| Vancomycin OR daptomycin OR linezolid PLUS piperacillin-tazobactam OR a carbapenem (imipenem-cilastatin, meropenem, ertapenem) OR ceftriaxone plus metronidazole; consider adding clindamycin if linezolid is not used | Empiric antibiotic treatment for presumed NF. Antibiotics should be tailored to Gram stain, culture result, and sensitivity data | Antimicrobial Inhibitor of toxin synthesis (clindamycin and linezolid) | V: 15-20 mg/kg q8-12h IV D: 4-6 mg/kg/q24 h IV L: 600 mg q12h IV PT: 3.375 g q6h IV IC: 1 g q6-8h IV M: 1 g q8h IV E: 1 g daily IV C: 1-2 g q24h IV Me: 500 mg q6h IV Cl: 600-900 mg q8h | General 1. Allergic reaction 2. GI side effects 3. C. difficile infection V: severe rash, nephrotoxicity, pancytopenia, ototoxicity D: rhabdomyolysis, eosinophilic pneumonia, nephrotoxicity, hepatotoxicity, headache L: myelosuppression, serotonin syndrome, hypoglycemia, hypertension, lactic acidosis, pancreatitis, irreversible neuropathy PT: myelosuppression, immune thrombocytopenia, nephrotoxicity I/M/E: CNS toxicity, myelosuppression C: rash, hypercalciuria, cholelithiasis, hemolytic anemia, kernicterus Me: CNS toxicity, peripheral neuropathy, disulfiram-like reaction, nausea, vomiting, diarreha Cl: hemolytic anemia, nephrotoxicity | General 1. Monitor signs of C. difficile infection 2. CBC and CMP are generally monitored daily in acute setting V: trough level after 3rd dose, goal 15-20 mg/mL D: baseline and weekly CPK | IV1,2,5,6,12,15 |