Santa Monica:Antibiotics in Sepsis

Unknown Source

1. Primary Therapy
   1. piperacillin/tazobactam 4.5g IV q6h OR cefepime 1g IV q8h OR meropenem 1g IV q8h
   2. +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
   3. +/- gentamicin 7mg/kg/dose IV q24h
   4. +/- fluconazole 400mg IV q24h
2. If allergy or prior exposure
   1. aztreonam 2g IV q8h OR levofloxacin 750mg IV q24h
   2. +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
   3. +/- gentamicin 7mg/kg/dose IV q24h
   4. +/- fluconazole 400mg IV q24h

Pneumonia (Community)

1. Comm. Acquired
   1. Ceftriaxone 1g IV q24h
   2. AND, Azithromycin 500mg IV q24h
2. If allergy or prior exposure
   1. Levofloxacin 750mg IV q24h AND Aztreonam 2g IV q8h

Pneumonia (Healthcare Assoc/Pseudomonas Risk)

1. Primary therapy
   1. cefepime 1g IV q8h OR piperacillin/tazobactam 4.5g IV q6h
   2. +/- azithromycin 500mg IV q24h
   3. +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
2. If allergy or prior exposure
   1. levofloxacin 750mg IV q24h
   2. +/- azithromycin 500mg IV q24h
   3. +/- gentamicin extended interval 7mg/kg/dose IV q24h

Abdominal/Pelvic

1. Primary therapy
   1. piperacillin/tazobactam 4.5g IV q6h OR ertapenem 1g IV q24h OR ceftriaxone 1g IV q24h
   2. AND, metronidazole 500mg IV q8h
   3. vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
2. If allergy or prior exposure
   1. aztreonam 2g IV q8h
   2. AND, metronidazole 500mg IV q8h
   3. +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]

Urosepsis

1. Primary therapy
   1. ertapenem 1g IV q24h OR ceftriaxone 1g IV q24h
2. If allergy or prior exposure
   1. ciprofloxacin 400mg IV q12h OR ciprofloxacin 400mg IV q12h
   2. AND, gentamicin 7mg/kg/dose IV q24h

Heme/Onch

1. Primary therapy
   1. meropenem 1g IV q8h
   2. +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
2. If allergy or prior exposure
   1. aztreonam 2g IV q8h
   2. +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]

See Also

• Initial Antibiotics in Sepsis (Main)
• Antibiotics (Main)
• Sepsis

Source

Santa-Monica UCLA 5/12