Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

AMPICILLIN/SULBACTAM (Unasyn ® )Usual DoseAdult: 1.5-3 g Q4-6H IV (UWHC cost/day $6.88-20.01)Pediatric:** 100-200 mg ampicillin component/kg/day IV in divided doses Q4-6HIndications1. Community-acquired (aspiration) pneumonia with high suspicion of anaerobic component.2. Polymicrobial soft tissue infections such as diabetic foot ulcers and postsurgical wound infections.3. Polymicrobial community-based intra-abdominal or genitourinary infections with microbiologically documentedsensitivities.4. Serious infected animal or human bite wounds – first-line intravenous therapy.5. Haemophilus influenzae infections, except meningitis.6. Susceptible Acinetobacter infectionsCommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect. Avoid use of ampicillin-classantibiotics in patients with mononucleosis due to high risk of development of erythematous rash and erroneous allergyattribution. Sulbactam enhances ampicillin's spectrum to include penicillinase-producing Staphylococcus aureus,Haemophilus influenzae, and anaerobic bacteria and improves its aerobic Gram-negative spectrum, but not forPseudomonas aeruginosa. For GI anaerobes, Unasyn ® has activity comparable to metronidazole, Zosyn ®(piperacillin/tazobactam) and meropenem but greater activity when compared to clindamycin, cefoxitin, and the thirdgenerationcephalosporins. Safety and effectiveness have not been established for children for intra-abdominal infections.CAUTION: Increasing numbers of Escherichia coli, Enterobacter, Klebsiella and Citrobacter produce high amounts ofbeta-lactamase and are resistant to Unasyn ® . NOTE: Other combination antibiotics base their dose either on onecomponent (e.g. Primaxin ® ) or both components (e.g. trimethoprim/sulfamethoxazole). Unasyn ® labeling states the doseby adding the two components of ampicillin (2 g) plus sulbactam (1 g), i.e., 3 g. For ampicillin-susceptibleEnterococcus there is no evidence that Unasyn ® is superior to ampicillin alone. Ampicillin is always the drug offirst choice for patients who are not penicillin-allergic and have an ampicillin-susceptible strain of Enterococcus.Sodium content = 2.9-3.1 mEq/G.ANIDULAFUNGIN – nonformulary at UWHCInfectious Disease approval required for all use of anidulafungin (see Appendix I)Anidulafungin, caspofungin and micafungin are therapeutically interchangeable at UWHC. Micafungin is the currentformulary choice.Usual DoseAdult: 200 mg loading dose, then 100 mg IV daily (UWHC cost/day $173.93)Indications1. Candidemia, Candida intra-abdominal abscesses and Candida peritonitis2. Esophageal candidiasisARTEMETHER/LUMEFANTRINE (Coartem®)Usual DoseAdult: 4 tablets initially, 4 tabs again after 8 hours and then 4 tabs twice daily for the following two days (24 total tablets)(UWHC cost/day $67.25)Pediatric (dose by body weight):5 to