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
