Anti-Infective Agents on Formulary

Anti-infective Agents on Formulary

IV PENICILLINS / Cost/day / ORAL PENICILLINS / Cost/day
Penicillin G / 2 million unit q4h / $9.00 / Penicillin VK / 500mg QID / $0.50
Ampicillin / 1gm q6h / $13.50 / Ampicilin / 500mg QID / $0.50
Nafcillin / 2gm q4h / $91.50 / Amoxicillin / 500mg TID / $0.50
Unasyn / 1.5gm q6h / $10.00 / Dicloxacillin / 500mg QID / $1.50
3gm q6h / $19.75 / Augmentin / 500mgTID / $3.25
Zosyn / 2.25gm q6h / $45.25 / 875mg BID / $2.25
3.375gm q6h / $68.00
4.5gm q6h / $86.00 / ORAL CEPHALOSPORINS
Cephalexin / 500mg QID / $0.50
IV CEPHALOSPORINS / Cefuroxime / 250mg BID / $2.75
Cefazolin / 1gm q8h / $2.50 / 500mg BID / $5.50
2gm q8h / $4.00 / Cefaclor / 250mg TID / $4.00
Cefuroxime / 750 mg q8h / $7.75 / 500mg TID / $8.00
Cefoxitin / 1gm q8h / $13.00
2gm q8h / $23.75 / ORAL QUINOLONES
Ceftriaxone / 1gm q24h / $10.50 / Levofloxacin / 250mg daily / $2.50
2gm q12h / $15.75 / 500mg daily / $2.50
Ceftazidime / 1gm q8h / $13.75 / 750mg daily / $4.75
2gm q8h / $26.00 / Ciprofloxacin / 250mg BID / $0.25
Cefotaxime / 1gm q8h / $6.75 / 500mg BID / $0.25
CARBAPENEMS
Primaxin / 500mg q6h / $83.75 / ORAL ANTIFUNGALS
Ertapenem / 1gm q24h / $51.75 / Fluconazole / 100mg daily / $0.25
200mg daily / $0.25
IV QUINOLONES / Ketoconazole / 200mg daily / $0.40
Levofloxacin / 250mg q24h / $6.50 / Itraconazole / 200mg BID / $13.25
500mg q24h / $12.75
750mg q24h / $12.00 / ORAL MISC. ANTIMICROBIALS
Ciprofloxacin / 200mg q12h / $3.00 / Acyclovir / 200mg 5x/d / $0.25
400mg q12h / $4.50 / Azithromycin / 250mg daily / $2.50
Clindamycin / 300mg QID / $2.50
IV ANTIFUNGALS / Doxycycline / 100mg BID / $0.25
Amphotericin-B / 50mg q24h / $11.50 / Linezolid / 600mg BID / $134.00
Ambisome / 300mg q24h / $303.25 / Rifaximin / 200mg TID / $13.00
Fluconazole / 200mg q24h / $3.75 / Vancomycin / 125mg QID / $65.25
400mg q24h / $7.25 / 250mg QID / $130.50
Micafungin / 100mg q24h / $82.80 / Metronidazole / 500mg q8h / $0.25
SMZ/TMP / DS BID / $0.50
IV MISCELLANEOUS ANTIMICROBIALS / Nitrofurantoin / 100mg BID / $1.00
Acyclovir / 400mg q8h / $11.50 / Erythromycin / 500mg QID / $0.75
Azithromycin / 500mg q24h / $7.00 / Clarithromycin / 500mg BID / $4.00
Aztreonam / 1gm q8h / $97.00 / (for H. pylori)
Clindamycin / 900mg q8h / $42.25
Daptomycin / 6 mg/kg q24h / $198.75 / IV AMINOGLYCOSIDES
Doxycycline / 100mg q12h / $7.25 / Gentamicin / 350mg q24h / $0.50
Erythromycin / 500mg q6h / $27.75 / Tobramycin / 350mg q24h / $4.00
Linezolid / 600mg q12h / $171.50
Metronidazole / 500mg q8h / $5.50
SMX/TMP / 800/160mg q6h / $7.25
Tigecycline / 50mg q12h / $111.25
Vancomycin / 1gm q12h / $12.00 / *cost is based on 70kg person

Antimicrobial Prophylaxis Recommendations

Surgery Type / First Choice / Alternative
Cardiac, Non-cardiac Thoracic, Vascular, Neurosurgery, Orthopedic, Spine / Cefazolin / Vancomycin
Head and Neck / Cefazolin + Metronidazole / Gentamicin + Clindamycin
Colon and Abdominal / Cefoxitin OR Unysyn
OR Cefazolin + Metronidazole OR Ertapenem / Levaquin + Metronidazole
OR Cleocin + Levaquin
OR Cleocin + Aztreonam
OB/GYN (hysterectomy) / Cefazolin OR Cefoxitin / Clindamycin

Antimicrobial Guideline

Bill Yee, Pharm.D. · Katherine Lee, Pharm.D. · Manuel Orellana, M.D.

Stephen Connolly, M.D. · Teresa Bryant, CLS · Lois Wagenman, CLS

Approved by the Infection Control and P & T Committees

2009 Recommended Empiric Antibiotic Therapy

of Selected Infections in Adults Requiring Hospitalization

Infection / 1st Line / Alternative / Allergy
Community Acquired Pneumonia / Ceftriaxone +
Azithromycin / Ceftriaxone +
Levofloxacin
Aspiration Pneumonia / Levofloxacin +
Clindamycin / Unasyn OR
Zosyn
Hospital Acquired Pneumonia / Zosyn +
Tobramycin ±
Vancomycin / Ceftazidime +
Levofloxacin OR
Gentamicin ± Vancomycin
Suspected Pseudomonas Infection / Zosyn +
Tobramycin / Ceftazidime OR
Ciprofloxacin +
Tobramycin
UTI, Uncomplicated / TMP/SMX / Levofloxacin OR
Nitrofurantoin
UTI, Complicated / Ceftriaxone ±
Gentamicin / Levofloxacin
Sepsis of Unknown Etiology / Ceftriaxone + Gentamicin ±
Vancomycin / Levofloxacin +
Vancomycin
Intra-Abdominal Sepsis / Levofloxacin ±
Metronidazole / Ertapenem
Endocarditis / Ceftriaxone or Nafcillin ±
Gentamicin / Vancomycin +
Gentamicin
Bacterial Meningitis / Ceftriaxone + Vancomycin ±
Ampicillin / None
Pelvic Inflammatory Disease / Cefoxitin +
Doxycyline / Clindamycin +
Gentamicin
Cellulitis, Uncomplicated / Cefazolin OR
Nafcillin / Vancomycin
Cellulitis, Complicated OR
Diabetic Foot Ulcer / Unasyn OR
Ertapenem / Levofloxacin +
Clindamycin
Febrile Neutropenia
(ANC less than 500) / Zosyn OR
Imipenem / Ceftazidime +
Gentamicin

References available on CHW Pharmacy Online

http://sjrh-intranet/pharmacy/htm

St. Joseph’s Medical Center

Antibiogram 01/01/08-12/31/08

NOTES:

E. coli, Klebsiella sp. and Proteus mirabilis can produce extended-spectrum Beta Lactamases (ESBLs). Ceftazidime resistance indicates the organisms ability to produce this enzyme. Treatment with a Carbapenem is recommended.

Strains of Klebsiella pneumoniae may produe a Carbapenemase (KPC) which confers resistance to all B-lactams, extended-spectrum cephalosporins, monobactams and carbapenems. Infectious Disease consult recommended.

61% of the Staph. aureus isolates are Methicillin-Resistant (MRSA)

Susceptibility results for both hospital-acquired and community-acquired MRSA isolates are combined on this antibiogram. Community acquired isolates tend to be susceptible to a greater number of antibiotics than Hospital-acquired strains of MRSA, but they can be associated with more virulent infections.

14% of the Strep. pneumoniae isolates were intermediate for penicillin.

High doses of IV penicillins or ampicillin can be used to treat pneumococcal pneumonia caused by strains in the intermediate category, however patients with pneumococcal meningitis require therapy with maximum doses of cetriaxone or cefotaxime.