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Antibiotic alternatives to Fluoroquinolones- INTENSIVE CARE

Antibiotic alternatives to Fluoroquinolones- INTENSIVE CARE - 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 2. Recommended alternative EMPIRIC regimens – INTENSIVE CARE MEDICINE
Diagnosis Historical Empiric Therapy Proposed New Empiric Therapy
Septic Shock –
unknown origin
empiric coverage of
Pseudomonas
Vancomycin PLUS
Piperacillin/tazoba
ctam AND
Ciprofloxacin
ξVancomycinA PLUS piperacillin/tazobactam PLUS tobramycin OR
ξVancomycinA PLUS cefepime PLUS tobramycin OR
ξVancomycinA PLUS meropenem PLUS tobramycin
For patients with IgE-mediated or severe reaction to β-lactam: vancomycinA PLUS aztreonam PLUS
tobramycin PLUS metronidazole
Community-acquired
Pneumonia Moxifloxacin
No risk factors for MDRO: ceftriaxone OR ampicillin/sulbactam
If concern for atypical bacteria or Legionnaires’ disease: ADD azithromycin
For patients with IgE-mediated or severe reaction to β-lactam: vancomycinA AND aztreonam
Healthcare-associated
Pneumonia
Vancomycin PLUS
Piperacillin/tazoba
ctam AND
Ciprofloxacin
With risk factors for MDRO: vancomycinA PLUS piperacillin/tazobactam OR cefepime
If patient in septic shock: ADD tobramycin
If concern for atypical bacteria or Legionnaires’ disease: ADD azithromycin
For patients with IgE-mediated or severe reaction to β-lactam: vancomycinA PLUS aztreonam
Sepsis (without septic
shock) of urinary
origin/pyelonephritis
Vancomycin
AND/OR
ciprofloxacin
No risk factors for MDRO: ceftriaxone
With risk factors for MDRO: vancomycinA PLUS cefepime
For patients with IgE-mediated or severe reaction to β-lactam: vancomycinA PLUS tobramycin
Intraabdominal
infection – with or
without septic shockB
Ciprofloxacin AND
metronidazole
No risk factors for MDRO:
ξceftriaxone AND metronidazole OR
ξcefoxitin OR
ξpiperacillin/tazobactam
Vancomycin PLUS
Piperacillin/tazoba
ctam AND
Ciprofloxacin
With risk factors for MDRO:
ξvancomycinA PLUS piperacillin/tazobactam PLUS tobramycin OR
ξvancomycinA PLUS cefepime PLUS tobramycin PLUS metronidazole OR
ξvancomycinA PLUS meropenem with or without tobramycin
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
For patients with IgE-mediated or severe reaction to β-lactam: vancomycinA PLUS aztreonam PLUS
tobramycin PLUS metronidazole
A Vancomycin therapy targeted to trough goal of 15-20 mcg/mL
B Assess patient for risk factors for invasive candidiasis and need for empiric antifungal coverage
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