ID - National Antibiotics Guidelines

Name	IV	Tab	Use
Aciclovir	500mg tds	800mg 5 times daily (Herpes)
AKURIT -4		30-37kg : 2 Tab OD 38-54kg: 3 Tab OD 55kg-70kg : 4 Tab OD >70kg : 5 Tab OD
Ampicillin	500mg-1gm  qid
Amoxycillin		250mg-500mg TDS
Augmentin	1.2g tds CrCl (10-30) : 1.2gm BD	625mg BD	CAP
Azithromycin	500mg OD	500mg OD	CAP/HAP
Bactrim		11/11 bd
Cefadroxil		500 mg–1g bd
Cefalexin		250mg -500mg qid
Cefepime	1-2g bd/tds HAP : 1gm TDS Neutropenia Sepsis: 2gm TDS		HAP
Cefoperazone	500mg-1g bd
Ceftriaxone	1-2g OD		HAP
Cefuroxime	750mg-1.5g tds	250-500mg bd
Ciprofloxacin	400mg bd	500mg OD-bd (Usually 500mg BD)
C-penicillin	1-2mU qid/2.4MU tds
Clindamycin	600mg qid
Cloxacillin	1-2g qid	500mg-1g qid
Erythromycin		400-800mg bd
Fluconazole	400mg OD	150mg OD	Candida
Gentamicin	180mg OD
Imipenem	500mg bd
Metronidazole/Flagyl	500mg tds	400mg tds
Meropenem	2g tds
Oseltamivir/tamiflu	75mg OD-bd	75mg BD
Penicillin V (Phenoxymethylpenicillin)		500mg qid
Polymyxin E	1mU bd
Roxithromycin		150 mg bd
Tazocin	4.5g qid
Unasyn	1.5g tds  (Max 12gm / day)	375mg bd
Vancomycin	500mg-1g OD		Need to do TDM

CVS - VTE prophylaxis and treatment

1. Rivaroxaban (Xarelto) - Direct Xa inhibitor - Peak 4 hours - Duration 8-12 hours 

- Use: prevent stroke in pt with AF, w/o heart valve disease, 1 stroke RF (age, HPT, DM, CCF, h/o CVA) - Use: prevent DVT in pt with THR/TKR - Use: treat DVT - Not for: prosthetic heart valve/ mitral stenosis - Dosage: Starting dose at 10 mg (6 - 10hours after surgery) followed by 10 mg daily - No dose adjustment in renal impairment with prophylactic dose 

2. Enoxaparin/LMWH (Clexane) - Potentiate antithrombin III  inhibit FXa and FIIa - Derive from pig intestine mucosa (Sanofi) - 

Use: prophylaxis and treat DVT +/- PE, with ACS - Use: treat UA, nonQ MI, THR, TKR, abd surgery - 40mg OD, half dose if renal impairment (GFR < 30ml/min) - Can give with aspirin 

3. Tinzaparin/LMWH (Innohep) - 3500U-4500U OD 

4. Fondaparinux (Arixtra) - synthetic pentasaccharide Factor Xa inhibitor - 2.5mg OD, CI in severe renal impairment 

5. Dabigatran etexilate (Pradaxa) - direct thrombin (factor IIa) inhibitor

 - Use: prevent stroke in pt with AF - 110mg, then 220mg OD - Elderly/mod AKI – 75mg, then 150mg OD - No need INR - Cannot reverse effect 

6. UFHeparin - Severe renal impairment (GFR < 15) - 5000U bd - Monitor platelet D4-14 (EOD basis)

 7. Consider extending anticoagulation beyond 3 months for patients with unprovoked proximal DVT/PE if their risk of VTE recurrence is high (e.g. male, family history) and there is no additional risk of major bleeding. 

 8. Offer LMWH to patients with active cancer and confirmed proximal DVT or PE, and continue the LMWH for 6 months. At 6 months, assess the risks and benefits of continuing anticoagulation

Living life with purpose

Time appears short. 

Rest assured that there will be time for the major events in life.

Time management is about finding the right recipe to spend time wisely. 

Goals in life:

1. Do good to those who gave me life (parents) 

2. Be helpful to those who help me along my life path (best friends NgKhoo) (good friends KB group/UPM Putra Court)

3. Be the best I can be, professionally (challenge the impossible) (endure the tougest hard work)

4. Give love to the one who loves me (Amy)

Intermediate goals - 5 years

1. Be independent (housing, bills, laundry, housekeeping, meals, purchase)

2. Allocate adequate social time to interact with my friends

3. Pass UM Masters Medical within 4 years timeframe KIV MRCP 

4. Get married to the love of my life KIV buy property

Pushing factor

Think of an action. 

Remind self of long term goals. 

Focus on the action. 

Just do it. 

Sleeping hours

=> 6 hours - to stay healthy

=> 7 hours - to be functional

+ 1 hour - if unwell/weekend

Time starved society

We are living in a time-starved culture. We are always rushing, we are always in a hurry.

The world is spinning fast as if life is a fixed routine. The path available is limited and clearcut. Not many is willing to take the risk of deviating from the fixed life path. 

Can I cope? I may not be able to change the ingraining cultural landscape. I am trying to adept to the faster paced world. 

I will need to prioritize life. If tomorrow is last day of my life, what would i do today with no regrets?

Why?

Why do humans live life?

Why do humans age?

Why do humans fall sick?

Why do humans die?

Buddha explains that the rules of existence includes the cycles of life as birth, ageing, sickness and death. 

Humankind is one of the best evolved being on Earth. We dominate the world we live in, influencing greatly our surroundings. We are the main predators.

I have inadequate experience to fully explain the reason of my existence. At least I know that i am the birthright of my parents. 

Life is indeed suffering

15 years ago, i had an attack of terrifying bronchospasm. I did not seek any treatment at that time. Luckily it resolved spontaneously. That incident and 'sinseh' fractured right ulna motivated me further into medical career path in my quest to allievate suffering for the ones i care for. 

Today i just had another episode of wheeze probably food/dust related. This time i have medications by my side. I feel more relieved and secure, though i had to endure the suffering first. In this life as human form, no one can escape suffering, though some may have to experience more pain than others. Having nerve cells keep us from harm's way, yet it causes so much suffering. 

Life is suffering for some times, yet can be pleasurable at other times. God and Devil are believed to coexist on the same plane of existence. 

Buddha states that good and bad will reach an equilibrium. And there is a cause for every effect, known as karma. 

Some cause is unknown to our consciousness ie past lives karma. 

Physics state that action = reaction. 

Humans believe as truth phenomenon that can be proven. 

Humans coexist because of biological reproduction. 

Humans live as long as their body can function to sustain life. 

Humans death create a ripple of loss/grief for the close ones. 

I am inexperienced enough to comment further on life. 

Yet i welcome life with each passing day. I accept death as part of life.