Empiric Antibiotic Therapy

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Contents 1 More Specific Terms 2 Introduction 3 Indications 4 Management 5 More General Terms 6 Additional Terms 7 References

More Specific Terms

• empiric antibiotic therapy for HIV Mycobacterial infection

Introduction

• Empiric antibiotic therapy for suspected infections when the organism(s) are unknown.

Indications

• intra-abdominal infection
• urinary tract infection ( UTI)
• pneumonia
• catheter-related sepsis (peripheral or central line)
• endocarditis
• meningitis
• sepsis of unknown site

Management

• general principles

• when gram stains, previous history, physical exam or laboratory information suggest a specific organism of known susceptibility, empiric therapy should be directed against that organism
• initial therapy should be altered to target identified organisms
• broad spectrum therapy is continued in febrile, neutropenic patients until neutropenia resolves
• additional therapy other than antibiotics may be indicated

• surgical drainage for abscesses
• decongestants for sinusitis

• intra-abdominal infection

• peritonitis

• spontaneous bacterial peritonitis

• usual pathogens

• enteric gram negative rods
• Streptococcus sp including pneumococcus

• antibiotics

• 3rd generation cephalosporin
• ampicillin/ gentamicin

• secondary peritonitis

• usual pathogens

• generally multiple organisms involved
• gram negative rods
• anaerobes
• Enterococci commonly found, but rarely pathogenic

• antibiotics

• cefotetan or ceftriaxone & metronidazole
• gentamicin & metronidazole
• add ciprofloxacin or amikacin if hospital- acquired

• biliary tract infection

• usual pathogens

• gram negative rods
• Streptococcus sp
• anaerobes with previous surgery

• antibiotics

• cefazolin or ampicillin/ gentamicin
• cefotetan or add metronidazole if history of biliary surgery
• ampicillin-sulbactam +/- aminoglycoside [2]
• piperacillin or mezlocillin + metronidazole +/- aminoglycoside [2]

• pseudomembranous colitis

• usual pathogen: Clostridium difficile
• antibiotics

• oral metronidazole
• oral vancomycin

• urinary tract infection (UTI)

• suspect infection with resistant organism when:

• history of previous infection with resistant organisms
• patient has recently received antibiotics
• patients with indwelling catheters
• patients with multiple previous UTIs
• patients with spinal cord injury

• community acquired UTI

• usual pathogens

• gram negative rods
• Enterococci

• antibiotics

• Bactrim DS
• ampicillin & gentamicin

• nosocomial UTI or otherwise suspected resistant organism

• usual pathogens: gram negative rods
• antibiotics

• ceftazidime
• amikacin
• gentamicin

• pneumonia

• communitiy acquired

• usual pathogens

• Streptococcus pneumonia
• Haemophilus influenzae
• Legionella
• Mycoplasma

• antibiotics: cefuroxime or ceftizoxime plus erythromycin

• nosocomial pneumonia & nursing home patients

• usual pathogens

• oral anaerobes (unless edentulous)
• gram negative rods
• Staphylococcus aureus

• antibiotics

• ceftazidime plus nafcillin plus metronidazole
• amikacin plus clindamycin

• lung abscess

• usual pathogens: anaerobes (mixed)
• antibiotics: clindamycin

• AIDS patient

• usual pathogens: Pneumocystis carinii
• antibiotics:
• Bactrim
• erythromycin (occasionally)

• catheter-related sepsis (peripheral or central line)

• usual pathogens

• Staphylococcus aureus
• Staphylococcus epidermidis
• gram negative rods

• antibiotics

• vancomycin
• add ceftazidime or amikacin if patient is septic

• endocarditis

• subacute

• usual pathogens

• Streptococcus
• Enterococci

• antibiotics: ampicillin plus gentamicin

• acute

• usual pathogens

• Streptococcus
• Staphylococcus aureus

• antibiotics: nafcillin plus gentamicin

• prosthetic valve

• usual pathogens

• Streptococcus
• Staphylococcus aureus
• Staphylococcus epidermidis
• gram negative rods

• antibiotics: vancomycin plus gentamicin

• meningitis

• community acquired

• usual pathogens

• Streptococcus pneumonia
• Neisseria meningitidis

• antibiotics

• penicillin
• ampicillin
• ceftriaxone

• post neurosurgery

• usual pathogens

• Staphylococcus aureus
• gram negative rods

• antibiotics: nafcillin plus ceftazidime

• neutropenic host

• usual pathogens

• gram negative rods
• Listeria

• antibiotics: ceftazidime plus ampicillin

• sepsis of unknown site

• neutropenic host (< 1000 neutrophils/ mm3)

• usual pathogens

• gram negative rods
• Staphylococcus aureus

• antibiotics:

• ceftazidime
• aminoglycoside & ceftazidime, ticarcillin, ticarcillin clavulanate, mezlocillin, piperacillin or imipenem [2]
• add vancomycin if central venous catheter

• others

• usual pathogens

• Staphylococcus aureus
• gram negative rods

• antibiotics: ceftazidime plus nafcillin

More General Terms

• antibiotic therapy

Additional Terms

• antibiotic (antimicrobial agent)
• antibiotic prescribing practices (antibiotic overuse)

References

1. R Libke, UCSF Fresno, 1998
2. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998

empiric antibiotic therapy