Bugs & Drugs - Antibiotic QuickCard

Antibiotic selection has been identified as a potential weak spot for our residents. So, I created the below table to serve as a quick reference while on shift. My hope is to condense it to the size of a badge (front and back) so that it can be worn on one's badge holder.  Please note the disclaimer below.  This has not been peer reviewed yet.  References are listed below.

Source		Bugs	Drugs	Comments
PNA	CAP	S. pneumonia, H. influenza, Moraxella Atypicals - Mycoplasma, Chlamydia, Legionella	OP - azithro x 5d OR doxy 100mg bid x 7d IP - ceftriaxone 1g + azithro 500mg	consider moxifloxacin for comorbidities (i.e COPD, DM, CHF)
	HCAP	PsA, MRSA, E. Coli, Acinetobacter, Serratia	IP - vanc 20mg/kg + pip/tazo 4.5g + azithro 500mg	Pen allergic - substitute aztreonam or cefepime for pip/tazo
Urine	UTI	E. Coli, S. saprophyticus, Klebsiella, Proteus, Enterobacter	OP - macrobid 100mg po BID x 5d	High resistance to cipro complicated: male, stones, catheter
	Pyelo	E. Coli, S. saprophyticus, Klebsiella, Proteus, Enterobacter	OP - cipro 500mg x 7d OR TMP/SMX 1 tab bid x 10d IP - ceftriaxone 1g	cephalosporin allergy - amp/gent OR pip/tazo OR cipro
Intra- abd	Biliary	Bacteroides, Clostridium, Enterobacteriaceae (E. Coli, Klebsiella, Proteus), Enterococcus	OP - (metro 500mg tid + cipro 500mg bid) x 10d IP - pip/tazo 4.5g OR (cipro 400mg + metro 500mg)	Gram negative + anaerobic coverage
	Appendicitis
	Abscess
	Diverticulitis
	SBP	E. coli, Klebsiella, S. pneumococcus	IP - ceftriaxone 2g	Alt: ciprofloxacin
Skin	SSTI	S. pyogenes, S. aureus	OP - (cephalexin 500mg tid + doxy 100mg bid) OR (cephalexin 500mg tid + TMP/SMX 1 tab bid) OR clinda 450mg tid x 10d IP - vanc 15mg/kg OR clinda 600mg vanc 20mg/kg + pip/tazo 4.5g + clinda 600mg if nec fasc susepcted	Everyone gets MRSA coverage If necrotizing fasciitis suspected, get early surgery consultation
Bone	Open Fx	S. epidermidis, polymycrobial	IP - cefazolin 2g + (gent 5mg/kg OR pip/tazo 4.5g if contaminated) OP - cephalexin 500mg tid x 7d	pip/tazo if barnyard injury (suspected clostridium contamination)
	Osteomyelitis	S. aureus, S. epidermidis, PsA	OP - clinda 300mg tid + cipro 500mg bid x 14d IP - (vanc 20mg/kg+ pip/tazo 4.5mg) OR (clinda 600mg + cipro 400mg)	PsA + MRSA coverage
	Septic Joint	S. aureus, streptococcus, PsA, enterococcus	vanc 20mg/kg + cipro 400mg
CNS	0 - 1 month	GBS, E. Coli, Listeria	IP - amp 50mg/kg + (gent 2.5mg/kg OR cefotaxime 50mg/kg)	consider acyclovir
	1 month - Adult	N. meningitidis, S. pneumococcus, Listeria (>65)	IP - vanc 25mg/kg + ceftriaxone 2g + amp (>65) 2g	Dexamethasone 10mg prior to abx to prevent hearing loss
Gyn	Cervicitis	Gonorrhea, Chlamydia, trichomonas	ceftriaxone 250mg IM + azithro 1g x 1 + metro 2g x 1 (if trich identified)
	PID	Gonorrhea, Chlamydia, polymycrobial	ceftriaxone 250mg IM + doxy 100mg bid x 14d + metro 500mg bid x 14d (if trich identified)
	BV	Gardnerella vaginalis, polymycrobial	metro 500mg bid x 7d
	Yeast	Candida	fluconazole 200mg x 1

IP, inpatient; OP, outpatient.  All inpatient antibiotics are intravenous unless otherwise specified.  All outpatient antibiotics are po unless otherwise specified.
amp, ampicillin; azithro, azithromycin; cipro, ciprofloxacin; clinda, clindamycin; doxy, doxycycline; metro, metronidazole; TMP/SMX, trimethoprim/sulfamythoxazole; vanc, vancomycin

HCAP, Healthcare associated pneumonia: hospitalization within 90d, NH or LTAC, chemo or IV abx within 30d, HD center within 30d

PNA, pneumonia; CAP, community acquired pneumonia; SBP, spontaneously bacterial peritonitis; SSTI, skin and soft tissue infection; PID, pelvic inflammatory disease

PsA, Pseudomonas aureginosa; GBS, group B streptotoccus; MRSA, methicillin-resistant staphylococcus aureus

References:

- Nassisi D, Oishi M.  Evidenced-Based Guidelines for Evaluation and Antimicrobial Therapy for Common Emergency Department Infections.  Emergency Medicine Practice.  2012;14(1):1-32.

- 2013 EMRA Antibiotic Guide.

- Ben Cooper's brain - many antibiotic selections are based on my personal preference and bias

Disclaimer: This is to be used as a guide for antibiotic use based on my experience and practice at Parkland Hospital.  It is not a gold-standard, nor is it endorsed by Parkland Hospital.