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Empiric antibiotic therapy for mesh graft infections in adults and adolescents

Empiric antibiotic therapy for mesh graft infections in adults and adolescents
Options for empiric parenteral therapy:
Drug Dose*
Monotherapy with a beta-lactam/beta-lactamase inhibitor or carbapenem such as ONE of the following:
Ampicillin-sulbactam 3 g every 6 hours
Piperacillin-tazobactamΔ 3.375 g every 6 hours or 4.5 g every 8 hours
ImipenemΔ 500 mg every 6 hours
MeropenemΔ 1 g every 8 hours
Ertapenem 1 g every 24 hours
Combination therapy with a third-generation cephalosporin or fluoroquinolone plus anti-anaerobic coverage, such as ONE of the following:
Ceftriaxone 1 g every 24 hours
CiprofloxacinΔ 400 mg every 12 hours
LevofloxacinΔ 750 mg every 24 hours
PLUS
Metronidazole 500 mg every 8 hours
If MRSA risk present, add vancomycin to any of the above regimens
Vancomycin For severely ill patients, a loading dose (20 to 35 mg/kg) is appropriate; the loading dose is based on actual body weight, rounded to the nearest 250 mg increment and not exceeding 3000 mg. Within this range, we use a higher dose for critically ill patients. The initial maintenance dose and interval are determined by nomogram (typically 15 to 20 mg/kg every 8 to 12 hours for most patients with normal renal function). Subsequent dose and interval adjustments are based on AUC-guided or trough-guided serum concentration monitoring.◊
Options for empiric oral therapy:
Monotherapy with combination beta-lactam/beta-lactamase inhibitor such as:
Amoxicillin-clavulanate 875/125 mg twice daily
Combination therapy with fluoroquinolone plus anti-anaerobic coverage such as:
CiprofloxacinΔ 500 mg twice per day
LevofloxacinΔ 750 mg once per day
PLUS
Metronidazole 500 mg three times per day
MRSA: methicillin-resistant Staphylococcus aureus; AUC: area under the 24-hour time-concentration curve.
* The doses recommended above are intended for patients with normal renal function; the doses of some of these agents must be adjusted in patients with renal insufficiency.
¶ Increasing gram-negative (Enterobacteriaceae) resistance to ampicillin-sulbactam; consult local susceptibilities prior to use as monotherapy; may be combined with an aminoglycoside.
Δ Provides anti-Pseudomonas aeruginosa coverage.
◊ Refer to the UpToDate topic on vancomycin dosing for sample nomogram and discussion of AUC-guided and trough-guided vancomycin dosing.
Adapted from: Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147.
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