Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

constructed systemic-pulmonary shunts or conduits. Avoid use of ampicillin-class antibiotics in patients withmononucleosis due to high risk of development of erythematous rash and erroneous allergy attribution.AMOXICILLIN/CLAVULANATE (Augmentin ® )Usual DoseAdult: 500 mg amoxicillin component Q8-12H PO or 875 mg Q12H PO (UWHC cost/day $1.06 -1.45) Also available in XLtablet formulation. Adult dose is 2000 mg Q12 PO (Non-formulary at UWHC; cost/day $11.48). This formulation ispreferred for stepdown of hospitalized patients on ampicillin/sulbactam.Pediatric:** 45 mg amoxicillin component/kg/day in divided doses Q12H PO; 80-90 mg amoxicillin component/kg/day inresistant S. pneumoniae infections.Indications1. Cat, dog or human bites treatment or prophylaxis - drug of choice.2. Acute sinusitis - second-line therapy.3. Acute otitis media - second-line therapy. In high-risk or treatment failures with standard dose amoxicillin,amoxicillin/clavulanate 80-90 mg amoxicillin component/kg/day may be used.4. Diabetic ulcers and other selected skin or skin structure infections.5. For severe infections or lower respiratory tract infections (500 mg Q8H or 875 mg Q12H PO) as stepdown therapy.CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.The amount of clavulanate (125 mg) is the same in the 500 mg and the 875 mg tablets. Do not cut tablets to make halfdoses,as this results in subtherapeutic amounts of clavulanate. When Staphylococcus aureus or streptococci aresuspected, use dicloxacillin or cephalexin. Avoid use of ampicillin-class antibiotics in patients with mononucleosis due tohigh risk of development of erythematous rash and erroneous allergy attribution.AMPHOTERICIN BUsual DoseAdult and Pediatric: 0.5 - 1 mg/kg daily IV (UWHC cost/day $6.76-13.54)Indications1. Candida (including glabrata) and other nosocomial yeasts – deep infections.2. Serious infections with Histoplasma capsulatum, Blastomyces dermatitidis, Coccidioides immitis.3. Invasive infections with Aspergillus or Mucorales4. Cryptococcus neoformans meningitis or other life-threatening infections. Use low dose (0.5 mg/kg daily), if combinedwith flucytosine, or high dose (0.6 mg - 1 mg/kg daily) if used as monotherapy.5. Systemic sporotrichosis.6. Persistent fever in the granulocytopenic patient, despite 4-5 days of empiric antibacterial therapy.CommentsTo avoid fever and rigors with amphotericin B, an antihistamine (e.g., diphenhydramine 25-50 mg PO/IV) and anantipyretic (e.g., acetaminophen 650 mg PO) should be given 30 minutes before the infusion. If the patient receives thepretreatment outlined above and the first dose is given slowly, a test dose is NOT needed. Acute infusion reactionsusually occur 1-3 hours after starting the infusion. These reactions are generally more severe with initial doses andusually diminish with subsequent doses. Amphotericin B causes hypokalemia, hypomagnesemia, renal tubular acidosisand azotemia. A high-salt diet and saline loading with 500-1000 mL 0.9% sodium chloride pre- and post-infusion andreplacement of potassium and magnesium losses along with treatment of metabolic acidosis are necessary to minimizeazotemia. For Candida cystitis, amphotericin bladder irrigations containing 20 mg/L have been used, but their efficacy isquestionable (dosing: 250 mL per Foley Q6H or by continuous irrigation).AMPHOTERICIN B LIPID COMPLEX (ABLC, Abelcet ® ) – non-formulary at UWHCInfectious Disease approval required for all use of ABLC (see Appendix I)