Mayo Clinic antimicrobial therapy: quick guide

346 Pages·2008·2.56 MB·English

by  Lynn Estes

I. Antimicrobial Agent Fundamentals
• Spectrum of Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
• Pharmacokinetics of Antimicrobial Agents . . . . . . . . . . . . . . . . . . . . . . .14 Mayo Clinic
• Antimicrobial Assays/Drug Levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
• Laboratory and Clinical Toxicity Monitoring . . . . . . . . . . . . . . . . . . . . .23
Antimicrobial Therapy
II. Antimicrobial Dosing—Adult and Pediatric
• Adult Antimicrobial Dosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35 Wilson
• Adult Dosing for Continuous Renal Replacement Therapy (CRRT). . . . .71
• Vancomycin Adult Dosing and Monitoring . . . . . . . . . . . . . . . . . . . . . .74 Estes QUICK GUIDE
• Aminoglycoside Adult Dosing and Monitoring . . . . . . . . . . . . . . . . . . .79
• Pediatric Antimicrobial Dosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
III. Treatment of Specific Organisms
• Bacteria: Preferred and Alternate Treatment Options . . . . . . . . . . . . .121 M
• Bacterial Drug Resistance Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .131
a
• Fungi: Preferred and Alternate Treatment Options . . . . . . . . . . . . . . .133 y
• Viruses: Preferred and Alternate Treatment Options . . . . . . . . . . . . .136 o

C
IV. Infectious Syndromes in Adults l
i
• Clinical Approach to Patients With Infection . . . . . . . . . . . . . . . . . . . .137 n
• Respiratory Tract Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .138 ic
• Infective Endocarditis: Diagnosis and Treatment . . . . . . . . . . . . . . . . .144 Q A
• Infective Endocarditis Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . .157 UI n
• Central Nervous System Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . .161 C t
• Urinary Tract Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .170 K G im
• Soft-Tissue Infections: Nontoxigenic . . . . . . . . . . . . . . . . . . . . . . . . . . .179
U i
• Soft-Tissue Infections: Necrotizing or Toxigenic . . . . . . . . . . . . . . . . .184 I c
D r
• Surgical Prophylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .188 E o
• Osteomyelitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .191 b
• Acute Native Joint Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .194 ia
• Gastrointestinal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .198 l

• Intra-Abdominal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .204 T
• Neutropenic Fever Empiric Management . . . . . . . . . . . . . . . . . . . . . . .212 h
• Sexually Transmitted Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215 e
r
• Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .225 a
• Nontuberculosis Mycobacterial Infections . . . . . . . . . . . . . . . . . . . . . .230 p
y
• Zoonotic (Animal-Associated) Infections . . . . . . . . . . . . . . . . . . . . . . .241
• Tick-Borne Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .252
• Fungal Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .261
John W. Wilson, MD
•Antiretroviral Therapy for
HIV Infection . . . . . . . . . . . . . . .274
Lynn L. Estes, PharmD
•Select Opportunistic Infections
in Adult HIV Patients . . . . . . . .296
•Occupational Postexposure
Prophylaxis and Management. . 306
MAYO CLINIC SCIENTIFIC PRESS
•Vaccination Schedules. . . . . . . . 313
•Travel Medicine/Prophylaxis. . 323
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Mayo Clinic
Antimicrobial Therapy
Quick Guide
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Mayo Clinic
Antimicrobial Therapy
Quick Guide
Editors
John W. Wilson, MD
Lynn L. Estes, PharmD
MAYO CLINIC SCIENTIFIC PRESS
and INFORMA HEALTHCARE USA, INC.
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ISBN-13: 978-1-4200-8518-1
The triple-shield Mayo logo and the words MAYO, MAYO CLINIC, and MAYO
CLINIC SCIENTIFIC PRESS are marks of Mayo Foundation for Medical Education and
Research.
©2008 Mayo Foundation for Medical Education and Research.
All rights reserved. This book is protected by copyright. No part of it may be
reproduced, stored in a retrieval system, or transmitted, in any form by any means—
electronic, mechanical, photocopying, recording, or otherwise—without the prior
written consent of the copyright holder, except for brief quotations embodied in critical
articles and reviews. Inquiries should be addressed to Scientific Publications, Plummer
10, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
For order inquiries, contact: Informa Healthcare, Kentucky Distribution Center, 7625
Empire Drive, Florence, KY 41042 USA.
E-mail: [email protected];
Web site: www.informahealthcare.com
Library of Congress Cataloging-in-Publication Data
Mayo Clinic antimicrobial therapy : quick guide/edited by John W. Wilson, Lynn L.
Estes.
p. ; cm.
Includes bibliographical references.
ISBN-13: 978-1-4200-8518-1 (pb : alk. paper)
ISBN-10: 1-4200-8518-2 (pb : alk. paper) 1. Anti-infective agents--
Handbooks, manuals, etc. 2. Communicable diseases--Chemotherapy--
Handbooks, manuals, etc. I. Wilson, John W., 1967- II. Estes, Lynn L. III. Mayo Clinic.
IV. Title: Antimicrobial therapy.
[DNLM: 1. Anti-Infective Agents--therapeutic use--Handbooks. 2. Communicable
Diseases--drug therapy--Handbooks. QV 39 M473 2007]
RM262.M377 2007
615'.1--dc22
2007027808
Nothing in this publication implies that Mayo Foundation endorses any of the
products mentioned in this book.
Care has been taken to confirm the accuracy of the information presented and to
describe generally accepted practices. However, the authors, editors, and publisher are
not responsible for errors or omissions or for any consequences from application of the
information in this book and make no warranty, express or implied, with respect to the
publication. This book should not be relied on apart from the advice of a qualified
health care provider. The information contained in this book does not pertain to
neonatal patient populations.
The authors, editors, and publisher have exerted efforts to ensure that drug
selections and dosages set forth in this text are in accordance with current
recommendations and practices at the time of publication. However, in view of ongoing
research, changes in government regulations, and the constant flow of information
relating to drug therapy and drug reactions, readers are urged to check the package
insert for each drug for any change in indications and dosage and for added warnings
and precautions. This precaution is particularly important when the recommended
agent is a new or infrequently used drug. Data regarding efficacy and safety in pediatric
populations is limited for many drugs.
Some drugs and medical devices presented in this publication have U.S. Food and
Drug Administration (FDA) clearance for limited use in restricted research settings. It is
the responsibility of health care providers to ascertain the FDA status of each drug or
device that they plan to use in their clinical practice.
Some of the dosages and suggested uses of medications in this handbook are
outside of FDA labeling. These suggestions are based on publications and clinical
judgment and should be considered “off-label” use. Package inserts should be
consulted for information on FDA-approved dosing and indications.
The information provided herein is not intended to replace clinical judgment. The
variable conditions of individual patients may mandate adjustments in therapy. An
infectious diseases consultation should be considered to assist with patient care.
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Dedication
We dedicate this book to the patients under our care and to our families,
who continue to support us in our work.
About the Cover
The image on the cover illustrates the dichotomous impact of human
intervention on infectious diseases and antimicrobial therapy worldwide.
Landmark achievements of mankind against infectious diseases include
vaccine and antimicrobial drug development, along with a growing
international cooperative in disease awareness, surveillance, and
containment. In contrast to such accomplishments, however, are human-
driven problems of inappropriate antimicrobial prescribing with secondary
development of drug-resistant microbes and the proliferation of the human
immunodeficiency virus, tuberculosis, and sexually transmitted diseases
through socioeconomic and educational inequalities and maladaptive
behaviors. Finally, in the age of jet aviation and global tourism, infectious
diseases that were once remote and geographically localized are emerging in
new locations. In the 21st century, health care providers and scientists
worldwide have the opportunity and the growing responsibility through
antimicrobial stewardship to collectively work toward effective and
responsible management of infectious diseases.
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Preface
The medical management of infectious diseases and antimicrobial
therapy can be a daunting task for health care professionals. Although
expansive textbooks and online resources are available, we believe that a
more simplified, quick reference guide is needed for the day-to-day office
and hospital clinical practice. This book is designed to provide information
about infectious diseases and antimicrobial therapy in a format that is
readily accessible and easily applicable to the clinical environment.
Highlights of this book include simplified and thorough drug dosing
recommendations for renal function and renal replacement therapies, drugs
of choice for specific organisms (including bacteria, fungi, and viruses), and
simplified antimicrobial and management recommendations for specific
infectious syndromes.
We hope that this book will assist health care providers in the
management of infectious diseases and in the selection of appropriate
antimicrobial therapy in a time-efficient manner. This book is not meant to
serve as a comprehensive review of all infectious diseases topics. Instead,
readers are encouraged to seek supplemental information from additional
published resources and from the prescribing information provided by
pharmaceutical manufacturers.
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Author Affiliations
John W. Wilson, MD
Consultant, Division of Infectious Diseases, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Medicine,
College of Medicine, Mayo Clinic
Lynn L. Estes, PharmD
Infectious Diseases Pharmacy Specialist, Mayo Clinic,
Rochester, Minnesota; Assistant Professor of Pharmacy,
College of Medicine, Mayo Clinic
Contributors
Larry M. Baddour, MD Raymund R. Razonable, MD
Elie F. Berbari, MD Ronald M. Sieve, PharmD
Rachel M. Chambers, PharmD James M. Steckelberg, MD
Lynn L. Estes, PharmD Rodney L. Thompson, MD
W. Charles Huskins, MD Abinash Virk, MD
William F. Marshall, MD Mark P. Wilhelm, MD
Robert Orenstein, DO John W. Wilson, MD
Douglas R. Osmon, MD
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