Spectrum: Local Antimicrobial Stewardship, for Providence Health Care

Empiric Treatment

Most likely pathogens

IV

Penicillin G 2 million units IV q4h

AND

Metronidazole 500mg IV q12h

Severe Penicillin Allergy

Vancomycin 25mg/kg IV loading dose x 1 dose followed by 15mg/kg IV with interval to be determined by vancomycin nomogram

View Vancomycin nomogram

AND

Metronidazole 500mg IV q12h

Oral Stepdown

Oral should only be used after adequate source control

Amoxicillin-clavulanate 875-125mg PO BID

Severe Penicillin Allergy (Oral)

Cotrimoxazole DS 2 tablets PO BID

AND

Metronidazole 500mg PO BID

OR

Doxycycline 100mg PO BID

AND

Metronidazole 500mg PO BID