Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

4. Complicated skin infections caused by methicillin-sensitive strains of S aureus or S pyogenes where a broaderspectrum of antimicrobial activity is initially needed. Maintains good spectrum of gram-positive activity for non-MRSAorganisms.5. Neutropenic fever, empiric therapy.6 Complicated healthcare-associated intraabdominal infections in combination with metronidazole.CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Cefepime is a fourth-generation cephalosporin with activity against P aeruginosa similar to ceftazidime but with moreactivity against staphylococci, group G streptococci, Enterobacter sp., C freundii, and M morganii than ceftazidime.Cefepime is ineffective against Burkholderia cepacia and less effective than ceftazidime against Stenotrophomonasmaltophilia. In these situations, ceftazidime is the preferred product. Cefepime can often be used to treat infectionscaused by Gram-negative bacteria possessing ESBL and AmpC resistance mechanisms.CEFOTAXIME – non-formulary at UWHC except for neonates and for infants with hyperbilirubinemiaUsual DoseAdult: 1-2 g Q6-12H IV (up to 12 g daily) (UWHC cost/day $2.30-9.20)Pediatric: 50-200 mg/kg/day in divided doses Q6-8 hours (up to 12 g daily)CEFOXITINFor adults, cefotetan and cefoxitin are therapeutically interchangeable at the UWHC. Cefoxitin is the current formularychoiceUsual DoseAdult: 1-2 g Q6-8H IV (UWHC cost/day $9.95-26.54).Surgical prophylaxis 1-2 g IV as a single dose (UWHC cost/day $3.32-6.64).Pediatric: 80-160 mg/kg/day in divided doses Q4-6H.Indications1. Surgical prophylaxis where anaerobic coverage is needed, e.g., colorectal or gynecological surgery (see Appendix B).2. Mixed community-acquired aerobic/anaerobic intraabdominal or pelvic infections. Drug of choice from 2010 IDSA andSurgical Infection Society Guidelines. Alternative to clindamycin, metronidazole or ampicillin/sulbactam. It is usually NOTnecessary to combine with metronidazole.3. Soft tissue and bone infection.4. Penetrating abdominal trauma.CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.CEFPODOXIME PROXETILFor adults, cefpodoxime proxetil and cefuroxime axetil are therapeutically interchangeable at the UWHC. Cefpodoximeproxetil is the current formulary choice for adults. For children, cefpodoxime proxetil and cefdinir are therapeuticallyinterchangeable at the UWHC. Cefdinir is the current formulary pediatric choice.Usual DoseAdult: 100-400 mg BID PO (UWHC cost/day $5.25-12.23) depending of severity of disease..Pediatrics** 10 mg/kg/day PO divided into 2 doses.Indications1. Sinusitis (200 mg BID PO) – third-line agent.2. Community-acquired pneumonia in patients who have comorbidity and/or are 60 years of age or older (200 mg BIDPO). May be used for step-down therapy from ceftriaxone.3. Cat or dog bites - alternative to ampicillin/sulbactam or doxycycline.4. Urinary tract, skin/soft tissue infections – an alternative to less expensive agents.