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Antibiotic DOC
| Question | Answer |
|---|---|
| Cardiac or Vascular Surgery Recommended | Cefazolin OR Cefuroxime OR Vancomycin |
| Cardiac or Vascular Surgery if Pen allergy | Vancomycin OR Clindamycin |
| Cardiac or Vascular Surgery if Pen allergy | Vancomycin OR Clindamycin |
| UTI | SMX/TMP DS x 3 days |
| UTI | SMX/TMP DS x 3 days |
| UTI if Sulfa allergy | Cipro 250mg BID OR Levofloxacin 250mg QD OR Nitrofurantoin 100mg BID x 5 days OR Fosfomycin 3g X 1 dose |
| UTI if Sulfa allergy | Cipro 250mg BID OR Levofloxacin 250mg QD OR Nitrofurantoin 100mg BID x 5 days OR Fosfomycin 3g X 1 dose |
| Uncomplicated Polynephritis | FQ x 5-7 days OR Cipro 500mg BID OR Levofloxicin 750mg QD OR Ofloxicin 400mg BID |
| Complicated UTI | Ampicillin+Gentamicin OR Pipiricillin+Tazobactam OR Ticarcillin+Clavulinic acid OR Ceftriaxone+-FQ OR Cefotaxime+-FQ |
| Complicated UTI with ESBL | Doripenem OR Imipenem OR Meropenem x 2 Weeks |
| UTI Special consideration; What groups require longer therapy 7+ days? | Pregnant, Elderly, Men, Children, and Diabetics |
| Phenazopyridine Dose | 200mg TID Max 2 days (OTC dose 100mg TID) |
| Traveler's Diarrhea | Cipro 500mg BID x 3 days OR SMX/TMP DS BID x 7-10 days OR Ofloxacin, levofloxacin, rifaxamin, metronidazole, Tinidazole, nitazoxanide, Azithromycin (Add Loperamide 4mg once then 2mg after each loose stool max 16mg/d) |
| Traveler's Diarrhea in Pregnancy | Azithromycin 1000mg x 1 dose OR 500mg QD x 1-3 days (also DOC for children) |
| Traveler's Diarrhea, When is Loperamide ContraIndicated? | Fever or Blood in stool |
| Traveler's Diarrhea, When do we consider parasites as cause? | >7days |
| C. Dif. Diarrhea Severe infection | Vancomycin 125mg QID x 10-14 Days |
| Clostidium Difficile Diarrhea | Metronidazole 500mg TID x 10-14 Days |
| C. Dif. Diarrhea Severe infection | Vancomycin 125mg QID x 10-14 Days |
| C. Dif upon 3rd episode at any severity | Vancomycin 125mg QID for 2 weeks, then BID x 1 week, then 3 times weekly for 2-8 weeks (Avoid metronidazole due to possible Neurotoxicity) |
| Special precautions with C. Diff Pt. | Wash hands with soap and water (alcohol sanitizers do not kill the spores) |
| Acute Bronchitis Initial treatment | Antitussive +- Inhaled bronchodilator |
| When do we consider ABX therapy for Bronchitis | persistent cough > 14 days |
| Persistent cough therapy | Z-Pack OR Erythromycine estolate 500mg QID x 14 days OR SMX/TMP DS BID x 14 days, OR Clarithromycin 500mg BID x 7 days |
| Acute Bacterial Exacerbation of Chronic Bronchitis (ABECB) | No ABX |
| CAP Therapy | Macrolide OR Doxycycline |
| CAP in AT Risk for Drug resistant S. Pneumonia, or 65+ and comorbidities | Respiratory FQ (Levo 750mg) OR Beta-lactam + Macrolide |
| CAP for Inpatient | (IV preferred) Respiratory FQ (Levo 750mg) OR Beta-lactam + Macrolide |
| CAP if Pseudomonas is suspected | Antipseudomonal Beta-lactam + (Antipseudomonal FQ OR AMG) |
| CA-MRSA | Vancomycin OR Linezolid |
| HAP/VAP Therapy | Piperacillin/Tazobactam 4.5g Q6H OR Ceftriaxone 1-2g Q24H OR Ampicillin/Sulbactam 3g Q6h OR Ertapenem 1g Q24H |
| HAP/VAP Therapy if Legionella or Bioterroorism | Add or Replace with Levo OR Moxifloxicin |
| HAP/VAP IF P. Aeruginosa is suspected | Anti-Pseudomonal Beta-lactam AND (Cipro OR Levo)OR AMG |
| Syphilis | Pen G 2.4MU IM, OR Doxycycline 100mg BID x 2 weeks. (pregnant patient who is allergic to pen must be desensitized) |
| Neurosyphilis | Pen G 3-4MU IV Q4H x 10-14 days (Outpatient Pen G + Probenecid x 10-14 days) |
| Gonorrhea | Ceftriaxone 250mg IM OR Cefixime 400mg PO, ORCefpodoxime 400mg PO. (Alt Azithromycin 2g OR Cefoxitin 2g IM + Probenecid OR Cefotaxime 500mg) |
| Chlamydia | Azithromycin 1g (Alt. Doxycycline 100mg BID x 7 days,OR Erythromycin 500mg QID x 7 days) |
| Bacterial Vaginosis | Metronidazole 500mg BID x 7 days OR Metrogel 5g vaginally x 5 days (Alt. Clindamycin 300mg BID x 7 days or vaginally 100mg QHS x 3 days OR Tinidazole 2g daily x2 days or 1g daily x 5 days) |
| Trichomoniasis | Metronidazole 2g OR Tinidazole 2g (Alt. metronidazole 500mg BID x 7 days) |
| Initial episode Herpes | Acyclovir 400mg TID x 7-10 days OR Valacyclovir 1g BID x 7-10 days (IF resistant strain and severe Foscarnet 40mg/kg IV Q8H until resolution) |
| Recurrent Herpes | Acyclovir 800mg TID x 2 days or BID for 5 days OR Valacyclovir 1g daily x 5 days or 500mg bid x 3 days |
| Herpes Suppression | Acyclovir 400mg BID OR Valacyclovir 500-1000mg QD |
| Tuberculosis | Isoniazid + Rifampin + Pyrazinamide + Ethambutol x 26 weeks (if resistant remove drug and add FQ increase TX dependant on drug replaced INH - 6 months, RIF - 12-18 months, multiple- 18-24 months) |
| Latent TB | INH 300mg QD x 9 months OR Rifampin 600mg QD x 4 months (add Pyridoxine-B6 to INH tx to prevent neuropathy) |
| Acute Otitis Media | Amoxicillin 90mg/kg/day Divided Q12 or Q8H x 5-7 days or 10 days if severe (Usually observe 48-72H before ABX to rule out Viral) (Alt. Azithromycin 10mg/kg/d day 1 5mg/kg/d 2-5) |
| Infective Endocarditis | NATIVE VALVE -Nafcillin or oxacillin 2g IV Q4H x 6 weeks +- Gentamycin 1mg/kg Q8H x 3-5 days (Increase Gentamycin to 14 days) IF Pen allergic Vanco 15mg/kg Q12H x 6 weeks |
| Infective Endocarditis due to Non MSSA | Pen G 12-30MU Divided Q4H OR Ampicillin 12g/d divided Q4H, plus Gentamycin OR Ceftriaxone OR Streptomycin |
| Infective Endocarditis Resistant | Vancomycin 15mg/kg Q12H x 6 weeks + Gentamicin 1mg/kg Q8H x 6 weeks (resistant to Vanco use Linezolid 600mg Q12H 8+ weeks OR Synersid 22.5mg/kg/d divided TID 8+ weeks |
| Bacterial Meningitis | Cefotaxime 2g Q4-6H OR Ceftriaxone 2g Q12H OR Meropenem 2G Q8H always add Dexamethasone 0.15mg/kg Q6H x 2-4 days AND Vancomycin 30-45 mg/kg divided (Add Ampicillin 2g Q4H if <1month, >50yrs, or listeria) |
| Bacterial Meningitis W/ Severe Pen allergy | Chloramphenicol 4-6g/d divided QID + Vancomycin (If Listeria suspected add SMX/TMP 5mg/kg Q6H) |
| Rocky Mountain Spotted Fever OR Typhus OR Ehrlichosis | Doxycycline 100mg BID x 7 days |
| Lyme Disease | Doxycycline 100mg BID OR Amoxicillin 500mg TID x 14-21 days |
| Tularemia | Gentamycin or Tobramycin 5mg/kg/d divided Q8H x 7-14 days |
Created by:
savejoseph
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