Regimen A

Ticarcillin/clavulanic acid (Timentin) 3.1 g IV [B] Ampicillin/sulbactam (Unasyn) 3 g IV [B] Piperacillin/tazobactam (Zosyn) 3.375 g IV [B] Imipenem (Primaxin) 500-1000 mg IV [C] Meropenem (Merrem) 1 g IV [B]

Regimen B (Note two drug therapy) Cefotaxime (Claforan) 2 g IV [B] Ceftriaxone (Rocephin) 1-2 g IV [B] Ceftizoxime (Cefizox) 2 g IV [B] Cefoperazone (Cefobid) 2 g IV [B] Ceftazidime (Fortaz) 2 g IV [B] PLUS

Metronidazole (Flagy1) 1 g IV [B, contraindicated 1st trimester] OR Clindamycin (Cleocin) 600 mg IV [B]

Regimen C (Note one or two drug therapy) Ticarcillin (Ticar) 3-4 g IV [B] OR Piperacillin (Pipracil) 3-4 g IV [B] PLUS/MINUS

Metronidazole (Flagyl) 1 g IV [B, contraindicated 1st trimester]

Regimen D (Note two drug therapy) Aztreonam (Azactam) 2 g IV [B] PLUS

Clindamycin (Cleocin) 600 mg IV [B]

Organisms: Enterobacteriaceae, enterococci, Bacteroides, Clostridium Open Fractures

(Note two drug therapy for severe fractures)

3. Clindamycin (Cleocin) 600 mg IV [B]

PLUS (for severe fractures—grade II and above) 1. Gentamicin (Garamycin) 2 mg/kg IV [D] Organisms: S. aureus, S. epidermidis, gram negative rods Penetrating Abdominal Wounds See PresurgjoalAntibiotics, BowelPejrforat[gn/Periton^itjs. RESPIRATORY TRACT INFECTIONS Bronchitis

A. ADULTS (NON-SMOKERS, NO UNDERLYING DISEASE OR HISTORY OF RESPIRATORY PROBLEMS)

Notes: Antibiotics are rarely necessary. Treat with inhaled beta-agonist therapy (e.g., albuterol, metaproterenol). If no improvement after 1 week, consider treatment

1. Erythromycin 500 mg PO qid [B, except estolate contraindicated]

2. Erythromycin ethyl succinate (EES) 400 mg PO qid [B]

3. Azithromycin (Zithromax) 500 mg PO initial dose, then 250 mg PO qd for 4 days [B]

4. Clarithromycin (Biaxin) 250-500 mg PO bid [C]

5. Doxycycline (Vibramycin) 100 mg PO bid [D]

(Chlamydia pneumonia (TWAR) has resistance to erythromycin. Consider azithromycin or clarithromycin.) Course: 7-10 days (except azithromycin as noted)

Organisms: usually viral, Mycoplasma pneumoniae, S. pneumoniae, Chlamydia pneumoniae (TWAR)

B. ADULTS (SMOKER OR CHRONIC ILLNESS)

Note: In addition to antibiotics, treat with an inhaled b-agonist (e.g., albuterol, metaproterenol)

1. TMP/SMX DS (Bactrim DS, Septra DS) 1 tablet PO bid [B; D in 3rd trimester]

2. Doxycycline (Vibramycin) 100 mg PO bid [D]

3. Azithromycin (Zithromax) 500 mg PO initial dose, then 250 mg PO qd for 4 days [B]

4. Clarithromycin (Biaxin) 250-500 mg PO bid [C]

5. Amoxicillin/clavulanate (Augmentin) 250-500 mg PO tid [B]

6. Levofloxacin (Levaquin) 250-500 mg PO qd [C]

7. Sparfloxacin (Zagam) 400 mg PO initial dose, then 200 mg PO qd [C]

8. Cefuroxime axetil (Ceftin) 250-500 mg PO bid [B]

9. Cefpodoxime proxetil (Vantin) 200 mg PO bid [B]

Course: 10 days (except azithromycin as noted)

Organisms: H. influenzae, M. catarrhalis, S. pneumonia, Klebsiella sp., anaerobes, E. coli

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