Version May 2024
| Options for empiric parenteral therapy: | |
| Drug | Dose* |
| Monotherapy with a beta-lactam/beta-lactamase inhibitor or carbapenem such as ONE of the following: | |
| Ampicillin-sulbactam¶ | 3 g every 6 hours |
| Piperacillin-tazobactamΔ | 3.375 g every 6 hours or 4.5 g every 8 hours |
| ImipenemΔ | 500 mg every 6 hours |
| MeropenemΔ | 1 g every 8 hours |
| Ertapenem | 1 g every 24 hours |
| Combination therapy with a third-generation cephalosporin or fluoroquinolone plus anti-anaerobic coverage, such as ONE of the following: | |
| Ceftriaxone | 1 g every 24 hours |
| CiprofloxacinΔ | 400 mg every 12 hours |
| LevofloxacinΔ | 750 mg every 24 hours |
| PLUS | |
| Metronidazole | 500 mg every 8 hours |
| If MRSA risk present, add vancomycin to any of the above regimens | |
| Vancomycin | For severely ill patients, a loading dose (20 to 35 mg/kg) is appropriate; the loading dose is based on actual body weight, rounded to the nearest 250 mg increment and not exceeding 3000 mg. Within this range, we use a higher dose for critically ill patients. The initial maintenance dose and interval are determined by nomogram (typically 15 to 20 mg/kg every 8 to 12 hours for most patients with normal renal function). Subsequent dose and interval adjustments are based on AUC-guided or trough-guided serum concentration monitoring.◊ |
| Options for empiric oral therapy: | |
| Monotherapy with combination beta-lactam/beta-lactamase inhibitor such as: | |
| Amoxicillin-clavulanate | 875/125 mg twice daily |
| Combination therapy with fluoroquinolone plus anti-anaerobic coverage such as: | |
| CiprofloxacinΔ | 500 mg twice per day |
| LevofloxacinΔ | 750 mg once per day |
| PLUS | |
| Metronidazole | 500 mg three times per day |
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