Oritavancin Use Flowchart

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Table 1. Oritavancin Exclusion Criteria Effective 8/16/2018. Contact [email protected] for previous versions. 1. Sepsis or Septic shock

2. ABSSSI including: UW Health Emergency Department (UH & TAC) Oritavancin Use Flowchart · Orbital cellulitis Contact for Content: Lucas Schulz, PharmD; 608-890-8617; [email protected] · Diabetic foot infections · Burn related infection · Bite wound · Osteomyelitis Oritavancin Order intravenous · Physician diagnoses Necrotizing fasciitis exclusion criteria? Yes antibiotics for patient with ABSSSI · Catheter/device related infection (Table 1) ABSSSI · Environmental/polymicrobial source

3. Severe allergy to: · Oritavancin No · Dalbavancin · Abbreviations: Vancomycin ABX: Antibiotic · Daptomycin ABSSSI: Acute Bacterial Skin and Skin Structure Infections · Telavancin MPP: Multipurpose Procedure Room ≥1 risk factor(s) for oral outpatient ABX Can patient take Discharge from ED 4. CDU or inpatient admission planned CDU: Clinical Decision Unit No Yes UH: University Hospital treatment failure? oral medication? on oral antibiotics TAC: The American Center (Table 2) 5. Age < 18 years old Table 2. Risk Factors for Oral Antibiotic Outpatient Treatment Failure

Yes 1. Psychosocial concern for adherence 2. Acquired Immunodeficiency Syndrome No 3. Intravenous Drug User Physician discusses 4. Cognitively impaired Appropriate ABSSSI treatment 5. Chronic edema Yes candidate for options with patient, 6. Lymphedema oritavancin including oritavancin 7. Chronic leg ulcers 8. Cirrhosis Approval via 3333 pager is not required for oritavancin 9. Duration of infection greater than 7 days administered in the ED for ABSSSI. The 3333 pager is 10. History of ABSSSI at same site within last 3 available from 0700-2200 daily if questions arise. months 11. Oral treatment failure (>24 hours of appropriate therapy)* 12. Incarcerated 13. Diabetes mellitus Order intravenous Patient accepts 14. Immunosuppression antibiotics for No treatment with ABSSSI oritavancin? *Expanding redness does not necessarily mean treatment failure

Physician orders Pharmacist Discharge with ABSSSI Administer oritavancin selecting completes progress information sheet oritavancin Yes “use is approved for note to document (includes return (Consider MPP room restricted no exclusion criteria precautions and close at UH) indication” & ≥ 1 risk factor outpatient follow-up)