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Antibiotic DOC

QuestionAnswer
Cardiac or Vascular Surgery Recommended Cefazolin OR Cefuroxime OR Vancomycin
Cardiac or Vascular Surgery if Pen allergy Vancomycin OR Clindamycin
Cardiac or Vascular Surgery if Pen allergy Vancomycin OR Clindamycin
UTI SMX/TMP DS x 3 days
UTI SMX/TMP DS x 3 days
UTI if Sulfa allergy Cipro 250mg BID OR Levofloxacin 250mg QD OR Nitrofurantoin 100mg BID x 5 days OR Fosfomycin 3g X 1 dose
UTI if Sulfa allergy Cipro 250mg BID OR Levofloxacin 250mg QD OR Nitrofurantoin 100mg BID x 5 days OR Fosfomycin 3g X 1 dose
Uncomplicated Polynephritis FQ x 5-7 days OR Cipro 500mg BID OR Levofloxicin 750mg QD OR Ofloxicin 400mg BID
Complicated UTI Ampicillin+Gentamicin OR Pipiricillin+Tazobactam OR Ticarcillin+Clavulinic acid OR Ceftriaxone+-FQ OR Cefotaxime+-FQ
Complicated UTI with ESBL Doripenem OR Imipenem OR Meropenem x 2 Weeks
UTI Special consideration; What groups require longer therapy 7+ days? Pregnant, Elderly, Men, Children, and Diabetics
Phenazopyridine Dose 200mg TID Max 2 days (OTC dose 100mg TID)
Traveler's Diarrhea Cipro 500mg BID x 3 days OR SMX/TMP DS BID x 7-10 days OR Ofloxacin, levofloxacin, rifaxamin, metronidazole, Tinidazole, nitazoxanide, Azithromycin (Add Loperamide 4mg once then 2mg after each loose stool max 16mg/d)
Traveler's Diarrhea in Pregnancy Azithromycin 1000mg x 1 dose OR 500mg QD x 1-3 days (also DOC for children)
Traveler's Diarrhea, When is Loperamide ContraIndicated? Fever or Blood in stool
Traveler's Diarrhea, When do we consider parasites as cause? >7days
C. Dif. Diarrhea Severe infection Vancomycin 125mg QID x 10-14 Days
Clostidium Difficile Diarrhea Metronidazole 500mg TID x 10-14 Days
C. Dif. Diarrhea Severe infection Vancomycin 125mg QID x 10-14 Days
C. Dif upon 3rd episode at any severity Vancomycin 125mg QID for 2 weeks, then BID x 1 week, then 3 times weekly for 2-8 weeks (Avoid metronidazole due to possible Neurotoxicity)
Special precautions with C. Diff Pt. Wash hands with soap and water (alcohol sanitizers do not kill the spores)
Acute Bronchitis Initial treatment Antitussive +- Inhaled bronchodilator
When do we consider ABX therapy for Bronchitis persistent cough > 14 days
Persistent cough therapy Z-Pack OR Erythromycine estolate 500mg QID x 14 days OR SMX/TMP DS BID x 14 days, OR Clarithromycin 500mg BID x 7 days
Acute Bacterial Exacerbation of Chronic Bronchitis (ABECB) No ABX
CAP Therapy Macrolide OR Doxycycline
CAP in AT Risk for Drug resistant S. Pneumonia, or 65+ and comorbidities Respiratory FQ (Levo 750mg) OR Beta-lactam + Macrolide
CAP for Inpatient (IV preferred) Respiratory FQ (Levo 750mg) OR Beta-lactam + Macrolide
CAP if Pseudomonas is suspected Antipseudomonal Beta-lactam + (Antipseudomonal FQ OR AMG)
CA-MRSA Vancomycin OR Linezolid
HAP/VAP Therapy Piperacillin/Tazobactam 4.5g Q6H OR Ceftriaxone 1-2g Q24H OR Ampicillin/Sulbactam 3g Q6h OR Ertapenem 1g Q24H
HAP/VAP Therapy if Legionella or Bioterroorism Add or Replace with Levo OR Moxifloxicin
HAP/VAP IF P. Aeruginosa is suspected Anti-Pseudomonal Beta-lactam AND (Cipro OR Levo)OR AMG
Syphilis Pen G 2.4MU IM, OR Doxycycline 100mg BID x 2 weeks. (pregnant patient who is allergic to pen must be desensitized)
Neurosyphilis Pen G 3-4MU IV Q4H x 10-14 days (Outpatient Pen G + Probenecid x 10-14 days)
Gonorrhea Ceftriaxone 250mg IM OR Cefixime 400mg PO, ORCefpodoxime 400mg PO. (Alt Azithromycin 2g OR Cefoxitin 2g IM + Probenecid OR Cefotaxime 500mg)
Chlamydia Azithromycin 1g (Alt. Doxycycline 100mg BID x 7 days,OR Erythromycin 500mg QID x 7 days)
Bacterial Vaginosis Metronidazole 500mg BID x 7 days OR Metrogel 5g vaginally x 5 days (Alt. Clindamycin 300mg BID x 7 days or vaginally 100mg QHS x 3 days OR Tinidazole 2g daily x2 days or 1g daily x 5 days)
Trichomoniasis Metronidazole 2g OR Tinidazole 2g (Alt. metronidazole 500mg BID x 7 days)
Initial episode Herpes Acyclovir 400mg TID x 7-10 days OR Valacyclovir 1g BID x 7-10 days (IF resistant strain and severe Foscarnet 40mg/kg IV Q8H until resolution)
Recurrent Herpes Acyclovir 800mg TID x 2 days or BID for 5 days OR Valacyclovir 1g daily x 5 days or 500mg bid x 3 days
Herpes Suppression Acyclovir 400mg BID OR Valacyclovir 500-1000mg QD
Tuberculosis Isoniazid + Rifampin + Pyrazinamide + Ethambutol x 26 weeks (if resistant remove drug and add FQ increase TX dependant on drug replaced INH - 6 months, RIF - 12-18 months, multiple- 18-24 months)
Latent TB INH 300mg QD x 9 months OR Rifampin 600mg QD x 4 months (add Pyridoxine-B6 to INH tx to prevent neuropathy)
Acute Otitis Media Amoxicillin 90mg/kg/day Divided Q12 or Q8H x 5-7 days or 10 days if severe (Usually observe 48-72H before ABX to rule out Viral) (Alt. Azithromycin 10mg/kg/d day 1 5mg/kg/d 2-5)
Infective Endocarditis NATIVE VALVE -Nafcillin or oxacillin 2g IV Q4H x 6 weeks +- Gentamycin 1mg/kg Q8H x 3-5 days (Increase Gentamycin to 14 days) IF Pen allergic Vanco 15mg/kg Q12H x 6 weeks
Infective Endocarditis due to Non MSSA Pen G 12-30MU Divided Q4H OR Ampicillin 12g/d divided Q4H, plus Gentamycin OR Ceftriaxone OR Streptomycin
Infective Endocarditis Resistant Vancomycin 15mg/kg Q12H x 6 weeks + Gentamicin 1mg/kg Q8H x 6 weeks (resistant to Vanco use Linezolid 600mg Q12H 8+ weeks OR Synersid 22.5mg/kg/d divided TID 8+ weeks
Bacterial Meningitis Cefotaxime 2g Q4-6H OR Ceftriaxone 2g Q12H OR Meropenem 2G Q8H always add Dexamethasone 0.15mg/kg Q6H x 2-4 days AND Vancomycin 30-45 mg/kg divided (Add Ampicillin 2g Q4H if <1month, >50yrs, or listeria)
Bacterial Meningitis W/ Severe Pen allergy Chloramphenicol 4-6g/d divided QID + Vancomycin (If Listeria suspected add SMX/TMP 5mg/kg Q6H)
Rocky Mountain Spotted Fever OR Typhus OR Ehrlichosis Doxycycline 100mg BID x 7 days
Lyme Disease Doxycycline 100mg BID OR Amoxicillin 500mg TID x 14-21 days
Tularemia Gentamycin or Tobramycin 5mg/kg/d divided Q8H x 7-14 days
Created by: savejoseph