Abx review

dinosaur1234's version from 2016-09-21 19:41


Question Answer
Uncomplicated common organismsE coli, S saprophyticus, P mirabilis, K pneumo, enterococcus
Uncomplicated 1st line optionsBactrim x3d, nitrofurantoin x5d, fosfomycin x1 dose
Uncomplicated alternativesFQ x3d, B-lactams x3-7d
Uncomplicated pyelo common organismsenterococcus, PSA, and ones in uncomplicated UTI
Outpt pyelo tx (i.e. if a patient is not immunocompromised or does not have N/V)Bactrim x14d, FQ x5-7d, B-lactam x10-14d (less effective than other 2 options)
UTI in Pg abxamoxicillin, nitrofurantoin, cephalexin x7d
Abx to avoid in PgFQ, tetracyclines, AG, Bactrim
Complicated UTI organismse coli, PSA, K pneumo, S aureus, proteus, enterococcus, fungi
Factors associated with complicated UTImale sex, hospital acquired, Pg, anatomic abnormality of GUT, childhood UTIs, recent abx, DM, indwelling cath, recent GUT instrumentation, immunosuppression
Complicated UTI txFQ, AG, extended-spectrum B-lactam x5-14d (5 days with Levo)
Prostatitis common organismsprimarily gram negatives (e coli, klebsiella, proteus, etc.)
Prostatitis txBactrim, FQ x4 weeks (chronic 1-4 months)
Epididymitis tx (>35 y)most likely caused by enteric organisms; Bactrim of FQ x10d to 4weeks
Epididymitis tx (<35 y)most likely gonococcal or chlamydial infection; ceftriaxone IM x1 + doxycycline x10 d


Question Answer
Abx with MRSA coverageBactrim, doxycycline, vancomycin, linezolid, daptomycin, clindamycin, ceftaroline, telavancin, quinupristin/dalfopristin, fosfomyxin, tigecycline
DOC for ESBL organismsCarbapenems
Abx with PSA coveragepip/tazo, tic/clav, ceftazidime (3rd gen), cefepime (4th gen), carbapenems (NOT ertapenem), aztreonam, AG, Cipro, levo; (also polymixin E (Colistin) and fosfomycin)
STATIC abxmacrolides (azithro, erythro, clarithro), tetracyclines (doxycycline), tigecycline, linezolid (static for enterococci and staph, cida for strept), clindamycin, chloramphenicol
Abx with anaerobic coverageamox/clav, amp/sul, pip/tazo, ticar/clab, cefotetan, cefoxitin, carbapenems, moxifloxacin, tetracyclines (doxy, mino, tetra), tigecycline, clindamycin (above the diaphragm, i.e. dental proph), metronidazole (below diaphragm)


Question Answer
Cellulitis common organismsusually s pyogenes, occasionally s aureus
Cellulitis treatmentantistaph penicillin (nafcillin, oxacillin, dicloxacillin); Pen G if definitely strept; x5-10d
Cellulitis tx alternativesClindamycin, b-lactamase inhibitor combinations, 1st gen cephalosporin
Outpatient cellulitis treatmentClindamycin, Bactrim, doxy, or linezolid x10d
Inpatient cellulitis txVanco, linezolid, dapto, ceftaroline, clinda x7-14d
Erysipelas treatmentPen G or Clindamycin x7-10d (infections may worsen when treatment begins)
Necrotizing fasciitis empiric txFQ + clinda OR pip/tazo OR anaerobic cephalosporin (i.e. cefoxitin) OR carbapenem (consider MRSA coverage if MRSA suspected) x10-14 (usually, but may be longer)
Streptococcal necrotizing fasciitis txhigh dose IV penicillin + clindamycin
Diabetic foot infections organismPOLYmicrobial; staph, strept, enterococcus, proteus, Ecoli, Klebsiella, Enterobacter, PSA, B frag, peptococcus
Mild/moderate diabetic foot (and no abx in past month) txpenicillinase-resistant penicillin, 1st gen cephalosporin, FQ, or clindamycin; if MRSA RF choos doxy or Bactrim; x1-2weeks
Severe diabetic foot txamp/sul, ertapenem, cefoxitin, 3rd gen ceph, moxi or Cipro/levo + clinda; tigecycline x2-3weeks
Osteomyelitis tx in neonates (<1 mo)nafcillin PLUS [cefotaxime or AG]
Osteomyelitis tx infants (1-36 mo)cefuroxime, ceftriaxone, nafcillin + cefotaxime
Osteomyelitis tx pediatricsnafcillin, cefazolin, clindamycin
Osteomyelitis tx adultsnafcillin, cefazolin, or vanco
Osteomyelitis tx adult pt with sickle cel anemiaadult tx PLUS ceftriaxone/cefotaxime or Cipro/levo
Osteomyelitis tx adult pt with prosthetic joint infectionsadult tx PLUS- vanco + rifampin; nafcillin + rifampin
Acute osteomyelitis treatment duration4-6 weeks; if successful amputation with no remaining infected tissue, continue for 2-5 days after amputation
Chronic osteomyelitis treatment duration6-8 weeks of parenteral therapy and 3-12 months of oral therapy