Harbor:Sepsis antibiotics

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• Severe Sepsis
  • Comm. Acquired
    • Ceftriaxone 1 g IV
    • Vancomycin 1 g IV
    • Gentamicin 5mg/kg
    • Metronidazole 500mg g IV
  • Health Care Associated
    • Cefepime 2 g IV
    • Vancomycin 1 g IV
    • Gentamicin 5-7mg/kg
    • Metronidazole 500mg g IV
• Septic Shock
  • Comm. Acquired
    • Ceftriaxone 1 g IV
    • Vancomycin 1 g IV
    • Gentamicin 5mg/kg
    • Metronidazole 500mg g IV
  • Health Care Associated
    • Meropenem 2 g IV
    • Vancomycin 1 g IV

Pneumonia

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)

• Mild/outpatient pneumonia(Port I/II):
  • Macrolide or doxycycline alone (Save quinolone for sicker patients):
    • Azithromycin 500mg PO Qday x 5 days OR
    • Clarithromycin 500mg PO BID x 5 days OR
    • Doxycycline 100mg PO BID x 7 days
• Hospitalized ward patients (PORT III):
  • Beta-lactam + macrolide OR doxycycline (quinolone ok, but save for sick pt):
    • Ceftriaxone 1 gm IV Qday + Azithromycin 500mg IV Qday OR Doxycycline 100mg IV BID
    • If cephalosporin allergy:
      • Moxifloxacin 400mg IV Qday OR Levofloxacin 750mg IV Qday
• PCU/ICU patients with out RF for Pseudomonas or MRSA:
  • Beta-lactam + macrolide OR Quinolone (Save for sick patients if possible). Quinolone monotheraphy not acceptable for these patients:
    • Ceftriaxone 1 gm IV Qday + Azithromycin 500mg IV Qday OR Levofloxacin 750mg IV Qday
• PCU/ICU patients w/RF for Pseudomonas:
  • Meropenam 1g IV + Levofloxacin 750mg IV (Levofloxacin for synergy)
• Aspiration risk:
  • Add Clindamycin 600 mg or Metronidazole 500 mg

Healthcare Associated pneumonia (HCAP) + Hospital Associated pneumonia (HAP)

HAP occurs if patient develops pneumonia 2-3 days after hospitalization. HCAP occus in non-hospitalized patient with extensive healthcare contact.

• Mild HAP/HCAP no recent antibiotic exposure:
  • Cefepime 1g IV Q8H +/- Clindamycin 600mg IV OR Metronidazole if risk of aspiration
• Moderate HAP/HCAP or necrotizing pneumonia:
  • Add Vancomycin for MRSA
  • If shock, recent antibiotics, or from SNF/ward:
    • Add Meropenem
• Cephalosporin allergy:
  • Clinda 600mg IV
  • Cipro 400mg IV
  • Gentamicin 5-7mg/kg IV

Abdominal/Pelvic

• Comm. Acquired
  • Severe sepsis Ceftriaxone 1 g IV + Metronidazole 500 mg IV
  • Septic shock Ceftriaxone 1 g IV + Metronidazole 500 mg IV
• Healthcare Assoc.
  • Severe sepsis Cefepime 1 g IV + Metronidazole 500 mg IV
  • Septic shock Meropenem 1 g IV
    • If recent surgery, add: Vancomycin 1 g IV
• Cephalosporin allergy
  • Cipro 400mg IV
  • Metronidazole 1.5 g IV
  • Gentamicin 5-7mg/kg IV

UTI with Sepsis

• Comm. Acquired
  • Severe sepsis Ceftriaxone 1 g IV
  • Septic shock Meropenem 1 g IV
• Healthcare Assoc.
  • Severe sepsis Ceftriaxone 1 g IV
    • If history of pseudomonas Cefepime 1 g IV
  • Septic shock Meropenem 1 g IV
    • If history of indwelling nephrostomy tubes, stents, or recent surgery add Vancomycin 1 g IV
• Cephalosporin allergy
  • Vancomycin 1g IV
  • Cipro 400mg IV
  • Gentamicin 5mg/kg IV

Meningitis

• Community Acquired
  • Ceftriaxone 2 g IV
  • Add Vancomycin 1 g IV if CSF Results suggest pneumococcal meningitis (for ceftriaxone resistant S. pneumoniae)
  • Add Ampicillin 2g IV Q4H in age >50 years and pregnant
  • Cephalosporin allergy
    • Chloramphenicol 1 g IV
    • Vancomycin 1.5g IV

• Healthcare Assoc/Post neurosurgical
  • Vancomycin 1.5 g IV
  • Cefepime 2 g IV
  • Cephalosporin allergy
    • Vancomycin 1.5g IV
    • Cipro 400mg IV

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

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

Necrotizing Soft-tissue Infection

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

Neutropenic Fever

• Severe Sepsis
  • Cefepime 2 g IVPB x 1
  • Vancomycin 1 g IVPB x 1
• Septic Shock

See Also

Harbor:Antibiotics by diagnosis

• Harbor:Pediatric antibiotics
• Harbor:Sepsis antibiotics
• Harbor:Antibiogram

See also Harbor: Sepsis core measures

Initial Antibiotics in Sepsis (Main)