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Transcript
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