University of Pennsylvania Medical Center Guidelines for Antimicrobial Therapy

Click on Our Bug for HUP/UPPMC Antimicrobial Susceptibility Data (updated 3/15/08)

TABLE OF CONTENTS

 
Antiinfectives on our Formulary  
Clinical Microbiology Laboratory  
UPHS Guidelines
Antimicrobial Therapy
  Infection Control
  Antimicrobial Prophylaxis
  Drug Dosing and Administration
Non-UPHS Guidelines  
  Endocarditis and Endovascular Infections
  Fungal Infections
  Gastrointestinal Tract Infections
  Intraabdominal Infections
  Hepatitis
  Urinary Tract Infections
  Sexually Transmitted Diseases
  Infection Control and Immunization
  IDSA and BSAC Guidelines
  Pneumonia and Upper Respiratory Tract Infections
  Tuberculosis
  WHO and IUATLD TB Guidelines - Resource Poor
  Parasitic, Tick-borne, Travel-related Infections
  HIV
  Bioterrorism
   

 


New Postings

Updated HUP Problem Bugs (UPHS only 12/07)
Updated IDSA guidelines for:

Updated CDC/NIH guidelines for:

ACIP Guidelines for Immunization Ages 0-18 years (1/08)


Antiinfectives on Our Formulary

Commonly Used Formulary Antiinfectives and Restriction Categories

Formulary Antimicrobial Costs

Drotrecogin Alfa (Xigris) information and approval (UPHS only)


Clinical Microbiology Laboratory

Antimicrobial Susceptibilities at UPHS

HUP Antimicrobial Susceptibility Profiles for 2007 Jan-Dec 

Presbyterian Medical Center Susceptibility Profiles for 2007 Jan-Dec

Antimicrobial Susceptibility Testing and Interpretation & Drug Resistance

Antimicrobial Susceptibility of Rapidly Growing Mycobacteria

How to Interpret Susceptibility Results - What "S", "I", and "R" Means and How Testing is Performed

British Society for Antimicrobial Chemotherapy Guidelines for Antimicrobial Susceptibility Testing including great updated (March 04) phenotypic tables by David Livermore (offsite link)

Drug Resistance Mechanisms and Prevalence

Problem bacteria at HUP (UPHS only)

Gram Stains - Method, Interpretation, and Atlas

All About Gram Stains and Gram Staining - Includes a Gram Stain Atlas

New Gram Stain Atlas

Specimen Collection

Alphabetical guide to laboratory specimen collection for all types of laboratory tests at UPHS (UPHS only)

Guide to Specimen Collection for Biowarfare Agents(UPHS only)

Mumps testing guidelines from CDC (4/06)

Problem Sets

Teaching problem sets and lectures (UPHS only)

HIV Testing

HIV antibody testing methods used at HUP

Laboratory Administration

Laboratory Errrors and Patient Safety Newsletter

Bacterial Taxonomy

Professor Euzeéby

Deutsche Sammlung von Mikroorganismen und Zellkulturen


UPHS Guidelines for Antimicrobial Therapy

Bone and Joint Infections 

Central Nervous System Infections 

Ear, Nose and Throat Infections 

Endocarditis(link to 2005 AHA Guidelines) 

Gastrointestinal Infections 

Genitourinary Tract Infections 

Group B Streptococcal Perinatal Prophylaxis

Liver transplantation antimicrobial prophylaxis

Neutropenia and Fever 

Ocular Infections

HIV-Opportunistic Infections

Pulmonary Infections

Renal transplantation antimicrobial prophylaxis

Sepsis  

Skin and Soft Tissue Infections 


UPHS Guidelines for Infection Control

Infection Control Isolation System 

Discontinuing Isolation 

Guidelines for Blood Culture Collection 

Tuberculosis Guidelines


UPHS Guidelines for Antimicrobial Prophylaxis

Guidelines for Surgical Wound Prophylaxis 

Antimicrobial Prophylaxis for Prevention of Bacterial Endocarditis(Link to the 2007 AHA Guidelines) 


 

UPHS Drug Dosing and Administration Guidelines

Vancomycin Use and Dosing Guidelines (now includes calculator) 

Aminoglycoside Dosing Guidelines (now includes calculator) 

Once-daily Tobramycin Dosing in Cystic Fibrosis Patients

Recommendations for the Administration and Dosing of Amphotericin B deoxycholate 

Recommendations for Chloramphenicol Dosing

Antimicrobial Dosing in Renal Impairment 

Voriconazole Usage Guidelines

Amphotericin B Liposomal (Ambisome) Usage Guidelines

Tigecycline Usage Guidelines

Posaconazole Usage Guidelines

Non-UPHS Guidelines and Information

Endocarditis and Endovascular Infections

Endocarditis Diagnosis and Management

AHA Diagnosis and Management of Infectious Endocarditis -1998 (link to AHA web page or link to offsite pdf file 168kb

AHA Infective Endocarditis (2005, offsite link)

Endocarditis Prophylaxis

AHA Endocarditis Prophylaxis Guidelines - April 2007 (pdf, 602 kb, off site link)

BSAC Endocarditis Guidelines -2004 (PubMed abstract) or off site pdf  ( 125 kb)

BSAC Endocarditis Prophylaxis Guidelines - 2006 off site pdf (103 kb)

Modified Duke Criteria for Endocarditis

Nonvalvular Device Infections and Prophylaxis

AHA Nonvalvular Cardiovascular Device-Related Infections -2003 (link to AHA web page or link to offsite AHA pdf file) -access may require subscription

Guidelines for the Management of Intravascular
Catheter–Related Infections
(319 kb, pdf) 2001 by the Infectious Diseases Society of America

Guidelines For The Prevention Of Intravascular Catheter-Related Infections (August 2002; CDC, IDSA, SHEA, et al) (pdf file 340 kb) or link to CDC html file


Fungal Infections

Introduction to Antifungal Drugs (pdf, 33 kb), ©2000 by the Infectious Diseases Society of America 

Guidelines for Treatment of Fungal Infections (pdf, 57 kb), ©2000 by the Infectious Diseases Society of America 

Treatment of Aspergillosis (pdf, 483 kb), ©2008 by the Infectious Diseases Society of America 

Management of Patients with Blastomycosis (pdf, 56 kb), ©2000 by the Infectious Diseases Society of America 

Treatment of Candidiasis (pdf, 281 kb), ©2003 by the Infectious Diseases Society of America 

Treatment of Coccidiodomycosis (pdf, 98 kb), ©2005 by the Infectious Diseases Society of America 

Management of Cryptococcal Disease (pdf, 84 kb), ©2000 by the Infectious Diseases Society of America 

Management of Patients with Histoplasmosis (pdf, 172 kb), ©2007 by the Infectious Diseases Society of America 

Management of Patients with Sporotrichosis (pdf, 120 kb), ©2007 by the Infectious Diseases Society of America 

Dr. Fungus- A website with extensive information on fungi


Gastrointestinal Tract Infections

Diagnosis and Management of Foodborne Illnesses - CDC RR-4, Apr 2004 (offsite html or onsite pdf 368kb)

Practice Guidelines for the Management of Infectious Diarrhea -IDSA Jan 2001 (pdf 284 kb), 2001 by the Infectious Diseases Society of America


 

Intraabdominal Infections

Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections - IDSA, Sept 2003 2003 by the Infectious Diseases Society of America

 Antimicrobial therapy for intraabdominal infections. Surgical Infection Society, 2002, offsite pdf of executive summary (182 kb) offsite pdf of background document ( 567 kb)

2005 Guidelines from the International Society of Peritoneal Dialysis for the Diagnosis and Management of Peritoneal Dialysis-Associated Peritonitis


Hepatitis

Chronic Hepatitis B Antiviral Treatment Guidelines Leading Article JAC 2006 Amer Assoc Study Liver Dis Guidelines 2007 (offsite pdf, 482 kb)

Chronic Hepatitis C - Amer Assoc Study Liver Dis Guidelines 2004 (offsite pdf, 431 kb)


Urinary Tract Infections

Diagnosis and treatment of asymptomatic bacteriuria in adults - IDSA, ASN, AGA, March 2005 ©2005 by the Infectious Diseases Society of America pdf 133 kb

1999 Practice Guidelines for Antimicrobial Treatment of Uncomplicated Cystitis and Pyelonephritis in Women (pdf, 217 kb), 1999 by the Infectious Diseases Society of America


Sexually Transmitted Diseases

CDC August 2006Guidelines for the Treatment of Sexually Transmitted Diseases (pdf 700 kb) OR offsite html link

See also Hepatitis and HIV sections


Guidelines for Infection Control and Immunization

Infection Control Guidelines

CDC Guidelines for the Prevention of Nosocomial Pneumonia (2003 published Mar04 offsite html link or onsite pdf file (811kb)

Guidelines for Preventing Opportunistic Infections Among Hematopoetic Stem Cell Transplant Recipients (CDC, IDSA, ASBMT, Oct 2000) pdf file 714 kb or link to CDC html file

Guidelines For The Prevention Of Intravascular Catheter-Related Infections (August 2002; CDC, IDSA, SHEA, et al) (pdf file 340 kb) or link to CDC html file

Guidelines for the Prevention of Perinatal Group B Streptococcal Disease (August 2002; CDC) pdf file 2.2 MB or link to CDC html file

CDC-HICPA Guidelines for Environmental Infection Control in Health-Care Facilities (June 2003) link to pdf file (1 MB) or html document

HICPAC Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, 2007  (6/07, 1.3 mb pdf)

CDC- Prevention of TB Transmission in Health Care Facilities, Dec 2005 (pdf 1.2 mb)

Guideline for Hand Hygiene in Healthcare Settings (October 2002; CDC) pdf file 506kb or link to CDC html file

Post-exposure Prophylaxis

Postexposure needlestick prophylaxis- Interactive UCLA web site

CDC guidelines for postexposure prophylaxis for HIV, HBV, and HCV (August 2001, pdf, 343kb)

Immunization

Adult and Pediatric Immunization Guidelines (2002; IDSA) pdf file 670 kb or link to IDSA html file 2002 by the Infectious Diseases Society of America

Adult Immunization Schedule Oct 2007-Sept 2008, Oct 2007, ACIP pdf file 162kb

Pertussis Treatment and Postexposure Prophylaxis, CDC, Dec 2005, pdf file 210kb

Smallpox vaccination and adverse Reactions (Jan 2003; CDC) link to pdf file (13MB) or html document

ACIP-HICPAC Use of Tdap (Tetanus, reduced diphtheria toxoid, acellular pertussis) Vaccine in Adults, Dec 2006 (pdf 412 kb)

ACIP Immunization Schedule for Persons 0-18 Years of Age, Jan 2008, (pdf 258 kb)

Surgical Prophylaxis

Antimicrobial Prophylaxis for Surgery IDSA June 2004 (pdf 124kb), 2004 by the Infectious Diseases Society of America

Communicable Disease Reporting

Reporting communicable diseases in Philadelphia (external link to Philadelphia Dept. of Public Health Division of Disease Control)


 

Infectious Diseases Society of America and British Society for Antimicrobial Chemotherapy Guidelines

2002 Guidelines for the Use of Antimicrobial Agents in Neutropenic Patients with Unexplained Fever (pdf, 95 kb), or link to IDSA html file ©2002 by the Infectious Diseases Society of America 

Practice Guidelines for Evaluating New Fever in Critically Ill Adult Patients, (264 kb), ©1998 by the Infectious Diseases Society of America

Fungal Infections

The Clinical Assessment, Treatment, and Prevention
of Lyme Disease, Human Granulocytic Anaplasmosis,
and Babesiosis
- IDSA Oct 2006, pdf 2.8 mb Excellent update of guidelines ©2006 by the Infectious Diseases Society of America

Practice Guidelines for Outpatient Parenteral Antimicrobial Therapy (pdf 189 kb, June 2004), ©2004 by the Infectious Diseases Society of America

Diagnosis and Treatment of Diabetic Foot Infections (pdf 426kb, Oct 2004) ©2004 by the Infectious Diseases Society of America

Practice Guidelines for the Management of Bacterial Meningitis (pdf 319kb, Nov 2004) ©2004 by the Infectious Diseases Society of America

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (pdf 313 kb, Nov 2005) ©2005 by the Infectious Diseases Society of America

Guidelines for the prophylaxis and treatment of methicillin-resistant Staphylococcus aureus ( MRSA) infections in the UK- BSAC Working Party offsite link (230 kb, pdf) (2/06)

Use of antibiotics in penetrating craniocerebral injuries -BSAC Working Party (1997), offsite link

The management of neurosurgical patients with postoperative bacterial or aseptic meningitis or external ventricular drain-associated ventriculitis- BSAC Working Party (2000), offsite link

Guideline for the management of the hot swollen joint in adults -BSR, BSAC, et al. (2006) offsite link

Treatment of Hospital Infections - great educational resource by the British Soc for Antimicrobial Chemotherapy (2002)


Pneumonia & Upper Respiratory Tract

Community Acquired Pneumonia

Hospital and Healthcare-Associated Pneumonia

    CDC Guidelines for the Prevention of Nosocomial Pneumonia (2003 published Mar04) offsite html link or onsite pdf file (811kb)

    ATS/IDSA Guidelines for the Management of Adults with Hospital-Acquired, Ventilator-associated, and Healthcare-associated pneumonia (2004, published 2005)-Offsite ATS link (360Kb, pdf)

Upper Respiratory Tract Infections


Tuberculosis

General Primers and Definitions

CDC Core Clinical Curriculum on Tuberculosis - includes information on prophylaxis, diagnosis, antituberculous drugs, epidemiology, and therapy (offsite link, updated periodically)

American Thoracic Society /CDC/IDSA Statement on Diagnostic Standards and Classification of Tuberculosis in Adults and Children -1999 (published April 2000, pdf 474 kb)

WHO TB and HIV Clinical Manual (2nd ed, 2004) pdf 726 kb

WHO/IAUTLD TB Manual for Medical Students (1999) pdf 1.1 mb

IAUTLD Diagnostic Atlas of Intrathoracic TB in Children (2003) pdf 6.2 mb

IUATLD TB Guide for Medical Specialists (2003)- pdf 8 mb

NICE - TB Clinical Diagnosis and Management (UK National Institute for Health and Clinical Excellence (2006) - all excellent, offsite links: main page, synopsis (pdf 110k), complete NICE guidelines (pdf 430 kb), full review by Royal College of Physicians (pdf, 1 mb)

Treatment Guidelines

American Thoracic Society/CDC/IDSA Statement on the Treatment of Tuberculosis (Oct 2002, pdf 525 kb)

Practice Guidelines for the Treatment of Tuberculosis -IDSA Oct 2000, pdf 70kb; ©2000 by the Infectious Diseases Society of America

Also see the above NICE guidelines

HIV Specific Treatment and Prevention Guidelines

Prevention and Treatment of Tuberculosis Among Patients Infected with Human Immunodeficiency Virus: Principles of Therapy and Revised Recommendations - CDC Recommendation October 1998 (pdf 750 kb) OR offsite link

Appendix to above HIV /TB treatment html document (link to CDC web)

Managing drug interactions in the treatment of HIV-related tuberculosis -CDC recommendations Dec 2007 pdf 228 kb OR offsite link

Diagnosis and Treatment of Latent TB

American Thoracic Society/CDC/IDSA/AAP Statement on Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection -1999 (published April 2000, pdf 699 kb) -Also view the warnings on use of rifampin/pza together (Aug 2002, html)

TB Drug Side-effect and Interactions

ATS-Hepatotoxicity of anti-Tb drugs (offsite pdf, 1.2 mb, 2006)

Managing drug interactions in the treatment of HIV-related tuberculosis -CDC recommendations Dec 2007 pdf 228 kb OR offsite link

Non-Tuberculous Mycobacterial Infections

ATS-IDSA guidelines for the diagnosis and treatment of non-tuberculous mycobacterial infections (offsite link, pdf 930 kb, 2/07) 


WHO, IUATLD Tuberculosis Guidelines, Especially for Low Income Countries

Laboratory Diagnosis and Management

IUATLD Direct Microscopy Guide for the Diagnosis of TB (5th ed, 2000) pdf 707kb

IUATLD Guide for Nat. TB Ref. Labs and National Laboratory Networks (1998) pdf 1.1 mb

Res. Inst. of TB/IUATLD AFB Microscopy Training (2005)-complete document pdf 11.4 mb

Research Inst. of TB/IUATLD AFB Microscopy Training (2005)Part 1 pdf 4mb

Research Inst. of TB/IUATLD AFB Microscopy Training (2005) Part 2 pdf 6mb

Research Inst. of TB/IUATLD AFB Microscopy Training (2005) Part 3 pdf 1.5 mb

Priorities for tuberculosis bacteriology services in low income countries. IUATLD (2007) Offsite link (pdf 5.4 mb)

 

Clinical Manuals

WHO TB and HIV Clinical Manual (2nd ed, 2004) pdf 726 kb

WHO/IAUTLD TB Manual for Medical Students (1999) pdf 1.1 mb

WHO Diagnosis and Treatment of Smear Negative Pulmonary and Extrapulmonary TB in HIV prevalent, resource-constrained regions (2007) pdf 460 kb

IAUTLD Diagnostic Atlas of Intrathoracic TB in Children (2003) pdf 6.2 mb

IUATLD TB Guide for Medical Specialists (2003)-complete document pdf 8 mb

IUATLD TB Guide for Medical Specialists (2003) Part 1 pdf 5.8 mb

IUATLD TB Guide for Medical Specialists (2003) Part 2 pdf 2mb

IUATLD TB Guide for Medical Specialists (2003) Part 3 pdf 1.9 mb

Best practice for the care of patients with tuberculosis.  A guide for low-income countries. IUATLD (2007) Offsite link (pdf 832 kb)

Epidemiology of Tuberculosis IUATLD (2003) (pdf 4 mb)

Links

WHO (World Health Organization)

IUATLD (International Union Against Tuberculosis and Lung Diseases, has other useful manuals for the management of lung diseases)


 Parasitic, Tick-Borne Diseases, Travel Medicine

CDC Malaria Treatment and Diagnosis (2007) (off site link)

CDC Malaria Treatment Guidelines Only (May 2007 pdf, 38 kb)

Tick borne North American rickettsial diseases - excellent review of epidemiology, treatment and diagnosis - CDC March 2006 (pdf 790 kb)

The Clinical Assessment, Treatment, and Prevention
of Lyme Disease, Human Granulocytic Anaplasmosis,
and Babesiosis
- IDSA Oct 2006, pdf 2.8 mb Excellent update of guidelines ©2006 by the Infectious Diseases Society of America

Treatment of Nervous System Lyme Disease - American Academy of Neurology, May 2007 (offsite link, 190 kb pdf)

IDSA Guidelines for the Practice of Travel Medicine (Jan 07, 3.8 Mb, pdf). A very good travel medicine primer. ©2007 by the Infectious Diseases Society of America

US Military Medical Textbooks - great chapters on parasitic and non-parasitic infectious diseases (offsite link)


HIV-Related Information

Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults and Adolescents - March 2004 USPHS pdf 1.0mb OR go to the offsite html link

Link to AIDSinfo US Dept HHS Website  

2004 USPHS/IDSA Guidelines for the Treatment of
Opportunistic Infections in Persons Infected with Human
Immunodeficiency Virus (Dec 2004), pdf 860K OR link to CDC site

Prevention and Treatment of Tuberculosis Among Patients Infected with Human Immunodeficiency Virus: Principles of Therapy and Revised Recommendations - CDC Recommendation October 1998 (pdf 750 kb) OR link to CDC html document

Managing drug interactions in the treatment of HIV-related tuberculosis -CDC recommendations Dec 2007 pdf 228 kb OR offsite link

Postexposure prophylaxis for HIV, HBV, HCV - CDC Aug 2001

Management of Occupational HIV exposure - CDC Sept 2005

Guidelines for the evaluation and management of dyslidipemia in HIV-infected adults - IDSA Aug 2003 2003 by the Infectious Diseases Society of America

National HIV/AIDS Clinician's Consultation Center

Primary Care Guidelines for the Management of Persons Infected with Human Immunodeficiency Virus IDSA (pdf 192kb, Sept 2004) 2004 by the Infectious Diseases Society of America

Treating Opportunistic Infections in HIV-exposed and Infected Children- CDC,NIH, IDSA, Dec 2004 pdf 741 kb or offsite link and appendices A, B, C

HIV Testing in Health Care Settings- Revised Recommendations - CDC Sept 2006 (pdf 214 kb)

Reducing perinatal transmission and treatment of HIV-infected pregnant women -US Public Health Service Nov 2007 (pdf 8 mb)


Bioterrorism

CDC Bioterrorism Webpages (link)

CDC Interim Smallpox Response Plan and Guidelines (Jan 2002, link)

Smallpox diagnosis Powerpoint slides- Prof. Stanley Foster, Emory University view online( requires Internet Explorer) OR download slide set (30 Mb, Powerpoint) (both offsite links)

Classical Clinical Description of Inhalation Anthrax (Dec 1960 Am J. Med. paper by Plotkin and colleagues)

Consensus Statements on Bioterrorism Agents, published in JAMA (links)

WHO Draft Guidelines on Biological and Chemical Terrorism(Nov 2001)pdf, 444 kb, link to site, and description of biological (212 kb pdf) and chemical agents(120 kb pdf)

Johns Hopkins Center for Civilian Biodefense Studies (link)

U.S. Army Medical Research Institute of Infectious Diseases Medical Management of Biological Casualties Handbook (link) OR (pdf -378kb)

Medical Letter Recommendations on anthrax postexposure prophylaxis (link to 48 kb pdf), smallpox vaccine (link to 57kb pdf) and use of drugs and vaccines against bioweapons (link to 50 kb pdf)

Powerpoint slides of cutaneous anthrax - much better quality than the CDC ones - from PHLS website (see below) ppt, 98kb.

PHLS website on anthrax with very good guidelines and good pictures of anthrax and smallpox (link to pdf file, 113kb)

IDSA Bioterrorism Webpages (link)

European Guidelines on Bioterrorism ("Bichat" Guidelines)- excellent brief summaries by agent, January 2005

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