Used for: Anaerobic infections usually in conjunction with other agents since anaerobes usually part of a polymicrobial infection. Also used for mild-moderate C. Unasyn better for anaerobic infections above the waist, less so for intraabdominal infections due to high rate of resistance in E. Carbapenems Imipenem, Meropenem, Ertapenem, Doripenem — all have excellent anaerobic activity. Nitrofurantoin Macrobid PO Bactericidal agent that is excreted into urine, where its active metabolites attack multiple sites within bacteria.
No activity vs Pseudomonas. Generally given for 7 day course. Cannot use for pyelonephritis poor kidney tissue penetration. Fosfomycin PO Bactericidal agent that is excreted into the urine and inhibits cell wall synthesis by interfering with peptidoglycan synthesis. Used for: Uncomplicated urinary tract infections in women, especially in those with history of resistant bugs.
Given as a one-time mega-dose of 3 g excreted into urine and achieves high levels there for several days. Methenamine PO Antimicrobial agent that is converted to formaldehyde in the bladder, leading to bacteriostatic effect.
Metronidazole — see anti-anaerobe section above for more details. First-line therapy for first or second episode of mild-moderate C. PO preferred if able, but IV is also effective. IV form used for severe, complicated cases e. Not recommended after 1st relapse due to cumulative neurotoxic effect. Oral Vancomycin — first-line therapy for severe C. Shown to be superior in severe cases of C. Fidaxomicin PO Mechanism: new macrocyclic antibiotic with narrow spectrum of activity against only C.
Other options - Rifaximin sometimes used at the end of a prolonged course to prevent relapse in high-risk patients , Nitazoxanide , Tigecycline case reports of success. Despite broad spectrum, only used for select indications. Not a bad choice if patient is very ill and unclear source of infection. But what does it not cover? Also used for Cryptococcus infections maintenance phase for cryptococcal meningitis after induction with Ampho B , Coccidioidomycosis, Histoplasmosis but inferior to Itraconazole , and others.
Itraconazole PO or IV Best activity among azoles vs Histoplasmosis — used for non-severe cases, and can also follow induction phase with Ambisome for severe disease. Also used for Blastomycosis, sometimes Cocci and Paracocci infections, and onychomycosis. Commonly used for prophylaxis in transplant patients. Active vs Fusarium and Scedosporium. Posaconazole PO only Broad spectrum of activity: yeast including many Fluconazole-resistant Candida , molds, endemic fungi, zygomycetes only azole other than Isavuconazole with activity.
Fusarium is resistant in vitro. Broad activity vs virtually all fungi like Posaconazole including Candida, Aspergillus, Mucormycosis, Fusarium, Scedosporium, Cryptococcus.
All are IV only. But higher MICs in vitro for C. Also, rare reports of resistance in C. Caspofungin First approved echinocandin.
Load 70 mg IV qday, then 50 mg qday. Hepatically cleared. Micafungin Similar to Caspofungin. Anidulafungin Newest echinocandin. Also no significant drug-drug interactions. Load mg IV once, then mg IV qday. Only available PO in the US Used in combination with Amphoterecin B for initial management of several severe fungal infections: Severe cryptococcal pneumonia and meningitis, severe candidal infections endocarditis, meningitis.
In Summary: 1. Azithromycin can be given for 5 days, but longer if confirmed Legionella. Clindamycin mg IV q8 hrs add Levofloxacin if concern for community-acquired pneumonia , or 3. Polymicrobial GI flora including gram negative rods especially E. For bowel perforation, microbiology depends on site. Upper GI tract e. Lower GI tract mainly gram negative rods and anaerobes. Enterococcus and Candida species usually less important, except in healthcare-associated cases.
Duration for abscesses depends on adequate drainage, but typically minimum days after drainage. Gram negative rods including E. Also, enteric Streptococci and Enterococci. Polymicrobial GI flora. Anaerobes if biliary-enteric anastomosis. Enterococcus coverage usually not required. Bactrim DS 1 tb po bid x 3 days, or 2.
Nitrofurantoin mg po bid x 5 days contraindicated in renal failure , or 3. Ceftriaxone 1 g IV q24 hrs, or 2. Cefepime 1 g IV q12 hrs especially if prior resistant organisms or Pseudomonas. Complicated UTI defined by presence of anatomic or functional abnormality in GU tract, or urinary catheter. Staph aureus is possible if chronic urinary catheters or stents. Also: Enterococcus, Candida. Consider adding Vancomycin especially if history of prior infection, chronic urinary catheters or stents.
Streptococcus species most commonly Group A , S. More unusual pathogens are possible depending on risk factors i. Oral options: Cephalexin mg po q6 hours, Clindamycin, Dicloxacillin. Video Tutorial intranet. Antibiotic Acquistion Cost Intranet. Brigg's Drug in Pregnancy and Lactation. Lexi-Comp Interactions. Kucers' the Use of Antibiotics. Sanford Guide Web Edition. All content and media on the buganddrugs.
It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Submit a question to the Team. Antimicrobial Guidebook. Dosing Guides. Extended Infusion B-Lactams. Timetables for Extended Infusion. Vancomycin Dosing Guide. AUC Excel Calculator. Share your guidelines and antibiograms hospital-wide with Sanford Guide's custom antimicrobial stewardship app and web site.
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