Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Bone or JointEndocarditis 4Streptococci,S. bovusNative Valve2-4 weeks: moderate to severe2-5 days: s/p amputation with no residual tissue2-4 weeks: s/p amputation with residual soft tissue (no bone)4-6 weeks: s/p amputation with residual tissue and viable but infected bone> 12 weeks: no amputation or s/p amputation with residual dead bonePCN susceptible (MIC ≤ 0.12 mg/L)4 weeks: PCN or Ceftri mono*OR2 weeks: PCN or Ceftri PLUS GENTPCN int (MIC >0.12 to ≤ 0.5 mg/L)4 weeks: PCN or Ceftri mono* PLUS2 weeks: GENTPCN resist (MIC >0.5 mg/L)Treat like Enterococcal EndocarditisPCN suscep (MIC ≤ 0.12 mg/L)6 weeks: PCN or Ceftri*Last Guideline: 2005 / Projected Update: UnknownProsthetic Valve ± 2 weeks: GENTPCN Int/Resist (MIC > 0.12 mg/L)6 weeks: PCN or Ceftri* PLUS GENTPCN susceptible (MIC ≤ 0.1 mg/L)4 weeks: PCN, Cefazolin, Ceftri*S. pneumoniae PCN Int (MIC >0.1 to ≥ 2 mg/L)4 weeks: high dose PCN or Ceftri (without meningitis)4 weeks with/meningitis: consider Vanco PLUS rifampinS. pyogenes 4 weeks: PCN G or Cefazolin or Ceftri*Groups B,C,G strepMethicillin SensitiveStaphylococciMethicillin ResistantStaphylococciEnterococcus –Native andProsthetic ValvesHACEK(Haemophilus,Actinogacillus,Cardiobacterium,Eikenella, Kingellasp.)Pseudomonas sp.Native ValveProsthetic ValveNative ValveProsthetic ValvePCN/AG/VancoSensitivePCN/VancoSensitive, GENTresistantVanco/AGSensitive, PCNresistantPCN/AG/VancoResistantNative ValveProsthetic ValveFungal(*Vanco can be substituted for PCN in case of allergy)** Vanco, then B-lactam desensitization†or susceptible AG or FQ4-6 weeks: PCN or Cefazolin or Ceftri ± 2 weeks: GENTMSSA - 4-6 weeks: Nafcillin (Cefazolin for PCN non-anaphylactic allergy)± 3-5 days: GENT**MSSA – ≥ 6 weeks: Nafcillin PLUS rifampin PLUS 2 weeks: GENTCoNS – 4-6 weeks: Nafcillin* PLUS rifampin PLUS 2 weeks: GENT†6 weeks: VANCO (linezolid or TMP/sulfa + rifampin alternatives)MRSA – ≥ 6 weeks: VANCO PLUS rifampin PLUS 2 weeks: GENTCoNS - 6 weeks: Vanco PLUS rifampin PLUS 2 weeks: GENT†4-6 weeks: PCN (AMP alt) PLUS4-6 weeks: GENT (TID dosing)*4-6 weeks: PCN (AMP alt) PLUS4-6 weeks: streptomycin*6 weeks: AMP or Vanco PLUS Gent(depending on β-lactamase activity)E. faecium8 weeks: Linezolid or quinupristin-dalfopristinE. faecalis8 weeks: Imipenem/cilastatin or Ceftri PLUS AMP4 weeks: Ceftri or Amp/Sulbactam (FQ as alternative)6 weeks: Ceftri or Amp/Sulbactam (FQ as alternative)≥6 weeks: extended spectrum β-lactam PLUS tobraInduction: Ampho B to clinical response, then life-long –azole suppression