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*[[File:Harbor-UCLA_Medical_Center_Empiric_Antibiotic_Recommendations_for_Inpatient_Adult_2022.pdf|Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Inpatient Adult 2022]]
*[[File:Harbor-UCLA_Medical_Center_Empiric_Antibiotic_Recommendations_for_Inpatient_Adult_2022.pdf|Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Inpatient Adult 2022]]
*[[File:Harbor-UCLA_Medical_Center_Empiric_Antibiotic_Recommendations_for_Outpatient_Adult_2022.pdf|Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Outpatient Adult 2022]]
*[[File:Harbor-UCLA_Medical_Center_Empiric_Antibiotic_Recommendations_for_Outpatient_Adult_2022.pdf|Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Outpatient Adult 2022]]
**SKIN & SOFT TISSUE INFECTIONS (SSTI)
==SKIN & SOFT TISSUE INFECTIONS (SSTI)==
***Cellulitis (no purulence) (x 5-7 days)
*Cellulitis (no purulence) (x 5-7 days)
****Dual antibiotic treatment is not indicated. Cephalexin 500mg PO QID OR Clindamycin 450mg PO TID OR TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg)
**'''Dual antibiotic treatment is not indicated.'''
***Purulent SSTI (x 5-7 days)
**Cephalexin 500mg PO QID OR Clindamycin 450mg PO TID OR TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg)
****Dual antibiotic treatment is not indicated. Incision & Drainage first and then TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg) OR Doxycycline 100mg PO BID
*Purulent SSTI (x 5-7 days)
**EAR, NOSE, & THROAT INFECTIONS
**'''Dual antibiotic treatment is not indicated.'''
***Otitis Externa (x 7 days)
**Incision & Drainage first and then TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg) OR Doxycycline 100mg PO BID
****Oral therapy is NOT recommended unless extension beyond the external ear canal or severely immunocompromised. Use antibiotic ear drops (Cortisporin Otic 4 drops in affected ear TID OR Ciprodex 4 drops in affected ear BID). If perforated, use Ciprodex.
==EAR, NOSE, & THROAT INFECTIONS==
***Acute Sinusitis (x 5 days)
*Otitis Externa (x 7 days)
****Mainly viral, consider watchful waiting with supportive measures. Consider antibiotics for failure to improve ≥10 d after onset of URI, or biphasic illness <10 d with worsening after initial improvement. Amoxicillin/clavulanate 875/125mg PO BID OR Doxycycline 100mg PO BID
**Oral therapy is NOT recommended unless extension beyond the external ear canal or severely immunocompromised.  
***Group A Strep (GAS) Pharyngitis
**Use antibiotic ear drops (Cortisporin Otic 4 drops in affected ear TID OR Ciprodex 4 drops in affected ear BID). If perforated, use Ciprodex.
****Antibacterial therapy should only be used when testing shows the presence of GAS. Do not rely on Centor criteria to diagnose GAS. Penicillin VK 500mg PO BID x 10 days OR Benzathine PCN 1.2 million units IM x 1. If PCN allergy, Azithromycin 500mg PO x 3 days
*Acute Sinusitis (x 5 days)
**RESPIRATORY INFECTIONS
**'''Mainly viral''', consider watchful waiting with supportive measures. Consider antibiotics for failure to improve ≥10 d after onset of URI, or biphasic illness <10 d with worsening after initial improvement.  
***Acute Bronchitis
**Amoxicillin/clavulanate 875/125mg PO BID OR Doxycycline 100mg PO BID
****NO antibiotics are indicated; offer symptomatic management and realistic timeframe for cough resolution (2-4 wk). To help reframe patient’s reference point, consider terminology such as “viral chest cold.”
*Group A Strep (GAS) Pharyngitis
***Acute Exacerbation of Chronic Bronchitis (x 3-5d)
**Antibacterial therapy should only be used when POC PCR testing shows the presence of GAS. '''Do not rely on Centor criteria to diagnose GAS.'''
****In patients with emphysema, COPD, or significant tobacco abuse, consider prescriptions for steroids and bronchodilators. Antibiotics help reduce risk of recurrence for moderate to severe symptoms (purulent sputum with dyspnea and/or increased sputum volume). Azithromycin 500mg PO Daily x 3 days OR Doxycycline 100mg PO BID x 5 days
**Penicillin VK 500mg PO BID x 10 days OR Benzathine PCN 1.2 million units IM x 1. If PCN allergy, Azithromycin 500mg PO x 3 days
***Community-acquired Pneumonia (x 5 days)
==RESPIRATORY INFECTIONS==
****Healthy adults without comorbidities: Amoxicillin 1g PO TID OR Doxycycline 100mg PO BID
*Acute Bronchitis
****Adults with comorbidities: Amoxicillin/clavulanate 875/125mg PO BID AND Azithromycin 500mg PO x 1 day then 250mg PO x 4 days OR Levofloxacin 750mg PO daily monotherapy
**'''No antibiotics are indicated'''; offer symptomatic management and realistic time frame for cough resolution (2-4 wk). To help reframe patient’s reference point, consider terminology such as “viral chest cold.”
**GENITAL INFECTIONS
*Acute Exacerbation of Chronic Bronchitis (x 3-5d)
***Urethritis/Cervicitis
**In patients with emphysema, COPD, or significant tobacco abuse, consider prescriptions for steroids and bronchodilators.  
****Empiric treatment for both gonorrhea and chlamydia is reasonable in symptomatic high risk patients. Screen for HIV/syphilis, use sexual assault order set if indicated. Ceftriaxone 500mg IM [1g if >150kg] x1 AND Doxycycline monohydrate 100mg PO BID x 7 days OR Azithromycin 1g PO x1 (if pregnant)
**Antibiotics help reduce risk of recurrence for moderate to severe symptoms defined as '''purulent sputum''' and either '''dyspnea''' and/or '''increased sputum volume'''
**URINARY INFECTIONS
**Azithromycin 500mg PO Daily x 3 days OR Doxycycline 100mg PO BID x 5 days
***Asymptomatic Bacteriuria (x 5-7 days)
*Community-acquired Pneumonia (x 5 days)
****Diagnosed by urine culture (>105 CFU), NOT urinalysis. No treatment indicated unless pregnant, received renal transplant in past 30 days, or undergoing GU procedure. Nitrofurantoin (Macrobid)† 100mg PO BID x 5d
**Healthy adults without comorbidities: Amoxicillin 1g PO TID OR Doxycycline 100mg PO BID
****If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
**Adults with comorbidities: Amoxicillin/clavulanate 875/125mg PO BID AND Azithromycin 500mg PO x 1 day then 250mg PO x 4 days OR Levofloxacin 750mg PO daily monotherapy
***Cystitis
==GENITAL INFECTIONS==
****Refer to outpatient urinary antibiogram below to guide empiric treatment. Presence of squamous cells in the urinalysis indicates that the specimen is contaminated and cannot be used for UTI diagnosis. Nitrofurantoin (Macrobid)† 100mg PO BID x 5 days OR TMP-SMX DS 1 tab PO BID x 3 days
*Urethritis/Cervicitis
****If history of ESBL, consider: FosfomycinR 3gm PO x 1 dose
**Empiric treatment for both gonorrhea and chlamydia is reasonable in symptomatic high risk patients. Screen for HIV/syphilis, use sexual assault order set if indicated.  
****If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
**Ceftriaxone 500mg IM [1g if >150kg] x1 AND Doxycycline monohydrate 100mg PO BID x 7 days OR Azithromycin 1g PO x1 (if pregnant)
***Pyelonephritis (x 7 days)
==URINARY INFECTIONS==
****Ceftriaxone 1g IV x1 can be considered in more severe cases pending cultures.TMP-SMX DS 1 tab PO BID OR Ciprofloxacin 500mg PO BID
*Asymptomatic Bacteriuria (x 5-7 days)
**Diagnosed by urine culture (>105 CFU), '''NOT urinalysis'''. No treatment indicated unless pregnant, received renal transplant in past 30 days, or undergoing GU procedure.  
**Nitrofurantoin (Macrobid)† 100mg PO BID x 5d
**If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
*Cystitis
**Refer to [https://wikem.org/w/index.php?title=Harbor:Antibiogram outpatient urinary antibiogram] to guide empiric treatment. Presence of squamous cells in the urinalysis indicates that the specimen is contaminated and cannot be used for UTI diagnosis.  
**Nitrofurantoin (Macrobid)† 100mg PO BID x 5 days OR TMP-SMX DS 1 tab PO BID x 3 days
**If history of ESBL, consider: FosfomycinR 3gm PO x 1 dose
**If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
*Pyelonephritis (x 7 days)
**Ceftriaxone 1g IV x1 can be considered in more severe cases pending cultures.
**TMP-SMX DS 1 tab PO BID OR Ciprofloxacin 500mg PO BID


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

Revisión del 04:40 9 jul 2022

This page is for antibiotics specific to the Harbor-UCLA Medical Center; see Antibiotics by diagnosis for for national guidelines.

Harbor:Antibiotics by diagnosis

Harbor Empiric Guidelines

SKIN & SOFT TISSUE INFECTIONS (SSTI)

  • Cellulitis (no purulence) (x 5-7 days)
    • Dual antibiotic treatment is not indicated.
    • Cephalexin 500mg PO QID OR Clindamycin 450mg PO TID OR TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg)
  • Purulent SSTI (x 5-7 days)
    • Dual antibiotic treatment is not indicated.
    • Incision & Drainage first and then TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg) OR Doxycycline 100mg PO BID

EAR, NOSE, & THROAT INFECTIONS

  • Otitis Externa (x 7 days)
    • Oral therapy is NOT recommended unless extension beyond the external ear canal or severely immunocompromised.
    • Use antibiotic ear drops (Cortisporin Otic 4 drops in affected ear TID OR Ciprodex 4 drops in affected ear BID). If perforated, use Ciprodex.
  • Acute Sinusitis (x 5 days)
    • Mainly viral, consider watchful waiting with supportive measures. Consider antibiotics for failure to improve ≥10 d after onset of URI, or biphasic illness <10 d with worsening after initial improvement.
    • Amoxicillin/clavulanate 875/125mg PO BID OR Doxycycline 100mg PO BID
  • Group A Strep (GAS) Pharyngitis
    • Antibacterial therapy should only be used when POC PCR testing shows the presence of GAS. Do not rely on Centor criteria to diagnose GAS.
    • Penicillin VK 500mg PO BID x 10 days OR Benzathine PCN 1.2 million units IM x 1. If PCN allergy, Azithromycin 500mg PO x 3 days

RESPIRATORY INFECTIONS

  • Acute Bronchitis
    • No antibiotics are indicated; offer symptomatic management and realistic time frame for cough resolution (2-4 wk). To help reframe patient’s reference point, consider terminology such as “viral chest cold.”
  • Acute Exacerbation of Chronic Bronchitis (x 3-5d)
    • In patients with emphysema, COPD, or significant tobacco abuse, consider prescriptions for steroids and bronchodilators.
    • Antibiotics help reduce risk of recurrence for moderate to severe symptoms defined as purulent sputum and either dyspnea and/or increased sputum volume
    • Azithromycin 500mg PO Daily x 3 days OR Doxycycline 100mg PO BID x 5 days
  • Community-acquired Pneumonia (x 5 days)
    • Healthy adults without comorbidities: Amoxicillin 1g PO TID OR Doxycycline 100mg PO BID
    • Adults with comorbidities: Amoxicillin/clavulanate 875/125mg PO BID AND Azithromycin 500mg PO x 1 day then 250mg PO x 4 days OR Levofloxacin 750mg PO daily monotherapy

GENITAL INFECTIONS

  • Urethritis/Cervicitis
    • Empiric treatment for both gonorrhea and chlamydia is reasonable in symptomatic high risk patients. Screen for HIV/syphilis, use sexual assault order set if indicated.
    • Ceftriaxone 500mg IM [1g if >150kg] x1 AND Doxycycline monohydrate 100mg PO BID x 7 days OR Azithromycin 1g PO x1 (if pregnant)

URINARY INFECTIONS

  • Asymptomatic Bacteriuria (x 5-7 days)
    • Diagnosed by urine culture (>105 CFU), NOT urinalysis. No treatment indicated unless pregnant, received renal transplant in past 30 days, or undergoing GU procedure.
    • Nitrofurantoin (Macrobid)† 100mg PO BID x 5d
    • If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
  • Cystitis
    • Refer to outpatient urinary antibiogram to guide empiric treatment. Presence of squamous cells in the urinalysis indicates that the specimen is contaminated and cannot be used for UTI diagnosis.
    • Nitrofurantoin (Macrobid)† 100mg PO BID x 5 days OR TMP-SMX DS 1 tab PO BID x 3 days
    • If history of ESBL, consider: FosfomycinR 3gm PO x 1 dose
    • If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
  • Pyelonephritis (x 7 days)
    • Ceftriaxone 1g IV x1 can be considered in more severe cases pending cultures.
    • TMP-SMX DS 1 tab PO BID OR Ciprofloxacin 500mg PO BID

See Also


References

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