NHSN Antimicrobial Use and Resistance (AUR) PharmaCy Data – Monthly Report

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X PharmaCy X PharmaCy Data X Antimicrobial X NHSN

OMB No. 0920-0666

NHSN           Antimicrobial Use and Resistance (AUR)         *                            *

PhariTiaCy Data – Monthly Report Form

Assi PUT Publ and this CDC Facility ID:                                 *Location Code:                     *Month:                       *Year:                        *Patient Days:
Parenteral Antibiotics
Antibiotic “Quantity Usedf Antibiotic “Quantity Usedf
amikacin

g

gatifloxacin

g

ampicillin

g

gentamicin

g

ampicillin**/sulbactam

g

imipenem

g

azithromycin

g

levofloxacin

g

aztreonam

g

linezolid

g

cefamandole

g

meropenem

g

cefazolin

g

metronidazole

g

cefepime

g

moxifloxacin

g

cefmetazole

g

nafcillin

g

cefotaxime

g

ofloxacin

g

cefotetan

g

oxacillin

g

cefoxitin

g

penicillin G

mill. I.U.

ceftazidime

g

pen. G benzathine

mill. I.U.

ceftizoxime

g

procaine pen. G

mill. I.U.

ceftriaxone

g

piperacillin

g

cefuroxime

g

piperacillin**/tazobactam

g

cephalothin

g

quinupristin**/dalfopristin

g

ciprofloxacin

g

ticarcillin

g

clindamycin

g

ticarcillin**/clavulanic acid

g

daptomycin

g

tigecycline

g

ertapenem

g

tobramycin

g

erythromycin

g

trimethoprim**/sulfamethoxazole

g

vancomvcin

a

Oral Antibiotics
Antibiotic “Quantity Usedf Antibiotic “Quantity Usedf
amoxicillin

g

gatifloxacin

g

amoxicillin**/clavulanic acid

g

levofloxacin

g

ampicillin

g

linezolid

g

azithromycin

g

lomefloxacin

g

cefaclor

g

metronidazole

g

cefadroxil

g

moxifloxacin

g

cefixime

g

norfloxacin

g

cefprozil

g

ofloxacin

g

cephalexin

g

penicillin V

g

ciprofloxacin

g

sparfloxacin

g

clarithromycin

g

telithromycin

g

clindamycin

g

tetracycline

g

dicloxacillin

g

trimethoprim**/sulfamethoxazole

g

doxycycline

g

vancomycin

g

Erythromycin

a

**For combination drugs, record grams for the drug marked with the asterisk. fEnter zero if drug not on formulary or not used; an entry is required in every field.

ranee of Confidentiality: The infonnation obtained in this surveillance system that would permit identification of any individual or institution is collected with a guarantee that it will be held in strict confidence, will be used only for the jses stated, and will not otheni/ise be disclosed or released without the consent of the individual, or the institution in accordance with Sections 304, 306 and 308(d) of the Public Health Service Act (42 USC 242b, 242k, and 242m(d». K reporting burden of this collection of infonnation is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing eviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding urden estimate or any other aspect of this collection of infonnation, including suggestions for reducing this burden to CDC, Reports Clearance Officer, 1 600 Clifton Rd., MS D-74, Atlanta, GA 30333, ATTN: PRA (0920-0666). 57.124 Rev. 1

X PharmaCy X PharmaCy Data X Antimicrobial X NHSN

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