Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Hospital-Acquired

Antimicrobial Treatment

Piperacillin-tazobactam 3.375-4.5 G IV Q6h

OR

Cefepime 2 G IV Q8-12h

PLUS

Metronidazole 500mg IV Q8h

Previous MRSA Infections

CONSIDER ADDING

Vancomycin 15 mg/kg IV Q8-12h

  • Consider pharmacy consult for dosing

  • Consider using cefepime + metronidazole regimen. Concomitant use of vancomycin and piperacillin-tazobactam is associated with an increased risk of nephrotoxicity.

Alternative Regimens

β-Lactam Allergy

Patients with penicillin allergy should not receive piperacillin-tazobactam.

Hyperbilirubinemia

Total bilirubin >4 mg/dL precluding ceftriaxone use or metronidazole intolerance

Duration

4-7 days after source control in localized IAI

Consider a 2-week course in patients with bloodstream infections

Please refer to PH Guidelines for Management of Gram-Negative Bloodstream Infections in Adults for further guidance

Additional Treatment Notes

Daily Assessment of Antimicrobial Regimen

Daily assessment of antimicrobial regimen is strongly encouraged:
1) Revision of empirical antimicrobial therapy based on identification of microorganism
2) Further streamlining to definitive therapy based on antimicrobial susceptibility testing results

Fluoroquinolones

The non-stratified use of fluoroquinolones for empirical therapy of hospitalized adults with IAI is not recommended due to increasing rates of antimicrobial resistance among E. coli and other gram-negative isolates.