, It is an excellent anti-anaerobic agent, but does not treat clostridium difficile infections. aureus ), Hemophilus, Moraxella, Enterobacteriaceae, and Pseudomonas aeruginosa. It covers Streptococci, Staphylococci (but not methicillin-resistant S. This antibiotic has activity against many Gram-positive, Gram-negative, and anaerobic pathogens. Piperacillin/tazobactam (Zosyn) is a combination antibiotic containing the extended-spectrum penicillin antibiotic piperacillin and the β-lactamase inhibitor tazobactam. Medication Backgroundīefore we get started, let’s go over some of the basics for Zosyn and Vancomycin. In this article, we will discuss instances where the classic combination of vancomycin and Zosyn may be indicated, and where its use may not be warranted. Appropriate antibiotic administration means that the indication for antibiotic use, the choice of the drug, timing of administration, route, dosage, frequency, and duration of administration have been carefully considered and determined to be warranted. The broad administration of vancomycin is of special concern, as it may lead to the emergence of vancomycin resistant gram-positive cocci. ![]() , It has been estimated that 55% of all antibiotic prescriptions may be unnecessary. Several studies show a disturbing trend toward increasing use of broad-spectrum antibiotics. Broad-spectrum agents, such as piperacillin-tazobactam (Zosyn) and vancomycin, are commonly used for empirical antibiotic coverage in suspected early sepsis and critically ill patients. Suspected sepsis is one of the most common causes of ED evaluation and hospital admission. Which antibiotic regimen should be administered?Įmergency Physicians are faced with the dilemma of antibiotic selection in patients with presumed sepsis or serious bacterial infection. After initial stabilization, he is taken to the operating room for emergency laparotomy for suspected peritonitis secondary to perforated appendicitis. His vital signs include temperature 102 F, heart rate 132 beats/minute, respiratory rate 36 breaths/minute, blood pressure 80/50 mm Hg, and oxygen saturation 91%. Georges University Grenada West Indies 3) // Edited by: Alex Koyfman, MD EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD Case:Ī 65-year-old man is brought to the ED in shock. Neutropenic patients should be treated according to febrile neutropenia guidelines and risk assessment.Authors: Mariam Abdelghany, PA-C 1, Minela Subasic, PA-C 1, Anthony Scoccimarro, MD 1, Joel Gernsheimer, MD 2, and Muhammad Waseem, MD, MS 1,3 (Lincoln Medical & Mental Health Center Bronx, New York 1 SUNY Downstate Medical Center New York 2 St. Aureus bacteremia have been shown to have better outcomes with mandatory ID consultation. Note of any indwelling devices, implants or hardware should be made to ensure that they do not haveĭo I need to get an infectious disease consult? Generally CNST requires treatment with vancomycin. No! Multiple positive cultures for CNST should be taken seriously. Is coagulase negative staphylococcus always a contaminant? Only patients with organisms causing endocarditis require echocardiograms ![]() ![]() Time to positivity 120 min - Central line infection.ĭo all patients require echocardiogram to rule out endocarditis? Blood cultures should be drawn from the central line and the peripheral site at the SAME time. Line infection vs peripheral infection can be distinguished using time to positivity. ![]() My patient has a central line - how do I know if it is a central line infection vs native bloodstream infection? Gram negative bacteremia - generally 7-10 days Gram positive bacteremia - generally 14 days Prior ESBL Positivity: Meropenem 1g IV q8h or Ertapenem 1g IV q24hĮmpiric Antibiotics: Caspofungin 70mg IV x 1 loading dose, then 50mg IV daily or Anidulafungin 200mg IV x1 loading dose, then 100mg IV dailyĭuration of Treatment for Uncomplicated Infections (ie - Bacillus Anthracis, Bacillus Cereus)Įmpiric Antibiotics: None if stable, redraw blood cultures to r/o contamination Gram Positive Bacilli - Generally skin organismsīacillus sp. Not aureusĮmpiric Antibiotics: Cloxacillin 2g IV q4h, Cefazolin 2g IV q8h or Vancomycin 15-20mg IV x 1 loading dose, then 1g IV BIDĮmpiric Antibiotics: Ceftriaxone 2g IV q24h Gram Stains, Common Organisms and Empiric AntibioticsĪll patients with bacteremia should have an examination to identify the sourceĬoagulase Positive - Staphylococcus Aureus (Can be MSSA or MRSA)Ĭoagulase Negative - Staphylococcus sp.
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