Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

PENTAMIDINEUsual DoseAdult: Treatment: 4 mg/kg daily IV (UWHC cost/day $47.50).Prophylaxis: 300 mg Q 3-4 weeks by inhalation (UWHC cost/day $50.90). Weekly IV prophylaxis is NOT effective.Pediatric:** 4 mg/kg/day IV Q24H.By inhalation: in children 5 years 300 mg Q 3-4 weeks.Indications1. Pneumocystis jiroveci infections - treatment (IV) or prophylaxis (aerosol).CommentsAerosolized pentamidine is inferior to TMP/SMZ or other systemic regimens for prophylaxis of PJP. To increase patienttolerance and efficacy of the aerosolized treatment, consider administering two puffs of an inhaled bronchodilator (e.g.,albuterol) prior to pentamidine doses. Pentamidine by inhalation should be administered in rooms with negative airflow.Patients receiving pentamidine IV should have glucose monitored frequently and creatinine levels monitored daily.Consider obtaining Infectious Disease assistance if intending to use IV pentamidine.PIPERACILLINUsual DoseAdult: Mild/moderate infections or empiric therapy 4 g Q6H IV (UWHC cost/day $51.32).Documented P aeruginosa or life-threatening infections 3 g Q4H IV or 4 g Q6H IV (UWHC cost/day $51.38-57.73).Pediatric:** 200-300 mg/kg/day IV in divided doses Q4-6H.Indications1. Treatment of Pseudomonas aeruginosa (in combination with an aminoglycoside or fluoroquinolone).2. Empiric therapy of febrile neutropenic patients (always in combination with an aminoglycoside or anti-staphylococcalbeta-lactam antibiotic).3. For enterococcal coverage when additional broad-spectrum Gram-negative coverage is needed.CommentsDose adjustment required for renal impairment. See renal dosing guideline on uconnect.Piperacillin is not effective against S aureus. Some clinicians have noted piperacillin has a higher incidence of neutropeniacompared with other extended-spectrum penicillins but produces less platelet dysfunction than ticarcillin. Piperacillin has ahigher incidence of hypersensitivity reactions in cystic fibrosis patients. Each gram of piperacillin contains 1.85 mEqsodium.Drug Interactions• Aminoglycosides – inactivated by penicillins in admixtures when penicillin:AG ratio is 50:1 or higher• Vecuronium – piperacillin has caused cases of enhanced neuromuscular blockade• Live typhoid vaccine – decreased efficacy; wait 24 hours after end of therapy to give vaccine