Table 2.
Commonly Used Antibiotics for Empiric Broad-Spectrum Coverage in Sepsis
| Drugs With Broad-Spectrum Gram-Negative Coverage Including Pseudomonas | ||||
|---|---|---|---|---|
| Drug | Standard Dose for Sepsis | Infusion Length | Renal Dose Adjustments Required? | Stability After Reconstitution |
| Piperacillin/tazobactam [75] | 4.5g IV q6h | Initial dose: 30 minutes Subsequent doses: 30 minutes to 4 hours | Yes at CrCl <40 mL/min | 24 hours at room temperature and up to 1 week refrigerated |
| Ceftazidime [76] | 2g IV q8h | Initial dose: can be administered IV push over 3–5 minutes or by intermittent infusion over 15 to 30 minutes Subsequent doses: 30 minutes to 4 hours | Yes at CrCl <50 mL/min | 12 hours at room temperature or 3 days under refrigeration |
| Cefepime [77, 78] | 2g IV q8h | Initial dose: can be administered IV push over 3–5 minutes or by intermittent infusion over 30 minutes Subsequent doses: 30 minutes to 4 hours | Yes at CrCl <60 mL/min | 24 hours at room temperature and up to 1 week refrigerated |
| Imipenem/cilastatin [79] | 1g IV q6h | Doses <500 mg should be infused over 20–30 minutes doses >500 mg should be infused over 40–60 minutes | Yes at CrCl <60 mL/min | 4 hours at room temperature and 24 hours under refrigeration |
| Meropenem [80] | 1–2g IV q8h | Initial dose: doses up to 1g can be administered IV push over 3–5 minutes, or by intermittent infusion over 30 minutes Subsequent doses: 30 minutes to 3 hours | Yes at CrCl <50 mL/min | 4 hours at room temperature (in SWFI or sodium chloride 0.9%) or 24 hours under refrigeration |
| Ciprofloxacin [93] | 400 mg IV q8h | Infuse over 60 minutes | Yes at CrCl <50 mL/min | 14 days at room temperature or under refrigeration |
| Levofloxacin [94] | 750 mg IV q24h | Doses ≤500 mg infuse over 60 minutes, 750 mg infuse over 90 minutes. Rapid infusion can lead to hypotension | Yes at CrCl <50 mL/min | 72 hours at room temperature or 14 days under refrigeration |
| Drugs With Broad-Spectrum Gram-Positive Coverage Including MRSA | ||||
| Vancomycin [81] | 15 to 20 mg/kg IV q8–12h | Minimum infusion time of 60 minutes, with additional 30 minutes added for each 500 mg beyond 1000 mg (eg, administer 1000 mg over 60 minutes and 1500 mg over 90 minutes) | Yes, at CrCl <90 mL/min and as guided by therapeutic drug monitoring | 14 days under refrigeration |
| Linezolid [82] | 600 mg IV/PO q12h | Over 30 to 120 minutes | No | Premade bags stable until expiration date on packaging when maintained in their overwrap |
| Daptomycin [83] (not for use in sepsis with suspected pulmonary source) | 6 to 8 mg/kg IV q24h | IV push over 2 minutes or IV infusion over 30 minutes | Yes, at CrCl <30 mL/min | 12 hours at room temperature and up to 48 hours under refrigeration |
| Ceftaroline [84] | 600 mg IV q12h | Infuse over 60 minutes | Yes at CrCl <50 mL/min | 6 hours at room temperature or within 24 hours under refrigeration |
| Antifungal Agents | ||||
| Micafungin [95] | 100 mg IV q24h | Infuse over 60 minutes, more rapid infusions may result in more frequent histamine-mediated reactions | No | 24 hours at room temperature |
| Caspofungin [96] | 70 mg IV loading dose on day 1, then 50 mg daily thereafter | Infuse over 60 minutes, more rapid infusions may result in more frequent histamine-mediated reactions | No | 24 hours at room temperature |
Abbreviations: CrCl, creatinine clearance; IV, intravenous; MRSA, methicillin-resistant Staphylococcus aureus; PO, per os; SWFI, sterile water for injection.