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 5-7 mg/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)

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
2. 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 Qday OR Levofloxacin 750mg IV Qday
3. PCU/ICU pts w/o RF for Pseudomonas or MRSA:
   1. Beta-lactam + macrolide OR Quinolone (Save for sick pts if possible). Quinolone monotheraphy not acceptable for these pts:
      1. Ceftriaxone 1 gm IV Qday + Azithromycin 500 mg IV Qday OR Levofloxacin 750mg IV Qday
4. PCU/ICU pts w/RF for Pseudomonas:
   1. Cefepime 2g IV Q8H + Levofloxacin 750mg IV Qday

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

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

1. Mild HAP/HCAP no recent abx exposure:
   1. Cefepime 2g IV Q8H +/- Clindamycin 600mg IV OR Metronidazole
2. Moderate HAP/HCAP or necrotizing PNA:
   1. Add Vancomycin for MRSA
   2. If shock, recent ABX, or from SNF/ward:
      1. Add Meropenem
3. 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. Add Vancomycin 1 g IV if CSF Results suggest pneumococcal meningitis (for ceftriaxone resistant S. pneumoniae)
   3. Add Ampicillin 2g IV Q4H in age >50 years and pregnant
2. Cephalosporin allergy
   1. Chloramphenicol 1 g IV
   2. Vancomycin 1.5g IV

Meningitis (Nl/Post neurosurgical)

1. Healthcare Assoc.
   1. Vancomycin 1.5 g IV
   2. Cefepime 2 g IV
2. Cephalosporin allergy
   1. Vancomycin 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. Vancomycin 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. Vancomycin 1 gm IV
   2. Clinda 600 mg IV
   3. Cipro 400 mg IV
   4. Gentamicin 5-7mg/kg

Neutropenic Fever

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

See Also

• Initial Antibiotics in Sepsis (Main)
• Antibiotics (Main)
• Sepsis
• Harbor-UCLA Antibiogram