Cover only if recovered from the blood or infected site.
ADD Vancomycin 15 mg/kg, then Pharmacy to dose
OR, If susceptible & no allergy
ADD Ampicillin 2 g IV q6h (unless on piperacillin-tazobactam)
Cover only if seen on a Gram stain or growth from a sterile site.
ADD Fluconazole
800 mg PO/IV (12 mg/kg) on day 1, then 400 mg q24h PO/IV (6 mg/kg)
OR, IF CRITICALLY ILL
ADD Caspofungin 70 mg IV on day 1, then 50 mg IV q24h