Recommended Antibiotics for Hospital Admission
For patients requiring hospital admission, the recommended empiric antibiotic therapy depends on the suspected infection source, with ceftriaxone being the most versatile first-line option for most community-acquired infections in adults, while ampicillin plus gentamicin or ceftazidime is preferred for infants under 28 days. 1
Age-Based Recommendations
Infants (8-60 days)
- 8-21 days old: Ampicillin IV (150 mg/kg/day divided q8h) PLUS either ceftazidime IV (150 mg/kg/day divided q8h) or gentamicin IV (4 mg/kg/dose q24h) 1
- 22-28 days old: Ceftriaxone IV (50 mg/kg/dose q24h) 1
- 29-60 days old: Ceftriaxone IV (50 mg/kg/dose q24h) 1
Children (>60 days)
- Sepsis:
Adults
- Community-acquired infections: Ceftriaxone IV (1-2g daily) 1
- Suspected MRSA: Add vancomycin (15 mg/kg every 12h IV) 1
- Suspected Pseudomonas or complicated intra-abdominal infection: Piperacillin-tazobactam (4.5g every 6h IV) 2
Infection-Specific Recommendations
Respiratory Infections
- Pneumonia:
Skin and Soft Tissue Infections
- Non-purulent: Cefazolin (1g every 8h IV) or oxacillin/nafcillin (2g every 6h IV) 1
- Purulent (likely S. aureus): Oxacillin/nafcillin, cefazolin, or clindamycin 1
- MRSA suspected: Vancomycin IV (15 mg/kg every 12h) 1
- Necrotizing fasciitis: Vancomycin or linezolid PLUS piperacillin-tazobactam or carbapenem, or ceftriaxone and metronidazole 1
Intra-abdominal Infections
- Single-drug regimens: Piperacillin-tazobactam (3.375g every 6h or 4.5g every 8h IV) 1
- Combination regimens: Ceftriaxone (1g every 24h) plus metronidazole (500 mg every 8h IV) 1
Meningitis
- Infants 8-28 days: Ampicillin IV (300 mg/kg/day divided q6h) plus ceftazidime IV (150 mg/kg/day divided q8h) 1
- Infants 29-60 days and older: Ceftriaxone IV (100 mg/kg/day once daily or divided q12h) 1
- Children: Ceftriaxone IV (50 mg/kg BD) or cefotaxime IV (50 mg/kg QDS) 1
Special Considerations
Antibiotic Resistance
- Consider local antibiogram data when available to guide therapy 1
- Recent studies show increasing broad-spectrum antibiotic use despite decreasing prevalence of resistant organisms 3, 4
- Both inadequate and unnecessarily broad empiric antibiotics are associated with higher mortality 4
Dosing Adjustments
- For renal impairment: Reduce dosing frequency and/or amount based on creatinine clearance 2
- For obese patients: Consider adjusted dosing based on actual or ideal body weight 1
Duration of Therapy
- Initial IV therapy should be continued until clinical improvement (typically 48-72 hours) 1
- Consider switch to oral therapy when patient is clinically improving, afebrile, and able to tolerate oral medications 1
- Failure to respond within 72 hours should prompt reevaluation and possible change in antibiotic therapy 1
Common Pitfalls to Avoid
- Overuse of broad-spectrum antibiotics: Recent studies show that most community-onset sepsis cases do not involve resistant pathogens, yet broad-spectrum antibiotics are frequently administered 3, 4
- Delayed administration: While timely administration is important, patient-specific factors should guide the choice of antimicrobial therapy 5
- Inadequate dosing: Ensure appropriate weight-based dosing, especially in pediatric patients 1
- Combination therapy risks: Combination therapy involving vancomycin and piperacillin/tazobactam is associated with increased risk of acute kidney injury 5
- Failure to obtain cultures: Cultures should be obtained before antibiotic administration when possible, without significantly delaying therapy 5
Remember that these recommendations are for empiric therapy and should be adjusted based on culture results and clinical response 1, 4.