surgical
debridement is necessary
to remove all necrotic
tissue.

Infection /
condition & likely
organism
Suggested Treatment
Comments
Soft Tissue
infection secondary
to gas producing
organism
Common organism:
Clostridium sp
Gram negative
organism
Benzylpenicillin 4MU
IV 4hourly
PLUS
Clindamycin 600-
900mg IV QID
PLUS/MINUS
Gentamicin 5mg/kg
IV OD
Cefotaxime 2gm IV TDS
PLUS
QID
Duration: 10-28days

Infection /
condition & likely
organism
Suggested Treatment
Comments
Suppurative wound
infection, surgical
or traumatic
• Suppurative
wound infections
, surgical or
traumatic
If there is
surrounding cellulitis
and/or systemic
symptoms are
present: cloxacillin
500mg PO/IV QID
PLUS/MINUS
Gentamicin 5mg/kg
IV OD ( if gram
negative organism
suspected or known
to be involved)
OR
As monotherapy:
Cefuroxime 1.5gm IV
TDS
Change antibiotic
accordingly after C&S
result are available.
Topical antibiotics are not
recommended for
treatment of wound
infection as it may result
in the emergence of
resistant organism.
Patient tetanus
immunization status
should be assessed in all
cases.

Infection /
condition & likely
organism
Suggested Treatment
Comments
Muscular , skeletal
and soft tissue
trauma, crush
injuries and stab
wounds.
Cloxacillin 2 gm IV
QID
PLUS/MINUS
Metronidazole (flagyl)
500mg IV TDS
PLUS/MINUS
Gentamicin 5mg/kg
IV OD
Cefazolin 2gm IV QID-TDS
OR
Cefuroxime (zinacef)1.5gm
as a loading dose , followed
by 750mg IV TDS
PLUS
500mg IV TDS
Metronidazole: in soil/rust
contamination or heavy
machinery.
Gentamicin: if there’s
extensive skin & soft
tissue involvement.
Thorough surgical
debridement, soft tissue
and fracture stabilization.
For severe penetrating
injuries, especially those
involving joints and/or
tendons, antibiotic must
be given for at least 5 days

& likely organism
Suggested Treatment
Comments
Compound
fractures: antibiotic
are administere as
prophylaxis within
3 hours of injury
• Gustilo 1 & 2
fracture
Cefazolin 1-2gm IV
TDS
OR
Cefuroxime (zinacef)
1.5gm IV TDS
Amoxicillin/clavulanate(aug
mentin)1.2gm IV TDS
Pre- debridement and post
debridement cultures are not
representative of actual
infection
• Gustilo 3
fractures
Mostly gram +ve
and nosocomial.
As per gustilo 1&2
fractures
PLUS
Gentamycin 3-5gm/kg
IV stat dose
PLUS/MINUS
500mg IV TDS
Duration of antibiotic for open
fracture classification:
-Gustilo type 1: stop after
24hour
-Gustilo type 2: discontinue
after 24 hour to 48hour
-gustilo type 3: 24hour after
wound closure or up to a
maximum of 72hrs ( whichever
is earlier)

Infection /
condition & likely
organism
Suggested Treatment
Comments
Depressed skull
fractures
Cefuroxime (zinacef)
1.5gm IV TDS
PLUS
metronidazole(flagyl)
500mg IV TDS
Duration: 5-7days
Review tetanus status of
patient and consider
vaccination

The 10 Rights of Medications Administration
1. Right patient
 Check the name on the prescription and wristband.
 Ideally, use 2 or more identifiers and ask the patient to identify themselves.
2. Right medication
 Check the name of the medication, brand names should be avoided.
 Check the expiry date.
 Check the prescription.
- Make sure medications, especially antibiotics, are reviewed regularly.
3. Right dose
 Check the prescription.
 Confirm the appropriateness of the dose using the BNF or local guidelines.
 If necessary, calculate the dose and have another nurse calculate the dose as well.

4. Right route
• Again, check the order and appropriateness of the route prescribed.
• Confirm that the patient can take or receive the medication by the ordered route.
 5. Right time
• Check the frequency of the prescribed medication.
• Double-check that you are giving the prescribed at the correct time.
• Confirm when the last dose was given.
 6. Right patient education
• Check if the patient understands what the medication is for.
• Make them aware they should contact a healthcare professional if they experience side-
effects or reactions.

7. Right documentation
Ensure you have signed for the medication AFTER it has been administered.
Ensure the medication is prescribed correctly with a start and end date if appropriate.
8. Right to refuse
Ensure you have the patient consent to administer medications.
Be aware that patients do have a right to refuse medication if they have the capacity to
do so.

9. Right assessment
Check your patient actually needs the medication.
Check for contraindications.
Baseline observations if required.
10. Right evaluation
Ensure the medication is working the way it should.
Ensure medications are reviewed regularly.
Ongoing observations if required.

 mohamedezz549221/antibiotics-46683217
 National antimicrobial guideline 2019, third edition sept 2019
 https://medlineplus.gov/antibiotics.html
 https://my.clevelandclinic.org/health/drugs/16386-antibiotics
 Classification and Characteristic of common organism by marina bt Idi

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