Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

1. Typhoid fever. (NOTE: Third-generation cephalosporins and quinolones have supplanted chloramphenicol in Westernmedical practice.)2. Rickettsial infections. Alternative to tetracyclines in adults and the drug of choice in children less than 8 years of age.(Rocky Mountain Spotted Fever – 500 mg four times daily PO).3. Invasive meningococcal disease in patients with anaphylactoid-type allergies to penicillins or cephalosporins.CommentsDose adjustment may be required for severe renal impairment. See renal dosing guideline on uconnect.Chloramphenicol should be used only for serious infections where other antibiotics are ineffective or contraindicated.Chloramphenicol should not be used for prophylaxis. Chloramphenicol can cause life-threatening bone marrowdepression, gray-baby syndrome in premature newborn infants and optic neuritis. Doses up to 25 mg/kg Q6H should bereserved for CNS infections or for severe infections where the organisms are moderately susceptible. In general,Infectious Disease consultation should be sought prior to chloramphenicol use.Kinetics: IV peak 2 hours after last dose; trough: before next dose.CHLOROQUINE PHOSPHATEUsual DoseAdult: 500 mg weekly – 1 g daily PO (UWHC cost/day $1.55-3.10).Indications1. Prophylaxis and treatment of malaria due to P vivax, P malariae, P ovale and susceptible strains of P falciparum. 300mg (base) OR 500 mg (salt), weekly beginning 1-2 weeks prior to exposure until 4 weeks after leaving endemic area.2. Second-line agent for treatment of extraintestinal amebiasis. The dose is 1 g PO daily for 2 days followed by 500 mgPO daily for 2-3 weeks (with iodoquinol and dehydroemetine).CommentsMost countries have shown increasing malarial resistance to chloroquine. Chloroquine is an antipyretic and may maskfever due to bacterial infection. Chloroquine-resistant falciparum malaria should be treated with an alternate antimalarial.CIDOFOVIRUsual DoseInduction: 5 mg/kg IV Q week x 2 weeks; Maintenance: 5 mg/kg Q 2 weeks (UWHC cost $667.38 per dose).Indications1. Ganciclovir-resistant cytomegalovirus infection.2. Under investigation for BK virus infectionCommentsThe dose-limiting toxicity of cidofovir is nephrotoxicity. The initial dose of cidofovir should be adjusted in renal impairment.Serum creatinine and urine protein should be monitored prior to each dose. If the serum creatinine increases by 0.3 to 0.4mg/dL from baseline during treatment, the dose should be adjusted to 3 mg/kg. If the serum creatinine increases greaterthan 0.5 above baseline or 3+ proteinuria occurs, cidofovir should be discontinued. Concomitant probenecid (2 g PO 3hours prior to infusion, then 1 g PO 1 hour after infusion and 8 hours after infusion, for a total of 4 g) and aggressive salinediuresis (a minimum of 500 mL before and 500 mL after treatment) have been shown to reduce the incidence ofnephrotoxicity (Polis MA et al. Antimicrob Agents Chemother. 1995;39:882-6).Cidofovir has been used in the treatment of BK polyomavirus infection after transplant; the dose ranges from 0.25-1 mg/kggiven at two-week intervals for at least four doses (Blanckaert K et al. Nephrol Dial Transplant 2006;21:3364-7.The safety and efficacy of cidofovir in children have not been established.CIPROFLOXACINUsual DoseAdult: 500-750 mg BID PO (UWHC cost/day $0.28-0.44) OR 400 mg Q8-12H IV (UWHC cost/day $3.08 -4.62).Urinary tract infections: 250 mg BID PO (UWHC cost/day $0.20).