Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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AMPICILLIN/SULBACTAM (Unasyn ® )Usual DoseAdult: 1.5-3 g Q4-6H IV (UWHC cost/day $6.88-20.01)Pediatric:** 100-200 mg ampicillin component/kg/day IV in divided doses Q4-6HIndications1. Community-acquired (aspiration) pneumonia with high suspicion of anaerobic component.2. Polymicrobial soft tissue infections such as diabetic foot ulcers and postsurgical wound infections.3. Polymicrobial community-based intra-abdominal or genitourinary infections with microbiologically documentedsensitivities.4. Serious infected animal or human bite wounds – first-line intravenous therapy.5. Haemophilus influenzae infections, except meningitis.6. Susceptible Acinetobacter infectionsCommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect. Avoid use of ampicillin-classantibiotics in patients with mononucleosis due to high risk of development of erythematous rash and erroneous allergyattribution. Sulbactam enhances ampicillin's spectrum to include penicillinase-producing Staphylococcus aureus,Haemophilus influenzae, and anaerobic bacteria and improves its aerobic Gram-negative spectrum, but not forPseudomonas aeruginosa. For GI anaerobes, Unasyn ® has activity comparable to metronidazole, Zosyn ®(piperacillin/tazobactam) and meropenem but greater activity when compared to clindamycin, cefoxitin, and the thirdgenerationcephalosporins. Safety and effectiveness have not been established for children for intra-abdominal infections.CAUTION: Increasing numbers of Escherichia coli, Enterobacter, Klebsiella and Citrobacter produce high amounts ofbeta-lactamase and are resistant to Unasyn ® . NOTE: Other combination antibiotics base their dose either on onecomponent (e.g. Primaxin ® ) or both components (e.g. trimethoprim/sulfamethoxazole). Unasyn ® labeling states the doseby adding the two components of ampicillin (2 g) plus sulbactam (1 g), i.e., 3 g. For ampicillin-susceptibleEnterococcus there is no evidence that Unasyn ® is superior to ampicillin alone. Ampicillin is always the drug offirst choice for patients who are not penicillin-allergic and have an ampicillin-susceptible strain of Enterococcus.Sodium content = 2.9-3.1 mEq/G.ANIDULAFUNGIN – nonformulary at UWHCInfectious Disease approval required for all use of anidulafungin (see Appendix I)Anidulafungin, caspofungin and micafungin are therapeutically interchangeable at UWHC. Micafungin is the currentformulary choice.Usual DoseAdult: 200 mg loading dose, then 100 mg IV daily (UWHC cost/day $173.93)Indications1. Candidemia, Candida intra-abdominal abscesses and Candida peritonitis2. Esophageal candidiasisARTEMETHER/LUMEFANTRINE (Coartem®)Usual DoseAdult: 4 tablets initially, 4 tabs again after 8 hours and then 4 tabs twice daily for the following two days (24 total tablets)(UWHC cost/day $67.25)Pediatric (dose by body weight):5 to
Indications1. Treatment of acute, uncomplicated malaria infection due to Plasmodium falciparum in patients of 5kg bodyweight andabove2. Shown to be effective in geographical regions where resistance to chloroquine has been reportedCommentsPlease contact the ID service when considering use of this medication.Artemether/Lumefantrine tablets are not approved for the prevention of malaria. Tablets should be taken with food andmay be crushed and mixed with a small amount of water immediately prior to use. In the event of vomiting within 1 to 2hours of administration, a repeat dose should be taken. If the repeat dose is vomited, the patient should be given analternative antimalarial for treatment. May cause QT prolongation and should be used cautiously with other agents thatmay cause QT prolongation.ATAZANAVIR – nonformulary at UWHCFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/ATOVAQUONEUsual DoseAdult: 750 mg BID PO for active therapy, once or twice daily for prophylaxis (UWHC cost/day $21.72-43.44).Indications1. Mild to moderate Pneumocystis jiroveci pneumonia treatment in patients unable to tolerate trimethoprim/sulfamethoxazole, dapsone, trimethoprim or pentamidine.2. P jiroveci infection prophylaxis in patients unable to tolerate trimethoprim/sulfamethoxazole.CommentsAtovaquone should be taken with food to improve bioavailability.
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 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
Page 30 and 31: DAPTOMYCINInfectious Disease approv
Page 32 and 33: Concurrent administration with peni
Page 34 and 35: • 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
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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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47. Courtney R, Wexler D, Radwanski
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2.1.7 Patient is without placement
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Medications Approved for Parenteral
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APPENDIX G: Serum Drug Concentratio
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APPENDIX H: Guidelines for Monitori
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1. Patients with large volumes of d
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16. Tsuji B, Rybak MJ. The influenc
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APPENDIX I: Infectious Diseases App
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APPENDIX J: UWHC Guidelines For the
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with aztreonam and other beta-lacta
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D. Side Chains1.2.5. The prescriber
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14. Pichichiro ME. Use of selected
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Appendix KUWHC Guidelines for Cost-
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sulfa and can be prescribed topatie
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superinfection: amoxicillin 1 g PO
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17. Smucny J, Fahey T, Becker L, Gl
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Appendix M: Guidelines for the Prop
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D. CategorizationPatients should be
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Empiric coverage for Enterococcus i
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H. Necrotizing PancreatitisThe publ
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Bone or JointEndocarditis 4Streptoc
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Candidemia or candidiasis 11Non-neu
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11. Pappas PG, Kauffman CA, Andes D
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piperacillin/tazobactam. There were
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D. Dose of Antibiotic1. Piperacilli
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TNAVasopressinVoriconazoleMeropenem
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pretreatment with an H1-histamine b
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formal consult is not required, but
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K. References1.0 Bliziotis IA, Ples
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