Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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APPENDIX I: Infectious Diseases Approval of Restricted AntimicrobialsPURPOSE: To describe a mechanism for obtaining Infectious Diseases Section Approval oforders for restricted antimicrobials.POLICY:Designated physicians from the Infectious Diseases Section will review forapproval all orders for restricted antimicrobials. The designated physician will becontacted via a centralized paging system.PROCEDURE:1.0 The Pharmacy and Therapeutics Committee will determine which antimicrobial agentsrequire Infectious Diseases approval before dispensing.2.0 The Department of Pharmacy will maintain a list of current restricted antimicrobials as partof the UWHC formulary.3.0 The Infectious Diseases Section will designate a physician or physicians to be responsiblefor the approval of restricted antimicrobials.4.0 A designated physician will be contacted whenever an order for a restricted antimicrobial iswritten.4.1 When the order for the restricted antimicrobial is written, the pharmacist will informthe ordering, covering or attending physician of the existence of this policy(Pharmacy Policy #13.19) and that Infectious Diseases approval is required beforethe drug can be dispensed.4.1.1 If a patient is admitted on a restricted antimicrobial, Infectious Diseasesapproval is still required unless previous ID approval for the specific drughas been obtained for the current course of therapy.4.2 Between the hours of 0700 and 2300, the ordering physician or his/her physiciandesignee will contact either the Infectious Diseases designated physician via pager#3333. The Infectious Diseases Fellow may be contacted as a backup for approvalat his or her assigned pager if there is no response at the #3333 pager.4.3 The ordering physician will provide information to the Infectious Diseasesdesignated physician including patient MR#, unit, clinical condition and clinicalrationale for the use of the restricted antimicrobial.4.4 If the request is made between 2300 and 0700, or if a delay in approval of greaterthan one hour is anticipated, the pharmacy may dispense a single dose of therestricted antimicrobial. However, Infectious Diseases approval is required beforeany subsequent doses may be dispensed.4.5 The Infectious Diseases designated physician will discuss the appropriateness ofthe request with the ordering physician or designee and make a decision onwhether or not to approve the order. The prescribing physician will notify the unitpharmacist when approval is given and inform the pharmacist of the name of thephysician who gave the approval. The unit pharmacist will contact the InfectiousDiseases designated physician to verify that approval has been given.4.5.1 If the attending physician and the designated Infectious Diseasephysician do not agree, a single dose of the drug may be dispensed untila formal or informal ID consultation is obtained. A second ID staffphysician may serve as an arbitrator for the case.
4.5.1.1 To assist with the resolution of these cases, a formal IDconsultation may be requested by the attending physician.4.5.1.2 If a formal consultation is not requested, an informalantimicrobial consultation will take place for which the IDrecommendations and rationale will be documented in thepatient’s medical record. These cases will be followed-up bythe UWHC MUE and P&T Committees for qualityimprovement purposes.4.6 The decentral pharmacist will document the name of the ID physician who approvedthe order in the comments section of the medication order in the pharmacy orderentry computer system.4.7 This policy does not apply to orders written by ID Section physicians.Antimicrobials restricted to ID ApprovalFormulary antimicrobials:Aztreonam (Azactam ® )Daptomycin (Cubicin ® )Ertapenem (Invanz ® )Levofloxacin (Levaquin ® ) – with some exceptionsLinezolid (Zyvox ® )Liposomal amphotericin B (Ambisome ® )Meropenem (Merrem ® ) - with some exceptionsMicafungin (Mycamine ® )Posaconazole (Noxafil ® )Rifampin, intravenous onlyTigecycline (Tygacil ® )Voriconazole (Vfend ® )Nonformulary antimicrobials:Anidulafungin (Eraxis ® )Caspofungin (Cancidas ® )Quinupristin/Dalfopristin (Synercid ® )
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PREFACEThe Antimicrobial Use Guidel
Page 4 and 5:
Antimicrobial Cost Table (Cost info
Page 6 and 7:
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
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AMPICILLIN/SULBACTAM (Unasyn ® )Us
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ATOVAQUONE/PROGUANIL (Malarone ® )
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CEFAZOLINUsual DoseAdult: Moderate/
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CommentsDose adjustment required fo
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1. Typhoid fever. (NOTE: Third-gene
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-Dutasteride-Eltrombopag-Theophylli
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CLINDAMYCINUsual DoseAdult: 600-900
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DAPTOMYCINInfectious Disease approv
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Concurrent administration with peni
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• Cisapride (contraindicated) •
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• Oral contraceptives/hormones -
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Synergy in infective endocarditis a
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• Colchicine • Indinavir • Ta
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• Donepezil • Pioglitazone• D
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with linezolid should be considered
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4. Life-threatening Gram-negative i
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MOXIFLOXACINLevofloxacin and moxifl
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Indications1. Uncomplicated cystiti
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CommentsDose adjustment required fo
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PIPERACILLIN/TAZOBACTAM (Zosyn ® )
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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 106 and 107: 16. Tsuji B, Rybak MJ. The influenc
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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Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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