DESENSITIZATION PROTOCOLS

See also, UMHHC Policy 07-01-017. Desensitization Policy for Drug Hypersensitivity for Inpatients for
information regarding dosing intervals, infusion times, IV access requirements and monitoring.

CONTENTS
Amiodarone Ceftazidime Minocycline
Ampicillin Ceftriaxone Nafcillin
Ampicillin-sulbactam Ciprofloxacin Penicillin G
Aspirin Clopidogrel Piperacillin-tazobactam
Atovaquone Levofloxacin Tigecycline
Trimethoprim-
Aztreonam Linezolid
sulfamethoxazole
Cefazolin Meropenem Vancomycin
Cefepime Metronidazole
 AMIODARONE

STEP 1: PHARMACY – PREPARE AND LABEL SERIAL DILUTIONS

Bag Concentration
1. Remove 13 mL out of 100 mL D5W bag
2. Inject 150 mg/3 mL of amiodarone into 100 mL D5W (Bag #1) 1.5 mg/mL
3. Remove 12 mL out of 100 mL D5W bag
4. Inject 100 mg/2 mL of amiodarone into 100 mL D5W (Bag #2) 1 mg/mL
5. Remove 11 mL out of 100 mL D5W Bag #2
6. Inject 1 mL of Bag #1 into 100 mL D5W (Bag #3) 0.01 mg/mL

STEP 2: PHARMACY - PREPARE IV DOSES

Goal dose 150 mg:
Dose # Dose Volume Bag #
1 0.01 mg 1 mL Bag 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 10 mL
5 0.3 mg 30 mL
6 1 mg 1 mL Bag 2 (1 mg/mL)
7 3 mg 3 mL
8 5 mg 5 mL
9 10 mg 10 mL
10 30 mg 30 mL
11 (cumulative 150 mg) 100 mg 100 mL
Goal dose 300 mg:
Dose # Dose Volume Bag #
1 0.01 mg 1 mL Bag 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 10 mL
5 0.3 mg 30 mL
6 1 mg 1 mL Bag 2 (1 mg/mL)
7 3 mg 3 mL
8 5 mg 5 mL
9 10 mg 10 mL
10 30 mg 30 mL
11 100 mg 100 mL
12 (cumulative 300 mg) 150 mg 100 mL Bag 1 (1.5 mg/mL)
Note: Doses should be given 30 minutes apart

Page 2 of 28
 Ampicillin
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 1 g AMPICILLIN vial with 9.5 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, label vial #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, label vial #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 1 g:
Dose # Dose Volume Vial #
1 0.01 mg 1 mL #3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL #2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL #1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL

Goal dose 2 g:
Dose # Dose Volume Vial #
1 0.01 mg 1 mL #3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL #2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL #3 (100 mg/mL
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1g Add-Vantage 1 g Add-Vantage vial
assembled with 50 mL NS

Page 3 of 28
 Ampicillin-sulbactam (Unasyn)
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS
Vial Concentration
1. Dilute 3 g Unasyn vial with 6.4 mL NS, label vial #1 375 mg/mL
2. 4 mL of vial 1 plus 11 mL NS into an empty vial, label vial #2 100 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL NS into an empty vial, label vial #3 1 mg/mL
4. 0.1 mL of vial 3 plus 9.9 mL NS into an empty vial, label vial #4 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal 1.5 g
Dose # Dose Volume Vial #
1 0.015 mg 1.5 mL 4 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.15 mg 0.15 mL 3 (1 mg/mL)
4 0.3 mg 0.3 mL
5 1.5 mg 1.5 mL
6 3 mg 3 mL
7 4.5 mg 4.5 mL
8 15 mg 0.15 mL 2 (100 mg/mL)
9 30 mg 0.3 mL
10 45 mg 0.45 mL
11 150 mg 1.5 mL
12 300 mg 3 mL
13 450 mg 4.5 mL
14 cumulative 1.5 g 500 mg 1.33 mL 1 (375 mg/mL)

Goal 3 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 4 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.1 mg 0.1 mL 3 (1 mg/mL)
4 0.3 mg 0.3 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 10 mg 0.1 mL 2 (100 mg/mL)
8 30 mg 0.3 mL
9 100 mg 1 mL
10 300 mg 3 mL
11 1g 2.67 mL 1 (375 mg/mL)
12 cumulative 3 g 1.5 g Add-Vantage 1.5 g Add-Vantage
assembled with 50 mL NS

Page 4 of 28
 ASPIRIN

STEP 1: ADMINISTER ASPIRIN DOSES USING ASPIRIN TABLETS

Dose # Dose Dosage Form
1 20.25 mg ¼ of 81 mg tab
2 40.5 mg ½ of 81 mg tab
3 40.5 mg ½ of 81 mg tab
4 81 mg 81 mg tab
5 121.5 mg 1 ½ 81 mg tab
6 202.5 mg 2 ½ 81 mg tab
7 325 mg 325 mg tab

Notes:
Doses are to be given orally
Doses should be given 90 – 180 minutes apart
Patient must not react to a dose before moving on to an escalating dose

Reference: White AA, Stevenson DD, Woessner KM, et al. Approach to patients with aspirin hypersensitivity and acute
cardiovascular emergencies. Allergy Asthma Proc. 34:138-142, 2013.

Page 5 of 28
 Atovaquone Oral Suspension (150 mg/mL)
STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. 1 mL of stock suspension (150 mg/mL) mixed with 14 mL SW, labeled #1 10 mg/mL
2. 1 mL of vial #1 plus 9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 1 mL of vial #2 plus 9 mL SW into an empty vial, labeled #3 0.1 mg/mL

STEP 2: PREPARE PO DOSES

Goal 750 mg
Dose # Dose Volume Vial #
1 0.1 mg 1 mL 3 (0.1 mg/mL)
2 0.3 mg 3 mL
3 0.5 mg 5 mL
4 1 mg 1 mL 2 (1 mg/mL)
5 3 mg 3 mL
6 5 mg 5 mL
7 10 mg 1 mL 1 (10 mg/mL)
8 30 mg 3 mL
9 50 mg 5 mL
10 100 mg 0.67 mL Stock suspension (150
mg/mL)
11 500 mg 3.33 mL

Goal 1.5 g
Dose # Dose Volume Vial #
1 0.1 mg 1 mL 3 (0.1 mg/mL)
2 0.3 mg 3 mL
3 0.5 mg 5 mL
4 1 mg 1 mL 2 (1 mg/mL)
5 3 mg 3 mL
6 5 mg 5 mL
7 10 mg 1 mL 1 (10 mg/mL)
8 30 mg 3 mL
9 50 mg 5 mL
10 100 mg 0.67 mL Stock suspension (150
mg/mL)
11 500 mg 3.33 mL
12 750 mg 5 mL

Page 6 of 28
 Aztreonam

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 1 g AZTREONAM vial with 10 mL SW. Label as vial #1. 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL

Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.1 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1g 1 g vial in 50 mL
Corrected August 7, 2013.

Page 7 of 28
 Cefazolin

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 1 g CEFAZOLIN vial with 9.6 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial , labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 500 mg

Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 5 mg 5 mL
7 10 mg 0.1 mL 1 (100 mg/mL)
8 30 mg 0.3 mL
9 50 mg 0.5 mL
10 100 mg 1 mL
11 300 mg 3 mL

Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL

Page 8 of 28
Cefazolin, continued

Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1g 1 g Add-Vantage in 50 mL

Page 9 of 28
 Cefepime

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 1 g CEFEPIME vial with 10 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL

Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1 g over 30 min Mini-bag plus or Add-Ease

Page 10 of 28
 Ceftazidime

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 1 g CEFTAZIDIME vial with 10 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 500 mg

Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 5 mg 5 mL
7 10 mg 0.1 mL 1 (100 mg/mL)
8 30 mg 0.3 mL
9 50 mg 0.5 mL
10 100 mg 1 mL
11 300 mg 3 mL

Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL

Page 11 of 28
Ceftazidime, continued

Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1g Add-Vantage

Page 12 of 28
 Ceftriaxone

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 1 g CEFTRIAXONE vial with 9.6 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg 3 mL
13 500 mg 5 mL

Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 3 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg 3 mL
15 500 mg 5 mL
16 1g Add-Vantage

Page 13 of 28
 Ciprofloxacin

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Inject 0.5 mL Cipro (2 mg/mL) plus 9.5 mL D5W into an empty vial labeled #1 0.1 mg/mL
2. 1 mL of vial 1 plus 9 mL D5W into an empty vial labeled #2 0.01 mg/mL
3. 1 mL of vial 2 plus 9 mL D5W into an empty vial labeled #3 0.001 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 400 mg

Dose # Dose Volume Vial #
1 0.01 mg 1 mL 2 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 1 mL 1 (0.1 mg/mL)
4 0.5 mg 5 mL
5 1 mg 0.5 mL Bag (2 mg/mL)
6 5 mg 2.5 mL
7 10 mg 5 mL
8 20 mg 10 mL
9 50 mg 25 mL
10 100 mg 50 mL
11 200 mg over 60 min 200 mg premix bag

Page 14 of 28
 CLOPIDOGREL

STEP 1: PHARMACY - PREPARE AND LABEL SERIAL DILUTION SOLUTIONS

Directions Concentration
1. Triturate 1 clopidogrel 75 mg tablet into a fine powder. Transfer powder to a 100 mL 3 mg/mL
graduated cylinder. Rinse remaining powder in mortar with sterile water for irrigation
and transfer to graduate. Add q.s. to 25 mL with sterile water for irrigation. Label
graduate solution #1
2. Transfer 1 mL of clopidogrel 3 mg/mL solution to a new graduated cylinder plus 29 0.1 mg/mL
mL sterile water for irrigation. Label as solution #2

Goal dose 75 mg (please note all doses solution)

Dose # Dose Volume Vial #

1 0.02 0.2 mL 2 (0.1 mg/mL)
2 0.05 0.5 mL
3 0.15 1.5 mL
4 0.5 5 mL
5 1.5 0.5 mL 1 (3 mg/mL)
6 5 1.7 mL
7 15 5 mL
8 45 15 mL

Notes:
Doses are to be given orally
Doses should be given 30 minutes apart
Initiate 75 mg clopidogrel 24 hours later.

Reference: Sanchez-Lopez J, Munoz-Cano R, Bartra A, et al. Desensitization to clopidogrel: a growing need. Allergy. 65 (2010); 274-
280.

Page 15 of 28
 Levofloxacin

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Inject 1 mL LEVOFLOXACIN (5 mg/mL) plus 9 mL SW 0.5 mg/mL
2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 0.05 mg/mL
3. 1 mL of vial 2 plus 9 mL SW into an empty vial, labeled #3 0.005 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 500 mg

Dose # Dose Volume Vial #
1 0.01 mg 0.2 mL 2 (0.05 mg/mL)
2 0.05 mg 1 mL
3 0.1 mg 2 mL
4 0.5 mg 1 mL 1 (0.5 mg/mL)
5 1 mg 2 mL
6 5 mg 1 mL Bag (5 mg/mL)
7 10 2 mL
8 30 mg 6 mL
9 50 mg 10 mL
10 100 mg 20 mL
11 300 mg over 60 minutes 60 mL

Goal dose 750 mg

Dose # Dose Volume Vial #
1 0.01 mg 0.2 mL 2 (0.05 mg/mL)
2 0.05 mg 1 mL
3 0.1 mg 2 mL
4 0.5 mg 1 mL 1 (0.5 mg/mL)
5 1 mg 2 mL
6 5 mg 1 mL Bag (5 mg/mL)
7 10 mg 2 mL
8 25 mg 5 mL
9 50 mg 10 mL
10 75 mg 15 mL
11 100 mg 20 mL
12 500 mg over 60 minutes 500 mg premix bag

Page 16 of 28
 LINEZOLID

STEP 1: PHARAMCY - PREPARE AND LABEL SERIAL DILUTIONS

Bag Concentration
1. Premixed bag of linezolid 600 mg/300 mL of D5W, label #1 2 mg/mL
2. 10 mL from bag 1 plus 90 mL D5W, labeled #2 0.2 mg/mL
3. 10 mL from bag 2 plus 90 mL D5W, labeled #3 0.02 mg/mL

STEP 2: PHARMACY - PREPARE IV DOSES

Goal dose 600 mg
Dose # Dose Volume Rate Bag #
1 0.03 mg 1.5 mL 18 mL/h #3 (0.02 mg/mL)
2 0.07 mg 3.5 mL 42 mL/h
3 0.15 mg 0.75 mL 9 mL/h #2 (0.2 mg/mL)
4 0.3 mg 1.5 mL 18 mL/h
5 0.6 mg 3 mL 36 mL/h
6 1.2 mg 6 mL 72 mL/h
7 2.3 mg 1.2 mL 13.8 mL/h #1 (2 mg/mL)
8 4.7 mg 2.3 mL 28.2 mL/h
9 9.4 mg 4.7 mL 56.4 mL/h
10 18.75 mg 9.4 mL 112.5 mL/h
11 37.5 mg 18.8 mL 225 mL/h
12 75 mg 37.5 mL 450 mL/h
13 150 mg 75 mL 300 mL/h
14 300 mg 150 mL 600 mL/h

Note:
Infuse doses 1-12 over five minutes and infuse doses 13-14 over fifteen minutes; wait ten minutes between each dose

Reference: Bagwell AD, Stollings JL, White KD, et al. Linezolid desensitization for a patient with multiple medication hypersensitivity
reactions. Ann Pharmacother. 2013; 47:e30.

Page 17 of 28
 Meropenem

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 1 g MEROPENEM vial with 20 mL SW label vial #1 50 mg/mL
2. 0.2 mL of vial 1 plus 19.8 mL SW into an empty vial, labeled #2 0.5 mg/mL
3. 0.2 mL of vial 2 plus 19.8 mL SW into an empty vial, labeled #3 0.005 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 500 mg
Dose # Dose Volume Vial #
1 0.01 mg 2 mL 3 (0.005 mg/mL)
2 0.05 mg 10 mL
3 0.1 mg 0.2 mL 2 (0.5 mg/mL)
4 0.5 mg 1 mL
5 1 mg 2 mL
6 5 mg 10 mL
7 10 0.2 mL 1 (50 mg/mL)
8 30 mg 0.6 mL
9 50 mg 1 mL
10 100 mg 2 mL
11 300 mg 6 mL

Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 2 mL 3 (0.005 mg/mL)
2 0.05 mg 10 mL
3 0.1 mg 0.2 mL 2 (0.5 mg/mL)
4 0.5 mg 1 mL
5 1 mg 2 mL
6 3 mg 6 mL
7 5 mg 10 mL
8 10 mg 0.2 mL 1 (50 mg/mL)
9 30 mg 0.6 mL
10 50 mg 1 mL
11 100 mg 2 mL 1 (50 mg/mL)
12 300 mg 6 mL
13 500 mg 10 mL

Page 18 of 28
Meropenem, continued

Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 2 mL 3 (0.005 mg/mL)
2 0.03 mg 6 mL
3 0.05 mg 10 mL
4 0.1 mg 0.2 mL 2 (0.5 mg/mL)
5 0.3 mg 0.6 mL
6 0.5 mg 1 mL
7 1 mg 2 mL
8 3 mg 6 mL
9 5 mg 10 mL
10 10 mg 0.2 mL 1 (50 mg/mL)
11 30 mg 0.6 mL
12 50 mg 1 mL
13 100 mg 2 mL
14 300 mg 6 mL
15 500 mg 10 mL
16 1g Mini-Bag Plus or Add-Ease

Page 19 of 28
 METRONIDAZOLE

STEP 1: PHARMACY - PREPARE AND LABEL SERIAL DILUTIONS

Bag/Vial Concentration
1. Use metronidazole 500 mg/100 mL pre-manufactured IV bag. Label as Bag #1. 5 mg/mL
2. 1 mL of Bag #1 plus 9 mL NS into an empty vial, labeled #2 0.5 mg/mL
3. 1 mL of vial #2 plus 9 mL NS into an empty vial, labeled #3 0.05 mg/mL
4. 1 mL of vial #3 plus 9 mL NS into an empty vial, labeled #4 0.005 mg/mL

STEP 2: PHARMACY - PREPARE IV DOSES

Goal dose 500 mg

Dose # Dose Volume Bag/Vial #
1 0.005 mg 1 mL 4 (0.005 mg/mL)
2 0.015 mg 3 mL
3 0.05 mg 1 mL
3 (0.05 mg/mL)
4 0.15 mg 3 mL
5 0.5 mg 1 mL
2 (0.5 mg/mL)
6 1.5 mg 3 mL
7 5 mg 1 mL
8 25 mg 5 mL
9 50 mg 10 mL 1 (5 mg/mL)
10 150 mg 30 mL
11 250 mg 50 mL
12 Then follow scheduled interval 500 mg dosing
Notes:
Intravenous increments are administered at 15 minute intervals
Infuse doses 1-2 over 10 minutes, doses 3-11 over 15 minutes, and dose 12 over 30 minutes

Goal dose 2 g
Dose # Dose Volume Bag/Vial #
1 0.005 mg 1 mL 4 (0.005 mg/mL)
2 0.015 mg 3 mL
3 0.05 mg 1 mL
3 (0.05 mg/mL)
4 0.15 mg 3 mL
5 0.5 mg 1 mL
2 (0.5 mg/mL)
6 1.5 mg 3 mL
7 5 mg 1 mL
8 25 mg 5 mL
9 50 mg 10 mL 1 (5 mg/mL)
10 150 mg 30 mL
11 250 mg 50 mL
12 500 mg 100 mL Pre-manufactured 500 mg/100 mL
13 1g 200 mL bag
14 Then follow scheduled interval 2 g dosing
Notes:
Intravenous increments are administered at 15 minute intervals
Infuse doses 1-2 over 10 minutes, doses 3-11 over 15 minutes, dose 12 over 30 minutes, and doses 13-14 over 60 minutes

Reference: Pearlman MD, Yashar C, Ernst S, Solomon W. An incremental dosing protocol for women with severe vaginal
trichomoniasis and adverse reactions to metronidazole. Am J Obstet Gynecol. 1996; 174;934-6.

Page 20 of 28
 Minocycline

STEP 1: Prepare oral

Recipe Amount
Minocycline hydrochloride 10 g
Glycerin 5 mL
Alcohol 95% 5 mL
Propylparaben 200 mg
Butylparaben 20 mg
Polysorbate 80 250 mg
Flavor QS
Syrup QS 100 mL

Goal Dose:
Day # Dose Volume
1 0.25 mg 0.025 mL
2 0.5 mg 0.05 mL
3 1 mg 0.1 mL
4 2 mg 0.2 mL
5 5 mg 0.5 mL
6 10 mg 1 mL
7 20 mg 2 mL
8 40 mg 4 mL
10 50 mg 5 mL
11 100 mg 10 mL
12 100 mg BID 10 mL BID

Page 21 of 28
 Nafcillin

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 1 g NAFCILLIN vial with 8.3 mL SW, label vial #1 100 mg/mL
2. 0.1 mL of vial 1 plus 9.9 mL SW into an empty vial, labeled #2 1 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 2 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 3 mg 3 mL
7 5 mg 5 mL
8 10 mg 0.1 mL 1 (100 mg/mL)
9 30 mg 0.3 mL
10 50 mg 0.5 mL
11 100 mg 1 mL
12 300 mg over 30 min 3 mL
13 500 mg over 30 min 5 mL

Goal dose 2 g
Dose # Dose Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.03 mg 3 mL
3 0.05 mg 5 mL
4 0.1 mg 0.1 mL 2 (1 mg/mL)
5 0.3 mg 0.3 mL
6 0.5 mg 0.5 mL
7 1 mg 1 mL
8 3 mg 3 mL
9 5 mg 5 mL
10 10 mg 0.1 mL 1 (100 mg/mL)
11 30 mg 0.3 mL
12 50 mg 0.5 mL
13 100 mg 1 mL
14 300 mg over 30 min 3 mL
15 500 mg over 30 min 5 mL
16 1 g over 30-60 min Add-Vantage

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 Penicillin G

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 5,000,000 unit PENICILLIN G vial with 8 mL SW label vial #1 500,000 units/mL
2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 50,000 units/mL
3. 1 mL of vial 2 plus 9 mL SW into an empty vial, labeled #3 5,000 units/mL
4. 1 mL of vial 3 plus 9 mL SW into an empty vial, labeled #4 500 units/mL
5. 1 mL of vial 4 plus 9 mL SW into an empty vial, labeled #5 50 units/mL
6. 1 mL of vial 5 plus 9 mL SW into an empty vial, labeled #6 5 units/mL

STEP 2: PREPARE IV DOSES

Goal dose 2.5 million units

Dose # Dose Volume Vial #
1 1 unit 0.2 mL 6 (5 units/mL)
2 5 units 1 mL
3 10 units 2 mL
4 50 units 1 mL 5 (50 units/mL)
5 100 units 2 mL
6 500 units 1 mL 4 (500 units/mL)
7 750 units 1.5 mL
8 1,000 units 2 mL
9 5,000 units 1 mL 3 (5,000 units/mL)
10 7,500 units 1.5 mL
11 10,000 units 2 mL
12 50,000 units 1 mL 2 (50,000 units/mL)
13 75,000 units 1.5 mL
14 100,000 units 2 mL
15 500,000 units 1 mL 1 (500,000 units/mL)
16 750,000 units 1.5 mL
17 1,000,000 units 2 mL

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Penicillin G, continued

Goal dose 3 million units

Dose # Dose Volume Vial #
1 1 unit 0.2 mL 6 (5 units/mL)
2 5 units 1 mL
3 10 units 2 mL
4 50 units 1 mL 5 (50 units/mL)
5 100 units 2 mL
6 500 units 1 mL 4 (500 units/mL)
7 750 units 1.5 mL
8 1,000 units 2 mL
9 5,000 units 1 mL 3 (5,000 units/mL)
10 7,500 units 1.5 mL
11 10,000 units 2 mL
12 50,000 units 1 mL 2 (50,000 units/mL)
13 75,000 units 1.5 mL
14 100,000 units 2 mL
15 500,000 units 1 mL 1 (500,000 units/mL)
16 1,000,000 units 2 mL
17 1,250,000 units 2.5 mL

Goal dose 4 million units

Dose # Dose Volume Vial #
1 1 unit 0.2 mL 6 (5 units/mL)
2 5 units 1 mL
3 10 units 2 mL
4 50 units 1 mL 5 (50 units/mL)
5 100 units 2 mL
6 500 units 1 mL 4 (500 units/mL)
7 1,000 units 2 mL
8 5,000 units 1 mL 3 (5,000 units/mL)
9 10,000 units 2 mL
10 30,000 units 0.6 mL 2 (50,000 units/mL)
11 50,000 units 1 mL
12 100,000 units 2 mL
13 300,000 units 0.6 mL 1 (500,000 units/mL)
14 500,000 units 1 mL
15 750,000 units 1.5 mL
16 1,000,000 units 2 mL
17 1,250,000 units 2.5 mL

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 Piperacillin-tazobactam (Zosyn)

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 3.375 g ZOSYN vial with 16.9 mL SW label vial #1 200 mg/mL
2. 5 mL of vial 1 plus 5 mL SW into an empty vial, labeled #2 100 mg/mL
3. 0.1 mL of vial 2 plus 9.9 mL SW into an empty vial, labeled #3 1 mg/mL
4. 0.1 mL of vial 3 plus 9.9 mL SW into an empty vial, labeled #4 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 3.375 g

Dose # Dose Volume Vial #

1 0.01 mg 1 mL 4 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 3 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 5 mg 5 mL
7 10 mg 0.1 mL 2 (100 mg/mL)
8 50 mg 0.5 mL
9 100 mg 1 mL
10 200 mg 2 mL
11 500 mg 2.5 1 (200 mg/mL)
12 1g 5
13 1.5 g 7.5

Goal dose 4.5 g

Dose # Dose Volume Vial #

1 0.01 mg 1 mL 4 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 0.1 mL 3 (1 mg/mL)
4 0.5 mg 0.5 mL
5 1 mg 1 mL
6 5 mg 5 mL
7 10 mg 0.1 mL 2 (100 mg/mL)
8 50 mg 0.5 mL
9 75 mg 0.75 mL
10 100 mg 1 mL 2 (100 mg/mL)
11 250 mg 2.5 mL
12 500 mg 5 mL
13 750 mg 3.75 mL 1 (200 mg/mL)
14 1250 mg 6.25 mL
15 1.5 g 7.5 mL

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 Tigecycline

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 2 x 50 mg TIGECYCLINE vials each with 5.3 mL D5W or NS, label both vials #1 10 mg/mL
2. 1 mL of vial 1 plus 9 mL D5W or NS into an empty vial labeled #2 1 mg/mL
3. 1 mL of vial 2 plus 9 mL D5W or NS into an empty vial labeled #3 0.1 mg/mL
4. 1 mL of vial 3 plus 9 mL D5W or NS into an empty vial labeled #4 0.01 mg/mL

STEP 2: PREPARE IV DOSES

Dose # Dose Volume Vial #

1 0.001 mg 0.1 mL 4 (0.01 mg/mL)
2 0.005 mg 0.5 mL
3 0.01 mg 1 mL
4 0.05 mg 5 mL
5 0.1 mg 1 mL 3 (0.1 mg/mL)
6 0.5 mg 5 mL
7 1 mg 1 mL 2 (1 mg/mL)
8 5 mg 5 mL
9 10 mg 1 mL 1 (10 mg/mL)
10 30 mg over 30 min 3 mL
11 50 mg over 30 min 5 mL

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 Trimethoprim-sulfamethoxazole (Bactrim)

Based on trimethoprim concentration 160 mg twice daily

Vial Concentration
1. 1.25 mL of 16 mg/mL original vial plus 18.75 mL D5W into an empty vial labeled #1 1 mg/mL
2. 2 mL of vial 1 plus 18 mL D5W into an empty vial labeled #2 0.1 mg/mL
3. 2 mL of vial 2 plus 18 mL D5W into an empty vial labeled #3 0.01 mg/mL

STEP 2: PREPARE IV DOSES

BASED ON TMP CONCENTRATION: GOAL DOSE 160 mg

Dose # Dose TMP Volume Vial #
1 0.01 mg 1 mL 3 (0.01 mg/mL)
2 0.05 mg 5 mL
3 0.1 mg 1ml 2 (0.1 mg/mL)
4 0.5 mg 5 mL
5 1 mg 1 mL 1 (1 mg/mL)
6 3 mg 3 mL
7 10 mg 10 mL
8 30 mg 1.9 mL Original vial (16 mg/mL)
9 50 mg 3.1 mL
10 75 mg 4.7 mL
11 100 mg 6.3 mL
12 160 mg 10 mL

Note: At the point of step 10 cumulative dose is 170 mg- the current protocol in Michart does not exceed this. The final steps 11 and
12 may be removed if deemed appropriate.

Stability: Final three doses should be made ~4 hours into infusion due to stability.

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 Vancomycin

STEP 1: PREPARE AND LABEL SERIAL DILUTIONS

Vial Concentration
1. Dilute 1 g VANCOMYCIN vial with 20 mL SW, label vial #1 50 mg/mL
2. 1 mL of vial 1 plus 9 mL SW into an empty vial, labeled #2 5 mg/mL
3. 1 mL of vial 2 plus 9 mL SW into an empty vial, labeled #3 0.5 mg/mL
4. 1 mL of vial 3 plus 9 mL SW into an empty vial, labeled #4 0.05 mg/mL

STEP 2: PREPARE IV DOSES

Goal dose 1 g
Dose # Dose Volume Vial #
1 0.01 mg 0.2 mL 4 (0.05 mg/mL)
2 0.05 mg 1 mL
3 0.1 mg 2 mL
4 0.5 mg 1 mL 3 (0.5 mg/mL)
5 1 mg 2 mL
6 3 mg 6 mL
7 5 mg 1 mL 2 (5 mg/mL)
8 10 mg 2 mL
9 30 mg 6 mL
10 50 mg 1 mL 1 (50 mg/mL)
11 100 mg 2 mL
12 300 mg over 30 min 6 mL
13 500 mg over 60 min Add-Vantage

Antimicrobial Subcommittee Approval: N/A Originated: Unknown

P&T Approval: N/A Last Revised: 11/2020
Revision History:
11/2020: Added minocycline and TMP-SMX
The recommendations in this guide are meant to serve as treatment guidelines for use at Michigan Medicine facilities. If you are an individual experiencing a medical
emergency, call 911 immediately. These guidelines should not replace a provider’s professional medical advice based on clinical judgment, or be used in lieu of an
Infectious Diseases consultation when necessary. As a result of ongoing research, practice guidelines may from time to time change. The authors of these guidelines
have made all attempts to ensure the accuracy based on current information, however, due to ongoing research, users of these guidelines are strongly encouraged to
confirm the information contained within them through an independent source.

If obtained from a source other than med.umich.edu/asp, please visit the webpage for the most up-to-date document.

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