Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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D. Dose of Antibiotic1. Piperacillin/tazobactam 7Estimated CrClDose> 20 ml/min 3.375G IV Q8H infused over 4 hours< 20 ml/min and HD/PD patients 3.375G IV Q12H infused over 4 hours2. MeropenemAll patients prescribed meropenem will initially receive 500mg IV every 6 hours infused over 3hours (adjusted based on renal function). IF after 72 hours no organism is recovered or theorganism recovered has an MIC that is ≤ 2 mcg/ml, the dose of meropenem will be dose reducedto 500mg IV every 8 hours infused over 3 hours (adjusted based on renal function). IF organismswith an MIC > 2 mcg/ml are recovered, the meropenem dose will be kept at every 6 hours infusedover 3 hours (adjusted based on renal function) until the meropenem is discontinued. Thispractice will ensure that organisms with higher MICs are appropriately treated prior toidentification.Estimated CrCl Initial Dosing Deescalated Dosing> 36 500mg IV Q6H over 3 hours 500mg IV Q8H over 3 hours26-35 500mg IV Q8H over 3 hours 500mg IV Q8H over 3 hours10-25 500mg IV Q12H over 3 hours 500mg IV Q12H over 3 hours
Compatibility:Piperacillin/TazobactamCompatible Incompatible No InformationAmikacinAcyclovirCalciumAmiodaroneCisatracurium (*) Amphotericin (all formulations)ClindamycinAzithromycinCyclosporinCiprofloxacinDaptomycinDiltiazemDexamethasoneDobutamineDexmedetomidine DoxycyclineDiazepamDroperidolDigoxinDrotrecoginDiphenhydramine GancyclovirDopamineGentamicinEnalaprilatHaloperidolEpinephrineHydralazineEsmololInsulinFenoldopamLabetalolFentanylMidazolamFluconazolePhenytoinFosphenytoinTobramycinFurosemideVancomycinHeparinVecuroniumHydrocortisoneHydromorphoneLidocaineLinezolidLorazepamMagnesiumMannitolMethylprednisoloneMetoclopramideMetoprololMetronidazoleMilrinoneMorphineNaloxoneNitroglycerinNitroprussideNorepinephrineOndansetronPantoprazolePhenylephrinePotassium ChloridePotassium PhosphateRanitidineSodium BicarbonateSodium PhosphateSulfamethoxazoletrimethoprimTacrolimus
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PREFACEThe Antimicrobial Use Guidel
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Antimicrobial Cost Table (Cost info
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Summary of Antibiotic Order Form: S
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LUNGS/PULMONARYCommunity-Acquired P
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PART I: BY DRUGABACAVIRFor up-to-da
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constructed systemic-pulmonary shun
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AMPICILLIN/SULBACTAM (Unasyn ® )Us
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ATOVAQUONE/PROGUANIL (Malarone ® )
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CEFAZOLINUsual DoseAdult: Moderate/
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CommentsDose adjustment required fo
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1. Typhoid fever. (NOTE: Third-gene
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-Dutasteride-Eltrombopag-Theophylli
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CLINDAMYCINUsual DoseAdult: 600-900
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DAPTOMYCINInfectious Disease approv
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Concurrent administration with peni
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• Cisapride (contraindicated) •
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• Oral contraceptives/hormones -
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Synergy in infective endocarditis a
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• Colchicine • Indinavir • Ta
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• Donepezil • Pioglitazone• D
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with linezolid should be considered
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4. Life-threatening Gram-negative i
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MOXIFLOXACINLevofloxacin and moxifl
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Indications1. Uncomplicated cystiti
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CommentsDose adjustment required fo
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PIPERACILLIN/TAZOBACTAM (Zosyn ® )
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PRIMAQUINEUsual DoseAdult: Malaria
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RIFABUTINUsual DoseAdult (150 mg ca
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• Chloramphenicol • Leflunomide
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SULFISOXAZOLENo longer available as
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TICARCILLIN/CLAVULANATE (Timentin
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2. Recurrent urinary tract infectio
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VANCOMYCINUsual DoseAdult: 1 g Q12H
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Careful monitoring of patients usin
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APPENDIX B: UWHC SURGICAL ANTIMICRO
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GI:Appendectomy 3Anaerobic organism
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VascularLIKELYPATHOGENS• ANTIMICR
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Cleanorthopedicprocedures(other)Sta
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APPENDIX C: THERAPY FOR TUBERCULOSI
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p-Aminosalicylic acid(PAS)Granules
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Appendix D: UNIVERSITY OF WISCONSIN
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Appendix E: UWHC Guidelines for the
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B. Antifungal Prophylaxis for BMT a
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D. Cost ComparisonDrugAmphotericin
Page 92 and 93: 17. Maertens J, Glasmacher A, Herbr
Page 94 and 95: 47. Courtney R, Wexler D, Radwanski
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Page 98 and 99: Medications Approved for Parenteral
Page 100 and 101: APPENDIX G: Serum Drug Concentratio
Page 102 and 103: APPENDIX H: Guidelines for Monitori
Page 104 and 105: 1. Patients with large volumes of d
Page 106 and 107: 16. Tsuji B, Rybak MJ. The influenc
Page 108 and 109: APPENDIX I: Infectious Diseases App
Page 110 and 111: APPENDIX J: UWHC Guidelines For the
Page 112 and 113: with aztreonam and other beta-lacta
Page 114 and 115: D. Side Chains1.2.5. The prescriber
Page 116 and 117: 14. Pichichiro ME. Use of selected
Page 118 and 119: Appendix KUWHC Guidelines for Cost-
Page 120 and 121: sulfa and can be prescribed topatie
Page 122 and 123: superinfection: amoxicillin 1 g PO
Page 124 and 125: 17. Smucny J, Fahey T, Becker L, Gl
Page 126 and 127: Appendix M: Guidelines for the Prop
Page 128 and 129: D. CategorizationPatients should be
Page 130 and 131: Empiric coverage for Enterococcus i
Page 132 and 133: H. Necrotizing PancreatitisThe publ
Page 134 and 135: Bone or JointEndocarditis 4Streptoc
Page 136 and 137: Candidemia or candidiasis 11Non-neu
Page 138 and 139: 11. Pappas PG, Kauffman CA, Andes D
Page 140 and 141: piperacillin/tazobactam. There were
Page 144 and 145: TNAVasopressinVoriconazoleMeropenem
Page 146 and 147: pretreatment with an H1-histamine b
Page 148 and 149: formal consult is not required, but
Page 150: K. References1.0 Bliziotis IA, Ples
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