Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Deep

Debridement and Cultures

Debridement if indicated

  • Please send deep tissue cultures upon debridement, preferably prior to starting antibiotics in the clinically stable patient

  • Superficial swab cultures have poor correlation with deep tissue cultures except Staphylococcus aureus

Empiric Therapy

Ceftriaxone 2G IV Q24h

PLUS

Metronidazole 500mg IV Q8h

OR

Cefoxitin 1-2G IV Q6-8h

Use 2G if weight >80kg

ALL OF THE ABOVE WITH OR WITHOUT

Vancomycin

  • If methicillin-resistant Staphylococcus aureus (MRSA) is suspected (known colonization, prior MRSA infections, etc.)

  • Loading dose of 20 mg/kg once is recommended

  • Q8h dosing preferred in young adults

Severe Penicillin Allergy

Definition

  • Anaphylaxis

  • Angioedema

  • Hives

Levofloxacin 750mg IV/PO Q24h

May be given orally in hemodynamically stable patients who can otherwise tolerate oral medications

PLUS

Metronidazole 500mg IV/PO Q8h

May be given orally in hemodynamically stable patients who can otherwise tolerate oral medications

WITH OR WITHOUT

Vancomycin

  • If methicillin-resistant Staphylococcus aureus (MRSA) is suspected (known colonization, prior MRSA infections, etc.)

  • Loading dose of 20 mg/kg once is recommended; Q8h dosing preferred in young adults

De-escalation

De-escalate based on deep tissue cultures