Harbor:Sepsis antibiotics: Difference between revisions
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==Unknown Source<ref>Form v2011.09.15</ref>== | ==Unknown Source<ref>Form v2011.09.15</ref>== | ||
*''' | *'''Comm. Acquired''' | ||
** | **Severe Sepsis and Septic Shock | ||
***[[ | ***[[Meropenem]] 1 g IV | ||
***[[Vancomycin]] 1 g IV | ***[[Vancomycin]] 1 g IV | ||
* | *'''Health Care Associated''' | ||
**Severe Sepsis and Septic Shock | |||
***[[Meropenem]] 1 g IV | |||
** | |||
***[[ | |||
***[[Vancomycin]] 1 g IV | ***[[Vancomycin]] 1 g IV | ||
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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 | ***'''[[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]]:''' | ||
**'''[[ | **'''[[Meropenam]] '''1g IV + '''[[Levofloxacin]] '''750mg IV (Levofloxacin for synergy) | ||
*'''Aspiration risk:''' | |||
**Add [[Clindamycin]] 600 mg or [[Metronidazole]] 500 mg (unless already on Meropenem) | |||
===Healthcare Associated [[pneumonia]] (HCAP) + Hospital Associated [[pneumonia]] (HAP)=== | ===Healthcare Associated [[pneumonia]] (HCAP) + Hospital Associated [[pneumonia]] (HAP)=== | ||
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*Mild HAP/HCAP no recent antibiotic exposure: | *Mild HAP/HCAP no recent antibiotic exposure: | ||
**'''[[Cefepime]] ''' | **'''[[Cefepime]] '''1g IV Q8H | ||
**If risk of aspiration add '''[[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]] | ||
**If shock, recent | **If shock, recent antibiotics, or from SNF/ward: | ||
***Add '''[[Meropenem]]''' | ***Add '''[[Meropenem]]''' | ||
*[[Cephalosporin]] allergy: | *[[Cephalosporin]] allergy: | ||
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==Abdominal/Pelvic== | ==Abdominal/Pelvic== | ||
*Comm. Acquired | *Comm. Acquired | ||
**[[Ceftriaxone]] 1 g IV | **Severe sepsis [[Ceftriaxone]] 1 g IV + [[Metronidazole]] 500 mg IV | ||
**[[ | **Septic shock [[Ceftriaxone]] 1 g IV + [[Metronidazole]] 500 mg IV | ||
*Healthcare Assoc. | *Healthcare Assoc. | ||
**[[ | **Severe sepsis [[Cefepime]] 1 g IV + [[Metronidazole]] 500 mg IV | ||
**[[ | **Septic shock [[Meropenem]] 1 g IV | ||
**[[ | ***If recent surgery add [[Vancomycin]] 1 g IV | ||
*Cephalosporin allergy | *Cephalosporin allergy | ||
**[[Cipro]] 400mg IV | **[[Cipro]] 400mg IV | ||
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**[[Gentamicin]] 5-7mg/kg IV | **[[Gentamicin]] 5-7mg/kg IV | ||
== | ==UTI with Sepsis== | ||
*Comm. Acquired | *Comm. Acquired | ||
**[[Ceftriaxone]] 1 g IV | **Severe sepsis [[Ceftriaxone]] 1 g IV | ||
**[[ | **Septic shock [[Meropenem]] 1 g IV | ||
*Healthcare Assoc. | *Healthcare Assoc. | ||
**[[ | **Severe sepsis [[Ceftriaxone]] 1 g IV | ||
**[[ | ***If history of pseudomonas [[Cefepime]] 1 g IV | ||
**[[ | **Septic shock [[Meropenem]] 1 g IV | ||
***If history of indwelling nephrostomy tubes, stents, or recent surgery add [[Vancomycin]] 1 g IV | |||
*Cephalosporin allergy | *Cephalosporin allergy | ||
**[[Vancomycin]] 1g IV | **[[Vancomycin]] 1g IV | ||
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**[[Gentamicin]] 5mg/kg IV | **[[Gentamicin]] 5mg/kg IV | ||
==[[Meningitis]] | ==[[Meningitis]]== | ||
* | *Community 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 | ||
*[[Cephalosporin]] allergy | **[[Cephalosporin]] allergy | ||
**[[Chloramphenicol]] 1 g IV | ***[[Chloramphenicol]] 1 g IV | ||
**[[Vancomycin]] 1.5g IV | ***[[Vancomycin]] 1.5g IV | ||
*Healthcare Assoc/Post neurosurgical | |||
**[[Vancomycin]] 1.5 g IV | **[[Vancomycin]] 1.5 g IV | ||
**[[Cefepime]] 2 g IV | **[[Cefepime]] 2 g IV | ||
*Cephalosporin allergy | **Cephalosporin allergy | ||
**[[Vancomycin]] 1.5g IV | ***[[Vancomycin]] 1.5g IV | ||
**[[Cipro]] 400mg IV | ***[[Cipro]] 400mg IV | ||
*Immunocompromised (Cirrhosis, EtoH, age > 65, steroids, HIV) | |||
(Cirrhosis, EtoH, age > 65, steroids, HIV) | |||
**[[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 | ||
**[[Chloramphenicol]] 1g IV | ***[[Chloramphenicol]] 1g IV | ||
**[[Trim/sulfa]] 10mg/kg IV | ***[[Trim/sulfa]] 10mg/kg IV | ||
**[[Vancomycin]] 1.5g IV | ***[[Vancomycin]] 1.5g IV | ||
==[[Necrotizing Soft-tissue Infection]]== | ==[[Necrotizing Soft-tissue Infection]]== | ||
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==[[Neutropenic Fever]]== | ==[[Neutropenic Fever]]== | ||
*''' | *'''Comm. Acquired''' | ||
**Cefepime 2 g | **Severe Sepsis [[Cefepime]] 2 g IV + [[Vancomycin]] 1 g IV | ||
**Vancomycin | **Septic Shock [[Meropenem]] 1g IV + [[Vancomycin]] 1g IV | ||
*''' | *'''Health Care Associated''' | ||
** | **Severe Sepsis [[Cefepime]] 2 g IV + [[Vancomycin]] 1 g IV | ||
**Septic Shock [[Meropenem]] 1g IV + [[Vancomycin]] 1g IV | |||
==See Also== | ==See Also== |
Latest revision as of 23:11, 21 February 2019
Unknown Source[1]
- Comm. Acquired
- Severe Sepsis and Septic Shock
- Meropenem 1 g IV
- Vancomycin 1 g IV
- Severe Sepsis and Septic Shock
- Health Care Associated
- Severe Sepsis and Septic Shock
- Meropenem 1 g IV
- Vancomycin 1 g IV
- Severe Sepsis and Septic Shock
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:
- Meropenam 1g IV + Levofloxacin 750mg IV (Levofloxacin for synergy)
- Aspiration risk:
- Add Clindamycin 600 mg or Metronidazole 500 mg (unless already on Meropenem)
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 1g IV Q8H
- If risk of aspiration add 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
- Severe sepsis Ceftriaxone 1 g IV + Metronidazole 500 mg IV
- Septic shock Ceftriaxone 1 g IV + Metronidazole 500 mg IV
- Healthcare Assoc.
- Severe sepsis Cefepime 1 g IV + Metronidazole 500 mg IV
- Septic shock Meropenem 1 g IV
- If recent surgery add Vancomycin 1 g IV
- Cephalosporin allergy
- Cipro 400mg IV
- Metronidazole 1.5 g IV
- Gentamicin 5-7mg/kg IV
UTI with Sepsis
- Comm. Acquired
- Severe sepsis Ceftriaxone 1 g IV
- Septic shock Meropenem 1 g IV
- Healthcare Assoc.
- Severe sepsis Ceftriaxone 1 g IV
- If history of pseudomonas Cefepime 1 g IV
- Septic shock Meropenem 1 g IV
- If history of indwelling nephrostomy tubes, stents, or recent surgery add Vancomycin 1 g IV
- Severe sepsis Ceftriaxone 1 g IV
- Cephalosporin allergy
- Vancomycin 1g IV
- Cipro 400mg IV
- Gentamicin 5mg/kg IV
Meningitis
- Community 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
- Healthcare Assoc/Post neurosurgical
- Vancomycin 1.5 g IV
- Cefepime 2 g IV
- Cephalosporin allergy
- Vancomycin 1.5g IV
- Cipro 400mg IV
- Immunocompromised (Cirrhosis, EtoH, age > 65, steroids, HIV)
- 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
- Comm. Acquired
- Severe Sepsis Cefepime 2 g IV + Vancomycin 1 g IV
- Septic Shock Meropenem 1g IV + Vancomycin 1g IV
- Health Care Associated
- Severe Sepsis Cefepime 2 g IV + Vancomycin 1 g IV
- Septic Shock Meropenem 1g IV + Vancomycin 1g IV
See Also
Harbor:Antibiotics by diagnosis
References
- ↑ Form v2011.09.15