/clinical/,/clinical/cckm-tools/,/clinical/cckm-tools/content/,/clinical/cckm-tools/content/cpg/,/clinical/cckm-tools/content/cpg/infection-and-isolation/,/clinical/cckm-tools/content/cpg/infection-and-isolation/related/,

/clinical/cckm-tools/content/cpg/infection-and-isolation/related/name-101335-en.cckm

201606180

page

100

UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Clinical Practice Guidelines,Infection and Isolation,Related

Recommended Empiric Regimens to Reduce Fluoroquinolone Exposure - Adult - B46

Recommended Empiric Regimens to Reduce Fluoroquinolone Exposure - Adult - B46 - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Infection and Isolation, Related


Table 2. Recommended empiric regimens to reduce fluoroquinolone exposure – B4/6
Diagnosis Previous Therapy Comments Proposed Empiric Therapy Step Down Therapy*
Cystitis/Urinary tract
infection (non-renal
transplant)
Ciprofloxacin OR
Levofloxacin
Nitrofurantoin
Fosfomycin
Cefpodoxime
Base on final culture results
Nitrofurantoin
Fosfomycin
Cefpodoxime
Positive urine culture in
the deceased renal
transplant donor
Ciprofloxacin
ADD Vancomycin IF
concern for Gram
positive organisms
No concern for MDRO Ceftriaxone Base on final culture results
Ceftriaxone susceptibility predicts
activity for cefpodoxime.
If no oral options, page 3333 for
fluoroquinolone approval
Concern for extended spectrum
GNRs Cefepime OR Piperacillin/tazobactam
For patients with immediate IgE-
mediated or severe allergy
Tobramycin
Aztreonam**
Cystitis in renal transplant
patient
Ciprofloxacin
ASYMPTOMATIC <3 months post
RENAL transplant
No empiric antibiotics. Await final
culture results to start therapy.
Provide 5-7 day therapy course.
Base on final culture results
Ceftriaxone susceptibility predicts
activity for cefpodoxime.
If no oral options, page 3333 for
fluoroquinolone approval
ASYMPTOMATIC >3 months post
RENAL transplant
No treatment, unless associated rise
in creatinine
N/A
SYMPTOMS PRESENT
Nonsystemic therapies
-nitrofurantoin if GFR >40 mL/min
-fosfomycin if GFR <40 mL/min or
concern for drug resistant isolates
Continuation of empiric, non-systemic
therapies (left) or based on final
culture results
Pyelonephritis in renal
transplant patient
Ciprofloxacin
ADD Vancomycin IF
concern for Gram
positive organisms
No concern for MDRO Ceftriaxone
Base on final culture results
Ceftriaxone susceptibility predicts
activity for cefpodoxime.
If no oral options, page 3333 for
fluoroquinolone approval
Concern for extended spectrum
GNRs Cefepime OR Piperacillin/tazobactam
For patients with immediate IgE-
mediated or severe allergy
- Tobramycin while awaiting
organism identification
- Aztreonam**
Reference: Prevention, Diagnosis, and Treatment of Clostridium difficile Infection – Adult/Pediatric – Inpatient/Ambulatory Guideline
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org

Diagnosis Previous Therapy Comments Proposed Empiric Therapy Step Down Therapy*
Cholangitis in the
historical liver transplant
recipient
Ciprofloxacin PLUS
Amoxicillin OR
Moxifloxacin
Piperacillin/tazobactam OR Cefepime
PLUS Metronidazole
Cefpodoxime OR Cefuroxime
PLUS Amoxicillin (Enterococcus)
For patients with immediate IgE-
mediated or severe allergy
Vancomycin (10-20) PLUS
Tobramycin OR Aztreonam**
If no oral options, page 3333 for
fluoroquinolone approval
Intraabdominal
infection – Other
community or
healthcare associated
Ciprofloxacin AND
metronidazole No risk factors for MDRO Ceftriaxone AND metronidazole
Base on final culture results, some
examples of potential oral options
-Cefpodoxime OR Cefuroxime
PLUS Metronidazole
-Amoxicillin/clavulanic acid
If final culture results require FQ
step down (Pseudomonas, etc)
single oral dose prior to discharge
is acceptable
Vancomycin PLUS
Piperacillin/tazobac
tam AND
Ciprofloxacin
With risk factors for MDRO
Vancomycin (15-20) PLUS
Piperacillin/tazobactam
Vancomycin (15-20) PLUS
Meropenem
For patients with immediate IgE-
mediated or severe allergy
Vancomycin (15-20) PLUS
Aztreonam PLUS Metronidazole
Community-acquired
Pneumonia <
Moxifloxacin OR
Levofloxacin
No risk factors for MDRO Ceftriaxone PLUS Azithromycin
Ceftriaxone PLUS Doxycycline
Cefpodoxime OR Cefuroxime
PLUS Azithromycin OR Doxycycline
If no oral options, page 3333 for
fluoroquinolone approval
For patients with immediate IgE-
mediated or severe allergy Vancomycin PLUS aztreonam**
Healthcare associated
Pneumonia <
Vancomycin PLUS
Cefepime AND
Ciprofloxacin
With risk factors for MDRO Vancomycin (15-20) PLUS
Cefepime
Double coverage for Pseudomonas
is not required in clinically stable,
general ward patient
If patient in septic shock ADD Tobramycin Pending transfer to higher care
level
For patients with immediate IgE-
mediated or severe allergy
Vancomycin (15-20) PLUS
Aztreonam** If no oral options, page 3333 for
fluoroquinolone approval
If concern for atypical bacteria ADD Azithromycin
* Base step down therapy on culture results, if no oral step down therapy except fluoroquinolones exist, please page 3333 for approval or other
options
** Empiric aztreonam use is allowed without ID approval for 72 hours. Further therapy with aztreonam will require approval via 3333 pager or
ID consult
<
If severe or immediate IgE-mediated beta-lactam allergy, please page 3333 for alternative options
Reference: Prevention, Diagnosis, and Treatment of Clostridium difficile Infection – Adult/Pediatric – Inpatient/Ambulatory Guideline
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org

Recommended Empiric Regimens to Reduce Fluoroquinolone
Exposure – Adult – Inpatient –Table
Collateral Document/Guideline: Prevention, Diagnosis, and Treatment of Clostridium difficile
Infection – Pediatric/Adult – Inpatient/Ambulatory Clinical Practice Guideline
Contact Information:
Name: Lucas Schulz , PharmD, BCPS AQ-ID - Pharmacy
Phone Number: (608) 890- 8617
Email Address: LSchulz2@uwhealth.org
Authors:
Lucas Schulz , PharmD, BCPS AQ -ID ± Pharmacy
Barry Fox, MD ± Infectious Disease
Coordinating Team Members:
Alex Lepak, MD ± Infectious Disease
Nasia Safdar, MD ± Infectious Disease
Dave Andes, MD ± Infectious Diseases
Didier Mandelbrot, MD ± Nephrology
Dixon Kaufman, MD ± Transplant Surgery
$QQ�2¶5RXUNH��0'�± Surgical Critical Care
Pierre Kory, MD ± Critical Care Medicine
Chris Green, MD ± Administration
Philip Trapskin, PharmD ± Drug Policy Program
Mei Jorgenson, PharmD ± Transplant Pharmacy
Jeff Fish, PharmD ± Critical Care Pharmacy
Joshua Vanderloo, PharmD ± Drug Policy Program
Review Individuals/Bodies:
Clostridium difficile Infection Reduction Workgroup
Antimicrobial Use Subcommittee, June 2016
Committee Approvals/Dates:
Pharmacy &Therapeutics Committee, June 2016
Copyright © 201� University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 06/2016CCKM@uwhealth.org