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THE CHOICE OF ANTIBACTERIAL DRUGS

Infectious Diseases in Clinical Practice: December 2001 - Volume 10 - Issue 9 - p 502
SPECIAL ARTICLE: Review of Literature: General Infectious Diseases
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This section of IDCP features summaries of publications relevant to the practice of general infectious diseases. In most cases, a comment is provided from the editor concerning interpretation, impact or further relevant information on the topic reviewed. This represents a modification of selected entries in the “What’s News” section of the Johns Hopkins website for ID (reprinted from http://www.hopkins.id.edu, with permission).

THE CHOICE OF ANTIBACTERIAL DRUGS

[Medical Letter 2001;43:69]:

This is the review of antimicrobial selection for empiric treatment for selected infectious diseases and recommendations for specific microbes. The recommendations for empiric treatment of selected infections are summarized below:

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MEDICAL RECOMMENDATIONS FOR ANTIBIOTIC SELECTION

CAP:

Hospitalized patients: Ceftriaxone or cefotaxime + macrolide or fluoroquinolone alone.

Streptococcus pneumoniae: MIC pen < 2: cefotaxime, ceftriaxone or IV penicillin (12 mil units/d) MIC pen 3 2: fluoroquinolone or vancomycin

Outpatients: Macrolide, doxy, fluoroquinolone

Outpatient who is older/underlying disease: fluoroquinolone

Aspiration: Add clindamycin or metronidazole

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NOSOCOMIAL PNEUMONIA:

Hospital ward: Aminoglycoside + cefotaxime, ceftriaxone, cefepime, ticar/clav, pip/tazo, meropenem/imipenem

ICU: Cefepime, imipenem/meropenem + aminoglycoside MRSA prevalent: add vancomycin

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MENINGITIS:

Community-acquired: Cefotaxime or ceftriaxone + vancomycin (up to 4 gm/d) ± rifampin

Nosocomial: Vancomycin + ceftazidime

Pseudomonas: Ceftazidime + aminoglycoside

Cephalosporin/betalactam allergy: chloramphenicol + vancomycin

Listeria: Amp ± gentamycin

Listeria + betalactam allergy: TMP-SMX

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SEPSIS:

Cephalosporin (cefotaxime, ceftriaxone, cefepime), ticar/clav, pip/tazo or imipenem/meropenem plus aminoglycoside ± vancomycin

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ENDOCARDITIS:

Acute, empiric: vancomycin + gentamycin

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INTRA-ABD SEPSIS:

Mixed infection: Ticar/clav, pip/tazo, amp/sulbactam, imipenem/meropenem, cefoxitin, cefotetan

Biliary tract: Pip + metro, pip/tazo or amp/sulbactam, each ± aminoglycoside

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NEUTROPENIA:

Pip/tazo (4.5 gm q6h) + amikacin or ticar/clav (3.1 g q4h) + amikacin; add vanco if unresponsive

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UTI:

Cystitis, uncomplicated: TMP-SMX × 3d; prevalence of E. coli resistance 15–20% 3/4 fluoroquinolone

Alternatives: Nitrofurantoin, oral cephalosporins, or fosfomycin × 1

Pyelonephritis, uncomplicated: Fluoroquinolone × 7d

UTI nosocomial, nursing home, recurrent: fluoroquinolone, amox/clav, cephalosporin (cefepime, cefpodoxime, cefdinir, ceftibuten)

Hospital acquired: cephalosporins (3rd gen), fluoroquinolone, ticar/clav, pip/tazo, imipenem/meropenem ± aminoglycoside

© 2001 Lippincott Williams & Wilkins, Inc.