Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

For adults recovering from intraabdominal infections who are able to tolerate anoral diet, completion of the antimicrobial course with oral forms of moxifloxacin,ciprofloxacin or levofloxacin plus metronidazole, an oral cephalosporin withmetronidazole, or amoxicillin/clavulanic acid is acceptable provided resistantorganisms have not been isolated.Cultures are not routinely needed unless patients have been on an antibioticwithin the last three months; then cultures should be considered and the priorantibiotic should be taken into account in the empiric antibiotic selection.If a lower-risk patient with a community-acquired infection is improving on empirictherapy and source control it is not necessary to adjust therapy if unsuspectedand untreated pathogens are reported later.2. Community-Acquired Severe Infection/High-Risk/Immunocompromised• Piperacillin/tazobactam• Metronidazole PLUS cefepime or ciprofloxacin• Meropenem,* ertapenem,* moxifloxacin, tigecycline*o Less desirable due to broad spectrum or costo *-ID restrictedCultures from the site of infection should be obtained routinely especially ifthe patient has had prior antibiotic exposure or is more likely to have resistantorganisms.Empiric coverage for yeast and/or MRSA is not recommended in the absenceof evidence of infection with these organisms. Empiric coverage forEnterococcus is recommended for severe infections:• Ampicillin• Piperacillin/tazobactam• VancomycinFor transplant and severely immunocompromised patients, also refer to theHealthcare-Associated Infection section3. Healthcare-Associated Infection• Piperacillin/tazobactam• Metronidazole PLUS cefepime or ciprofloxacin• Meropenem,* ertapenem*o *-ID restrictedo Carbapenems do not cover the enterococci well