Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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Indications1. Uncomplicated cystitis – treatment of initial and recurrent.2. Recurrent cystitis – prophylaxis.3. Vesicoureteral reflux – prophylaxis.4. UTI due to susceptible enterococci including VRE.CommentsNitrofurantoin is not indicated for pyelonephritis or systemic infections. Nitrofurantoin is contraindicated in children lessthan one month of age. Nitrofurantoin is not useful in patients with creatinine clearance
OXACILLINOxacillin and nafcillin are therapeutically interchangeable at the UWHC. Oxacillin is the current formulary choice.Usual DoseAdult: 1-2 g Q 4 hours IV (UWHC cost/day $45.74-91.48)Pediatric: 25-100 mg/kg/day in divided doses Q 4 hours IV;Indications1. Staphylococcus aureus infections sensitive to oxacillin.2. Skin and soft tissue infections due to Staphylococcus or group A streptococcus.3. Empiric therapy of community-acquired Gram-positive skin and soft-tissue infections.CAUTION: None of the semi-synthetic penicillins are effective against enterococci, methicillin-resistant S aureus,methicillin-resistant coagulase-negative staphylococci, Gram-negative bacilli or Bacteroides fragilis. For endocarditis, thedose is 1.5 - 2 g Q4H IV or 9 -12 g/24H by continuous infusion.Drug Interactions• Aminoglycosides – inactivated by penicillins in admixtures when penicillin:AG ratio is 50:1 or higher• Oral contraceptives – decreased efficacy due alteration of intestinal flora and resultant reduction of enterohepaticcirculation of hormones• Live typhoid vaccine – decreased efficacy; wait 24 hours after end of therapy to give vaccinePAROMOMYCINUsual DoseAdult: 500 mg four times daily PO (UWHC cost/day $8.08).Pediatric:** 30 mg/kg/day PO in divided doses Q8H.Indications1. Intestinal amebiasis (with metronidazole).2. Dientamoeba fragilis infections – alternative treatment to iodoquinol (non-formulary).3. Tapeworm – alternative treatment to praziquantel for tapeworm (niclosamide is a second-line agent).4. Cryptosporidial diarrhea (effectiveness unproven).5. Intestinal Giardia infection during pregnancy.CommentsA non-absorbable oral aminoglycoside. Paromomycin is only effective for intestinal disease and as a back-upantimicrobial for all the indications listed with the exception of cryptosporidial diarrhea. The most prominent side effect isdiarrhea in doses >3 g daily.PENICILLIN G (K + or Na + Salts)Usual DoseAdult: 1-4 million units Q4-6H IV (UWHC cost/day $2.68-16.13).Meningitis 2-4 million units Q4H or continuous infusion IV (UWHC cost/day $8.06-16.13).Pediatric:** 100,000 – 500,000 units/kg/day IV in divided doses Q4H.Indications1. Susceptible pneumococci, beta-hemolytic streptococci, viridans streptococci, meningococci, clostridia and Pasteurellamultocida infections.2. Severely contaminated open fractures, especially those occurring in the farm yard setting, to cover for potentialclostridial contamination.3. Actinomycosis.4. Lyme Disease (ceftriaxone is recommended for therapy of late disease).5. Congenital syphilis.6. CNS syphilis.
Page 2 and 3: PREFACEThe Antimicrobial Use Guidel
Page 4 and 5: Antimicrobial Cost Table (Cost info
Page 6 and 7: Summary of Antibiotic Order Form: S
Page 8: LUNGS/PULMONARYCommunity-Acquired P
Page 12 and 13: PART I: BY DRUGABACAVIRFor up-to-da
Page 14 and 15: constructed systemic-pulmonary shun
Page 16 and 17: AMPICILLIN/SULBACTAM (Unasyn ® )Us
Page 18 and 19: ATOVAQUONE/PROGUANIL (Malarone ® )
Page 20 and 21: CEFAZOLINUsual DoseAdult: Moderate/
Page 22 and 23: CommentsDose adjustment required fo
Page 24 and 25: 1. Typhoid fever. (NOTE: Third-gene
Page 26 and 27: -Dutasteride-Eltrombopag-Theophylli
Page 28 and 29: CLINDAMYCINUsual DoseAdult: 600-900
Page 30 and 31: DAPTOMYCINInfectious Disease approv
Page 32 and 33: Concurrent administration with peni
Page 34 and 35: • Cisapride (contraindicated) •
Page 36 and 37: • Oral contraceptives/hormones -
Page 38 and 39: Synergy in infective endocarditis a
Page 40 and 41: • Colchicine • Indinavir • Ta
Page 42 and 43: • Donepezil • Pioglitazone• D
Page 44 and 45: with linezolid should be considered
Page 46 and 47: 4. Life-threatening Gram-negative i
Page 48 and 49: MOXIFLOXACINLevofloxacin and moxifl
Page 52 and 53: CommentsDose adjustment required fo
Page 54 and 55: PIPERACILLIN/TAZOBACTAM (Zosyn ® )
Page 56 and 57: PRIMAQUINEUsual DoseAdult: Malaria
Page 58 and 59: RIFABUTINUsual DoseAdult (150 mg ca
Page 60 and 61: • Chloramphenicol • Leflunomide
Page 62 and 63: SULFISOXAZOLENo longer available as
Page 64 and 65: TICARCILLIN/CLAVULANATE (Timentin
Page 66 and 67: 2. Recurrent urinary tract infectio
Page 68 and 69: VANCOMYCINUsual DoseAdult: 1 g Q12H
Page 70 and 71: Careful monitoring of patients usin
Page 72 and 73: APPENDIX B: UWHC SURGICAL ANTIMICRO
Page 74 and 75: GI:Appendectomy 3Anaerobic organism
Page 76 and 77: VascularLIKELYPATHOGENS• ANTIMICR
Page 78 and 79: Cleanorthopedicprocedures(other)Sta
Page 80 and 81: APPENDIX C: THERAPY FOR TUBERCULOSI
Page 82 and 83: p-Aminosalicylic acid(PAS)Granules
Page 84 and 85: Appendix D: UNIVERSITY OF WISCONSIN
Page 86 and 87: Appendix E: UWHC Guidelines for the
Page 88 and 89: B. Antifungal Prophylaxis for BMT a
Page 90 and 91: D. Cost ComparisonDrugAmphotericin
Page 92 and 93: 17. Maertens J, Glasmacher A, Herbr
Page 94 and 95: 47. Courtney R, Wexler D, Radwanski
Page 96 and 97: 2.1.7 Patient is without placement
Page 98 and 99: Medications Approved for Parenteral
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APPENDIX G: Serum Drug Concentratio
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APPENDIX H: Guidelines for Monitori
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1. Patients with large volumes of d
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16. Tsuji B, Rybak MJ. The influenc
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APPENDIX I: Infectious Diseases App
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APPENDIX J: UWHC Guidelines For the
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with aztreonam and other beta-lacta
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D. Side Chains1.2.5. The prescriber
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14. Pichichiro ME. Use of selected
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Appendix KUWHC Guidelines for Cost-
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sulfa and can be prescribed topatie
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superinfection: amoxicillin 1 g PO
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17. Smucny J, Fahey T, Becker L, Gl
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Appendix M: Guidelines for the Prop
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D. CategorizationPatients should be
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Empiric coverage for Enterococcus i
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H. Necrotizing PancreatitisThe publ
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Bone or JointEndocarditis 4Streptoc
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Candidemia or candidiasis 11Non-neu
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11. Pappas PG, Kauffman CA, Andes D
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piperacillin/tazobactam. There were
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D. Dose of Antibiotic1. Piperacilli
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TNAVasopressinVoriconazoleMeropenem
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pretreatment with an H1-histamine b
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formal consult is not required, but
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K. References1.0 Bliziotis IA, Ples
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Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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