Antibiotics Inpatient Treatment Flashcards
Community Acquired Pneumonia First Line therapy
Ceftriaxone 1g IV q24h Plus
Azithromycin 500 mg PO/IV q24h
Community Acquired Pneumonia Second Line therapy
1-Levofloxacin 750 mg PO/IV q24h
2-Ceftriaxone 1g IV q24h Plus Doxycycline 100 mg PO/IV q24h
3-Ertrapenem 1g IV q24h PLUS Azithromycin 500 mg IV q24h-pregnancy & cephalosporin allergy or severe penicillin allergy
Community Acquired Pneumonia: Notes
-Ceftriaxone + doxycycline for patients with
concern for prolonged QTc
• Levofloxacin for patients with a cephalosporin
allergy
• Consider adding vancomycin for MRSA if:
necrotizing/cavitary infiltrates, empyema, or
requires ICU admission
• Duration of treatment should be a minimum of
5 days. Patient should be afebrile for 48-72
hours before discontinuation of therapy
Hospital-acquired pneumonia; First Line Therapy • Pneumonia not incubating at the time of hospital admission, occurring ≥48 hours after admission, and not associated with mechanical ventilation
-Cefepime 2 g IV q8h PLUS Vancomycin IV Pharmacy to Dose -Double antipseudomonal/gram-negative coverage criteria met*: -Cefepime 2 g IV q8h PLUS -Ciprofloxacin 400 mg IV q8h OR Ciprofloxacin 750 mg PO q12h PLUS -Vancomycin IV Pharmacy to Dose
Hospital-acquired pneumonia; Second Line Therapy
-Meropenem 1 g IV q8h PLUS Vancomycin IV Pharmacy to Dose -Double antipseudomonal/gram-negative coverage criteria met*: -Meropenem 1 g IV q8h PLUS -Ciprofloxacin 400 mg IV q8h OR Ciprofloxacin 750 mg PO q12h PLUS -Vancomycin IV Pharmacy to Dose
HAP notes
• Meropenem if cephalosporin allergy or severe
penicillin allergy
• Aminoglycoside for patients with concern for
prolonged QTc if double coverage indicated
• 7 days of antibiotic therapy recommended
• *Double antipseudomonal/gram-negative coverage with two agents from a different
class (β-Lactam + non- β-Lactam) if: IV
antibiotic use within 90 days, septic shock, ventilatory support required due to HAP,
bronchiectasis, cystic fibrosis
Ventilator Associated Pneumonia (VAP): Pneumonia occurring >48 hours after endotracheal intubation—First Line Therapy
-Cefepime 2 g IV q8h PLUS
Vancomycin IV Pharmacy to Dose
-Double antipseudomonal/gram-negative coverage criteria met*:
-Cefepime 2 g IV q8h PLUS Ciprofloxacin 400 mg IV q8h PLUS
-Vancomycin IV
Pharmacy to Dose
VAP: Second Line Therapy
-Meropenem 1 g IV q8h PLUS Vancomycin IV Pharmacy to Dose -Double antipseudomonal/gram-negative coverage criteria met*: -Meropenem 1 g IV q8h PLUS Ciprofloxacin 400 mg IV q8h PLUS Vancomycin IV Pharmacy to Dose
VAP Notes
-Meropenem if cephalosporin allergy or severe
penicillin allergy
• Aminoglycoside for patients with concern for
prolonged QTc
• 7 days of antibiotic therapy recommended
• *Double antipseudomonal/gram-negative
coverage with two agents from a different
class (β-Lactam + non- β-Lactam): if IV abx
use within 90 days, septic shock, ARDS
preceding VAP, >5 days hospitalization prior to
VAP, acute renal replacement therapy prior to
VAP, unit where >10% of gram-negative
isolates are resistant to monotherapy
Aspiration Pneumonia: First Line
1) Ampicillin-sulbactam 3 g IV q6h
2) Ceftriaxone 1g IV q24h
Severe Sepsis/Septic Shock:
Piperacillin-tazobactam 4.5 g IV x 1 over
30 minutes, followed by 3.375 g IV q8h
over 4 hours
Aspiration Pneumonia: Second line
Levofloxacin 750 mg PO/IV q24h
Severe Sepsis/Septic Shock:
Meropenem1 g IV q8h
Aspiration Pneumonia: Notes
-Ceftriaxone if mild-moderate penicillin allergy;
-Levofloxacin if cephalosporin allergy or severe
penicillin allergy
• 7 days of antibiotic therapy recommended
• Healthcare-acquired aspiration pneumonia
should follow the recommendations for HAP
above
Uncomplicated Cystitis: First Line
1) Nitrofurantoin* 100 mg PO q12h
2) Cephalexin 500 mg PO q12h
3) Ceftriaxone 1 g IV q24h
Uncomplicated Cystitis: Second line
1) Ertapenem 1 g IV q24h
2) Gentamicin IV Pharmacy to Dose
3) Ciprofloxacin 250 mg po q12h
4) SMX/TMP DS po q12h
Uncomplicated Cystitis, Pyelonephritis (uncomplicated), Complicated Cystitis: Notes
• Strongly recommend AGAINST treatment of asymptomatic bacteriuria in most patients
• Add vancomycin IV for MRSA and Enterococcus coverage
(if patient has Foley catheter, urinary stents, or <7 days urinary instrumentation)
• *Nitrofurantoin recommended in females with CrCl>40
mL/min and males with CrCl >60 ml/min
• E. coli resistance to Cipro (15-23%), SMX/TMP (20-
25%), Ampicillin (41-46%)
• Avoid ciprofloxacin, gentamicin & SMX/TMP in pregnancy and warfarin
• Ertapenem if cephalosporin allergy, severe penicillin allergy or history of ESBL organism
• Usual duration depends on severity and choice of agent and dose
Pyelonephritis
(uncomplicated): First line
Ceftriaxone 1 g IV q24h
Complicated Cystitis • Men, pregnant, functional abnormality, immunocompromised, indwelling or recent catheter/stent: First line
- Ceftriaxone 1 g IV q24h
- Severe Sepsis or Septic Shock: Cefepime 2 g IV q8h
Pyelonephritis
(uncomplicated): Second Line
1) Ertapenem 1 g IV q24h
2) Gentamicin IV Pharmacy to Dose
Complicated Cystitis: Second line
- Ertapenem 1 g IV q24h
- Severe Sepsis or Septic -Shock: Meropenem 1 g IV q8h
Cellulitis: First Line
Cefazolin 1-2 g IV q8h
• 1g if < 80 kg
• 2g if > 80 kg
-Severe Sepsis or Septic Shock: Ceftriaxone x1 followed by cefazolin dosed
as above
Cellulitis: Second Line
Vancomycin IV Pharmacy to Dose
Necrotizing skin & soft tissue infection: First Line
Piperacillin-tazobactam 4.5 g IV x 1 over 30
minutes, followed by 3.375 g IV q8h over 4
hours PLUS Vancomycin IV Pharmacy to
Dose PLUS Clindamycin 600 mg IV q8h
Necrotizing skin & soft tissue infection: Second Line
Meropenem 500 mg IV q8h PLUS Vancomycin IV Pharmacy to Dose PLUS Clindamycin 600 mg IV q8h
Cellulitis Notes
Vancomycin if cephalosporin or severe
penicillin allergy, cephalosporin allergy,
abscess or purulence
• Elevation of infected area is recommended
• Recommended duration of antibiotic therapy is 5 days, but can be extended if
not improved (up to 14 days)
Necrotizing skin & soft tissue infection
• Meropenem if cephalosporin or severe penicillin allergy • Surgery and ID should be consulted • Consider clindamycin 900 mg if confirmed or suspected Streptococcal toxic shock
Diabetic foot infection - Moderate
• Local infection with erythema >2 cm, or
involving structures deeper than skin and subcutaneous tissue and no systemic inflammatory response signs: First Line
Ampicillin-sulbactam 3 g IV q6h
Diabetic foot infection - Moderate: Second Line
1) Ceftriaxone 2 g IV q24h
2) Ertapenem 1g IV q24h
Diabetic Foot Infection: Notes
Ertapenem if severe penicillin allergy
• Treatment must include wound care
• Usual duration is 1-3 weeks. Antibiotics
can be discontinued once clinical signs and
symptoms have resolved
• Consider adding vancomycin if prior
history of MRSA
Diabetic foot infection - Severe
• Local infection with the signs of SIRS, as manifested by >2 of the following:
o Temperature >38°C or <36°C
o Heart rate >90 beats/min
o Respiratory rate >20 breaths/min
o WBC >12,000 or <4,000: ——First Line
1) Piperacillin-tazobactam 4.5 g IV x 1 over 30 minutes, followed by 3.375 g IV q8h over 4 hours PLUS Vancomycin IV Pharmacy to Dose 2) Cefepime 2 g IV q8h PLUS Metronidazole 500 mg IV q12h PLUS Vancomycin IV Pharmacy to Dose
Diabetic foot infection - Severe: Second Line
Meropenem 500 mg IV q8h PLUS Vancomycin IV Pharmacy to Dose
Diabetic foot infection - severe-notes
Meropenem if severe penicillin allergy
• Treatment must include wound care
• Usual duration is 2-4 weeks. Antibiotics
can be discontinued once clinical signs and
symptoms have resolved
