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/clinical/cckm-tools/content/order-sets/inpatient/emergency-medicine/name-98364-en.cckm

20180122

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UWHC,UWMF,

Tools,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Order Sets,Inpatient,Emergency Medicine

ED - Anti-Infectives - Adult - Supplemental [4949]

ED - Anti-Infectives - Adult - Supplemental [4949] - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Order Sets, Inpatient, Emergency Medicine


ED - Anti-infectives - Adult - Supplemental [4949]
are listed in the order of recommendation Medications
Patient Care Orders
Other Patient Care Instructions [237188]
Other Discharge Patient Care Instructions -
Monitor your temperature 3 times per day
following discharge [NURCOM0071]
You will be called tomorrow by a pharmacist to check
in on how therapy is working for you.
Call the oncology clinic (608) 263-1700 as soon as
possible to schedule a follow up assessment with your
provider.
It is very important to take the full course of both
antibiotics exactly as instructed.
Call the nurse triage for any of the following:
- Temperature greater than 100.4°F ( 38°C) that
persists for more than 48 hours from emergency
department discharge
- Constant or uncontrolled diarrhea
- Inability to swallow medications, or vomiting after
taking medications
- Redness, soreness or pus-like discharge or fluid at
your central line site or at any other open area/site of
injury.
- Pain or burning with urination.
- Cough, especially if the cough is new
- Confusion
- Shaking chills
- Feeling dizzy or lightheaded
Pneumonia, Community Acquired
Community-Acquired Pneumonia [139948]
Preliminary data suggests a lower incidence of Clostridium difficile infection in patients with a
using a doxycycline based regimen-history of C.difficile infection
Azithromycin and Ceftriazone - First Line
[234159]
azithromycin (ZITHROMAX) intraVENOUS
[800011]
500 mg, Intravenous, ONCE For 1 Doses
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, ONCE For 1 Doses
Doxycycline - Ceftriaxone - Second Line [234160]
doxycycline hyclate tab [67296] 100 mg, Oral, ONCE For 1 Doses
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, ONCE For 1 Doses
moxifloxacin (AVELOX) 400 mg in sodium
chloride 0.9% 250 mL bag - Third Line [168649]
400 mg, Intravenous, ONCE For 1 Doses, for 60
Minutes
levofloxacin (LEVAQUIN) intraVENOUS - NOTE:
Order if concomitant concern for UTI [800052]
500 mg, Intravenous, ONCE For 1 Doses
Pneumonia, Healthcare-Acquired
For Patients with Suspected MRSA (Single Response) [139970]
Cefepime - Vancomycin [228057]
cefepime (MAXIPIME) intraVENOUS [800016] 2 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS - NOTE:
Maximum dose 2 grams) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
For Patients with NO Suspected MRSA (Single Response) [139968]
cefepime (MAXIPIME) intraVENOUS [800016] 2 g, Intravenous, ONCE For 1 Doses
Page 1 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 2:29:12 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

piperacillin/tazobactam (ZOSYN) intraVENOUS -
NOTE: Add when concern for aspiration [800074]
4.5 g, Intravenous, ONCE For 1 Doses
For Severely Ill patients (ADD-ON) (Single Response) [139971]
tobramycin (NEBCIN) intraVENOUS [800081] 7 mg/kg, Intravenous, ONCE For 1 Doses
Sepsis
Undifferentiated (Single Response) [139988]
Cefepime - Vancomycin [234669]
cefepime (MAXIPIME) intraVENOUS [800016] 2 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS
(Maximum Dose 2 grams) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Maximum concentration: peripheral 5 mg/mL; central
line 10 mg/mL
Maximum dose 2 grams
Vancomycin - Piperacillin/Tazobactam [234670]
vancomycin (VANCOCIN) intraVENOUS
(Maximum dose 2 grams) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
Maximum concentration: peripheral 5 mg/mL; central
line 10 mg/mL
Maximum dose 2 grams
piperacillin/tazobactam (ZOSYN) intraVENOUS
[800074]
4.5 g, Intravenous, ONCE For 1 Doses
For Severely Ill patients (ADD-ON) (Single Response) [139971]
tobramycin (NEBCIN) intraVENOUS [800081] 7 mg/kg, Intravenous, ONCE For 1 Doses
Neutropenic Fever
Management of Neutropenic Fever - Adult -
Inpatient/Ambulatory Clinical Practice Guideline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/?path=/content/cpg/oncology/name-
97716-en.cckm
Inpatient Treatment [199081]
ALWAYS order cefepime.
THERAPY:ADJUNCT
tissue infection, severe -related infection, skin and soft- Vancomycin = suspicion for catheter●
associated pneumonia, or hemodynamic instability-mucositis, healthcare
Metronidazole = anaerobic infection is suspected such as neutropenic typhlitis ●
cefepime (MAXIPIME) intraVENOUS [800016] 1 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS [800084] 25 mg/kg, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
Inpatient Treatment (severe or immediate IgE-mediated beta-lactam allergy) [199085]
order vancomycin and ciprofloxacinALWAYS
THERAPY based on criteria belowADJUNCT
Metronidazole = If anaerobic infection is suspected such as neutropenic typhilitis●
vancomycin (VANCOCIN) intraVENOUS [800084] 25 mg/kg, Intravenous, ONCE For 1 Doses
aztreonam (AZACTAM) intraVENOUS [800013] 2 g, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
First Oral Dose in Emergency Department (Omit if patient has already received IV antibiotics) [232372]
• Ciprofloxacin should be combined with amoxicillin/clavulanate for outpatient therapy
• Patients should be monitored for at least 2 hours after first oral dose of medication to
ensure tolerance and hemodynamic stability prior to discharge
• Use clindamycin in combination with ciprofloxacin only for patients with severe or IgE
mediated penicillin allergy.
ciprofloxacin (CIPRO) tab [720037] 750 mg, Oral, ONCE For 1 Doses
Page 2 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 2:29:12 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

amoxicillin-clavulanate (AUGMENTIN XR) 1000-
62.5 MG per 12hr ER tab [70757]
2 tab, Oral, ONCE For 1 Doses
clindamycin (CLEOCIN) cap [35962] 300 mg, Oral, ONCE For 1 Doses
Neutropenic Fever - OUTPATIENT ORDERS [236887]
• Ciprofloxacin should be combined with amoxicillin/clavulanate for outpatient therapy
• Patients should be monitored for at least 2 hours after first oral dose of medication to
ensure tolerance and hemodynamic stability prior to discharge
• Use clindamycin in combination with ciprofloxacin only for patients with severe or IgE
mediated penicillin allergy.
NOTE: If neutropenic fever therapy is ordered, please also order all three Follow-Up
Care orders in the following section.
ciprofloxacin (CIPRO) 750 MG tab [61501] 750 mg, 19 tab, 0, starting 1/22/18, Normal
amoxicillin-clavulanate (AUGMENTIN XR) 1000-
62.5 MG per 12hr ER tab [70757]
2 tab, 38 tab, 0, starting 1/22/18, Normal
clindamycin (CLEOCIN) 300 MG cap [44723] 300 mg, 39 cap, 0, starting 1/22/18, Normal
Follow-up Care [237189]
Patient to Schedule Appointment [NURCOM0056] Routine
Purpose: Follow up
With whom: Nurse Practitioner
For when: Within 3 days
Please call (608) 265-1700 to make an appointment
with your oncologist.
Adult Oncology Pharmacist Follow-Up (for ED)
[REF0009]
Details
Adult Oncology Scheduling Follow-Up (for ED)
[REF0010]
Details
Cellulitis
Diagnosis and Treatment of Skin, Skin Structure,
and Soft Tissue Infections - Adult - Clinical
Practice Guildeline
URL: https://uconnect.wisc.edu/clinical/cckm-
tools/content/cpg/infection-and-isolation/name-
97538-en.cckm
If No Suspicion of MRSA (Single Response) [139993]
URL:
cefazolin (ANCEF) intraVENOUS [800000] 2 g, Intravenous, ONCE For 1 Doses
oxacillin intraVENOUS [800065] 2 g, Intravenous, ONCE For 1 Doses
clindamycin (CLEOCIN) intraVENOUS - Patients
with Immediate/Severe Reactions to Penicillin or
Known Cephalosporin Allergies [800033]
900 mg, Intravenous, ONCE For 1 Doses
If High Suspicion of MRSA [140002]
to Vancomycin.high suspicion of MRSA please order MRSA by PCR (2 specimens) in addition If
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose 2 grams) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
For Skin Infections Caused by animal or human bites [140003]
ampicillin/sulbactam (UNASYN) intraVENOUS
[800010]
3 g, Intravenous, ONCE For 1 Doses
No Concern for MRSA - OUTPATIENT SCRIPTS [140007]
DICLOXACILLIN SODIUM 500 MG PO CAPS -
For 7-14 Days [36692]
500 mg, starting 1/22/18, Normal
CEPHALEXIN 500 MG PO CAPS - For 7-14 Days
[44594]
500 mg, starting 1/22/18, Normal
Concern for MRSA - OUTPATIENT SCRIPTS [140008]
sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab - Take 1-2 tabs for 7-14
Days [46804]
starting 1/22/18, Normal
Page 3 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 2:29:12 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

DOXYCYCLINE HYCLATE 100 MG PO CAPS -
For 7-14 Days [36917]
100 mg, starting 1/22/18, Normal
CLINDAMYCIN HCL 300 MG PO CAPS - For
7-14 Days [44723]
300 mg, starting 1/22/18, Normal
PID
PID [140010]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 250 mg, Intravenous, ONCE For 1 Doses
doxycycline hyclate tab [67296] 100 mg, Oral, ONCE For 1 Doses
BV [140017]
metRONIDazole (FLAGYL) tab [39639] 500 mg, Oral, ONCE For 1 Doses
PID - OUTPATIENT SCRIPTS [140018]
DOXYCYCLINE HYCLATE 100 MG PO CAPS -
For 14 Days [36917]
100 mg, 28 cap, , starting 1/22/18, Normal
METRONIDAZOLE 500 MG PO TABS - Note:
Order if diagnosis is BV [39640]
500 mg, 14 tab, , starting 1/22/18 until 1/29/18, Normal
METRONIDAZOLE 500 MG PO TABS - Note:
Order if diagnosis is PID [39640]
500 mg, 28 tab, , starting 1/22/18 until 2/5/18, Normal
Intraabdominal Infections
Community-Acquired, Mild-to-moderate infection (Single Response) [140019]
cefoxitin (MEFOXIN) intraVENOUS [800022] 2 g, Intravenous, ONCE For 1 Doses
Ciprofloxacin - metRONIDazole - For patient with
SEVERE PCN ALLERGIES [224348]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
Community-Acquired, Severe Infection/Immunocompromised/High-risk - NOTE: Select one option from
this group and consider adding additional coverage as warranted (Single Response) [140022]
piperacillin/tazobactam (ZOSYN) intraVENOUS
[800074]
4.5 g, Intravenous, ONCE For 1 Doses
Cefepime and metRONIDazole [228056]
cefepime (MAXIPIME) intraVENOUS [800016] 2 g, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
Ciprofloxacin - metRONIDazole [228054]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
Healthcare-Associated Infection - NOTE: Select one option from this group and consider adding
additional coverage as warrented (Single Response) [140032]
Cefepime and metRONIDazole [228053]
cefepime (MAXIPIME) intraVENOUS [800016] 2 g, Intravenous, ONCE For 1 Doses
metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
Ciprofloxacin - metRONIDazole [228051]
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, ONCE For 1 Doses
Page 4 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 2:29:12 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

metRONIDazole (FLAGYL) intraVENOUS
[800062]
500 mg, Intravenous, ONCE For 1 Doses
For Patients with Suspected MRSA (Additional Coverage) [140030]
vancomycin (VANCOCIN) intraVENOUS -
(Maximum 2 grams) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
For Patients with Yeast, CONSIDER for empiric use, RECOMMENDED if seen on gram stain or in culture
(Additional Coverage) [140031]
fluconazole (DIFLUCAN) intraVENOUS [800044] 400 mg, Intravenous, ONCE For 1 Doses
Urinary Tract Infection / Pyelonephritis
Urinary Tract Infection /Pyelonephritis (Single Response) [140041]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 1 g, Intravenous, ONCE For 1 Doses
gentamicin (GARAMYCIN) intraVENOUS
[800049]
5 mg/kg, Intravenous, ONCE For 1 Doses
ciprofloxacin (CIPRO) intraVENOUS - NOTE:
Order for patients with severe or immediate IgE-
mediatied beta-lactam allergy or intolerance
[800031]
400 mg, Intravenous, ONCE For 1 Doses
Urinary Tract Infection - OUTPATIENT SCRIPTS - NOTE: If ordering for a MALE urinary tract infection,
change duration of the medication to 10-14 days [140049]
Medications are listed in order of preference
NITROFURANTOIN MONOHYD MACRO 100
MG PO CAPS [45880]
100 mg, 10 cap, , starting 1/22/18 until 1/27/18,
Normal
sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab [46804]
1 tab, 6 tab, 0, starting 1/22/18 until 1/25/18, Normal
cephalexin (KEFLEX) 500 MG cap [44594] 500 mg, starting 1/22/18 until 1/29/18, Normal
CEFPODOXIME PROXETIL 100 MG PO TABS
[44562]
100 mg, 14 tab, , starting 1/22/18 until 1/29/18, Normal
fosfomycin (MONUROL) 3 G oral packet [50484] 3 g, starting 1/22/18, Normal
CIPROFLOXACIN HCL 250 MG PO TABS -
NOTE: Order for patients with severe or
immediate IgE-mediatied beta-lactam allergy or
intolerance [61499]
250 mg, 6 tab, , starting 1/22/18 until 1/25/18, Normal
Pyelonephritis - OUTPATIENT SCRIPTS [140050]
are listed in order of preferenceMedications
CEFPODOXIME PROXETIL 200 MG PO TABS -
For 7-10 days [44563]
400 mg, starting 1/22/18, Normal
sulfamethoxazole-trimethoprim (BACTRIM DS)
800-160 MG per tab [46804]
1 tab, 28 tab, 0, starting 1/22/18 until 2/5/18, Normal
CIPROFLOXACIN HCL 250 MG PO TABS - Take
500-750 mg for 7-10 days - NOTE: Order for
patients with severe or immediate IgE-mediatied
beta-lactam allergy or intolerance [61499]
starting 1/22/18, Normal
Central Nervous System
coverageceftriaxone and vancomycin and consider other medications for additional Select
CNS [140057]
Ceftriaxone - Vancomycin [228050]
ceftriaxone (ROCEPHIN) intraVENOUS [800027] 2 g, Intravenous, ONCE For 1 Doses
vancomycin (VANCOCIN) intraVENOUS -
(Maximum Dose 2 grams) [800084]
25 mg/kg, Intravenous, ONCE For 1 Doses
CNS - Additional Coverage [140061]
ampicillin (OMNIPEN) intraVENOUS - NOTE:
Consider if over 50 years of age or
immunocompromised [800009]
2 g, Intravenous, ONCE For 1 Doses
Page 5 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 2:29:12 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org

acyclovir (ZOVIRAX) intraVENOUS - NOTE:
Consider if altered mental status and LP CSF
status and LP CSF appears nonbacterial [800102]
10 mg/kg, Intravenous, ONCE For 1 Doses
dexamethasone (DECADRON) intraVENOUS -
NOTE: Consider with strong suspicion for S.
Pneumonia [800037]
0.15 mg/kg, Intravenous, ONCE For 1 Doses
Adminster with or just before antibiotic administration
Discharge Prescriptions
Conjunctivitis Prescriptions [140065]
SULFACETAMIDE SODIUM 10 % OPHTH SOLN
[42231]
1 drop, starting 1/22/18 until 1/29/18, Normal
POLYMYXIN B-TRIMETHOPRIM 10000-0.1
UNIT/ML-% OPHTH SOLN [46801]
1 drop, starting 1/22/18 until 1/29/18, Normal
CIPROFLOXACIN HCL 0.3 % OPHTH SOLN
[44710]
1 drop, starting 1/22/18 until 1/29/18, Normal
BACITRACIN 500 UNIT/GM OPHTH OINT
[34988]
starting 1/22/18 until 1/29/18, Normal
GENTAMICIN SULFATE 0.3 % OPHTH SOLN
[37862]
1-2 drop, starting 1/22/18 until 1/29/18, Normal
Page 6 of 6
Printed by STRAKA, KEVIN F [KFS1] at 1/22/2018 2:29:12 PM
Copyright © 2018 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 01/2018CCKM@uwhealth.org