High Risk
Usual Pathogens
Gram positive:
Coagulase negative Staph
Enterococcus spp
Viridans Group Streptococci
S. aureus/MRSA
S. lugdunensis
Corynebacterium spp
Bacillus cereus
Rothia spp
ß-haemolytic Streptococci
S. pneumoniae
Rhodococcus spp
Abiotrophia spp
Granulicatella spp
Leuconostoc spp
Pediococcus spp
Gram negative:
Enterobacteriaceae
Pseudomonas spp
Stenotrophomonas maltophilia
Achromobacter spp
Acinetobacter spp
Burkholderia spp
Capnocytophaga spp
Eikenella spp
Anaerobes
Polymicrobial (20-30%)
Fungi (< 5%)
Hemodynamically stable
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Piperacillin-tazobactam | 300mg piperacillin/kg/d IV div q6h | See Duration |
| + | ||
| [Gentamicin | 7mg/kg IV q24h x 1 dose | |
| or | ||
| Tobramycin] | 7mg/kg IV q24h x 1 dose |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| [Cefepime | 150mg/kg/d IV div q8h | See Duration |
| or | ||
| Imipenem | 80mg/kg/d IV div q6h | |
| or | ||
| Meropenem] | 60mg/kg/d IV div q6-8h | |
| + | ||
| [Gentamicin | 7mg/kg IV q24h x 1 dose | |
| or | ||
| Tobramycin] | 7mg/kg IV q24h x 1 dose |
Hemodynamically unstable
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Piperacillin-tazobactam | 300mg piperacillin/kg/d IV div q6h | See Duration |
| + | ||
| Vancomycin | 60mg/kg/d IV div q6h | |
| + | ||
| [Gentamicin | 7mg/kg IV q24h x 1 dose | |
| or | ||
| Tobramycin] | 7mg/kg IV q24h x 1 dose |
Severe ß-lactam allergy/anaphylaxis
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Ciprofloxacin | 30mg/kg/d IV/PO div q12h | See Duration |
| + | ||
| Clindamycin | 40mg/kg/d IV/PO div q8h | |
| + | ||
| [Gentamicin | 7mg/kg IV q24h x 1 dose | |
| or | ||
| Tobramycin] | 7mg/kg IV q24h x 1 dose |