Harbor:Empiric antibiotics
This page is for antibiotics specific to the Harbor-UCLA Medical Center; see Antibiotics by diagnosis for for national guidelines.
Harbor:Antibiotics by diagnosis
Harbor Empiric Guidelines
- File:Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Inpatient Adult 2022.pdf
- File:Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Outpatient Adult 2022.pdf
SKIN & SOFT TISSUE INFECTIONS (SSTI)
- Cellulitis (no purulence) (x 5-7 days)
- Inpatient
- [No to Minimal Systemic Signs/Symptoms] Cefazolin 1-2g IV q8h (If documented severe ß-lactam allergy: Clindamycin 600mg IV q8h)
- [Presence of Systemic Signs/Symptoms] Vancomycin per Pharmacy
- Outpatient
- Dual antibiotic treatment is not indicated.
- Cephalexin 500mg PO QID OR Clindamycin 450mg PO TID OR TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg)
- Inpatient
- Purulent SSTI (x 5-7 days)
- Inpatient
- Vancomycin per Pharmacy
- Outpatient
- Dual antibiotic treatment is not indicated.
- Incision & Drainage first and then TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg) OR Doxycycline 100mg PO BID
- Inpatient
- Necrotizing Soft Tissue Infection
- Inpatient
- Ceftriaxone 1g IV q24h [infuse first] + Vancomycin per Pharmacy Metronidazole 500mg IV q8h (+ Clindamycin 900mg IV q8h if suspect streptococcal toxic shock)
- Inpatient
- Diabetic Foot Ulcer
- Inpatient
- Refer to Anti-Infective Management Program (https://lacounty.sharepoint.com/sites/dhs-harbor-amp) > Documents > Diabetic Foot Infection Pathway (DFIP)
- Inpatient
EAR, NOSE, & THROAT INFECTIONS
- Otitis Externa (x 7 days)
- Outpatient
- Oral therapy is NOT recommended unless extension beyond the external ear canal or severely immunocompromised.
- Use antibiotic ear drops (Cortisporin Otic 4 drops in affected ear TID OR Ciprodex 4 drops in affected ear BID). If perforated, use Ciprodex.
- Outpatient
- Acute Sinusitis (x 5 days)
- Outpatient
- Mainly viral, consider watchful waiting with supportive measures. Consider antibiotics for failure to improve ≥10 d after onset of URI, or biphasic illness <10 d with worsening after initial improvement.
- Amoxicillin/clavulanate 875/125mg PO BID OR Doxycycline 100mg PO BID
- Outpatient
- Group A Strep (GAS) Pharyngitis
- Outpatient
- Antibacterial therapy should only be used when POC PCR testing shows the presence of GAS. Do not rely on Centor criteria to diagnose GAS.
- Penicillin VK 500mg PO BID x 10 days OR Benzathine PCN 1.2 million units IM x 1. If PCN allergy, Azithromycin 500mg PO x 3 days
- Outpatient
RESPIRATORY INFECTIONS
- Acute Bronchitis
- Outpatient
- No antibiotics are indicated; offer symptomatic management and realistic time frame for cough resolution (2-4 wk). To help reframe patient’s reference point, consider terminology such as “viral chest cold.”
- Outpatient
- Acute Exacerbation of Chronic Bronchitis (x 3-5d)
- Outpatient
- In patients with emphysema, COPD, or significant tobacco abuse, consider prescriptions for steroids and bronchodilators.
- Antibiotics help reduce risk of recurrence for moderate to severe symptoms defined as purulent sputum and either dyspnea and/or increased sputum volume
- Azithromycin 500mg PO Daily x 3 days OR Doxycycline 100mg PO BID x 5 days
- Outpatient
- Community-acquired Pneumonia (x 5 days)
- Inpatient
- Ceftriaxone 1g IV q24h [infuse first] + Azithromycin 500mg IV q24h
- If documented severe ß-lactam allergy: Levofloxacin 750mg IV q24h
- Outpatient
- Healthy adults without comorbidities: Amoxicillin 1g PO TID OR Doxycycline 100mg PO BID
- Adults with comorbidities: Amoxicillin/clavulanate 875/125mg PO BID AND Azithromycin 500mg PO x 1 day then 250mg PO x 4 days OR Levofloxacin 750mg PO daily monotherapy
- Inpatient
- Hospital-acquired Pneumonia in non-ICU (x 7 days)
- Inpatient
- Ceftriaxone 1g IV q24h
- Inpatient
- Hospital-acquired Pneumonia in ICU or Ventilator-associated Pneumonia (x 7 days)
- Inpatient
- Cefepime 2g IV q8h [infuse first] + Vancomycin per Pharmacy
- Inpatient
- Aspiration Pneumonia (x 5-7 days)
- Inpatient
- Ceftriaxone 1g IV q24h [infuse first]
- If severe periodontal disease, necrotizing pneumonia, or lung abscess/empyema, add Metronidazole 500mg IV/PO q8h and consider longer treatment
- Inpatient
GENITAL INFECTIONS
- Urethritis/Cervicitis
- Outpatient
- Empiric treatment for both gonorrhea and chlamydia is reasonable in symptomatic high risk patients. Screen for HIV/syphilis, use sexual assault order set if indicated.
- Ceftriaxone 500mg IM [1g if >150kg] x1 AND Doxycycline monohydrate 100mg PO BID x 7 days OR Azithromycin 1g PO x1 (if pregnant)
- Outpatient
URINARY INFECTIONS
- Asymptomatic Bacteriuria (x 5-7 days)
- Outpatient
- Diagnosed by urine culture (>105 CFU), NOT urinalysis. No treatment indicated unless pregnant, received renal transplant in past 30 days, or undergoing GU procedure.
- Nitrofurantoin (Macrobid)† 100mg PO BID x 5d
- If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
- Outpatient
- Cystitis
- Inpatient
- Ceftriaxone 1g IV q24h x 1-5 days
- If documented severe ß-lactam allergy†: Gentamicin 5mg/kg IV once
- Outpatient
- Refer to outpatient urinary antibiogram to guide empiric treatment. Presence of squamous cells in the urinalysis indicates that the specimen is contaminated and cannot be used for UTI diagnosis.
- Nitrofurantoin (Macrobid)† 100mg PO BID x 5 days OR TMP-SMX DS 1 tab PO BID x 3 days
- If history of ESBL, consider: FosfomycinR 3gm PO x 1 dose
- If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
- Inpatient
- Pyelonephritis (x 7 days)
- Outpatient
- Ceftriaxone 1g IV x1 can be considered in more severe cases pending cultures.
- TMP-SMX DS 1 tab PO BID OR Ciprofloxacin 500mg PO BID
- Outpatient
- Complicated Urinary Tract Infections, including Catheter-associated and Pyelonephritis) (x 5-7 days)
- Inpatient
- Ceftriaxone 1g IV q24h
- If documented severe ß-lactam allergy†: Gentamicin 5mg/kg IV q24h* or Ciprofloxacin 400mg IV q12h
- Inpatient
- Hospital-Acquired or Recent Hospitalization and IV Antibiotic Use
- Inpatient
- Cefepime 2g IV q8h
- Inpatient
- If Septic Shock and/or Recent History of ESBL
- Inpatient
- Meropenem 1g IV q8h
- Inpatient
INTRA-ABDOMINAL INFECTIONS
- Community-acquired (x 4 days after source control)
- Inpatient
- Ceftriaxone 1g IV q24h [infuse first] + Metronidazole 500mg IV/PO q8h
- If documented severe ß-lactam allergy: Ciprofloxacin 400mg IV q12h + Metronidazole 500mg IV/PO q8h
- Inpatient
- Healthcare-associated (x 4 days after source control)
- Inpatient
- Piperacillin/Tazobactam 3.375g IV q8h
- Inpatient
- If Healthcare-associated with Septic Shock
- Inpatient
- Meropenem 1g IV q8h
- Inpatient
- Spontaneous Bacterial Peritonitis (x 5 days)
- Inpatient
- Ceftriaxone 2g IV q24h
- Inpatient
- C. difficile Infection (x 10-14 days)
- Inpatient
- Vancomycin 125mg PO QID
- Inpatient
CARDIOVASCULAR INFECTIONS
- Endocarditis
- Inpatient
- Ceftriaxone 2g IV q24h [infuse first] + Vancomycin per Pharmacy
- Inpatient
NEURO INFECTIONS
- Meningitis
- Inpatient
- Ceftriaxone 2g IV q12h [infuse first] + Vancomycin per Pharmacy
- + Ampicillin 2g IV q4h if age>50yr, pregnant, AIDS or immunosuppressed
- Inpatient
IMMUNOCOMPROMISED INFECTIONS
- Neutropenic Fever
- Inpatient
- Cefepime 2g IV q8h
- + Vancomycin per Pharmacy if line infection, pneumonia, skin and soft tissue infection, severe mucositis, or other gram-positive infection
- Inpatient