1. DR SANDIP GUPTA
PGT,PEDIATRICS
B.S.M.C.H.
RATIONAL ANTIBIOTIC THERAPYRATIONAL ANTIBIOTIC THERAPY

2. Why Rational Antibiotic Therapy ?
• Better care of patients.
• Combating antimicrobial resistance.
• Prevent misuse of antibiotics.
• Reduce cost of treatment.

3. Misuse of antibiotics
• Lack of awareness & evidence based practice.
• Fear of secondary infection.
• False sense of security.
• Fear of losing patients.
• Parental anxiety & pressure.

4. • Is an antibiotic really necessary?
• Must have a provisional diagnosis.
• Predict the organisms.
• Consider stensitivity pattern.
• Narrowest spectrum, least toxic, less costly.
• Host factors.
• Co existing medical problem.
HOW TO CHOOSE ANTIBIOTICS

5. • Skin & soft tissue infections
• ENT infections
• LRTI
• GI infections
• UTI
• CNS infections
• CVS infections
• Osteoarticular infections
Common bacterial infections

6. • This includes impetigo, pyoderma, abscesses,
lymphadenitis, pyomyositis & bites.
• Common organism responsible : GrA
streptococcus,staphylococcus.
• 1st generation cephalosporins
(cephalexin,cefadroxil) amoxyclav, cloxacillin.
• Duration of therapy is 5-10 days.
Skin & soft tissue infection

7. ENT INFECTIONS
Otitis media & sinusitis:
cover pseudomonas, H influenze &
moraxella.
(a) 1st line: Amoxycillin for 5 to 10 days.
(b) 2nd line: coamoxyclav/inj
ceftriaxone/macrolide.
(c) for sinusitis complete at least 14-21 days
of therapy

8. LOWER RESPIRATORY TRACT
INFECTIONS
Community acquired:
Cover for Gp A streptococcus, pneumococcus, &
staph aureus in infants& toddlers . Atypical
agents in school age & adolescent.
(a) Outpatient– consider in less severe illness.
(i) Amoxycillin.
(ii)coamoxyclav/cefpodoxime/cefuroxime axetil.
(iii) Add macrolide if atypical pneumonia
suspected.

9. Cont.
(b) Hospitalized:
 1st line:inj cetriaxone/inj cefotaxime/inj cefuroxime for 10 to 14 days
 if staph is suspected (rapid evolution,empyema,pneumatocele)
initial antibiotic should include vancomycin or clindamycin.
 Add macrolides if atypical pneumonia is suspected.
 Respiratory floroquinolones are alternative in adolescence
 Reassess choice of antibiotic after 48 -96 hrs if no response/modify as
per results of cultures, look for other factors.

10. GASTROINTESTINAL INFECTIONS
1.Cholera: Doxycycline 4mg/kg/day bid for 3d cotrimoxazole,
erythromycin, furazolidone.
2. Enteric fever:
3rd gen cephalosporin (14 days), azithromycin.
3. Acute dysentery: ciprofloxacin 30mg /kg for 5d.
4. Peritonitis:
(a) SBP– inj cetriaxone/inj cefotaxime.
(b) Secondary to bowel pathology– inj meropenem/inj
imipenem/inj ampicillin+inj gentamycin+inj clindamycin

11. URINARY TRACT INFECTIONS
1. Uncomplicated UTI:
oral:cefixime,amoxyclav,cephalexin,floroquinolones
for 7-10 days.
2. Complicated UTI:
inj ceftriaxone,amikacin,amoxyclav for 10-14
days.
3. Prophylaxis:
Nitrofurantoin/cotrimoxazole,cephalexin,cefadroxil.

12. CNS INFECTIONS
Meningitis:
Empirical– inj vancomycin + inj ceftriaxone/inj
cefotaxime .
H influenza-ceftriaxone/cefotaxime for 7-10 d
Pneumococcus– If penicillin susceptible inj penicillin G
or 3rd gen cephalosporin . If resistant continue on
inj ceftriaxone+ inj vancomycin for 10-14 days.
N.Meningitidis-inj penicillinG 4lacU/kg/d for 5-7 d.
Gm –ve organism t/t for 3 wks with 3rd gen
cephalosporin (ceftazidime for pseudomonas).
Brain abcess t/t for 4-6 wks with 3rd gen cephalosporin
+ inj vancomycin + metronidazole.
2nd Line: meropenem+ vancomycin

13. CARDIOVASCULAR INFECTIONS
Endocarditis:
inj vancomycin & inj gentamycin to start with. Modify as per
c/s report.
(a) inj penicillin G / inj ceftriaxone & inj gentamycin/ inj
vancomycin in case of S Viridans.
(b) Enterococcus– Ampicillin/vancomycin & inj gentamycin.
(c)S aureus/ Epidermidis– inj vancomycin/ inj cloxacillin & inj
gentamycin for 6wks.
(d) Pneumococcus/ Gonococcus/ Gp A streptococcus– inj
penicillin G/ inj ceftriaxone/ inj vancomycin.
HACEKorganisms: inj ceftriaxone & inj gentamycin for 6wks
Gm-veorganisms:piperacillin/ceftazidime+gentamycin 6wks

14. OSTEOARTICULAR INFECTIONS
1. Bacterial arthritis/ osteomyelitis:
Cover S aureus & Gp A streptococcus;
Pneumococcus & H influenze in infancy. Modify
therpy according to c/s reports.
(a) 1st line: inj cloxacillin iv for 21 days followed by
oral therapy for a total of 4-6 weeks+ceftriaxone.
(b) 2nd line: inj vancomycin or inj clindamycin for
21 days followed by oral therapy for a total
period of 4-6 weeks. Use as first line if MRSA is
suspected.
.

15. Antibiotic prophylaxis
• UTI: in infants waiting imaging, VUR,
Frequent febrile UTI(30 or more/yr).
• Rheumatic fever
• Tuberculosis
• IE prophylaxis
• Pertussis contacts

16. Stratergies to prevent antibiotic
resistance
• Optimal use of antimicrobials.
• National protocol .
• Restriction policy.
• Antibiotic cycling.
• Combination therapy.
• Surveillance for resistant bacterial pathogen.

17. Non antimicrobial prevention
stratergies
Primary prevention programme for specific
infections
a. Adoption of WHO stratergies, e.g.DOTS.
b. Vaccines & immunoglobins.
c. Reducing length of hospital admission.
d. Avoiding invasive procedures.
Prevention of horizonital transmission
a. Hand washing
b. Gloves & gowns
Health education