General Information
- Antibiotics may be unrestricted, restricted by guideline or always require approval (see list).
- Many restricted antimicrobials are available without prior approval for use in accordance with GLA ID guidelines to treat specified infections (see below or consult specific guidelines).
- During nights and weekends, pharmacy can release restricted antimicrobials pending ID approval. For continued therapy, such approval must be received by 11 AM on the next day.
- To obtain antibiotic approval call the antibiotic approval pager (5-5243).
Antibiotics Restricted to Guidelines
ID approval not required if guideline satisfied
Amikacin
- Healthcare-associated infections (e.g., patient with hospitalization or antimicrobial therapy in preceding 90 days, or an immunocompromised state)
- Nosocomial infections (onset after 3 days of hospital stay)
May also be approved by ENT, Pulmonary, Allergy, or Oral Surgery for up to 14 days
- Human/Animal (e.g., Dog, Cat, Rat) Bites
- Dental Abscess
- Sinusitis or chronic otitis media unresponsive to TMP-SMX (Bactrim™), amoxicillin, or erythromycin or T <35°C or >38°C.
- Alternative to cephalexin, clindamycin, or dicloxacillin for outpatient treatment of diabetic foot infections
- Oral powder: Chlamydia therapy (single dose) or M. avium prophylaxis (once/week)
- PO (tablets): Discharge treatment for community-acquired pneumonia in patients who cannot tolerate oral doxycycline up to 7 days (moxifloxacin is preferred)
- Alternative to piperacillin-tazobactam criteria (add metronidazole if anaerobic coverage is warranted)
- Hospital-acquired pneumonia (see guidelines)
- Hospital-acquired UTI if creatinine clearance is <30 ml/min (otherwise amikacin is recommended).
- Treatment of susceptible P. aeruginosa for 7 d (1 renewal)
- Single dose therapy for GC
- Surgical prophylaxis (24 hours perioperatively)
- Surgical prophylaxis (Approval by ID Attending Staff [discouraged])
- Cefepime will be automatically substituted
- Diabetic foot infections (for patients receiving other antibiotics to cover gram positive organisms per guidelines)
- Urinary tract infections, pyelonephritis, prostatitis
- Diverticulitis
- SPB prophylaxis (weekly)
- Treatment of documented M. avium infection or H. pylori
ID approval not required up to 7 days (1 renewal) for the following indications
- Treatment of healthcare and hospital-associated pneumonia in ward patients
- Diabetic foot infections (with vancomycin)
- Treatment of herpes zoster
- Single dose treatment for vaginal candidiasis
- Oral thrush refractory to clotrimazole troches
- Esophageal candidiasis
- Fungal UTI (yeast in urine culture and pyuria on UA; if catheter related, change catheter first)
meropenem may be substituted without ID approval in patients with a history of seizures
- Empiric treatment of hospital-acquired pneumonia in ICU patients (3 day limit).
- Targeted therapy (7 day limit with 1 renewal) of susceptible gram-negative pathogen resistant to all available fluoroquinolones, penicillins, cephalosporins and aminoglycosides
- Susceptible P. aeruginosa resistant to all other ß-lactam antibiotics
- IV: Severe community-acquired pneumonia (requiring ICU care) and severe PCN allergy (see guidelines)
- PO: Step-down therapy from piperacillin/tazobactam or ertapenem for treatment of HCAP and HAP (see guidelines)
- Treatment of suspected disseminated candidemia in ICU patients (3 days)
7 – 10 days PO does not require ID approval for
- Treatment of sinusitis and acute exacerbations of chronic bronchitis in patients unresponsive to TMP-SMX, doxycycline or amoxicillin or with WBC >15,000, WBC <3,000, or T >38°C) and who cannot tolerate oral amoxicillin/clavulanate
- Outpatient treatment of community acquired pneumonia in high risk patients (>60 yrs old, comorbid contitions, unstable vital signs)
- Stepdown therapy for patients receiving parenteral levofloxacin or ceftriaxone who required ICU care for CAP
- Empiric therapy of hospital-acquired UTI in patients with creatinine clearance <30 ml/min (cefepime is preferred agent; amikacin recommended in patients with better creatinine clearance or with severe infection)
- Pathogen-directed therapy of susceptible P. aeruginosa (7 days with 1 renewal); cefepime is preferred agent if sensitive
- Empiric therapy of necrotizing fasciitis
- Alternative to cefepime for empiric therapy of hospital-acquired pneumonia and imipenem for ventilator associated pneumonia
- Suspected or proven infection due to MRSA or methicillin-resistant coagulase-negative Staphylococcus
- Suspected or proven infection due to ampicillin-resistant Enterococcus
- Gram-positive bacterial infection in a patient with a history of serious allergy to penicillins. A delayed rash after > 4 days of treatment with a penicillin is NOT a contraindication to use of a cephalosporin.
- Surgical prophylaxis (2 doses at 12 hour intervals) for any surgery involving permanent placement of a foreign body or coronary artery bypass surgery
- Endocarditis prophylaxis per AHA guidelines in patients with-allergies to ampicillin/amoxicillin
- Other surgical prophylaxis in patients with serious allergy (i.e., urticaria, angioedema or laryngeal edema or anaphylaxis) to ß-lactam antibiotics
- Suspected (3 days) or proven (7 days) treatment of severe C. difficile colitis