View source for Harbor:Empiric antibiotics

''This page is for antibiotics specific to the Harbor-UCLA Medical Center; see [[Antibiotics by diagnosis]] for for national guidelines.''

{{Harbor Antibiotics by diagnosis navigation}}

==Harbor Empiric Guidelines==
*[[File:Harbor-UCLA_Medical_Center_Empiric_Antibiotic_Recommendations_for_Inpatient_Adult_2022.pdf|Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Inpatient Adult 2022]]
*[[File:Harbor-UCLA_Medical_Center_Empiric_Antibiotic_Recommendations_for_Outpatient_Adult_2022.pdf|Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Outpatient Adult 2022]]

==SKIN & SOFT TISSUE INFECTIONS (SSTI)==
*[[Cellulitis#Management|Cellulitis (no purulence) (x 5-7 days)]]
**Inpatient
***[No to Minimal Systemic Signs/Symptoms] Cefazolin 1-2g IV q8h (If documented severe ß-lactam allergy: Clindamycin 600mg IV q8h)
***[Presence of Systemic Signs/Symptoms] Vancomycin per Pharmacy
**Outpatient
***'''Dual antibiotic treatment is not indicated.''' 
***Cephalexin 500mg PO QID OR Clindamycin 450mg PO TID OR TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg)
*[[Skin_abscess#Management|Purulent SSTI (x 5-7 days)]]
**Inpatient
***Vancomycin per Pharmacy
**Outpatient
***'''Dual antibiotic treatment is not indicated.''' 
***Incision & Drainage first and then TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg) OR Doxycycline 100mg PO BID
*Necrotizing Soft Tissue Infection
**Inpatient
***Ceftriaxone 1g IV q24h [infuse first] + Vancomycin per Pharmacy Metronidazole 500mg IV q8h (+ Clindamycin 900mg IV q8h if suspect streptococcal toxic shock)
*[[Diabetic_foot_infection#Management|Diabetic Foot Ulcer]]
**Inpatient
***Refer to Anti-Infective Management Program (https://lacounty.sharepoint.com/sites/dhs-harbor-amp) > Documents > Diabetic Foot Infection Pathway (DFIP)

==EAR, NOSE, & THROAT INFECTIONS==
*[[Otitis_externa#Management|Otitis Externa (x 7 days)]]
**Outpatient
***Oral therapy is NOT recommended unless extension beyond the external ear canal or severely immunocompromised. 
***Use antibiotic ear drops (Cortisporin Otic 4 drops in affected ear TID OR Ciprodex 4 drops in affected ear BID). If perforated, use Ciprodex.
*[[Sinusitis#Management|Acute Sinusitis (x 5 days)]]
**Outpatient
***'''Mainly viral''', consider watchful waiting with supportive measures. Consider antibiotics for failure to improve ≥10 d after onset of URI, or biphasic illness <10 d with worsening after initial improvement. 
***Amoxicillin/clavulanate 875/125mg PO BID OR Doxycycline 100mg PO BID
*[[Streptococcal_pharyngitis#Management|Group A Strep (GAS) Pharyngitis]]
**Outpatient
***Antibacterial therapy should only be used when POC PCR testing shows the presence of GAS. '''Do not rely on Centor criteria to diagnose GAS.''' 
***Penicillin VK 500mg PO BID x 10 days OR Benzathine PCN 1.2 million units IM x 1. If PCN allergy, Azithromycin 500mg PO x 3 days

==RESPIRATORY INFECTIONS==
*[[Acute_bronchitis#Management|Acute Bronchitis]]
**Outpatient
***'''No antibiotics are indicated'''; offer symptomatic management and realistic time frame for cough resolution (2-4 wk). To help reframe patient’s reference point, consider terminology such as “viral chest cold.”
*[[COPD_exacerbation#Management|Acute Exacerbation of Chronic Bronchitis (x 3-5d)]]
**Outpatient
***In patients with emphysema, COPD, or significant tobacco abuse, consider prescriptions for steroids and bronchodilators. 
***Antibiotics help reduce risk of recurrence for moderate to severe symptoms defined as '''purulent sputum''' and either '''dyspnea''' and/or '''increased sputum volume'''
***Azithromycin 500mg PO Daily x 3 days OR Doxycycline 100mg PO BID x 5 days
*[[Pneumonia_(main)#Management|Community-acquired Pneumonia (x 5 days)]]
**Inpatient
***Ceftriaxone 1g IV q24h [infuse first] + Azithromycin 500mg IV q24h 
***If documented severe ß-lactam allergy: Levofloxacin 750mg IV q24h
**Outpatient
***Healthy adults without comorbidities: Amoxicillin 1g PO TID OR Doxycycline 100mg PO BID
***Adults with comorbidities: Amoxicillin/clavulanate 875/125mg PO BID AND Azithromycin 500mg PO x 1 day then 250mg PO x 4 days OR Levofloxacin 750mg PO daily monotherapy
*[[Pneumonia_(main)#Management|Hospital-acquired Pneumonia in non-ICU (x 7 days)]]
**Inpatient
***Ceftriaxone 1g IV q24h
*[[Pneumonia_(main)#Management|Hospital-acquired Pneumonia in ICU or Ventilator-associated Pneumonia (x 7 days)]]
**Inpatient
***Cefepime 2g IV q8h [infuse first] + Vancomycin per Pharmacy
*[[Pneumonia_(main)#Management|Aspiration Pneumonia (x 5-7 days)]]
**Inpatient
***Ceftriaxone 1g IV q24h [infuse first]
***If severe periodontal disease, necrotizing pneumonia, or lung abscess/empyema, add Metronidazole 500mg IV/PO q8h and consider longer treatment

==GENITAL INFECTIONS==
*[[Cervicitis#Management|Urethritis/Cervicitis]]
**Outpatient
***Empiric treatment for both gonorrhea and chlamydia is reasonable in symptomatic high risk patients. Screen for HIV/syphilis, use sexual assault order set if indicated. 
***Ceftriaxone 500mg IM [1g if >150kg] x1 AND Doxycycline monohydrate 100mg PO BID x 7 days OR Azithromycin 1g PO x1 (if pregnant)

==URINARY INFECTIONS==
*Asymptomatic Bacteriuria (x 5-7 days)
**Outpatient
***Diagnosed by urine culture (>10<sup>5</sup> CFU), '''NOT urinalysis'''. No treatment indicated unless pregnant, received renal transplant in past 30 days, or undergoing GU procedure. 
***Nitrofurantoin (Macrobid)† 100mg PO BID x 5d
***If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
*[[Acute_cystitis#Management|Cystitis]]
**Inpatient
***Ceftriaxone 1g IV q24h x 1-5 days
***If documented severe ß-lactam allergy†: Gentamicin 5mg/kg IV once
**Outpatient
***Refer to [https://wikem.org/w/index.php?title=Harbor:Antibiogram outpatient urinary antibiogram] to guide empiric treatment. Presence of squamous cells in the urinalysis indicates that the specimen is contaminated and cannot be used for UTI diagnosis. 
***Nitrofurantoin (Macrobid)† 100mg PO BID x 5 days OR TMP-SMX DS 1 tab PO BID x 3 days
***If history of ESBL, consider: FosfomycinR 3gm PO x 1 dose
***If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
*[[Pyelonephritis#Management|Pyelonephritis (x 7 days)]]
**Outpatient
***Ceftriaxone 1g IV x1 can be considered in more severe cases pending cultures.
***TMP-SMX DS 1 tab PO BID OR Ciprofloxacin 500mg PO BID
*Complicated Urinary Tract Infections, including Catheter-associated and Pyelonephritis) (x 5-7 days)
**Inpatient
***Ceftriaxone 1g IV q24h
***If documented severe ß-lactam allergy†: Gentamicin 5mg/kg IV q24h* or Ciprofloxacin 400mg IV q12h
*Hospital-Acquired or Recent Hospitalization and IV Antibiotic Use
**Inpatient
***Cefepime 2g IV q8h
*If Septic Shock and/or Recent History of ESBL
**Inpatient
***Meropenem 1g IV q8h

==INTRA-ABDOMINAL INFECTIONS==
*Community-acquired (x 4 days after source control)
**Inpatient
***Ceftriaxone 1g IV q24h [infuse first] + Metronidazole 500mg IV/PO q8h
***If documented severe ß-lactam allergy: Ciprofloxacin 400mg IV q12h + Metronidazole 500mg IV/PO q8h
*Healthcare-associated (x 4 days after source control)
**Inpatient
***Piperacillin/Tazobactam 3.375g IV q8h
*If Healthcare-associated with Septic Shock
**Inpatient
***Meropenem 1g IV q8h
*Spontaneous Bacterial Peritonitis (x 5 days)
**Inpatient
***Ceftriaxone 2g IV q24h
*[[Clostridium_difficile#Management|C. difficile Infection (x 10-14 days)]]
**Inpatient
***Vancomycin 125mg PO QID

==CARDIOVASCULAR INFECTIONS==
*[[Endocarditis#Management|Endocarditis]]
**Inpatient
***Ceftriaxone 2g IV q24h [infuse first] + Vancomycin per Pharmacy

==NEURO INFECTIONS==
*[[Meningitis#Antibiotics|Meningitis]]
**Inpatient
***Ceftriaxone 2g IV q12h [infuse first] + Vancomycin per Pharmacy
***+ Ampicillin 2g IV q4h if age>50yr, pregnant, AIDS or immunosuppressed

==IMMUNOCOMPROMISED INFECTIONS==
*[[Neutropenic_fever#Management|Neutropenic Fever]]
**Inpatient
***Cefepime 2g IV q8h
***+ Vancomycin per Pharmacy if line infection, pneumonia, skin and soft tissue infection, severe mucositis, or other gram-positive infection

==SEPSIS==
*[[Harbor:Sepsis antibiotics]]

==PEDIATRIC INFECTIONS==
*[[Harbor:Pediatric antibiotics]]

==See Also==
*[[Harbor:Antibiogram]]
*[[Antibiotics (Main)]] 
*[[Antibiotics by organism]]

==References==
<references/>
[[Category:ID]] [[Category:Pharmacology]]