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       Treatment Options Empiric

·        Treatment is generally 7 days +

·        Treatment is generally IV conversion to PO is recommended in many patients based on protocols

·        Based on what frequently occurs

·        The location of the patient and past living conditions will frequently determine the degree of therapy and the seriousness

       Gram negative suspected (not an exhaustive list)

§         Cetfazidime or Cefepime or Aztreonam + Aminoglycoside

§         Piperacillin or Mezlocillin + Aminoglycoside

§         Cetfazidime or Cefepime or Aztreonam + Ciprofloxacin

§         Piperacillin or Mezlocillin + Ciprofloxacin

§         Imipenem cilastatin + Ciprofloxacin

§         Imipenem cilastatin + Aminoglycoside

§         Zosyn or Timentin + Aminoglycoside

§         Zosyn or Timentin + Ciprofloxacin

·        Additive vs. Synergistic

·        Aminoglycoside spectrum and dosing, levels

·        What about renal patients?

·        What about pen allergic patients?

       Gram positive suspected (frequently used)

§         Vancomycin

§         Linezolid

·        What about vancomycin PO/IV

·        Vancomycin dosing/monitoring?

·        Static vs. cidal?

·        What about rifampin?

       Definitive Therapy

²      What about ESBL producers

§         E. coli, K. pneumoniae, E. cloaceae, Acinetobacter spp.

§         What treatments can be used

·        Ciprofloxacin

·        Imipenem/Cilastatin

·        Meropenem

·        Aminoglycoside

·        Zosyn or Timentin (sometimes)

·        Lone therapy or combination?

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