Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

CEFAZOLINUsual DoseAdult: Moderate/severe infections 1-2 g Q8H IV (UWHC cost/day $1.74-3.49).Surgical prophylaxis 1-2 g preop single dose (UWHC cost/day $0.58-1.16). If patient weighs >80 kg, use 2 g dose.Pediatrics:** 50-100 mg/kg/day IV in divided doses Q8H.Indications1. Perioperative surgical prophylaxis; agent of choice for most elective operations with the exceptions of colorectal andcardiovascular surgery (see Appendix B). Duration of pre/post-op prophylaxis should not exceed a total of 24 hours.2. Open fracture repair prophylaxis (see Appendix B).3. Klebsiella or Escherichia coli infections caused by susceptible organisms.4. Peritonitis in chronic ambulatory peritoneal dialysis patients – intraperitoneal administration.5. Bacterial endocarditis prophylaxis (see Appendix A).CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.The pharmacokinetics of cefazolin do not require dosing more frequently than Q8H.CEFDINIRCefdinir suspension and cefpodoxime proxetil suspension are therapeutically interchangeable at UWHC. Cefdinir is thecurrent formulary choice.Usual DosePediatrics: 7 mg/kg orally every 12 hours, up to 600 mg/dayIndications1. Otitis media caused by H. influenzae, S. pneumoniae, or M, catarrhalis2. Community-acquired pneumonia caused by H. influenzae, H. parainfluenzae, S. pneumoniae and M. catarrhalis3. Skin or subcutaneous tissue infection caused by S. aureus and S. pyogenes4. Acute maxillary sinusitis caused by H. influenzae, S. pneumoniae, and M. catarrhalis5. Pharyngitis caused by S. pyogenesCommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Drug InteractionsIron, magnesium and aluminum decrease C max and AUC by 40-60%. Separate from iron supplements and antacids by atleast two hours.CEFEPIMECefepime and ceftazidime are therapeutically interchangeable at the UWHC except for use in Burkholderia cepacia andStenotrophomonas maltophilia infections. Cefepime is the current formulary choice.Usual DoseAdult: 0.5-2 g Q8-12H IM/IV (UWHC cost/day $3.38-20.25).Neutropenic fever or Pseudomonas: 2 g Q8H IV (UWHC cost/day 20.25).Pediatrics** 150 mg/kg/day IV in divided doses Q8H.Indications1. Moderate to severe pneumonias and associated bacteremias caused by K pneumoniae, P aeruginosa or Enterobacterspp2 .Complicated urinary tract infections including pyelonephritis caused by E coli, K pneumoniae, P aeruginosa or Pmirabilis.3. Bacteremias caused by E coli, K pneumoniae, P aeruginosa or P mirabilis.