Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

• Astemizole (contraindicated)• Chloral hydrate• Cisapride (contraindicated)• Fluconazole• Terfenadine (contraindicated)• TMP/SMZ• Tricyclic antidepressantsConcurrent administration of foscarnet with other nephrotoxic drugs increases the risk of development of renalimpairment.FOSFOMYCIN (Monurol ® )Usual DoseAdult women: Single 3 g dose mixed in 3 to 4 ounces of water (UWHC cost/day $37.90)Indications1. Uncomplicated urinary tract infections in women due to E. coli and E. faecalis2. Fosfomycin may have utility in UTIs caused by ESBL-producing organisms and VRE.CommentsLab is capable of providing susceptibilities for E. coli and Enterococcus faecialisorganisms only.GANCICLOVIR (Also see valganciclovir)Usual DoseAdult: Treatment 5 mg/kg Q12H IV (UWHC cost/day $87.93).Maintenance 5 mg/kg Q24H IV (UWHC cost/day $43.97)Pediatrics:** Induction 5 mg/kg Q12H IV.Maintenance 5 mg/kg Q24H IV.Indications1. Cytomegalovirus (CMV) retinitis, pneumonitis or enterocolitis, esophagitis or bloodstream infections.2. CMV prophylaxis - oral formulation is now valganciclovir3. Congenital CMV infectionsCommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect. Dosing in excess of thatrecommended by the renal dosing guideline may occasionally be necessary depending on the clinical scenario.Ganciclovir has a high incidence of complicating neutropenia (30-40%) and thrombocytopenia (20%). Dosage reductionsshould be considered if patients develop neutropenia, anemia or thrombocytopenia. Do not administer to patients withsevere neutropenia. Patients have received longer courses of ganciclovir when the neutropenia has been controlled withcolony-stimulating factors. If colony-stimulating factors are given to maintain ANC >1000, the cost is less than foscarnettherapy. The alkaline pH of ganciclovir causes pain and phlebitis at the injection site. The manufacturer recommends thatganciclovir be handled similarly to chemotherapeutic drugs during preparation and administration – discard waste in blackmedication bins. Ganciclovir has activity against herpes simplex virus and varicella-zoster virus. Concomitant use ofganciclovir and acyclovir is unnecessary, and increases costs and toxicity.Drug InteractionsGanciclovir increases the hematotoxicity of zidovudine.Ganciclovir increases the bioavailablity of didanosine, thus increasing the toxicity of didanosine.Ganciclovir increases drug exposure to tenofovir (and vice-versa) due to competition for drug secretion, potentiallyincreasing toxicity.Concurrent administration with tacrolimus increases the risk of nephrotoxicity.GENTAMICINUsual DoseAdult: Systemic infections 5 mg/kg daily or 2.5 mg/kg Q12H or 1.5 mg/kg Q8H IV (UWHC cost/day $2.48-4.31).Urinary tract infections 1-3 mg/kg daily IV/IM (UWHC cost/day $0.83-2.48).