Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Intra-abdominal Infection 5Complicated intra-abdominal infectionsAcute stomach & proximal jejunumperforationsBowel injuries (penetrating, blunt, oriatrogenic trauma)Acute appendicitis (without perforation,abscess, or local peritonitis)Cholecystitis, bowel obstruction andbowel infarctionSevere necrotizing pancreatitis prior tothe diagnosis of infectionMeningitis 6Neisseria meningitides and HaemophilusinfluenzaeStreptococcus pneumoniaeStreptococcus agalactiaeAerobic gram-negative bacilliListeria monogytogenesPneumonia 7,8Community Acquired PneumoniaHospital AssociatedPneumonia/Ventilator AssociatedSepsis 9Good source controlPoor source controlLast Guideline: 2010 / Projected Update: Unknown4-7 days: (> 7 days if unable to achieve adequate source control)< 24 hours: assumes adequate source control (focus of inflammation orinfection is completely eliminated surgically and no extension of infectionbeyond the organ in question) and antibiotic therapy within 1 hour prior tooperation.< 24 hours: Repair 12 hours< 24 hours: Prophylactic therapy with narrow spectrum aerobic andfacultative anaerobic coverage (administer within 1 hour before operation)< 24 hours: assumes adequate source control (focus of inflammation orinfection is completely eliminated surgically and no extension of infectionbeyond the organ in question)No antibiotic therapy recommended7 days10-14 days14-21 days21 days≥ 21 daysLast Guideline: 2007 and 2005 / Projected Update: Unknown5 days PLUS afebrile x48-72hrs and clinically stable(*clinical instability defined by tachycardia, tachypnea, hypotension, O 2desaturation, NPO status, and/or mental status changes from baseline)>5-7 days: initial therapy not active or complicated by extrapulmonaryinfection7 days: initial antimicrobial selection correct and good clinical response>7 days: P. aeruginosaLast Guideline: 2008 / Projected Update: Unknown7-10 days>10 days: slow clinical response, undrainable foci, immunologic deficiencySkin and Skin structure infection 10 Last Guideline: 2005 / Projected Update: Spring 2010NeutropeniaImmune-compromised with cellularimmunity deficiency (lymphomas, BMT,solid organ transplants, corticosteroidand other immunosuppressant use)Impetigo (due to Staphylococcus &Streptococcus species)`Animal bitesHuman bites7-14 days: Gram Negative Bacteria7-10 days: Gram Positive Bacteria7-14 days: Secondary Infection with antibiotic-resistant bacteriaDependent on clinical and radiological resolution3-12 months Nocardia species3-6 weeks Atypical mycobacteria8-12 weeks Cryptococcus species8-12 weeks Histoplasma species7-10 days Varicella-zoster virus7 days Herpes simplex virus21 days Cytomegalovirus~7 days, depending on clinical response3-5 days prophylaxis for moderate to severe wound, have crush injury,associated edema, are on the hands, or are close to bones/joints, or are incompromised hosts5-10 days if associated cellulitis and abscess4 weeks Septic Arthritis6 weeks Osteomyelitis