1.

Penicillins
- Pen-G (benzylpenicillin)
- Pen-V (phenoxymethylpenicillin)
- procaine benzylpenicillin
- benzathine benzylpenicillin
- cloxacillin
- amocillin/co-amoxiclav (augmentin)
- ampicillin/ampicillin + sulbactam (unasyn)
- piperacillin + tazobactam (tazocin)
a) Pen G (benzylpenicillin)
- V !orm
- microbes" gram +ve# streps (strep pneumoniae $ viri%ians)# meningococcus# syphilis#
anthrax# actinomycosis# anaerobes# leptospirae# &yme's %isease.
- %oes not inclu%e pneumococcal meningitis# tetanus# staphylococcus
- treatment !or
( bacterial meningitis (neiserria meningitis# streptococcus pneumoniae)
V bolus# V ).* g every * hours
( so!t tissue an% s+in in!ection (streptococcus pyrogenes/ s. ,ureus)
V bolus/ - in.ection/ V ).* / *.0g %aily 12 %osing
( empirical treatment !or cellulitis
1 / ) -u V 12
( empirical treatment !or syphilis
&atent" - ).3 -u once 4ee+ly !or 5 4ee+s
6euro" 5 / * -u *hourly !or 5 4ee+s.
( leptospirosis
V 1.3 -u 12 !or 1 4ee+.
b) Pen V (phenoxymethyl penicillin)
- 7ral !orm (gastric aci% stable8 ta+en 9 hour be!ore !oo%)
- microbes" similar antibacterial spectrum as Pen G
:trep group# strep pneumonia# strep milleri
- uses" oral in!ections# tonsillitis# otitis me%ia# cellulitis
( cellulitis / )3;-3;;mg 12
,%% cloxacillin (synergy)
c) Procaine benzyl penicillin
- !orm" %epot in.ection# 72 %osing !or ) 4ee+s.
- uses"
( neurosyphillis / - <;;mg/)* hours !or 1* %ays ().* -u/%ay)
( gonorrhoea / starting %ose " !emale " 5.<g
-ale " ).3g
%) benzathine benzylpenicillin
- !ri%ge item
- !orm" - in.ection !or 5 4ee+s
- uses"
( latent syphilis / - ).* -u once 4ee+ly !or 5 4ee+s
( early syphilis / ).* -u as single in.ection
e) cloxacillin
- 1
st
choice !or -::, (methicillin sensitive staph aureus)
- uses"
( staphylococci in%uce% respiratory tract# s+in $ so!t tissue structure# .oint# =>
( line relate% in!ections (%ialysis# chemo)# P??
( en%ocar%itis (+gentamicin)
( cellulitis (+benzylpenicillin !or strep $ staph coverage)
( empirical treatment !or post op
- !orm"
( V 3;;mg
( cap )3;mg
( syrup 1)3mg/3ml
- %ose"
( oral" )3; / 3;;mg 12 # 5; mins be!ore !oo%
( slo4 V in. (over ) / * mins)/V (over 5; - *;mins)" ;.3 / )g every * / < hours
!) ,mpicillin
- - or V
- microbes" gram +ve# gram /ve
:treptococcus sp# penicillin sensitive staph# @. ?oli# enterococcus# 6 meningitis
- uses"
( respiratory tract in!ection cause% by A in!luenza
( s+in an% so!t tissues
( urogenital tract (gonorrhoea# urethritis)
( G tract (typhoi% !ever)
( =>
( en%ocar%itis
( meningitis / %ose" 5;; / *;;mg/+g %aily or 0 / 1<g %aily by short V
- %ose" 3;;mg / 1g every * / < hours by - or V
)3;mg / 3;;mg 12

g) ,mpicillin (1g) + :ulbactam (1g) / =nasyn
- !orm" V
- no pseu%omonas activity
- +eep !or acinetobacter in!ection
- microbes" gram +ve" strep# staph aureus
Gram /ve" A in!lueanzae# @ coli# Blebsiella# acinetobacter
- uses"
( %iabetic !oot ulcer / V 5g 12
( severe pus in!ection / V 5g 12
- %ose" 1.3 / 5g 12# 1.3g >2:
- renal impairment" ampicillin not more than 1g every 0 hours (5g %aily)
?l ?r C1;ml/min / ampicillin given D2 (5g D2)
h) amoxicillin
- !orm" oral
- uses" same as ampicillin but better absorbe% orally
- %ose" )3; / 3;;mg >2:
5g D2 in recurrent/severe pneumonia
i) ?o-,moxiclav (,ugmentin)
- !orm" tab / 3;;mg amoxicillin + 1)3mg clavulanic aci%
V / 1g amoxicillin + );;mg clavulanic aci%
:uspension" );;mg amoxicillin + )0.3mg clavulanic aci%.
-microbes" gram +ve" strep# staph
Gram /ve" @. ?oli# A in!luenza# +lebsiella# enterobacter
,naerobes
- uses"
( Eespiratory tract in!ection
( genitor-urinary tract in!ection
( s+in an% so!t tissue
( bone an% .oint
( %ental in!ections
( ab%ominal in!ections
- %ose" oral / <)3mg D2
V / 1.)g >2: -( more serious" 1.)g 12
.) Piperacillin (*g) + tazobactam (;.3g) / >azocin *.3g.
- !orm V
- * criterias"
1) empirical treatment !or bronciectasis (un%erlying lung problem)
)) empirical treatment !or !ebrile neutropenia (chemo# hemato pt)
5) empirical treatment !or nosocomial in!ections (hospital acFuire%)
- pt ha% no in!ection %uring a%mission but %evelope% it a!ter *0-G) hours
- recent %ischarge ( H 1 month ago)
- nursing home
*) empirical escalation therapy (not respon%ing to previous ,bx a!ter min 5 %ays)
- targete% treatment !or pseu%omonas in!ection
- microbes"
gram +ve" staphylococcus aureus# epi%ermi%is# streptococcus pyogenes# pneumoniae
gram /ve" e. ?oli# acinetobacter# +lebbsiella# pseu%omonas
anaerobes" clostri%ium
- uses"
( &E>
( =>
( intra ab%ominal in!ection
( s+in an% so!t tissue
- %ose" *.3g >2:/12 over 5-3 mins (max 10g/%ay)
:evere in!ection" a%% tobramycin/cipro!loxacin
). ?ephalosporins
- ce!azolin
- cephalexin
- ce!uroxime ()
n%
gen)
- ce!operazone + sulbactam (sulperazon)
- ce!tazi%ime
- ce!triaxone
- ce!otaxime
- ce!epime (*
th
gen)
a) ce!azolin
- !orm" V
- microbes" gram +ve (strep# staph aureus)
Gram /ve (+lebsiella# e. ?oli)
- uses"
( surgical prophylaxis only (bone# hip replacement# car%io)
1 vial pre op# 1 or ) vials %uring op# 1 vial post op
( can be given i! line bun+ing occurs 4hen given cloxacillin / 1g 72 ce!azolin
- %ose" 1 / )g >2:/12
b) cephalexin
- !orm" cap )3;mg
- microbes" gram +ve $ some gram /ve (+lebsiella# e. ?oli)
- uses"
( !or => (i! no response to other %rugs# occurs in pregnancy)
( E># s+in $ so!t tissue in!ections
- %ose" )3;mg (max 1g) 12 P7
c) ce!uroxime
- !orm"
( oral" )3;mg
( V" G3;mg
( suspension" 1)3mg/3m&
- microbes" gram +ve (strep group# staph aureus# staph epi%ermi%is)
-ore gram /ve (e. ?oli# A in!luenzae# +lebsiella# neisseria
- uses"
( =>
( E>
( s+in $ so!t tissue in!ection
( gonorrhea
( pre $ post surgical $ amputation
2ose" 1.3g by V in. at in%uction# !ollo4e% by t4o G3;mg - %oses later.
- %ose"
( common in!ection G3;mg >2: V/-
( severe in!ection 1.3g >2: V/-
( oral )3;mg / 3;;mg D2
- not pre!erre% !or %ischarge patients %ue to lo4 bioavailability (C3;I). :uggest augmentin.
(1
st
gen)
(5
r%
gen)
%) ce!operazone (ce!obi%)
- !orm" V )g
- microbes" gram +ve# more gam /ve# pseu%omonas (not as goo% as ce!tazi%ime + tazo)
- goo% biliary excretion / use% !or empirical biliary treatment
- empirical !or in!ection in surgical 4ar%
- %ose" 1 / )g D2
e) ce!operazone (1g) + sulbactam (1g) (sulperazone)
- !orm" V
- microbes" anaerobes# acinetobacter
- uses"
( acinetobacter in!ection
)g D2
- sulperazone + cloxacillin -( covers more gram +ve.
!) ce!tazi%ime (!ortrum)
- !orm" in. (1g)
- microbes"
Gram +ve" less e!!ective compare% to ce!triaxone
Gram /ve" e. ?oli# +lebsiella# enterobacter
Pseu%omonas
- uses"
( meningitis (gram /ve bacilli eg. A in!luenzae)
not severe" )g D2/ 1g >2:
severe" )g >2:
( pseu%omonas (bur+hol%eria pseu%omallaei)
Aigh ris+ patients / %iabetic
- 4al+ing bare !oot in gar%en/ !armer
>reatment !or < 4ee+s -( a!ter %ischarge more than 5 months.
2ose" ;.3 / )g D2/>2:
( Dur+hol%eria capecia
- =sually hospital acFuire% (A,P)
- Eesistant to ce!tazi%ime
- treatment 4ith sul!amethoxazole + trimethoprim / cipro!loxacin# meropenem (J)
- a!ter 5 %ays o! ce!triaxone# i! no response (still !ebrile)# escalate to ce!tazi%ime/tazocin
?e!ta covers gram +ve poorly (strep# not staph)# %oes not cover anaerobes
>azocin has goo% coverage o! gram +ve (strep an% staph)# covers anaerobes.
g) ce!triaxone (rocephin)
- !orm" )g n.
- microbes"
Gram +ve (staph aureus. :trep)
-ostly gram /ve (e. ?oli# +lebsiella# neisseria meningitis# salmonella (atypical)# enterobacter)
2oes not cover Pseu%omonas
,naerobes -( change to augmentin or a%% metroni%azole (!lagyl)
?e!triaxone 1g 72 + !lagyl 3;;mg >2:
- uses" (max *g %aily)
( =>
( severe ?,P
( strep pneumoniae in!ection
( 1
st
line !or meningitis" )g D2
( leptospirosis" 1 / )g 72
( meningoencephalitis" ce!triaxone )g D2 + acyclovir 3;;mg
( brain abscess" ce!triaxone )g D2 + ampicillin ;.)3
- escalation therapy / escalate to ce!tazi%ime/ tazocin
- better penetration to DDD than augmentin
- combination" ce!triaxone 1g 72 + cloxacillin )3; / 3;;mg 12
h) ce!otaxime
- !orm" n. 1;;;mg
- microbes" strep + gram /ve.
- goo% penetration to ?:K
- only !or pae%iatric use
- %osage"
( not severe / 3; / 1;;mg/+g %aily in )-* %ivi%e% %oses
( severe / 13; / );;mg/+g %aily (max 1)g %aily)
i) ce!epime (maxipime)
- !orm" 1g in.
- microbes" less gram /ve# more pseu%omonas activity
- screening criteria sae as tazocin
( con!irm pseu%omonas
( !ebrile neutropenia
( A,P
( empirical escalation therapy
- starte% by haematologist $ 2 team / neutropenic patient
- uses"
( pneumonia
( =>
( s+in $ so!t tissue in!ection
( septicaemia
( empirical treatment !or !ebrile neutropenia
- %ose"
( mil% to mo%erate" 3;;mg / 1g D2 V/-
( severe" )g D2 V
( very severe" )g >2: V
5. ?arbapenams
- imipenem + cilastin (tienam)
- meropenem
a) imipenem
- !orm" in.
- microbes"
-ore gram +ve (strep# staph)
Gram /ve (e. ?oli# +lebsiella# pseu%omonas# enterobacter)
,naerobes (bacteroi%es sp)
- cilastin to bloc+ metabolism o! imipenem in +i%ney
- prescribing criteria
( @:D& (exten%e% spectrum D-lactamase)
- %evelope% resistance to cephalosporin $ penicillin
- lab results / organism (eg. @ coli)
- only sensitive to imipenem
- state% in report @:D& pro%ucer
- resistant to all cephalosporin
- overuse%
( @:D& in%ucible organism
- organism is expose% to D lactamase coul% turn @:D& soon (eg citrobacter# serratia#
enterobacter)
- overuse o! cephalosporin increases chance to in%uce @:D&
( empirical escalation therapy
?ephalosporin (ce!ta) -( tazocin -( carbapenem
?ephalosporin -( carbapenem i! con!irme% selelction !or @:D&.
( !ebrile neutropenia
- escalate !rom tazocin
- lo4 neutrophil count
- uses"
( en%ocar%itis ( septicemia
( &E> ( bone $ .oin in!ections
( s+in $ so!t tissue in!ection ( gynaecological in!ections
( intra ab%ominal in!ection ( genitourinary tract in!ections
- %oses" V ;.)3 / 1g %aily in 5-* %ivi%e% %oses (>2:/12)
3;;mg 12
b) meropenem
- !orm" in.
- microbes" more gram /ve (acinetobacter# citrobacter# +lebsiella# neisseria
?overs more anaerobes
- goo% ?:K penetration
- si%e e!!ects are lo4er
- given i! patient has seizures on imipenem
- uses"
( pseu%omonas $ nosocomial pneumonia
( bur+hol%eria capecia
( =>
( intra ab%ominal in!ection
( bacterial meningitis
( empirical treatment !or !ebrile neutropenia
- %oses"
( A,P# !ebrile neutropenia# septicaemia / 1g >2: V
( meningitis / )g >2:
( Dur+hol%eria capecia / )g >2:
- screening criteria
( pt 4ith ris+ o! seizures
( :?6 baby
*. 1uinolones
- cipro!loxacin
- levo!loxacin
- moxi!loxacin
- nor!loxacin
( only oral antipseu%omonal preparation
( goo% +i%ney penetration !or severe =>
( LGI oral bioavailability
a) cipro!loxacin
- !orm" in. )mg/ml# 1;;ml (ciprobay)
7ral 3;;mg tab (ci!ran)
- microbes" (broa% spectrum)
( goo% antipseu%omonas
( gram +ve
( gram /ve
( anaerobes less susceptible
- uses"
( E>
( in!ection o! eyes# +i%neys# genital organs# ab%ominal cavity
( in!ection o! s+in $ so!t tissue# bones an% .oints
- easily get resistance / collateral %amage# increases chances to get -E:, resistance
- %ose" V" *;;mg D2
7ral" 3;;mg / G3;mg D2
b) levo!loxacin
- !orm" in.# oral
- microbes" pseu%omonas (community acFuire%)
- can be use% in ?,P but not in =--?
- restricte% use in >D as )
n%
line a!ter @thambutol# Ei!ampicin# Pyrazinami%e# soniazi%
(a+urit *)
- %ose" )3; / G3;mg 72
c) moxi!loxacin
- only allo4e% !or 2
- *;;mg 72 !or 1; %ays o! pneumonia
%) nor!loxacin
- !orm" V -
7ral /
- %ose"
3. -acroli%es
- ,zithromycin
- clarithromycin
- erythromycin (@@:)
( goo% coverage against atypical organism (mycoplasma) Monly covere% by macroli%esN an%
gram /ve
( use% 4i%ely in high ris+ patients / ?,P (empirical)
- immunosuppresse% pt eg AV
a) ,zithromycin
- !orm" V / 3;;mg 72
7ral / 3;;mg 72 (2# @6># ?hest)
- microbes"
( atypical org / mycobacterium avium# tuberculosis mycoplasma# ?hlamy%ia#
legionella# intracellulare complex (-,?)
( gram /ve / h. n!luenza# neisseria gonorrhoea# parain!lluenza
- %ose" !or 5 / 3 %ays# not more than 3 %ays because azitromycin has long hal! li!e# can cover
!or 4ee+.
V / 3;;mg 72
7ral / 3;;mg 72
- uses"
( ?,P
- rocephin 1g 72 + ,zithromycin 3;;mg 72 or
- augmentin 1.)g >2: + ,zithromycin 3;;mg 72
( cystic !ibrosis
- act as immunomo%ulator 4hen use% in combination 4ith inhalers $
- chil% 3mg/+g/%ay
( mycobacterium in AV patients
- longer %uration use% in AV patient
- restricte% oral use to chest# @6># 2
- 3;;mg 72 !or OOOOO months (E-);/4ee+) G&/GP !ree
( :>2s
- 1g :>,># 1 %ose %aily
- !or in!ecte% genital ulcer# can use %oxycycline 1;;mg D2 !or a OOOOOOOOOOOOOO

P ( -,?
- azithromycin 3;;mg 72 + ri!ampicin + ethambutol
(up to < months)

b) erythromycin
- cheaper# long term
- immunomo%ulator# brochiectasis# cystic !ibrosis# structural lung problem
( pro%uce a lot o! %ischarge / *;;mg D2
- lo4 %ose
( move bo4el an% promote gut motility (si%e e!!ect) -( 1)3mg OOOO
( ?= patient 4ith nasogastric tube.
- normal %ose / *;;mg D2
<. ?olistin (polymyxin @/ polymyxin D)
- !orm" V
- microbes"
( pseu%omonas# acinetobacter baucolli# +lebsiella pneumonia
( must be +ve !or culture test (acinetobacter) / mostly seen in ventilate% pt
- uses"
( resistant acinetobacter (resistant to unasyn)
( carbapenem resistance
( @:D&
( super bug in!ection
- strictly !or chest an% 2 team
- penetration to lung is less / give short nebuliser $ OOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOOO
- nephrotoxic
- %ose" 1 - ) -u >2:/12
0; / 1;;mg >2: (max 0;;mg/%ay)
G. ?lin%amycin
- !orm" oral
V
- microbes"
( anaerobes
( ?hlamy%ia trachomatis
- uses"
( acne / 13; / 5;;mg 12 up to *3;mg 12 !or severe in!ection
( taxoplasmosis (AV pt)
- as )
n%
line (unlabele% use) / <;;mg 12 4ith pyrimethamine $ OOOOOOOOOO
- 1
st
line is sul!a%iazine 1g 12
( gas gangrene (contaminate% traumatic 4oun%) / L;;mg >2: V 4ith Pen-G
( necrotising !ascilitis (%ue to 2-# trauma# liposuction)
- !lesh eating bacteria
- treatment !or 1 4ee+ (empirical use)
- %ose" <;;mg >2: V 4ith tazocin *.3g 12 V
0. >igecycline
- !orm" V 3;mg
- microbes"
Gram +ve / -E:,# -::,
Gram /ve / e. ?oli# h in!uenzae# 6 gonorrhoea $ multi resistant OOOOOOOOO
,naerobes / enterobacter# acinetobacter !or renal pt
- uses" gas gangrene
?omplicate% s+in $ structure in!ection
- starte% by 2 %octors
- very expensive / non government pt has to pay
- not goo% penetration to the bloo% / not !or sepsis
- goo% %istribution in tissue / use !or bone/lung in!ection
- use 4hen pt cannot use vanco %ue to allergy $ renal impairment
- not nephrotoxic# but nee% to a%.ust %ose !or liver impairment
- %ose" 1;;mg# !ollo4e% by 3;mg D2 (V over 5;-<; mins)
9 %ose in liver impairment.
L. Vancomycin
- glycopepti%es
- starte% by 2 team
- !orm" V 3;;mg
- microbes" gram +ve only (-E:,# -::,# ?occi# enterococcus)
- uses"
( con!irme% -E:,
( empirical treatment !or en%ocar%itis
( penicillin allergy
( neutropenic / tazo + vanco
( line relate% in!ections
( hemo%ialysis patient / 1
st
line vanco
( post surgical prophylaxis/ orthoper%ic surgery eg car%iothoracic surgery.
- !or empirical treatment / 5 to 3 %ays# i! more than that# VE@ vancomycin resistant
enterococci might %evelop.
- %ose" 1g D2 or 3;;mg 12 (max *g %aily)
- :@" re% man syn%rome / 4ithhol% vanco then give antihistamine (piriton)
- prolong in!usion time / up to < hours
- stop vanco an% give teicoplanin i! syn%rome is not too ba%
1;. >eicoplanin
- !orm V );;mg/)ml
- microbes" gram +ve only (-E:, in brain# anaerobes)
- starte% by 2 team
- less nephrotoxic
- use !or allergy reaction to vancomycin or re% man syn%rome
- %ose
( mo%erate in!ection / &2" *;;mg single %ose
- maintenance %ose" );;mg 72
( severe / &2" three *;;mg V a%ministere% 1) hours apart
- maintenance" *;;mg 72
11. :o%ium Kusi%ate
- !orm" oral )3;mg
- microbes"
Gram +ve (staph# -E:,# an% less !or strep)
Gram /ve (only 6 gonorrhoea an% 6 meningitis)
- starte% by 2 team or orthopae%ic
- not use% as single agent. ,l4ays combine% 4ith ri!ampicin
( Kusi%ate 3;;mg >2: + ri!ampicin 5;;mg/<;;mg D2
- Ei!ampicin a%%e% to %ecrease chances o! getting resistance
- GP2 / !ree. 6ot GP2 / E-);/4ee+.
1). ,nti!ungal
- starte% by haematologist (chemo pt) / syrup
2ermatologist
2 tea
- to onco pt# transplant pt (long term)# AV pt (long term)
a) !luconazole
b) itraconazole
c) voriconazole
%) amphotericin D
e) caspo!ungin (V)
a) !luclonazole
- !orm" V# oral
- uses"
( cryptococcal meningitis
*;;mg on 1
st
%ay# !ollo4e% by );; / *;;mg 72 !or <-0 4ee+s
( systemic can%i%iasis
*;;mg on 1
st
%ay# !ollo4e% by );; / *;;mg 72
( mucosal can%i%iasis
3; / 1;;mg 72 !or G-1* %ays
( vaginal can%i%iasis
13;mg single %ose
( prevention o! !ungal in!ection in chemo patients
5 / 1) mg/+g %aily
( %ermatomycosis
13;mg once 4ee+ly or 3;mg 72
- narro4 spectrum
b) itraconazole
- !orm" capsule 1;;mg $ syrup 1;mg/ml
:yrup" D-> patient can or%er
2 / pro! ,%eeba only
Aave 53I better bioavailability
:tarte% by haematologist or s+in specialist
- %ose" 1;; / );;mg 72
- uses"
( systemic mycoses
( onychomyosis
( %ermal# mucosal# ophthalmological in!ections
( gynaecological in!ection
c) voriconazole
- bone marro4 transplant patient only
- !orm" tablet# oral suspension
- %ose"
( oral" *;;mg D2 !or 1
st
%ay# !ollo4e% by );;mg D2
%) ,mphotericin D
- starte% by 2 team
- !or progressive# potentially li!e threatening !ungal in!ections
- %ose" max / 1.3mg/+g/%ay

n!ections
1. Drain (4ar%s 3=, $ 3=D)
a) encephalitis
- in!ection o! parenchyma o! the brain
- viral cause
- treatment using acyclovir 1;;mg >2: !or normal $ hepatic patient
V 1;mg/+g (in!use% over 1 hr) >2: !or 1*-)1 %ays
b) meningitis
- viral/bacterial origin
- must cover !or bacterial in!ection until lumbar puncture OOOOOOOOOOOOOOOOOOOOOOO
(protein# QD?# bacteria culture)
- mmicrobes" meningococci# A in!luenza# neisseria meningitis
- &P shoul% be %one be!ore starting (high ris+ o! blee%ing - OOOOOOOOOOOOOOOOOOOO)
- treatment / ce!triaxone )g D2 + acyclovir 1;;mg
- escalation" meropenem )g >2:
c) Post ?6: surgery in!ection
- shunt / %rain !lui% !rom brain to heart/peritoneal
- atrial shunt / staph aureus in!ection (-E:,) (gram +ve)
( treatment" vancomycin
- peritoneal shunt / +lebsiella# proteus# pseu%omonas (gram /ve)
( tazocin or ce!tazi%ime
%) brain abscess
- gram +ve# gram /ve# anaerobes
( ce!triaxone )g D2 + metroni%azole