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Winter 2010 Adult Emergency Department Initial Empiric Antibiotic Recommendations

The enclosed are recommendations and are not to substitute for clinical judgment for the following common infections:

Neutropenic fever
Urinary tract infections
Intra-abdominal infections
Skin and soft-tissue infections
Clostridium difficile colitis

When possible draw 2 sets of blood cultures on patients admitted with a documented or suspected infection. This increases diagnostic yield and helps tailor antimicrobial therapy.

Previous culture data should guide empiric antimicrobial choices.
Community and institutional microbiology can change and checking prior culture data on patients with frequent healthcare and antibiotic exposures is strongly recommended.

Does antibiotic need approval? PAGER 9407
Piperacillin-tazobactam, imipenem-cilastatin, meropenem, ertapenem, oral vancomycin, and aztreonam require ID approval.
Initial doses of IV fluoroquinolones, cefepime, and ampicillin-sulbactam may not need ID approval for specific indications in the ED. Documentation in IBEX reflecting indication is required. TDS (inpatient) orders need ID approval.
Between 9am – 5pm, call Antimicrobial Stewardship Program for approval of these antibiotics.
During off hours (5pm – 9am), please fill out “night time request for restricted antimicrobials” form available in IBEX.
When ordering in IBEX, chart must reflect clinical indication for restricted antimicrobial.

Antimicrobial Stewardship Program:
(ID pharmacists and ID physicians available for approvals and recommendations)
Pager 9407 (adults)
Page Pediatric ID on call (pediatrics)

Other Infectious Disease pagers:
General ID consult – Pager 0649
Transplant ID consult – Pager 8678
Jeff Gumprecht – Pager 3043, Office 212-427-9550
Glenn Hammer – Pager 2562, Office 212-427-9550
Eric Neibart – Pager 2962, Office 212-427-9550
John Wolff – Pager 917-975-3175

NOTE: If there is delay in reaching an ID pharmacist/physician, call pharmacy or ED pharmacist directly. A first dose will be released STAT if restricted antimicrobial needed emergently. All subsequent doses will need approval.

C. diff
Neutropenic fever

Written by reuben

December 14th, 2010 at 6:41 am

Posted in Antibiotics,ID

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