Samaritan Infectious Disease - Antibiotic Guidelines Table View

Syndrome	Primary Rx	Alternate Rx	Comments
Pneumonia, community acquired - inpatient, ICU, pseudomonas	(Cefepime 2gm IV q8 or Pip/tazo 4.5 gm IV q 6 or Imipenem/Meropenem) + (Cipro 400 mg IV q12 or levofloxacin 750 mg qd)	(Pip/tazo or Cefepime or Imipenem/ Meropenem) + Tobramycin + Azithromycin Aztreonam + (Levofloxacin or Moxifloxacin)	Add vancomycin (or linezolid) for MRSA risk
Pneumonia, healthcare acquired	Piperacillin/tazobactam 4.5gm iv q 6hr plus (Gentamicin, Aztreonam, or Resp quinolone) +/- Vancomycin	(Cefepime or Imipenem/Meropenem) + Resp quinolone Clindamycin + Resp quinolone + Aztreonam Add vancomycin if MRSA is supected	Pneumonia acquired by persons in long term care, frequent hospitalization, etc.
Pneumonia, aspiration	Clindamycin 900mg q 8-12 hr +/- (3rd gen cephalosporin,aztreonam, or resp quinolone)	Ampicillin/sulbactam +/- (Gentamicin, Aztreonam, or quinolone)	This applies to community acquired aspiration; for healthcare aquired aspiraton, see pneumonia, heathcare acquired.
Cystitis, uncomplicated	TMP/SMX DS po bid x 3d	Nitrofurantoin (7 day course) Ciprofloxacin (3d)	Infection in young women without complicating urologic abnormalities. E. Coli are the most common cause of this syndrome.
Pyelonephritis, uncomplicated	Ciprofloxacin x 5-7 days	TMP/sulfa x14d Augmentin x 14d Ceftriaxone (IV)	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	Ampicillin 2 gm IV q 6 hr + Gentamicin IV Piperacillin/tazobactam	(Gentamicin or Aztreonam) + Vancomycin Imipenem	Complicated pyelo includes patients with obstruction, stones, urologic instrumentation, etc.
Cellulitis, mild	Dicloxacillin 500 mg po qid Cephalexin 500 mg po qid	Clindamycin	Beta streptococci are the typical cause of this syndrome; suspect MRSA if purulent skin disease is present - see MRSA algorithms.
Cellulitis, severe	Cefazolin 2 gm IV q8 hr Nafcillin 2 gm IV q 4-6 hr	Clindamycin Vancomycin	These patients may require hospitalization; if MRSA is suspected, see MRSA algorithm.
Diabetic foot infection, outpatient	Dicloxacillin 500 mg po qid Cephalexin 500 mg po qid Augmentin	Clindamycin + (TMP/SMX or Ciprofloxacin)	If MRSA is supected, see MRSA algorithm.

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Respiratory quinolones--Levofloxacin, Moxifloxacin
2nd generation cephalosporins--Cefuroxime, Cefpodoxime