Infectious Diseases in Critical Care Medicine

Table 1

Empiric Antibiotic Selections in ICU (

Continued

)

Abdomen

Blood

Central nervous system

Lung

Skin

Urine

Site

Peritonitis

Sepsis



shock

Bacterial meningitis

a

Posttrauma

CAP

HCAP

cSSTI

Complicated UTI

Cefepime

$$

Ceftazidime may be

substituted forcefepime addvancomycin for MRSA

Add vancomycin or

linezolid forMRSA

Tigecycline

$$

The following drugs have effective gram-positive coverage only and should be combined with an agent appropriate for the clinical settingVancomycin

j$

If MRSA is suspected

Linezolid

j $$–$$$

Daptomycin

j $$$

Shaded boxes represent approved/recommended indications.aAdd ampicillin if

Listeria monocytogenes

meningitis is suspected.

bEnterobacteriaceae include

Escherichia coli

,Klebsiella

sp.,

Proteus

sp., and

Enterobacter

sp.

cPseudomonas aeruginosa

is a potential pathogen in secondary peritonitis.

dRationale for clindamycin is suppression of toxin production in

Streptococcus pyogenes

infection.

eImipenem and meropenem are interchangeable; however, imipenem has a slightly increased risk for precipitating seizures.fDoripenem is an emerging carbapenem with activity similar to meropenem, but currently is only approved for complicated UTI and intra-abdominal infections.gCiprofloxacin is inadequate monotherapy for

Staphylococcus pneumoniae

, but maintains a more favorable AUC/MIC ratio for

P. aeruginosa

.

hUse in combination with agent appropriate for clinical setting.iCombination therapy with aminoglycosides, although potentially nephrotoxic, remains controversial but may be useful in empiric treatment in critically ill.jUse when resistant gram-positive pathogen(s) suspected.Abbreviations

: ICU, intensive care unit; CAP, community-acquired pneumonia; HCAP, health care–associated pneumonia; cSSTI, complicated skin and soft tissue infection; UTI, urinary tract infection; moxi, moxifloxacin; MRSA,

methicillin-resistant

S. aureus

. $, $$, $$$, approximate relative cost, ranging from least expensive ($) to most expensive ($$$).

490 Ahuja et al.