Olive view-ucla medical center
OLIVE VIEW-UCLA MEDICAL CENTER
Medicine Ward / ICU Empiric Antibiotic Recommendations 2013
These are the agents generally preferred for first-line empiric therapy at Olive View-UCLA.
Circumstances of individual cases may dictate different antibiotic choices.
INFECTION/DIAGNOSIS LIKELY PATHOGEN
q6h prior to abx if bacterial meningitis
meningitis confirmed by LP or GS: GPC pairs/chains
coli, Klebsiella, Proteus), Enterococcus
necrotizing pna, often with cavitation, abscess, and empyema formation
Eikenella (human) streptococci, S. aureus, oral anaerobes
3rd type involving CA-MRSA is uncommon and has more sub-acute course
and no amputation, need longer IV therapy (6-8 weeks)
and Vancomycin if central line, soft tissue source, severe pneumonia, and/or sepsis (ICU)
-If nosocomial, use Pip/tazo instead of ceftriaxone/metronidazole
Antibiotic Dosing and Cost
INJECTABLE Cost range per day: $=<20, $$=20-45, $$$=45-70, $$$=70-120, $$$$$=>120
ORAL Cost range per day: $=<2, $$=2-4, $$$=4-6, $$$$=6-10, $$$$$=>10
USUAL ADULT DOSE
Replaces ampicillin PO on formulary
Extends amoxicillin activity to include ß -lactamase producing
strains, enteric gram (-) bacilli, and anaerobes.
Active against Gm (+) cocci, some Shigella, Salmonella,
Extends spectrum of ampicillin to include b-lactamase producing
strains of H. influenzae, M. catarrhalis, S. aureus, Neisseria & Bacteroides sp. Not usually active vs. Ps. aeruginosa, Serratia or
Penicillinase-resistant penicillin, Oral anti-staphylococcal agent
Penicillinase-resistant penicillin. Good anti-staphylococcal
CNS (seizures) reactions can occur with high doses (>20 MU/day)
Antipseudomonal, broad spectrum. Restricted to I.D.
Active against Gm(+) cocci, E. Coli, S. pneumoniae, Proteus
mirabilis. (Not effective against enterococci or MRSA)
Improved Gm (-) coverage over 1st gen. & good anaerobic
Good Gm (-) & H. influenzae, N. gonorrhea coverage.
(Cefotaxime on formulary Restricted to Pediatrics or ID
Antipseudomonal cephalosporin. Good Gm (-), poor Gm (+), poor
anaerobic activity. Restricted to ID or Oncology
(Reserve for patients that cannot tolerate ceftriaxone IM in
Antipseudomonal cephalosporin. Good Gm (-) and Gm (+)
coverage. Restricted to ID except for neutropenic fever
Similar to meropenem, but no pseudomonas activity. Restricted
Broad spectrum antibiotic. Restricted to ID
Ciprofloxacin preferred over levofloxacin for UTI
Activity vs. S. pneumoniae and other respiratory pathogens. Use
Check baseline Scr to evaluate renal function. For once daily
dosing, check a single level 8 to12 hours after the start of
infusion. For traditional and synergy dosing, check peak and
trough level around the fourth dose. Call pharmacy for
Macrolide antibiotic, better activity vs. H. influenzae compared
to erythromycin, with better GI tolerance.
Good gm (+) cocci & anaerobic coverage. Can cause severe
Covers gm (+) including MRSA. Not to be used for pneumonia.
Oral powder, mix in 3 oz of water. Restricted to ID
Used only for gram-positive infections resistant to other agents.
Very good anaerobic coverage. Agent of choice for
pseudomembranous enterocolitis caused by Clostridium difficile
Not recommended with significant renal dysfunction. (Crcl
Double strength tab contains 800mg SMX and 160mg TMP.
Standard 5ml vial (1 amp) contains 400mg SMX and 80mg
Drug of choice for infections caused by methicillin-resistant
S.aureus/epidermidis. PO form not for systemic infections.
USUAL ADULT DOSE
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