Antimicrobial
Utilization Guidelines
These guidelines have been drafted
to provide criteria for which use of specific antimicrobials is considered
appropriate. These guidelines should not
replace clinical judgment in patient-specific situations but should serve to
help clinicians make appropriate antimicrobial choices.
Cefepime
Criteria
for Use:
1. Serious infections due to
Gram-negative organisms susceptible to cefepime but resistant to other, more
narrow-spectrum agents.
2. Empiric therapy in serious
infections in which Gram-negative or mixed aerobic organisms, including Pseudomonas aeruginosa, are suspected.
3. Culture documented Pseudomonas aeruginosa infection that is
susceptible to cefepime.
4. Empiric treatment in febrile
neutropenia, usually in combination with another agent.
5. Part of initial, empiric therapy for
serious respiratory tract infections in which multidrug-resistant organsisms,
such as P. aeruginosa, are
suspected. Note: Empiric therapy should
be streamlined to definitive, targeted therapy as soon as cultures and
susceptibilities are reported.
Daptomycin
Criteria
for Use:
1. Complicated skin and skin structure
infection due to multidrug-resistant Gram-positive organisms. Daptomycin is generally considered for use in
patients failing or intolerant to therapy with vancomycin. Dose =
4 mg/kg
2. Bacteremia and/or endocarditis due
to multidrug-resistant Gram-positive organisms in a patient failing/intolerant
of therapy with vancomycin. Dose = 6 mg/kg **Requires approval from Infectious Diseases
for continuation beyond first dose.
Note:
Daptomycin has been associated with elevations in CK. Baseline and weekly monitoring is
recommended. Concomitant statin therapy
should be discontinued while patient is receiving daptomycin.
Imipenem
Criteria
for Use:
1. Culture proven infection due to
bacteria resistant to other broad-spectrum antibiotics, such as cefepime, but
susceptible to imipenem.
2. Culture-documented serious infection
with Enterobacter, Morganella, Acinetobacter,
or Citrobacter species. Administration of a third-generation
cephalosporin is not recommended for these organisms due to an inducible
extended-spectrum beta-lactamase.
3. Serious infection suspected of being
polymicrobial and/or involving anaerobic bacteria in patients intolerant of
piperacillin/tazobactam or ampicillin/sulbactam (or with resistance to these
agents)
4. Complicated intra-abdominal
infections where other beta-lactam agents are not appropriate due to
intolerance or resistance.
5. Necrotizing pancreatitis.
6. Part of initial, empiric therapy for
serious respiratory tract infections in which multidrug-resistant organsisms,
such as P. aeruginosa, are
suspected. Note: Empiric therapy should
be streamlined to definitive, targeted therapy as soon as cultures and
susceptibilities are reported.
Linezolid
Criteria
for Use:
1. Infections due to MRSA. Linezolid is generally considered for use in
patients failing or intolerant to therapy with vancomycin.
2. Infections due to VRE, including
bacteremia.
3. Initial, empiric therapy for
respiratory tract infections in patients in whom MRSA is suspected. Linezolid is generally considered for use in
patients failing or intolerant to therapy with vancomycin. Note: Empiric therapy should be streamlined
to definitive, targeted therapy as soon as cultures and susceptibilities are
reported.
Note:
Linezolid has been associated with thrombocytopenia and
anemia, particularly when therapy is continued beyond two weeks. Weekly monitoring of CBC is recommended while
receiving linezolid.
Micafungin
Criteria
for Use:
Vancomycin
Criteria
for Use:
1. Treatment of serious infections due
to beta-lactam resistant Gram-positive organisms.
2. Surgical prophylaxis in a patient
allergic to beta-lactam antibiotics.
**Therapy should not continue beyond 24 hours after the end of the
surgical procedure.**
3. Treatment of infections due to
Gram-positive organisms in the setting of beta-lactam allergy.
Voriconazole
Criteria
for Use:
1. Treatment of proven or probable
invasive aspergillosis.
2. Treatment of serious Scedosporium apiospermum and Fusarium spp. infections.
3. Treatment of invasive candida
infections refractory to amphotericin B and other triazoles.
4. Prophylaxis of
aspergillosis in patients meeting one of the following criteria: severe graft-versus-host
disease and high-dose steroid treatment, remission induction therapy for acute
myelogenous leukemia, or history of aspergillus infection with indication to
undergo additional immunosuppressive therapy.