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 
     Chapter 7 ................................................................................................................................................................................................................ 53 
      Dosage Guide For Commonly Used Antimicrobial Agents ........................................................................................................................... 53 
     Chapter 8 ................................................................................................................................................................................................................ 57 
      Link To National Programme Current Guidelines For Treatment Of Specific Infections......................................................................... 57 
     Chapter 9 ................................................................................................................................................................................................................ 59 
      Case Definitions And Diagnosis For Common Infections .................................................................................................................................. 59 
       DIARRHEA ................................................................................................................................................................................................... 59 
       ENTERIC FEVER ......................................................................................................................................................................................... 59 
       SPONTANEOUS BACTERIAL PERITONITIS ........................................................................................................................................... 59 
       ACUTE PANCREATITIS ............................................................................................................................................................................. 59 
       ACUTE BACTERIAL MENINGITIS ........................................................................................................................................................... 60 
       BRAIN ABSCESS ......................................................................................................................................................................................... 60 
       INFECTIVE ENDOCARDITIS ..................................................................................................................................................................... 60 
       CELLULITIS ................................................................................................................................................................................................. 61 
       FURUNCULOSIS ......................................................................................................................................................................................... 61 
       URINARY TRACT INFECTIONS ............................................................................................................................................................... 61 
       PNEUMONIA ............................................................................................................................................................................................... 61 
     ABBREVIATIONS ................................................................................................................................................................................................ 63 
                      
                                                             2 
      
                                                       3     
     
                                                  4