Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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.