Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Cefpodoxime proxetil 100 mg BID PO is equivalent to cefuroxime axetil 250 mg BID PO (for upper respiratory tractinfections and bronchitis).CEFTAZIDIMEUse of ceftazidime is limited to endophtalmitis per order sets and in antibiotic lock solutionsUsual DoseAdult: 2.25 mg in 0.1 mg for intravitreous administration for treating endophthalmitis; systemic dosing is 0.5-2 g Q8Hdepending on indication (UWHC cost/day $5.41-21.66 for systemic dosing)CEFTRIAXONECefotaxime, ceftriaxone and ceftizoxime are therapeutically interchangeable at the UWHC. Ceftriaxone is the currentformulary choice. Cefotaxime may be used in children 1 month of age or younger or in infants with hyperbilirubinemia.Usual DoseAdult: Moderate infections 1 g Q24H IV/ IM (UWHC cost/day $1.21). The 1 gram dose should be used for communityacquired pneumonia, and should be efficacious in most infections.Severe infections: 2 g Q24H IV/IM (UWHC cost/day $2.89).Pediatrics:** 50 - 100 mg/kg/day IV/IM in divided doses Q12 – 24H.Meningitis 100 mg/kg/day IM/IV in divided doses Q12H, to a maximum dose of 2 g IV Q12H in adults.Indications1. Community-acquired pneumonia in patients >60 years old or with comorbidity, given with a macrolide or doxycycline.The usual dose in the CAP UW pathway is 1 gram/24 hours.2. Bacterial meningitis, including infection with enteric Gram-negative bacilli, S pneumoniae or Haemophilus influenzae,pending susceptibility or test results.3. H influenzae or pneumococcal life-threatening infections (e.g., bacteremias, epiglottitis).4. Uncomplicated gonorrhea (125 mg IM as a single dose).5. Serious Gram-negative bacillus infections, other than Pseudomonas, especially if the patient is at high risk foraminoglycoside toxicity (CAUTION: Many nosocomial Gram-negative bacillus infections, especially those due toEnterobacter spp. and Pseudomonas aeruginosa, are resistant to ceftriaxone).6. Pneumonia caused by Gram-negative bacilli, other than P aeruginosa.7. Acute otitis mediaa. One-time dose in patients unable to take oral medications.b. Single daily dose times 3 days in patients with clinical treatment failure with oral antibiotics.8. Community-acquired pneumonia, urosepsis, skin and soft tissue infection or sepsis of unknown etiology.9. Endocarditis due to slow-growing fastidious Gram-negative organisms, usually in combination with an aminoglycoside.10. Alternative to ampicillin plus gentamicin. Also alternative therapy in endocarditis caused by Streptococcus viridans.11. Lyme Disease, especially with rheumatologic, neurologic or cardiac involvement (2 g IV daily).12. Presumptive bacteremia/sepsis in febrile children > 2 months old.13. Meningococcal prophylaxis, in ambulatory clinics. (Pregnant women 250 mg IM single dose, children 125 mg IM singledose).CommentsDo not use as empiric therapy for nosocomial infections where resistant Gram-negative rods such as Pseudomonas maybe present. Ceftriaxone is not active against Listeria monocytogenes, an organism of increasing importance inimmunosuppressed or transplant patients. Ceftriaxone can cause biliary sludging, especially in high doses in adults (2 gQ12H) and children. Ceftriaxone displaces bilirubin from plasma protein binding sites, which may be important if aneonate is already hyperbilirubinemic. For IM use, 1% lidocaine (without epinephrine) can be used as the diluent todecrease local pain. NOTE: Ceftriaxone 1 g/day is equal to cefotaxime 1 g Q8H and ceftriaxone 2 g/day is equal tocefotaxime 2 g Q8H. Monotherapy is usually possible for community-acquired Gram-negative bacillus septicemia,pneumonia, osteomyelitis and sepsis of unknown cause (unless in ICU, where double coverage is recommended forCAP). Ceftriaxone in combination with vancomycin is now considered the initial regimen of choice for suspectedpenicillin-resistant pneumococcal meningitis given the increase and spread of pneumococcal strains highlyresistant to penicillin, including southern Wisconsin and northern Illinois (up to 5%). Most pulmonary infections