Sandbox Rim: Difference between revisions
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<table class="wikitable"> | <table class="wikitable"> | ||
<tr class="v-firstrow"><th>Scenario </th><th> Recommendation</th></tr> | <tr class="v-firstrow"><th>Scenario </th><th> Recommendation</th></tr> | ||
<tr><td>Outpatient: Previously healthy and no use of antimicrobials within the previous 3 months </td><td> A macrolide <br> Doxycyline</td></tr> | <tr><td>Outpatient: Previously healthy and no use of antimicrobials within the previous 3 months </td><td> A macrolide, '''''OR''''' <br> Doxycyline</td></tr> | ||
<tr><td>Outpatient: Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs</td><td>A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])<br> | <tr><td>Outpatient: Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs</td><td>A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])<br> | ||
A b-lactam plus a macrolide</td></tr> | A b-lactam plus a macrolide</td></tr> | ||
<tr><td>Outpatient: Use of antimicrobials within the last 3 months</td><td> An alternative from a different class should be selected:<br> | <tr><td>Outpatient: Use of antimicrobials within the last 3 months</td><td> An alternative from a different class should be selected:<br> | ||
A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])<br> | A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), '''''OR'''''<br> | ||
A b-lactam plus a macrolide</td></tr> | A b-lactam plus a macrolide</td></tr> | ||
<tr><td>Outpatient: In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae</td><td>A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg])<br> | <tr><td>Outpatient: In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae</td><td>A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), '''''OR'''''<br> | ||
A b-lactam plus a macrolide</td></tr> | A b-lactam plus a macrolide</td></tr> | ||
<tr><td>Inpatient general medical ward </td><td> A respiratory fluoroquinolone<br>A b-lactam plus a macrolide</td></tr> | <tr><td>Inpatient general medical ward </td><td> A respiratory fluoroquinolone, '''''OR'''''<br>A b-lactam plus a macrolide</td></tr> | ||
<tr><td>Inpatient ICU </td><td> A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus azithromycin<br> A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus a fluoroquinolone | <tr><td>Inpatient ICU </td><td> A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus azithromycin, '''''OR'''''<br> A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus a fluoroquinolone, '''''OR'''''<br> For penicillin-allergic patients: a respiratory fluoroquinolone and aztreonam</td></tr> | ||
<br> For penicillin-allergic patients: a respiratory fluoroquinolone and aztreonam</td></tr> | <tr><td>Outpatient: Concern about pseudomonas</td><td>An antipneumococcal, antipseudomonal b-lactam (piperacillintazobactam, cefepime, imipenem, or meropenem) plus either ciprofloxacin or levofloxacin (750 mg), '''''OR'''''<br> B-lactam plus an aminoglycoside and azithromycin, '''''OR'''''<br>B-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone, '''''OR'''''<br> | ||
<tr><td>Outpatient: Concern about pseudomonas</td><td>An antipneumococcal, antipseudomonal b-lactam (piperacillintazobactam, cefepime, imipenem, or meropenem) plus either ciprofloxacin or levofloxacin (750 mg) | |||
<br> B-lactam plus an aminoglycoside and azithromycin | |||
<br>B-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone<br> | |||
For penicillin-allergic patients, substitute aztreonam for above b-lactam</td></tr> | For penicillin-allergic patients, substitute aztreonam for above b-lactam</td></tr> | ||
<tr><td>Concern about community acquired MRSA </td><td> Add vancomycin or linezolid</td></tr> | <tr><td>Concern about community acquired MRSA </td><td> Add vancomycin or linezolid</td></tr> | ||
Revision as of 19:28, 19 February 2015
| Scenario | Recommendation |
|---|---|
| Outpatient: Previously healthy and no use of antimicrobials within the previous 3 months | A macrolide, OR Doxycyline |
| Outpatient: Presence of comorbidities such as chronic heart, lung, liver or renal disease; diabetes mellitus; alcoholism; malignancies; asplenia; immunosuppressing conditions or use of immunosuppressing drugs | A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]) A b-lactam plus a macrolide |
| Outpatient: Use of antimicrobials within the last 3 months | An alternative from a different class should be selected: A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), OR |
| Outpatient: In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae | A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), OR A b-lactam plus a macrolide |
| Inpatient general medical ward | A respiratory fluoroquinolone, OR A b-lactam plus a macrolide |
| Inpatient ICU | A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus azithromycin, OR A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus a fluoroquinolone, OR For penicillin-allergic patients: a respiratory fluoroquinolone and aztreonam |
| Outpatient: Concern about pseudomonas | An antipneumococcal, antipseudomonal b-lactam (piperacillintazobactam, cefepime, imipenem, or meropenem) plus either ciprofloxacin or levofloxacin (750 mg), OR B-lactam plus an aminoglycoside and azithromycin, OR B-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone, OR For penicillin-allergic patients, substitute aztreonam for above b-lactam |
| Concern about community acquired MRSA | Add vancomycin or linezolid |