Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

3. Pyelonephritis.4. Susceptible Stenotrophomonas maltophilia infections.5. Mycobacterial infections.6. Bacterial sinusitis.7. Acute bacterial exacerbations of chronic bronchitis.8. Skin and skin structure infections.9. Bacterial proctatitis.10. Chlamydial infections.11. Epidydimitis12. Non-gonococcal urethritis.13. Nosocomial pneumonia.14. Inhalational anthrax post-exposure prophylaxis.CommentsDose adjustment required in renal failure. See guideline on uconnect.Drug InteractionsLevofloxacin may prolong the QT interval, an effect that may be additive with the QT-prolonging effects of many drugsincluding the following:• Anti-arrhythmic agents• Lumefantrine• Antipsychotic drugs• Methadone• Dronaderone• Nilotinib• Droperidol• Pazopanib• Fluconazole• Sunitinib• Haloperidol• Telavancin• Lapatinib• TetrabenazineLevofloxacin has other miscellaneous drug interactions:• Insulin and oral antidiabetic agents – increased risk of hyper- or hypoglycemia• Nonsteroidal anti-inflammatory drugs – increased risk of seizures, especially in patients with seizure disorders• Antacids and divalent cations – chelate levofloxacin; must be administered 2H before or 6H after levofloxacin dose• Corticosteroids – increased risk of quinolone-related tendon rupture• Quercetin – reduced efficacy of levofloxacin via competition for DNA gyrase binding sitesLINEZOLIDInfectious Disease approval is required for all use of linezolid (See Appendix I).Usual DoseAdult: 600 mg BID PO/IV (UWHC cost/day PO $148.12; IV $193.43).Pediatric: 10 mg/kg dose PO/IV Q8HIndications1. Vancomycin-resistant Enterococcus faecium infections, including those with concurrent bacteremia.2. Methicillin-resistant S. aureus infections in patients unable to tolerate vancomycin therapy, or in transition to outpatienttherapy where IV therapy would be necessary. Combination therapy may be warranted if Gram-negative organisms arepresent.3. Serious MRSA infections, including documented MRSA hospital-acquired pneumonia.4. In the rare case of a patient with a Gram-positive infection who is unable to tolerate other conventional antibiotics.CommentsMyelosuppression (including anemia, leukopenia, pancytopenia, and thrombocytopenia) has been reported withprolonged use, especially greater than 14 days. Complete blood counts should be monitored weekly in patients whoreceive linezolid, particularly in those who receive linezolid for longer than 2 weeks, and especially transplant patients,those with pre-existing myelosuppression, those receiving concomitant drugs that produce bone marrow suppression orthose with a chronic infection who have received previous or concomitant antibiotic therapy. Discontinuation of therapy