Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

ATOVAQUONE/PROGUANIL (Malarone ® ) - nonformulary at UWHCUsual DoseAdult, prophylaxis: 250/100 mg daily (UWHC cost/day $6.50). Adult, treatment: 1000/400 mg daily (UWHC cost/day$26.00).IndicationsPrevention and treatment of malariaATRIPLA ® -- tenofovir + emtricitabine + efavirenzFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/AZITHROMYCINUsual DoseAdult: 500 mg daily PO on day 1, then 250 mg daily PO days 2-5 (UWHC cost/day $1.03) OR 500 mg daily IV (UWHCcost/day $4.46).Pediatric: 10 mg/kg PO on day 1, then 5 mg/kg/day daily PO days 2-5.Indications1. Community-acquired pneumonia.2. Non-gonococcal urethritis and cervicitis due to Chlamydia trachomatis or Ureaplasma urealyticum (1 g PO singledose).3. Mild to moderate bacterial exacerbations of chronic obstructive pulmonary disease; community-acquired pneumonia ofmild severity, including suspected mycoplasma or chlamydial pneumonia, in patients unable to tolerate erythromycin.4. Pharyngitis/tonsillitis - Second-line therapy.5. Uncomplicated skin and skin structure infections – Second-line therapy.6. Toxoplasmosis, Campylobacter and Helicobacter infections.7. Mycobacterium avium complex prophylaxis and therapy (1.2 g/week).8. Bacterial endocarditis prophylaxis (see Appendix A).9. Second-line therapy for acute sinusitis and acute otitis media.10. Pertussis11. Legionnaire’s disease (1 g daily).12 Use as an anti-inflammatory in lung transplant recipients and patients with cystic fibrosis. The standard dose is 500 mgevery other day OR 250 mg daily, not 500 mg daily.CommentsThe contents of a one gram packet should be mixed with two ounces (60 mL) of water and swallowed immediately. Thepacket should be rinsed with an additional two ounces of water and the contents mixed and swallowed.Drug InteractionsAzithromycin may result in QTc prolongation when administered with Class I or Class III anti-arrhythmics, and concurrentuse should be avoided. Azithromycin may disrupt gut microbes partially responsible for digoxin metabolism, resulting inincreased digoxin levels and potential digoxin toxicity with concurrent use. Digoxin level monitoring is warranted if aprolonged course of azithromycin therapy is indicated. Azithromycin may decrease warfarin metabolism in patients onestablished warfarin regimens, increasing the risk of bleeding with concurrent use. Increased monitoring isrecommended.AZTREONAM- Infectious Disease approval is required for all use (see Appendix I)Limit use to patients with severe penicillin allergy for suspected Gram-negative infections in patients with renalinsufficiency. If patients can tolerate cephalosporins, they should receive cephalosporins or carbapenems beforeaztreonam. See Appendix J: Guidelines for the Use of Beta-Lactam Antibiotics in Patients with Reported Allergies toPenicillin or on uconnectUsual DoseAdult: 1-2 g Q8H IV (UWHC cost/day $82.89-169.78).Pediatrics** 90-120 mg/kg/day IV/IM in divided doses Q6-8H.