Agentes antimicrobianos preferidos en la sepsis, para patógenosespecíficos

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Organismo                       Agente preferido                       Alternativa

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Acinetobacter                   Imipenem                                 Fluoroquinolona

                                    Fluoroquinolona +                        Ceftazidima o Cefepime

                                    Amikacina o Ceftazidima      Penicilina antipseudomona

                                                                                    Trimetropin-Sulfa

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Anaerobios                      Betalactámico-Inhibidor           Clindamicina

                                    Betalactamasa                          Cefoxitin

                                    Cloranfenicol                           Cefotetan

                                    Imipenem/Meropenem        Cefmetazol

                                    Metronidazol                           Penicilina AntiPseudomona

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Bacillus            Vancomicina                            Imipenem

                                                                                     Aminoglucósidos

                                                                                       Fluoroquinolona

                                                                                    Clindamicina

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Bacteroides                     Metronidazol                           Cloranfenicol

                                    Clindamicina                           Penicilina AntiPseudomona

                                    Cefoxitin/Cefotetan/                   Imipenem

                                    Cefmetazol                                         Betalactámico-Inhibidor

                                                                                               Betalactamasa         

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Candida Albicans                Anfotericin B +                        Fluconazol

                                    Flucitosina

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Clostridium                     Penicilina G                                       Cloranfenicol

                                                                                    Metronidazol

                                                                                   Clindamicina

                                                                                    Imipenem

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Enterobacter                    Imipenem                                   Cefalosporina 3ra G

                                    Aminoglucósidos                        Aztreonam

                                    Fluoroquinolona                        Cefepime

                                    Penicilina AntiPseudomona

                                    Trimetopin-Sulfa

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Escherichia Coli                Cefalosporina 3ra G                    Aminoglucósidos

                                    Ampicillin*                                        Imipenem

                                    Trimetopin-Sulfa*                      Fluoroquinolona

                                                                                               Aztreonam

                                                                                               Penicilina AntiPseudomona

                                                                                               Betalactámico-Inhibidor

                                                                                   Betalactamasa         

Estafilococo                    Vancomicina o Penicilina          Trimetoprim-Sulfa

                                    Penicilinasa resistente +          Fluoroquinolona

                                    Rifampicina o Gentamicina      Minociclina

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Klebsiella                      Cefalosporina 3ra G                    Aminoglucósidos

                                    Imipenem                               Trimetoprim-Sulfa

                                    Betalactámico-Inhibidor                Piperacillin/Mezlocillin

                                    Betalactamasa                          Cefepime

                                    Aztreonam

                                    Fluoroquinolona

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Proteus                         Cefalosporina 3ra G                   Aminoglucósido

                                    Imipenem                                       Trimetoprim-Sulfa

                                    Betalactámico-Inhibidor           Penicilina Anti-Pseudomona

                                    Betalactamasa                          Cefepime      

                                                                                   Aztreonam     

                                                                                   Fluoroquinolona

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Pseudomonas                     Amikacina + Penicilina          Amikacina +

                                    Anti-Pseudomona                        Imipenem/Meropenem

                                                                                   Ceftazidima

                                                                                   Aztreonam

                                                                                   Cefepime

                                                                                   Ciprofloxacino

                                    Si un solo agente, cualquiera de los alternativos.

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Serratia                        Cefalosporina 3ra G +          Amikacina +

                                    Amikacina                              Penicilina Anti-Pseudomona

                                    Imipenem                               Aztreonam

                                    Fluoroquinolona                        Cefepime

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* Si resulta sensible

Antimicrobianos, dosis diaria, vías de administración, e intervalos de administración en el tratamiento de la sepsis.

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Antimicrobiano                                        Dosis diaria, Vías e Intervalos interdosis

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Penicilina G Cristalina                               20-30 mega Uds., IV, c/4-6 hs    

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Ampicillin                                2-8 g/día, IV, c/4-6 hs

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Ampicillin + Sulbactan                                4-8 g/día, IV, c/4-6 hs

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Ticarcillin + Clavulanato                             12-24 g/día, IV, c/4-6 hs

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Piperacillin + Tazobactam                             12:1.5 g/dia, IV, c/6 hs

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Ticarcillin                                               4-24 g/día, IV, c/4-6 hs

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Piperacillin                                6-24 g/día, IV, c/4-6 hs

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Mezlocillin                               6-24 g/día, IV, c/4-6 hs

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Nafcillin                                                2 -12 g/día, IV/IM, c/4-6 hs

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Cefotaxima                                            2-12 g/día, IV/IM, c/6-8 hs

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Ceftizoxima                                           2-12 g/día, IV/IM, c/8-12 hs

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Ceftazidima                                           3-6 g/día, IV/IM, c/8-12 hs

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Cefoperazona                                          2-8 g/día, IV/IM, c/12 hs

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Ceftriaxona                                           1-4 g/día, IV/IM, c/24 hs

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Moxalactam                                            6-24 g/día, IV, c/8-12 hs

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Cefepime                                              1-4 g/día, IV, c/12 hs

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Cefoxitin                                   2-12 g/día, IV/IM, c/4-6 hs

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Cefotetan                                             2-4 g/día, IV/IM, c/12 hs

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Cefmetazol                                            4-8 g/día, IV, c/8-12 hs

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Aztreonam                                             1.5-6 g/día, IV/IM, c/6-8 hs

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Imipenem/Cilastatin                                   1-4 g/día, IV, c/6 hs

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Meropenem                                             1-6 g/día, IV, c/8 hs

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Ciprofloxacino                                        400-800 mg/día, IV, c/12 hs

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Ofloxacino                                            200-400 mg/día, IV, c/12 hs

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Gentamicina                                           3-5 mg.Kg/día, IV/IM, c/24 hs

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Amikacina                                             15 mg.Kg/día, IV/IM, c/24 hs

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Tobramicina                                           3-5 mg.Kg/día, IV/IM, c/24 hs

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Netilmicina                                           4-6.5 mg.Kg/día, IV/IM, c/8 hs

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Anfotericin B                                         0.3-1 mg.Kg/día, IV, c/4-6 hs

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Anfotericin B complejo Lípido              5 mg.Kg/día, IV, c/24 hs

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Flucitosina                               50-150 mg.Kg/día, PO, c/6 hs

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Fluconazol                                            100-200 mg/día, IV, c/24 hs

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Cloranfenicol                                         50-100 mg.Kg/día, IV, c/6 hs

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Rifampicina                                           600 mg/día, IV, c/24 hs

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Vancomicina                                           1-2 g/día, IV, c/12 hs

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Trimetoprim-Sulfa                                     2-20 mg.Kg/día, IV, c/6-8 hs

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Clindamicina                                          1.8-2.7 g/día, IV, c/6-8 hs

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Metronidazol                                          0.75-2 g/día, IV, c/6-12 hs

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