Harbor:Sepsis antibiotics

Unknown Source

1. Comm. Acquired
   1. Vanco 1 g IV
   2. Ceftriaxone 1 g IV
   3. Metronidazole 1.5 g IV
   4. Gentamicin 5mg/kg
2. Healthcare Assoc.
   1. Vanco 1 gm IV
   2. Cefepime 2g gm IV
   3. Metronidazole 1.5 g IV
   4. Gentamicin 5-7 mg/kg
3. Cephalosporin allergy
   1. Vanco 1 gm IV
   2. Metronidazole 1.5 g IV
   3. Gentamicin 5-7 mg/kg IV
   4. Levofloxacin 750mg IV or (Meropenem or Imipenem 1gm IV outside HGH)

Pneumonia (Pneumonia (Main))

Community Acquired Pneumonia (CAP)

MCC by S. pneumoniae. In young must cover for mycoplasma and other atypicals. See Pneumonia (Pathogens)

Treatment based on Pneumonia (Port Score)

1. Mild/outpatient PNA(Port I/II):
   1. Macrolide or doxycycline alone (Save quinolone for sicker pts):
      1. Azithromycin 500mg PO Qday x 5 days OR
      2. Clarithromycin 500mg PO BID x 5 days OR
      3. Doxycycline 100mg PO BID x 7 days

1. Hospitalized ward patients (PORT III):
   1. Beta-lactam + macrolide OR doxycycline (quinolone ok, but save for sick pt):
      1. Ceftriaxone 1 gm IV Qday + Azithromycin 500 mg IV Qday OR Doxycycline 100mg IV BID
      2. If cephalosporin allergy:
         1. Moxifloxacin 400 mg IV OR Levofloxacin 750mg IV

Pneumonia (Healthcare Assoc/Pseudomonas Risk)

1. Healthcare Assoc.
   1. Cefipime 2 g IV
   2. Cipro 400 mg IV
   3. Clinda 600 mg IV
2. Cephalosporin allergy
   1. Clinda 600 mg IV
   2. Cipro 400 mg IV
   3. Gentamicin 5-7 mg/kg IV

Abdominal/Pelvic

1. Comm. Acquired
   1. Ceftriaxone 1 g IV
   2. Metronidazole 1.5 g IV
   3. Gentamicin 5-7 mg/kg IV
2. Healthcare Assoc.
   1. Ceftazidime 2 g IV
   2. Gentamicin 5 mg/kg IV
   3. Metronidazole 1.5 mg IV
3. Cephalosporin allergy
   1. Cipro 400 mg IV
   2. Metronidazole 1.5 g IV
   3. Gentamicin 5-7 mg/kg IV

Urosepsis

1. Comm. Acquired
   1. Ceftriaxone 1 g IV
   2. Gentamicin 5-7 mg/kg IV
2. Healthcare Assoc.
   1. Vancomycin 1 g IV
   2. Ceftazidime 1g IV
   3. Gentamicin 5-7 mg/kg IV
3. Cephalosporin allergy
   1. Vancomycin 1g IV
   2. Cipro 400 mg IV
   3. Gentamicin 5 mg/kg IV

Meningitis (Nl/Community)

1. Comm. Acquired
   1. Ceftriaxone 2 g IV
   2. Vancomycin 1.5 g IV
2. Cephalosporin allergy
   1. Chloramphenicol 1 g IV
   2. Vancomycin 1.5g IV

Meningitis (Nl/Post neurosurgical)

1. Healthcare Assoc.
   1. Vanco 1.5 g IV
   2. Cefepime 2 g IV
2. Cephalosporin allergy
   1. Vanco 1.5g IV
   2. Cipro 400mg IV

Meningitis (Immunocomp)

(Cirrhosis, EtoH, age > 65, steroids, HIV)

1. Comm. Acquired
   1. Penicillin G 4M Units IV
   2. Ceftriaxone 2 g IV
   3. Vancomycin 1g IV
2. Cephalosporin allergy
   1. Chloramphenicol 1g IV
   2. Trim/sulfa 10mg/kg IV
   3. Vancomycin 1.5g IV

Necrotizing Soft-tissue Infection

1. Comm. Acquired/Healthcare Assoc.
   1. Vanco 1 gm IV
   2. Ceftriaxone 1 gm IV
   3. Clinda 600 mg IV
   4. Consider: Gent 5-7mg/k IV
2. Healthcare Assoc.
   1. Vancomycin 1g IV
   2. Piperacillin/Tazobactam 3.375g IV
   3. Clindamycin 600mg IV
3. Cephalosporin allergy
   1. Vanco 1 gm IV
   2. Clinda 600 mg IV
   3. Cipro 400 mg IV
   4. Gentamicin 5-7mg/kg

See Also

• Initial Antibiotics in Sepsis (Main)
• Antibiotics (Main)
• Sepsis

Source

Harbor-UCLA Antibiotics Review Committee (Rev. 07/27/06)