Harbor:Sepsis antibiotics

Unknown Source

1. Comm. Acquired
   1. Vancomycin 1 g IV
   2. Ceftriaxone 1 g IV
   3. Metronidazole 1.5 g IV
   4. Gentamicin 5mg/kg
2. Healthcare Assoc.
   1. Vancomycin 1 gm IV
   2. Cefepime 2g gm IV
   3. Metronidazole 1.5 g IV
   4. Gentamicin 5-7 mg/kg
3. Cephalosporin allergy
   1. Vancomycin 1 gm IV
   2. Metronidazole 1.5 g IV
   3. Gentamicin 5-7 mg/kg IV
   4. Levofloxacin 750mg IV or (Meropenem or Imipenem 1gm IV outside HGH)

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

See Also

• Initial Antibiotics in Sepsis (Main)
• Antibiotics (Main)
• Sepsis

Source

8/16/13 Dr. Spellberg, Uptodate, Harbor-UCLA Antibiotics Review Committee (Rev. 07/27/06)