Harbor:Empiric antibiotics

This page is for antibiotics specific to the Harbor-UCLA Medical Center; see Antibiotics by diagnosis for for national guidelines.

Harbor:Antibiotics by diagnosis

• Harbor:Pediatric antibiotics
• Harbor:Sepsis antibiotics
• Harbor:Antibiogram

Harbor Empiric Guidelines

• File:Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Inpatient Adult 2022.pdf
• File:Harbor-UCLA Medical Center Empiric Antibiotic Recommendations for Outpatient Adult 2022.pdf

SKIN & SOFT TISSUE INFECTIONS (SSTI)

• Cellulitis (no purulence) (x 5-7 days)
  • Inpatient
    • [No to Minimal Systemic Signs/Symptoms] Cefazolin 1-2g IV q8h (If documented severe ß-lactam allergy: Clindamycin 600mg IV q8h)
    • [Presence of Systemic Signs/Symptoms] Vancomycin per Pharmacy
  • Outpatient
    • Dual antibiotic treatment is not indicated.
    • Cephalexin 500mg PO QID OR Clindamycin 450mg PO TID OR TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg)
• Purulent SSTI (x 5-7 days)
  • Inpatient
    • Vancomycin per Pharmacy
  • Outpatient
    • Dual antibiotic treatment is not indicated.
    • Incision & Drainage first and then TMP-SMX DS 1-2 tabs PO BID (2 tabs if >100kg) OR Doxycycline 100mg PO BID
• Necrotizing Soft Tissue Infection
  • Inpatient
    • Ceftriaxone 1g IV q24h [infuse first] + Vancomycin per Pharmacy Metronidazole 500mg IV q8h (+ Clindamycin 900mg IV q8h if suspect streptococcal toxic shock)
• Diabetic Foot Ulcer
  • Inpatient
    • Refer to Anti-Infective Management Program (https://lacounty.sharepoint.com/sites/dhs-harbor-amp) > Documents > Diabetic Foot Infection Pathway (DFIP)

EAR, NOSE, & THROAT INFECTIONS

• Otitis Externa (x 7 days)
  • Outpatient
    • Oral therapy is NOT recommended unless extension beyond the external ear canal or severely immunocompromised.
    • Use antibiotic ear drops (Cortisporin Otic 4 drops in affected ear TID OR Ciprodex 4 drops in affected ear BID). If perforated, use Ciprodex.
• Acute Sinusitis (x 5 days)
  • Outpatient
    • Mainly viral, consider watchful waiting with supportive measures. Consider antibiotics for failure to improve ≥10 d after onset of URI, or biphasic illness <10 d with worsening after initial improvement.
    • Amoxicillin/clavulanate 875/125mg PO BID OR Doxycycline 100mg PO BID
• Group A Strep (GAS) Pharyngitis
  • Outpatient
    • Antibacterial therapy should only be used when POC PCR testing shows the presence of GAS. Do not rely on Centor criteria to diagnose GAS.
    • Penicillin VK 500mg PO BID x 10 days OR Benzathine PCN 1.2 million units IM x 1. If PCN allergy, Azithromycin 500mg PO x 3 days

RESPIRATORY INFECTIONS

• Acute Bronchitis
  • Outpatient
    • No antibiotics are indicated; offer symptomatic management and realistic time frame for cough resolution (2-4 wk). To help reframe patient’s reference point, consider terminology such as “viral chest cold.”
• Acute Exacerbation of Chronic Bronchitis (x 3-5d)
  • Outpatient
    • In patients with emphysema, COPD, or significant tobacco abuse, consider prescriptions for steroids and bronchodilators.
    • Antibiotics help reduce risk of recurrence for moderate to severe symptoms defined as purulent sputum and either dyspnea and/or increased sputum volume
    • Azithromycin 500mg PO Daily x 3 days OR Doxycycline 100mg PO BID x 5 days
• Community-acquired Pneumonia (x 5 days)
  • Inpatient
    • Ceftriaxone 1g IV q24h [infuse first] + Azithromycin 500mg IV q24h
    • If documented severe ß-lactam allergy: Levofloxacin 750mg IV q24h
  • Outpatient
    • Healthy adults without comorbidities: Amoxicillin 1g PO TID OR Doxycycline 100mg PO BID
    • Adults with comorbidities: Amoxicillin/clavulanate 875/125mg PO BID AND Azithromycin 500mg PO x 1 day then 250mg PO x 4 days OR Levofloxacin 750mg PO daily monotherapy
• Hospital-acquired Pneumonia in non-ICU (x 7 days)
  • Inpatient
    • Ceftriaxone 1g IV q24h
• Hospital-acquired Pneumonia in ICU or Ventilator-associated Pneumonia (x 7 days)
  • Inpatient
    • Cefepime 2g IV q8h [infuse first] + Vancomycin per Pharmacy
• Aspiration Pneumonia (x 5-7 days)
  • Inpatient
    • Ceftriaxone 1g IV q24h [infuse first]
    • If severe periodontal disease, necrotizing pneumonia, or lung abscess/empyema, add Metronidazole 500mg IV/PO q8h and consider longer treatment

GENITAL INFECTIONS

• Urethritis/Cervicitis
  • Outpatient
    • Empiric treatment for both gonorrhea and chlamydia is reasonable in symptomatic high risk patients. Screen for HIV/syphilis, use sexual assault order set if indicated.
    • Ceftriaxone 500mg IM [1g if >150kg] x1 AND Doxycycline monohydrate 100mg PO BID x 7 days OR Azithromycin 1g PO x1 (if pregnant)

URINARY INFECTIONS

• Asymptomatic Bacteriuria (x 5-7 days)
  • Outpatient
    • Diagnosed by urine culture (>10⁵ CFU), NOT urinalysis. No treatment indicated unless pregnant, received renal transplant in past 30 days, or undergoing GU procedure.
    • Nitrofurantoin (Macrobid)† 100mg PO BID x 5d
    • If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
• Cystitis
  • Inpatient
    • Ceftriaxone 1g IV q24h x 1-5 days
    • If documented severe ß-lactam allergy†: Gentamicin 5mg/kg IV once
  • Outpatient
    • Refer to outpatient urinary antibiogram to guide empiric treatment. Presence of squamous cells in the urinalysis indicates that the specimen is contaminated and cannot be used for UTI diagnosis.
    • Nitrofurantoin (Macrobid)† 100mg PO BID x 5 days OR TMP-SMX DS 1 tab PO BID x 3 days
    • If history of ESBL, consider: FosfomycinR 3gm PO x 1 dose
    • If pregnant, consider: Amoxicillin/clavulanate 875/125mg PO BID x 7 days OR Cephalexin 500mg PO BID x 7 days
• Pyelonephritis (x 7 days)
  • Outpatient
    • Ceftriaxone 1g IV x1 can be considered in more severe cases pending cultures.
    • TMP-SMX DS 1 tab PO BID OR Ciprofloxacin 500mg PO BID
• Complicated Urinary Tract Infections, including Catheter-associated and Pyelonephritis) (x 5-7 days)
  • Inpatient
    • Ceftriaxone 1g IV q24h
    • If documented severe ß-lactam allergy†: Gentamicin 5mg/kg IV q24h* or Ciprofloxacin 400mg IV q12h
• Hospital-Acquired or Recent Hospitalization and IV Antibiotic Use
  • Inpatient
    • Cefepime 2g IV q8h
• If Septic Shock and/or Recent History of ESBL
  • Inpatient
    • Meropenem 1g IV q8h

INTRA-ABDOMINAL INFECTIONS

• Community-acquired (x 4 days after source control)
  • Inpatient
    • Ceftriaxone 1g IV q24h [infuse first] + Metronidazole 500mg IV/PO q8h
    • If documented severe ß-lactam allergy: Ciprofloxacin 400mg IV q12h + Metronidazole 500mg IV/PO q8h
• Healthcare-associated (x 4 days after source control)
  • Inpatient
    • Piperacillin/Tazobactam 3.375g IV q8h
• If Healthcare-associated with Septic Shock
  • Inpatient
    • Meropenem 1g IV q8h
• Spontaneous Bacterial Peritonitis (x 5 days)
  • Inpatient
    • Ceftriaxone 2g IV q24h
• C. difficile Infection (x 10-14 days)
  • Inpatient
    • Vancomycin 125mg PO QID

CARDIOVASCULAR INFECTIONS

• Endocarditis
  • Inpatient
    • Ceftriaxone 2g IV q24h [infuse first] + Vancomycin per Pharmacy

NEURO INFECTIONS

• Meningitis
  • Inpatient
    • Ceftriaxone 2g IV q12h [infuse first] + Vancomycin per Pharmacy
    • + Ampicillin 2g IV q4h if age>50yr, pregnant, AIDS or immunosuppressed

IMMUNOCOMPROMISED INFECTIONS

• Neutropenic Fever
  • Inpatient
    • Cefepime 2g IV q8h
    • + Vancomycin per Pharmacy if line infection, pneumonia, skin and soft tissue infection, severe mucositis, or other gram-positive infection

SEPSIS

• Harbor:Sepsis antibiotics

PEDIATRIC INFECTIONS

• Harbor:Pediatric antibiotics

See Also

• Harbor:Antibiogram
• Antibiotics (Main)
• Antibiotics by organism