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>== | ||
*'''Severe Sepsis''' | *'''Severe [[Sepsis]]''' | ||
**Comm. Acquired | **Comm. Acquired | ||
***[[Ceftriaxone]] 1 g IV | ***[[Ceftriaxone]] 1 g IV | ||
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===Community Acquired Pneumonia (CAP) === | ===Community Acquired Pneumonia (CAP) === | ||
MCC by S. pneumoniae. In young must cover for mycoplasma and other atypicals. See [[Pneumonia (Pathogens)]] | MCC by [[S. pneumoniae]]. In young must cover for [[mycoplasma]] and other atypicals. See [[Pneumonia (Pathogens)]] | ||
Treatment based on [[Pneumonia (Port Score)]] | Treatment based on [[Pneumonia (Port Score)]] | ||
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**'''[[Cefepime]] '''2g IV Q8H + '''[[Levofloxacin]] '''750mg IV Qday | **'''[[Cefepime]] '''2g IV Q8H + '''[[Levofloxacin]] '''750mg IV Qday | ||
===Healthcare Associated PNA (HCAP) + Hospital Associated PNA (HAP) === | ===Healthcare Associated [[PNA]] (HCAP) + Hospital Associated [[PNA]] (HAP) === | ||
HAP occurs if patient develops PNA 2-3 days after hospitalization. HCAP occus in non-hospitalized patient with extensive healthcare contact. | HAP occurs if patient develops [[PNA]] 2-3 days after hospitalization. HCAP occus in non-hospitalized patient with extensive healthcare contact. | ||
*Mild HAP/HCAP no recent antibiotic exposure: | *Mild HAP/HCAP no recent antibiotic exposure: | ||
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**If shock, recent ABX, or from SNF/ward: | **If shock, recent ABX, or from SNF/ward: | ||
***Add '''[[Meropenem]]''' | ***Add '''[[Meropenem]]''' | ||
*Cephalosporin allergy: | *[[Cephalosporin]] allergy: | ||
**[[Clinda]] 600 mg IV | **[[Clinda]] 600 mg IV | ||
**[[Cipro]] 400 mg IV | **[[Cipro]] 400 mg IV | ||
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**[[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 | ||
==Meningitis (Nl/Post neurosurgical)== | ==[[Meningitis]] (Nl/Post neurosurgical)== | ||
*Healthcare Assoc. | *Healthcare Assoc. | ||
**[[Vancomycin]] 1.5 g IV | **[[Vancomycin]] 1.5 g IV | ||
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**[[Cipro]] 400mg IV | **[[Cipro]] 400mg IV | ||
==Meningitis (Immunocomp)== | ==[[Meningitis]] (Immunocomp)== | ||
(Cirrhosis, EtoH, age > 65, steroids, HIV) | (Cirrhosis, EtoH, age > 65, steroids, HIV) | ||
*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 | ||
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**[[Vancomycin]] 1.5g IV | **[[Vancomycin]] 1.5g IV | ||
==Necrotizing Soft-tissue Infection== | ==[[Necrotizing Soft-tissue Infection]]== | ||
*Comm. Acquired/Healthcare Assoc. | *Comm. Acquired/Healthcare Assoc. | ||
**[[Vancomycin]] 1 gm IV | **[[Vancomycin]] 1 gm IV | ||
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**[[Gentamicin]] 5-7mg/kg | **[[Gentamicin]] 5-7mg/kg | ||
==Neutropenic Fever== | ==[[Neutropenic Fever]]== | ||
*'''Severe Sepsis''' | *'''Severe Sepsis''' | ||
**Cefepime 2 g IVPB x 1 | **Cefepime 2 g IVPB x 1 |
Revision as of 15:23, 18 July 2016
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 5-7 mg/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 PNA(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 500 mg IV Qday OR Doxycycline 100mg IV BID
- If cephalosporin allergy:
- Moxifloxacin 400 mg 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 500 mg 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 PNA (HCAP) + Hospital Associated PNA (HAP)
HAP occurs if patient develops PNA 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 PNA:
- Add Vancomycin for MRSA
- If shock, recent ABX, or from SNF/ward:
- Add Meropenem
- Cephalosporin allergy:
- Clinda 600 mg IV
- Cipro 400 mg IV
- Gentamicin 5-7 mg/kg IV
Abdominal/Pelvic
- Comm. Acquired
- Ceftriaxone 1 g IV
- Metronidazole 1.5 g IV
- Gentamicin 5-7 mg/kg IV
- Healthcare Assoc.
- Ceftazidime 2 g IV
- Gentamicin 5 mg/kg IV
- Metronidazole 1.5 mg IV
- Cephalosporin allergy
- Cipro 400 mg IV
- Metronidazole 1.5 g IV
- Gentamicin 5-7 mg/kg IV
Urosepsis
- Comm. Acquired
- Ceftriaxone 1 g IV
- Gentamicin 5-7 mg/kg IV
- Healthcare Assoc.
- Vancomycin 1 g IV
- Ceftazidime 1g IV
- Gentamicin 5-7 mg/kg IV
- Cephalosporin allergy
- Vancomycin 1g IV
- Cipro 400 mg IV
- Gentamicin 5 mg/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 600 mg 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 600 mg IV
- Cipro 400 mg 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