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Empiric Antibiotic Recommendations for Adults

2003

The following guidelines cannot take all factors into account in an individual patient; therefore, clinical judgment must be applied.  When prior cultures or settings suggest risk for resistant organisms, these guidelines are not valid.  Clinicians should narrow the spectrum of antibiotics when microbiologic and clinical information is available.

Pneumonia Bronchitis Acute Urinary Tract Infection Pelvic Inflammatory Infection
Sepsis/Bacteremia Skin and Soft Tissue Intra-Abdominal Infection C. Difficile Colitis
Acute Bacterial Menngitis Candidiasis Legend  

 

 

 

   
Clinical Setting Primary Alternative
Pneumonia    
Outpatient:   Macrolide(µ) or Levofloxacin  Cefuroxime
Hospitalized    Levofloxacin Ceftriaxone + Macrolide
Hospitalized, ICU   
•No increased risk of Pseudomonas		 Ceftriaxone +  
Azithromycin or Levofloxacin 		  
•With increased risk of Pseudomonas        
   

Ceftazidime or Piperacillin/Tazo  +Amikacin                    +Azithromycin or Levofloxacin 

 Ceftazidime or Piperacillin/Tazobactam +Ciprofloxacin
   
Clinical Setting Primary Alternative
Bronchitis Acute    
•No underlying diseases  Antibiotics unnecessary (ƒ)                                                      
•COPD  Trimeth-sulfa (PO) or Amoxicillin (PO) 
or Doxycycline (PO)		  
   
Clinical Setting Primary Alternative
Urinary Tract Infection  
Cystitis, pyelonephritis    
•Outpatient   Trimeth-sulfa (PO) Levofloxacin (PO)
•Complicated/inpatient Levofloxacin (PO) Imipenem                                  
Pregnancy     
•Cystitis, UTI  Nitrofurantoin  (PO) or Amoxicillin (PO)  
•Pyelonephritis  Cefotaxime  
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Clinical Setting Primary Alternative
Pelvic Inflammatory Infection                                                            
•Outpatient  Levofloxacin + Metronidazole (PO)   
•Inpatient          
Ceftriaxone + Doxycycline    		 Clindamycin + Gentamicin + Doxycycline
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Clinical Setting Primary Alternative
Sepsis/Bacteremia                                                          
•IV catheter source/shunt  Vancomycin + Ceftazidime  Vancomycin + Imipenem 
•Unknown source Imipenem ±Vancomycin ± Amikacin  Ceftazidime ±Vancomycin ± Amikacin
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Clinical Setting Primary Alternative
Skin and Soft Tissue    
Cellulitis/Post surgical    Cefazolin  Ampicillin/Sulbactam
Necrotizing/Complicated*    Imipenem + Amikacin Timentin
Diabetic Foot    
•Moderate    Amoxicillin/clavulanate (PO) or Ampicillin/sulbactam (IV) Levofloxacin + Metronidazole (PO) or
Levofloxacin + Clindamycin
•Limb/life-threatening  Imipenem  
SURGICAL CONSULT		  
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Clinical Setting Primary Alternative
Intra-Abdominal   Infection                           
Stable      Amoxicillin/clavulanate (PO) or  Ampicillin/sulbactam (IV) Levofloxacin + Metronidazole (PO)
Critical infection*    Piperacillin/Tazo + Tobramycin Imipenem/cilastatin
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Clinical Setting Primary Alternative
C. Difficile Colitis                                              
C. Difficile Colitis Metronidazole (PO)                                 
   
Clinical Setting Primary Alternative
Acute Bacterial Menngitis*    
Competent host   Ceftriaxone + Vancomycin  Chloramphenicol + Vancomycin
Post-op or post trauma    Ceftazidime + Vancomycin  CONSIDER ID CONSULT
Immunocompromised   Ceftazidime + Ampicillin + Vancomycin    
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Clinical Setting Primary Alternative
Candidiasis  

                                   

  
Line-related infection   Remove line  Remove line + Fluconazole
Candidemia, or suspected candidiasis   Fluconazole (†)        Amphotericin B

Legend

*    Consider ID consult    
#     Single blood isolates of Gram Positive Cocci -- consider as possible contaminant    
PO  Oral forms active/preferred    
ƒ     Treat symptomatically (analgesic, cough suppressant, etc.)    
µ     Macrolides - azithromycin, clarithromycin, erythromycin    
†     Fluconazole should be given PO whenever GI tract absorption permits 

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