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Recommended Empiric Regimens to Reduce Fluoroquinolone Exposure - Adult - TLC

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


Table 1. Recommended empiric regimens to reduce fluoroquinolone exposure – TLC
If fluoroquinolone therapy is required, approval via the Restricted Antimicrobial Pager (*3333) is necessary. The alternative therapy course should be
continued at discharge from the unit.
Diagnosis Previous Therapy Proposed Empiric Therapy Comments
Septic Shock – unknown origin
empiric coverage of
Pseudomonas
Vancomycin PLUS Piperacillin/tazobactam
AND Ciprofloxacin
Vancomycin (15-20) PLUS
Piperacillin/tazobactam OR Cefepime PLUS
tobramycin

Vancomycin (15-20) PLUS Meropenem
PLUS Tobramycin
Vancomycin (15-20) PLUS Aztreonam
PLUS Tobramycin PLUS Metronidazole
For patients with severe or immediate IgE-
mediated allergy
Community-acquired
Pneumonia Moxifloxacin
Ceftriaxone OR Ampicillin/sulbactam No risk factors for MDRO
Vancomycin (15-20) AND Aztreonam For patients with severe or immediate IgE-mediated allergy
ADD Azithromycin If concern for atypical bacteria or
Legionnaires
Healthcare associated
Pneumonia
Vancomycin PLUS Piperacillin/tazobactam
AND Ciprofloxacin
Vancomycin (15-20) PLUS Cefepime or
Piperacillin/tazobactam With risk factors for MDRO
Vancomycin (15-20) AND Aztreonam For patients with severe or immediate IgE-mediated allergy
ADD Tobramycin If patient in septic shock
ADD Azithromycin If concern for atypical bacteria or
Legionnaires
Sepsis (without septic shock) of
urinary origin/pyelonephritis
Vancomycin AND/OR Ciprofloxacin
Ceftriaxone No risk factors for MDRO
Vancomycin (15-20) PLUS Cefepime With risk factors for MDRO
Vancomycin (15-20) PLUS Tobramycin For patients with severe or immediate IgE-mediated allergy
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 Proposed Empiric Therapy Comments
Intraabdominal infection –
with or without septic shock*
Ciprofloxacin AND Metronidazole
Ceftriaxone AND Metronidazole
OR
Cefoxitin OR Piperacillin/tazobactam
No risk factors for MDRO
Vancomycin PLUS Piperacillin/tazobactam
AND Ciprofloxacin
Vancomycin (15-20) PLUS
Piperacillin/tazobactam PLUS Tobramycin
With risk factors for MDRO Vancomycin (15-20) PLUS Cefepime PLUS
Tobramycin PLUS Metronidazole
Vancomycin (15-20) PLUS Meropenem
with or without Tobramycin
Vancomycin (15-20) PLUS Aztreonam
PLUS Tobramycin PLUS Metronidazole
For patients with severe or immediate IgE-
mediated allergy
MDRO = multidrug resistant organism
* Assess patient for risk factors for invasive candidiasis and need for empiric antifungal coverage.
** Empiric aztreonam use is allowed without ID approval for 72 hours. Further therapy with aztreonam will require approval via 3333 pager or
ID consult

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