Antibiotic Stewardship Program Guide to Antimicrobial Chemotherapy 2020–2021, Tenth edition © 2020 UPMC All rights reserved. Contributors ................................................................................................. V Beta-lactam allergy documents UPMC Formulary Medications................................................................. VI Questionnaire .............................................................................................33 Antibiograms Documentation ...........................................................................................34 Housewide Evaluation and management pathway ...................................................35 UPMC Presbyterian ........................................................................... 2-12 Penicillin allergy background ..................................................................32 UPMC Shadyside ............................................................................. 13-16 Antibiotic Recommendations in Pulmonary Disease Organism/Site Specific - UPMC Presbyterian Mendelson’s syndrome .............................................................................37 Streptococcus pneumoniae ................................................................2,3 COPD Exacerbation ...................................................................................37 ICU antibiograms ............................................................................... 8-12 Aspiration Pneumonia Candida Species ......................................................................................7 Hospitalized < 5 days .............................................................................37 UPMC Hospitals Other Than UPMC Presbyterian-Shadyside ...........17 Hospitalized ≥ 5 days ............................................................................37 Organism Identification ......................................................................18, 19 Community Acquired Pneumonia Antibiotics by Class and Restriction................................................20, 21 On floor or In ICU Without Risks for Pseudomonas .........................38 Procedure for AMP Restricted Agents (Presbyterian Campus) ........22 In ICU or floor With Risks for Pseudomonas .....................................38 Procedure for AMP Restricted Agents(Shadyside Campus) .............23 Hospital-Acquired Pneumonia.................................................................39 Ventilator-Associated Pneumonia ..........................................................39 Anti-infective Agents That Should Not Be Crushed ...........................24 Pneumocystis Pneumonia (PJP) Vancomcyin Appropriate Use .................................................................25 Antimicrobial Therapy for .....................................................................40 Community-Associated MRSA (CA-MRSA) ....................................26, 27 Adjunctive Steroid Therapy for ...........................................................40 Microbiology and Dose Optimization Pearls .......................................28 Antibiotic Recommendations in Gastrointestinal Infections Antibiotic and Ethanol Lock Therapy.....................................................29 Antibiotic Prophylaxis Antibiotics of Choice by Organism For Spontaneous Bacterial Peritonitis ...............................................41 After Large GI bleed ..............................................................................41 Staphylococcus aureus Active SBP ..................................................................................................41 Methicillin-Sensitive .............................................................................30 Mild to Moderate Severity Community-Associated IAI ......................41 Methicillin-Resistant .............................................................................30 High Risk Severity or Health-Care Associated IAI ...............................42 Group A Streptococci (S pyogenes) .......................................................30 Crohn’s Disease Flare ................................................................................42 Listeria monocytogenes............................................................................30 C difficile Colitis ..........................................................................................42 Enterococcus spp ......................................................................................30 Stenotrophomonas malthophilia .............................................................30 Extended Spectrum Beta-Lactamase (ESBL) Producing Bacteria ...............................................................................30 Pseudomonas aeruginosa ........................................................................30 Duration of Antibiotic Treatment for Bloodstream Infections...........31 I II Antibiotic Recommendations in Skin/Soft Tissue Infections (SSTI) Empiric Treatment Guidelines for Candidiasis Infection severity .......................................................................................43 Candidemia .................................................................................................58 Purulent and Non-purulent SSTI .............................................................44 Candidiasis Necrotizing Soft Tissue Infections (NSTI)..............................................45 Intra-Abdominal .....................................................................................58 Wound Infection Endocarditis ............................................................................................58 Nontraumatic ..........................................................................................45 Endophthalmitis ......................................................................................59 Traumatic and Severe ...........................................................................45 Meningitis ...............................................................................................59 Mediastinitis ...............................................................................................46 Mucocutaneous .....................................................................................59 Diabetic Foot ...............................................................................................46 Esophageal .............................................................................................60 Bite Wounds Urinary .....................................................................................................60 Cat/Dog ....................................................................................................47 Vaginal .....................................................................................................60 Human ......................................................................................................47 Antifungal Recommendations in Systemic Fungal Infections Antibiotic Recommendations in Meningitis Bronchopulmonary Aspergillosis ............................................................61 Meningitis....................................................................................................48 Aspergilloma ...............................................................................................61 Head Trauma Invasive Aspergillosis ...............................................................................61 Basilar Skull Fracture ............................................................................48 Blastomycosis Pulmonary Infection and Penetrating Trauma ...............................................................................49 Extra-CNS Disease .........................................................................61, 62 Post Neurosurgical or CSF Shunt .......................................................49 CNS Disease ...........................................................................................62 Antibiotic Recommendations in Endocarditis (Native and Prosthetic Coccidiomycosis Pulmonary and Extra-CNS Disease .........................62 Valve) CNS Disease ...........................................................................................63 Streptococci .........................................................................................50, 51 Cryptococcosis Pulmonary Disease .......................................................63 Enterococci ...........................................................................................51, 52 Cryptococcosis (Meningoencephalitis) .................................................64 Staphylococcus aureus Histoplasmosis Pulmonary and Disseminated ......................................65 Methicillin-Susceptible .........................................................................53 Mucormycosis ............................................................................................65 Methicillin-Resistant .............................................................................54 Sporotrichosis Cutaneous ........................................................................65 HACEK Organisms......................................................................................54 Deep-Seated (mild/moderate) .............................................................66 Gram-Negative ...........................................................................................54 Disseminated/Meningeal/Severe Deep-Seated