Table 3 Antibiotics Safe in Penicillin-Allergic Adult Patients in the CCU
Clinical Syndrome PCN allergy Non-PCN allergic
.Acute bacterial meningitis
H. meningitidis Meropenem (meningeal dose)a Ceftriaxoneb
H. influenzae
S. pneumoniae
MSSA
Listeria TMP-SMX
Chloramphenicol
Ampicillin.Brain abscess Meropenem (meningeal dose)a Ceftriaxoneplusmetronidazole
Chloramphenicol
.Severe CAP (typical/atypical
pathogens)
Levofloxacind Ceftriaxoneplus eitherdoxycyclineor
Moxifloxacin azithromycin
Doxycycline
.NP/VAP Levofloxacind
Meropenem
Cefepime
Piperacillin/tazobactam
.ABE plusamikacin
MSSA/MRSA Daptomycin Nafcillin
Linezolid Cefazolin
Minocycline
Vancomycin
None.Cholangitis Meropenem Cefoperazone
Tigecycline Piperacillin/tazobactam
.Liver abscess Meropenem Cefoperazone
Tigecycline Piperacillin/tazobactam
.Intra-abdominal source (colitis,
peritonitis, or abscess)
Meropenem Piperacillin/tazobactam
Tigecycline Cefoxitin
Ertapenem Cefoperazone
Moxifloxacinc Ceftizoxime
Levofloxacinplus either
metronidazoleorclindamycin
.Pelvic source (peritonitis,
abscess, septic pelvic
thrombophlebitis)
Meropenem Piperacillin/tazobactam
Ertapenem Cefoxitin
Tigecycline Cefoperazone
Moxifloxacin Ceftizoxime
Levofloxacinplus either
metronidazoleorclindamycin
.Urosepsis
GNB Meropenem Piperacillin/tazobactam
Group D enterococci
E. faecalis(VSE)
E. faecium(VRE)Vancomycin
Linezolid Ampicillin
Meropenem
Linezolid
Quinupristin/dalfopristin None
.Complicated wound infections
(cSSSIs)
Tigecycline Piperacillin/tazobactam
Meropenem
Ertapenem
Moxifloxacin
Levofloxacinplus either
metronidazoleorclindamycin
.Necrotizing fasciitis Meropenem Piperacillin/tazobactam
Tigecycline Cefoxitin
Ertapenem
.Sepsis (unknown source) Meropenem Piperacillin/tazobactam
Tigecycline
a2 g (IV) q8h.b2 g (IV) q12h.cFor mild/moderately severe infection.d750 mg (IV) q24h.
Abbreviations: PCN, penicillin, CAP, community-acquired pneumonia; TMP-SMX, trimethoprim-sulfamethoxazole;
I.T., intrathecal; MSSA, methicillin-sensitiveStaphylococcus aureus;MRSA, methicillin-resistantStaphylococcus
aureus;NP, nosocomial pneumonia; VAP, ventilator associated pneumonia; ABE, acute bacterial endocarditis;
VRE, vancomycin-resistant enterococci; VSE, vancomycin-susceptible enterococci; GNB, gram-negative bacilli.
Antibiotic Therapy in the Penicillin Allergic Patient in Critical Care 539