Antibiotic Guidelines
Central Western Oregon
Syndrome |
Primary Rx |
Alternate Rx |
Comments |
Pharyngitis, streptococcal |
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Diagnosis is based on streptococcal throat screen or culture. |
Sinusitis, acute |
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Symptoms should have been present for more than 7 days. Antibiotic therapy is not always indicated. |
Sinusitis, chronic |
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Bronchitis, acute |
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This is usually viral in origin. | |
Otitis media, acute |
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Antibiotics are not always required. |
COPD, acute exacerbation |
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Antibiotics are not always indicated. |
Pneumonia, community acquired - outpatient |
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Use respiratory quinolone if significant comorbidities present. |
Pneumonia, community acquired - inpatient, non-ICU |
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Streptococcus pneumoniae, Haemophilus influenzae, "atypicals" are common causes of this syndrome. |
Pneumonia, community acquired - inpatient, ICU, non-pseudomonal |
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Add Vancomycin (or linezolid) for MRSA risk |
Pneumonia, community acquired - inpatient, ICU, pseudomonas |
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Add vancomycin (or linezolid) for MRSA risk |
Pneumonia, healthcare acquired |
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Pneumonia acquired by persons in long term care, frequent hospitalization, etc. |
Pneumonia, aspiration |
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This applies to community acquired aspiration; for healthcare aquired aspiraton, see pneumonia, heathcare acquired. |
Cystitis, uncomplicated |
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Infection in young women without complicating urologic abnormalities. E. Coli are the most common cause of this syndrome. |
Pyelonephritis, uncomplicated |
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No complicating urologic problems; p.o. beta-lactams not as effective as FQ's; 10-20% FQ and T/S resistance (E. Coli) |
Pyelonephritis, complicated |
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Complicated pyelo includes patients with obstruction, stones, urologic instrumentation, etc. |
Cellulitis, mild |
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Beta streptococci are the typical cause of this syndrome; suspect MRSA if purulent skin disease is present - see MRSA algorithms. |
Cellulitis, severe |
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These patients may require hospitalization; if MRSA is suspected, see MRSA algorithm. |
Diabetic foot infection, outpatient |
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If MRSA is supected, see MRSA algorithm. |
Diabetic foot infection, inpatient |
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Avoid gentamicin in older diabetics or those with renal insufficiency; use vancomycin if MRSA likely. |
Peritonitis; intra-abdominal, intra-pelvic abscess |
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Infection is often polymicrobic; GNR's and anaerobes are common etiologies. |
Clostridium difficile associated disease |
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Vancomcyin is likely more effective for severe disease; epidemic strain causes more relapses, complications. |
Arthritis, septic |
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Acute, community acquired, non-prosthetic joint. If MRSA is suspected, see MRSA algorithm-severe. |
Bite, animal or human, outpatient |
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Pasturella multocida is a common cauae of animal (cat or dog) bite infections. |
Bite, animal or human, inpatient |
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Pasturella multocida is a common cauae of animal (cat or dog) bite infections. |
MRSA, mild to moderate |
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MRSA is more reliably susceptible to TMP/SMX or doxycycline than clindamycin. |
MRSA, severe |
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Daptomycin ineffective for pneumonia; Avoid tigecycline for bloodstream infection. |
Cutaneous abscess, carbuncles |
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I&D may be sufficient; obtain cultures |
These guidelines are created by physicians ofSamaritan 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