Antibiogram + Adult Antimicrobial Guide

Adult Antimicrobial Guide (2019). 

Reviewed against the 2020 antimicrobiogram and sensitivities confirmed. 

The recommendations made in this guide are based on susceptibility data and generalized guidelines. They are not intended to be used in all circumstances and individualized patient evaluations should be made before initiating antibiotics.

Skin and Soft Tissue (SSTI)

• Collect wound culture from any drainage, open sore or blister

• Think staph and strep

  • Local resistances as follows:

    • Strep with high resistance to clindamycin and tetracyclines

    • MSSA with moderate resistance to erythromycin, high resistance to penicillin (but sensitive to cephalosporins and unasyn). 

    • MRSA resistant to unasyn, cefazolin, erythromycin, oxacillin, penicillin, but sensitive to vancomycin. 

• Initial Empiric inpatient regimen

  • Moderate non-purulent

    • Ceftriaxone 1g IV q24h OR

    • Vancomycin 15-20 mg/kg/dose then dosing per pharmacist

  • Severe Non-Purulent

    •  Vancomycin 15-20 mg/kg/dose then dosing per Pharmacist AND

    • Pip/Tazo 3.375 mg IV Q8hours (LD: over 30 mins; MD over 4 hours)

  • Moderate Purulent

    • Doxycycline 100 mg PO BID

    • TMP/SMX DS 1 tab PO BID

  • Severe Purulent

    • Vancomycin 15-20 mg/kg/dose then dosing per Pharmacist

    • Duration of treatment: redness has clearly receded 48 hours past fever resolution - Generally 5 to 10 days

Nosocomial Pneumonia (hospital / Ventilator acquired)

• Cefepime 2 g IV q 8 hr OR Piperacillin/Tazobactam (Pip/Taz) 3.375 gm IV (infuse over 4 hours except for 30 min loading dose) Q8h

• AND

• Vancomycin 15-20 mg/kg then dosing per pharmacy (goal trough 15-20)

• Please draw cultures before initiating antibiotic regimen

• Duration of therapy typically is 7 days

Community Acquired Pneumonia

• Inpatient:

  • Ceftriaxone 1 g IV q24h + Azithromycin 500 mg IV/PO q12h

  • Alternative - Levofloxacin 750 mg IV/PO q24h (if severe PCN and cephalosporin allergy)

•  Suspected Pseudomonas:

  • Cefepime 2 gm IV q8hr + Azithromycin 500 mg IV/PO q12h

  • Alternative - Levofloxacin 750 mg IV/PO q24h (if severe PCN and cephalosporin allergy)

•  Suspected MRSA (in addition to ONE of the above treatments) :

  • Vancomycin (trough: 15-20 mg/dL)

• Duration of therapy is typically 5 to 7 days

Genitourinary Infections

• Acute Cystitis (in order of preference)

  • Nitrofurantoin mono. (macrocrystals) 100 mg po BID x 5 days ( do not use CrCl < 30)

  • Cephalexin 500 mg po BID x 7 days

• Complicated UTI/Urosepsis/Pyelonephritis

  • Ceftriaxone 1-2 gm IV q 24hr x 7 – 14 days

  • Ciprofloxacin 400 IV every 12 hours x 7 days (if cephalosporin allergy)

• Do not treat (+) urine cultures without symptoms in non-pregnant patients

Intraabdominal infections

• Appendicitis

  • Cefoxitin 2 g IV q6h (intra-op q2h)

  • OR

  • Pip/Taz 3.375 g IV q8h (infuse over 4 hours except for over 30 min for loading dose)

  • Duration of therapy is typically 5 days

• Cholecystitis

  • Ceftriaxone 2 gm IV q24h + Metronidazole 500 mg IV q8h

  • OR

  • Pip/Taz 3.375 g IV q8h (LD: over 30 mins; MD over 4 hours)

  • Treat until obstruction relieved

• Diverticulitis

  • Ceftriaxone 2 gm IV q24h + Metronidazole 500 mg IV q8h

  • OR

  • Pip/Taz 3.375 g IV q8h (LD: over 30 mins; MD over 4 hours)

Clostridium Difficile Infection (CDI)

• Clostridium difficile Infection (CDI)

  • Initial Episode Mild – Severe:

  • Vancomycin PO 125 mg q 6 hr x 10 days

• First Recurrence: Vancomycin taper

  • 125 mg po QID for 10-14 days

  • 125 mg po BID for 7 days

  • 125 mg po QD for 7 days

  • 125 mg po every 2 to 3 days for 2 to 8 weeks

• Second Recurrence or subsequent recurrence

  • Consider ID referral, fidaxomicin, addition of rifaximin, OR GI referral