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 Empiric Guidelines

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

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
    • 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)
    • 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
    • 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)
    • 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

See Also


References

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