/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-113170-en.cckm

20170246

page

100

UWHC,UWMF,

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

Antibiotic alternatives to Fluoroquinolones- ABDOMINAL TRANSPLANT

Antibiotic alternatives to Fluoroquinolones- ABDOMINAL TRANSPLANT - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Infection and Isolation, Related


Appendix C. Antibiotic alternatives to Fluoroquinolones
From: PK/PD Dose Optimization of Antibiotics for the Treatment of Gram-negative Infections – Adult – Inpatient Clinical Practice Guideline
Last Reviewed 1/2017; Last Updated 1/2017
Contact information: Lucas Schulz, PharmD, Phone Number: (608)890-8617, LSchulz2@uwhealth.org
Table 3. Recommended alternative EMPIRIC regimens – ABDOMINAL TRANSPLANT
Diagnosis Historical Empiric Therapy Proposed New Empiric Therapy Comments/Step Down Therapy
A
Cystitis or
Uncomplicated
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 risk factors for MDRO: ceftriaxone
Concern for extended spectrum Gram-negative rods: cefepime or
piperacillin/tazobactam
Base on final culture results
Ceftriaxone susceptibility predicts
activity for cefpodoxime
If no oral options, page 3333 for
fluoroquinolone approval
For patients with IgE-mediated or severe reaction to β-lactam:
tobramycin or aztreonamB
Cystitis in renal
transplant patient Ciprofloxacin
ASYMPTOMATIC <3
months post renal
transplant
No empiric antibiotic. Await final
culture results to start therapy. If
treatment started, 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
SYMPTOMS present
Nonsystemic therapies
ξ nitrofurantoin if CRCL >40 mL/min
ξ fosfomycin if CRCL <40 mL/min
or concern for drug resistant
isolates
Continuation of empiric, non-systemic
therapies or based on final culture
results
Pyelonephritis in
renal transplant
patient
Ciprofloxacin
ADD Vancomycin
IF concern for
Gram-positive
organisms
No risk factors for MDRO: ceftriaxone
Concern for extended spectrum Gram-negative rods: cefepime or
piperacillin/tazobactam
For patients with IgE-mediated or severe reaction to β-lactam:
tobramycin (while awaiting pathogen identification) OR
aztreonamB
Base on final culture results
Ceftriaxone susceptibility predicts
activity for cefpodoxime
If no oral options, page 3333 for
fluoroquinolone approval
Copyright © 2017 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org

Diagnosis Historical Empiric Therapy Proposed New Empiric Therapy Comments/Step Down Therapy
A

Cholangitis in the
historical liver
transplant recipient
Ciprofloxacin
PLUS amoxicillin
OR moxifloxacin
ξ Piperacillin/tazobactam PLUS metronidazole OR
ξ Cefepime PLUS metronidazole

For patients with IgE-mediated or severe reaction to β-lactam:
ξ vancomycin (trough goal 10-20 mcg/mL) PLUS tobramycin OR
ξ vancomycin (trough goal 10-20 mcg/mL) PLUS aztreonam
Cefpodoxime OR cefuroxime PLUS
amoxicillin (Enterococcus coverage)

If no oral options, page 3333 for
fluoroquinolone approval
Intra-abdominal
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:
ξ cefpodoxime OR cefuroxime PLUS
metronidazole
ξ amoxicillin/clavulanic acid

If final culture results require
fluoroquinolone step down (e.g.
Pseudomonas) single oral dose prior
to discharge is acceptable
Vancomycin PLUS
Piperacillin/
tazobactam AND
Ciprofloxacin
With risk factors for MDRO:
ξ vancomycinC PLUS piperacillin/tazobactam OR
ξ vancomycinC PLUS meropenem

With risk factors for MDRO and IgE-mediated or severe reaction to
β-lactam: vancomycinC PLUS aztreonam PLUS metronidazole
Community-acquired
PneumoniaD
Moxifloxacin OR
Levofloxacin
No risk factors for MDRO:
ξ ceftriaxone PLUS doxycycline OR
ξ ceftriaxone PLUS azithromycin
Potential oral options: cefpodoxime
OR cefuroxime PLUS azithromycin OR
doxycycline

If no oral options, page 3333 for
fluoroquinolone approval
For patients with IgE-mediated or severe reaction to β-lactam:
vancomycinC PLUS aztreonamB
Healthcare-associated
PneumoniaD
Vancomycin PLUS
Cefepime AND
Ciprofloxacin
With risk factors for MDRO: vancomycinB PLUS cefepime

If patient in septic shock: ADD tobramycin (pending transfer to
higher care level)

If concern for atypical bacteria: ADD azithromycin
Double coverage for Pseudomonas is
not required in clinically stable, general
care patient

If no oral options, page 3333 for
fluoroquinolone approval For patients with IgE-mediated or severe reaction to β-lactam:
vancomycinB PLUS aztreonamC
A Base step down therapy on culture results, if no oral step down therapy except fluoroquinolones exist, please page 3333 for approval or other
options
B Empiric aztreonam use is approved for 72 hours. Further therapy with aztreonam will require approval via 3333 pager or ID consult
C
Vancomycin therapy targeted to trough goal of 15-20 mcg/mL
D
If severe or immediate IgE-mediated beta-lactam allergy, please page 3333 for alternative options
MDRO: Multidrug-resistant organism
Copyright © 2017 Univ ersity of Wisconsin Hospital s and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 02/2017CCKM@uwhealth.org