MEDICAL RECOMMENDATIONS FOR ANTIBIOTIC SELECTION

CAP:

Hospitalized patients: Ceftriaxone or cefotaxime + macrolide or fluoroquinolone alone.

Streptococcus pneumoniae: MIC pen < 2: cefotaxime, ceftriaxone or IV penicillin (12 mil units/d) MIC pen 3 2: fluoroquinolone or vancomycin

Outpatients: Macrolide, doxy, fluoroquinolone

Outpatient who is older/underlying disease: fluoroquinolone

Aspiration: Add clindamycin or metronidazole

NOSOCOMIAL PNEUMONIA:

Hospital ward: Aminoglycoside + cefotaxime, ceftriaxone, cefepime, ticar/clav, pip/tazo, meropenem/imipenem

ICU: Cefepime, imipenem/meropenem + aminoglycoside MRSA prevalent: add vancomycin

MENINGITIS:

Community-acquired: Cefotaxime or ceftriaxone + vancomycin (up to 4 gm/d) ± rifampin

Nosocomial: Vancomycin + ceftazidime

Pseudomonas: Ceftazidime + aminoglycoside

Cephalosporin/betalactam allergy: chloramphenicol + vancomycin

Listeria: Amp ± gentamycin

Listeria + betalactam allergy: TMP-SMX

SEPSIS:

Cephalosporin (cefotaxime, ceftriaxone, cefepime), ticar/clav, pip/tazo or imipenem/meropenem plus aminoglycoside ± vancomycin

ENDOCARDITIS:

Acute, empiric: vancomycin + gentamycin

INTRA-ABD SEPSIS:

Mixed infection: Ticar/clav, pip/tazo, amp/sulbactam, imipenem/meropenem, cefoxitin, cefotetan

Biliary tract: Pip + metro, pip/tazo or amp/sulbactam, each ± aminoglycoside

NEUTROPENIA:

Pip/tazo (4.5 gm q6h) + amikacin or ticar/clav (3.1 g q4h) + amikacin; add vanco if unresponsive

UTI:

Cystitis, uncomplicated: TMP-SMX × 3d; prevalence of E. coli resistance 15–20% 3/4 fluoroquinolone

Alternatives: Nitrofurantoin, oral cephalosporins, or fosfomycin × 1

Pyelonephritis, uncomplicated: Fluoroquinolone × 7d

UTI nosocomial, nursing home, recurrent: fluoroquinolone, amox/clav, cephalosporin (cefepime, cefpodoxime, cefdinir, ceftibuten)

Hospital acquired: cephalosporins (3rd gen), fluoroquinolone, ticar/clav, pip/tazo, imipenem/meropenem ± aminoglycos