Злобные инфекции в реанимации

Инфекция

АБ

Pseudomonas aeruginosa

Ticarcillin and clavulanate (Timentin)

3.1 g IV q4-6h

Perform CBC count prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; exercise caution in patients diagnosed with hepatic insufficiency; perform urinalysis and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions

 

Piperacillin and tazobactam (Zosyn)

3.375 g IV q6h

Perform CBC count prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; exercise caution in patients diagnosed with hepatic insufficiency; perform urinalysis and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions

 

Imipenem and cilastatin (Primaxin)

Base initial dose on severity of infection and administer in equally divided doses 250-500 mg IV q6h; not to exceed 3-4 g/d 500-750 mg IM or intra-abdominally q12h

Adjust dose in renal insufficiency

 

Aztreonam (Azactam)

500-2000 mg IV/IM q8-12h

Adjust dose in renal insufficiency

 

Cefepime (Maxipime)

1-2 g IV q12h; pseudomonal infections require higher or more frequent doses Dosage adjustments (adult adjustments) CrCl (mL/min) 80-50: 0.5-2 g IV q12-24h CrCl 50-10: 0.5-2 g/d IV CrCl <10: 0.25-0.5 g/d IV HD: as for CrCl <10, with an extra 0.25 g after HD During peritoneal dialysis: 1-2 g IV q48h

 

Ceftazidime (Fortaz)

1-2 g IV/IM q8-12h; not to exceed 6 g/d

 

Meropenem (Merrem)

1 g IV q8h

Adjust dose in renal impairment; pseudomembranous colitis and thrombocytopenia may occur, requiring immediate discontinuation of medication

МРСА

Vancomycin

1 g or 15 mg/kg IV q12h

Infuse slowly, rapid infusion may cause hypotension or tingling and flushing (red man syndrome); red man syndrome is caused by IV infusion that is too rapid but rarely happens when dose is administered as 2-h IV administration or with PO or IP administration; red man syndrome is not an allergic reaction; caution in renal failure and neutropenia

 

Linezolid (Zyvox)

400-600 mg PO/IV q12h

Has mild MAOI properties and has potential to have same interactions as other MAOIs; caution in uncontrolled hypertension, pheochromocytoma, carcinoid syndrome, or untreated hyperthyroidism and in and patients who are at increased risk for bleeding, have preexisting thrombocytopenia, receive concomitant medications that may decrease platelet count or function, or who may require > 2 wk of therapy (monitor platelet counts); unnecessary use may lead to development of resistance to drug

 

Tigecycline (Tygacil)

Infuse each dose over 30-60 min 100 mg IV once, then 50 mg IV q12h Severe hepatic impairment (ie, Child Pugh class C): 100 mg IV once, then 25 mg IV q12h

Caution in severe hepatic impairment (reduce dose); may adversely effect tooth development; may permit clostridia overgrowth, resulting in antibiotic-associated colitis

Acinetobacter

Meropenem

Colistin

Polymyxin B

Amikacin

Rifampin

Minocycline

Tigecyclin