Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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16. Tsuji B, Rybak MJ. The influence of Staphylococcus aureus accessory gene regulator function onthe development of glycopeptide hetroresistance in an in vitro phmarcodynamic model [abstractP-1590]. Presented at 15th European Congress of Clinical Microbiology and Infectious Diseases.Vol Copenhagen, Denmark2005.17. Rybak MJ. Pharmacodynamics: relation to antimicrobial resistance. Am J Med. 2006;119:S37-44;discussion S62-70.18. Wang G, Hindler JF, Ward KW, Bruckner DA. Increased vancomycin MICs for Staphylococcusaureus clinical isolates from a university hospital during a 5-year period. J Clin Microbiol.2006;44:3883-3886.19. Hidayat LK, Hsu DI, Quist R, Shriner KA, Wong-Beringer A. High-dose vancomycin therapy formethicillin-resistant Staphylococcus aureus infections: efficacy and toxicity. Arch Intern Med.2006;166:2138-2144.20. Sakoulas G, Moise-Broder PA, Schentag J, Forrest A, Moellering RC, Jr., Eliopoulos GM.Relationship of MIC and bactericidal activity to efficacy of vancomycin for treatment of methicillinresistantStaphylococcus aureus bacteremia. J Clin Microbiol. 2004;42:2398-2402.21. Tenover FC, Moellering RC, Jr. The rationale for revising the Clinical and Laboratory StandardsInstitute vancomycin minimal inhibitory concentration interpretive criteria for Staphylococcusaureus. Clin Infect Dis. 2007;44:1208-1215.22. Moise PA, Sakoulas G, Forrest A, Schentag JJ. Vancomycin in vitro bactericidal activity and itsrelationship to efficacy in clearance of methicillin-resistant Staphylococcus aureus bacteremia.Antimicrob Agents Chemother. 2007;51:2582-2586.23. Lodise TP, Graves J, Evans A, et al. Relationship between vancomycin MIC and failure amongpatients with methicillin-resistant Staphylococcus aureus bacteremia treated with vancomycin.Antimicrob Agents Chemother. 2008;52:3315-3320.24. Elting LS, Rubenstein EB, Kurtin D, et al. Mississippi mud in the 1990s: risks and outcomes ofvancomycin-associated toxicity in general oncology practice. Cancer. 1998;83:2597-2607.25. Bailie GR, Neal D. Vancomycin ototoxicity and nephrotoxicity. A review. Med Toxicol AdverseDrug Exp. 1988;3:376-386.26. Rybak MJ, Albrecht LM, Boike SC, Chandrasekar PH. Nephrotoxicity of vancomycin, alone andwith an aminoglycoside. J Antimicrob Chemother. 1990;25:679-687.27. Ingram PR, Lye DC, Tambyah PA, Goh WP, Tam VH, Fisher DA. Risk factors for nephrotoxicityassociated with continuous vancomycin infusion in outpatient parenteral antibiotic therapy. JAntimicrob Chemother. 2008;62:168-171.28. Lodise TP, Lomaestro B, Graves J, Drusano GL. Larger vancomycin doses (at least four gramsper day) are associated with an increased incidence of nephrotoxicity. Antimicrob AgentsChemother. 2008;52:1330-1336.29. Jeffres MN, Isakow W, Doherty JA, Micek ST, Kollef MH. A retrospective analysis of possiblerenal toxicity associated with vancomycin in patients with health care-associated methicillinresistantStaphylococcus aureus pneumonia. Clin Ther. 2007;29:1107-1115.30. Forouzesh A, Moise PA, Sakoulas G. Vancomycin ototoxicity: a reevaluation in an era ofincreasing doses. Antimicrob Agents Chemother. 2009;53:483-486.31. Bauer LA, Black DJ, Lill JS. Vancomycin dosing in morbidly obese patients. Eur J ClinPharmacol. 1998;54:621-625.32. Blouin RA, Bauer LA, Miller DD, Record KE, Griffen WO, Jr. Vancomycin pharmacokinetics innormal and morbidly obese subjects. Antimicrob Agents Chemother. 1982;21:575-580.33. Ducharme MP, Slaughter RL, Edwards DJ. Vancomycin pharmacokinetics in a patient population:effect of age, gender, and body weight. Ther Drug Monit. 1994;16:513-518.34. Hall RG, 2nd, Payne KD, Bain AM, et al. Multicenter evaluation of vancomycin dosing: emphasison obesity. Am J Med. 2008;121:515-518.35. Pai MP, Bearden DT. Antimicrobial dosing considerations in obese adult patients.Pharmacotherapy. 2007;27:1081-1091.36. Penzak SR, Gubbins PO, Rodvold KA, Hickerson SL. Therapeutic drug monitoring of vancomycinin a morbidly obese patient. Ther Drug Monit. 1998;20:261-265.37. Vance-Bryan K, Guay DR, Gilliland SS, Rodvold KA, Rotschafer JC. Effect of obesity onvancomycin pharmacokinetic parameters as determined by using a Bayesian forecastingtechnique. Antimicrob Agents Chemother. 1993;37:436-440.
38. Matzke GR, McGory RW, Halstenson CE, Keane WF. Pharmacokinetics of vancomycin inpatients with various degrees of renal function. Antimicrob Agents Chemother. 1984;25:433-437.39. Moellering RC, Jr. Pharmacokinetics of vancomycin. J Antimicrob Chemother. 1984;14 SupplD:43-52.40. Murphy JE, Gillespie DE, Bateman CV. Predictability of vancomycin trough concentrations usingseven approaches for estimating pharmacokinetic parameters. Am J Health Syst Pharm.2006;63:2365-2370.41. Roberts JA, Lipman J. Antibacterial dosing in intensive care: pharmacokinetics, degree of diseaseand pharmacodynamics of sepsis. Clin Pharmacokinet. 2006;45:755-773.42. Spinler SA, Nawarskas JJ, Boyce EG, Connors JE, Charland SL, Goldfarb S. Predictiveperformance of ten equations for estimating creatinine clearance in cardiac patients. IohexolCooperative Study Group. Ann Pharmacother. 1998;32:1275-1283.43. Yang RH, Rong XZ, Hua R, Zhang T. Pharmacokinectics of vancomycin and amikacin in thesubeschar tissue fluid in patients with severe burn. Burns. 2009;35:75-79.44. Nakayama H, Echizen H, Tanaka M, Sato M, Orii T. Reduced vancomycin clearance despiteunchanged creatinine clearance in patients treated with vancomycin for longer than 4 weeks.Ther Drug Monit. 2008;30:103-107.45. Foote EF, Dreitlein WB, Steward CA, Kapoian T, Walker JA, Sherman RA. Pharmacokinetics ofvancomycin when administered during high flux hemodialysis. Clin Nephrol. 1998;50:51-55.46. Ariano RE, Fine A, Sitar DS, Rexrode S, Zelenitsky SA. Adequacy of a vancomycin dosingregimen in patients receiving high-flux hemodialysis. Am J Kidney Dis. 2005;46:681-687.47. Barth RH, DeVincenzo N. Use of vancomycin in high-flux hemodialysis: experience with 130courses of therapy. Kidney Int. 1996;50:929-936.48. Pai AB, Pai MP. Vancomycin dosing in high flux hemodialysis: a limited-sampling algorithm. Am JHealth Syst Pharm. 2004;61:1812-1816.49. Trotman RL, Williamson JC, Shoemaker DM, Salzer WL. Antibiotic dosing in critically ill adultpatients receiving continuous renal replacement therapy. Clin Infect Dis. 2005;41:1159-1166.Additional helpful references50. Forouzesh A, Moise PA, Sakoulas G. Vancomycin ototoxicity: a reevaluation in an era ofincreasing doses. Antimicrob Agents Chemother 2009;53:483-6.51. Nakayama H, Echizen H, Tanaka M, Sato M, Orii T. Reduced vancomycin clearance despiteunchanged creatinine clearance in patients treated with vancomycin for longer than 4 weeks.Ther Drug Monit 2008;30:103-7.52. Pea F, Furlanut M, Negri C, Pavan F, Crapis M, Cristini F, Viale P. Prospectively validateddosing nomograms for maximizing the pharmacodynamics of vancomycin administered bycontinuous infusion in critically ill patients. Antimicrob Agents Chemother 2009;53:1863-1867.
Page 2 and 3:
PREFACEThe Antimicrobial Use Guidel
Page 4 and 5:
Antimicrobial Cost Table (Cost info
Page 6 and 7:
Summary of Antibiotic Order Form: S
Page 8:
LUNGS/PULMONARYCommunity-Acquired P
Page 12 and 13:
PART I: BY DRUGABACAVIRFor up-to-da
Page 14 and 15:
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
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DAPTOMYCINInfectious Disease approv
Page 32 and 33:
Concurrent administration with peni
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• 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 66 and 67: 2. Recurrent urinary tract infectio
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 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
Page 116 and 117: 14. Pichichiro ME. Use of selected
Page 118 and 119: Appendix KUWHC Guidelines for Cost-
Page 120 and 121: sulfa and can be prescribed topatie
Page 122 and 123: superinfection: amoxicillin 1 g PO
Page 124 and 125: 17. Smucny J, Fahey T, Becker L, Gl
Page 126 and 127: Appendix M: Guidelines for the Prop
Page 128 and 129: D. CategorizationPatients should be
Page 130 and 131: Empiric coverage for Enterococcus i
Page 132 and 133: H. Necrotizing PancreatitisThe publ
Page 134 and 135: Bone or JointEndocarditis 4Streptoc
Page 136 and 137: Candidemia or candidiasis 11Non-neu
Page 138 and 139: 11. Pappas PG, Kauffman CA, Andes D
Page 140 and 141: piperacillin/tazobactam. There were
Page 142 and 143: D. Dose of Antibiotic1. Piperacilli
Page 144 and 145: TNAVasopressinVoriconazoleMeropenem
Page 146 and 147: pretreatment with an H1-histamine b
Page 148 and 149: formal consult is not required, but
Page 150: K. References1.0 Bliziotis IA, Ples
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