Harbor:Sepsis antibiotics
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- 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:
- Meropenam 1g IV + Levofloxacin 750mg IV (Levofloxacin for synergy)
- Aspiration risk:
- Add Clindamycin 600 mg or Metronidazole 500 mg
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 +/- Clindamycin 600mg IV OR Metronidazole if risk of aspiration
- 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
- 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 (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