Sandbox/00015

Pathogen-Based Therapy — Bacteria Adapted from Lancet. 2010;375(9717):846-55. and Clin Microbiol Rev. 2002;15(4):527-44.

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Bacteria   ▸  Bacteroides fragilis   ▸  Brucella melitensis   ▸  Enterococcus spp.   ▸  Escherichia coli   ▸  Haemophilus influenzae   ▸  Morganella morganii   ▸  Neisseria gonorrhoeae   ▸  Proteus mirabilis   ▸  Proteus vulgaris, Proteus rettgeri   ▸  Pseudomonas aeruginosa   ▸  Serratia marcescens   ▸  Staphylococcus aureus   ▸  Staphylococcus epidermidis   ▸  Streptococcus agalactiae   ▸  Streptococcus pyogenes   ▸  Tropheryma whipplei Mycobacteria   ▸  Mycobacterium tuberculosis Spirochetes   ▸  Borrelia burgdorferi   ▸  Treponema pallidum

Bacteroides fragilis Preferred Regimen ▸ Clindamycin 900 mg IV/IM q8h OR ▸ Metronidazole 500 mg IV q8h Alternative Regimen ▸ Ampicillin-Sulbactam 3 g IV q6h OR ▸ Ticarcillin-Clavulanate 3.1 g IV q4–6h Morganella morganii Preferred Regimen ▸ Cefotaxime 2 g IV q6h OR ▸ Imipenem 500 mg IV q6h OR ▸ Levofloxacin 500 mg IV/PO q24h Alternative Regimen ▸ Gentamicin 3–5 mg/kg/day IV q6–8h OR ▸ Ticarcillin-Clavulanate 3.1 g IV q4–6h Proteus vulgaris, Proteus rettgeri Preferred Regimen ▸ Cefotaxime 2 g IV q6h OR ▸ Imipenem 500 mg IV q6h OR ▸ Levofloxacin 500 mg IV/PO q24h Alternative Regimen ▸ Gentamicin 3–5 mg/kg/day IV q6–8h OR ▸ Ticarcillin-Clavulanate 3.1 g IV q4–6h Serratia marcescens Preferred Regimen ▸ Cefotaxime 2 g IV q6h Alternative Regimen ▸ Levofloxacin 500 mg IV/PO q24h OR ▸ Gentamicin 3–5 mg/kg/day IV q6–8h OR ▸ Imipenem 500 mg IV q6h Brucella melitensis Preferred Regimen ▸ Doxycycline 100 mg PO bid for ≥6 weeks PLUS ▸ Streptomycin 15 mg/kg IM qd for 2–3 weeks OR ▸ Rifampin 600–900 mg qd for ≥6 weeks Alternative Regimen ▸ Doxycycline 100 mg PO bid for ≥6 weeks PLUS ▸ Gentamicin 5 mg/kg IV qd for 7 days Adapted from PLoS Med. 2007;4(12):e317. and Lancet Infect Dis. 2007;7(12):775-86. and Cochrane Database Syst Rev. 2012;10:CD007179. Methicillin-Sensitive S. aureus Preferred Regimen ▸ Nafcillin 2 g IV q6h OR ▸ Clindamycin 900 mg IV q8h Alternative Regimen ▸ Cefazolin 0.25–1 g IV/IM q6–8h OR ▸ Vancomycin 500 mg IV q6h (or 1 g IV q12h) Methicillin-Resistant S. aureus (Adult) Preferred Regimen ▸ Vancomycin 15–20 mg/kg IV q8–12h OR ▸ Daptomycin 6 mg/kg IV q24h OR ▸ Linezolid 600 mg PO/IV q12h Alternative Regimen 1 ▸ TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) PLUS ▸ Rifampin 300–600 mg PO/IV q12h Alternative Regimen 2 ▸ Clindamycin 600 mg IV/IM q8h Methicillin-Resistant S. aureus (Pediatric) Preferred Regimen ▸ Vancomycin 15 mg/kg IV q6h OR ▸ Clindamycin 10 mg/kg PO/IV q6h (or 13 mg/kg PO/IV q8h) Alternative Regimen ▸ Daptomycin 6–10 mg/kg IV q24h OR ▸ Linezolid 10 mg/kg PO/IV q8h (Maximum: 600 mg/dose) Adapted from Clin Infect Dis. 2011;52(3):e18-55. Methicillin-Sensitive S. epidermidis Preferred Regimen ▸ Nafcillin 2 g IV q6h OR ▸ Clindamycin 900 mg IV/IM q8h Alternative Regimen ▸ Cefazolin 0.25–1 g IV/IM q6–8h OR ▸ Vancomycin 500 mg IV q6h (or 1 g IV q12h) Methicillin-Resistant S. epidermidis Preferred Regimen ▸ Vancomycin 500 mg IV q6h (or 1 g IV q12h) OR ▸ Linezolid 600 mg IV q12h Alternative Regimen 1 ▸ TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) OR ▸ Minocycline 200 mg PO x 1 dose, then 100 mg PO q12h PLUS ▸ Rifampin 300–600 mg PO/IV q12h Alternative Regimen 2 ▸ Clindamycin 900 mg IV/IM q8h Streptococcus agalactiae Preferred Regimen ▸ Penicillin G 2 MU IV/IM q4h OR ▸ Ampicillin 2 g IV q6h Alternative Regimen ▸ Clindamycin 600–1200 mg/day IV/IM q6–12h OR ▸ Cefazolin 0.25–1 g IV/IM q6–8h Streptococcus pyogenes Preferred Regimen ▸ Penicillin G 2 MU IV/IM q4h OR ▸ Ampicillin 2 g IV q6h Alternative Regimen ▸ Clindamycin 600–1200 mg/day IV/IM q6–12h OR ▸ Cefazolin 0.25–1 g IV/IM q6–8h Escherichia coli Preferred Regimen ▸ Ampicillin-Sulbactam 3 g IV q6h Alternative Regimen ▸ Cefazolin 0.25–1 g IV/IM q6–8h OR ▸ Levofloxacin 500–750 mg IV/PO q24h OR ▸ Gentamicin 3–5 mg/kg/day IV q6–8h OR ▸ TMP-SMX 8–10 mg/kg/day IV/PO q6–12h (TMP component) Pseudomonas aeruginosa Preferred Regimen ▸ Cefepime 2 g IV q12h OR ▸ Piperacillin 3–4 g IV q4–6h OR ▸ Imipenem 500 mg IV q6h Alternative Regimen ▸ Ticarcillin-Clavulanate 3.1 g IV q4–6h OR ▸ Tobramycin 3-5 mg/kg/day IV q6–8h OR ▸ Amikacin 15 mg/kg/day IV/IM q8–12h OR ▸ Ciprofloxacin 400 mg IV q8–12h Neisseria gonorrhoeae Preferred Regimen ▸ Ceftriaxone 2 g IV q24h OR ▸ Cefotaxime 1 g IV q8h Alternative Regimen ▸ Levofloxacin 500 mg IV/PO q24h OR ▸ Ampicillin 2 g IV q6h Haemophilus influenzae Preferred Regimen ▸ Amoxicillin-clavulanate 875/125 mg PO q12h OR ▸ Cefprozil 500 mg PO q12h OR ▸ Cefuroxime 500 mg PO q12h OR ▸ Cefdinir 600 mg PO q24h Alternative Regimen ▸ Levofloxacin 750 mg IV/PO q24h OR ▸ Moxifloxacin 400 mg IV/PO q24h OR ▸ Clarithromycin 500 mg PO q12h Mycobacterium tuberculosis Intensive Phase ▸ Isoniazid 5mg/kg PO q24h for 2 months OR ▸ Isoniazid 10 mg/kg PO 3 times per week × 2 months PLUS ▸ Rifampicin 10 mg/kg PO q24h for 2 months OR ▸ Rifampicin 10 mg/kg PO 3 times per week × 2 months PLUS ▸ Pyrazinamide 25mg/kg PO q24h for 2 months OR ▸ Pyrazinamide 35 mg/kg PO 3 times per week × 2 months PLUS ▸ Ethambutol 15mg/kg PO q24h for 2 months Continuation Phase ▸ Isoniazid 5mg/kg PO for 4-7 months OR ▸ Isoniazid 10 mg/kg PO 3 times per week × 4-7 months PLUS ▸ Rifampicin 10 mg/kg PO q24h for 4-7 months OR ▸ Rifampicin 10 mg/kg PO 3 times per week for 4-7 months Adapted from Treatment of Tuberculosis: Guidelines. Borrelia burgdorferi Preferred Regimen ▸ Amoxicillin 500 mg q8h for 28 days OR ▸ Doxycycline 100 mg q12h for 28 days OR ▸ Cefuroxime 500 mg q12h for 28 days Alternative Regimen ▸ Azithromycin 500 mg PO q24h for 7–10 days OR ▸ Clarithromycin 500 mg PO q12h for 14–21 days OR ▸ Erythromycin 500 mg PO q6h for 14–21 days Adapted from IDSA Guidelines: The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: Treponema pallidum Preferred Regimen ▸ Penicillin G 2.4 MU IM single dose Alternative Regimen ▸ Doxycycline 100 mg PO q12h x 14 days OR ▸ Tetracycline 500 mg PO q6h x 14 days OR ▸ Ceftriaxone 1 g IM/IV q24h x 10 -14 days Adapted from MMWR Recomm Rep. 2006;55(RR-11):1-94 Tropheryma whipplei Preferred Regimen ▸ Penicillin G 2 MU IV q4h for 2 weeks PLUS ▸ Streptomycin 1 g IM/IV q24h for 2 weeks FOLLOWED BY ▸ Trimethoprim/Sulfamethoxazole 160mg/800mg PO q24h for 1 year Alternative Regimen ▸ Ceftriaxone 2 g IV q24h FOLLOWED BY ▸ Trimethoprim/Sulfamethoxazole 160mg/800mg PO q24h for 1 year Adapted from N Engl J Med 2007; 356:55-66 Enterococcus spp. Preferred Regimen ▸ Ampicillin 2 g IV q6h OR ▸ Vancomycin 1 g IV q12h Alternative Regimen ▸ Ampicillin-Sulbactam 3 g IV q6h OR ▸ Linezolid 600 mg PO/IV q12h Proteus mirabilis Preferred Regimen ▸ Ampicillin 2 g IV q6h OR ▸ Levofloxacin 500 mg IV/PO q24h Alternative Regimen ▸ Cefazolin 0.25–1 g IV/IM q6–8h OR ▸ TMP-SMX 8–10 mg/kg/day IV/PO q6–12h (TMP component) OR ▸ Gentamicin 3–5 mg/kg/day IV q6–8h