Microsoft word - antibiogram 2013

RESTRICTED ANTIMICROBIALS-ANTI-INFETICIVES 2013
GUIDELINES FOR USE OF ORAL VANCOMYCIN
First Dose Rule:
Category 1: To obtain a restricted antimicrobial in this category, the
If the ID Specialist (Fellow or Staff) cannot be contacted, a first dose may be dispensed
-IV preparation will be used for oral use prescriber must contact the Infectious Disease (ID) Fellow or
when a physician writes a clear indication and reason to choose Category 1 medication.
Staff/Attending on call for the ID approval. He/She will contact the
Subsequent doses can ONLY be released after ID specialist gives approval.
-Approved indication: Pseudomembranous colitis in documented Example: 1st dose of pipercillin/tazobactam can be dispensed if patient with unstable renal staff pharmacist and give verbal approval. The prescriber is responsible function or fails to respond to vancomycin. for writing the order for the medication, including the drug name, dose,
route and frequency of administration. The prescriber must indicate
AUTOMATIC THERAPEUTIC SUBSTITUTIONS
“approval by Dr. XXX (Name of ID specialist)” after obtaining the
Category 2:
To obtain a restricted medication from this group you The following antibiotics are Therapeutic Substitutions:
verbal authorization of the ID specialist. If the prescriber is an ID
must write the correct indication on the order sheet along with the drug  Ceftriaxone for cefotaxime in all patients except neonates or infants
specialist, please indicate that on the order and clearly write name and name, dose, route and frequency of administration. Unapproved (<13 months). The maximum dose for sepsis is 2 GM per day. The
physician number. If the prescriber is an intern/resident rounding with ID indications must have ID approval as Category 1 medications. A substitute maximum dose for meningitis is 4 GM per day.
team and writing orders on behalf of your team, you must indicate the
dose will be dispensed without ID approval.
name of ID fellow. To contact the ID specialist on-call, call the operator.
Category 2 Medications
 Cefepime for ceftazidime in all patients except infants and neonates
Category 1 Medications
APPROVED INDICATIONS
(< 2 months of age) or if used as an ophthalmic preparation (ONLY ADULT DOSE
APPROVED INDICATIONS
Dose greater
for Ophthalmology and EENT specialists). All other ceftazidime than 1 gm IV
“sepsis” or “SBP” (2gm Q24h) & orders will be substituted with cefepime.
renal toxicity, severe reaction or failure Cefepime 1 gm Q12h is equivalent to Ceftazidime 1 gm Q8-12h unless the order indicates above conditions Dose greater
Skin and soft tissue infections in diabetic Pipercallin-tazobactam for Ampicillin-sulbactam
Refractory invasive aspergillosis and than 4.5gm IV
Candida infections (acute disseminated vascular disease, clenched fist injuries, Nafcillin for Oxacillin in all patients (no exceptions).
head and neck injuries, intra-abdominal & nosocomial infections. For suspected or
Nafcillin 2 gm Q6h is equivalent to Oxacillin 2gm Q6h GUIDELINES FOR USE OF FLUCONAZOLE
Dose greater
than 15mg /kg
Loading/Induction Dose: 200-800mg IV or PO (doses > 400mg may be split) penicillin allergy; therapeutic failures (e.g.
Empiric therapy (< 72 hours) when a high Indications: Hepatosplenic candidiasis; Oral or vaginal candidiasis 1. Doses of Vancomycin > 2gm q12h in adult patients MUST BE APPROVED
(VRE) (both E. faecalis & E. faecium) by an ID Specialist or a Clinical Pharmacist (Clinical Pharmacokinetic
unresponsive to nystatin or clotrimazole; Cryptococcal infections and Consult).
secondary prophylaxis for Cryptococcal meningitis in immunosuppressed patients; Febrile ICU patients with TWO sites positive for yeast or yeast in AUTOMATIC IV TO PO SUBSTITUTION
Complicated intra-abdominal infections.
The pharmacist will review all orders for the desired IV Not indicated for Pseudomonas species antibiotics and determine if the patient is eligible to be switched to PO.
IV: LD: 6mg/kg
Serious infections caused by Aspergillus The pharmacist will automatically substitute the oral formulation for the IV to PO Antibiotics
PO: LD: 200-
Medication
Bioavailability
Equivalent IV to PO Dose
ALL RESTRICTIONS WILL BE STRICTLY ENFORCED BY
THE PHARMACY
Operator:
UH Campus:
903-3000
Pharmacy:
UH Campus:
903-3017
Interim LSU Hospital – New Orleans Antibiogram 2013 (Reflective of FY 2013) Antibiotic % Susceptibility Data for Selected Organisms) pg. 1 of 1
Antibiotic /
Pathogen
Acinetobacter
species
Citrobacter koseri
Enterobacter
aerogenes
Enterobacter cloacae
Klebsiella
pneumoniae
Proteus mirabilis
Pseudomonas
aeruginosa
Serratia marcescens
Stenotrophomonas
maltophilia
Enterococcus
faecium7
Enterococcus
faecalis7
Staph aureus
Staph epidermidis3
Streptococcus
pneumoniae
Nitrofurantoin reported on URINE isolates ONLY
Less than 30 isolates tested, may not be statistically significant.
Number of Staphylococcus epidermidis tested, more were isolated Ceftriaxone vs. S. pneumoniae data is using break points for non-meningitis therapy Penicillin vs. S. pneumoniae data is using break points for non-meningitis, oral therapy.
This number represents Moxifloxacin susceptibility.
Susceptibility to high level gentamicin indicates synergy with a beta-lactam is likely: E. faecium 91%, susceptible, E. faecalis 74% susceptible

Source: http://www.mclno.org/WebResources/ILH%20Antibiogram%202013.pdf