Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Limb-threatening

Debridement and Cultures

Urgent debridement

  • 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

Piperacillin/tazobactam 4.5G IV Q6h

OR

Cefepime 2G IV Q8-12h

PLUS

Vancomycin 15 mg/kg IV Q8-12h

  • 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

PLUS

Metronidazole 500mg IV Q8h

Severe Penicillin Allergy

Definition

  • Anaphylaxis

  • Angioedema

  • Hives

Ciprofloxacin 400mg IV Q8h

PLUS

Vancomycin 15 mg/kg IV Q8-12h

  • 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

PLUS

Metronidazole 500mg IV Q8h

De-escalation

De-escalation based on deep tissue cultures