Antibiotic Guidelines
West Central Oregon

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Antibiotic
Indications
Adverse Effects
Comments
Ampicillin
  • Sinusitis
  • Enterococci
  • Listeria
  • Lyme disease
  • Allergic reactions
  • Rash with inadvertant Rx of infectious mononucleosis
Amoxicillin is preferred to ampicillin for oral use as it is more bioavailable
Azithromycin
  • Community acquired pneumonia
  • Atypical pneumonia
  • Non-tuberculous mycobacterial infections
  • Pertussis
  • Gonorrhea
  • Diarrhea
  • QTc prolongation
Long half life; fewer drug interactions than other macrolides
Aztreonam
  • Serious aerobic gram negative infections
  • Diarrhea
Ideal for use in cases of severe beta-lactam allergy: no GPC or anaerobic activity
Cefazolin
  • Staph aureus infections
  • Cellulitis
  • Surgical prophylaxis
  • Rash/allergy
1st gen cephalosporin - generally has better GPC coverage, lesser GNR coverage than later generations
Cefepime
  • Broad spectrum agent
  • Pseudomonas
  • Neutropenic fever
  • Rash/allergy
4th generation cephalosporin; excellent Staph aureus (non-MRSA) and GNR coverage
Ceftaroline
  • Complicated skin and soft tissue infections
  • Community acquired pneumonia
  • Nausea, vomiting
  • Rash/allergy
MRSA activity; not reliable for pseudomonas
Ceftazidime
  • Serious gram negative infections
  • Neutropenic fever
  • Rash/allergy
3rd generation cephalosporin; relatively poor activity against GPC
Ceftazidime/avi
  • Complicated intra-abdominal infections
  • Complicated urinary tract infections
  • Nausea, vomiting
  • Anxiety
  • Rash/allergy
Active against GNR including ESBL and CRE producing; Poor anaerobic activity. Add metronidazole for intra-abdominal infections
Ceftolozane/tazo
  • Complicated intra-abdominal infections
  • Complicated urinary tract infections
  • Nausea, vomiting
  • Rash/allergy
Novel, advanced generation cephalosporin; active against many ESBL forming enterobacteriacae and may be active against MDR P. aeruginosa
Ceftriaxone
  • CAP
  • Pyelonephritis
  • Bacterial meningitis
  • Gonorrhea
  • Neuroborreliosis
  • Rash/allergy
  • Biliary/gallbladder sludge
Broad spectrum; once daily administration - useful for outpatient infusion; association with C. diff infection
Cefuroxime
  • Sinusitis
  • Cellulitis
  • Rash/allergy
2nd generation cephalosporin, p.o. and IV forms
Ciprofloxacin
  • UTI/pyelonephritis
  • Intra-abdominal infection
  • Hypo/hyperglycemia
  • QTc prolongation
  • Tendinopathy
  • Photosensitivity
Not as active against respiratory pathogens as respiratory quinolones; assocation with C. diff infection; drug interactions
Clarithromycin
  • Non-tuberculous mycobacteria
  • H. pylori
  • Diarrhea
Azithromycin is often better tolerated; drug interactions
Clindamycin
  • Anaerobic infection
  • Aspiration pneumonia
  • Odontogenic infection
  • Skin and soft tissue infection
  • Diarrhea
  • Rash/allergy
  • Dysguesia
Associated with C. diff infection; Beta strep not universally susceptible; effective against some strains of MRSA; B. fragilis resistance
Dalbavancin
  • Skin and soft tissue infections due to susceptible GPC
  • Nausea, vomiting
  • Rash, "Red-Man"
Effective against GPC including MRSA and VISA; not active against VRE
Daptomycin
  • MRSA
  • VRE
  • Rhabdomyolysis
  • Eosinophilic pneumonitis
Ineffective in treatment of pneumonia; only available parenterally
Doripenem
  • Intra-abdominal infection
  • Complicated UTI
  • Nosocomial pneumonia
  • Nausea, vomiting
  • Rash/allergy
Similar spectrum of activity to imipenem, meropenem
Doxycycline
  • Many zoonotic illnesses (lyme, ehrlichia, rickettsia)
  • Minor MRSA skin infections
  • Malaria prophylaxis
  • Chlamydia
  • Photosensitivity
  • "Pill" esophagitis
Versatile, multiple uses; excellent bioavailability; no need to adjust dose for renal insufficiency
Ertapenem
  • Intra-abdominal infections
  • Skin and soft tissue infection
  • Diarrhea
  • Rash/allergy
Once daily administration - useful for outpatient infusion; no anti-pseudomonal activity; only parenteral
Erythromycin
  • Pertussis
  • Legionellosis
  • Grp A strep pharnygitis (alternative to pen)
  • Diarrhea
Other macrolides better tolerated; possible drug interactions
Gentamicin
  • UTI
  • Intra-abdominal infections
  • Synergistic therapy of endocarditis
  • Plague/tularemia
  • Nephrotoxicity
  • Otovestibular toxicity
Once daily administration is less toxic; avoid in older diabetics and the elderly
Imipenem
  • Broad spectrum coverage of serious infection
  • Healthcare associated pneumonia
  • Sepsis
  • Neutropenic fever
  • Seizure potential
Intrinsic resistance in stenotrophomonas; poor stability for outpatient infusion
Levofloxacin
  • Community acquired pneumonia
  • Drug resistant Streptococcus pneumoniae
  • Hypo/hyperglycemia
  • QTc prolongation
  • Tendinopathy
  • Photosensitivity
Ciprofloxacin has better anti-pseudomonal activity and is preferred for Rx of UTI and intra-abdominal infections; association with C. diff.
Linezolid
  • MRSA
  • VRE
  • Thrombocytopenia
  • Serotonin syndrome
  • Neurotoxicity
Excellent bioavailability; expensive; failure of therapy can occur in bloodstream infection
Meropenem
  • Broad spectrum coverage of serious infection
  • Sepsis
  • Rash/allergy
Similar spectrum to that of imipenem; less seizure risk
Metronidazole
  • Anaerobic infections
  • Clostridium difficile
  • Giardia
  • Amebiasis
  • Trichomoniasis
  • Bacterial vaginosis
  • Foul taste
  • Neurotoxicity (prolonged use)
Excellent bioavailability; disulfiram-like reaction with alcohol
Moxifloxacin
  • Community acquired pneumonia
  • Non-tuberculous mycobacterial infections
  • Hypo/hyperglycemia
  • QTc prolongation
  • Tendinopathy
  • Photosensitivity
Hepatically excreted - not indicated for UTI; association with C. diff.
Nitrofurantoin
  • Cystitis
  • UTI prophylaxis
  • Pulmonary hypersensitivity
  • Peripheral neuropathy
Not effective for upper tract urinary tract infection (pyelonephritis)
Oritavancin
  • Skin and soft tissue infection due to susceptible GPC
  • Nausea, vomiting
  • Infusion reactions
Single dose; may artificially prolong PT, PTT; No data for indications other than skin infections
Oxacillin/Nafcillin
  • Staph aureus infections
  • Interstitial nephritis
  • Rash/allergy
Drug of choice for serious methicillin senstive Staph aureus infections; no need to adjust dose for renal dysfuncion
Penicillin
  • Grp A strep pharnygitis
  • Neurosyphillis
  • Streptococcal and enterococcal endocarditis
  • Meningococcus
  • Rash
  • Immune cytopenias
  • Neurotoxicity
First antibiotic; still drug of choice for Beta streptococcal infections
Piperacillin
  • Pseudomonas
  • Enterobacteriaceae
  • Rash/allergy
Piperacillin/tazo
  • Broad spectrum coverage of serious infection
  • Healthcare associated pneumonia
  • Sepsis
  • Intra-abdominal infection
  • Rash/allergy
  • Hypersensitivity reaction
Tazobactam, a beta lactamase inhibitor, extends the spectrum of piperacillin; excellent anaerobic activity; broadest spectrum of the beta-lactamase inhibitor combination drugs
Rifampin
  • Tuberculosis
  • Combination therapy Staph infections
  • Meningococcal prophylaxis
  • Non-tuberculous mycobacteria
  • Leprosy
  • GI upset
  • Hepatitis
  • Lupus like illness (rare)
Multiple drug interactions; rapid resistance if used as sole agent for Staph
Tedizolid
  • Skin and soft tissue infection due to GPC
  • Nausea, vomiting
  • Cytopenias (prolonged use)
Active against MRSA and VRE; Much less MAO inhibition than linezolid; Avoid in bloodstream infections
Telavancin
  • Complicated skin and soft tissue infections
  • Nausea, vomiting
  • Foamy urine
  • Potential for nephrotoxicity
Once daily; MRSA activity; no drug monitoring necessary; avoid use in pregnancy
Telithromycin
  • Mild to moderately severe CAP (second line)
  • Nausea, vomiting
  • LFT elevation
Rare fulminant hepatitis; FDA withdrew indications for sinusitis, AECB accordingly
Ticarcillin/Clav
  • Broad spectrum agent for serious infection
  • Pseudomonas
  • Stenotrophomonas
  • Rash/allergy
  • Hypokalemia
Relatively inactive against enterococci; currently unavailable in U.S.
Tigecycline
  • Resistant GNR and GPC
  • MRSA
  • VRE
  • Nausea
Low serum levels - not advised for bloodstream infections
TMP/SMX
  • Cystitis
  • Minor MRSA infections
  • Pneumocystis pneumonia
  • Sinusitis
  • Rash
  • Hypersensitivity
  • Nephrotoxcity
Excellent bioavailability
Tobramycin
  • Gram neg infections
  • Intra-abdominal infections
  • UTI
  • Nephrotoxicity
  • Otovestibular toxicity
More active than gentamicin against pseudomonas
Unasyn/Augmentin
  • Bite wound infections
  • CAP
  • Diabetic foot infections
  • Biliary infections
  • Diarrhea
  • Rash/allergy
Excellent anaerobic activity; Unasyn (IV) and Augmentin (p.o.) have similar antimicrobial activity
Vancomycin
  • Serious MRSA infections
  • C. diff (p.o.)
  • Alternative antibiotic for pen allergy
  • Prosthetic device infections
  • Red man's syndrome
  • Nephrotoxicity
  • Otovestibular toxicity
  • Cytopenias
Less effective than beta-lactam antibiotics for methicillin sensitive Staph aureus

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These guidelines are created by physicians of Samaritan Infectious Disease, Corvallis, OR. They are created based on likely antibiotic effectiveness and local antibiotic susceptiblities and are intended as empiric recommendations only. Individual patient circumstances may necessitate alternate choices.
Doses are for adults with normal renal function.
2nd gen cephalosporins include cefuroxime, cefpodoxime; Resp quinolones include levofloxacin, moxifloxacin