Antibiotic Guidelines
West Central Oregon
Antibiotic |
Indications |
Adverse Effects |
Comments |
Ampicillin |
|
|
Amoxicillin is preferred to ampicillin for oral use as it is more bioavailable |
Azithromycin |
|
|
Long half life; fewer drug interactions than other macrolides |
Aztreonam |
|
|
Ideal for use in cases of severe beta-lactam allergy: no GPC or anaerobic activity |
Cefazolin |
|
|
1st gen cephalosporin - generally has better GPC coverage, lesser GNR coverage than later generations |
Cefepime |
|
|
4th generation cephalosporin; excellent Staph aureus (non-MRSA) and GNR coverage |
Ceftaroline |
|
|
MRSA activity; not reliable for pseudomonas |
Ceftazidime |
|
|
3rd generation cephalosporin; relatively poor activity against GPC |
Ceftazidime/avi |
|
|
Active against GNR including ESBL and CRE producing; Poor anaerobic activity. Add metronidazole for intra-abdominal infections |
Ceftolozane/tazo |
|
|
Novel, advanced generation cephalosporin; active against many ESBL forming enterobacteriacae and may be active against MDR P. aeruginosa |
Ceftriaxone |
|
|
Broad spectrum; once daily administration - useful for outpatient infusion; association with C. diff infection |
Cefuroxime |
|
|
2nd generation cephalosporin, p.o. and IV forms |
Ciprofloxacin |
|
|
Not as active against respiratory pathogens as respiratory quinolones; assocation with C. diff infection; drug interactions |
Clarithromycin |
|
|
Azithromycin is often better tolerated; drug interactions |
Clindamycin |
|
|
Associated with C. diff infection; Beta strep not universally susceptible; effective against some strains of MRSA; B. fragilis resistance |
Dalbavancin |
|
|
Effective against GPC including MRSA and VISA; not active against VRE |
Daptomycin |
|
|
Ineffective in treatment of pneumonia; only available parenterally |
Doripenem |
|
|
Similar spectrum of activity to imipenem, meropenem |
Doxycycline |
|
|
Versatile, multiple uses; excellent bioavailability; no need to adjust dose for renal insufficiency |
Ertapenem |
|
|
Once daily administration - useful for outpatient infusion; no anti-pseudomonal activity; only parenteral |
Erythromycin |
|
|
Other macrolides better tolerated; possible drug interactions |
Gentamicin |
|
|
Once daily administration is less toxic; avoid in older diabetics and the elderly |
Imipenem |
|
|
Intrinsic resistance in stenotrophomonas; poor stability for outpatient infusion |
Levofloxacin |
|
|
Ciprofloxacin has better anti-pseudomonal activity and is preferred for Rx of UTI and intra-abdominal infections; association with C. diff. |
Linezolid |
|
|
Excellent bioavailability; expensive; failure of therapy can occur in bloodstream infection |
Meropenem |
|
|
Similar spectrum to that of imipenem; less seizure risk |
Metronidazole |
|
|
Excellent bioavailability; disulfiram-like reaction with alcohol |
Moxifloxacin |
|
|
Hepatically excreted - not indicated for UTI; association with C. diff. |
Nitrofurantoin |
|
|
Not effective for upper tract urinary tract infection (pyelonephritis) |
Oritavancin |
|
|
Single dose; may artificially prolong PT, PTT; No data for indications other than skin infections |
Oxacillin/Nafcillin |
|
|
Drug of choice for serious methicillin senstive Staph aureus infections; no need to adjust dose for renal dysfuncion |
Penicillin |
|
|
First antibiotic; still drug of choice for Beta streptococcal infections |
Piperacillin |
|
|
|
Piperacillin/tazo |
|
|
Tazobactam, a beta lactamase inhibitor, extends the spectrum of piperacillin; excellent anaerobic activity; broadest spectrum of the beta-lactamase inhibitor combination drugs |
Rifampin |
|
|
Multiple drug interactions; rapid resistance if used as sole agent for Staph |
Tedizolid |
|
|
Active against MRSA and VRE; Much less MAO inhibition than linezolid; Avoid in bloodstream infections |
Telavancin |
|
|
Once daily; MRSA activity; no drug monitoring necessary; avoid use in pregnancy |
Telithromycin |
|
|
Rare fulminant hepatitis; FDA withdrew indications for sinusitis, AECB accordingly |
Ticarcillin/Clav |
|
|
Relatively inactive against enterococci; currently unavailable in U.S. |
Tigecycline |
|
|
Low serum levels - not advised for bloodstream infections |
TMP/SMX |
|
|
Excellent bioavailability |
Tobramycin |
|
|
More active than gentamicin against pseudomonas |
Unasyn/Augmentin |
|
|
Excellent anaerobic activity; Unasyn (IV) and Augmentin (p.o.) have similar antimicrobial activity |
Vancomycin |
|
|
Less effective than beta-lactam antibiotics for methicillin sensitive Staph aureus |
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
Doses are for adults with normal renal function.
2nd gen cephalosporins include cefuroxime, cefpodoxime; Resp quinolones include levofloxacin, moxifloxacin