National Treatment Guidelines for Antimicrobial Use in Infectious Diseases Version 1.0 (2016) NATIONAL CENTRE FOR DISEASE CONTROL Directorate General of Health Services Ministry of Health & Family Welfare Government of India CONTENTS Chapter 1 .................................................................................................................................................................................................................. 7 Introduction ........................................................................................................................................................................................................ 7 Chapter 2. ................................................................................................................................................................................................................. 9 Syndromic Approach For Empirical Therapy Of Common Infections.......................................................................................................... 9 A. Gastrointestinal & Intra-Abdominal Infections ......................................................................................................................................... 10 B. Central Nervous System Infections ........................................................................................................................................................... 13 C. Cardiovascular Infections .......................................................................................................................................................................... 14 D. Skin & Soft Tissue Infections ................................................................................................................................................................... 15 E. Respiratory Tract Infections ...................................................................................................................................................................... 16 F. Urinary Tract Infections ............................................................................................................................................................................. 17 G. Obstetrics And Gynaecological Infections ................................................................................................................................................ 18 H. Bones And Joint Infections ....................................................................................................................................................................... 22 I. Eye Infections ............................................................................................................................................................................................ 23 J. Ear Infections ............................................................................................................................................................................................ 25 K. Infections in Burn and Plastic Surgery ...................................................................................................................................................... 26 L. Fungal Infections ...................................................................................................................................................................................... 27 M. Febrile Neutropenia .................................................................................................................................................................................. 27 N. Post-Cardiovascular Surgery Infections .................................................................................................................................................... 29 O. Pediatric Infections ................................................................................................................................................................................... 31 P. Neonatal Infections .................................................................................................................................................................................... 39 R. Post Solid Organ Transplant ...................................................................................................................................................................... 40 S. Surgical Antimicrobial Prophylaxis ........................................................................................................................................................... 41 Chapter 3 ................................................................................................................................................................................................................ 42 Treatment Of Muti-Drug Resistant Bacterial Pathogens .............................................................................................................................. 42 1. Methicillin- Resistant S. aureus (MRSA) .................................................................................................................................................. 42 2. Vancomycin Resistant Enterococcus (VRE) ........................................................................................................................................... 42 3. Extended Spectrum Βeta-Lactamases (ESBL) Producing Enterobacteriaceae. .......................................................................................... 42 4. Carbapenem- Resistant Enterobacteriaceae (CRE) .................................................................................................................................... 42 Chapter 4 ................................................................................................................................................................................................................ 44 Guidelines For Optimizing Use Of Key Antimicrobials ................................................................................................................................ 44 A. Antimicrobial Prescribing: Good Practice ................................................................................................................................................ 44 B. Reserve Antimicrobials ............................................................................................................................................................................ 45 C. Hypersensitivity ....................................................................................................................................................................................... 45 D. Alert Antimicrobials.................................................................................................................................................................................. 46 E. Alert Antibiotics And Their Indications .................................................................................................................................................... 46 Chapter 5 ................................................................................................................................................................................................................ 49 Preventive Strategies For Healthcare Associated Infections ......................................................................................................................... 49 A. Healthcare Associated Infections .............................................................................................................................................................. 49 B. Reducing the risk of Health care associated infections.............................................................................................................................. 49 Chapter 6 ................................................................................................................................................................................................................ 50 Monitoring Antimicrobial Use ......................................................................................................................................................................... 50 A. Background ............................................................................................................................................................................................... 50 B. Need For Surveillance To Track Antimicrobial Use And Resistance ....................................................................................................... 50 C. Standardized Methodology And Outcome Measures ................................................................................................................................ 50 D. Situation In Developing Countries ............................................................................................................................................................ 51 High-end Antibiotic Monitoring Sheet .......................................................................................................................................................... 52 Surgical Prophylaxis Monitoring Sheet ......................................................................................................................................................... 52