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
INITIAL TREATMENT
COMMENTS
+ Metronidazole
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
ANTIBIOTIC (Generic/Brand)
USUAL ADULT DOSE
COMMENTS
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. Antiretroviral Agents
Antiretroviral
USUAL ADULT DOSE
AVAILABLE
COMMENTS
RESTRICTION

Source: http://www.oliveviewim.org/docs/resources/OV%20Empiric%20Antibiotic%20Recommendation%20card.pdf