Hccl.com
Anti-infective Agents on Formulary
Antimicrobial Prophylaxis Recommendations
IV PENICILLINS
ORAL PENICILLINS
Surgery Type
First Choice
Alternative
Antimicrobial Guideline
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
ORAL CEPHALOSPORINS
IV CEPHALOSPORINS
Implementation of an antimicrobial stewardship program will help ensure that
ORAL QUINOLONES
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.
Infection
Alternative / Al ergy
Ceftriaxone
+
Ceftriaxone
+
- Vancomycin (MRSA) and nafcil in (MSSA) are considered first line therapy
Unasyn
OR
Levofloxacin
+
S. aureus bacteremia, including right-side endocarditis
CARBAPENEMS
3. VRE bacteremia not responding to linezolid, or methicil in resistant coagulase
ORAL ANTIFUNGALS
Ceftazidime
+
negative staph bacteremia not clearing with vancomycin and removal of infected
Levofloxacin
OR
IV QUINOLONES
Ceftazidime
OR
1. Complicated severe intra-abdominal infections
Ciprofloxacin
+
ORAL MISC. ANTIMICROBIALS
3. Pulmonary infection in cystic fibrosis patients colonized with P. aeruginosa or
Levofloxacin
OR
Nosocomial pneumonia, including ventilator-associated pneumonia (VAP)
IV ANTIFUNGALS
Ceftriaxone
+
Levofloxacin
+
2. Complicated intra-abdominal infections
3. Complicated skin and skin structure infections (including diabetic foot infections
Levofloxacin
+
IV MISCELLANEOUS ANTIMICROBIALS
Ceftriaxone
OR
6. NOT active against Pseudomonas, Acinetobacter, or Enterococcus
Vancomycin
+
IV AMINOGLYCOSIDES
Ceftriaxone
+
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,
Cefoxitin
+
Clindamycin
+
pneumonia, wound infection or other skin and soft tissue infection (for
uncomplicated UTI or cystitis with VRE, consider the use of nitrofurantoin or
Vancomycin
OR
Cefazolin
OR
Use oral route when possible – 100% bioavailable
References available on CHW Pharmacy Online
Unasyn
OR
Levofloxacin
+
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
Doripenem
OR
Ciprofloxacin
+
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
Fluoroquin-
Penicillins
Cephalosporins
Carbapenem
Aminoglycoside
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
instrument limitations.
ISOLATION PRECAUTIONS.
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
Source: http://hccl.com/docs/Antibiogram-guideline-2011.pdf
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-
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