Sandbox Rim: Difference between revisions
Jump to navigation
Jump to search
Rim Halaby (talk | contribs) No edit summary |
Rim Halaby (talk | contribs) No edit summary |
||
| Line 1: | Line 1: | ||
<table class="wikitable"> | <table class="wikitable"> | ||
<tr class="v-firstrow"><th>Scenario </th><th> Recommendation</th></tr> | <tr class="v-firstrow"><th>Scenario </th><th> Recommendation</th></tr> | ||
<tr><td>Outpatient: Previously healthy and no use of | <tr><td>Outpatient: Previously healthy and no use of antibiotics within the last 3 months </td><td> A [[macrolide]], '''''OR''''' <br> [[Doxycyline]]</td></tr> | ||
<tr><td>Outpatient: Presence of comorbidities | <tr><td>Outpatient: Presence of comorbidities ([[diabetes mellitus]]; chronic heart, lung, liver or renal disease; alcoholism; malignancies; asplenia; immunosuppression)</td><td>A [[fluoroquinolone]] ([[moxifloxacin]], [[gemifloxacin]], or [[levofloxacin]] [750 mg]), '''''OR'''''<br> | ||
A b-lactam plus a macrolide</td></tr> | A [[b-lactam]] plus a [[macrolide]]</td></tr> | ||
<tr><td>Outpatient: Use of | <tr><td>Outpatient: Use of antibiotics within the last 3 months</td><td> An alternative from a different class should be selected:<br> | ||
A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), '''''OR'''''<br> | A [[fluoroquinolone]] ([[moxifloxacin]], [[gemifloxacin]], or [[levofloxacin]] [750 mg]), '''''OR'''''<br> | ||
A b-lactam plus a macrolide</td></tr> | A [[b-lactam]] plus a [[macrolide]]</td></tr> | ||
<tr><td>Outpatient: In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae</td><td>A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), '''''OR'''''<br> | <tr><td>Outpatient: In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) [[macrolide]]-resistant Streptococcus pneumoniae</td><td>A [[fluoroquinolone]] ([[moxifloxacin]], [[gemifloxacin]], or [[levofloxacin]] [750 mg]), '''''OR'''''<br> | ||
A b-lactam plus a macrolide</td></tr> | A [[b-lactam]] plus a [[macrolide]]</td></tr> | ||
<tr><td>Inpatient general medical ward </td><td> A | <tr><td>Inpatient general medical ward </td><td> A [[fluoroquinolone]], '''''OR'''''<br>A [[b-lactam]] plus a [[macrolide]]</td></tr> | ||
<tr><td>Inpatient ICU </td><td> A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus azithromycin, '''''OR'''''<br> A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus a fluoroquinolone, '''''OR'''''<br> For penicillin-allergic patients: a | <tr><td>Inpatient ICU </td><td> A [[b-lactam]] ([[cefotaxime]], [[ceftriaxone]], or [[ampicillin]]-[[sulbactam]]) plus [[azithromycin]], '''''OR'''''<br> A [[b-lactam]] ([[cefotaxime]], [[ceftriaxone]], or [[ampicillin]]-[[sulbactam]]) plus a [[fluoroquinolone]], '''''OR'''''<br> For [[penicillin-allergic]] patients: a [[fluoroquinolone]] plus [[aztreonam]]</td></tr> | ||
<tr><td>Outpatient: Concern about | <tr><td>Outpatient: Concern about [[pseudomona]]s</td><td>An antipneumococcal, antipseudomonal b-lactam ([[piperacillintazobactam]], [[cefepime]], [[imipenem]], or [[meropenem]]) plus either [[ciprofloxacin]] or [[levofloxacin]] (750 mg), '''''OR'''''<br> [[B-lactam]] plus an [[aminoglycoside]] and [[azithromycin]], '''''OR'''''<br>[[B-lactam]] plus an [[aminoglycoside]] and an antipneumococcal [[fluoroquinolone]], '''''OR'''''<br> | ||
For penicillin-allergic patients, substitute aztreonam for above b-lactam</td></tr> | For [[penicillin]]-allergic patients, substitute [[aztreonam]] for above [[b-lactam]]</td></tr> | ||
<tr><td>Concern about community acquired MRSA </td><td> Add vancomycin or linezolid</td></tr> | <tr><td>Concern about community acquired [[MRSA]] </td><td> Add [[vancomycin]] or [[linezolid]]</td></tr> | ||
Revision as of 19:37, 19 February 2015
| Scenario | Recommendation |
|---|---|
| Outpatient: Previously healthy and no use of antibiotics within the last 3 months | A macrolide, OR Doxycyline |
| Outpatient: Presence of comorbidities (diabetes mellitus; chronic heart, lung, liver or renal disease; alcoholism; malignancies; asplenia; immunosuppression) | A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), OR A b-lactam plus a macrolide |
| Outpatient: Use of antibiotics within the last 3 months | An alternative from a different class should be selected: A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), OR |
| Outpatient: In regions with a high rate (125%) of infection with high-level (MIC 16 mg/mL) macrolide-resistant Streptococcus pneumoniae | A fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin [750 mg]), OR A b-lactam plus a macrolide |
| Inpatient general medical ward | A fluoroquinolone, OR A b-lactam plus a macrolide |
| Inpatient ICU | A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus azithromycin, OR A b-lactam (cefotaxime, ceftriaxone, or ampicillin-sulbactam) plus a fluoroquinolone, OR For penicillin-allergic patients: a fluoroquinolone plus aztreonam |
| Outpatient: Concern about pseudomonas | An antipneumococcal, antipseudomonal b-lactam (piperacillintazobactam, cefepime, imipenem, or meropenem) plus either ciprofloxacin or levofloxacin (750 mg), OR B-lactam plus an aminoglycoside and azithromycin, OR B-lactam plus an aminoglycoside and an antipneumococcal fluoroquinolone, OR For penicillin-allergic patients, substitute aztreonam for above b-lactam |
| Concern about community acquired MRSA | Add vancomycin or linezolid |