2. Therapeutic Antibiotic Therapy Guideline

Therapeutic Antibiotic Therapy Guideline

Date: 07/2026 | Location: MH Katy

Sepsis of Unknown Etiology
Antibiotics initiated after cultures obtained.

  • Vancomycin 2 g loading dose once (then pharmacy consult for additional dosing based on body mass and renal function)
  • Cefepime 1 g IV q 8 hours

Pneumonia
Antibiotics initiated after cultures obtained.

  • Use “Pneumonia Infection Antibiotic Orders Panel”
  • Non severe community acquired pneumonia (admission to onset ≤48 hours)
    • Azithromycin 500 mg IV q24 hours
    • Ceftriaxone 1g IV q24 hours
  • Severe community acquired pneumonia (ventilator requirement and/or septic shock with admission to onset ≤48 hours)
    • Azithromycin 500 mg IV q24 hours
    • Ceftriaxone 1g IV q24 hours
  • Hospital acquired pneumonia or ventilator associated pneumonia
    • Vancomycin Dosing per Pharmacy
      • Note: if the nasal MRSA PCR is negative, vancomycin can be discontinued.
    • Cefepime 2 g IV loading dose followed by 1 g IV q 8 hours

 Urinary Tract Infection
Antibiotics initiated after urinalysis and/or cultures obtained.

Oral therapy: Sulfamethoxazole-trimethoprim DS PO q 12 hours

Intravenous therapy: ceftriaxone 1 g IV q24 hours

Duration of therapy:
Uncomplicated UTI (afebrile men and women): 3 days for sulfamethoxazole-trimethoprim and quinolones and 5 days for cephalosporins

Complicated UTI (men or women with: pyelonephritis, fever or bacteremia, catheter-associated infections): 7 days

Bacteremia
Narrow antibiotics after cultures have returned.

Duration:
Gram negative rods – 7 days
MRSA – 14 days (*for uncomplicated MRSA bacteremia)

* Uncomplicated course defined as 1) negative results of follow up blood culture 2-4 days after bacteremia identified, 2) defervescence within 72 hours of therapy, and 3) no evidence of metastatic infection among patients with catheter related blood stream infection or with primary bacteremia without evidence of endocarditis on TTE or TEE.