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.
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