Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

• Methyldopa – concurrent administration may result in hypertensive emergency• Reserpine – increased catecholamine toxicityLOPINAVIR/RITONAVIR (Kaletra ® )For up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/MALARONE ® --see atovaquone/proguanilMARAVIROC (Selzentry ® ) – nonformulary at UWHCFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/MEFLOQUINEUsual DoseAdult: Prophylaxis 250 mg weekly PO (UWHC cost/day $4.19).Treatment 1.25 g PO one dose only (UWHC cost/day $20.959).Pediatric:** Prophylaxis in children >6 years 4.6 mg/kg weekly PO.Treatment 20 – 30 mg/kg PO one dose only.Indications1. Malaria prophylaxis in regions with chloroquine and multiple-drug-resistant malaria. Prophylaxis should begin 1 weekprior to traveling, then continue weekly during travel in malarious area followed by at least 4 weeks of prophylaxis afterleaving the malarious area. If mefloquine is used, it is NOT necessary to give chloroquine for prophylaxis of nonfalciparummalaria.2. Malaria treatment (utility may be limited by central nervous system toxicity): Alternative to quinine in chloroquineresistantmalaria.CommentsIncreasing mefloquine resistance of P falciparum in many parts of Southeast Asia may contraindicate its use for treatmentof falciparum malaria in these areas. Safety and effectiveness in children have not been established; however, mostexperts believe that benefits outweigh risk in prophylaxing traveling children.FDA warning: Lariam ® is contraindicated for prophylaxis in patients with active depression, a recent history ofdepression, generalized anxiety disorder, psychosis, schizophrenia or other major psychiatric disorders, or with a historyof convulsions. During prophylactic use, if psychiatric symptoms such as acute anxiety, depression, restlessness orconfusion occur, these may be considered prodromal to a more serious event. In these cases, the drug must bediscontinued and an alternative medication should be substituted.MEROPENEM (Merrem ® ) - requires ID approval with some exceptionsPrimaxin ® , meropenem and doripenem are therapeutically interchangeable at the UWHC. Merrem ® is the preferredformulary product.Usual DoseAdult: 500 mg Q6H IV; Serious infections with high MIC (>2 mcg/mL) organisms (outside TLC or Neuro ICU) 2 g Q8H IV(UWHC cost/day $58.04-$174.16).Usual dose is 500 mg IV Q6H. Higher doses may be used depending on clinical circumstances.Febrile neutropenia dose is 500 mg IV Q6H. Dose in cystic fibrosis is 1 or 2 g IV Q8H. Meningitis dose is 2 g IV Q8H.Pediatrics:** 10-40 mg/kg Q8H IV, IM; maximum dose 2 g/doseIndications1. Multiply-resistant Pseudomonas aeruginosa or other Gram-negative bacilli (usually with an aminoglycoside).2. Nosocomial Gram-negative bacillary pneumonia (usually given with an aminoglycoside until susceptibility is confirmed),especially when ESBL-producing Gram-negative bacteria are suspected.3. Intra-abdominal sepsis