Sandbox ID Skin and Soft Tissues: Difference between revisions
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:* Preferred regimen (4): [[Doxycycline]] 100 mg PO bid {{or}} 100 mg IV every 12 h (Excellent activity against Pasteurella multocida; some streptococci are resistant) | :* Preferred regimen (4): [[Doxycycline]] 100 mg PO bid {{or}} 100 mg IV every 12 h (Excellent activity against Pasteurella multocida; some streptococci are resistant) | ||
:* Preferred regimen (5): [[Penicillin]] {{and}} [[Dicloxacillin]] 500 mg oral | :* Preferred regimen (5): [[Penicillin]] {{and}} [[Dicloxacillin]] 500 mg oral | ||
:* Preferred regimen (6): [[sulfamethoxazole]-Trimethoprim]] 160–800 mg PO bid {{or}} IV 5–10 mg/kg/day of TMP component (Good activity against aerobes; poor activity against anaerobes) | :* Preferred regimen (6): [[sulfamethoxazole]]-[[Trimethoprim]] 160–800 mg PO bid {{or}} IV 5–10 mg/kg/day of TMP component (Good activity against aerobes; poor activity against anaerobes) | ||
:* Preferred regimen (7): [[Metronidazole]] 250–500 mg PO tid {{or}} 500 mg IV every 8 h (Good activity against anaerobes; no activity against aerobes) | :* Preferred regimen (7): [[Metronidazole]] 250–500 mg PO tid {{or}} 500 mg IV every 8 h (Good activity against anaerobes; no activity against aerobes) | ||
:* Preferred regimen (8): [[Clindamycin]] 300 mg PO tid {{or}} 600 mg IV every 6–8 h (Good activity against staphylococci, streptococci, and anaerobes; misses P. multocida) | :* Preferred regimen (8): [[Clindamycin]] 300 mg PO tid {{or}} 600 mg IV every 6–8 h (Good activity against staphylococci, streptococci, and anaerobes; misses P. multocida) | ||
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===Bubonic plague=== | ===Bubonic plague=== | ||
* '''Bubonic Plague''' | * '''Bubonic Plague''' | ||
:* Preferred regimen: [[Streptomycin]] 15 mg/kg IM every 12 hours {{or}} [[Doxycycline]] 100 mg bid PO {{or}} [[Gentamicin]] could be substituted for streptomycin | :* Preferred regimen: [[Streptomycin]] 15 mg/kg IM every 12 hours {{or}} [[Doxycycline]] 100 mg bid PO {{or}} [[Gentamicin]] could be substituted for [[streptomycin]] | ||
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Revision as of 16:53, 27 May 2015
Staphylococcal and streptococcal skin and soft tissue infections
(table 2)
- Impetigo (Staphylococcus and Streptococcus), adult
- Preferred regimen (1): Dicloxacillin 250 mg PO qid
- Preferred regimen (2): Cephalexin 250 mg PO qid
- Preferred regimen (3): Erythromycin 250 mg qid PO (Some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant)
- Preferred regimen (4): Clindamycin 300–400 mg qid PO
- Preferred regimen (5): Amoxicillin-Clavulanate 875/125 mg bid po
- Preferred regimen (6): Retapamulin ointment applied to lesions bid (for patients with limited number of lesions)
- Preferred regimen (7): Mupirocin ointment applied to lesions bid (for patients with limited number of lesions)
- Impetigo (Staphylococcus and Streptococcus), pediatric
- Preferred regimen (1): Cephalexin 25–50 mg/kg/d in 3–4 divided doses PO
- Preferred regimen (2): Erythromycin 40 mg/kg/d in 3–4 divided doses PO (some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant)
- Preferred regimen (3): Clindamycin 20 mg/kg/d in 3 divided doses PO
- Preferred regimen (4): Amoxicillin-Clavulanate 25 mg/kg/d of the amoxicillin component in 2 divided doses PO
- Preferred regimen (5): Retapamulin ointment applied to lesions bid (for patients with limited number of lesions)
- Preferred regimen (6): Mupirocin ointment applied to lesions bid (for patients with limited number of lesions)
- MSSA SSTI, adult
- Preferred regimen (1): Nafcillin 1-2 g every 4 h IV OR oxacillin 1-2 g every 4 h IV (Parental drug of choice; inactive against MRSA)
- Preferred regimen (2): Cefazolin 40 mg/kg/d in 3–4 divided doses PO (some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant)
- Preferred regimen (3): Clindamycin 600 mg every 8 h IV OR 300–450 mg qid po (Bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
- Preferred regimen (4): Dicloxacillin 500 mg qid po (Oral agent of choice for methicillin-susceptible strains in adults. Not used much in pediatrics)
- Preferred regimen (5): Cephalexin 500 mg qid po (For penicillin-allergic patients except those with immediate hypersensitivity reactions. The availability of a suspension and requirement for less frequent dosing)
- Preferred regimen (6): Doxycycline, minocycline 100 mg bid po (Bacteriostatic; limited recent clinical experience)
- Preferred regimen (7): Trimethoprim-sulfamethoxazole 1–2 doublestrength tablets bid po (Bactericidal; efficacy poorly documented)
- MSSA SSTI, pediatric
- Preferred regimen (1): Nafcillin 100–150 mg/kg/d in 4 divided doses IV OR oxacillin 100–150 mg/kg/d in 4 divided doses IV (Parental drug of choice; inactive against MRSA)
- Preferred regimen (2): Cefazolin 40 mg/kg/d in 3–4 divided doses PO (some strains of Staphylococcus aureus and Streptococcus pyogenes may be resistant)
- Preferred regimen (3): Clindamycin 25–40 mg/kg/d in 3 divided doses IV OR 25–30 mg/kg/d in 3 divided doses po (Bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
- Preferred regimen (4): Dicloxacillin 25–50 mg/kg/d in 4 divided doses po (Oral agent of choice for methicillin-susceptible strains in adults. Not used much in pediatrics)
- Preferred regimen (5): Cephalexin 25–50 mg/kg/d 4 divided doses po (For penicillin-allergic patients except those with immediate hypersensitivity reactions. The availability of a suspension and requirement for less frequent dosing)
- Preferred regimen (6): Doxycycline, minocycline Not recommended for age <8 y (Bacteriostatic; limited recent clinical experience)
- Preferred regimen (7): Trimethoprim-sulfamethoxazole 8–12 mg/kg (based on trimethoprim component) in either 4 divided doses IV or 2 divided doses po (Bactericidal; efficacy poorly documented)
- MRSA SSTI, adult
- Preferred regimen (1): Vancomycin 30 mg/kg/d in 2 divided doses IV (For penicillin allergic patients; parenteral drug of choice for treatment of infections caused by MRSA)
- Preferred regimen (2): Linezolid 600 mg every 12 h IV or 600 mg bid po (Bacteriostatic; limited clinical experience; no crossresistance with other antibiotic classes; expensive)
- Preferred regimen (3): Clindamycin 600 mg every 8 h IV or 300–450 mg qid po (Bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
- Preferred regimen (4): Daptomycin 4 mg/kg every 24 h IV (Bactericidal; possible myopathy)
- Preferred regimen (5): Ceftaroline 600 mg bid IV (Bactericidal)
- Preferred regimen (6): Doxycycline, minocycline 100 mg bid po (Bacteriostatic; limited recent clinical experience)
- Preferred regimen (7): Trimethoprim-sulfamethoxazole1–2 doublestrength tablets bid po (Bactericidal; limited published efficacy data)
- MRSA SSTI, pediatric
- Preferred regimen (1): Vancomycin 40 mg/kg/d in 4 divided doses IV (For penicillin allergic patients; parenteral drug of choice for treatment of infections caused by MRSA)
- Preferred regimen (2): Linezolid 10 mg/kg every 12 h IV or po for children <12 y (Bacteriostatic; limited clinical experience; no crossresistance with other antibiotic classes; expensive)
- Preferred regimen (3): Clindamycin 25–40 mg/kg/d in 3 divided doses IV or 30–40 mg/kg/d in 3 divided doses po (Bacteriostatic; potential of cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA. Important option for children)
- Preferred regimen (4): Doxycycline, minocycline Not recommended for age <8 y (Bacteriostatic; limited recent clinical experience)
- Preferred regimen (5): Trimethoprim-sulfamethoxazole 8–12 mg/kg/d (based on trimethoprim component) in either 4 divided doses IV or 2 divided doses po
- Streptococcal skin infections, adult
- Preferred regimen (1): Penicillin 2–4 million units every 4–6 h IV
- Preferred regimen (2): Clindamycin 600–900 mg every 8 h IV
- Preferred regimen (3): Nafcillin 1–2 g every 4– 6 h IV
- Preferred regimen (4): Cefazolin 1 g every 8 h IV
- Preferred regimen (5): Penicillin VK 250–500 mg every 6 h po
- Preferred regimen (6): Cephalexin 500 mg every 6 h po
- Streptococcal skin infections, pediatric
- Preferred regimen (1): Penicillin 60– 100 000 units/kg/ dose every 6 h 10–13 mg/kg dose every 8 h IV 50 mg/kg/dose every 6 h 33 mg/kg/dose every 8 h IV
Incisional surgical site infections
(table 3)
- Surgery of intestinal or genitourinary tract
- Single-drug regimens
- Preferred regimen (1): Ticarcillin-clavulanate 3.1 g every 6 h IV
- Preferred regimen (2): Piperacillin-tazobactam 3.375 g every 6 h OR 4.5 g every 8 h IV
- Preferred regimen (3): Imipenem-cilastatin 500 mg every 6 h IV
- Preferred regimen (4): Meropenem 1 g every 8 h IV
- Preferred regimen (5): Ertapenem 1 g every 24 h IV
- Combination regimens
- Preferred regimen (1): Ceftriaxone 1 g every 24 h AND metronidazole 500 mg every 8 h
- Preferred regimen (2): IV Ciprofloxacin 400 mg IV every 12 h or 750 mg po every 12 h AND metronidazole 500 mg every 8 h
- Preferred regimen (3): IV Levofloxacin 750 mg IV every 24 h AND metronidazole 500 mg every 8 h
- Preferred regimen (4): IV Ampicillin-sulbactam 3 g every 6 h AND gentamicin OR tobramycin 5 mg/kg every 24 h IV
- Surgery of trunk or extremity away from axilla or perineum
- Preferred regimen (1): Oxacillin or nafcillin 2 g every 6 h IV
- Preferred regimen (2): Cefazolin 0.5–1 g every 8 h IV
- Preferred regimen (3): Cephalexin 500 mg every 6 h po
- Preferred regimen (4): SMX-TMP 160–800 mg po every 6 h
- Preferred regimen (5): Vancomycin 15 mg/kg every 12 h IV
- Surgery of axilla or perineum
- Preferred regimen: Metronidazole 500 mg every 8 h IV AND (Ciprofloxacin 400 mg IV every 12 h OR Ciprofloxacin 750 mg po every 12 h OR Levofloxacin 750 mg every 24 h IV/PO OR Ceftriaxone 1 g every 24 h)
Necrotizing infections of the skin, fascia, and muscle
(table 4)
- Mixed infections, adult
- Mixed infections, pediatric
- Streptococcus, adult
- Streptococcus, pediatric
- Staphylococcus aureus, adult
- Staphylococcus aureus, pediatric
- Clostridium species, adult
- Clostridium species, pediatric
- Aeromonas hydrophila, adult
- Aeromonas hydrophila, pediatric
- Vibrio vulnificus, adult
- Vibrio vulnificus, pediatric
Infections following animal or human bites
(table 5)
- Animal bite
- Preferred regimen (1): Amoxicillin-clavulanate 875/125 mg PO bid (Some gram-negative rods are resistant; misses MRSA)
- Preferred regimen (2): Ampicillin-sulbactam 1.5–3.0 g IV every 6–8 h (Some gram-negative rods are resistant; misses MRSA)
- Preferred regimen (3): Piperacillin-tazobactam 3.37 g IV every 6–8 h (Misses MRSA)
- Preferred regimen (4): Doxycycline 100 mg PO bid OR 100 mg IV every 12 h (Excellent activity against Pasteurella multocida; some streptococci are resistant)
- Preferred regimen (5): Penicillin AND Dicloxacillin 500 mg oral
- Preferred regimen (6): sulfamethoxazole-Trimethoprim 160–800 mg PO bid OR IV 5–10 mg/kg/day of TMP component (Good activity against aerobes; poor activity against anaerobes)
- Preferred regimen (7): Metronidazole 250–500 mg PO tid OR 500 mg IV every 8 h (Good activity against anaerobes; no activity against aerobes)
- Preferred regimen (8): Clindamycin 300 mg PO tid OR 600 mg IV every 6–8 h (Good activity against staphylococci, streptococci, and anaerobes; misses P. multocida)
- Preferred regimen (9): Cefuroxime 500 mg PO bid OR 1 g IV every 12 h
- Preferred regimen (10): Cefoxitin 1g IV every 6–8 h
- Preferred regimen (11): Ceftriaxone 1g IV every 12 h
- Preferred regimen (12): Cefotaxime 1–2 g IV every 6–8 h
- Preferred regimen (13): Ciprofloxacin 500–750 mg PO bid OR 400 mg IV every 12 h
- Preferred regimen (14): Levofloxacin 750 mg PO daily OR 750 mg IV daily
- Preferred regimen (15): Moxifloxacin 400 mg PO daily OR 400 mg IV daily (Monotherapy; good for anaerobes also)
- Human bite
- Preferred regimen (1): Amoxicillin-clavulanate 875/125 mg PO bid (Some gram-negative rods are resistant; misses MRSA)
- Preferred regimen (2): Ampicillin-sulbactam 1.5–3.0 g IV every 6 h (Some gram-negative rods are resistant; misses MRSA)
- Preferred regimen (3): Doxycycline PO 100 mg bid (Good activity against Eikenella species, staphylococci, and anaerobes; some streptococci are resistant)
Cat scratch disease
- Cat scratch disease in patients > 45 kg
- Preferred regimen: Azithromycin 500 mg on day 1 followed by 250 mg for 4 additional days
- Cat scratch disease in patients < 45 kg
- Preferred regimen: Azithromycin 10 mg/kg on day 1 and 5 mg/kg for 4 more days
Bacillary angiomatosis
- Bacillary angiomatosis
- Preferred regimen: Erythromycin 500 mg PO qid for 2 weeks to 2 months OR Doxycycline 100 mg PO bid for 2 weeks to 2 months
Erysipeloid
- Erysipeloid
- Preferred regimen: Penicillin 500 mg qid for 7–10 days OR Amoxicillin 500 mg tid for 7–10 days
Glanders
- Glanders
- Preferred regimen: Ceftazidime OR Gentamicin OR Imipenem OR Doxycycline OR Ciprofloxacin is recommended based on in vitro susceptibility
Bubonic plague
- Bubonic Plague
- Preferred regimen: Streptomycin 15 mg/kg IM every 12 hours OR Doxycycline 100 mg bid PO OR Gentamicin could be substituted for streptomycin
Tularemia
- Tularemia
- Preferred regimen (1): Streptomycin 15 mg/kg every 12 hours IM OR Gentamicin 1.5 mg/kg every 8 hours IV
- Preferred regimen (2): Tetracycline 500 mg qid OR doxycycline 100 mg bid PO (for mild cases)
Cutaneous anthrax
- Cutaneous anthrax
- Preferred regimen (1): Penicillin V 500 mg PO qid for 7–10 days
- Preferred regimen (2): Ciprofloxacin 500 mg PO bid OR Levofloxacin 500 mg IV/PO every 24 hours for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure