Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

Indications1. Oropharyngeal candidiasis.COARTEM ® (see Artemether/Lumetantrine)COLISTIMETHATE SODIUM (Coly-Mycin ® )Usual DoseAdult: 2.5-5 mg/kg/day divided Q6-12H IV (UWHC cost/day $12.06 - $24.12)Pediatric:** 2.5-5 mg/kg/day divide Q6-12H IVIndications1. Susceptible Gram-negative infections caused by multi-drug-resistant organisms, including E. coli, P. aeruginosa, K.pneumoniae, E. cloacae and Acinetobacter baumanii.2. Inhalation therapy of respiratory infections due to P. aeruginosa.3. Maintenance inhalation for suppression of resistant Gram-negative bacteria in cystic fibrosis patientsCommentsDose adjustment required for IV dosing renal impairment. See renal dosing guideline on uconnect. Dose for inhalationtherapy of P. aeruginosa respiratory infection is 150 mg Q8H. Dose for maintenance inhalation in cystic fibrosis patientsis 75-150 mg twice daily. Colistimethate sodium (CMS) is not FDA-approved for nebulization. Solutions for nebulizationshould be used promptly because CMS in solution undergoes spontaneous hydrolysis to form colistin, which is toxic tolung tissue. See the FDA’s Information for Healthcare Professionals:http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm124896.htmCOMBIVIR ®For up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/DAPSONEUsual DoseAdult: 50-100 mg daily PO (UWHC cost/day $1.04-1.70).Pediatrics:** 1 mg/kg/day PO.Indications1. Leprosy.2. Pneumocystis jiroveci pneumonia.a. Prophylaxis, second-line agent, with or without pyrimethamine.b. Treatment, third-line agent, in combination with trimethoprim.3. Alternate for Pneumocystis jiroveci prophylaxis in patients with a sulfa allergy. Dose is 50 mg Q12H or 100 mg oncedaily.4.Toxoplasma gondii treatment.CommentsThe most frequent adverse effects of dapsone are methemoglobinemia and dose-related hemolytic anemia (checkglucose-6-phosphate dehydrogenase prior to prescribing dapsone).Drug InteractionsAmprenavir and Saquinavir inhibit the metabolism of dapsone by CYP3A4, potentially increasing its toxicity.Probenecid and trimethoprim reduce the clearance of dapsone, thereby potentially increasing serum levels.Rifabutin and rifampin decrease the efficacy of dapsone, possibly by inducing CYP 3A4.Zidovudine increases the hematologic toxicity of dapsone.