Recommended Antibiotics for Inpatient Care
For severely ill inpatients requiring empiric antibiotic therapy, piperacillin-tazobactam is the recommended first-line treatment due to its broad spectrum of activity against gram-positive, gram-negative, and anaerobic pathogens. 1
First-Line Options Based on Patient Severity
Severe Infections/ICU Patients
Piperacillin-tazobactam: 4.5g IV every 6 hours 2, 3
- Provides excellent coverage against Pseudomonas and other serious gram-negative pathogens
- Appropriate for complicated intra-abdominal infections, nosocomial pneumonia, and sepsis
- Dosage adjustment required for renal impairment (see table below)
Alternative for ICU patients: Combination therapy with a β-lactam plus either:
- Macrolide (e.g., azithromycin)
- Fluoroquinolone (e.g., levofloxacin)
- For patients at risk for Pseudomonas, use two antipseudomonal agents 2
Non-ICU Inpatients
- Ceftriaxone: 1-2g IV daily (plus metronidazole if anaerobic coverage needed)
- Cefotaxime: 1-2g IV every 8 hours (plus metronidazole if anaerobic coverage needed)
- Ampicillin-sulbactam: 3g IV every 6 hours 2
Special Considerations
MRSA Coverage
When MRSA is suspected or confirmed:
- Vancomycin: 30-60 mg/kg/day IV in 2-4 divided doses 2
- Linezolid: 600mg IV/PO every 12 hours
- Daptomycin: 4-6 mg/kg IV daily 2, 1
Renal Dosing Adjustments for Piperacillin-Tazobactam
| Creatinine Clearance | Standard Indications | Nosocomial Pneumonia |
|---|---|---|
| >40 mL/min | 3.375g every 6 hours | 4.5g every 6 hours |
| 20-40 mL/min | 2.25g every 6 hours | 3.375g every 6 hours |
| <20 mL/min | 2.25g every 8 hours | 2.25g every 6 hours |
| Hemodialysis | 2.25g every 12 hours | 2.25g every 8 hours |
Treatment Duration Guidelines
- Complicated skin/soft tissue infections: 7-14 days
- Pneumonia: 7-21 days
- Intra-abdominal infections: 5-14 days (longer for severe cases)
- Bacteremia: 14 days (uncomplicated), 4-6 weeks (complicated)
- Endocarditis: 4-6 weeks 1
Clinical Response Assessment
Most patients with appropriate antibiotic therapy should show clinical improvement within 72 hours. If no improvement is seen, consider:
- Resistant organisms
- Inadequate source control
- Non-infectious etiology
- Need for surgical intervention 2
Common Pitfalls to Avoid
- Delaying first antibiotic dose: Administer first dose within 8 hours of hospital arrival 2
- Inappropriate de-escalation: Wait for clinical improvement and culture results before narrowing therapy
- Inadequate dosing: Consider higher doses for severe infections and altered pharmacokinetics in critically ill patients
- Overlooking source control: Antibiotics alone may be insufficient without drainage of abscesses or removal of infected devices
- Fluoroquinolone overuse: Avoid fluoroquinolones in patients who received them as prophylaxis 2
Piperacillin-tazobactam's broad spectrum of activity against gram-positive, gram-negative, and anaerobic bacteria makes it particularly valuable for empiric therapy in hospitalized patients with serious infections 4. Its efficacy has been demonstrated in clinical trials for various infection types, including intra-abdominal, respiratory, and skin/soft tissue infections 5.