EXPLODING BACTERIAMed Decision Speed Tools
lipopeptidesUnverified

Daptomycin

Generic, Cubicin®
?Pregnancy?Breastfeeding?Warfarin
Open the full DFI page →
Scope: soft-tissue infection without evidence of osteomyelitis. Probe-to-bone or exposed bone suggests osteomyelitis — treat as osteomyelitis (different workup and a longer course).
IV — Severe/Moderate — withOUT Pseudomonas Risk Factors
IV — Severe/Moderate — WITH Pseudomonas Risk Factors
Consider antipseudomonal coverage if: significant water exposure or wound soaking, a warm/humid climate, a severe or chronically-wet wound, prior Pseudomonas isolation from the wound, or failure of non-antipseudomonal therapy.
Group APick onerequired
+
Anti-MRSAPick onerequired
Group A
Ampicillin-Sulbactam
???
3 g IV q6h
IV / IM
1.5 g (1 g / 0.5 g) vial3 g (2 g / 1 g) vial
BrandsGeneric, Unasyn®
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Ertapenem
???
Your EMR may offer you a “helpful” allergy warning when ordering a carbapenem because your patient is allergic to penicillins or cephalosporins; the cross reactivity is very low and most people tolerate carbapenems with a low risk of allergic reaction.
1 g IV q24h
IV / IM
1 g vial
BrandsGeneric, Invanz®
View full Ertapenem page →
Piperacillin-TazobactamNon-pseudomonal dose
???
3.375 g IV q6h
IV
2.25 g3.375 g4.5 g
BrandsGeneric, Zosyn®
View full Piperacillin-Tazobactam page →
Aztreonam AND Metronidazole
Do NOT give aztreonam to those with a Ceftazidime₃ allergy (shared side chain → cross-reactivity).
Aztreonam has 'some' antipseudomonal activity.
Aztreonam2 g IV q8h
Metronidazole500 mg IV q8h
Ceftazidime₃ AND MetronidazoleNon-pseudomonal dose
Ceftazidime₃1 g IV q8h
Metronidazole500 mg IV q8h
Ceftriaxone₃ AND Metronidazole
Ceftriaxone₃1 g to 2 g IV q24h
Metronidazole500 mg IV q8h
Moxifloxacin AND Metronidazole
Moxifloxacin400 mg IV q24h
Metronidazole500 mg IV q8h
+
Anti-MRSA
DaptomycinMRSA and VRE
???
4 mg to 6 mg/kg/day IV q24h
IV
350 mg vial500 mg vial
BrandsGeneric, Cubicin®
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LinezolidMRSA and VRE
???
PO and IV have the same bioavailability.
600 mg IV/PO q12h
Tablets
600 mg
Liquid
100 mg/5 mL
IV
600 mg/300 mL
BrandsGeneric, Zyvox®
View full Linezolid page →
VancomycinMRSA
???
Rounding to nearest 250 mg is common and based on actual body weight.
15 mg/kg IV q8h to q12h + therapeutic monitoring
20 mg/kg IV q8h to q12h + therapeutic monitoring

Consider a loading dose in critically ill patients
25 mg/kg IV (loading dose)
30 mg/kg IV (loading dose)
IV
500 mg750 mg1 g1.25 g5 g
Capsules — PO, C. diff only
125 mg250 mg
BrandsGeneric, Vancocin®
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Drug Info

IV
350 mg vial500 mg vial
BrandsGeneric, Cubicin®

Safety

?PregnancyNot yet reviewed.
?BreastfeedingNot yet reviewed.
?WarfarinNot yet reviewed.