Download Antimicrobial Durations of Therapy Reference Table 2015

Antimicrobial Durations of Therapy Reference Table
This chart is intended to serve as a guide for the appropriate duration of treatment and its use should be
combined with clinical judgment taking into account patient specific responses to therapy. Infectious
Disease service is often consulted for complex patients and duration of antimicrobial therapy can vary
widely from the following recommendations.
Infection
Length of Therapy
1
Bacteremia
Uncomplicated (not including Staphylococcus aureus)
S. aureus
Complicated (septic thrombosis, endocarditis)
Pneumonia2, 3
Community-acquired afeb x 48 hrs and clinically stable*
*tolerating PO without
tachycardia, tachypnea,
hypotension, mental
status changes from
baseline, hypoxia
Hospital-acquired/
ventilator-associated
S. aureus
Legionella, Chlamydia pneumonie
Empyema, lung abscess, or
necrotizing pneumonia
Initial abx selection correct and
good clinical response
Nonfermenting Gram neg bacilli
(Pseudomonas, Acinetobacter)
Aspiration
COPD Exacerbation4
Treated with azithromycin
Treated with doxycycline
Treated with levofloxacin
Treated with amoxicillin, amoxicillin/clavulanate,
clarithyromycin, cefuroxime, cefpodoxime, cefdinir
Intra-abdominal Infections5
Diverticulitis
Complicated (perforation or abscess)
Empiric pancreatitis
Clostridium Difficile Infection6
First episode, mild/moderate or severe
Second episode
Third or greater episode
7-14 days
Request ID physician consult
4-6 weeks PLUS remove catheter
5-7 days
14-28 days
10-21 days
2-4 weeks
7-8 days
14-15 days
7-10 days
3-5 days
5 days
5-7 days
7-10 days
7-10 days
Request ID physician consult
Not indicated
10-14 days
10-14 days
Tapered/pulsed regimen
(10-14 days then taper and continue to total 6 weeks)
7,8
Skin and Soft-Tissue Infections
Surgical site infections after adequate I&D
24-48 hours
Updated by Chau Luong, PharmD and Serena Von Ruden, PharmD
Approved by ASP Committee, PT&T
Last Revision Date May 2015
Non-purulent skin infections
5 days
(Erysipelas and cellulitis)
(extended if infection has not improved in this time)
Purulent skin infections
I&D is primary therapy
(cutaneous abscess, furuncles, carbuncles)
Antibiotics only for SIRS, failed outpatient therapy,
or immunosuppressed
Associated with febrile neutropenia
Recurrent skin abscesses
7-14 days
5-10 days
Diabetic foot
infections
1-2 weeks
2-4 weeks
2-5 days
Mild
Moderate to severe
Status post amputation
UTI/Pyelonephritis9-11
Bacteriuria ±
Pregnant
pyuria in the
absence of
Prior to invasive urologic procedure
symptoms
Any other patient population
Uncomplicated
Young and otherwise healthy
Pregnant
Post-menopausal
Women with Diabetes Mellitus
Failure of short course antibiotics,
culture and re-treat
Complicated
Rapid improvement
(catheter, obstruction,
reflux, azotemia, s/p
transplant, male sex)
Delayed response
Pyelonephritis
Pyelonephritis after antibiotic failure
3-7 days with periodic screening for
recurrent bacteriuria
Through completion of procedure and
removal of urinary catheter
Not indicated
3-5 days
7 days
5-7 days
7-10 days
14 days
7 days
10-21 days
14 days
Up to 6 weeks
References
1. Mermel LA, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related
infections. Clin Infect Dis. 2009;49:1-45.
2. Mandell LA,Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society
consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-72.
3. American Thoracic Society. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and
healthcare-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388-416.
4. Stoller JK, et al. Clinical Practice. Acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med.
2002;346:988.
5. Solomin JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children. Clin Infect
Dis. 2010;50:133-164.
Updated by Chau Luong, PharmD and Serena Von Ruden, PharmD
Approved by ASP Committee, PT&T
Last Revision Date May 2015
6.
Cohen SH, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for
Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp
Epidemiol. 2010;31:431.
7. Stevens DL, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections: 2014 update by
the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2);147-59.
8. Lipsky BA, et al. 2012 Infectious Diseases Society of America: Diagnosis and treatment of diabetic foot infections. Clin
Infect Dis. 2012;54(12):132-173.
9. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM. Infectious Diseases Society of America guidelines for
the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40:643-654.
10. Gupta K, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and Pyelonephritis
in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and
Infectious Diseases. Clin Infect Dis. 2011;52:e103.
11. Hooten TM, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009
International clinical practice guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:62.
Updated by Chau Luong, PharmD and Serena Von Ruden, PharmD
Approved by ASP Committee, PT&T
Last Revision Date May 2015