Respiratory

Most common bacteria: Multi-drug resistant:

 Streptococcus pneumoniae (gram +)  MRSA (gram +)
 Hemophilus influenzae (gram -)  Pseudomonas aeruginosa (gram -)
 Mycoplasma pneumoniae (atypical)  Enterobacteriaceae (gram -)
 Moraxella catarrhalis (gram -)
Empiric treatment: Empiric treatment MDRs:
 Ampicillin/sulbactam + doxycycline (covers strep &  Piperacillin/tazobactam
mouth anaerobes + atypicals and gram -)  Cefepime
 Ceftriaxone  Vancomycin
De-escalation options:
 Amoxicillin/clavulanate + doxycycline

Genitourinary
Most common bacteria (PEcK): Multi-drug resistant:
 Proteus mirabilis (gram -)  Pseudomonas aeruginosa (gram -)
 E. coli (gram -)  ESBL (extended-spectrum beta-
 Klebsiella spp. (gram -) lactamases)
 Enterococcus spp. (gram +)
Empiric treatment: Empiric treatment MDRs:
 Ampicillin + gentamicin (Amp covers Enterococcus,  Piperacillin/tazobactam
gent covers gram -)  Cefepime
 Cefazolin (non-resistant E. coli)  Carbapenems
 Ceftriaxone (not good urinary penetration in
reduced renal function)
 Clorpactin in pts with urinary catheters
De-escalation options:
 Nitrofurantoin (covers VRE – vancomycin resistant enterococci)
 Amoxicillin/clavulanate
 Fosfomycin (covers VRE)

Intrabdominal
Most common bacteria:
 Similar to GU bugs plus Enterobacteriaceae and Bacteroides spp. (anaerobes)
Empiric treatment (outpatient): Empiric treatment (inpatient):
 Amoxicillin/clavulanate  Cefazolin + metronidazole
 Cephalexin + metronidazole  Ampicillin/sulbactam + gentamicin
 Piperacillin/tazobactam

Skin/Soft Tissue
Most common bacteria: Multi-drug resistant:
 Staphylococcus aureus (gram +)  MRSA
 Staphylococcus epidermidis  Pseudomonas aeruginosa (diabetic foot
 Streptococcus pyogenes (gram +) infection)
Empiric treatment: Empiric treatment MDRs:
 Cefazolin + vancomycin  Vancomycin
 Ampicillin/sulbactam + vancomycin  Piperacillin/tazobactam or cefepime
De-escalation options:
 Cephalexin  SMX/TMP
 Doxycycline (or minocycline)
C. Diff
High Risk Agents Low Risk/Protective Agents
 Clindamycin  Aminoglycosides
 Fluoroquinolones (Cipro, Levo, Moxi)  Doxycycline
 Ceftriaxone  Penicillins
 Cefepime  Metronidazole
 Meropenem  PO Vancomycin

1st Generation 2nd Generation 3rd Generation 4th Generation 5th Generation
Cephalexin Cefuroxime Ceftriaxone Cefepime* Ceftaroline#
Cefazolin Cefoxitin^ Cefpodoxime
Cefotetan^ Cefdinir
Cefixime
Ceftazidime*
^
Covers anaerobes
*Covers Pseudomonas
#
Covers MRSA