Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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4. Life-threatening Gram-negative infections due to organisms such as Acinetobacter species known or likely to beresistant to third-generation cephalosporins (e.g., P aeruginosa, Enterobacter, Serratia or Citrobacter) or in patientsvulnerable to nephrotoxicity with aminoglycosides.5. Neutropenic fever (dose as 500 mg IV Q6H).CommentsAll doses except the first dose are given as prolonged infusion. The first dose is given over 30 minutes to rapidly achievetherapeutic concentrations. Excusion criteria: patients receiving CVVH and patients treated for meningitis. Cystic fibrosispatients may receive prolonged infusion, but are not limited to lower doses specified in the prolonged infusion guideline.Dose adjustment required for renal impairment. See renal dosing guideline on uconnect.For use in patients with reported penicillin allergies, see Appendix J: UWHC Guidelines For the Use of Beta-LactamAntibiotics in Patients with Reported Allergies to Penicillin.METRONIDAZOLEUsual DoseAdult: 500 mg Q8H IV OR 1 g Q12H IV (UWHC cost/day $3.31-4.41) OR 250-750 mg TID PO OR 250 mg four timesdaily PO (colitis) (UWHC cost/day $0.36-1.08).Pediatrics:** 15-35 mg/kg/day PO in divided doses Q8H OR 30 mg/kg/day IV in divided doses Q6H.Indications1.Intra-abdominal abscesses where anaerobes are likely to be pathogens. Usually given with an aminoglycoside or otherantibiotic with Gram-negative activity.2. Bacterial vaginosis.3. Trichomonal vaginitis.4. Giardiasis (250 mg TID PO x 5 days).5. Clostridium difficile colitis (usually oral only; IV is less effective for C difficile colitis, although IV is used with POvancomycin in initial, severe, complicated cases).6. Prophylaxis for colorectal surgery (see Appendix B).7. Brain abscess or anaerobic meningitis (usually given with beta-lactam antibiotics).8. Amebic dysentery and other Entamoeba histolytica infections (especially liver abscesses).9. Treatment of H pylori infection as part of combination regimens.CommentsThe manufacturer recommends a loading dose of 15 mg/kg IV, although this is rarely, if ever, used. Disulfiram-likereactions have been reported. Patients should be counseled regarding alcohol use while taking metronidazole. (NOTE:Many agents contain alcohol as a vehicle.) Metronidazole has limited activity against Gram-positive anaerobic cocci; ithas essentially no activity against aerobic bacteria and no activity against anaerobic Gram-positive rods other thanClostridium (e.g., Actinomyces and Propionibacterium). This usually limits its use to anaerobic infections below thediaphragm. It is not usually necessary to combine metronidazole with ampicillin/sulbactam orpiperacillin/tazobactam as these drugs have adequate anaerobic coverage for most situations. An exception tothis would be a case where C. difficile is suspected or an undrained intra-abdominal abscess. Avoid in firsttrimester of pregnancy. Safety and efficacy in children have not been established except for amebiasis. Metronidazole isused as a second-line drug for giardiasis in children. See IV-to-PO conversion policy (Appendix F) on uconnect. The oralformulation is preferred for treating C. difficile. The 2010 IDSA Guidelines for the treatment of C. difficile recommend adose of 500 mg Q8H PO for the initial and first recurrence of mild-to-moderate C. difficile.Drug InteractionsMetronidazole in combination with warfarin causes increased anticoagulation.
MICAFUNGINInfectious Disease approval required for all use of micafungin (see Appendix I)Anidulafungin, caspofungin and micafungin are therapeutically interchangeable at UWHC. Micafungin is the currentformulary choice.Usual DoseAdult: 50-100 mg/day IV (UWHC cost/day $43. 37-86.74). Daily dose is 50 mg for prophylaxis, 100 mg for treatment ofyeast (Candida), and 100 mg for treatment of molds (Aspergillus).Pediatric: 1-3 mg/kg/day IVIndications1. Systemic candidiasis in patients at risk for infection by yeasts that may be resistant to azole antifungals2. Invasive aspergillosis in patients intolerant of or unresponsive to treatment with alternative agents3. Empiric therapy for candidemia with yeast in blood until idenfication of yeast known.MINOCYCLINEUsual DoseAdult: Load 100-200 mg PO x1 dose; then 100 mg Q12H PO (UWHC cost/day $0.20).Pediatric:** (Not for children
Page 2 and 3: PREFACEThe Antimicrobial Use Guidel
Page 4 and 5: Antimicrobial Cost Table (Cost info
Page 6 and 7: Summary of Antibiotic Order Form: S
Page 8: LUNGS/PULMONARYCommunity-Acquired P
Page 12 and 13: PART I: BY DRUGABACAVIRFor up-to-da
Page 14 and 15: constructed systemic-pulmonary shun
Page 16 and 17: AMPICILLIN/SULBACTAM (Unasyn ® )Us
Page 18 and 19: ATOVAQUONE/PROGUANIL (Malarone ® )
Page 20 and 21: CEFAZOLINUsual DoseAdult: Moderate/
Page 22 and 23: CommentsDose adjustment required fo
Page 24 and 25: 1. Typhoid fever. (NOTE: Third-gene
Page 26 and 27: -Dutasteride-Eltrombopag-Theophylli
Page 28 and 29: CLINDAMYCINUsual DoseAdult: 600-900
Page 30 and 31: DAPTOMYCINInfectious Disease approv
Page 32 and 33: Concurrent administration with peni
Page 34 and 35: • Cisapride (contraindicated) •
Page 36 and 37: • Oral contraceptives/hormones -
Page 38 and 39: Synergy in infective endocarditis a
Page 40 and 41: • Colchicine • Indinavir • Ta
Page 42 and 43: • Donepezil • Pioglitazone• D
Page 44 and 45: with linezolid should be considered
Page 48 and 49: MOXIFLOXACINLevofloxacin and moxifl
Page 50 and 51: Indications1. Uncomplicated cystiti
Page 52 and 53: CommentsDose adjustment required fo
Page 54 and 55: PIPERACILLIN/TAZOBACTAM (Zosyn ® )
Page 56 and 57: PRIMAQUINEUsual DoseAdult: Malaria
Page 58 and 59: RIFABUTINUsual DoseAdult (150 mg ca
Page 60 and 61: • Chloramphenicol • Leflunomide
Page 62 and 63: SULFISOXAZOLENo longer available as
Page 64 and 65: TICARCILLIN/CLAVULANATE (Timentin
Page 66 and 67: 2. Recurrent urinary tract infectio
Page 68 and 69: VANCOMYCINUsual DoseAdult: 1 g Q12H
Page 70 and 71: Careful monitoring of patients usin
Page 72 and 73: APPENDIX B: UWHC SURGICAL ANTIMICRO
Page 74 and 75: GI:Appendectomy 3Anaerobic organism
Page 76 and 77: VascularLIKELYPATHOGENS• ANTIMICR
Page 78 and 79: Cleanorthopedicprocedures(other)Sta
Page 80 and 81: APPENDIX C: THERAPY FOR TUBERCULOSI
Page 82 and 83: p-Aminosalicylic acid(PAS)Granules
Page 84 and 85: Appendix D: UNIVERSITY OF WISCONSIN
Page 86 and 87: Appendix E: UWHC Guidelines for the
Page 88 and 89: B. Antifungal Prophylaxis for BMT a
Page 90 and 91: D. Cost ComparisonDrugAmphotericin
Page 92 and 93: 17. Maertens J, Glasmacher A, Herbr
Page 94 and 95: 47. Courtney R, Wexler D, Radwanski
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2.1.7 Patient is without placement
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Medications Approved for Parenteral
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APPENDIX G: Serum Drug Concentratio
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APPENDIX H: Guidelines for Monitori
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1. Patients with large volumes of d
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16. Tsuji B, Rybak MJ. The influenc
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APPENDIX I: Infectious Diseases App
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APPENDIX J: UWHC Guidelines For the
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with aztreonam and other beta-lacta
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D. Side Chains1.2.5. The prescriber
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14. Pichichiro ME. Use of selected
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Appendix KUWHC Guidelines for Cost-
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sulfa and can be prescribed topatie
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superinfection: amoxicillin 1 g PO
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17. Smucny J, Fahey T, Becker L, Gl
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Appendix M: Guidelines for the Prop
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D. CategorizationPatients should be
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Empiric coverage for Enterococcus i
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H. Necrotizing PancreatitisThe publ
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Bone or JointEndocarditis 4Streptoc
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Candidemia or candidiasis 11Non-neu
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11. Pappas PG, Kauffman CA, Andes D
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piperacillin/tazobactam. There were
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D. Dose of Antibiotic1. Piperacilli
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TNAVasopressinVoriconazoleMeropenem
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pretreatment with an H1-histamine b
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formal consult is not required, but
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K. References1.0 Bliziotis IA, Ples
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Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

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