Version May 2024
| Drug | Dose |
| First-line agents | |
| Ceftazidime | 2 g intravenously every 8 hours (infuse each dose over 3 to 4 hours)* |
| Cefepime | 2 g intravenously every 8 hours (infuse each dose over 3 to 4 hours)* |
| Piperacillin-tazobactam | 4.5 g intravenously every 8 hours (infuse each dose over 4 hours)* |
| Ampicillin-sulbactam¶ | Mild carbapenem-susceptible infections: 3 g intravenously every 6 hours Mild carbapenem-resistant infections: 3 g intravenously every 4 hours Moderate to severe infections: 9 g intravenously every 8 hours (infuse each dose over 4 hours)*, or 27 g intravenously every 24 hours as a continuous infusion* |
| Sulbactam-durlobactamΔ | Sulbactam 1 g/durlobactam 1g intravenously every 6 hours (infuse each dose over 3 hours) For patients with augmented renal clearance (CrCl ≥130 mL/minute): Sulbactam 1 g/durlobactam 1 g intravenously every 4 hours (infuse each dose over 3 hours) |
| Meropenem | Cystitis: 1 g intravenously every 8 hours (infuse each dose over 30 minutes) Infections other than cystitis: 2 g intravenously every 8 hours (infuse each dose over 3 hours)* |
| Imipenem-cilastatin | Cystitis: 500 mg intravenously every 6 hours (infuse each dose over 30 minutes) Infections other than cystitis: 500 mg intravenously every 6 hours, or 1 g intravenously every 6 to 8 hours (infuse each dose over 3 hours)* |
| Ciprofloxacin◊ | 400 mg intravenously every 8 hours, or 750 mg orally every 12 hours |
| Levofloxacin◊ | 750 mg intravenously or orally once daily |
| Trimethoprim-sulfamethoxazole§ | Cystitis: 1 double-strength tablet (trimethoprim 160 mg and sulfamethoxazole 800 mg) orally twice daily |
| Second-line agents | |
| Colistin (colistimethate)¥ | Intravenous dose: Loading dose of 300 mg CBA (equivalent to approximately 9 million units colistimethate sodium), followed by a daily maintenance dose of 300 to 360 mg CBA (approximately 9 to 11 million units colistimethate sodium) divided into 2 doses infused over 1 hour Inhaled dose: 75 to 150 mg CBA (2.25 to 4.5 million units) every 12 hours |
| Polymyxin B | Loading dose of 2 to 2.5 mg/kg (20,000 to 25,000 units/kg), followed by 1.25 to 1.5 mg/kg (12,500 to 15,000 units/kg) every 12 hours; doses should be based on total body weight |
| Minocycline‡ | 200 mg intravenously or orally every 12 hours |
| Doxycycline‡ | 100 mg intravenously or orally every 12 hours |
| Tigecycline‡ | Mild infections and carbapenem-susceptible infections: 100 mg loading dose, followed by 50 mg intravenously every 12 hours Moderate to severe carbapenem-resistant infections: 200 mg loading dose, followed by 100 mg intravenously every 12 hours |
| Cefiderocol | 2 g intravenously every 8 hours (infuse each dose over 3 hours); in patients with creatinine clearance ≥120 mL/minute, administer 2 g intravenously every 6 hours (infuse each dose over 3 hours) |
| Agents typically used in combination with another agent | |
| Gentamicinנ | Cystitis: 5 mg/kg/dose intravenously for 1 dose Infections other than cystitis: 7 mg/kg/dose intravenously for first dose with subsequent doses and dosing intervals based on pharmacokinetic evaluation |
| Tobramycinנ | Cystitis: 5 mg/kg/dose intravenously for 1 dose Infections other than cystitis: 7 mg/kg/dose intravenously for first dose with subsequent doses and dosing intervals based on pharmacokinetic evaluation |
| Amikacinנ | Cystitis: 15 mg/kg/dose intravenously for 1 dose Infections other than cystitis: 20 mg/kg/dose intravenously for first dose with subsequent doses and dosing intervals based on pharmacokinetic evaluation |
CBA: colistin base activity; CrCl: creatinine clearance; UTI: urinary tract infection.
* May administer first dose over 30 minutes when rapid attainment of therapeutic drug concentrations is desired.
¶ Sulbactam is the active component. Dose is expressed as sum of ampicillin and sulbactam.
Δ Reserve use of sulbactam-durlobactam for patients with hospital-acquired or ventilator-associated pneumonia or bacteremia due to carbapenem-resistant Acinetobacter baumannii in whom other first-line agents are not an option[4].
◊ For moderate to severe infections, fluoroquinolones are generally used in combination with another agent. Aminoglycosides can be used as monotherapy for mild urinary tract infections; for all other infections, they should be used in combination with another agent.
§ For susceptible UTIs, oral trimethoprim-sulfamethoxazole (TMP-SMX) is an option. However, most Acinetobacter isolates are resistant to TMP-SMX. TMP-SMX is not recommended for infections outside the urinary tract or as part of combination therapy.
¥ Dose is expressed as colistin base activity as in United States licensed product information. 1 mg CBA is approximately 30,000 units (also known as international units) colistimethate sodium. Parenteral dosages should be adjusted based on creatinine clearance and match those recommended in international guidelines[2]. For inhaled colistin, optimal dosing is uncertain; doses up to 167 mg CBA (approximately 5 million units colistimethate sodium) inhaled every 8 hours have been used for ventilator-associated pneumonia due to Acinetobacter.
‡ Minocycline, doxycycline, and tigecycline may not reach adequate levels in the serum or urinary tract to successfully treat infections in these compartments.
† For patients >120% of ideal body weight, use adjusted body weight for aminoglycoside dosing.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
