Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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2. Recurrent urinary tract infection prophylaxis.3. Pneumocystis jiroveci pneumonia, as the drug of first choice (15-20 mg TMP/kg/day; 75-100 mg/kg/day divided Q6HIV). Rash or hematologic toxicity is common in patients with AIDS.4. Pneumocystis jiroveci prophylaxis for transplant or HIV + (whose CD 4 has ever been
VALACYCLOVIRUsual DoseAdult: 1 g TID PO OR 500 mg BID PO (UWHC cost/day $5.92-17.76).Indications1. Herpes zoster (shingles) in immunocompetent individuals (1 g TID PO x 7 days). Must be started within 72 hours ofonset of rash to be effective, except in immunocompromised hosts.2. Herpes simplex (genital herpes) – acute recurrence (500 mg BID PO x 3- 5 days).3. Herpes labialis (cold sores) – initiate therapy at first sign of tingling (2 g BID for 1 day).CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Valacyclovir, a prodrug, is the L-valyl ester of acyclovir. It is metabolized to acyclovir by hepatic enzymes. The oralbioavailability of valacyclovir is 3 to 5 times higher than that of acyclovir, making lower doses and longer dosing intervalspossible. An increasing trend toward mortality from thrombotic thrombocytopenic purpura/hemolytic uremic syndrome(TTP/HUS) was seen in one clinical trial with immunocompromised patients at supranormal doses, making its use in thispopulation questionable. The safety and efficacy of valacyclovir in children have not been established.VALGANCICLOVIRUsual DoseAdult: Induction 900 mg BID PO x 21 days (UWHC cost/day 158.16).Maintenance and prophylaxis 900 mg Q24H PO (UWHC cost/day $79.08).Indications1. Cytomegalovirus (CMV) retinitis, pneumonitis, enterocolitis, esophagitis or bloodstream infections.2. CMV prophylaxis - oral formulation restricted to prophylaxis of CMV infections in transplant recipients receiving a graftfrom a seropositive donor or who are seropositive for CMV and in patients receiving anti-rejection therapy.CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Oral bioavailability is 60%. Patients should be monitored for progression of CMV retinitis and signs and symptoms ofadverse effects including granulocytopenia, anemia, thrombocytopenia, seizures, sedation, ataxia, confusion, increasedcreatinine, diarrhea, nausea, vomiting, fever, headache, insomnia, peripheral neuropathy, paresthesia and retinaldetachment. Valganciclovir should not be administered if the absolute neutrophil count is less than 500 cells/mcL, theplatelet count is less than 25,000/mcL or the hemoglobin is less than 8 g/dL. The bioavailability of ganciclovir fromvalganciclovir differs significantly from that of ganciclovir capsules; therefore, valganciclovir tablets cannot be substitutedfor ganciclovir capsules on a one-to-one basis. Valganciclovir tablets should not be crushed; may use suspension.Patients taking zidovudine and valganciclovir may not be able to tolerate full doses of both drugs because of themyelosuppressive effects of each drug.Drug InteractionsProbenecid may increase the area under the curve (AUC) of valganciclovir and thus may increase the likelihood of toxicityfrom valganciclovir. Valganciclovir may increase the AUC of didanosine and increase the potential for didanosine toxicity.
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PREFACEThe Antimicrobial Use Guidel
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Antimicrobial Cost Table (Cost info
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Summary of Antibiotic Order Form: S
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LUNGS/PULMONARYCommunity-Acquired P
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PART I: BY DRUGABACAVIRFor up-to-da
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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 50 and 51: Indications1. Uncomplicated cystiti
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 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
Page 100 and 101: APPENDIX G: Serum Drug Concentratio
Page 102 and 103: APPENDIX H: Guidelines for Monitori
Page 104 and 105: 1. Patients with large volumes of d
Page 106 and 107: 16. Tsuji B, Rybak MJ. The influenc
Page 108 and 109: APPENDIX I: Infectious Diseases App
Page 110 and 111: APPENDIX J: UWHC Guidelines For the
Page 112 and 113: with aztreonam and other beta-lacta
Page 114 and 115: 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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