Antibiotic Recommendations/Dosing

General Principles

1. Initiate empiric therapy based on severity of illness, likely pathogen, likelihood of drug resistance, host factors (allergy, poor renal function, immunocompromised)
2. Initiate antibiotic therapy as soon as possible
3. tailor antibiotic therapy based on culture results
4. tailor antibiotic therapy once culture results are available (often 48-72 hours)
5. Transition from IV to oral antibiotic as soon as feasible to decrease cost and reduce complications from IV access
6. Consult ID for further assistance

Disease // Treatment with Dosing

*All drug dosing is based on immunocompetent patients with no renal or hepatic dysfunction and normal weight, not elderly

BONE/JOINT

Joint infections with hardware // Consult ID and wait for results

Non-Vertebral Osteomyelitis // Vancomycin 1000 mg IV q8h

Septic Arthritis // Vancomycin 1000 mg IV q8h + Ceftriaxone 2 g IV q24h

CNS

Brain Abscess // Ceftriaxone 2 g IV q12h+ Metronidazole 500 mg IV/PO q8h+/- Vancomycin 1000 mg IV q8h 

Epidural Abscess // Ceftriaxone + Vancomycin 1000 mg q8h

Meningitis (community-onset) // Ceftriaxone 2 g IV q12h + Vancomycin 1000 mg IV q8h +/- Ampicillin 2 g IV q4h

INTRAABDOMINAL INFECTION

C. difficile (non-complicated) // Vancomycin 125 mg PO q6h

Community-Acquired Secondary Peritonitis // Ceftriaxone 1g IV q24h + Metronidazole 500 mg IV/PO q8h OR Ertapenem 1g IV q24h

Diverticulitis // Ceftriaxone 1 g IV 24h + Metronidazole 500 mg IV/PO q8h

Liver Abscess // Ceftriaxone 1 g IV 24h + Metronidazole 500 mg + Vancomycin 1000 mg IV q8h

Spontaneous Bacterial Peritonitis // Ceftriaxone 1 g IV q24h

Traveler's Diarrhea // if mild, fluid and electrolyte repletion +/- bismuth subsalicylate

 

 

 

Community Acquired Pneumonia // 

Cystitis // 

Pyelonephritis //

Meningitis //

Treatment

Acute Rhinosinusitis: Amoxicillin or Amoxicillin/Clavulanate. If allergic to Penicillin, Doxycycline or Respiratory Fluoroquinolones

Acute uncomplicated Bronchitis:

Common Cold: 

Pharyngitis: Amoxicillin of Penicillin V

Community Acquired Pneumonia

Acute Uncomplicated Cystitis: Nitrofurantoin, TM P/SMX, Fosfomycin

 

 

Reference:

Adult Outpatient Treatment Recommendations | Antibiotic Use | CDC

Antibiotic Courses for Common Infections: Recommendations From the ACP - Practice Guidelines - American Family Physician (aafp.org)

Antimicrobial stewardship in hospital settings - UpToDate

Guidelines for Empiric Therapy: Adults | Infectious Diseases Management Program at UCSF