Antimicrobial Stewardship Program

Guidebook 

UCLA Antibiotic Handbook 

Second Edition, 2015

Introduction
            How to Use This Guide
                           Important Phone Numbers
Microbiology Overview

            Interpretation of Preliminary Microbiology Data
            Interpretation of Key Phrases
            Susceptibility Testing
            Bacteriology 
                         Contaminant vs Pathogen
            Specific Cultures
                         Stool Cultures
                         Blood Cultures
                         Respiratory Cultures
            Mycobacteriology
            Virology
            Mycology
            Parasitology
Microbiology Misconceptions

           Bacteriuria in Patients with Neurogenic Bladder and/or Indwelling Catheters
           VRE in the Stool (VRE Colonization)
           The Role of Candida Isolated from Bronchoscopic Samples in Nonneutropenic
           Patients
           Double Coverage 
                         Anaerobes
Antimicrobial Formulary and Restriction Status

          Restricted Formulary Antimicrobials
          Restricted Non-Formulary Antimicrobials
Antimicrobial Fundamental Concepts
          Pharmacodynamics and Therapeutic Drug Monitoring
          Laboratory and Clinical Toxicity Monitoring
Antibiotics
          Ampicillin/Sulbactam 
          Ceftaroline
Ceftazidime-Avibactam
          Ceftolozane/tazobactam
          Cidofovir
Colistin  
          Daptomycin
          Fidaxomicin
          Ertapenem
          Fosfomycin
          Isavuconazole
          Linezolid
          Polymyxin B
          Quinupristin/dalfopristin
          Ribavirin
          Tigecycline
          Vancomycin
Antifungals
          Caspofungin
          Posaconazole
          Voriconazole
Infectious Syndromes 

Specific Treatment of Select Bacterial Organisms at UCLA
Bloodstream Infections

                        Central line-Associated Bloodstream Infection (CLABSI)
                                        Coagulase-Negative Staphylococci (CoNS)
                                        Enterococcus Faecalis 
                                        Enterococcus Faecium 
                                        Gram-Negative Bacilli 
Pulmonary Infections
                       Community-Acquired Pneumonia in Hospitalized Patients
                       Healthcare-Associated Pneumonia (NOT Ventilator-Associated) 
                       Ventilator-Associated Pneumonia (VAP) 
                      Tuberculosis (TB) Infection 

Sepsis
Skin and Soft Tissue Infections
                      Non-Purulent Infection
                      Purulent Infection 
                      Recurrent MRSA Skin Infections
                      Diabetic Foot Infections
                      Surgical Site Infections
                      Necrotizing Fasciitis (Serious, Deep-Tissue Infections) 
Urinary Tract Infections
                      Management of Patients without a Urinary Catheter
                      Management of Patients WITH a Urinary Catheter  
Neutropenic Fever

Clostridium Difficile Infection (CDI)

Endocarditis Prophylaxis
          Prevention of Endocarditis
          Candidates for Prophylaxis 
          Dental Procedures 
          Respiratory Procedures
          Gastrointestinal or Genitourinary Procedures
          Procedures Involving Infected Skin or Soft Tissue
Abdominal Infections

          Biliary Tract Infections 
          Pancreatitis
          Peritonitis 
                         Primary Peritonitis/Spontaneous Bacterial Peritonitis (SBP)  
                        Secondary Peritonitis/GI Perforation 
Central Nervous System Infections
          Meningitis
          Encephalitis 
          Brain Abscess
         CNS Shunt Infection
Penicillin Allergy
Seasonal Influenza
          Adult Patients
          Pediatric Patients

Dosing (Adult)

Dosing (Colistin)

Dosing (Pediatrics)

**Pip/tazo Extended Infusion Dosing, as of 03/17/14**

Extended-infusion piperacillin/tazobactam (ZosynŽ) dosing recommendations

Patient population

Estimated CrCl (mL/min)a or mode of dialysis

Bolus dose

(infused over 30 minutes)

Maintenance dose

(infused over 4 hours)

Adults

CrCl ≥ 20 mL/min or

CRRT

3.375g IV x1 dose

3.375g IV q8h

CrCl < 20 mL/min or

Intermittent HD

3.375g IV q12h

Pediatrics

CrCl ≥ 20 mL/minb

100mg pip/kg/dose

x1 dose

50-100mg pip/kg/dose IV q6h

aCreatinine clearance (CrCl) estimated by Cockcroft and Gault
bOnly pediatric patients with estimated CrCl ≥ 20 mL/min qualify for extended-infusion dosing. Pediatrics with severe renal impairment or hemodialysis should be continued on traditional dosing (over 30-minutes) with doses adjusted for CrCl

References:
Lodise, TP et al. Clin Infect Dis. 2007; 44(3):357-63 Yost, RJ et al. Pharmacotherapy. 2011; 31(8): 767-75
Kim, A. et al. Pharmacotherapy. 2007; 27(11):1490-97 Patel, N et al. Antimicrob Agents Chemother. 2010; 54(1):460-65
Heintz, BH. et al. Pharmacotherapy 2009; 29(5):562-577

Pediatrics Cystic Fibrosis Antibiotic Dosing Guide
Hematologic Malignancies
Cytomegalovirus Infection and Disease
Fever and Neutropenia
Fungal Disease
Interstitial Pneumonia
Other Viral Infections in Immunocompromised Hosts 
Prophylactic Antimicrobials for Patients with Solid Organ Transplants  
Antimicrobial Therapy in Head and Neck Surgery

Acknowledgments