Harbor:Sepsis antibiotics: Difference between revisions
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*'''Severe [[Sepsis]]''' | *'''Severe [[Sepsis]]''' | ||
**Comm. Acquired | **Comm. Acquired | ||
*** | ***[[Ceftriaxone]] 1 g IV | ||
***[[Vancomycin]] 1 g IV | ***[[Vancomycin]] 1 g IV | ||
***[[Gentamicin]] 5mg/kg | ***[[Gentamicin]] 5mg/kg | ||
Line 13: | Line 13: | ||
*'''Septic Shock''' | *'''Septic Shock''' | ||
**Comm. Acquired | **Comm. Acquired | ||
*** | ***[[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 ( | *'''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 | ||
***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 | ||
*'''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 | ||
**[[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 | ||
**[[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 | ||
**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 | ||
**[[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 | ||
**[[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]
- 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
- Comm. Acquired
- 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
- Comm. Acquired
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
- Macrolide or doxycycline alone (Save quinolone for sicker patients):
- 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
- Beta-lactam + macrolide OR doxycycline (quinolone ok, but save for sick pt):
- 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
- Beta-lactam + macrolide OR Quinolone (Save for sick patients if possible). Quinolone monotheraphy not acceptable for these patients:
- PCU/ICU patients w/RF for Pseudomonas:
- Cefepime 2g IV Q8H + Levofloxacin 750mg IV Qday
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 2g IV Q8H +/- Clindamycin 600mg IV OR Metronidazole
- 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
- Ceftriaxone 1 g IV
- Metronidazole 1.5 g IV
- Gentamicin 5-7mg/kg IV
- Healthcare Assoc.
- Ceftazidime 2 g IV
- Gentamicin 5mg/kg IV
- Metronidazole 1.5mg IV
- Cephalosporin allergy
- Cipro 400mg IV
- Metronidazole 1.5 g IV
- Gentamicin 5-7mg/kg IV
Urosepsis
- Comm. Acquired
- Ceftriaxone 1 g IV
- Gentamicin 5-7mg/kg IV
- Healthcare Assoc.
- Vancomycin 1 g IV
- Ceftazidime 1g IV
- Gentamicin 5-7mg/kg IV
- Cephalosporin allergy
- Vancomycin 1g IV
- Cipro 400mg IV
- Gentamicin 5mg/kg IV
Meningitis (Nl/Community)
- Comm. 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
Meningitis (Nl/Post neurosurgical)
- Healthcare Assoc.
- Vancomycin 1.5 g IV
- Cefepime 2 g IV
- Cephalosporin allergy
- Vancomycin 1.5g IV
- Cipro 400mg IV
Meningitis (Immunocomp)
(Cirrhosis, EtoH, age > 65, steroids, HIV)
- Comm. Acquired
- 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
References
- ↑ Form v2011.09.15