Use of antibiotics to treat some common infections

2021-06-25 04:55 PM

Always remember that aminoglycoside drugs, amikacin, gentamicin, should not be administered directly intravenously but only intramuscularly and intravenously, the solution for infusion should be evenly dissolved in a large amount of sodium chloride solution.

When using the information below to choose antibiotic treatment, it must also be based on the clinical response of the patient and on the drug resistance situation of pathogenic bacteria in the locality. If possible, you should make an antibiotic chart and choose a drug according to the results of the antibiotic chart.

Always remember that aminoglycoside drugs (amikacin, gentamicin...) are not administered directly intravenously, but only intramuscularly and intravenously, the solution for infusion should be evenly dissolved in a large amount of sodium chloride solution (NaCl). 0.9%, or 5% glucose, then infused over a period of 30 - 60 minutes.

Antibiotics treat common diseases:

Heart: infective endocarditis

Empiric treatment

Bacteria most likely to cause disease:

Streptococcus spp. Or Staphylococcus spp.

Treatment recommendations:

Benzylpenicillin 1,2 - 1.8g, IV every 4 hours.

In combination with gentamicin 3-5mg/kg body weight, intravenously every 24 hours

Combined with cloxacillin or oxacillin 3g, intravenous. Blood cultures are required before starting treatment.

Endocarditis

The bacteria most likely to cause illness:

Streptococcus.

Treatment recommendations:

Treat as above.

Endocarditis

The bacteria most likely to cause illness:

Enterococcus and Streptococcus, when these bacteria are resistant to benzylpenicillin to a relatively high degree (MIC penicillin G > 0.25 mg/litre)

Treatment recommendations:

Benzylpenicillin 1.8 - 2.4g IV every 4 hours for 6 weeks or Amoxicillin 2g IV every 4 hours for 6 weeks

In combination with gentamicin 1 mg/kg IV for 6 weeks. Prolonged treatment time is essential.

Endocarditis

The bacteria most likely to cause illness:

Staphylococcus viridians.

Treatment recommendations:

Cloxacillin/Oxacillin, and gentamicin, or if Staph spp. If methicillin (oxacillin) ​​resistance is suspected, vancomycin 1g should be administered by slow intravenous infusion over 2 hours, every 12 hours, for 6 weeks.

Infections of the lungs, nose, ears... respiratory tract infections

Acute pharyngitis/tonsillitis

The bacteria most likely to cause illness:

This infection is usually caused by a virus.

Patients often have skin rashes with ampicillin or amoxicillin, but penicillin V usually does not cause this.

Tonsillitis is usually caused by Streptococcus pyogenes.

Streptococcus tonsillitis should be treated with phenoxy methyl penicillin (Penicillin V), because we want to prevent the low risk of disease following this infection.

Treatment recommendations:

Streptococcus in Vietnam is still very sensitive to penicillin treatment but is usually resistant to tetracyclines and macrolides. These antibiotics should be avoided!

Treat with Phenoxymethylpenicillin 500mg (10mg/kg to 500g children) orally every 8 or 12 hours for 5 to 10 days.

In case the patient is not taking prescription drugs, it is necessary to treat with benzathine penicillin 900mg IM as a single dose, (this dose should be repeated after 3-4 weeks when necessary to prevent rheumatic heart disease).

When it is necessary to eradicate Streptococcus pyogene in carriers of this bacterium (to prevent rheumatic fever) 10 days of treatment is considered appropriate.

Family members and others who have close contact with the sick person and are likely to carry Streptococcus bacteria should also be treated to avoid re-infection following the "ping pong" effect.

Recurrent tonsillitis

The bacteria most likely to cause illness:

Streptococcus.

Treatment recommendations:

Prolonged prophylactic treatment with penicillin V, if the patient has more than 3 infections per year.

Acute bacterial sinusitis

The bacteria most likely to cause illness:

Streptococcus pneumonia.

Haemophilus influenza.

Treatment recommendations:

Amoxicillin 500 mg every 8 hours orally for 10 days, or a higher dose of phenoxy methyl-penicillin (see PcV article).

Antihistamines, expectorants, and corticosteroids have been found to be ineffective in the treatment of bacterial sinusitis.

Acute laryngitis - gas - bronchiolitis

The bacteria most likely to cause illness:

Parainfluenza virus.

Treatment recommendations:

Do not use antibiotics in mild to moderate cases without obvious symptoms of dyspnoea.

Treatment should be initiated with dexamethasone 0.15 - 0.25 mg/kg.

In moderate to severe cases with marked airway obstruction, intravenous dexamethasone (0.5-20 mg) plus nebulized salbutamol or terbutaline, budesonide or beclomethasone should be initiated.

Otitis externa

The bacteria most likely to cause illness:

Pseudomonas aeruginosa and sometimes Staph. Aurus.

Treatment recommendations:

Glucocorticoids for topical use and antibiotics for ear drops: dexamethasone, framycetin + gramicidin.

Acute purulent otitis media

The bacteria most likely to cause illness:

Streptococcus pneumoniae or Haemophilus influenza.

Treatment recommendations:

Amoxicillin 500mg orally every 8 hours for at least 7-10 days.

If the disease is less responsive to drugs, it can be thought of because of Streptococcus pneumonia, which is less susceptible to penicillin, or Haemophilus influenzae, which produces beta-lactamases.

High doses of Amoxicillin + clavulanic acid should be indicated:

Amoxicillin 500mg every 8 hours (children 15mg/kg up to 500mg) + oral clavulanic acid.

It should be remembered that the drug is taken every 8 hours for at least 10 days.

Or cefaclor 375mg tablets every 8 hours for 10-14 days.

Acute epiglottitis

The bacteria most likely to cause illness:

Haemophilus influenzae type B.

Treatment recommendations:

Cefotaxime 2g IV every 8 hours, or ceftriaxone 2g IV once a day. In the past, chloramphenicol could be used in cases where the patient was allergic to penicillin. However, because currently, H. influenza resistance to chloramphenicol is quite common, chloramphenicol is no longer used.

Treatment is required for at least 5 days.

The excessive oropharyngeal examination should be avoided because of the potential for fatal complications of airway obstruction and should be prepared for intubation.

Whooping cough

The bacteria most likely to cause illness:

Bordetella pertussis.

Treatment recommendations:

Antibiotic treatment in the exudative and early stages will cure the disease quickly. Treat with erythromycin 250mg (children 10mg/kg up to 250mg) orally every 6 hours for 10 days or with trimethoprim/sulphathiazole 160/800mg (children 4/20mg/kg up to 160/800mg) orally every 12 hours, for 1-2 weeks.

Acute bronchitis

The bacteria most likely to cause illness:

Usually caused by viruses, not bacteria.

Treatment recommendations:

Antibiotic treatment is not recommended because acute bronchitis is usually viral. In young children inhalation of aerosol salbutamol may be necessary for the treatment of bronchiolitis caused by the Synovial virus.

Severe bronchitis with fever

The bacteria most likely to cause illness:

Strep. Pneumoniae; H. influenzae; Moraxella catarrhalis.

Treatment recommendations:

Amoxicillin 500mg tablet every 8 hours for 14 days, or co-trimoxazole 1 tablet (Trim/sulpha: 160/800mg) every 12 hours for 14 days.

(Another effective and safe way is to use Trimethoprim with a dose of 1 tablet of 300mg, once a day.) Remember to reduce the dose if the patient's kidney function is reduced.

Infectious rhinitis (with yellow nasal discharge)

The bacteria most likely to cause illness:

Staphylococcus or Streptococcus and/or Pneumococcus and Brahamella catarrhalis.

Treatment recommendations:

Amoxicillin 500mg 1 tablet every 8 hours for 14 days, or co-trimoxazole 1 tablet (Trim/sulpha: 160/800mg) every 12 hours for 14 days. (Another effective and safe way is to use trimethoprim with a dose of 1 tablet of 300mg, once a day.) Remember to reduce the dose if the patient's kidney function is reduced.

Lungs: Pneumonia

Acquired bronchitis

"Classic" community-acquired bronchitis usually has a rapid onset of illness, with high fever but not many upper respiratory tract symptoms.

Usually high fever, chest pain when breathing.

It should be remembered that patients with other medical conditions associated with pneumonia are at greater risk. Therefore, these patients need more care and follow-up.

The bacteria most likely to cause illness:

Strep. Pneumoniae; H. influenzae.

Treatment recommendations:

Moderate disease: Start treatment with amoxicillin 500 mg orally every 8 hours for 10 days, or use a higher dose of phenoxy methyl penicillin 500 mg (children 10 mg/kg to 500 mg) every 8 or 12 hours in 7-10 days.

Cotrimoxazole with appropriate dose (Trim/sulpha: 160/800mg) every 12 hours, for 7-10 days also has a good therapeutic effect.

Severe disease: start with intravenous antibiotics, benzylpenicillin (penicillin G) 600mg intravenous dose, repeated every 4 hours.

If the patient is allergic to penicillin, replace with cephalothin 1g every 6 hours. Treatment should last at least 7-10 days.

Severe pneumonia, extensive lung damage acquired from the community

Treatment recommendations:

Cefotaxime 1g, IV, every 8 hours

Ceftriaxone 1g, IV daily, in combination with:

Erythromycin 500mg, slow intravenous, every 6 hours.

(Erythromycin is not expected to be effective against Pneumococcus or Haemophilus but should be added against Legionella, Mycoplasma, Chlamydia if infection with the same bacteria is present.)

Atypical pneumonia

Atypical pneumonia is often progressive with cough and other upper gastrointestinal symptoms.

The bacteria most likely to cause illness:

Mycoplasma pneumonia; Legionella phneumophilia; Chlamydia pneumonia.

Treatment recommendations:

Children need to be very careful and remember that symptoms can be very different from adults. For children 2 weeks to 3 months old need to give erythromycin 10mg/kg, orally every 6 hours for
7-10 days is at least.

For adults and older children (over 3 months) roxithromycin 300mg tablets once a day (4mg/kg up to 150mg every 12 hours).

Aspiration pneumonia

The bacteria most likely to cause illness:

Mixed bacteria including anaerobes.

Treatment recommendations:

Amoxicillin/ampicillin 1g IV every 6 hours.

In addition, add gentamicin 3-5mg/kg once every 24 hours as an infusion over 60 minutes (remember to dilute gentamicin before infusion) in combination with metronidazole 500mg IV every 12 hours, to protect against the risk of anaerobic bacterial infection.

Gastrointestinal infections

Acute cholecystitis

The bacteria most likely to cause illness:

E.coli, Klebsiella spp., Enterococcus faecalis, Bacteroides spp.

Treatment recommendations:

First choice: Ampicillin 1g IV 4 times a day at 6-hour intervals, in combination with:

Gentamicin 3 - 5 mg/kg by slow intravenous infusion in 0.9% NaCl diluent (30 - 60 minutes / 1 infusion every 24 hours).

If there is a contraindication to Gentamicin or ampicillin, the second choice is cefotaxime 1g IV 4 times a day (every
8 hours apart ).

Or ceftriaxone 1g IV 1 dose in 24 hours. Pay attention to dose reduction in patients with impaired renal function.

Note: Cephalosporins are not active against Enterococcus faecalis.

Retrograde bile duct inflammation

The bacteria most likely to cause illness:

Gram-negative bacilli, Enterobacter, Enterococcus faecalis.

Treatment recommendations:

Gentamicin 3 - 5 mg/kg, in a diluent intravenously, infusion slowly over 30 - 60 minutes every 24 hours. associate with:

Metronidazole 500mg every 12 hours, ampicillin 2g IV every 6 hours.

If gentamicin is contraindicated due to severe renal disease, use cefotaxime or ceftriaxone, remembering to reduce the dose in patients with renal disease. It should be remembered that cephalosporins are not active against Enterococcus faecalis.

Peritonitis due to perforation of hollow viscera

The bacteria most likely to cause illness:

Many types of bacteria including aerobic and anaerobic intestinal bacteria

Treatment recommendations:

Ampicillin 2g IV every 6 hours.

In combination with gentamicin 3-5mg/kg IV once a day,

Metronidazole 500mg IV every 12 hours.

Peritonitis due to sporadic bacteria

The bacteria most likely to cause illness:

Gram-negative bacilli, E.coli, Strep. pneumoniae, Enterococcus spp.

Treatment recommendations:

Ampicillin in combination with gentamicin, dose as above.

The second way: Cefotaxime or Ceftriaxone, dose as above.

It should be remembered that Cephalosporins are not active against Enterococcus faecalis

Peritonitis due to complications of peritoneal dialysis

The bacteria most likely to cause illness:

Staph. epidermidis, Gram-negative bacilli (E.coli, Klebsiella, Pseudomonas..), or fungal infections although rare but difficult to treat.

Treatment recommendations:

Vancomycin 2g injected into the peritoneal cavity as a single dose and kept in the peritoneal cavity for 6-8 hours in combination with gentamicin 80mg into the peritoneal cavity (Long-term use of gentamicin in haemodialysis patients should be avoided due to the risk of neurotoxicity). number VIII).

Mild diverticulitis

The bacteria most likely to cause illness:

Gram-negative bacilli, anaerobic bacteria

Treatment recommendations:

Augmentin (amoxicillin + clavulanic acid) is equivalent to 500 mg of amoxicillin every 8 hours, or metronidazole 250 mg orally every 8 hours + cephalexin 500 mg orally every 6 hours.

Severe infections are treated as peritonitis above.

Severe diarrhoea after taking antibiotics

Severe diarrhoea following antibiotics and Pseudomembranous colitis may occur as a complication of Clostridium difficile hyperplasia following administration of broad-spectrum antibiotics.

The bacteria most likely to cause illness:

Clostridium difficile.

Treatment recommendations:

Metronidazole 250 - 500 mg orally every 8 hours for 7-10 days.

Avoid oral vancomycin.

Acute pancreatitis

 Treatment recommendations:

Antibiotics are not indicated for initial treatment. If the pancreatic abscess is present, treat as peritonitis (above).

Urinary tract infection

Acute cystitis

The bacteria most likely to cause illness:

E. coli, Proteus mirabilis, Klebsiella spp Coliforms.

Treatment recommendations:

Trimethoprim 300mg orally for 3 days, or cephalexin 500mg orally every 12 hours for 5 days, or amoxicillin.

Combined with clavulanic acid every 8 hours or nitrofurantoin 50mg, every 6 hours for 5 days.

Nephritis - acute pyelonephritis

The bacteria most likely to cause illness:

E. coli

Treatment recommendations:

Ampicillin 2g every 6 hours IV in combination with gentamicin 3 - 5mg/kg once daily, until the antibiogram gives results to choose the optimal antibiotic.

Vaginal infections

The bacteria most likely to cause illness:

Candida albicans Trichomonas vaginalis; Gardnerella vaginalis.

Treatment recommendations:

Clotrimazole 500mg vaginal or nystatin 100,000 units vaginally daily for 7 days.

Tinidazole or metronidazole 2g orally as a single dose and treat both sex partners.

Metronidazole 400mg orally every 12 hours (or as a single dose) or tinidazole 2g orally as a single dose.

Metritis

The bacteria most likely to cause illness:

Chlamydia trachomatis; Neisseria gonorrhoea.

Attention:

Infections can be caused by many bacteria

Treatment recommendations:

Doxycycline 100mg orally every 12 hours for 10 days.

Or azithromycin 1g orally, a single dose. Or ceftriaxone 250mg IM, a single dose.

Pelvic inflammatory disease

The bacteria most likely to cause illness:

Sexual transmission:

Chlamydia trachomatis; Neisseria gonorrhoea.

Not sexually transmitted:

Mixed bacteria (anaerobic bacteria, mycoplasma spp).

Treatment recommendations:

Mild infections: Ceftriaxone 250mg IM as a single dose, in combination with:

Metronidazole 400mg orally every 12 hours for 14 days.

Doxycycline 100mg orally every 12 hours for 14 days.

Severe infections: Ceftriaxone 1g IV daily, or cefotaxime 1g IV every 8 hours in combination with:

Metronidazole 500mg IV every 12 hours,

Doxycycline 100mg orally every 12 hours.

In pregnant women, do not use doxycycline, but use erythromycin 500 mg intravenously or orally every 6 hours.

Skin, muscle, and bone infections

Connective tissue inflammation and inflammation of the skin and underlying tissues

The bacteria most likely to cause illness:

Strep. Pyogenes.

Treatment recommendations:

Cephalexin 500mg every 6 hours orally. Or take cloxacillin/oxacillin 500mg, every 6 hours.

For severe infections:

Benzylpenicillin 600mg to 1g IV, every 6 hours, in combination with cloxacillin/oxacillin 2g, every 6 hours.

Muscle and soft tissue injuries

The bacteria most likely to cause illness:

Staph. aureus, Strep. pyogenes, Clostridium perfringens, Negative Gram

Treatment recommendations:

Cloxacillin/oxacillin 1 - 2g IV, every 6 hours, in combination with:

Gentamicin 5mg/kg every 24 hours for 5-10 days.

Metronidazole 500mg IV every 12 hours.

Bites

The bacteria most likely to cause illness:

Human bite: Staph. aureus, Eikenella corrodens, Streptococcus spp., beta-lactamase-producing anaerobes.

Animal bites: Pasteurella multocida, Staph aureus, Streptococcus spp., anaerobic bacteria.

Treatment recommendations:

Procaine penicillin 1 g intramuscularly for the first dose, then use Amoxicillin + clavulanic acid (Augmentin) every 8 hours for 5 - 10 days, in combination with tetanus vaccination.

Metronidazole in combination with doxycycline or trimethoprim-sulphamethoxazole for patients allergic to penicillin.

Osteomyelitis and septic arthritis

The bacteria most likely to cause illness:

Staph. aureus

Treatment recommendations:

Cloxacillin/oxacillin 2g IV, every 6 hours, every 2 to 4 weeks for osteomyelitis and acute infectious arthritis, or 2 to 6 weeks for chronic infections.

Follow-up: Cloxacillin/oxacillin 1g, orally every 6 hours, for at least 6 weeks with acute infections and for many months with chronic infections.

Osteomyelitis

The bacteria most likely to cause illness:

Methicillin-resistant Staphylococcus aureus (MRSA).

Treatment recommendations:

Vancomycin 1g by slow intravenous infusion, every 12 hours.

Next use: Rifampicin 600mg orally daily in combination with Fucidic acid 500mg orally every 12 hours. The duration of treatment depends on the response to the drug.

Wounds on patients immobile for a long time in the hospital.

The bacteria most likely to cause illness:

Acinetobacter, which is a gangrene bacterium that enters the wound.

Treatment recommendations:

Usually no antibiotic treatment. If treatment is required, co-trimoxazole should be started.

Nervous system infection

Meningitis empiric treatment

The bacteria most likely to cause illness:

N. meningitides, Streptococcus pneumonia, Listeria monocytogenes, and Haemophilus influenzae in children.

Treatment recommendations:

Treatment should be directed against the three most common pathogens. Specimens must be taken for bacterial culture and for making antibiograms.

Empiric treatment: Cefotaxime 100mg/kg/day, maximum dose 6g/day intravenously, divided into 3 times or Ceftriaxone 50mg/kg/day maximum dose 4g/day, divided into 1-2 times.

Combination with: Benzylpenicillin 180mg/kg/day, maximum dose 12g/day intravenously, divided into 6 times.

Where there is a risk of spreading Neisseria meningitis, prophylactic treatment should be given to everyone in contact with the patient.

Prophylactic treatment with: Rifampicin 600mg orally every 12 hours for at least 2 days or ceftriaxone 2g IM as a single dose or ciprofloxacin 500mg orally as a single dose.

Note: Although Ciprofloxacin may be effective in prevention, it is not effective in treating bacterial infections!

Meningitis acquired in hospital

The bacteria most likely to cause illness:

Common strains of bacteria that are resistant to antibiotics.

Treatment recommendations:

Treatment can be started with vancomycin 1g intravenously, every 12 hours (children 50mg/kg, maximum dose 2g, every 6 hours).

Associate with:

Cefotaxime 2g IV, every 6 hours or ceftriaxone 2g, every 12 hours. Or meropenem 1g (children 40mg/kg up to 1g) IV every 8 hours (meropenem is preferred over imipenem, because of the lower risk of seizures).

Brain or subdural abscess

The bacteria most likely to cause illness:

Many bacteria include Streptococcus milleri, and anaerobes.

Nocardia and Actinomyces infections are also common.

After an ear infection, it is usually caused by intestinal Gram-negative bacilli.

After a post-operative trauma, it may be due to Staph. Aurus.

Treatment recommendations:

Microbiological testing and antibiotic susceptibility testing are very important.

Treatment: benzylpenicillin 1.8g (children 60mg/kg maximum 1.8g) intravenously, every 4 hours.

Combined with metronidazole 500mg (children 12.5mg/kg, maximum 500mg) intravenously, every 8 hours.

Combined with cefotaxime 2g (children 50mg/kg maximum 2g) intravenously, every 6 hours or ceftriaxone 2g (children 50mg/kg maximum 2g) intravenously, every 12 hours.

In case of brain abscess after neurosurgery: vancomycin 1g IV, every 12 hours (children 15mg/kg, maximum 500mg IV, every 6 hours).

Epidural abscess

The bacteria most likely to cause illness:

Staph. aureus

Treatment recommendations:

Epidural abscesses are usually caused by osteomyelitis in that area. Acute surgery is very important, and treatment should be initiated immediately on the basis of Gram staining and culture specimens obtained from surgery.

Prior to surgery, empiric therapy should be started with flucloxacillin/dicloxacillin 2g (can be replaced by oxacillin), children 50mg/kg up to 2g intravenously, every 6 hours.

Combined with gentamicin 3-5mg/kg IV once a day (children 7.5mg/kg/day IV, divided from 1 to 3 times).

They don't come from Herpes simplex

The bacteria most likely to cause illness:

Herpes simplex virus.

Treatment recommendations:

Acyclovir 10mg/kg IV, every 8 hours, for 14 days

Toxoplasma encephalitis or abscess

The bacteria most likely to cause illness:

Toxoplasma gondii

Treatment recommendations:

Sulphadiazine 1g orally combined with pyrimethamine 25mg, every 8 hours.

Combined with folinic acid 7.5mg orally daily. Duration of treatment is from 3 to 6 weeks.

Recurrence is quite common, so maintenance therapy with 1/2 dose is required in immunocompromised patients. Patients allergic to sulphonamides are treated with oral clindamycin 600mg, every 6 hours.

Eye infections

Eyelid infection, eyelid inflammation

The bacteria most likely to cause illness:

Staphylococcus spp.

Treatment recommendations:

Flucloxacillin/dicloxacillin 500mg orally every 6 hours (or oxacillin). If eyelid inflammation is accompanied by rosacea, then treat with doxycycline 100mg orally, every 12 hours, for 2 weeks.

Inflammation of the lacrimal gland

The bacteria most likely to cause illness:

Staphylococcus spp.

Treatment recommendations:

Infection of the lacrimal sac is often associated with obstruction and in mild cases can be treated with eye drops containing 0.25% zinc sulphate, 0.12% phenylephrine, 1 or 2 drops 3 times a day.

Severe acute pouchitis is usually caused by S. aureus or S. pyogenes and requires treatment with flucloxacillin/ dicloxacillin/ oxacillin 500 mg orally every 6 hours.

Inflammation around the eye socket

The bacteria most likely to cause illness:

Streptococcus pneumoniae  or Haemophilus influenzae type b (Hib).

Treatment recommendations:

Children under 5 years old without trauma, the most common cause is S. pneumonia or Hib, treated with cefotaxime 50mg/kg up to 2g IV every 8 hours or ceftriaxone 50mg/kg up to 2g IV daily pulse and amoxicillin + clavulanic acid (Augmentin) 15mg/kg maximum 500mg orally, every 8 hours, at least 1 week treatment until cured.

For older children and adults, usually caused by Staphylococci or Streptococcus, so add flucloxacillin/oxacillin 500mg to 2g every 6 hours.

Conjunctivitis

The bacteria most likely to cause illness:

Adenovirus. H. influenzae (especially in young children), Strep. pneumonia, Strep. pyogenes, Staph. Aureus is sometimes Neisseria gonorrhoea. Herpes simplex virus if conjunctival cystitis.

Treatment recommendations:

Most cases are caused by allergies or irritation. Adenovirus infections are relatively common. Symptomatic treatment with cold compresses and topical vasoconstrictors such as phenylephrine 0.12% is usually recommended.

In mild cases, use propamidin 0.1%, 1-2 drops/time x 3-4 times/day.

Severe infections polymyxin B 5000 UI/ml and neomycin 2.5mg/ml and gramicidin eye drops 25microgram/ml, eye drops 1-2 drops, once every hour

Gonococcal conjunctivitis

The bacteria most likely to cause illness:

N. gonorrhoea.

Treatment recommendations:

Topical antibiotics are not sufficient, and it is noted that penicillin-resistant gonococcus is relatively common. Cefotaxime 50mg/kg IV every 8 hours or ceftriaxone 50mg/kg IV daily for 1 week.

Chlamydia trachomatis co-infection is common in some areas, so erythromycin should be added.

Trachoma disease

The bacteria most likely to cause illness:

Chlamydia trachomatis.

Treatment recommendations:

Acute bacterial infections and recurrent conjunctivitis can lead to blindness. Infants and children under 6 kg: erythromycin 10mg/kg orally every 6 hours for 3 weeks.

Adults and children over 6 kg: azithromycin 1g (20mg/kg up to 1g in children) orally, as a single dose

Eye wound

The bacteria most likely to cause illness:

Many bacteria.

Treatment recommendations:

Vancomycin 1g (children; 15mg/kg maximum 1g) IV. Combined with ciprofloxacin 750mg (children 15mg/kg maximum 750mg orally). A single dose of gentamicin 3 - 5 mg/kg (for all ages) can be given.

in combination with cefotaxime 1g (children 50mg/kg up to 1g), or ceftriaxone 1g (children 50mg/kg up to 1g), intravenously.

Cytomegalovirus retinitis 

Treatment recommendations:

Often seen in AIDS patients, cancer patients, immunocompromised patients due to other causes.

Treatment with ganciclovir 5mg/kg for all ages, every 12 hours by intravenous injection for 2-3 weeks

Herpes zoster eye (eye shingles) 

Treatment recommendations:

Aciclovir 800mg (children 20mg/kg maximum 800mg) orally 5 times daily, every 4 hours, for at least 10 days.

Either famciclovir 250mg or valaciclovir 1g orally every 8 hours for 10 days.

Or aciclovir 10mg/kg (for all ages) intravenously, every 8 hours, for 10 days.