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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