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G. acyclovir ointment applied to eye five times a day, continued for at least 3 days after healing. • Stromal disease: Complex - combination of antiviral therapy and topical corticosteroids. • Bacterial keratitis: Usually due to Pseudomonas aeruginosa, Streptococcus pneumoniae and rarely Staphylococcus aureus. Cefazolin eye drops (100 mg/ml; parenteral cefazolin mixed with tears naturale) and either gentamicin or tobramycin eye drops (3 mg/ ml) or ciprofloxacin instilled every 15 - 60 minutes around the clock for the first 24 72 hours, with a slow reduction in dosing over a period of several weeks.

For beta-lactam allergy, gentamicin 120 mg plus clindamicin 600 mg IV preop. 5. BILIARY TRACT SURGERY Most studies show that achieving adequate drainage will prevent post-procedural cholangitis or sepsis and there is no further benefit from prophylactic antibiotics. With inadequate drainage, antibiotics may be of value. The American Society for GI Endoscopy recommends prophylaxis for known or suspected biliary obstruction. The value of prophylaxis for ERCP is controversial. Note that cephalosporins are not active against the enterococci, yet are clinically effective as prophylaxis in biliary surgery.

Thus, the definitive regimen to be used depends on the sensitivity results. A. Penicillin-sensitive: Penicillin G 20 mU per day in equally divided doses every 4 hours by IV bolus injection for 28 days PLUS gentamicin 80 – 120 mg IV 8 hourly for 28 days. B. Penicillin-resistant, methicillin-(oxacillin/cloxacillin) sensitive: Cloxacillin 2 g 4 hourly by IV bolus injection for 28 days PLUS gentamicin 80 – 120 mg IV 8 hourly for the initial 7 days of therapy. C. Penicillin- and methicillin-resistant: Vancomycin 1 g by IV infusion over at least 100 minutes twice daily for 28 days PLUS gentamicin 80 – 120 mg IV 8 hourly for 7 days.

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Antibiotic Guideline

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