Harbor:Sepsis antibiotics: Difference between revisions

(Text replacement - "Cefepime " to "Cefepime ")
(Text replacement - "OR" to "'''OR'''")
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*'''Severe [[Sepsis]]'''
*'''Severe [[Sepsis]]'''
**Comm. Acquired
**Comm. Acquired
***[[[[Ceftriaxone]]]] 1 g IV
***[[Ceftriaxone]] 1 g IV
***[[Vancomycin]] 1 g IV
***[[Vancomycin]] 1 g IV
***[[Gentamicin]] 5mg/kg
***[[Gentamicin]] 5mg/kg
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*'''Septic Shock'''
*'''Septic Shock'''
**Comm. Acquired
**Comm. Acquired
***[[[[Ceftriaxone]]]] 1 g IV
***[[Ceftriaxone]] 1 g IV
***[[Vancomycin]] 1 g IV
***[[Vancomycin]] 1 g IV
***[[Gentamicin]] 5mg/kg
***[[Gentamicin]] 5mg/kg
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*'''Mild/outpatient pneumonia(Port I/II):'''  
*'''Mild/outpatient pneumonia(Port I/II):'''  
**[[Macrolide]] or [[doxycycline]] alone (Save [[quinolone]] for sicker patients):  
**[[Macrolide]] or [[doxycycline]] alone (Save [[quinolone]] for sicker patients):  
***'''[[Azithromycin]] '''500mg PO Qday x 5 days OR  
***'''[[Azithromycin]] '''500mg PO Qday x 5 days '''OR'''
***'''[[Clarithromycin]] '''500mg PO BID x 5 days OR  
***'''[[Clarithromycin]] '''500mg PO BID x 5 days '''OR'''
***'''[[Doxycycline]] '''100mg PO BID x 7 days  
***'''[[Doxycycline]] '''100mg PO BID x 7 days  
*'''Hospitalized ward patients (PORT III):'''  
*'''Hospitalized ward patients (P'''OR'''T III):'''  
**[[Beta-lactam]] + [[macrolide]] OR [[doxycycline]] ([[quinolone]] ok, but save for sick pt):  
**[[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  
***'''[[Ceftriaxone]] '''1 gm IV Qday + '''[[Azithromycin]] '''500mg IV Qday '''OR''' '''[[Doxycycline]] '''100mg IV BID  
***If cephalosporin allergy:  
***If cephalosporin allergy:  
****'''[[Moxifloxacin]] '''400mg IV Qday OR '''[[Levofloxacin]] '''750mg IV Qday  
****'''[[Moxifloxacin]] '''400mg IV Qday '''OR''' '''[[Levofloxacin]] '''750mg IV Qday  
*'''PCU/ICU patients with out RF for [[Pseudomonas]] or [[MRSA]]:'''  
*'''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:  
**[[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  
***'''[[Ceftriaxone]] '''1 gm IV Qday + '''[[Azithromycin]] '''500mg IV Qday '''OR''' '''[[Levofloxacin]] '''750mg IV Qday  
*'''PCU/ICU patients w/RF for [[Pseudomonas]]:'''  
*'''PCU/ICU patients w/RF for [[Pseudomonas]]:'''  
**'''[[Cefepime]] '''2g IV Q8H + '''[[Levofloxacin]] '''750mg IV Qday
**'''[[Cefepime]] '''2g IV Q8H + '''[[Levofloxacin]] '''750mg IV Qday
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*Mild HAP/HCAP no recent antibiotic exposure:  
*Mild HAP/HCAP no recent antibiotic exposure:  
**'''[[Cefepime]] '''2g IV Q8H +/- '''[[Clindamycin]] '''600mg IV OR '''[[Metronidazole]]'''  
**'''[[Cefepime]] '''2g IV Q8H +/- '''[[Clindamycin]] '''600mg IV '''OR''' '''[[Metronidazole]]'''  
*Moderate HAP/HCAP or necrotizing [[pneumonia]]:  
*Moderate HAP/HCAP or necrotizing [[pneumonia]]:  
**Add '''[[Vancomycin]] '''for [[MRSA]]
**Add '''[[Vancomycin]] '''for [[MRSA]]
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==Abdominal/Pelvic==
==Abdominal/Pelvic==
*Comm. Acquired           
*Comm. Acquired           
**[[[[Ceftriaxone]]]] 1 g IV
**[[Ceftriaxone]] 1 g IV
**[[Metronidazole]] 1.5 g IV
**[[Metronidazole]] 1.5 g IV
**[[Gentamicin]] 5-7mg/kg IV
**[[Gentamicin]] 5-7mg/kg IV
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==Urosepsis==
==Urosepsis==
*Comm. Acquired           
*Comm. Acquired           
**[[[[Ceftriaxone]]]] 1 g IV
**[[Ceftriaxone]] 1 g IV
**[[Gentamicin]] 5-7mg/kg IV
**[[Gentamicin]] 5-7mg/kg IV
*Healthcare Assoc.           
*Healthcare Assoc.           
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*Comm. Acquired           
*Comm. Acquired           
**[[[[Ceftriaxone]]]] 2 g IV
**[[Ceftriaxone]] 2 g IV
**Add [[Vancomycin]] 1 g IV if [[CSF Results]] suggest pneumococcal [[meningitis]] (for [[ceftriaxone]] resistant [[S. pneumoniae]])
**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
**Add [[Ampicillin]] 2g IV Q4H in age >50 years and pregnant
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*Comm. Acquired           
*Comm. Acquired           
**[[Penicillin]] G 4M Units IV
**[[Penicillin]] G 4M Units IV
**[[[[Ceftriaxone]]]] 2 g IV
**[[Ceftriaxone]] 2 g IV
**[[Vancomycin]] 1g IV
**[[Vancomycin]] 1g IV
*Cephalosporin allergy           
*Cephalosporin allergy           
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*Comm. Acquired/Healthcare Assoc.           
*Comm. Acquired/Healthcare Assoc.           
**[[Vancomycin]] 1 gm IV
**[[Vancomycin]] 1 gm IV
**[[[[Ceftriaxone]]]] 1 gm IV
**[[Ceftriaxone]] 1 gm IV
**[[Clinda]] 600mg IV
**[[Clinda]] 600mg IV
**Consider: Gent 5-7mg/k IV
**Consider: Gent 5-7mg/k IV

Revision as of 20:53, 30 May 2017

Unknown Source[1]

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)

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.

Abdominal/Pelvic

Urosepsis

Meningitis (Nl/Community)

Meningitis (Nl/Post neurosurgical)

Meningitis (Immunocomp)

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

Necrotizing Soft-tissue Infection

Neutropenic Fever

See Also

Harbor:Antibiotics by diagnosis

See also Harbor: Sepsis core measures
Initial Antibiotics in Sepsis (Main)

References

  1. Form v2011.09.15