Policies

Antibiotic policies usually place antibiotics in one of three categories: unrestricted, those that can be prescribed after discussion with a microbiologist or infectious disease physician, and those that are unavailable. Penicillin G (benzylpenicillin), amoxicillin (amoxycillin), nafcillin (or flucloxacillin), trimethoprim, cefuroxime (or cefotaxime or ceftriaxone), and metronidazole are usually unrestricted. Ceftazidime, ciprofloxacin, glycopeptides, amikacin, imipenem (or meropenem), and piptazobactam (or piperacillin) may fall into the second category of a restricted formulary. These antibiotics, which are commonly prescribed in the ICU, can be discussed during daily ward rounds with the microbiologist or infectious disease physician. Other cephalosporins, aminoglycosides, ureidopenicillins (depending on the hospital), and sulfonamides may not be available for use.

New antibiotics should be used if they have been demonstrated to be more effective than existing agents or if the pathogens are resistant to standard regimens. In this way their useful life can be prolonged. The dose needs to be adjusted to the severity of infection, the size of the patient, and renal or hepatic function. Intravenous administration should usually be stipulated for the critically ill, although the oral route can be just as efficacious for some agents. Intramuscular administration produces unreliable serum concentrations because of poor tissue perfusion in these patients. The duration of treatment should be tailored to the type of infection; treatment generally lasts for 5 to 7 days (or even longer for cardiac valve infection). Prolonged courses run the risk of superinfection or adverse reactions.

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