National Antibiotic Guidelines 2018 Department of Health Manila, Philippines Cover Design John Michael L. Roque Layout Design Adell R. Azuelo Lora Alaine D. Raymundo John Michael L. Roque All rights reserved 2018 National Antibiotic Guidelines Committee Pharmaceutical Division Department of Health Philippine Blood Center, Lung Center Compound, Quezon Avenue, Quezon City, 1100 ISBN - 978-621-95675-1-0 Any part of the book or its entirety may be reproduced or transmitted without any alteration, in any form or by any means, with permission from DOH provided it is not used for commercial purposes. TABLE OF CONTENTS Message ...................................................................................................................................... i Acknowledgments .................................................................................................................... ii Editorial Team .......................................................................................................................... iv Abbreviations and Acronyms .................................................................................................. v Introduction ............................................................................................................................... 1 Blood-Borne Infections and Other Systemic Syndromes .................................................... 8 Bone and Joint Infections - Pediatric ................................................................................... 32 Bone and Joint Infections - Adult ......................................................................................... 39 Cardiovascular Infections ...................................................................................................... 47 Central Nervous System Infections ...................................................................................... 62 Dental and Oral Infections ..................................................................................................... 71 Gastrointestinal and Other Intraabdominal Infections ....................................................... 78 Ocular Infections ..................................................................................................................... 93 Respiratory Tract Infections Upper Respiratory Tract Infections……………………………………………………..105 Lower Respiratory Tract Infections…………………………………………………….128 Skin and Soft Tissue Infections - Pediatric ........................................................................ 148 Skin and Soft Tissue Infections - Adult .............................................................................. 173 Surgical Prophylaxis ............................................................................................................ 194 Urinary Tract Infections ........................................................................................................ 206 National Health Programs Filiariasis (Selective Treatment) ……………………………………………………..……221 Leprosy………………………………………………………………………..…………….…223 Malaria…………………………………………………………….……………………………225 Schistosomiasis…………………………………………………………………………..….236 Sexually Transmitted Infections………………………………………………………..….238 Tuberculosis…………………………………………………………………………..………261 Republic of the Philippines Department of Health OFFICE OF THE SECRETARY MESSAGE The discovery of antibiotics, considered as “Miracle Drugs” in the 1920s revolutionized man’s ability to treat many infectious diseases and save countless lives. However, with their misuse, an increasing number of microorganisms are now resistant to them, thus the emergence of antimicrobial resistance. This public health threat intensifies the risk of falling into more severe and prolonged illness leading to increased mortality and health care costs. The Philippine Action Plan to Combat AMR: One Health Approach in 2015 has set a strategic direction towards preventing the spread and potential harm caused by AMR, unifying and linking all relevant sectors in the country, to strengthen the prudent use of antibiotics. The Department of Health created the National Antibiotic Guidelines Committee (NAGCom), a body composed of infectious disease experts and other relevant fields to develop the National Antibiotic Guidelines (NAG). The guidelines aim to strengthen our program implementation on the rational use of antimicrobials. This contains the therapeutic recommendations for the common infectious diseases in the community setting and hospitals that will supplement the knowledge of our physicians on optimizing antibiotic treatment. The NAG will help improve quality of care in the country, improve patient outcomes and lower health care costs. We all have a responsibility to protect our people from the threat of antimicrobial resistance. As we move to achieve the Philippine Health Agenda, let us harmonize our efforts in the pursuit of better health care system. Together, we can win the war against AMR! FRANCISCO T. DUQUE III, MD, MSc Secretary of Health i ACKNOWLEDGMENTS The participation and assistance of the following experts and reviewers of this document are gratefully acknowledged: Dr. Estrella B. Paje-Villar, former NAG Committee Chair Dr. Ivan Olegario, former editor Dr. Corazon I. Flores, former Director of the Pharmaceutical Division DOH offices: Disease Prevention and Control Bureau (DPCB) Epidemiology Bureau (EB) Food and Drug Administration (FDA) Health Facilities Development Bureau (HFDB) Development Partner: World Health Organization Professional Associations: Pediatric Infectious Disease Society of the Philippines (PIDSP) Pediatric Nephrology Society of the Philippines (PNSP) Philippine Academy of Family Physicians (PAFP) Philippine Academy of Ophthalmology (PAO) Philippine Academy of Pediatric Pulmonologists (PAPP) Philippine Coalition Against Tuberculosis (PhilCAT) Philippine College of Chest Physicians (PCCP) Philippine College of Physicians (PCP) Philippine College of Surgeons (PCS) Philippine Dental Association (PDA) Philippine Dermatological Society (PDS) Philippine Hospital Infection Control Society, Inc. (PHICS) Philippine Neurological Association (PNA) Philippine Obstetrical and Gynecological Society (POGS) Philippine Orthopedic Association (POA) Philippine Pediatric Society (PPS) Philippine Pharmacists Association, Inc. (PPhA) Philippine Society for Microbiology and Infectious Disease (PSMID) Philippine Society of Nephrology (PSN) Philippine Society of Newborn Medicine (PSNBM) Philippine Society of Otolaryngology Head and Neck Surgery (PSO-HNS) ii Philippine Society for Pediatric Gastroenterology, Hepatology and Nutrition (PSPGHAN) Philippine Society of Pediatric Surgeons (PSPS) Philippine Urological Association (PUA) Hospitals: Philippine Children’s Medical Center (PCMC) Research Institute for Tropical Medicine (RITM) San Lazaro Hospital (SLH) The Medical City (TMC) Universirty of the Philippines-Philippine General Hospital (UP-PGH) iii EDITORIAL TEAM National Antibiotic Guidelines Committee Chair MEDIADORA C. SANIEL, MD, MBA-H, FPCP Members CELIA C. CARLOS, MD, FPPS, FPIDSP, FPSMID CARMINA A. DELOS REYES, MD, FPPS, FPIDSP MARI ROSE A. DE LOS REYES, MD, FPCP BENILDA B. GALVEZ, MD, FPCCP MARY ANN D. LANSANG, MD, MMEDSC CECILIA C. MARAMBA-LAZARTE, MD, MSCID, MSCCT ROSALIND G. VIANZON, MD, MPH CYNTHIA S. FABREGAS, MD, DPCOM OLIVIA M. LIMUACO, RPh, PhD YOLANDA R. ROBLES, RPh, PhD VITO G. ROQUE, Jr. MD Antimicrobial Resistance Program Secretariat ANNA MELISSA M. GUERRERO, MD, MPH (HTA) IRENE V. FLORENTINO-FARIÑAS, RPH, MD, MNSA MS. ANNE JULIENNE M. GENUINO, RPH MS. NIÑA ISABELLE M. TOLENTINO, RPH MS. LORA ALAINE D. RAYMUNDO, RPH iv ABBREVIATIONS AND ACRONYMS ABECB Acute bacterial exacerbation of chronic bronchitis ABP Acute bacterial prostatitis ABRS Acute bacterial rhinosinusitis ABSSSI Acute bacterial skin and skin structure infections AL Artemether-lumefantrine ALT Alanine aminotransferase AOM Acute otitis media ARSP Antimicrobial Resistance Surveillance Program ART Antiretroviral therapy AS Artesunate ASB Asymptomatic bacteriuria AUC Acute uncomplicated cystitis BMI Body mass index BUN Blood urea nitrogen CAMRSA Community-associated MRSA CAP Community-acquired pneumonia CBP Chronic bacterial prostatitis CHD Congenital heart disease CMV Cytomegalovirus CNS Central nervous system CRP C-reactive protein CRS Chronic rhinosinusitis CSF Cerebrospinal fluid CSOM Chronic suppurative otitis media CT Computed tomography CVC Central venous catheter CVS Cardiovascular system DAIR Debridement and retention of prosthesis DEC Diethylcarbamazine DFI Diabetic foot infections EIA Enzyme immunoassay ELISA Enzyme-linked immunosorbent assay ENT Ears, nose and throat EPTB Extra pulmonary tuberculosis ESBL Extended spectrum beta-lactamase ESR Erythrocyte sedimentation rate ETEC Entero-toxigenic Escherichia coli FDC Fixed dose combination FQ Fluoroquinolone FTA-ABS Fluorescent treponemal antibody absorption test GIT Gastro-intestinal tract GABHS Group A Beta-hemolytic Streptococci v GAS Group A Streptococcus GCSF Granulocyte colony stimulating factor GNB Gram-negative bacteria GUT Genitourinary tract HACEK Haemophilus sp., Aggregatibacter sp., Cardiobacterium hominis, Eikinella corrodens, and Kingella sp. HAI Hospital-associated infections HAP Hospital-acquired pneumonia HBIG Hepatitis B Immunoglobulin HBeAg Hepatitis B envelope antigen HBsAg Hepatitis B surface antigen HBV Hepatitis B virus HCV Hepatitis C virus HR Isoniazid + Rifampicin HRZE/S Isoniazid + Rifampicin + Pyrazinamide + Ethambutol/Streptomycin