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Empiric Sepsis Antibiotic Chart

Source of Infection
Empiric Antimicrobial Therapy
Alternative Therapy (Severe Penicillin Allergy**)
Comments
Source of Infection
Unknown Source (includes IV-associated bacteremia)
Empiric Antimicrobial Therapy
Vancomycin (see comments)
+
(Cefepime or Piperacillin/ Tazobactam)
+/- Tobramycin
Alternative Therapy
(Severe Penicillin Allergy**)
Vancomycin (see comments)
+
Aztreonam
+/-
Tobramycin (if high suspicion for Pseudomonas)
Comments
Daptomycin 6 mg/kg is an option for severe vancomycin allergy (not Redman syndrome).
Source of Infection
Community-acquired Pneumonia
Empiric Antimicrobial Therapy
Ceftriaxone
+
Azithromycin or Levofloxacin
Alternative Therapy (Severe Penicillin Allergy**)
Vancomycin
+
Levofloxacin
Comments
Consider the addition of empiric Oseltamivir during influenza season. Aztreonam has lower susceptibilities to Pseudomonas than beta-lactams.
Source of Infection
Community-acquired Pneumonia (with Pseudomonal Risk Factors)
Empiric Antimicrobial Therapy
Ceftriaxone
+
Azithromycin or Levofloxacin
Alternative Therapy (Severe Penicillin Allergy**)
Aztreonam
+
Levofloxacin
Comments
Consider the addition of empiric Oseltamivir during influenza season. Aztreonam has lower susceptibilities to Pseudomonas than beta-lactams.
Source of Infection
Healthcare-acquired Pneumonia
Empiric Antimicrobial Therapy
(Cefepime or Piperacillin/ Tazobactam)
+
(Vancomycin or Linezolid)
+/- (Tobramycin or Levofloxacin)
Alternative Therapy (Severe Penicillin Allergy**)
Aztreonam
+
(Vancomycin or Linezolid)
+
(Tobramycin or Levofloxacin)
Comments
Consider the addition of empiric Oseltamivir during influenza season.
Aztreonam has lower susceptibilities to Pseudomonas than beta-lactams.
Source of Infection
Intra-abdominal Infection (Community-acquired)
Empiric Antimicrobial Therapy
Ceftriaxone + Metronidazole or
Piperacillin/Tazobactam
Alternative Therapy (Severe Penicillin Allergy**)
Option 1: Aztreonam + Metronidazole
+ (Vancomycin or Linezolid)
Option 2: Levofloxacin + Metronidazole
Comments
Consider adding empiric Micafungin if concern for bowel perforation.
If PCN allergy is not anaphylaxis, consider Ertapenem (Community) and Meropenem (Hospital) for monotherapy.
Source of Infection
Healthcare-acquired Pneumonia
Empiric Antimicrobial Therapy
(Cefepime or Piperacillin/ Tazobactam)
+ (Vancomycin or Linezolid)
+/- (Tobramycin or Levofloxacin)
Alternative Therapy (Severe Penicillin Allergy**)
Aztreonam
+ (Vancomycin or Linezolid)
+ (Tobramycin or Levofloxacin)
Comments
Consider the addition of empiric Oseltamivir during influenza season. Aztreonam has lower susceptibilities to Pseudomonas than beta-lactams.
Source of Infection
Intra-abdominal Infection (Community-acquired)
Empiric Antimicrobial Therapy
Ceftriaxone + Metronidazole or
Piperacillin/Tazobactam
Alternative Therapy (Severe Penicillin Allergy**)
Option 1: Aztreonam + Metronidazole
+
(Vancomycin or Linezolid)
Option 2: Levofloxacin + Metronidazole
Comments
Consider adding empiric Micafungin if concern for bowel perforation.
If PCN allergy is not anaphylaxis, consider Ertapenem (Community) and Meropenem (Hospital) for monotherapy.
Source of Infection
Intra-abdominal Infection (Hospital-acquired)
Empiric Antimicrobial Therapy
Cefepime + Metronidazole or
Piperacillin/ Tazobactam
Alternative Therapy (Severe Penicillin Allergy**)
Aztreonam + Metronidazole
+
(Vancomycin or Linezolid)
Comments
Consider adding empiric Micafungin if concern for bowel perforation.
If PCN allergy is not anaphylaxis, consider Ertapenem (Community) and Meropenem (Hospital) for monotherapy.
Source of Infection
Urinary Tract Infection
Empiric Antimicrobial Therapy
Ceftriaxone (or Cefepime if catheter-associated)
+/- Tobramycin
Alternative Therapy (Severe Penicillin Allergy**)
Levofloxacin
+
(Aztreonam or Tobramycin)
Comments
For documented or suspected ESBL producing-organisms use Ertapenem.
Source of Infection
Febrile Neutropenia
Empiric Antimicrobial Therapy
(Cefepime or Piperacillin/ Tazobactam)
+
Tobramycin
+/-
Vancomycin (see comments)
Alternative Therapy (Severe Penicillin Allergy**)
Aztreonam
+
Tobramycin
+
Vancomycin
Comments
For patients without severe Beta-lactam allergies, add empiric vancomycin if patient is MRSA colonized or has MRSA risk factor.
Source of Infection
Necrotizing/Severe Skin and Soft Tissue Infection (patient requires an immediate surgery consult)
Empiric Antimicrobial Therapy
Vancomycin
+
Piperacillin/ Tazobactam
+/-
Clindamycin (see comments)
Alternative Therapy (Severe Penicillin Allergy**)
Vancomycin
+
Aztreonam
+/-
Clindamycin (see comments)
Comments
Add Clindamycin if Streptococcus pyogenes or toxic shock syndrome suspected. In addition for severe Beta-lactam allergic patient, add clindamycin if anaerobic coverage required.
Source of Infection
Necrotizing/Severe Skin and Soft Tissue Infection (Waterborne Infection)
Empiric Antimicrobial Therapy
(Ceftriaxone or Ceftazidime)
+
Doxycycline
Alternative Therapy (Severe Penicillin Allergy**)
Vancomycin
+
Aztreonam
+
Doxycycline
Comments
Add Clindamycin if Streptococcus pyogenes or toxic shock syndrome suspected. In addition for severe Beta-lactam allergic patient, add clindamycin if anaerobic coverage required. ​​​​
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Empiric Sepsis Antibiotic Chart