Diferencia entre revisiones de «Harbor:Sepsis antibiotics»
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Línea 3: Línea 3:
##[[Vancomycin]] 1 g IV
##[[Vancomycin]] 1 g IV
##[[Ceftriaxone]] 1 g IV
##[[Ceftriaxone]] 1 g IV
##Metronidazole 1.5 g IV
##[[Metronidazole]] 1.5 g IV
##Gentamicin 5mg/kg
##[[Gentamicin]] 5mg/kg
#Healthcare Assoc.
#Healthcare Assoc.
##[[Vancomycin]] 1 gm IV
##[[Vancomycin]] 1 gm IV
##Cefepime 2g gm IV
##[[Cefepime]] 2g gm IV
##Metronidazole 1.5 g IV
##[[Metronidazole]] 1.5 g IV
##Gentamicin 5-7 mg/kg
##[[Gentamicin]] 5-7 mg/kg
#Cephalosporin allergy
#Cephalosporin allergy
##[[Vancomycin]] 1 gm IV
##[[Vancomycin]] 1 gm IV
##Metronidazole 1.5 g IV
##[[Metronidazole]] 1.5 g IV
##Gentamicin 5-7 mg/kg IV
##[[Gentamicin]] 5-7 mg/kg IV
##Levofloxacin 750mg IV or (Meropenem or Imipenem 1gm IV outside HGH)
##[[Levofloxacin]] 750mg IV or ([[Meropenem]] or [[Imipenem]] 1gm IV outside HGH)


== [[Pneumonia (Main)|Pneumonia]]  ==
== [[Pneumonia (Main)|Pneumonia]]  ==
Línea 24: Línea 24:


#'''Mild/outpatient PNA(Port I/II):'''  
#'''Mild/outpatient PNA(Port I/II):'''  
##[[Macrolide]] or doxycycline alone (Save [[quinolone]] for sicker pts):  
##[[Macrolide]] or [[doxycycline]] alone (Save [[quinolone]] for sicker pts):  
###'''Azithromycin '''500mg PO Qday x 5 days OR  
###'''[[Azithromycin]] '''500mg PO Qday x 5 days OR  
###'''Clarithromycin '''500mg PO BID x 5 days OR  
###'''[[Clarithromycin]] '''500mg PO BID x 5 days OR  
###'''Doxycycline '''100mg PO BID x 7 days  
###'''[[Doxycycline]] '''100mg PO BID x 7 days  
#'''Hospitalized ward patients (PORT III):'''  
#'''Hospitalized ward patients (PORT III):'''  
##[[Beta-lactam]] + [[macrolide]] OR doxycycline ([[quinolone]] ok, but save for sick pt):  
##[[Beta-lactam]] + [[macrolide]] OR [[doxycycline]] ([[quinolone]] ok, but save for sick pt):  
###'''[[Ceftriaxone]] '''1 gm IV Qday + '''Azithromycin '''500 mg IV Qday OR '''Doxycycline '''100mg IV BID  
###'''[[Ceftriaxone]] '''1 gm IV Qday + '''[[Azithromycin]] '''500 mg IV Qday OR '''[[Doxycycline]] '''100mg IV BID  
###If cephalosporin allergy:  
###If cephalosporin allergy:  
####'''Moxifloxacin '''400 mg IV Qday OR '''Levofloxacin '''750mg IV Qday  
####'''[[Moxifloxacin]] '''400 mg IV Qday OR '''[[Levofloxacin]] '''750mg IV Qday  
#'''PCU/ICU pts w/o RF for Pseudomonas or MRSA:'''  
#'''PCU/ICU pts w/o RF for [[Pseudomonas]] or [[MRSA]]:'''  
##[[Beta-lactam]] + [[macrolide]] OR [[Quinolone]] (Save for sick pts if possible). [[Quinolone]] monotheraphy not acceptable for these pts:  
##[[Beta-lactam]] + [[macrolide]] OR [[Quinolone]] (Save for sick pts if possible). [[Quinolone]] monotheraphy not acceptable for these pts:  
###'''[[Ceftriaxone]] '''1 gm IV Qday + '''Azithromycin '''500 mg IV Qday OR '''Levofloxacin '''750mg IV Qday  
###'''[[Ceftriaxone]] '''1 gm IV Qday + '''Azithromycin '''500 mg IV Qday OR '''Levofloxacin '''750mg IV Qday  
#'''PCU/ICU pts w/RF for Pseudomonas:'''  
#'''PCU/ICU pts w/RF for [[Pseudomonas]]:'''  
##'''Cefepime '''2g IV Q8H + '''Levofloxacin '''750mg IV Qday
##'''[[Cefepime]] '''2g IV Q8H + '''[[Levofloxacin]] '''750mg IV Qday


=== Healthcare Associated PNA (HCAP) + Hospital Associated PNA (HAP)  ===
=== Healthcare Associated PNA (HCAP) + Hospital Associated PNA (HAP)  ===
Línea 44: Línea 44:


#Mild HAP/HCAP no recent abx exposure:  
#Mild HAP/HCAP no recent abx exposure:  
##'''Cefepime '''2g IV Q8H +/- '''Clindamycin '''600mg IV OR '''Metronidazole'''  
##'''[[Cefepime]] '''2g IV Q8H +/- '''[[Clindamycin]] '''600mg IV OR '''[[Metronidazole]]'''  
#Moderate HAP/HCAP or necrotizing PNA:  
#Moderate HAP/HCAP or necrotizing [[PNA]]:  
##Add '''[[Vancomycin]] '''for MRSA  
##Add '''[[Vancomycin]] '''for [[MRSA]]
##If shock, recent ABX, or from SNF/ward:  
##If shock, recent ABX, or from SNF/ward:  
###Add '''Meropenem'''  
###Add '''[[Meropenem]]'''  
#Cephalosporin allergy:  
#Cephalosporin allergy:  
##Clinda 600 mg IV  
##[[Clinda]] 600 mg IV  
##Cipro 400 mg IV  
##[[Cipro]] 400 mg IV  
##Gentamicin 5-7 mg/kg IV
##[[Gentamicin]] 5-7 mg/kg IV


==Abdominal/Pelvic==
==Abdominal/Pelvic==
# Comm. Acquired           
# Comm. Acquired           
##[[Ceftriaxone]] 1 g IV
##[[Ceftriaxone]] 1 g IV
##Metronidazole 1.5 g IV
##[[Metronidazole]] 1.5 g IV
##Gentamicin 5-7 mg/kg IV
##[[Gentamicin]] 5-7 mg/kg IV
# Healthcare Assoc.           
# Healthcare Assoc.           
##Ceftazidime 2 g IV
##[[Ceftazidime]] 2 g IV
##Gentamicin 5 mg/kg IV
##[[Gentamicin]] 5 mg/kg IV
##Metronidazole 1.5 mg IV
##[[Metronidazole]] 1.5 mg IV
# Cephalosporin allergy           
# Cephalosporin allergy           
##Cipro 400 mg IV
##[[Cipro]] 400 mg IV
##Metronidazole 1.5 g IV
##[[Metronidazole]] 1.5 g IV
##Gentamicin 5-7 mg/kg IV
##[[Gentamicin]] 5-7 mg/kg IV


==Urosepsis==
==Urosepsis==
#Comm. Acquired           
#Comm. Acquired           
##[[Ceftriaxone]] 1 g IV
##[[Ceftriaxone]] 1 g IV
##Gentamicin 5-7 mg/kg IV
##[[Gentamicin]] 5-7 mg/kg IV
# Healthcare Assoc.           
# Healthcare Assoc.           
##[[Vancomycin]] 1 g IV
##[[Vancomycin]] 1 g IV
##Ceftazidime 1g IV
##[[Ceftazidime]] 1g IV
##Gentamicin 5-7 mg/kg IV
##[[Gentamicin]] 5-7 mg/kg IV
# Cephalosporin allergy           
# Cephalosporin allergy           
##[[Vancomycin]] 1g IV
##[[Vancomycin]] 1g IV
##Cipro 400 mg IV
##[[Cipro]] 400 mg IV
##Gentamicin 5 mg/kg IV
##[[Gentamicin]] 5 mg/kg IV


==Meningitis (Nl/Community)==
==[[Meningitis]] (Nl/Community)==


# Comm. Acquired           
# Comm. Acquired           
##[[Ceftriaxone]] 2 g IV
##[[Ceftriaxone]] 2 g IV
## Add [[Vancomycin]] 1 g IV if CSF results suggest pneumococcal meningitis (for [[ceftriaxone]] resistant S. pneumoniae)
## Add [[Vancomycin]] 1 g IV if [[CSF]] results suggest [[pneumococcal]] meningitis (for [[ceftriaxone]] resistant [[S. pneumoniae]])
## Add Ampicillin 2g IV Q4H in age >50 years and pregnant
## Add Ampicillin 2g IV Q4H in age >50 years and pregnant
# Cephalosporin allergy           
# Cephalosporin allergy           
##Chloramphenicol 1 g IV
##[[Chloramphenicol]] 1 g IV
##[[Vancomycin]] 1.5g IV
##[[Vancomycin]] 1.5g IV


Línea 94: Línea 94:
# Healthcare Assoc.           
# Healthcare Assoc.           
##[[Vancomycin]] 1.5 g IV
##[[Vancomycin]] 1.5 g IV
##Cefepime 2 g IV
##[[Cefepime]] 2 g IV
# Cephalosporin allergy           
# Cephalosporin allergy           
##[[Vancomycin]] 1.5g IV
##[[Vancomycin]] 1.5g IV
##Cipro 400mg IV
##[[Cipro]] 400mg IV


==Meningitis (Immunocomp)==
==Meningitis (Immunocomp)==
Línea 107: Línea 107:
##[[Vancomycin]] 1g IV
##[[Vancomycin]] 1g IV
# Cephalosporin allergy           
# Cephalosporin allergy           
##Chloramphenicol 1g IV
##[[Chloramphenicol]] 1g IV
##[[Trim/sulfa]] 10mg/kg IV
##[[Trim/sulfa]] 10mg/kg IV
##[[Vancomycin]] 1.5g IV
##[[Vancomycin]] 1.5g IV
Línea 115: Línea 115:
##[[Vancomycin]] 1 gm IV
##[[Vancomycin]] 1 gm IV
##[[Ceftriaxone]] 1 gm IV
##[[Ceftriaxone]] 1 gm IV
##Clinda 600 mg IV
##[[Clinda]] 600 mg IV
##Consider: Gent 5-7mg/k IV
##Consider: Gent 5-7mg/k IV
# Healthcare Assoc.           
# Healthcare Assoc.           
##[[Vancomycin]] 1g IV
##[[Vancomycin]] 1g IV
##Piperacillin/Tazobactam 3.375g IV
##[[Piperacillin/Tazobactam ]]3.375g IV
##Clindamycin 600mg IV
##[[Clindamycin]] 600mg IV
#Cephalosporin allergy           
#Cephalosporin allergy           
##[[Vancomycin]] 1 gm IV
##[[Vancomycin]] 1 gm IV
##Clinda 600 mg IV
##[[Clinda]] 600 mg IV
##Cipro 400 mg IV
##[[Cipro]] 400 mg IV
##Gentamicin 5-7mg/kg
##[[Gentamicin]] 5-7mg/kg


==See Also==
==See Also==

Revisión del 20:28 8 mar 2014

Unknown Source

  1. Comm. Acquired
    1. Vancomycin 1 g IV
    2. Ceftriaxone 1 g IV
    3. Metronidazole 1.5 g IV
    4. Gentamicin 5mg/kg
  2. Healthcare Assoc.
    1. Vancomycin 1 gm IV
    2. Cefepime 2g gm IV
    3. Metronidazole 1.5 g IV
    4. Gentamicin 5-7 mg/kg
  3. Cephalosporin allergy
    1. Vancomycin 1 gm IV
    2. Metronidazole 1.5 g IV
    3. Gentamicin 5-7 mg/kg IV
    4. Levofloxacin 750mg IV or (Meropenem or Imipenem 1gm IV outside HGH)

Pneumonia

Community Acquired Pneumonia (CAP)

MCC by S. pneumoniae. In young must cover for mycoplasma and other atypicals. See Pneumonia (Pathogens)

Treatment based on Pneumonia (Port Score)

  1. Mild/outpatient PNA(Port I/II):
    1. Macrolide or doxycycline alone (Save quinolone for sicker pts):
      1. Azithromycin 500mg PO Qday x 5 days OR
      2. Clarithromycin 500mg PO BID x 5 days OR
      3. Doxycycline 100mg PO BID x 7 days
  2. Hospitalized ward patients (PORT III):
    1. Beta-lactam + macrolide OR doxycycline (quinolone ok, but save for sick pt):
      1. Ceftriaxone 1 gm IV Qday + Azithromycin 500 mg IV Qday OR Doxycycline 100mg IV BID
      2. If cephalosporin allergy:
        1. Moxifloxacin 400 mg IV Qday OR Levofloxacin 750mg IV Qday
  3. PCU/ICU pts w/o RF for Pseudomonas or MRSA:
    1. Beta-lactam + macrolide OR Quinolone (Save for sick pts if possible). Quinolone monotheraphy not acceptable for these pts:
      1. Ceftriaxone 1 gm IV Qday + Azithromycin 500 mg IV Qday OR Levofloxacin 750mg IV Qday
  4. PCU/ICU pts w/RF for Pseudomonas:
    1. Cefepime 2g IV Q8H + Levofloxacin 750mg IV Qday

Healthcare Associated PNA (HCAP) + Hospital Associated PNA (HAP)

HAP occurs if pt develops PNA 2-3 days after hospitalization. HCAP occus in non-hospitalized pt with extensive healthcare contact.

  1. Mild HAP/HCAP no recent abx exposure:
    1. Cefepime 2g IV Q8H +/- Clindamycin 600mg IV OR Metronidazole
  2. Moderate HAP/HCAP or necrotizing PNA:
    1. Add Vancomycin for MRSA
    2. If shock, recent ABX, or from SNF/ward:
      1. Add Meropenem
  3. Cephalosporin allergy:
    1. Clinda 600 mg IV
    2. Cipro 400 mg IV
    3. Gentamicin 5-7 mg/kg IV

Abdominal/Pelvic

  1. Comm. Acquired
    1. Ceftriaxone 1 g IV
    2. Metronidazole 1.5 g IV
    3. Gentamicin 5-7 mg/kg IV
  2. Healthcare Assoc.
    1. Ceftazidime 2 g IV
    2. Gentamicin 5 mg/kg IV
    3. Metronidazole 1.5 mg IV
  3. Cephalosporin allergy
    1. Cipro 400 mg IV
    2. Metronidazole 1.5 g IV
    3. Gentamicin 5-7 mg/kg IV

Urosepsis

  1. Comm. Acquired
    1. Ceftriaxone 1 g IV
    2. Gentamicin 5-7 mg/kg IV
  2. Healthcare Assoc.
    1. Vancomycin 1 g IV
    2. Ceftazidime 1g IV
    3. Gentamicin 5-7 mg/kg IV
  3. Cephalosporin allergy
    1. Vancomycin 1g IV
    2. Cipro 400 mg IV
    3. Gentamicin 5 mg/kg IV

Meningitis (Nl/Community)

  1. Comm. Acquired
    1. Ceftriaxone 2 g IV
    2. Add Vancomycin 1 g IV if CSF results suggest pneumococcal meningitis (for ceftriaxone resistant S. pneumoniae)
    3. Add Ampicillin 2g IV Q4H in age >50 years and pregnant
  2. Cephalosporin allergy
    1. Chloramphenicol 1 g IV
    2. Vancomycin 1.5g IV

Meningitis (Nl/Post neurosurgical)

  1. Healthcare Assoc.
    1. Vancomycin 1.5 g IV
    2. Cefepime 2 g IV
  2. Cephalosporin allergy
    1. Vancomycin 1.5g IV
    2. Cipro 400mg IV

Meningitis (Immunocomp)

(Cirrhosis, EtoH, age > 65, steroids, HIV)

  1. Comm. Acquired
    1. Penicillin G 4M Units IV
    2. Ceftriaxone 2 g IV
    3. Vancomycin 1g IV
  2. Cephalosporin allergy
    1. Chloramphenicol 1g IV
    2. Trim/sulfa 10mg/kg IV
    3. Vancomycin 1.5g IV

Necrotizing Soft-tissue Infection

  1. Comm. Acquired/Healthcare Assoc.
    1. Vancomycin 1 gm IV
    2. Ceftriaxone 1 gm IV
    3. Clinda 600 mg IV
    4. Consider: Gent 5-7mg/k IV
  2. Healthcare Assoc.
    1. Vancomycin 1g IV
    2. Piperacillin/Tazobactam 3.375g IV
    3. Clindamycin 600mg IV
  3. Cephalosporin allergy
    1. Vancomycin 1 gm IV
    2. Clinda 600 mg IV
    3. Cipro 400 mg IV
    4. Gentamicin 5-7mg/kg

See Also

Source

8/16/13 Dr. Spellberg, Uptodate, Harbor-UCLA Antibiotics Review Committee (Rev. 07/27/06)

Obtenido de «https://www.wikem.org/w/index.php?title=Harbor:Sepsis_antibiotics&oldid=18264»