Aerobic Gram Positive Bacteria

COCCI

Micrococcus

  • flucloxacillin
  • vancomycin

Staphylococcus aureus

  • flucloxaciliin 100mg/kg/day in divided doses
  • clindamycin 4mg/kg Q6hrly
  • piperacillin-tazobactam
  • cephazolin
  • co-trimoxazole 10mg/kg of sulphamethoxazole
  • erythromycin 20mg/kg/day in divided doses
  • fusidic acid 1g Q8hrly
  • gentamicin 3-5mg/kg LD -> titrate to trough
  • tetracycline 500mg Q12hrly
  • vancomycin 10mg/kg LD -> dose as per trough level
  • linezolid 600mg Q12hrly (adult)
  • meropenem 1g Q8hrly (adult)
  • quinpristin-dalfopristin 7.5mg/kg Q8hrly
  • rifampicin 20mg/kg /day
  • teicoplanin 400mg LD -> 400mg @ 12 hrs -> 400mg Q24hrly
  • tigecycline 100mg LD -> 50mg Q12hrly

-> penicillin = waste of time
-> MRSA is resistant to imipenem

Coag Negative Staphylococcus (from blood)

  • vancomycin 10mg/kg LD -> dose as per trough level
  • linezolid 600mg Q12hrly (adult)
  • meropenem 1g Q8hrly (adult)
  • quinpristin-dalfopristin 7.5mg/kg Q8hrly
  • rifampicin 20mg/kg /day
  • teicoplanin 400mg LD -> 400mg @ 12 hrs -> 400mg Q24hrly
  • tigecycline 100mg LD -> 50mg Q12hrly

-> penicillin, fluclox and erythromycin = waste of time
-> clindamycin, co-trimoxazole and gentamicin = basically a waste of time

Staphylococcus saprophyticus

  • penicillin

Streptococcus + Enterococcus

A – S. pyogenes

  • penicillin G
  • penicillin V
  • erythromycin

-> in invasive infections (toxic shock syndrome or necrotising fasciitis) consider adding clindamycin

B – Streptococcus agalactiae (beta-haemolytic)

  • penicillin G

C and G

  • penicillin

D

Enterococcus

  • penicillin G
  • benzylpenicillin 1-5g/day in divided doses
  • amoxicillin 1g Q4 hrly
  • vancomycin 10mg/kg LD -> dose as per trough level
  • nitrofurantoin 100mg QID PO (5-7mg/kg/day)

-> tetracycline and gentamicin = waste of time
-> facecalis: amoxicillin, imipenem
-> faceium: vancomycin (resistant to imipenem)
-> VRE: linezolid

Streptococcus bovis

  • ampicillin
  • penicillin
  • vancomycin

Streptococcus pneumoniae

  • moxifloxacin – 400mg Q24 hrly (drug of choice)
  • penicillin – becomes less sensitive with decreasing age
    – amoxicillin 1g Q4 hrly
    – benzylpenicillin 1-5g/day in divided doses
    – ceftriaxone (good cover for all age groups) 1-4g Q24hrs
    – cefotaxime
    – vancomycin
    – linezolid

Viridans Group – Streptococcus mutans, mitis, sanguinis, salavarius, constellatus

  • penicillin G
  • gentamicin + either: ampicillin, penicillin or vancomycin
  • vancomycin

RODS/BACILLI

Bacillus

  • anthracis: penicillin G, erythromycin
  • cereus: vancomycin, clindamycin

Corynebacterium

  • antitoxin, penicillin or erythromycin, vaccination (DPT)

Erysipelothrix

  • amoxycillin
  • penicillin

Lactobacillus

  • penicillin

Listeria

  • ampicillin
  • co-trimoxazole 10mg/kg of sulphamethoxazole

Nocardia

  • co-trimoxazole 10mg/kg of sulphamethoxazole
  • ceftriaxone
  • meropenem

-> sensitivities vary according to species and strain – empiric combinatorial therapy often requred


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, a Clinical Adjunct Associate Professor at Monash University, and the Chair of the Australian and New Zealand Intensive Care Society (ANZICS) Education Committee. 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

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