Aerobic Gram Negative Bacteria

COCCI

Neisseria

  • meningitides: vaccination, penicillin G or ceftriaxone, rifampicin (prophylaxis)
  • gonorrhoea: piperacillin-tazobactam 4.5g Q8hrly, ceftriaxone

Moraxella

  • azithromycin
  • clarithromycin
  • amoxicillin + clavulanate
  • second or third generation cephalosporin
  • co-trimoxazole 10mg/kg of sulphamethoxazole

RODS/BACILLI

-> aminoglycosides are good agents (gentamicin, tobramycin, amikacin, streptomycin)

Campylobacter

  • fluoroquinolones
  • erythromycin

Citrobacter

E. coli (from blood)

  • cefuroxime 1.5g Q8 hrly
  • ceftriaxone 1-4g Q24hrs
  • ciprofloxacin 300mg Q12 hourly
  • meropenem 2g Q8hrly
  • gentamicin 3-5mg/kg LD -> titrate to trough
  • tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
  • piperacillin-tazobactam 4.5g Q8hrly
  • nitrofurantoin 100mg QID PO (5-7mg/kg/day)

-> amoxicillin and penicillin = waste of time

E. coli (from urine)

  • cefuroxime 1.5g Q8 hrly
  • ceftriaxone 1-4g Q24hrs
  • ciprofloxacin 300mg Q12 hourly
  • meropenem 2g Q8hrly
  • gentamicin 3-5mg/kg LD -> titrate to trough
  • tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
  • piperacillin-tazobactam 4.5g Q8hrly
  • nitrofurantoin 100mg QID PO (5-7mg/kg/day)

-> not as much cover with amoxicillin-clavulnate, trimethoprim and co-trimoxazole

Enterobacter species

  • ceftriaxone
  • ciprofloxacin 300mg Q12 hourly
  • imipenem 500mg Q6 hrly
  • meropenem 2g Q8hrly
  • gentamicin 3-5mg/kg LD -> titrate to trough
  • tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
  • co-trimoxazole 10mg/kg of sulphamethoxazole

Helicobacter

  • clarithromycin + omeprazole

Klebsiella

  • piperacillin-tazobactam 4.5g Q8hrly
  • ceftriaxone
  • ciprofloxacin

Morganella morganii

  • piperacillin-tazobactam 4.5g Q8hrly
  • meropenem 2g Q8hrly
  • imipenem 500mg Q6 hrly
  • tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
  • gentamicin 3-5mg/kg LD -> titrate to trough

Proteus mirabilis

  • cefuroxime 1.5g Q8 hrly
  • ceftriaxone 1-4g Q24hrs
  • amoxicillin-clavulate 1.2g Q6 hrly
  • meropenem 2g Q8hrly
  • imipenem 500mg Q6 hrly
  • gentamicin 3-5mg/kg LD -> titrate to trough
  • tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
  • piperacillin-tazobactam 4.5g Q8hrly
  • ciprofloxacin 300mg Q12 hourly
  • co-trimoxazole 10mg/kg of sulphamethoxazole

-> only 90% coverage with penicillin & amoxicillin

Salmonella

  • fluroquinolones: ciprofloxacin, moxifloxacin
  • ceftriaxone
  • co-trimoxazole 10mg/kg of sulphamethoxazole
  • azithromycin

Serratia species

  • ciprofloxacin 300mg Q12 hourly
  • meropenem 2g Q8hrly
  • imipenem 500mg Q6 hrly
  • gentamicin 3-5mg/kg LD -> titrate to trough
  • tobramycin 3-5mg/kg/day in 3 divided doses -> monitor
  • co-trimoxazole 10mg/kg of sulphamethoxazole

Shigella

  • fluroquinolones: ciprofloxacin, moxifloxacin
  • co-trimoxazole 10mg/kg of sulphamethoxazole

Vibrio

  • doxycycline
  • fluoroquinolone

Yersinia

  • pestis: streptomycin, gentamycin, doxycycline
  • enterocolitica: fluoroquinolone, co-trimoxazole 10mg/kg of sulphamethoxazole

PSEUDOMONAS + RELATIONS

Acinetobacter

  • fluroquinolones: ciprofloxacin, moxifloxacin

Burkholderia cepacea

  • co-trimoxazole 10mg/kg of sulphamethoxazole, ciprofloxacin

Burkholderia pseudomallei

  • mild/ moderate: ceftazidine + co-trimoxazole
  • severe: meropenem + co-trimoxazole

Flavobacterium

  • -> resistant to imipenem

Pseudomonas aeruginosa:

(1) piperacillin-tazobactam + gentamicin
(2) imipenem or meropenem
(3) ceftazidime + gentamicin
(4) cefepime + gentamicin
(5) tobramycin
(5) fluroquinolones: ciprofloxacin, moxifloxacin

-> resistance to imipenem can develop during treatment

Stenotrophomonas maltophilia:

  • co-trimoxazole

-> resistant to imipenem

COLLOBACILLI

Brucella

  • doxycycline + gentamycin

Bartonella

  • doxycycline
  • chloramphenicol

Bordetella

  • erythromycin, DPT vaccine

Haemophilus

  • influenzae:
    piperacillin-tazobactam 4.5g Q8hrly, second or third generation cephalosporins, fluroquinolones (ciprofloxacin, moxifloxacin)
    Hib vaccination
  • ducreyi:
    azithromycin or erythromycin, ceftriaxone, ciprofloxacin

Legionella

  • erythromycin
  • rifampicin
  • fluroquinolones: ciprofloxacin, moxifloxacin

Pasturella

  • penicillin G
  • doxycycline
  • third generation cephalosporin

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.