University of Pennsylvania Health System Antimicrobial Use Guidelines- Sepsis

Graduate Medical Education

University of Pennsylvania Medical Center Guidelines for Antimicrobial Therapy

SEPSIS

Antimicrobial Dosage Regimens

Drug	Dosage Regimen
Amikacin	15 mg/kg x 1 (round to the nearest 50 mg increment) refer to the aminoglycoside dosing page for determination of subsequent doses
Aztreonam¹	2gm IV q 8 hr
Caspofungin²	70mg x 1, then 50mg IV q 24 hr
Cefepime¹	1gm IV q 8 hr
Levofloxacin¹	750mg IV q 24 hr
Meropenem¹	1gm IV q 8 hr
Metronidazole	500mg IV q 12 hr
Vancomycin	70kg = 1 gm x 1, > 70kg+ 1.5gm x 1 refer to the vancomycin dosing page for determination of subsequent doses

¹ Dosage adjustment required with renal dysfunction. Refer to renal failure dosing page for dosage adjustment

² Dosage adjustment required with hepatic dysfunction:

•Moderate (Child-Pugh 7-9): 70mg x 1, then 35mg IV q 24 hr
•Severe (Child - Pugh score > 9): no clinical data available, discuss dosing with the Antimicrobial Management Service (beeper 306-0336)

Antimicrobial Administration and Compatibility

	Infusion time	Not compatible
Amikacin	30 minutes	Meropenem, metronidazole
Aztreonam	15 minutes	Vancomycin, metronidazole
Caspofungin	60 minutes	Cefepime
Cefepime	IV push over 5 minutes	Vancomycin, caspofungin
Levofloxacin	500 mg - 60 minutes 750 mg - 90 minutes	Compatible with all agents coadministered per algorithm
Meropenem	15 minutes	Amikacin
Metronidazole	30 minutes	Aztreonam, amikacin
Vancomycin	60 minutes for 1 gram 90 minutes for > 1 gram	Aztreonam, cefepime

Reference: Trissel's ™ 2 Clinical Pharmaceuticals Database (Parental Compatibility)

updated 7/2/08 by Neil Fishman

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