Basic Neuroscience · Neuropharmacology
Empirical Antibiotics in the ICU
Empirical antibiotic coverage for common infections in the ICU, plus surgical prophylaxis.
| Infection | Definition | First line | Second line | Duration |
|---|---|---|---|---|
| HAP / VAP | HAP: >48 h after admission. VAP: >48 h after intubation | Vancomycin + Pip/Tazo, or Vancomycin + Cefepime | Vancomycin + Aztreonam + Tobramycin | 7 days; stop vanc if MRSA not isolated after 72 h |
| UTI | 1–4 days since admission / >4 days since admission | Ceftriaxone / Pip-Tazo | Aztreonam | Uncomplicated: 7 days; complicated: 7–14 days |
| C. difficile | Mild: WBC <15k & normal Cr. Severe: WBC >15k or Cr 1.5× baseline. Complicated: hypotension, ileus | Mild: metronidazole 500 mg TID. Severe: vanc PO 125 mg q6h. Complicated: vanc PO 500 mg q6h + metronidazole IV 500 mg q8h | 1st recurrence: same as first episode. 2nd recurrence: vanc taper or pulse | 14 days (or until symptoms resolve if complicated) |
| Cellulitis | No abscess/penetrating trauma (strep). Abscess/penetrating trauma (MRSA) | Strep: IV nafcillin 2 g q4h or cefazolin 2 g q8h (PO: cephalexin 500 mg q6h or clindamycin 300 mg q8h). MRSA: IV vancomycin (PO: TMP-SMX DS 2 tabs BID) | — | — |
| Surgical site infection | Clean wound / perineal, GI, genital surgery | Clean: nafcillin 2 g q4h or cefazolin 2 g q8h. Perineal/GI/genital: metronidazole 500 mg IV q6h + cefazolin or ceftriaxone | — | — |
Surgical prophylaxis
| Surgery | First line | Second line |
|---|---|---|
| Neurosurgery | Cefazolin or Cefuroxime | Vancomycin or Clindamycin |
| Head & Neck | Cefazolin, Cefuroxime, or Unasyn | Vancomycin or (Clindamycin + Gentamicin) |
Price of commonly used antibiotics (illustrative): Vancomycin 1 g $4.28 · Metronidazole 500 mg $1.10 · Ciprofloxacin 400 mg $1.70 · Levofloxacin 500 mg $3.84 · Cefazolin 2 g $2.00 · Cefoxitin 2 g $6.10 · Cefuroxime 1.5 g $3.57 · Clindamycin 900 mg $7.85 · Ertapenem 1 g $77.94 · Gentamicin 80 mg $0.69.
NeurologyResidents.Net by Ahmed Koriesh, M.D.