Introduction

Antibiotic resistance has increased dramatically over the past several decades. Increasing resistance, coupled with a pipeline for new antimicrobial agents which has all but dried up, has meant prudent use of antibiotics is critically important. The selection of optimal therapy for infections can be a daunting task for healthcare professionals. Antibiotic resistance is among the most serious issues facing contemporary healthcare. Changing antibiotic resistance patterns, rising antibiotic costs and the introduction of new antibiotics have made selecting optimal antibiotic regimens more difficult now than ever before. Antibiotics are the only class of medications where use in one patient can directly impact another patient. As a response to these challenges, the UCLA Antimicrobial Stewardship Program was created in July 2010. Directed by an Infectious Diseases physician (Daniel Z. Uslan, M.D.) and Infectious Disease pharmacist (Meganne Kanatani, Pharm.D.), the intent of the program is to optimize antimicrobial use at UCLA through appropriate selection, dosing, and duration of therapy. Our goals are to improve clinical outcomes by ensuring patients with infection are appropriately treated, reducing the emergence of resistance, limiting drug-related adverse events, and minimizing the risk of unintentional consequences associated with antimicrobials, such as C. diff. These guidelines are a step in that direction.

These guidelines are based on current literature reviews, including national guidelines and consensus statements, current microbiology data from the UCLA lab, and UCLA faculty expert opinion. Faculty from various departments have reviewed and approved these guidelines. As you will see, in addition to antibiotic recommendations, the guidelines also contain information about diagnosis, test ordering, and other useful management tips.

As the name implies, these are only guidelines, and can never substitute for clinical judgement. This book is not intended to serve as a comprehensive resource for treatment of infections, and expert consultation is always s uggested for complex infections. If you have specific feedback on sections or are interested in more information on any of the topics herein, please feel free to contact us. Our goal is for the Antimicrobial Stewardship Program to serve as a valued service in optimizing the care of the 60% of UCLA patients who receive antimicrobials. We welcome your thoughts and comments to: (310) 267-7567 or to ASP@ucla.edu.
Thank you,
Daniel Z. Uslan, M.D., M.S. Director, Antimicrobial Stewardship Program
Meganne Kanatani, Pharm.D. Infectious Diseases Pharmacist

How to use this guide

• Each section begins by giving recommendations for the choice and dose of antibiotics for the particular infection.
• ALL DOSES IN THE TEXT ARE FOR ADULTS WITH NORMAL RENAL AND HEPATIC FUNCTION.
• If your patient does NOT have normal renal or hepatic function, please refer to the sections on antibiotic dosing to determine the correct dose, or ask your friendly neighborhood pharmacist.
• Following the antibiotic recommendations, we have tried to include some important treatment notes that explain a bit about WHY the particular antibiotics were chosen and that provide some important tips on diagnosis and management. PLEASE glance at these notes when you are treating infections, as we think the information will prove helpful.

The recommendations given in this guide are meant to serve as treatment guidelines. They should NOT supplant clinical judgment or Infectious Diseases consultation. The recommendations were developed for use at UCLA Health System hospitals are may not be appropriate for other settings. We have attempted to verify that all information is correct, but research changes. If there is any doubt, please verify the information in this guide by calling the antimicrobial stewardship program at (310) 267-7567 or obtaining Infectious Diseases consultation.