Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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TNAVasopressinVoriconazoleMeropenemCompatible Incompatible No InformationAtropine Acyclovir AmiodaroneDaptomycin Amphotericin (all formulations) AzithromycinDexamethasone Diazepam CalciumDexmedetomidine Doxycycline CiprofloxacinDigoxin Fenoldopam CisatracuriumDiltiazem Metronidazole DroperidolDiphenhydramine Mannitol DrotrecoginDobutamine Ondansetron EsmololDopamine Pantoprazole FentanylEnalaprilat Sodium Bicarbonate FosphenytoinFluconazoleGanciclovirFurosemideHaloperidolGentamicinHydralazineHeparinHydrocortisoneHydromorphoneLabetalolInsulinLidocaineLinezolidMethylprednisoloneLorazepamMetoprololMagnesiumMicafunginMetoclopramideMidazolamMilrinoneNaloxoneMorphineNitroglycerinNorepinephrineNitroprussidePotassium ChloridePhenylephrineRanitidinePotassium PhosphateTacrolimusPropofolTNASodium PhosphateVancomycinTobramycinVasopressinVoriconazole
UWHC Guidelines for the Use of Daptomycin (Cubicin ® )Guidelines developed by: Antimicrobial Use Subcommittee; UWHC Drug Policy Program (DPP)Authors: Barry Fox, MD, Sarah E. Bland, RPhUpdated by: Lucas Schulz, PharmDCoordination: Sara Shull, PharmD, MBA, Manager, DPPReviewed by: David Andes, MD; Barry Fox, MD; Dennis Maki, MD, Antimicrobial UseSubcommittee; Carol A. Spiegel, PhD, Marie Pietruszka, PharmDOriginally Approved by P&T Committee: July 2010Updated: February 2011Scheduled For Review: February 2013A. BackgroundAntimicrobial resistance among Gram-positive organisms, particularly the sharply risingincidence of life-threatening infections caused by methicillin-resistant staphylococci (MRSA)and vancomycin-resistant enterococci (VRE), has become a major concern. Newantimicrobial drugs that are effective against these organisms are available; however, topreserve their utility, minimize their unique toxicities and provide cost-effective therapy, it isessential to ensure that these newer agents are used selectively and appropriately.Daptomycin (Cubicin ® , Cubist Pharmaceuticals) is the first antibiotic in the new cycliclipopeptide class. It is bactericidal in a concentration-dependent manner against a widevariety of Gram-positive organisms, including those resistant to vancomycin.B. Appropriate IndicationsAppropriate use of daptomycin for extended therapy will usually require aculture/susceptibility test with identification of an organism that exhibits resistance to otherpossible antimicrobial agents. Based on the potential for bacterial resistance associated withthe use of daptomycin, the UW Pharmacy and Therapeutics Committee has approved its usein the following conditions:1.0 For patients with bacteremia with suspected MRSA, (i.e., coagulase-positive grampositivecocci in a blood culture with identification and sensitivities not yet completed)with daptomycin dosed at 6 mg/kg. Step-down therapy to vancomycin should usually bemade if the vancomycin MIC of the organism is ≤1.5 mcg/mL. Under certaincircumstances approved by Infectious Diseases, daptomycin may be continued unlessthe vancomycin MIC is ≤1.0 mcg/mL, usually in more serious staphylococcal infections.2.0 Life-threatening infection, usually septic shock, endocarditis, complex deep skin andsoft tissue infections (SSTIs) or intraabdominal sepsis, where there is strong suspicionthat the patient is infected by MRSA or VRE (e.g., the patient is known to have been or iscurrently colonized by these organisms). If the cultures do not confirm MRSA or VREinfection within 72 hours, daptomycin should be switched to vancomycin or otherantibiotics.3.0 Invasive infections caused by vancomycin-resistant Enterococcus faecium such asbacteremia, intraabdominal infection, or deep SSTIs.4.0 SSTIs or osteomyelitis caused by MRSA with a vancomycin MIC >1.5 mcg/mL. Undercertain circumstances approved by Infectious Diseases, daptomycin may be continuedunless the vancomycin MIC is ≤1.0 mcg/mL.5.0 Other MRSA/VRE indications :5.1 Unable to tolerate vancomycin therapy. Combination therapy may bewarranted if gram-negative organisms are present. A history of vancomycin“red man syndrome” (the histamine-release reaction) should generally not beconsidered a reason to use daptomycin for primary treatment; in that circumstance,
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PREFACEThe Antimicrobial Use Guidel
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Antimicrobial Cost Table (Cost info
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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
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RIFABUTINUsual DoseAdult (150 mg ca
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• Chloramphenicol • Leflunomide
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SULFISOXAZOLENo longer available as
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TICARCILLIN/CLAVULANATE (Timentin
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2. Recurrent urinary tract infectio
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VANCOMYCINUsual DoseAdult: 1 g Q12H
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Careful monitoring of patients usin
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APPENDIX B: UWHC SURGICAL ANTIMICRO
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GI:Appendectomy 3Anaerobic organism
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VascularLIKELYPATHOGENS• ANTIMICR
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Cleanorthopedicprocedures(other)Sta
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APPENDIX C: THERAPY FOR TUBERCULOSI
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p-Aminosalicylic acid(PAS)Granules
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Appendix D: UNIVERSITY OF WISCONSIN
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Appendix E: UWHC Guidelines for the
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B. Antifungal Prophylaxis for BMT a
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D. Cost ComparisonDrugAmphotericin
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17. Maertens J, Glasmacher A, Herbr
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Page 98 and 99: Medications Approved for Parenteral
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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 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 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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