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Anti-infective Agents on Formulary
Antimicrobial Prophylaxis Recommendations
Teresa Bryant, CLS Stephen Connolly, MD Indra De, MD
Katherine Lee, PharmD Manuel A. Orellana, MD
Faye Sasaki, CLS Lois Wagenman, CLS Wei Wang, PharmD
Implementation of an antimicrobial stewardship program will help ensure that
hospitalized patients receive the right antibiotic, at the right dose, at the right time,
2012 Recommended Empiric Antibiotic Therapy
and for the right duration. As a result, there is reduced mortality, reduced risks
of Selected Infections in Adults Requiring Hospitalization
of Clostridium difficile-associated diarrhea, shorter hospital stays, reduced overal
antimicrobial resistance within the facility, and cost savings.
Alternative / Al ergy
- Vancomycin (MRSA) and nafcil in (MSSA) are considered first line therapy
S. aureus bacteremia, including right-side endocarditis
3. VRE bacteremia not responding to linezolid, or methicil in resistant coagulase
negative staph bacteremia not clearing with vancomycin and removal of infected
1. Complicated severe intra-abdominal infections
ORAL MISC. ANTIMICROBIALS
3. Pulmonary infection in cystic fibrosis patients colonized with P. aeruginosa or
Nosocomial pneumonia, including ventilator-associated pneumonia (VAP)
2. Complicated intra-abdominal infections
3. Complicated skin and skin structure infections (including diabetic foot infections
IV MISCELLANEOUS ANTIMICROBIALS
6. NOT active against Pseudomonas, Acinetobacter, or Enterococcus
a. Patients not responding to or are intolerant of vancomycin
b. Patients with renal failure or on concurrent nephrotoxic agents
2. Serious documented VRE infections such as bacteremia, pyelonephritis,
pneumonia, wound infection or other skin and soft tissue infection (for
uncomplicated UTI or cystitis with VRE, consider the use of nitrofurantoin or
Use oral route when possible – 100% bioavailable
References available on CHW Pharmacy Online
1. Complicated skin and skin structure infections due to MRSA and vancomycin
sensitive E. faecalis in patients either intolerant of vancomycin or with no clinical
Complicated intra-abdominal infections when other first line (Levaquin + Flagyl,
Ertapenem) can’t be used (documented al ergy, intolerance, or failure)
3. NOT active against Pseudomonas aeruginosa
St. Joseph's Medical Center
Antibiogram 01/01/2011 - 12/31/2011
Percent (%) susceptible
Gram negative rods:
Gram positive cocci:
* Urinary Tract isolates only
** 61% of Pseudomonas aeruginosa isolates were reported as susceptible to Doripenem.
Per SJMC Infection Control Dept. policy for Multi-Drug Resistant Organisms: In
The remaining tested isolates were classified as Not Susceptible or not reported due to
addition to appropriate antibiotic therapy, patients must be placed in CONTACT
57% of the Staph aureus isolates are MRSA (methicillin resistant) Susceptibility
Some strains of Escherichia coli, Klebsiella sp., and Proteus mirabilis can produce
results for both hospital-acquired and community acquired MRSA isolates are
Extended Spectrum Beta Lactamases (ESBLs). These strains should be considered
combined on this antibiogram. Community acquired isolates tend to be susceptible
resistant to all penicillins, cephalosporins, and monobactams. Treatment with a
to a greater number of antibiotics than hospital acquired MRSA strains, but they can
carbapenem is recommended.
be associated with more virulent infections.
Emerging resistance in Gram negative rods due to Carbapenemase and Metallo Beta
13% of the Strep. pneumoniae isolates were intermediate for penicillin. High doses
Lactamase production is increasing world wide. These strains should be considered
of IV penicillins or ampicillin can be used to treat penumococcal pneumonia caused
resistant to all penicillins, cephalosporins, carbapenems, and monobactams. Resistance
by strains in the intermediate category, however patients with pneumococcal
may also be demonstrated to the aminoglycosides and fluoroquinolones. Treatment with
meningitis require therapy with maximum doses of ceftriaxone or cefotaxime.
tigecycline is recommended.
ANTIBIOGRAM SJMC 2011 - ALL YEAR.pdf
ANTIBIOGRAM SJMC 2011 - ALL YEAR
Antimicrobial recommendations 0312.pdf
ANTIBIOGRAM SJMC 2011 - ALL YEAR
American Family Physician March 1, 1999 v59 i5 p1190(1) Congenital Adrenal Hyperplasia: Not Really a Zebra. by Michael A. Deaton, John E. Glorioso and David B. Mclean © COPYRIGHT 1999 American Academy of Family hyperplasia have 21- hydroxylase deficiency.2-4,6 Physicians Because this enzyme functions in both glucocorticoid and mineralocorticoid synthesis, some patients with 21-
Now Is The Time To Sign Up For A Flexible Spending Account For The Calendar Year 2012 Open Enrollment Period November 16, 2011 through December 16, 2011 This benefit is available to all active employees working 20 or more hours a week. By participating in a Flexible Spending Account, you will not pay federal or state taxes on your elected amount. This generally means a 25