Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

RIFAXIMIN (Xifaxan ® )Usual doseAdult: 200-400 mg Q8H PO (UWHC cost/day $24.06-48.12)Indications1. Travelers’ diarrhea.2. Reduction of the risk of recurrence of overt hepatic encephalopathy (NOT approved for treatment)CommentsIn the limited studies that have been done with Rifaximin in the reduction of the risk of recurrence of overt hepaticencephalopathy, the most effective dose was found to be 600 mg Q12H. However, it was not possible to manufacture atablet this large; the largest tablet that could be manufactured was a 550 mg tablet. This was the tablet that was used inthe pivotal trial for FDA approval for the hepatic encephalopathy indication, but this dose is not the optimal dose for thisindication.RITONAVIRFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/SAQUINAVIRFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/SPECTINOMYCINNo longer available in the U.S.STAVUDINEFor up-to-date information on the use of antiretrovirals, consult an HIV expert or www.aidsinfo.nih.gov/STREPTOMYCINUsual DoseAdult: 15 mg/kg/day (max 1 g) or 20-40 mg/kg (max 1.5 g) two or three times per week IM (UWHC cost/day $10.15-15.22).Indications1. Mycobacterium tuberculosis – initial treatment in combination with isoniazid, rifampin and pyrazinamide in situationswhere ethambutol is contraindicated or ineffective (see Appendix E).2. Streptococcal or enterococcal endocarditis caused by high-level gentamicin-resistant but streptomycin-sensitive strains.3. Plague, tularemia, or brucellosis.CommentsMonitor serum drug levels (test must be sent out). Use extreme caution and reduce dose when prescribing for patientswith renal insufficiency.SULFADIAZINEUsual DoseAdult: Load 2-4 g PO; Maintenance 500 mg-2 g Q6H PO (UWHC cost/day $7.40-29.62).Pediatric:** 120 - 150 mg/kg/day PO in divided doses Q4-6H.Indications1. Toxoplasmosis - treatment of choice. Use in combination with pyrimethamine (1-1.5 g Q6H PO for 3-6 weeks, then 1 gBID PO for maintenance dosing).CommentsSulfadiazine is not recommended for use in infants less than 2 months of age with the exception of congenitaltoxoplasmosis treatment (in combination with pyrimethamine) where the benefit might exceed the risk. Do not confusewith sulfasalazine.