Anti-Biotic Guidelines
*Alternate therapy reserved for reasons listed.Reasons for use must be included when ordered.* ** All dosage recommendations are for adults (unless otherwise indicated) and assume normal renal function**
SME: Director of Pharmacy
Last Review Date: 9/21/10
Last Revision Date: 12/08/2010
DIAGNOSIS |
DRUG OF CHOICE |
ALTERNATE* |
| BITES | ||
| Bite, Animal (Prophylaxis) | Cat: Amoxicillin Clavulanate 875/125 PO BID x 5 days Dog: Amoxicillin/Clavulanate 875/125 PO BID x 5 days |
For PCN allergic patients: Dog: Doxycycline 100 mg PO BID x 5 days |
| Bite, Human (Prophylaxis) | Amoxicillin/Clavulanate 875/125 PO BID x 5 days |
For PCN allergic patients: Clindamycin 300mg PO TID + Cipro 500mg PO BID x 5 days or Clindamycin 300mg PO TID + Septra DS 1 tab PO BID x 5 days |
| DENTAL ABCESS | ||
| Dental Infection | Amoxicillin 2 grams 1 hr before procedure | Clindamycin 600mg PO 1 hour before procedure (PCN allergy) |
| EAR INFECTIONS | ||
| Otitis Externa | Cortisporin Otic Susp or Soln 3 drops QID x 10days (suspension for ruptured ear drum, solution if ear drum intact) | |
| Otitis Media | Amoxicillin 250 PO TID x 7 days | Septra DS 1 PO BID x 10 days (PCN allergy) Ceftin 500mg PO BID x 7 days (PCN or SULFA allergy) |
| EYE INFECTIONS | ||
| Suppurative Conjunctivitis(Non-gonococcal; Non chlamydial) | Neosporin Opth. Soln Instill 2 drops in affected eye Q4H x 7 days | Sulfacetamide Sodium Opth Soln 10% Instil 2 drops in affected eye q 4h x 7 days. Bacitracin Opth Ointment Apply a thin film(1/2 inch ribbon of ointment) q 4h x 7 days |
| FUNGAL INFECTIONS | ||
| Candidiasis Thrush Orpharyngeal/esophageal | Nystatin liquid Swish and Swallow 4-6ml qid x 14 days | Fluconazole 200mg PO x 1 |
| Tinea Capitis (Ringworm) | Tolnaftate 1% cream apply to affected area bid for 3 weeks | |
| Tinea Cruris (jock itch) Tinea Pedis, Tinea Corporis | Tolnaftate 1% cream Apply to affected area bid for 3 weeks | |
| Tinea Versicolor | Ketoconazole 400mg PO QD x1 | Selenium Sulfide 2.5% Apply shampoo to affected area once a day for 10minutes then wash off x 7 days |
| Bacterial Vaginosis(malodorous vaginal discharge(Ph >4.5) | Metronidazole 500mg PO BID x 7 days(avoid in 1st trimester pregnancy) | |
| Vaginitis/Candidiasis | Fluconazole 150mg x 1 | Clotrimazole Vag Cream 1 applicatorful QHS x 7 days |
| LRI (LOWER RESPIRATORY) | ||
| Bronchitis, acute | Erythromycin 500mg PO QID x 14 days | Septra DS 1 tab PO BID x14days |
| PCP Prophylaxis | Septra DS 1 tab MWF (dc when CD4 count > 200 x 3 months) | Dapsone 100mg PO QD (Sulfa Allergy) dc when CD4 counts > 200 x 3 months) |
| PCP Treatment | Septra DS 2 tabs q 8 Hr x 21 days | Clindamycin 300 PO Q6H + Primaquine 15mg base PO QD x 21 days (NF) |
| SKIN INFECTIONS | ||
| Skin abcesses/infected cyst(skin postules,skin boils,furunculosis) | Cephalexin 500mg PO QID x 14 days | Clindamycin 300mg PO TID x 14 days. |
| Cellulitis, Erysipelas(Diabetic foot) | Cephalexin 500mg PO QID x 14 days | Dicloxacillin 500mg PO QID x 14 days |
| Lice | Nix Rinse (Permethrin) Wash hair, towel dry, apply Nix to saturate hair. Leave on 10 minutes. Rinse .Reaeat in a week.(Pregnancy Category B) | |
| Scabies | Elimite (Permethrin) 5% cream Apply from chin down to toes at bedtime. Wash off in morning. Repeat in a week. (Pregnancy Category B) | |
| STD | ||
| Chlamydia | Doxycycline 100mg PO BID x 7 day | Erythromycin 500mg PO QID x 7 days (Doxycycline/PCN allergy) |
| Gonorrhea | Rocephin 125mg IM x 1 + Doxycycline 100mg PO BID x 7 days (Tx Chlamydia empirically) | |
| Herpes, genital | Acyclovir 400mg PO TID x 10 days | |
| PID | Rocephin 250mg IM x 1 + Doxycycline 100mg BID x 14 days | Rocephin 250mg IM x 1 + Probenecid 1000mg PO x 1 |
| Syphyllis | Benzathine Pen G 2.4 MU IM x 1 Benzathine Pen G 2.4MU IM q week x 3 (latent > 1 yr) | Doxycycline 100mg PO BID x 14 days x 28 days( for latent,(PCN allergy) |
| UTI | ||
| UTI Uncomplicated | Uncomplicated: Septra DS 1 tab BID x 3 days Complicated: Septra DS 1 tab BID X 10 days |
Ampicillin 500mg PO QID (PREGNANT or SULFA allergy.Treat pregnant patients X7 days) Cipro 250mg PO BID x 3 days (PCN or Sulfa allergy) |
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