Santa Monica:Antibiotics in Sepsis

Unknown Source

• Primary Therapy
  • piperacillin/tazobactam4.5g IV q6h OR cefepime 1g IV q8h OR meropenem 1g IV q8h
  • +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
  • +/- gentamicin 7mg/kg/dose IV q24h
  • +/- fluconazole 400mg IV q24h
• If allergy or prior exposure
  • aztreonam 2g IV q8h OR levofloxacin 750mg IV q24h
  • +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
  • +/- gentamicin 7mg/kg/dose IV q24h
  • +/- fluconazole 400mg IV q24h

Pneumonia (Community)

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

Pneumonia (Healthcare Assoc/Pseudomonas Risk)

• Primary therapy
  • cefepime 1g IV q8h OR piperacillin/tazobactam4.5g IV q6h
  • +/- azithromycin 500mg IV q24h
  • +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
• If allergy or prior exposure
  • levofloxacin 750mg IV q24h
  • +/- azithromycin 500mg IV q24h
  • +/- gentamicin extended interval 7mg/kg/dose IV q24h

Abdominal/Pelvic

• Primary therapy
  • piperacillin/tazobactam4.5g IV q6h OR ertapenem 1g IV q24h OR ceftriaxone 1g IV q24h
  • AND, metronidazole 500mg IV q8h
  • vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]
• If allergy or prior exposure
  • aztreonam 2g IV q8h
  • AND, metronidazole 500mg IV q8h
  • +/- vancomycin 15mg/kg/dose IV q12h [Maximum dose of 1500mg]

Urosepsis

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

Heme/Onch

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

See Also

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

References

Santa-Monica UCLA 5/12

Authors

Allen Bookatz, Michael O'Brien, MD