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WikiDoc Infectious Disease Project — Pathogen-Based Infections

Pathogens of Public Health Significance

3

Pathogens of Clinical Significance

3

Bacteria – Gram-Positive Cocci

Enterococcus faecalis

Enterococcus faecalis Return to Top

1. Bacteremia^[1]

1.1 Ampicillin or penicillin susceptible

Preferred regimen (1): Ampicillin 2 g IV q4-6h
Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h

1.2 Ampicillin resistant and vancomycin susceptible or penicillin allergy

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
Preferred regimen (2): Linezolid 600 mg IV q12h
Preferred regimen (3): Daptomycin 6 mg/kg IV q24h

1.3 Ampicillin and vancomycin resistant

Preferred regimen (1): Linezolid 600 mg IV q12h
Preferred regimen (2): Daptomycin 6 mg/kg IV q24h

2. Endocarditis^[2]^[3]

2.1 Endocarditis in adults

2.1.1 Strains susceptible to penicillin, gentamicin, and vancomycin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

2.1.2 Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU IV q24h for 4–6 weeks) AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.1.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin

2.1.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h 6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.3.2 Intrinsic penicillin resistance

Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.4 Strains resistant to penicillin, aminoglycoside, and vancomycin

Preferred regimen (1): (Imipenem OR Cilastatin 2 g/day IV for ≥ 8weeks) AND Ampicillin 12 g/day IV for ≥ 8 weeks
Preferred regimen (2): Ceftriaxone sodium 4 g IV/IM q24h for ≥ 8weeks AND Ampicillin 12 g IV q24h for ≥ 8 weeks

2.2 Endocarditis in pediatrics

2.2.1 Strains susceptible to penicillin, gentamicin, and vancomycin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.2 Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.2.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin

2.2.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.3.2 Intrinsic penicillin resistance

Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.4 Strains resistant to penicillin, aminoglycoside, and vancomycin

Preferred regimen: Imipenem/Cilastatin 60–100 mg/kg IV q24h for ≥ 8 weeks AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks
Alternate regimen: Ceftriaxone 100 mg/kg IV/IM q24h AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks

3. Meningitis^[4]

3.1 Ampicillin susceptible

Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

3.2 Ampicillin resistant

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h

3.3 Ampicillin and vancomycin resistant

Preferred regimen: Linezolid 600 mg IV q12h

4. Urinary tract infections ^[5]

Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
Preferred regimen (2): Fosfomycin 3 g PO single dose
Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days

5. Intra abdominal or wound infections ^[6]

Preferred regimen (1): Penicillin
Preferred regimen (2): Ampicillin
Alternative regimen (Penicillin allergy or high-level Penicillin resistance): Vancomycin
Alternative regimen (For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h

Enterococcus faecium Return to Top

1. Bacteremia^[7]

1.1 Ampicillin or penicillin susceptible

Preferred regimen (1): Ampicillin 2 g IV q4-6h
Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h

1.2 Ampicillin resistant and vancomycin susceptible or penicillin allergy

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
Preferred regimen (2): Linezolid 600 mg IV q12h
Preferred regimen (3): Daptomycin 6 mg/kg IV q24h.

1.3 Ampicillin and vancomycin resistant

Preferred regimen (1): Linezolid 600 mg IV q12h
Preferred regimen (2): Daptomycin 6 mg/kg IV q24h

2. Endocarditis^[2]^[8]

2.1 Endocarditis in adults

2.1.1 Strains susceptible to penicillin, gentamicin, and vancomycin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

2.1.2 Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU/day IV q24h for 4–6 weeks) AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.1.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin

2.1.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.3.2 Intrinsic penicillin resistance

Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks

2.1.4 Strains resistant to penicillin, aminoglycoside, and vancomycin

Preferred regimen (1): Linezolid 1200 mg IV/PO q24h ≥ 8 weeks
Preferred regimen (2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks

2.2 Endocarditis in pediatrics

2.2.1 Strains susceptible to penicillin, gentamicin, and vancomycin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.

2.2.2 Strains Susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin

Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks

2.2.3 Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin

2.2.3.1 β Lactamase–producing strain

Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.3.2 Intrinsic penicillin resistance
Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks

2.2.4 Strains resistant to penicillin, aminoglycoside, and vancomycin

Preferred regimen (1): Linezolid 30 mg/kg IV/PO q24h ≥ 8 weeks
Preferred regimen (2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks

3. Meningitis^[4]

3.1 Ampicillin susceptible

Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h

3.2 Ampicillin resistant

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h

3.3 Ampicillin and vancomycin resistant

Preferred regimen: Linezolid 600 mg IV q12h

4. Urinary tract infections^[9]

Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
Preferred regimen (2): Fosfomycin 3 g PO single dose
Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days

5. Intra abdominal or wound infections ^[10]

Preferred regimen (1): Penicillin
Preferred regimen (2): Ampicillin
Alternative regimen (penicillin allergy or high-level penicillin resistance): Vancomycin
Alternative regimen (for complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h

Staphylococcus aureus Return to Top

Staphylococcus aureus treatment

1. Infectious endocarditis^[11]

1.1 In adults

Preferred regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
Preferred regimen (2): Daptomycin 6mg/kg/dose IV qd

2. Intravascular catheter-related infections^[12]

2.1 Methicillin susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q6h
Preferred regimen (2): Oxacillin 2 g IV q6h
Alternative regimen (1): Cefazolin 2 g IV q8h
Alternative regimen (2): Vancomycin 15 mg/kg IV q12h

2.1.1 Pediatric dose of Nafcillin

2.1.1.1 Neonates (< 4 weeks)

For < 1200 g: Nafcillin 50 mg/kg/day q12h
For ≤ 7 days of age and 1200–2000 g: Nafcillin 50 mg/kg/day q12h
For ≤ 7 days of age and > 2000 g: Nafcillin 75 mg/kg/day q8h
For > 7 days of age and 1200–2000 g: Nafcillin 75 mg/kg/day q8h
For > 7 days of age and > 2000 g: Nafcillin 100 mg/kg/day q6h

2.1.1.2 Infants and children (> 4 weeks)

Nafcillin 100–200 mg/kg/day q4–6h

2.1.2 Pediatric dose of Oxacillin

2.1.2.1 Neonates (< 4 weeks)

For < 1200 g: Oxacillin 50 mg/kg/day q12h
For Postnatal age < 7 days and 1200–2000 g: Oxacillin 50–100 mg/kg/day q12h
For Postnatal age < 7 days and > 2000 g: Oxacillin 75–150 mg/kg/day q8h
For Postnatal age ≥ 7 days and 1200–2000 g: Oxacillin 75–150 mg/kg/day q8h
For Postnatal age ≥ 7 days and > 2000 g: Oxacillin 100–200 mg/kg/day q6h

2.1.2.2 Infants and children(> 4weeks)

Oxacillin 150–200 mg/kg/day q4–6h

2.1.3 Pediatric dose of Cefazolin

2.1.3.1 Neonates (< 4 weeks)

Postnatal age ≤ 7 days: Cefazolin 40 mg/kg/day q12h
Postnatal age > 7 days and ≤ 2000 g: Cefazolin 40 mg/kg/day q12h

Postnatal age > 7 days and > 2000 g: Cefazolin 60 mg/kg/day q8h

2.1.3.2 Infants and children (> 4 weeks)

Cefazolin 50 mg/kg/day q8h.

2.1.4 Pediatric dose of Vancomycin

2.1.4.1 Neonates (< 4 weeks)

Postnatal age ≤ 7 days and < 1200 g: Vancomycin 15 mg/kg/day q24h.
Postnatal age ≤ 7 days and 1200–2000 g: Vancomycin 10–15 mg/kg q12–18h.
Postnatal age ≤ 7 days and > 2000 g: Vancomycin 10–15 mg/kg q8–12h.
Postnatal age > 7 days and < 1200 g: Vancomycin 15 mg/kg/day q24h.
Postnatal age > 7 days and 1200–2000 g: Vancomycin 10–15 mg/kg q8–12h.
Postnatal age > 7 days and > 2000 g: Vancomycin 15–20 mg/kg q8h.

2.1.4.2 Infants and children (> 4 weeks)

Vancomycin 40 mg/kg/day q6–8h.

2.2 Methicillin resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h
Preferred regimen (2): Daptomycin 6–8 mg/kg/day IV
Preferred regimen (3): Linezolid 10 mg/kg IV/PO q12h
Preferred regimen (4): Vancomycin 15 mg/kg IV q12h AND (Rifampicin IV or Gentamycin IV)
Preferred regimen (5): Trimethoprim-Sulfamethoxazole 6–12 mg TMP/kg/day q12h alone (if susceptible)

2.2.1 Pediatric dose of Linezolid

2.2.1.1 Neonates (< 4 weeks)

For < 1200 g: Linezolid 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
For < 7 days of age and ≥ 1200 g: Linezolid 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
For ≥ 7 days and ≥ 1200 g: Linezolid 10 mg/kg q8h

2.2.1.2 Infants and children < 12 years (> 4 weeks)

Linezolid 10 mg/kg q8h

2.2.1.3 Children ≥ 12 years and adolescents

Linezolid 10 mg/kg q12h

2.2.2 Pediatric dose of Gentamycin

2.2.2.1 Neonates (< 4 weeks)

Premature neonates and < 1000 g: Gentamycin 3.5 mg/kg q24h
< 1200 g: Gentamycin 2.5 mg/kg q18-24h.
Postnatal age ≤ 7 days: Gentamycin 2.5 mg/kg q12h.
Postnatal age > 7 days and 1200–2000 g: Gentamycin 2.5 mg/kg q8-12h.
Postnatal age > 7 days and > 1200 g: Gentamycin 2.5 mg/kg q8h.
Premature neonates with normal renal function: Gentamycin 3.5–4 mg/kg q24h.
Term neonates with normal renal function: Gentamycin 3.5–5 mg/kg q24h.

2.2.2.2 Infants and children < 5 years (> 4 weeks)

Gentamycin 2.5 mg/kg q8h; qd dosing in patients with normal renal function, Gentamycin 5–7.5 mg/kg q24h.

2.2.2.3 Children ≥ 5 years

Gentamycin 2–2.5 mg/kg q8h; qd with normal renal function, Gentamycin 5–7.5 mg/kg q24h.

2.2.3 Pediatric dose of Trimethoprim-Sulfamethoxazole

2.2.3.1 Infants > 2 months of age and children of mild-to-moderate infections

Trimethoprim-Sulfamethoxazole 6–12 mg TMP/kg/day q12h; serious infection- Trimethoprim-Sulfamethoxazole 15–20 mg TMP/kg/day q6-8h.

3. Cellulitis^[13]

3.1 Purulent cellulitis (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)

3.1.1 In adults

Preferred regimen (1): Clindamycin 300–450 mg PO tid
Preferred regimen (2): Trimethoprim-Sulfamethoxazole 1–2 DS (double strength) tab PO bid
Preferred regimen (3): Doxycycline 100 mg PO bid
Preferred regimen (4): Minocycline 200 mg as a single dose THEN 100 mg PO bid
Preferred regimen (5): Linezolid 600 mg PO bid

3.1.2 In children

Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
Preferred regimen (3)

3.1 If patient body weight < 45kg then Doxycycline 2 mg/kg PO q12h
3.2 If patient body weight 45kg then Doxycycline adult dose

Preferred regimen (4): Minocycline 4 mg/kg PO 200 mg as a single dose, THEN Minocycline 2 mg/kg PO q12h
Preferred regimen (5): Linezolid 10 mg/kg PO q8h, (max: 600 mg)

3.2 Nonpurulent cellulitis (defined as cellulitis with no purulent drainage or exudate and no associated abscess)

3.2.1 In adults

Preferred regimen (1): Beta-lactam (eg, Cephalexin and Dicloxacillin) 500 mg PO qid
Preferred regimen (2): Clindamycin 300–450 mg PO tid
Preferred regimen (3): Amoxicillin 500 PO mg tid
Preferred regimen (4): Linezolid 600 mg PO bid
Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity.
Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, Amoxicillin) with or without Trimethoprim-Sulfamethoxazole or a Tetracycline

3.2.2 In children

Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
Preferred regimen (3): Linezolid 10 mg/kg PO q8h, not to exceed 600 mg
Note (1): Clindamycin causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents.
Note (2): Trimethoprim-Sulfamethoxazole not recommended for women in the third trimester of pregnancy and for children ,2 months of age.
Note (3): Tetracyclines are not recommended for children under 8 years of age and are pregnancy category D.

4. Brain abscess^[14]^[15]^[16]

4.1 Methicillin-resistant Staphylococcus aureus (MRSA)

4.1.1 In adults

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks

4.1.2 In children

Preferred regimen (1): Vancomycin15 mg/kg/dose IV q6h
Preferred regimen (2): Linezolid 10 mg/kg/dose PO/IV q8h
Note: Consider the addition of Rifampin 600 mg qd OR 300–450 mg bid to Vancomycin.

4.2 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q4h
Preferred regimen (2): Oxacillin 2 g IV q4h
Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h

5. Cerebrospinal fluid shunt infection^[17]^[18]

5.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h with or without Rifampin 600 mg IV or PO q24h
Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.

5.2 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q4h with or without Rifampin 600 mg IV/PO q24h
Preferred regimen (2): Oxacillin 2 g IV q4h

6. Spinal epidural abscess^[19]^[20]^[21]^[22]

6.1 Penicillin-susceptible Staphylococcus aureus or Streptococcus

Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks

6.2 Methicillin-susceptible Staphylococcus aureus or Streptococcus

Preferred regimen (1): Cefazolin 2 g IV q8h for 2–4 weeks, THEN PO to complete 6–8 weeks
Preferred regimen (2): Nafcillin 2 g IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks
Preferred regimen (3): Oxacillin 2 g IV q4h for 2–4 weeks, THEN PO to complete 6–8 weeks
Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, THEN PO to complete 6–8 weeks

6.3 Methicillin-resistant Staphylococcus aureus (MRSA)

6.3.1 In adults

Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV THEN Vancomycin 15–20 mg/kg IV q8–12h for 2–4 weeks, THEN PO to complete 6–8 weeks
Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks

6.3.2 Pediatric dose

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h
Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.

7. Bacterial meningitis

7.1 Methicillin susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 9–12 g/day IV q4h
Preferred regimen (2): Oxacillin 9–12 g/day IV q4h
Alternative regimen (1): Vancomycin 30–45 mg/kg/day IV q8–12h
Alternative regimen (2): Meropenem 6 g/day IV q8h

7.2 Methicillin resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
Alternative regimen (1): Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h
Alternative regimen (2): Linezolid 600 mg IV q12h
Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.

8. Septic thrombosis of cavernous or dural venous sinus^[23]

8.1 Methicillin-resistant Staphylococcus aureus (MRSA)

8.1.1 In adults

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h for 4–6 weeks
Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks

8.1.2 Pediatric dose

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h
Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.

9. Subdural empyema

9.1 Methicillin-resistant Staphylococcus aureus (MRSA)^[24]

9.1.1 In adults

Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks

9.1.2 In children

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Linezolid 10 mg/kg PO/IV q8h
Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.

10. Acute conjunctivitis^[25]

10.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin ointment 1% qid

11. Appendicitis

11.1 Health care–associated complicated intra-abdominal infection^[26]

11.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h

12. Diverticulitis

12.1 Health care–associated complicated intra-abdominal infection^[26]

12.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h.

13. Peritonitis secondary to bowel perforation, peritonitis secondary to ruptured appendix, peritonitis secondary to ruptured appendix, typhlitis

13.1 Health care–associated complicated intra-abdominal infection^[26]

13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h

14. Cystic fibrosis^[27]

14.1 Adults

14.1.1 If methicillin sensitive staphylococcus aureus

Preferred Regimen (1): Nafcillin 2 gm IV q4h
Preferred Regimen (2): Oxacillin 2 gm IV q4h

14.1.2 If methicillin resistant staphylococcus aureus

Preferred Regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
Preferred Regimen (2): Linezolid 600 mg PO/IV q12h

14.2 Pediatric

14.2.1 If methicillin sensitive staphylococcus aureus

Preferred Regimen (1): Nafcillin 5 mg/kg q6h (Age >28 days)
Preferred Regimen (2): Oxacillin 75 mg/kg q6h (Age >28 days)

14.2.2 If methicillin resistant staphylococcus aureus

Preferred Regimen (1): Vancomycin 40 mg/kg q6-8h (Age >28 days)
Preferred Regimen (2): Linezolid 10 mg/kg PO/IV q8h (up to age 12)

15. Bronchiectasis^[28]

15.1 In adults

15.1.1 Recommended first-line treatment and length of treatment

15.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin 500 mg PO qds for 14 days

15.1.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Patient's body weight is < 50 kg

Preferred regimen: Rifampicin 450 mg PO qd AND Trimethoprim 200 mg PO bd for 14 days

Patient's body weight is > 50 kg

Preferred regimen: Rifampicin 600 mg PO qd AND Trimethoprim 200 mg PO bd for 14 days

15.1.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 1 g IV bd (monitor serum levels and adjust dose accordingly)
Preferred regimen (2): Teicoplanin 400 mg qd for 14 days

15.1.2 Recommended second-line treatment and length of treatment

15.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 500 mg PO bd 14 days

15.1.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Patient's body weight is < 50 kg

Preferred regimen: Rifampicin 450 mg PO qd AND Doxycycline 200 mg PO qd for 14 days

Patient's body weight is > 50 kg

Preferred regimen: Rifampicin 600 mg PO qd AND Doxycycline 200 mg PO qd for 14 days

Third-line: Linezolid 600 mg bd for 14 days

15.1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Linezolid 600 mg IV bd for 14 days

15.2 In children

15.2.1 Recommended first-line treatment and length of treatment

15.2.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin

15.2.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)

15.2.1.2.1 Children (< 12 yr)

Preferred regimen: Trimethoprim 4-6 mg/kg/day PO q12h

15.2.1.2.2 Children (> 12 yr)

Preferred regimen (1): Trimethoprim 100-200 mg PO q12h
Preferred regimen (2): Rifampicin 450 mg PO od (or Rifampicin 600 mg PO od)

15.2.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 45-60 mg/kg/day IV q8-12h
Preferred regimen (2): Teicoplanin 400 mg qd for 14 days

15.2.2 Recommended second-line treatment and length of treatment

15.2.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 15 mg/kg/day PO q12h

15.2.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Rifampicin AND Doxycycline 2-5 mg/kg/day PO/IV q12-24h (max dose: 200 mg/24 hr)
Preferred regimen (2): Rifampicin AND Doxycycline 2-5 mg/kg/day PO/IV q12-24h (max dose: 200 mg/24 hr)
Third-line: Linezolid 10 mg/kg PO/IV q12h

15.2.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Linezolid 10 mg/kg PO/IV q12h

15.3 Long-term oral antibiotic treatment

15.3.1 In adults

15.3.1.1 Recommended first-line treatment and length of treatment

15.3.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin 500 mg PO bd

15.3.1.2 Recommended second-line treatment and length of treatment

15.3.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 250 mg PO bd

16. Empyema^[29]

Preferred regimen (1): Nafcillin 2 gm IV q4h
Preferred regimen (2): oxacillin 2 gm IV q4h (if MSSA)
Alternative regimen (1): Vancomycin 1 gm IV q12h
Alternative regimen (2): Linezolid 600 mg PO bid (if MRSA)

17. Community-acquired pneumonia^[30]

17.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred Regimen (1): Nafcillin 1000-2000 mg q4h
Preferred Regimen (2): Oxacillin 2 g IV q4h
Preferred Regimen (3): Flucloxacillin 250 mg IM/IV q6h
Alternative Regimen (1): Cefazolin 500 mg IV q12h
Alternative Regimen (2): Clindamycin 150-450 mg PO q6-8h

17.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred Regimen (1): Vancomycin 45-60 mg/kg/day q8-12h (max: 2000 mg/dose) for 7-21 days
Preferred Regimen (2): Linezolid 600 mg PO/IV q12h for 10-14 days
Alternative Regimen: Trimethoprim-Sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h

18. Olecranon bursitis or prepatellar bursitis

18.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q4h
Preferred regimen (2): Oxacillin 2 g IV q4h
Preferred regimen (3): Dicloxacillin 500 mg PO qid

18.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen (1): Vancomycin 1 g IV q12h
Preferred regimen (2): Linezolid 600 mg PO qd
Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.

19. Septic arthritis

19.1 In adults

19.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
Alternative regimen (1): Daptomycin 6 mg/kg IV q24h in adults
Alternative regimen (2): Linezolid 600 mg PO/IV q12h
Alternative regimen (3): Clindamycin 600 mg PO/IV q8h
Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h

19.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q6h
Preferred regimen (2): Clindamycin 900 mg IV q8h
Alternative regimen (1): Cefazolin 0.25–1 g IV/IM q6–8h
Alternative regimen (2): Vancomycin 500 mg IV q6h or 1 g IV q12h

19.2 In childern

Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
Preferred regimen (2): Daptomycin 6–10 mg/kg IV q24h
Preferred regimen (3): Linezolid 10 mg/kg PO/IV q8h
Preferred regimen (4): Clindamycin 10–13 mg/kg PO/IV q6–8h

20. Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)

20.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin 2 g IV q4–6h
Preferred regimen (2): Oxacillin 2 g IV q4–6h
Alternative regimen (1): Cefazolin 1–2 g IV q8h
Alternative regimen (2): Ceftriaxone 2 g IV q24h
Alternative regimen (if allergic to penicillins) (3): Clindamycin 900 mg IV q8h
Alternative regimen (if allergic to penicillins) (4): Vancomycin 15–20 mg/kg IV q8–12h, (max: 2 g per dose)

20.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Early-onset (2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
Preferred regimen: Vancomycin AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
Alternative regimen (1): Daptomycin 6 mg/kg IV q24h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
Alternative regimen (2): Linezolid 600 IV q8h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
Note: The above regimen should be followed by Rifampin and a Fluoroquinolone, TMP/SMX, a Tetracycline or Clindamycin for 3-6 months for hips and knees, respectively.

21. Hematogenous osteomyelitis

21.1 Adult (> 21 yrs)

21.1.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)

21.1.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen (1): Nafcillin
Preferred regimen (2): Oxacillin 2 gm IV q4h

21.2 Children (> 4 months)-Adult

21.2.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen: Vancomycin 40 mg IV q6–8h

21.2.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen (1): Nafcillin
Preferred regimen (2): Oxacillin q6h (max. 8–12 gm per day)
Note: Add Ceftazidime 50 mg q8h or Cefepime 150 mg q8h if Gram negative bacilli on Gram stain

21.3 Newborn (< 4 months.)

21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen (1): Vancomycin AND Ceftazidime 2 gm IV q8h
Preferred regimen (2): Vancomycin AND Cefepime 2 gm IV q12h

21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

Preferred regimen (1): Nafcillin AND Ceftazidime
Preferred regimen (2): Oxacillin AND Cefepime

21.4 Specific therapy

21.4.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen (1): Nafcillin
Preferred regimen (2): Oxacillin 2 gm IV q4h
Preferred regimen (3): Cefazolin 2 gm IV q8h
Alternative regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)

21.4.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin 1 gm IV q12h
Alternative regimen: Linezolid 600 mg q12h PO/IV with or without Rifampin 300 mg PO/IV bid

22. Diabetic foot osteomyelitis

High risk for MRSA

Preferred regimen (1): Linezolid 600 mg IV or PO q12h
Preferred regimen (2): Daptomycin 4 mg/kg IV q24h
Preferred regimen (3): Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)

23. Necrotizing fasciitis^[31]

23.1 In adult

Preferred regimen (1): Nafcillin 1–2 g IV q4h (severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
Preferred regimen (2): Oxacillin 1–2 g IV q4h
Preferred regimen (3): Cefazolin 1 g IV q8h
Preferred regimen (4): Vancomycin 15 mg/kg IV bid
Preferred regimen (5): Clindamycin 600–900 mg IV q8h

23.2 In childern

Preferred regimen (1): Nafcillin 50 mg/kg/dose IV q6h (severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
Preferred regimen (2): Oxacillin 50 mg/kg/dose IV q6h
Preferred regimen (3): Cefazolin 33 mg/kg/dose IV q8h
Preferred regimen (4): Vancomycin 15 mg/kg/dose IV q6h
Preferred regimen (5): Clindamycin 10–13 mg/kg/dose IV q8h (Bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in methicillin resistent staphylococcus aureus)

24. Staphylococcal toxic shock syndrome^[32]

24.1 Methicillin sensitive Staphylococcus aureus

Preferred regimen (1): Cloxacillin 250-500 mg PO q6h (max dose: 4 g/24 hr)
Preferred regimen (2): Nafcillin 4-12 g/24 hr IV q4-6hr (max dose: 12 g/24 hr)
Preferred regimen (3): Cefazolin 0.5-2g IV/IM q8h (max dose: 12 g/24 hr) AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
Alternative regimen (1): Clarithromycin 250-500 mg PO q12h (max dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO)
Alternative regimen (2): Rifampicin AND Linezolid 600 mg IV/PO q12h
Alternative regimen (3): Daptomycin
Alternative regimen (4): Tigecycline 100 mg loading dose THEN 50 mg IV q12h

24.2 Methicillin resistant Staphylococcus aureus

Preferred regimen (1): Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24h IV/IM or 2 g/24h PO)
Preferred regimen (2): Linezolid 600 mg IV/PO q12h AND Vancomycin 15-20 mg/kg IV q8-12h, (max: 2 g per dose)
Preferred regimen (3): Teicoplanin
Alternative regimen (1): Rifampicin AND Linezolid 600 mg IV/PO q12h
Alternative regimen (2): Daptomycin
Alternative regimen (3): Tigecycline 100 mg loading dose THEN 50 mg IV q12h

24.3 Glycopeptide resistant or intermediate Staphylococcus aureus

Preferred regimen: Linezolid 600 mg IV/PO q12h AND Clindamycin 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO) (if sensitive)
Alternative regimen (1): Daptomycin
Alternative regimen (2): Tigecycline 100 mg loading dose THEN 50 mg IV q12h

Staphylococcus aureus ,prophylaxis

1. Prophylaxis for coronary artery bypass graft-associated acute mediastinitis^[33]

1.1 Methicillin susceptible staphylococcus aureus (MSSA)

Preferred regimen: A first- or second-generation Cephalosporin is recommended for prophylaxis in patients without MRSA colonization.

1.2 Methicillin resistant staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin alone or in combination with other antibiotics to achieve broader coverage is recommended for prophylaxis in patients with proven or suspected MRSA colonization
Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.
Note (2): The use of intranasal Mupirocin is reasonable in nasal carriers of Staphylococcus aureus.

Staphylococcus haemolyticus Return to Top

1. Methicillin-susceptible strain^[34]^[35]

Preferred regimen (1): Nafcillin 1–2 g IV q4-6h (maximum 12 g/day)
Preferred regimen (2): Oxacillin 1–2 g IVq4-6h (maximum 12 g/day)
Preferred regimen (3): Cefazolin 0.5–2 g IV q6-8h
Alternative regimen (1): TMP-SMX 4–5 mg/kg IV q6–12h
Alternative regimen (2): Doxycycline 100–200 mg IV q12-24h

2. Methicillin-resistant, Glycopeptide-susceptible strain

Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h

3. Methicillin-resistant, Glycopeptide-resistant strain

Preferred regimen (1): Daptomycin 4–6 mg/kg IV q24h
Preferred regimen (2): Linezolid 600 mg PO/IV q12h

Staphylococcus epidermidis Return to Top

Staphylococcus epidermidis^[36]
1. Methicillin-sensitive Staphylococcus epidermidis

Preferred regimen (1): Oxacillin 1-2 g IV q4h
Preferred regimen (2): Nafcillin 1-2 g IV q4h
Preferred regimen (3): Cephalothin
Alternative regimen: Rifampin 600 mg/day PO qd AND Sulfamethoxazole and Trimethoprim ((or) Fluoroquinolones) AND Daptomycin 600 mg PO or IV q12h^[37]
Note: 75% of the S. epidermidis are methicillin-resistant.

2. Methicillin-resistant Staphylococcus epidermidis

Preferred regimen: Vancomycin 1 g IV q12h with or without Rifampin 600 mg/day PO qd
Note: For deep-seated infections consider adding Gentamicin with or without Rifampin 600 mg/day PO qd to the regimen^[11]

3. Prosthetic device infections

Preferred regimen: Oxacillin 1-2 g IV q4h ((or) Vancomycin 1 g IV q12h) AND Rifampin 600 mg/day PO qd AND Gentamicin 3 mg/kg/day IV/IM q8-24h is appropriate^[11]
Note: Duration depends on site of infection and severity.

Staphylococcus lugdunensis Return to Top

Staphylococcus lugdunensis treatment

1. Skin and soft tissue infections^[38]

Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks
Note: Abscesses should be drained if possible.

2. Endocarditis^[39]

2.1 Native valve infectious endocarditis

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
Preferred regimen (for most patients with normal renal function) (2): Vancomycin 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
Note: should consist of 6 weeks of parenteral beta-lactam therapy or Vancomycin (depending on susceptibility testing and beta-lactam hypersensitivity).

2.2 Prosthetic valve infective endocarditis

Preferred regimen: Combination therapy including a beta-lactam (or Vancomycin) with an Aminoglycoside- Gentamicin 3 mg/kg/day in 1-3 divided doses and Rifampin 300 mg PO/IV q8h for at least 6 weeks
Note (1): Combine with Vancomycin for the entire duration of therapy and Gentamicin for the first 2 weeks.
Note (2): The Gentamicin should be administered for the first 2 weeks of therapy; the beta-lactam (or Vancomycin) and Rifampin should be continued for 6 weeks.

Note (3): Surgery must be considered given the frequency of valvular compromise in the setting of Staphylococcus lugdunensis infective endocarditis.
Note (4): The treatment of Staphylococcus lugdunensis pacemaker endocarditis includes antibiotic therapy as well as removal of the pacer system

3. Bacteremia^[12]

Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks

Note (1): Bacteremia without endocarditis (often related to an intravascular catheter) appears to have a good prognosis.
Note (2): For intravascular catheter-related Staphylococcus lugdunensis bacteremia, the catheter should be removed, followed by 14 days of antibiotics, provided that all of the following are applicable

2.1 The patient is not diabetic or immunosuppressed.
2.2 There is no prosthetic material, thrombophlebitis, infective endocarditis, evidence of metastatic infection.
2.3 The patient’s fever and bacteremia resolve within 72 hours after initiation of appropriate antibiotic therapy.

4. Prosthetic devices^[40],^[12]

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
Preferred regimen (for most patients with normal renal function) (2): Vancomycin 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
Preferred regimen (3): Daptomycin 6 mg/kg IV qd for 3 to 4 weeks
Preferred regimen (4): Linezolid 600 mg IV q12h

5. Vertebral osteomyelitis, discitis

Preferred regimen: Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose

6. Septic arthritis in adults

Preferred regimen: Vancomycin 15 mg/kg IV bd, not to exceed 2 g per 24 hours (unless cncentrations in serum are inappropriately low) for 4 weeks.

Staphylococcus lugdunensis treatment

1. Skin and soft tissue infections^[38]

Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks
Note: Abscesses should be drained if possible.

2. Endocarditis^[39]

2.1 Native valve infectious endocarditis

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
Preferred regimen (for most patients with normal renal function) (2): Vancomycin 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
Note: should consist of 6 weeks of parenteral beta-lactam therapy or Vancomycin (depending on susceptibility testing and beta-lactam hypersensitivity).

2.2 Prosthetic valve infective endocarditis

Preferred regimen: Combination therapy including a beta-lactam (or Vancomycin) with an Aminoglycoside- Gentamicin 3 mg/kg/day in 1-3 divided doses and Rifampin 300 mg PO/IV q8h for at least 6 weeks
Note (1): Combine with Vancomycin for the entire duration of therapy and Gentamicin for the first 2 weeks.
Note (2): The Gentamicin should be administered for the first 2 weeks of therapy; the beta-lactam (or Vancomycin) and Rifampin should be continued for 6 weeks.

Note (3): Surgery must be considered given the frequency of valvular compromise in the setting of Staphylococcus lugdunensis infective endocarditis.
Note (4): The treatment of Staphylococcus lugdunensis pacemaker endocarditis includes antibiotic therapy as well as removal of the pacer system

3. Bacteremia^[12]

Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks

Note (1): Bacteremia without endocarditis (often related to an intravascular catheter) appears to have a good prognosis.
Note (2): For intravascular catheter-related Staphylococcus lugdunensis bacteremia, the catheter should be removed, followed by 14 days of antibiotics, provided that all of the following are applicable

2.1 The patient is not diabetic or immunosuppressed.
2.2 There is no prosthetic material, thrombophlebitis, infective endocarditis, evidence of metastatic infection.
2.3 The patient’s fever and bacteremia resolve within 72 hours after initiation of appropriate antibiotic therapy.

4. Prosthetic devices^[40],^[12]

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
Preferred regimen (for most patients with normal renal function) (2): Vancomycin 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
Preferred regimen (3): Daptomycin 6 mg/kg IV qd for 3 to 4 weeks
Preferred regimen (4): Linezolid 600 mg IV q12h

5. Vertebral osteomyelitis, discitis

Preferred regimen: Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose

6. Septic arthritis in adults

Preferred regimen: Vancomycin 15 mg/kg IV bd, not to exceed 2 g per 24 hours (unless cncentrations in serum are inappropriately low) for 4 weeks.

Staphylococcus lugdunensis treatment

1. Skin and soft tissue infections^[38]

Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks
Note: Abscesses should be drained if possible.

2. Endocarditis^[39]

2.1 Native valve infectious endocarditis

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
Preferred regimen (for most patients with normal renal function) (2): Vancomycin 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
Note: should consist of 6 weeks of parenteral beta-lactam therapy or Vancomycin (depending on susceptibility testing and beta-lactam hypersensitivity).

2.2 Prosthetic valve infective endocarditis

Preferred regimen: Combination therapy including a beta-lactam (or Vancomycin) with an Aminoglycoside- Gentamicin 3 mg/kg/day in 1-3 divided doses and Rifampin 300 mg PO/IV q8h for at least 6 weeks
Note (1): Combine with Vancomycin for the entire duration of therapy and Gentamicin for the first 2 weeks.
Note (2): The Gentamicin should be administered for the first 2 weeks of therapy; the beta-lactam (or Vancomycin) and Rifampin should be continued for 6 weeks.

Note (3): Surgery must be considered given the frequency of valvular compromise in the setting of Staphylococcus lugdunensis infective endocarditis.
Note (4): The treatment of Staphylococcus lugdunensis pacemaker endocarditis includes antibiotic therapy as well as removal of the pacer system

3. Bacteremia^[12]

Preferred regimen: Oxacillin 1-2 g IV q4h for 1-2 weeks

Note (1): Bacteremia without endocarditis (often related to an intravascular catheter) appears to have a good prognosis.
Note (2): For intravascular catheter-related Staphylococcus lugdunensis bacteremia, the catheter should be removed, followed by 14 days of antibiotics, provided that all of the following are applicable

2.1 The patient is not diabetic or immunosuppressed.
2.2 There is no prosthetic material, thrombophlebitis, infective endocarditis, evidence of metastatic infection.
2.3 The patient’s fever and bacteremia resolve within 72 hours after initiation of appropriate antibiotic therapy.

4. Prosthetic devices^[40],^[12]

Preferred regimen (1): Vancomycin 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
Preferred regimen (for most patients with normal renal function) (2): Vancomycin 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
Preferred regimen (3): Daptomycin 6 mg/kg IV qd for 3 to 4 weeks
Preferred regimen (4): Linezolid 600 mg IV q12h

5. Vertebral osteomyelitis, discitis

Preferred regimen: Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose

6. Septic arthritis in adults

Preferred regimen: Vancomycin 15 mg/kg IV bd, not to exceed 2 g per 24 hours (unless cncentrations in serum are inappropriately low) for 4 weeks.

eeks

Staphylococcus saprophyticus Return to Top

Urinary tract infections^[41]

Preferred regimen (1): Cephalexin 500 mg PO qid
Preferred regimen (2): Amoxicillin-Clavulanate 875/125 mg PO bid
Preferred regimen (3): TMP-SMX 160–800 mg PO bid
Alternative regimen: Levofloxacin 500 mg PO qd

Streptobacillus moniliformis Return to Top

Streptobacillus moniliformis treatment^[42]

1. Migratory arthropathy and arthritis

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

2. Diarrhea, (especially kids) liver or spleen abscess

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

3. Undifferentiated fever

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

4. Endocarditis, myocarditis, pericarditis (cardiac)

Preferred regimen: Penicillin 20 MU/day IV divided q4h. Optimal duration recommendation for infective endocarditis is 4 weeks.
Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.

5. Meningitis, brain abscess

Preferred regimen: Penicillin 20 MU/day IV divided q4h.
Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.

6. Anemia

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

7. Pneumonia

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

8. Amnionitis (pregnancy)

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

9. Renal abscess

Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.

Streptococcus anginosus Return to Top

1. Dental abscess^[43]

Preferred regimen: Penicillin V 500 mg PO qid
Alternative regimen: Vancomycin 15–20 mg/kg IV q8–12h

2. Brain abscess

Preferred regimen (1): Penicillin G 18–24 MU/day IV q4–6h
Preferred regimen (2): Ceftriaxone 2 g IV q12h
Alternative regimen: Vancomycin 15–20 mg/kg IV q8–12h

Streptococcus pneumoniae Return to Top

Streptococcus pneumonia treatment

1. Lung (Community-acquired pneumonia)^[30]

1.1 Penicillin sensitive (minimum inhibitory concentration < 2 mcg/ml)

Preferred regimen: Penicillin G 5 to 24 MU IV in equally divided doses q4-6h, Amoxicillin 1 g PO tid (+/- macrolide)
Alternative regimen: Macrolides (Azithromycin (IV) 500 mg IV qd for at least 2 days followed by 500 mg PO qd 7 to 10 days or Clarithromycin extended-release tablets 1000 mg PO qd for 7 days) and Oral Cephalosporins-Cefpodoxime 200 mg PO bd, (Cefprozil 500 mg PO bd, Cefditoren 400 mg PO bd, Cefdinir 300 mg PO bd), OR parenteral Cephalosporins-Ceftriaxone 2 g IV q24h (or Cefotaxime 1-2 g IV q6-8h), Clindamycin 600 to 1200 mg IV or IM q6-12h, do not give single IM doses >600 mg; IV infusion rates should not exceed 30 mg/min , Doxycycline 100 mg PO bd, respiratory flouroquniolones.

1.2 Penicillin-resistant (Penicillin minimum inhibitory concentration ≥2)

Preferred regimen: Ceftriaxone 2 g IV q24h (or Cefotaxime 1-2 g IV q6-8h), respiratory Flouroquniolones Levofloxacin (Levaquin) 500 mg IV/PO q24h for 7 to 14 days or 750 mg IV/PO q24h for 5 days (or Moxifloxacin (Avelox) 400 mg PO/IV over 60 minutes q24h for 7 to 14 days)
Alternative regimen: Vancomycin 2 g/day IV q6-12h over at least 60 minutes, Linezolid 600 mg IV/PO q12h for 7 to 21 days , high-dose Amoxicillin (3 g qd with Penicillin minimum concentration of inhibitory <4 mcg/mL).

2.Endocarditis^[11]

Preferred regimen (1): Aqueous crystalline Penicillin-G 6 MU q4-6h IV for 4 weeks
Preferred regimen (2) (who are unable to tolerate beta lactams therapy): Vancomycin 15 mg/kg IV every 12 hours (target trough concentration, 10 to 15 mcg/mL) [9]; for troughs of 15 to 20 mcg/mL (MIC, 1 mcg/mL or less), dose 15 to 20 mg/kg (actual body weight) IV every 8 to 12 hours for most patients with normal renal function
Preferred regimen (3) (If the isolate is resistant (MIC 2 g/mL) to cefotaxime): Cefotaxime 1-2 g q8-12h IV or IM (max dose: 12 g/24 hr) AND Vancomycin 15 mg/kg/day IV q12h AND Rifampin 300 mg IV/PO q8h for 6 weeks, in combination with appropriate antimicrobial therapy
Alternative regimen (1): Cefazolin 0.5-2 g q8h IV or IM (max dose: 12 g/24 hr)
Alternative regimen (2): Ceftriaxone 2 g IV q12h

Note : Streptococcus pneumoniae with intermediate doses minimum inhibitory concentration (MIC) 0.12 g/mL–0.5 g/mL Penicillin resistance (MIC 0.1 to 1.0 g/mL) or high Penicillin resistance (MIC 2.0 g/mL) is being recovered from patients with bacteremia.

3. Sinuses (sinusitis)^[44]

Empiric therapy

3.1 For initial empiric treatment of acute bacterial rhinosinusitis in adults

Preferred regimen: Amoxicillin 500 mg/Clavulanate 125 mg PO tid or Amoxicillin 875 mg/Clavulanate 125 mg PO bid for 5 to 7 days recommended by the Infectious Disease Society of America (IDSA)
Alternative regimen (1): Doxycycline 100 mg PO q12h

Note: Doxycycline can be used in patients with Penicillin allergy.

Alternative regimen (2): A respiratory Fluoroquinolone (Levofloxacin or Moxifloxacin) is another recommended drug for Penicillin-allergic patients.

3.2 For second-line high-dose therapy for acute bacterial rhinosinusitis in adults

Preferred regimen: Amoxicillin 2 g/Clavulanate 125 mg PO bid recommended by the Infectious Disease Society of America (IDSA).
Note: The second line high dose therapy is recommended in adults who have failed initial therapy, in regions of high endemic rates (10% or greater) of invasive Penicillin-nonsusceptible Streptococcus pneumoniae, severe infection.

4. Bronchi (acute exacerbation of chronic bronchitis)^[45]

Preferred regimen (1): Amoxicillin 875 mg PO q12h or 500 mg PO q8h
Preferred regimen (2): Doxycycline 100 mg PO q12h

5. CNS (meningitis)^[4]

Empiric therapy

Preferred regimen: Vancomycin 15 mg/kg/day IV q12h AND a third-generation cephalosporin (Ceftriaxone 2 g IV q12h OR Cefotaxime 2 g IV q4h or 3 g q6h) AND Rifampin 600 mg IV qd in combination with Vancomycin
Alternative regimen: Meropenem, fluoroquinolones

Note: Middle ear infections (otitis media), peritoneum infections (spontaneous bacterial peritonitis), pericardium infections (purulent pericarditis), skin infections (cellulitis) and eye infections (conjunctivitis) caused by Streptococcus pneumonia.

Prevention

1. Pneumovax (23-valent) prevents bacteremia; impact on rates of CAP are modest or nil.
2. Prevnar vaccine for children <2 yrs age prevents invasive pneumococcal infection in adults by herd effect. Impact is impressive with rates of invasive pneumococcal infection down 80% in peds and 20-40% in adults.
3. Risk for bacteremia in splenectomy, HIV, smokers, black race, multiple myeloma, asthma.

Streptococcus pyogenes Return to Top
1. Streptococcus pyogenes tonsilitis^[46]

Preferred regimen (1): Penicillin V 250 mg PO bid or tid (for children) 250 mg PO qid or 500 mg PO bid (for adults) for 10 days^[47]
Preferred regimen (2): Benzathine penicillin G if <27kg: 600,000 U, if >27kg 1,200,000 U IM single-dose^[48]
Alternative regimen (1): Amoxicillin 50 mg/kg/day PO qd for 10 days OR 25 mg/kg/day PO bid for 10 days. Its oral suspension is more tolerable to children and it is better absorbed by the GI tract^[49]
Alternative regimen (2): first generation Cephalosporins are acceptable for treating recurrent group A streptococcus infection but not as first-line therapy^[50]^[48]
Alternative regimen (3): Clarithromycin 250 mg PO bid for 10 days OR Azithromycin 12 mg/kg maximum 500 mg PO on day 1 THEN 6 mg/kg maximum 250 mg PO qd on days 2 through 5 OR Erythromycin 20 mg/kg/day PO or 40 mg/kg/day (ethylsuccinate) PO bid for 10 days.
Alternative regimen (4): Clindamycin for penicillin-intolerant patients with erythromycin-resistant strains.
Note: Intramuscular penicillin is the only therapy that has been shown to prevent initial attacks of rheumatic fever in controlled studies^[51]

2. Recurrent Streptococcus pyogenes tonsilitis^[52]

Preferred regimen (1): Clindamycin 20-30 mg/kg/day PO tid (for children), 600 mg/day bid, tid or qid (for adults) for 10 days
Preferred regimen (2): Amoxicillin-clavulanic acid 40 mg/kg/day PO tid (for children), 500 mg bid (for adults) for 10 days
Alternative regimen: Benzathine penicillin G if <27kg: 600,000 U, if >27kg 1,200,000 U IM single-dose ± Rifampin 20 mg/kg/day PO bid for 4 days

3. Secondary prophylaxis for rheumatic fever^[48]

Preferred regimen (1): Benzathine penicillin G if <27kg: 600,000 U, if >27kg 1,200,000 U IM every 4 weeks
Alternative regimen (1): Penicillin V potassium 250 mg PO bid
Alternative regimen (2): Sulfadiazine if <27kg 0.5 g PO qd, if >27kg 1 g PO qd
Duration of treatment: if residual cardiac disease, keep treatment until 40 patient is 40 years old or for 10 years (whichever is longer); if there's no residual cardiac disease keep treatment for 10 years or until age 21 years (whichever is longer); if there's rheumatic fever without carditis keep it for 5 years or until age 21 years (whichever is longer).
Note: For patients allergic to penicillin and sulfadiazine, consider a macrolide or azalide antibiotic

4. Streptococcus pyogenes bacteremia^[53]

Preferred regimen: Penicillin G 4 million units IV q4h AND Clindamycin 900 mg IV q8h for at least 14 days
Penicillin is added to the regimen to cover any other group A streptococcus which might be resistant to Clindamycin.
Alternative regimen (1): Erythromycin
Alternative regimen (2): Azithromycin
Alternative regimen (3): Clarithromycin
Alternative regimen (4): any other β-lactam^[54]
Note (1): Macrolide resistance is increasing.
Note (2): Consider using intravenous immune globulin in patients with invasive infection and signs of shock. Immunoglobulin-G IV 1 g/kg day 1, then 0.5 g/kg days 2 & 3.
Note (3): If shock, administer massive IV fluids (10-20 L/day), Albumin if <2 g/dL, debridement of necrotic tissue.

5. Streptococcus pyogenes celulitis

Preferred regimen: treat as Streptococcus pyogenes bacteremia

6 Epiglottitis in childern^[55]

Preferred regimen (1): Cefotaxime 50 mg/kg IV q8h
Preferred regimen (2): Ceftriaxone 50 mg/kg IV q24h
Alternative regimen (1): Amoxicillin-SB 100–200 mg/kg qd q6h
Alternative regimen (2): Trimethoprim-Sulfamethoxazole 8–12 mg/kg bid
Note: Have tracheostomy set “at bedside.” Chloro is effective, but potentially less toxic alternative agents available.

7 Burn wound sepsis^[56]

Preferred regimen: Vancomycin 1 gm IV q12h AND (Amikacin 10 mg/kg IV loading dose then 7.5 mg/kg IV q12h) AND [ Piperacillin 4 g IV q4h (give ½ q24h dose of Piperacillin into subeschar tissues with surgical eschar removal within 12 hours]. Can use Piperacillin-Tazobactam if Piperacillin not available.

8. Soft tissue^[57]

Note: For necrotizing fasciitis, surgical consultation for emergent fasciotomy and debridement; repeat debridements usually necessary.

9. Muscle^[58]

Note: For myositis-debirdement is recommended.

10. Eye^[59]

10.1 Keratitis

10.1.1 Acute bacterial keratitis

Preferred regimen: Moxifloxacin eye gtts. 1 gtt tid for 7 days
Alternative therapy: Gatifloxacin eye gtts. 1-2 gtts q2h while awake for 2 days, then q4h for 3-7 days.
Note: Prefer Moxifloxacin due to enhanced lipophilicity and penetration into aqueous humor (1 gtt = 1 drop).

10.1.2 Keratitis due to dry cornea, diabetes, immunosuppression

Preferred regimen: Cefazolin (50 mg/mL) AND (Gentamicin OR Tobramycin (14 mg/mL) q15–60 min around clock for 24–72 hrs, then slow reduction)
Alternative therapy: Vancomycin (50 mg/mL) AND Ceftazidime (50 mg/mL) q15–60 min around clock for 24–72 hrs, then slow reduction.
Note: Specific therapy guided by results of alginate swab culture and sensitivity. Ciprofloxacin 0.3% found clinically equivalent to CefazolinAND Tobramycin; only concern was efficacy of Ciprofloxacin vs S. pneumoniae

10.2 Dacryocystitis (lacrimal sac)

Preferred regimen: Moxifloxacin 1 gtt tid for 7 days OR Cefazolin (50 mg/mL) (1 gtt = 1 drop)

11. Suppurative phlebitis^[60]

Preferred regimen: Vancomycin 15 mg/kg IV q12h (normal weight)
Alternative regimen: Daptomycin 6 mg/kg IV q12h
Note: Retrospective study for suppurative phlebitis recommends 2-3 weeks IV therapy and 2 weeks PO therapy.

12. Infected prosthetic joint^[61]

Preferred regimen: Penicillin G 2 million units IV q4h OR Ceftriaxone 2 g IV q24h for 4 weeks
Note: Debridement & prosthesis retention with intravenous antibiotics.

13. “Hot” tender parotid swelling^[62]

Preferred regimen: Nafcillin OR Oxacillin 2 g IV q4h
Note: Predisposing factors are stone(s) in Stensen’s duct, dehydration. Therapy depends on ID of specific etiologic organism.

14. Diabetic foot ulcer (ulcer with <2 cm of superficial inflammation)^[63]

Preferred regimen: (Trimethoprim-Sulfamethoxazole 800/160 mg 1-2 tabs PO bid OR Minocycline 100 mg PO bid) AND (Penicillin VK 500 mg PO qid OR selected Cephalosporins 2nd, 3rd generation - cefprozil 500 mg PO bid OR cefuroxime axetil 500 mg PO bid OR cefdinir 300 mg PO bid or 600 mg PO qd OR cefpodoxime 200 mg PO bid OR Fluoroquinolones Levofloxacin 750 mg PO qd).

15. Recurrent cellulitis, chronic lymphedema prophylaxis^[64]

Preferred regimen: Clindamycin 150 mg PO qd OR Trimethoprim-Sulfamethoxazole 800/160 mg 1 tablet PO qd OR “stand-by therapy” immediate treatment with Penicillin V OR Amoxicillin 500-750 mg PO bd at onset of symptoms.

Streptococcus agalactiae Return to Top

Streptococcus agalactiae treatment (GBS-group B Streptococcus)

1. Early onset group B streptococcal infections^[65]

1.1 Bacteremia or sepsis or pneumonia

1.1.1 Empiric therapy

Preferred regimen: Ampicillin 150 mg/kg IV q12h for 10 days AND Gentamicin 4 mg/kg IV q12h for 10 days-for infants born at ≥ 35 weeks gestation; Gentamicin 3 mg/kg IV q24h for 10 days-for infants born at < 35 weeks gestation

1.1.2 Definitive therapy

Preferred regimen: Penicillin G 50,000-100,000 units/kg per day IV divided q12h for 10 days

1.2 Meningitis

1.2.1 Empiric therapy

Preferred regimen: Ampicillin 100-150 mg/kg IV q8h for 14-21 days AND Gentamicin 4 mg/kg IV q24h for 14-21 days-for infants born at ≥ 35 weeks gestation; Gentamicin 3 mg/kg IV q24h for 14-21 days-for infants born at < 35 weeks gestation

1.2.2 Definitive therapy

Preferred regimen: Penicillin G 250,000-450,000 units/kg per day IV divided q8h for 14-21 days
Note: Cellulitis is the most frequent clinical manifestation of GBS-associated skin and soft tissue infections.

2. Late onset group b streptococcus infections in neonates and young infants (age > 1 week and body weight ≥ 1 kg with normal renal function)^[66]

2.1 Bacteremia without a focus

2.1.1 Empiric therapy

Preferred regimen: Ampicillin IV for 10 days, Nafcillin IV for 10 days, (OR Vancomycin IV for 10 days) AND Gentamicin IV for 10 days (OR Cefotaxime IV for 10 days)

2.1.2 Definitive therapy

Preferred regimen: Penicillin G 75,000-150,000 units/kg per day IV divided q8h for 10 days

2.2 Meningitis

2.2.1 Empiric therapy

Preferred regimen: Ampicillin IV for 14-21 days with or without Vancomycin IV for 14-21 day AND Gentamicin IV for 14-21 days OR Cefotaxime IV for 14-21 day

2.2.2 Definitive therapy

Preferred regimen: Penicillin G 450,000-500,000 units/kg per day IV divided q6h for 14-21 days

2.3 Cellulitis or adenitis

2.3.1 Empiric therapy

Preferred regimen: Nafcillin IV for 10-14 days (OR [[Vancomycin IV for 10-14 days) AND Gentamicin IV for 10-14 days (OR Cefotaxime IV for 10-14 days)

2.3.2 Definitive therapy

Preferred regimen: Penicillin-G 75,000-150,000 units/kg per day IV divided q8h for 10-14 days

2.4 Septic arthritis

2.4.1 Empiric therapy

Preferred regimen: Nafcillin IV for 14-21 days OR Vancomycin IV for 14-21 days AND Cefotaxime IV for 14-21 days

2.4.2 Definitive therapy

Preferred regimen: Penicillin-G 75,000-150,000 units/kg per day IV divided q8h for 14-21 days

2.5 Osteomyelitis

2.5.1 Empiric therapy

Preferred regimen: Nafcillin IV for 21-28 days OR Vancomycin IV for 21-28 days AND Cefotaxime IV for 21-28 days

2.5.2 Definitive therapy

Preferred regimen: Penicillin-G 75,000-150,000 units/kg per day IV divided q8h for 21-28 days

2.6 Urinary tract infection

2.6.1 Empiric therapy

Preferred regimen: Ampicillin IV for 10 days, Nafcillin IV for 10 days, (OR Vancomycin IV for 10 days) AND Gentamicin IV for 10 days (OR Cefotaxime IV for 10 days)

2.6.2 Definitive therapy

Preferred regimen: Penicillin-G 75,000-150,000 units/kg per day IV divided q8h for 10 days

Neonatal prophylaxis^[67]

Group B streptococcus infection (maternal dose for neonatal prophylaxis)

Preferred regimen: Penicillin-G, Ampicillin 2 g IV initial dose, THEN 1 g q4h until delivery, Cefazolin ≥ 4h prior to delivery

Bacteria – Gram-Positive Bacilli

Actinomycosis Return to Top
Actinomyces species including A. israeli^[68]

Preferred regimen: Penicillin 3-4 million units IV q4h for 2-6 weeks THEN Penicillin V 2-4 g/day PO qid for 6-12 months
Alternative regimen (1): Erythromycin 500-1000 mg IV q6h OR 500 mg PO qid
Alternative regimen (2): Tetracyclin 500 mg PO qid
Alternative regimen (3): Doxycycline 100 mg IV q12h OR 100 mg PO bid
Alternative regimen (4): Clindamycin 900 mg IV q8h OR 300-450 mg PO qd
Alternative regimen (5): Minocycline 100 mg IV q12h OR 100 mg PO bid

Arcanobacterium haemolyticum Return to Top

Arcanobacterium haemolyticum treatment

Preferred regimen: Erythromycin Base: 333 mg PO q8h; estolate/stearate/base: 250-500 mg q6h PO
Alternative regimen: Benzathine Penicillin G 1.2 MU IM q3-4 weeks

Note: Arcanobacterium haemolyticum is sensitivity to most drugs but resistent to Trimethoprim-Sulfamethoxazole

Anthracis

Bacillus anthracis Return to Top

Bacillus anthracis treatment

1. Treatment for cutaneous anthrax, without systemic involvement^[69]

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (1): Ciprofloxacin 500 mg PO bid for 7-10 days

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (2): Doxycycline 100 mg PO bid for 7-10 days

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (3): Levofloxacin 750 mg PO qd for 7-10 days

Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (4): Moxifloxacin 400 mg PO qd for 7-10 days

Alternative regimen (1): Clindamycin 600 mg PO tid for 7-10 days

Alternative regimen (2): Amoxicillin 1 g PO tid (for penicillin-susceptible strains) for 7-10 days

Alternative regimen (3): Penicillin VK 500 mg PO qid (for penicillin-susceptible strains) for 7-10 days

Note: Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.

2. Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck^[69]

2.1 Systemic anthrax with possible/confirmed meningitis

2.1.1 Bactericidal agent (fluoroquinolone)

Preferred regimen (1): Ciprofloxacin 400 mg IV q8h for 2-3 weeks

Preferred regimen (2): Levofloxacin 750 mg IV q24h for 2-3 weeks

Preferred regimen (3): Moxifloxacin 400 mg IV q24h for 2-3 weeks AND

2.1.2 Bactericidal agent (ß-lactam) for all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Meropenem 2 g IV q8h for 2-3 weeks

Preferred regimen (2): Imipenem 1 g IV q6h for 2-3 weeks

Preferred regimen (3): Doripenem 500 mg IV q8h for 2-3 weeks

Preferred regimen (4): Penicillin G 4 MU IV q4h (for penicillin-susceptible strains) for 2-3 weeks

Preferred regimen (5): Ampicillin 3 g IV q6h (for penicillin-susceptible strains) for 2-3 weeks AND

2.1.3 Protein synthesis inhibitor

Preferred regimen (1): Linezolid 600 mg IV q12h for 2-3 weeks

Preferred regimen (2): Clindamycin 900 mg IV q8h for 2-3 weeks

Preferred regimen (3): Rifampin 600 mg IV q12h for 2-3 weeks

Preferred regimen (4): Chloramphenicol 1 g IV q6-8h for 2-3 weeks

Note (1): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.

Note (2): Increased risk for seizures associated with Imipenem/Cilastatin treatment.

Note (3): Linezolid should be used with caution in patients with thrombocytopenia because it might exacerbate it. Linezolid use for > 14 days has additional hematopoietic toxicity.

Note (4): Rifampin is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.

2.2 Systemic anthrax when meningitis has been excluded

2.2.1 Bactericidal agent

Preferred regimen (1): Ciprofloxacin 400 mg IV q8h for 2 weeks

Preferred regimen (2): Levofloxacin 750 mg IV q24h for 2 weeks

Preferred regimen (3): Moxifloxacin 400 mg q24h for 2 weeks

Preferred regimen (4): Meropenem 2 g IV q8h for 2 weeks

Preferred regimen (5): Imipenem 1 g IV q6h for 2 weeks

Preferred regimen (6): Doripenem 500 mg IV q8h for 2 weeks

Preferred regimen (7): Vancomycin 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 µg/mL) for 2 weeks

Preferred regimen (8): Penicillin G 4 MU IV q4h (penicillin-susceptible strains) for 2 weeks

Preferred regimen (9): Ampicillin 3 g IV q6h (penicillin-susceptible strains) for 2 weeks AND

2.2.2 Protein synthesis inhibitor

Preferred regimen (1): Clindamycin 900 mg IV q8h for 2 weeks

Preferred regimen (2): Linezolid 600 mg IV q12h for 2 weeks

Preferred regimen (3): Doxycycline 200 mg IV initially, then 100 mg IV q12h for 2 weeks

Preferred regimen (4): Rifampin 600 mg IV q12h for 2 weeks

Note: Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.

3. Specific considerations

3.1 Treatment of anthrax for pregnant Women

3.1.1 Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis ^[70]

3.1.1.1 A Bactericidal Agent (Fluoroquinolone)

Preferred regimen (1): Ciprofloxacin 400 mg IV q8h for 2–3 weeks OR

Preferred regimen (2): Levofloxacin 750 mg IV q24h for 2–3 weeksOR

3.1.1.2 A Bactericidal Agent (ß-lactam)

3.1.1.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen: Meropenem 2 g q8h for 2–3 weeks

3.1.1.2.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Ampicillin 3 g IV q6h for 2–3 weeks

Alternative regimen (2): Penicillin G 4 MU IV q4h for 2–3 weeks OR

3.1.1.3 A Protein Synthesis Inhibitor

Preferred regimen (1): Clindamycin 900 IV mg q8h for 2–3 weeks

Preferred regimen (2): Rifampin 600 IV mg q12h for 2–3 weeks

Note: At least one antibiotic with transplacental passage is recommended.

3.1.2 Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded

3.1.2.1 A Bactericidal Antimicrobial

Preferred regimen (1): Ciprofloxacin 400 mg IV q8h for 2 weeks

Preferred regimen (2): Levofloxacin 750 mg IV q24h for 2 weeks OR

3.1.2.2 A Bactericidal Agent (ß-lactam)

3.1.2.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen: Meropenem 2 g q8h for 2 weeks OR

3.1.2.2.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Ampicillin 3 g IV q6h for 2 weeks

Alternative regimen (2): Penicillin G 4 MU IV q4h for 2 weeks OR

3.1.2.3 A Protein Synthesis Inhibitor

Preferred regimen (1): Clindamycin 900 IV mg q8h for 2 weeks

Preferred regimen (2): Rifampin 600 IV mg q12h for 2 weeks

3.1.3 Oral antimicrobial treatment for cutaneous anthrax without systemic involvement

3.1.3.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen: Ciprofloxacin 400 mg IV q8h

Note: Duration of treatment is 60 days

3.2 Treatment for anthrax in childern ^[71]

3.2.1 Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)

3.2.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid (not to exceed 500 mg/dose) for 7-10 days

Preferred regimen (2):

If patients body weight is < 45 kg: Doxycycline 4.4 mg/kg/day PO bid (not to exceed 100 mg/dose) for 7-10 days

If patients body weight is = 45 kg: Doxycycline 100 mg/dose PO bid for 7-10 days

Preferred regimen (3): Clindamycin 30 mg/kg/day PO tid (not to exceed 600 mg/dose) for 7-10 days

Preferred regimen (4):

If patients body weight is < 50 kg: Levofloxacin 16 mg/kg/day PO bid (not to exceed 250 mg/dose) for 7-10 days

If patients body weight is > 50 kg: Levofloxacin 500 mg PO qd for 7-10 days

3.2.1.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1):Amoxicillin 75 mg/kg/day PO tid (not to exceed 1 g/dose) for 7-10 days

Alternative regimen (2): Penicillin VK 50-75 mg/kg/day PO tid or qid for 7-10 days

3.2.2 Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)

3.2.2.1 A bactericidal antimicrobial

3.2.2.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q8h (not to exceed 400 mg/dose) for 14 days

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h (not to exceed 2 g/dose) for 14 days

Preferred regimen (3):

If patients body weight is < 50 kg: Levofloxacin 20 mg/kg/day IV divided q12h (not to exceed 250 mg/dose) for 14 days

If patients body weight is > 50 kg: Levofloxacin 500 mg IV q24h for 14 days

Preferred regimen (4): Imipenem/Cilastatin 100 mg/kg/day IV divided q6h (not to exceed 1 g/dose) for 14 days

Preferred regimen (5): Vancomycin 60 mg/kg/day IV divided q8h (follow serum concentrations) for 14 days

3.2.2.1.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Penicillin G 400 000 U/kg/day IV divided q4h (not to exceed 4 MU/dose) for 14 days

Alternative regimen (2): Ampicillin 200 mg/kg/day IV divided q6h (not to exceed 3 g/dose) for 14 days AND

3.2.2.2 A Protein Synthesis Inhibitor

Preferred regimen (1): Clindamycin, 40 mg/kg/day IV divided q8h (not to exceed 900 mg/dose) for 14 days

Preferred regimen (2): (non-CNS infection dose)

If patient is < 12 y old: Linezolid 30 mg/kg/day IV divided q8h for 14 days

If patient is = 12 y old: Linezolid 30 mg/kg/day IV divided q12h (not to exceed 600 mg/dose) for 14 days

Preferred regimen (3):

If patients body weight is < 45 kg: Doxycycline 4.4 mg/kg/day IV loading dose (not to exceed 200 mg) THEN Doxycycline 4.4 mg/kg/day IV divided q12h (not to exceed 100 mg/dose) for 14 days

If patients body weight is =45 kg: Doxycycline 200 mg IV loading dose THEN Doxycycline 100 mg IV given q12h for 14 days

Preferred regimen (4): Rifampin 20 mg/kg/day IV divided q12h (not to exceed 300 mg/dose) for 14 days

Note: Duration of therapy for 14 days or longer until clinical criteria for stability are met. Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.

3.2.3 Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older

3.2.3.1 A bactericidal antimicrobial (fluoroquinolone)

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q8h (not to exceed 400 mg/dose) for 2–3 wks

Preferred regimen (2):

If patients body weight is < 50 kg: Levofloxacin 16 mg/kg/day IV divided q12h (not to exceed 250 mg/dose) for 2–3 wks

If patients body weight is > 50 kg: Levofloxacin 500 mg IV q24h for 2–3 wks

Preferred regimen (3):

If patients age is 3 months to < 2 years: Moxifloxacin 12 mg/kg/day IV, divided q12h (not to exceed 200 mg/dose) for 2–3 wks

If patients age is 2-5 years: Moxifloxacin 10 mg/kg/day IV divided q1h (not to exceed 200 mg/dose) for 2–3 wks

If patients age is 6–11 years: Moxifloxacin 8 mg/kg/day IV divided q12h (not to exceed 200 mg/dose) for 2–3 wks

If patients age is 12–17 years, = 45 kg body weight: Moxifloxacin 400 mg IV q24h for 2–3 wks

If patients age is 12–17 years, < 45 kg body weight: Moxifloxacin 8 mg/kg/day IV divided q12h (not to exceed 200 mg/dose) for 2–3 wks AND

3.2.3.2 A bactericidal antimicrobial (ß-lactam or glycopeptide)

3.2.3.2.1 For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown:

Preferred regimen (1): Meropenem 120 mg/kg/day IV divided q8h (not to exceed 2 g/dose) for 2–3 wks

Preferred regimen (2): Imipenem/Cilastatin 100 mg/kg/day IV divided q6h (not to exceed 1 g/dose) for 2–3 wks

Preferred regimen (3): Doripenem 120 mg/kg/day IV divided q8h (not to exceed 1 g/dose) for 2–3 wks

Preferred regimen (4): Vancomycin 60 mg/kg/day IV divided q8h for 2–3 wks

3.2.3.2.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Penicillin G 400 000 U/kg/day IV divided q4h (not to exceed 4 MU/dose) for 2–3 wks

Alternative regimen (2): Ampicillin 400 mg/kg/day IV divided q6h (not to exceed 3 g/dose) for 2–3 wks AND

3.2.3.3 A Protein Synthesis Inhibitor

Preferred regimen (1):

If patients age is < 12 y old: Linezolid 30 mg/kg/day IV divided q8h for 2–3 wk

If patients age is = 12 y old: Linezolid 30 mg/kg/day,IV divided q12h (not to exceed 600 mg/dose) for 2–3 wk

Preferred regimen (2): Clindamycin 40 mg/kg/day IV divided q8h (not to exceed 900 mg/dose) for 2–3 wk

Preferred regimen (3): Rifampin 20 mg/kg/day IV divided q12h (not to exceed 300 mg/dose) for 2–3 wk

Preferred regimen (4): Chloramphenicol 100 mg/kg/day IV divided q6h for 2–3 wk

Note (1): Duration of therapy for 2–3 wk or greater, until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.

Note (2): A 400-mg dose of Ciprofloxacin IV, provides an equivalent exposure to that of a 500-mg ciprofloxacin oral tablet.

3.2.4 Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)

3.2.4.1 A bactericidal antimicrobial

3.2.4.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid (not to exceed 500 mg/dose)

Preferred regimen (2):

If patients body weight is < 50 kg: Levofloxacin 16 mg/kg/day PO bid (not to exceed 250 mg/dose)

If patients body weight is = 50 kg: Levofloxacin 500 mg PO qd

3.2.4.1.2 Alternatives for penicillin-susceptible strains

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid (not to exceed 1 g/dose)

Alternative regimen (2): Penicillin VK 50–75 mg/kg/day PO tid or qds AND

3.2.4.2 A protein synthesis inhibitor:

Preferred regimen (1):Clindamycin 30 mg/kg/day PO tid (not to exceed 600 mg/dose)

Preferred regimen (2):

If the patients body weight is < 45 kg: Doxycycline 4.4 mg/kg/day PO bid (not exceed 100 mg/dose)

If the patients body weight is = 45 kg: Doxycycline 100 mg PO bid

Preferred regimen (3): (non-CNS infection dose):

If the patients age is < 12 yrs old: Linezolid 30 mg/kg/day PO tid

If the patients age is = 12 yrs old: Linezolid 30 mg/kg/day PO bid (not to exceed 600 mg/dose)

Note: Duration of therapy to complete a treatment course of 14 days or greater. May require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.

3.2.5 Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)

3.2.5.1 Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)

3.2.5.1.1 Bactericidal antimicrobial (fluoroquinolone) therapy

3.2.5.1.1.1 For 32–34 weeks gestational age

For 0–1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 5 mg/kg/day IV q24h for 2–3 weeks

For 1–4 weeks of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 5 mg/kg/day IV q24h for 2–3 weeks

3.2.5.1.1.2 For 34–37 week gestational age

For 0–1 wk of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2):Moxifloxacin 5 mg/kg/day IV q24h for 2–3 weeks

For 1–4 wk of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 5 mg/kg/day IV q24h for 2–3 weeks

3.2.5.1.1.3 Term newborn infant

For 0–1 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 10 mg/kg/day IV q24h for 2–3 weeks

For 1–4 weeks of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Moxifloxacin 10 mg/kg/day IV q24h for 2–3 weeks AND

3.2.5.1.2 A bactericidal antimicrobial (ß-lactam)

3.2.5.1.2.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown:

3.2.5.1.2.1.1 For 32–34 weeks gestational age

For 0–1 week of Age :

Preferred regimen (1): Meropenem 60 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 50 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (3): Doripenem 20 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 wk of Age :

Preferred regimen (1): Meropenem 90 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 75 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Doripenem 30 mg/kg/day IV divided q8h for 2–3 weeks

3.2.5.1.2.1.2 For 34–37 week gestational age

For 0–1 week of Age :

Preferred regimen (1): Meropenem 60 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 50 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (3): Doripenem 20 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of Age :

Preferred regimen (1): Meropenem 90 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 75 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Doripenem 30 mg/kg/day IV divided q8h for 2–3 weeks

3.2.5.1.2.1.3 Term newborn infant

For < 1 week of age

Preferred regimen (1): Meropenem 60 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 50 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (3): Doripenem 20 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of age

Preferred regimen (1): Meropenem 90 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Imipenem 75 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Doripenem 30 mg/kg/day IV divided q8h for 2–3 weeks

3.2.5.1.2.2 Alternatives for penicillin-susceptible strains

3.2.5.1.2.2.1 For 32–34 weeks gestational age

For 0–1 week of age

Alternative regimen (1): Penicillin G 200000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 100 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of age :

Alternative regimen (1): Penicillin G 300000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day divided IV q12h for 2–3 weeks

3.2.5.1.2.2.2 For 34–37 week gestational age

For < 1 week of age

Alternative regimen (1): Penicillin G 300000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 400000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 200 mg/kg/day IV divided q12h for 2–3 weeks

3.2.5.1.2.2.3 Term newborn infant

For 0–1 week of age

Alternative regimen (1): Penicillin G 300000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q12h for 2–3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 400000 Units/kg/day IV divided q12h for 2–3 weeks

Alternative regimen (2): Ampicillin 200 mg/kg/day IV divided q12h for 2–3 weeks AND

3.2.5.1.3 A protein synthesis inhibitor

3.2.5.1.3.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Linezolid 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (2): Clindamycin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 25 mg/kg/day IV q24h for 2–3 weeks

For 1–4 week of age

Preferred regimen (1): Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 50 mg/kg/day IV q12h for 2–3 weeks

3.2.5.1.3.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 25 mg/kg/day IV q24h for 2–3 weeks

For 1–4 week of age

Preferred regimen (1): Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 20 mg/kg/day IV divided q6h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 50 mg/kg/day IV q12h for 2–3 weeks

3.2.5.1.3.3 Term newborn infant

For < 1 week of age

Preferred regimen (1): Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (3): Rifampin 10 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 25 mg/kg/day IV q24h for 2–3 weeks

For 1–4 week of age

Preferred regimen (1): Linezolid 30 mg/kg/day IV divided q8h for 2–3 weeks

Preferred regimen (2): Clindamycin 20 mg/kg/day IV divided q6h for 2–3 weeks

Preferred regimen (3): Rifampin 20 mg/kg/day IV divided q12h for 2–3 weeks

Preferred regimen (4): Chloramphenicol 50 mg/kg/day IV q12h for 2–3 weeks

Note :Duration of therapy for 2–3 weeks, until clinical criteria for stability are met. Will require prophylaxis to complete an antibiotic course of upto 60 days from onset of illness.

3.2.5.2 Therapy for severe anthrax when meningitis can be ruled out

3.2.5.2.1 A bactericidal antimicrobial

3.2.5.2.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.2.1.1.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 40 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 40 mg/kg/day IV divided q12h for 2-3 weeks

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 50 mg/kg/day IV divided q12h for 2-3 weeks

3.2.5.2.1.1.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 50 mg/kg/day IV divided q12h for 2-3 weeks

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 75 mg/kg/day IV divided q8h for 2-3 weeks

3.2.5.2.1.1.3 Term Newborn Infant

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 50 mg/kg/day IV divided q12h for 2-3 weeks

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day IV divided q12h for 2-3 weeks

Preferred regimen (2): Meropenem 60 mg/kg/day IV divided q8h for 2-3 weeks

Preferred regimen (3): Imipenem 75 mg/kg/day IV divided q8h for 2-3 weeks

Vancomycin IV (dosing based on serum creatinine for infants of 32 wk gestational age). Follow vancomycin serum concentrations to modify dose.

If Serum creatinine < 0.7 then Vancomycin 15 mg/kg/dose IV q12h for 2-3 weeks

If Serum creatinine 0.7 -0.9 then Vancomycin 20 mg/kg/dose IV q24h for 2-3 weeks

If Serum creatinine 1–1.2 then Vancomycin 15 mg/kg/dose IV q24h for 2-3 weeks

If Serum creatinine 1.3–1.6 then Vancomycin 10 mg/kg/dose IV q24h for 2-3 weeks

If Serum creatinine > 1.6 then Vancomycin mg/kg/dose IV q48h for 2-3 weeks

Note: Begin treatment with a 20 mg/kg loading dose OR

3.2.5.2.1.2 Alternatives for penicillin-susceptible strains

3.2.5.2.1.2.1 For 32–34 weeks gestational age

For < 1 week of age

Alternative regimen (1): Penicillin G 200000 U/kg/day IV divided q12h for 2-3 weeks

Alternative regimen (2): Ampicillin 100 mg/kg/day IV divided q12h for 2-3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 300000 U/kg/day IV divided q8h for 2-3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q8h for 2-3 weeks

3.2.5.2.1.2.2 For 34–37 week gestational age

For < 1 week of age

Alternative regimen (1): Penicillin G 300000 U/kg/day IV divided q8h for 2-3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q8h for 2-3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 400000 U/kg/day IV divided q6h for 2-3 weeks
Alternative regimen (2): Ampicillin 200 mg/kg/day IV divided q6h for 2-3 weeks

3.2.5.2.1.2.3 Term newborn infant

For < 1 week of age

Alternative regimen (1): Penicillin G 300000 U/kg/day IV divided q8h for 2-3 weeks

Alternative regimen (2): Ampicillin 150 mg/kg/day IV divided q8h for 2-3 weeks

For 1–4 week of age

Alternative regimen (1): Penicillin G 400000 U/kg/day IV divided q6h for 2-3 weeks

Alternative regimen (2):Ampicillin 200 mg/kg/day IV divided q6h for 2-3 weeks

3.2.5.2.2 A protein synthesis inhibitor

3.2.5.2.2.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Clindamycin 10 mg/kg/day IV divided q12h for 2–3 wks

Preferred regimen (2): Linezolid 20 mg/kg/day IV divided q12h for 2–3 wks

Preferred regimen (3): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

For 1–4 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

3.2.5.2.2.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

For 1–4 week of age

Preferred regimen (1): Clindamycin 20 mg/kg/day IV divided q6h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

3.2.5.2.2.3 Term newborn infant

For 0–1 week of age :

Preferred regimen (1): Clindamycin 15 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Doxycycline 4.4 mg/kg/day IV divided q12h, (loading dose 4.4 mg/kg) for 2–3 wks

Preferred regimen (4): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

For 1–4 week of age :

Preferred regimen (1): Clindamycin 20 mg/kg/day IV divided q6h for 2–3 wks

Preferred regimen (2): Linezolid 30 mg/kg/day IV divided q8h for 2–3 wks

Preferred regimen (3): Doxycycline 4.4 mg/kg/day IV divided q12h, (loading dose 4.4 mg/kg) for 2–3 wks

Preferred regimen (4): Rifampin 10 mg/kg/day IV q24h for 2–3 wks

Note: Duration of therapy for 2–3 wks, until clinical criteria for stability are met (see text). Will require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness

3.2.5.3 Oral follow-up combination therapy for severe anthrax

3.2.5.3.1 A bactericidal antimicrobial

3.2.5.3.1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.3.1.1.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen: Ciprofloxacin 20 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen: Ciprofloxacin 20 mg/kg/day PO bid

3.2.5.3.1.1.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen: Ciprofloxacin 20 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen: Ciprofloxacin 20 mg/kg/day PO bid

3.2.5.3.1.1.3 Term newborn infant

For < 1 week of age

Preferred regimen: Ciprofloxacin 30 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen: Ciprofloxacin 30 mg/kg/day PO bid OR

3.2.5.3.1.2 Alternatives for penicillin-susceptible strains

3.2.5.3.1.2.1 For 32–34 weeks gestational age

For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid

Alternative regimen (2): Penicillin VK 50 mg/kg/day PO bid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO bid

Alternative regimen (2): Penicillin VK 75 mg/kg/day PO bid

3.2.5.3.1.2.2 For 34–37 week gestational age

For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid

Alternative regimen (2): Penicillin VK 50 mg/kg/day PO bid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO bid

Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid

3.2.5.3.1.2.3 Term newborn infant

For < 1 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid
Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid or qid

3.2.5.3.2 A protein synthesis inhibitor

3.2.5.3.2.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Clindamycin 10 mg/kg/day PO bid

Preferred regimen (2): Linezolid 20 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day PO bid

Preferred regimen (2): Linezolid 30 mg/kg/day PO bid

3.2.5.3.2.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day PO tid

Preferred regimen (2): Linezolid 30 mg/kg/day PO tid

For 1–4 week of age

Preferred regimen (1): Clindamycin 20 mg/kg/day PO qid

Preferred regimen (2): Linezolid 30 mg/kg/day PO tid

3.2.5.3.2.3 Term newborn infant

For < 1 week of age

Preferred regimen (1): Clindamycin 15 mg/kg/day PO tid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (loading dose 4.4 mg/kg)
Preferred regimen (3): Linezolid 30 mg/kg/day PO tid

For 1–4 week of age

Preferred regimen (1): Clindamycin 20 mg/kg/day PO qid
Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (loading dose 4.4 mg/kg)
Preferred regimen (3): Linezolid 30 mg/kg/day PO tid

Note: Duration of therapy to complete a treatment course of 10–14 days or greater. May require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness.

3.2.5.4 Treatment of cutaneous anthrax without systemic involvement

3.2.5.4.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.2.5.4.1.1 For 32–34 weeks gestational age

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 10 mg/kg/day PO bid

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid
Preferred regimen (2): Clindamycin 15 mg/kg/day PO tid

3.2.5.4.1.2 For 34–37 week gestational age

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 15 mg/kg/day PO tid

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day PO bid

Preferred regimen (2): Clindamycin 20 mg/kg/day PO qid

3.2.5.4.1.3 Term newborn infant

For < 1 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)

Preferred regimen (3): Clindamycin 15 mg/kg/day PO tid

For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day PO bid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)

Preferred regimen (3): Clindamycin 20 mg/kg/day PO qid

3.2.5.4.2 Alternatives for penicillin-susceptible strains

3.2.5.4.2.1 For 32–34 weeks gestational age

For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid
Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid

3.2.5.4.2.2 For 34–37 week gestational age

For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day PO bid
Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO bid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO bid

3.2.5.4.2.3 Term newborn infant

For < 1 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid
Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid

For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day PO tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid or qid
Note : Duration of therapy for naturally acquired infection is 7–10 days and for a biological weapon–related event,may require additional prophylaxis for inhaled spores to complete an antimicrobial course of up to 60 days from onset of illness.

Bacillus anthracis, postexposure prophylaxis

1. For adults^[69]

1.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

Preferred regimen (1): Ciprofloxacin 500 mg IV q12h

Preferred regimen (2): Doxycycline 100 mg IV q12h

Preferred regimen (3): Levofloxacin 750 mg IV q24h

Preferred regimen (4): Moxifloxacin 400 mg IV q24h

Preferred regimen (5): Clindamycin 600 mg IV q8h

1.2 Alternatives for penicillin-susceptible strain

Preferred regimen (1): Amoxicillin 1 g IV q8h

Preferred regimen (2): Penicillin VK 500 mg IV q6h

2. For children = 1 month^[71]

2.1 For penicillin-resistant strains or prior to susceptibility testing

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day, PO, bid (not to exceed 500 mg/dose)

Preferred regimen (2):

If patients body weight < 45 kg: Doxycycline 4.4 mg/kg/day, PO, bid (not to exceed 100 mg/dose)

If patients body weight > 45 kg: Doxycycline 100 mg/dose, PO, bid

Preferred regimen (3): Clindamycin 30 mg/kg/day, PO, tid (not to exceed 900 mg/dose)

Preferred regimen (4):

If patients body weight < 50 kg: Levofloxacin 16 mg/kg/day, PO, bid (not to exceed 250 mg/dose)

If patients body weight > 50 kg: Levofloxacin 500 mg, PO, qd

2.2 For penicillin-susceptible strains

Preferred regimen (1): Amoxicillin 75 mg/kg/day, PO, tid (not to exceed 1 g/dose)

Preferred regimen (2): Penicillin VK 50-75 mg/kg/day, PO, id or tid

Note: Duration of Therapy is 60 days after exposure

3. For children < 1 month

3.1 For all strains, regardless of penicillin susceptibility or if susceptibility is unknown

3.1.1 For 32–34 weeks gestational age

3.1.1.1 For < 1 week of Age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day, PO, bid

Preferred regimen (2): Clindamycin 10 mg/kg/day, PO, bid

3.1.1.2 For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day, PO,bid

Preferred regimen (2): Clindamycin 15 mg/kg/day, PO, tid

3.1.2 For 34–37 week gestational age

3.1.2.1 For < 1 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day, PO, bid

Preferred regimen (2): Clindamycin 15 mg/kg/day, PO, tid

3.1.2.2 For 1–4 week of age

Preferred regimen (1): Ciprofloxacin 20 mg/kg/day, PO, bid

Preferred regimen (2): Clindamycin 20 mg/kg/day, PO, id

3.1.3 Term newborn infant

3.1.3.1 For < 1 week of age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day, PO, bid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day, PO, bid (Loading dose 4.4 mg/kg)

Preferred regimen (3): Clindamycin 15 mg/kg/day, PO, tid

3.1.3.2 For 1–4 week of Age

Preferred regimen (1): Ciprofloxacin 30 mg/kg/day, PO, bid

Preferred regimen (2): Doxycycline 4.4 mg/kg/day, PO, bid (Loading dose 4.4 mg/kg)

Preferred regimen (3): Clindamycin 20 mg/kg/day, PO, qid

3.2 Alternatives for penicillin-susceptible strains

3.2.1 For 32–34 weeks gestational age

3.2.1.1 For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day, PO, bid

Alternative regimen (2): Penicillin Vk 50 mg/kg/day, PO, bid

3.2.1.2 For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day, PO, tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day, PO, tid

3.2.2 For 34–37 week gestational age

3.2.2.1 For < 1 week of age

Alternative regimen (1): Amoxicillin 50 mg/kg/day, PO, bid

Alternative regimen (2): Penicillin Vk 50 mg/kg/day, PO, bid

3.2.2.2 For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day, PO, tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day, PO, tid

3.2.3 Term newborn infant

3.2.3.1 For < 1 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day, PO, tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day, PO, tid

3.2.3.2 For 1–4 week of age

Alternative regimen (1): Amoxicillin 75 mg/kg/day, PO, tid

Alternative regimen (2): Penicillin Vk 75 mg/kg/day, PO, id or tid

Note: Duration of therapy is 60 days from exposure

Bacillus cereus Return to Top

1. Food poisoning^[72]

Preferred regimen: Food poisoning is usually self-limited and requires no antibiotic therapy.

2. Bacteremia

Preferred regimen: Vancomycin 15 mg/kg IV q12h
Alternative regimen: Clindamycin 600 mg IV q8h
Note (1): Bacillus cereus is commonly resistant to beta-lactams.
Note (2): Pseudobacteremia is transient and usually results from contaminated blood cultures, gloves, or syringes.

3. Meningitis or brain abscess

Preferred regimen: Vancomycin 15 mg/kg IV q12h
Alternative regimen: Clindamycin 600 mg IV q8h
Note: Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.

4. Endophthalmitis

Preferred regimen: Clindamycin 450 μg intravitreal AND Gentamicin 400 μg intravitreal OR Dexamethasone intravitreal AND Vancomycin 15 mg/kg IV q12h
Alternative regimen: Clindamycin 600 mg IV q8h
Note: Ophthalmological consultation, culture ocular fluids, early vitrectomy, and intravitreal antibiotics are necessary.

5. Endocarditis

Preferred regimen: Vancomycin 15 mg/kg IV q12h
Note: Most blood cultures in intravenous drug users are contaminates or represent transient bacteremia.

6. Soft tissue infection

Preferred regimen: Vancomycin 15 mg/kg IV q12h
Alternative regimen: Clindamycin 600 mg IV q8h

7. Pneumonia

Preferred regimen: Vancomycin 15 mg/kg IV q12h
Alternative regimen: Clindamycin 600 mg IV q8h

Bacillus subtilis Return to Top

Bacillus subtilis infection treatment^[73]^[74]^[75]

1. Food poisoning

Preferred regimen: supportive treatment

2. Other infections

Preferred regimen: Vancomycin OR Clindamycin
Alternative regimen: Ciprofloxacin OR Imipenem
Note: Distinguish clinically significant infection from contamination before administering antibiotics.

Clostridium botulinum Return to Top

Botulism

1.Foodborne botulism^[76]

1.1 Adult

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min

1.2 Children

1.2.1 Children < 1 year

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (10% of adult dose regardless of body weight)

1.2.1 Children 1-17 years

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (20 – 100% of adult dose)
Note:Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. A patient with severe botulism may require a ventilator as well as intensive medical and nursing care for several months.

2. Infant botulism^[77]

Preferred regimen: BabyBIG, Botulism Immune Globulin Intravenous (Human) (BIG-IV) is for the treatment of patients below one year of age.The recommended total dosage is 1mL/kg (50mg/kg), given as a single IV infusion as soon as the clinical diagnosis of infant botulism is made
Note: infant with botulism must receive supportive care during their recovery. This includes ensuring proper nutrition,keeping the airway clear,watching for respiratory failure and if it develops,ventilator may be needed.

3. Wound botulism

3.1 Adult

Preferred regimen (adult): Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min

3.2 Children

3.2.1 Children < 1 year

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (10% of adult dose regardless of body weight)

3.2.2 Children 1-17 years

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (20 – 100% of adult dose)
Note (1): Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. A patient with severe botulism may require a ventilator as well as intensive medical and nursing care for several months.
Note (2): For wound botulism, antibiotics are used in addition to appropriate debridement.
Note (3): Antibiotic therapy is recommended for wound botulism after antitoxin has been administered. Penicillin G 3 MU IV q4h in adults is frequently used. Metronidazole 500 mg IV q8h may be used as an alternative for penicillin-allergic patients.

Clostridium perfringens Return to Top

Clostridium perfringens ^[78]
Gas gangrene

Preferred regimen: Penicillin G 3-4 million units IV q4h AND (Clindamycin 900 mg IV q8h OR Tetracycline 500 mg IV q6h)^[79]

Clostridium tetani Return to Top

1. General measures

Preferred regimen: Patients should be placed in a quiet shaded area and protected from tactile and auditory stimulation as much as possible; All wounds should be cleaned and debrided as indicated

2. Immunotherapy

Preferred regimen: Human TIG 500 units IV/IM as soon as possible AND Age-appropriate TT-containing vaccine, 0.5 cc IM at a separate site
Note: patients without a history of primary TT vaccination should receive a second dose 1–2 months after the first dose and a third dose 6–12 months later

3. Antibiotic treatment^[80]

Preferred regimen: Metronidazole 500 mg IV/PO q6h OR Penicillin G 100,000–200,000 IU/kg/day IV, administered in 2–4 divided doses
Alternative regimen: Tetracyclines OR Macrolides OR Clindamycin OR Cephalosporins OR Chloramphenicol

4. Muscle spasm control

Preferred regimen: Diazepam 5 mg IV OR Lorazepam 2 mg IV titrating to achieve spasm control without excessive sedation and hypoventilation
Alternative regimen (1): Magnesium sulphate 5 g (or 75mg/kg) IV loading dose, then 2–3 g per hour until spasm control is achieved ± Benzodiazepines
Note: Monitor patellar reflex as areflexia (absence of patellar reflex) occurs at the upper end of the therapeutic range (4mmol/L). If areflexia develops, dose should be decreased
Alternative regimen (2): Baclofen OR Dantrolene 1–2 mg/kg IV/PO q4h
Alternative regimen (3): Barbiturates 100–150 mg q1-4h by any route
Alternative regimen (4): Chlorpromazine 50–150 mg IM q4–8h
Pediatric regimen: Lorazepam 0.1–0.2 mg/kg IV q2–6h, titrating upward as needed; Barbiturates 6–10 mg/kg in children by any route; Chlorpromazine 4–12 mg IM every q4–8h
Note: As for Benzodiazepines, large amounts may be required (up to 600 mg/day); oral preparations could be used but must be accompanied by careful monitoring to avoid respiratory depression or arrest

5. Autonomic dysfunction control

Preferred regimen: Magnesium sulphate OR Morphine OR Esmolol

6. Airway/respiratory control

Note: Drugs used to control spasm and provide sedation can result in respiratory depression. If spasm, including laryngeal spasm, is impeding or threatening adequate ventilation, mechanical ventilation is recommended when possible. Early tracheostomy is preferred as endotracheal tubes can provoke spasm and exacerbate airway compromise.

Clostridium difficile Return to Top

1. Pseudomembranous colitis - mild to moderate^[81]

Preferred regimen:Metronidazole 500 mg PO tid for 10-14 days
Alternative regimen: Vancomycin 125 mg PO qid for 10-14 days
Note: If significant risk of recurrence: Vancomycin 125 mg PO qid for 10-14 days OR Fidaxomicin 200 mg PO bid for 10 days

2. Pseudomembranous colitis - severe^[81]

Preferred regimen: Vancomycin 125 mg PO qid for 10-14 days
Note: If significant risk of recurrence: Vancomycin 125 mg PO qid for 10-14 days OR Fidaxomicin 200 mg PO bid for 10 days

3. Pseudomembranous colitis - severe, complicated^[81]

Preferred regimen: Vancomycin 125-500 mg PO qid for 10-14 days AND Vancomycin 500 mg diluted in 500 ml of saline as enema per rectum q6h AND Metronidazole 500 mg IV q8h
Note: Consider urgent surgical consult

4. Recurrent pseudomembranous colitis^[81]

First recurrence treatment

Preferred regimen: same as first episode or [Fidaxomicin]] 200 mg PO bid for 10 days

Second or more recurrence treatment

Preferred regimen: Vancomycin 125 mg PO qid for 14 days THEN Vancomycin 125 mg PO tid for 7 days THEN Vancomycin 125 mg PO bid for 7 days THEN Vancomycin 125 mg PO qd for 7 days THEN Vancomycin 125 mg PO q48h for 7 days THEN Vancomycin 125 mg PO q72h for 7 days OR Fidaxomicin 200 mg PO bid for 10 days
Note: Consider expert consult for fecal microbiota transplantation

Corynebacterium

Corynebacterium diphtheriae Return to Top

Diphtheria treatment ^[82] ^[83]

1. Antitoxin

1.1 Pharyngeal disease <48 hrs

Preferred regimen: 20,000-40,000 U IV/IM

1.2 Nasopharyngeal

Preferred regimen: 40-60,000 U IV/IM

1.3 Extensive disease, or > 72 hrs

Preferred regimen: 80-120,000 U IV/IM

Note: IV administration for severe disease

2. Antibiotics

Preferred regimen: Erythromycin 40 mg/kg/day (Maximum, 2 gm/day) PO/IV for 14 days
Alternative regimen: Procaine penicillin G 600,000 U/day IM qd for 14 days
Note: Procaine penicillin G 300,000 U/day for those weighing 10 kg or less

3. Preventive antibiotic use

Note: For close contacts, especially household contacts, a diphtheria booster, appropriate for age, should be given
Preferred regimen: Benzathine penicillin G

younger than 6 years old: 600,000 U IM
6 years old and older: 1,200,000 U IM

Alternative regimen: Erythromycin

Adult: 1 g/day PO 7-10 days

Pediatric: 40 mg/kg/day PO 7-10 days

Note (1): If surveillance of contacts cannot be maintained, they should receive benzathine penicillin G
Note (2): Maintain close surveillance and begin antitoxin at the first signs of illness

Corynebacterium jeikeium Return to Top

Corynebacterium jeikeium^[84]

Preferred regimen : Vancomycin 1 gm IV q12h
Alternative regimen : Penicillin G AND Anti pseudomonal aminoglycosides like Tobramycin, Gentamicin, Amikacin

Corynebacterium urealyticum Return to Top

Corynebacterium urealyticum^[85]

1. Post renal transplant obstructive uropathy

Preferred regimen (1): Vancomycin 1 gm IV q12h
Preferred regimen (2): Teicoplanin 6 mg/kg/day IV q24h

Coxiella burnetii Return to Top

Q fever^[86]

1. Acute Q fever

1.1 Adults

Preferred Regimen: Doxycycline 100 mg PO bid for 14 days

1.2 Children

1.2.1 Children with age ≥8 years

Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum 100 mg per dose)

1.2.2 Children with age <8 years with high risk criteria

Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)

1.2.3 Children with age <8 years with mild or uncomplicated illness

Preferred regimen: Doxycycline 2.2 mg/kg PO bid for 5 days (maximum 100 mg per dose).

1.2.3 Children with age < 8 years with mild or uncomplicated illness,who remains febrile past 5 days of treatment

Preferred regimen: Trimethoprim/Sulfamethoxazole 4-20 mg/kg PO bid for 14 days (maximum: 800 mg per dose)

1.3 Pregnant women

Preferred regimen: Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO bid a day throughout pregnancy

2. Chronic Q fever

2.1 Endocarditis or vascular infection

Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for ≥18 months
Note: childern and pregnant women- consultation Recommended

2.2 Noncardiac organ disease

Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid
Note: childern and pregnant women- consultation Recommended

2.3 Postpartum with serologic profile for chronic Q fever

Preferred regimen: Doxycycline 100 mg PO bid AND Hydroxychloroquine 200 mg PO tid for 12 months
Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
Note (2): Post-Q fever fatigue syndrome- no current recommendation.

Ehrlichia Return to Top

1. Human Monocytic Ehrlichiosis or Human Granulocytic Anaplasmosis (adult) ^[87]

Preferred regimen: Doxycycline 100 mg PO/IV q12h for 7-14 days
Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
Alternative regimen (1): Chloramphenicol 500mg PO qid

Alternative regimen (2): Rifampin 600 mg PO/IV qd for 7-10 days

2. Human Monocytic Ehrlichiosis or Human Granulocytic Anaplasmosis (pediatric)

2.1 ≥ 8 years old

Preferred regimen: Doxycycline 2 mg/kg IV/PO q12h (Maximum, 200 mg/day) for 10 days

2.2 < 8 years old without Lyme disease

Preferred regimen: Doxycycline 2 mg/kg IV/PO q12h (Maximum, 200 mg/day) for 4-5 days (or 3 days after resolution of fever)

2.3 co-infected with Lyme disease

Preferred regimen: Doxycycline (see above) THEN Amoxicillin 50 mg/kg/day tid (Maximum, 500 mg/dose) OR Cefuroxime 30 mg/kg/day bid (Maximum, 500 mg/dose) for 14 days

Erysipelothrix rhusiopathiae Return to Top

Erysipelothrix rhusiopathiae ^[88]

1. Erysipeloid of Rosenbach (localized cutaneous infection)

Preferred regimen (1): Penicillin G benzathine 1.2 MU IV single dose
Preferred regimen (2): Penicillin VK 250 mg PO qid for 5-7 days
Preferred regimen (3): Procaine penicillin 0.6-1.2 MU IM qd for 5-7 days
Alternative regimen (1): Erythromycin 250 mg PO qid for 5-7 days
Alternative regimen (2): Doxycycline 100 mg PO bid for 5-7 days

2. Diffuse cutaneous infection

Preferred regimen: See localized infection

3. Bacteremia or endocarditis

Preferred regimen: Penicillin G benzathine 2-4 MU IV q4h for 4-6 weeks
Alternative regimen (1): Ceftriaxone 2 g IV q24h for 4-6 weeks
Alternative regimen (2): Imipenem 500 mg IV q6h for 4-6 weeks
Alternative regimen (3): Ciprofloxacin 400 mg IV q12h for 4-6 weeks
Alternative regimen (4): Daptomycin 6 mg/kg IV q24h for 4-6 weeks
Note: Recommended duration of therapy for endocarditis is 4 to 6 weeks, although shorter courses consisting of 2 weeks of intravenous therapy followed by 2 to 4 weeks of oral therapy have been successful

Listeria monocytogenes Return to Top

1. Meningitis ^[89]

Preferred regimen: Ampicillin 2g IV q4-6h ± Gentamicin 1.7 mg/kg IV q8h for more than 3 weeks

Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) IV q6h for more than 3 weeks

2. Bacteremia

Preferred regimen: Ampicillin 2g IV q4-6h ± Gentamicin 1.7 mg/kg IV q8h for 2 weeks
Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 2 weeks

3. Brain abscess or rhomboencephalitis

Preferred regimen: Ampicillin 2g IV q4-6h ± Gentamicin 1.7 mg/kg IV q8h for 4-6 weeks
Alternative regimen: TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 4-6 weeks

4. Gastroenteritis

Preferred regimen (1): Amoxicillin 2g IV q4-6h
Preferred regimen (2): TMP-SMX 3-5 mg/kg (trimethoprim) q6h IV for 7 days

Lactobacillus Return to Top

1. Endovascular Infection ^[90]

Preferred regiemn (1): Penicillin G 20 MU/day for 6 weeks
Preferred regiemn (2): Gentamicin 1.3 mg/kg IV q8h (trough <1.5 mg/L) AND Polychlorinated naphthalene

2. Odontogenic Infection

Preferred regiemn: Clindamycin 450 mg PO qid

3. Intrabdominal Abscess

Preferred regiemn: Clindamycin 450 mg PO qid

Leuconostoc Return to Top

Leuconostoc ^[91]

Preferred regimen (1): Penicillin G

Preferred regimen (2): Ampicillin

Alternative regimen (1): Clindamycin

Alternative regimen (2): Erythromycin

Alternative regimen (3): Minocycline

Nocardia Return to Top

1. Sulfonamide-based therapies ^[92]

1.1 Pulmonary

Preferred regimen: TMP-SMX 10 mg/kg/day (TMP) IV q6-12h for 3-6 weeks THEN 2 DS PO bid for at least 5 months

1.2 Pulmonary alternatives

Preferred regimen: Sulfisoxazole OR Sulfadiazine OR Trisulfapyrimidine 3-6 g/day PO bid-qid OR TMP-SMX 2 DS bid up to 2 DS tid

1.3 CNS (AIDS, severe or disseminated disease)

Preferred regimen: TMP-SMX 15 mg/kg/day (TMP) IV for 3-6 weeks THEN 3 DS PO bid for 6-12 months

1.4 CNS alternatives

Preferred regimen: Imipenem 1000 mg IV q8h OR Ceftriaxone 2 g IV q12h OR Cefotaxime 2-3 g IV q6h AND Amikacin

1.5 Severe disease, compromised host, multiple sites

Preferred regimen: TMP-SMX 15 mg/kg/day (TMP) IV AND Amikacin 7.5 mg/kg q12h OR Sulfonamide 6-12 mg/day PO

1.6 Sporotrichoid (cutaneous)

Preferred regimen: TMP-SMX 1 DS bid for 4-6 months

Note (1): Immunocompetent medicine use for 6 months; Immunosuppressed medicine for 12 months
Note (2): Treat based on host, site of disease and in vitro activity; Sulfonamide usually preferred, must treat for 6-12 months; Preferred drugs for resistant strains are Amikacin and/or Imipenem
Note (3): Seriously ill usually treated with IV Imipenem or Sulfonamide or Cefotaxime all potentially combined with Amikacin; less seriously ill treated with oral agents— especially TMP-SMX or Minocycline

2. Sulfonamide alternatives

2.1 Severe

Preferred regimen (1): (For AIDS) (Imipenem 1000 mg IV q8h OR Meropenem 2 g q8h AND Amikacin 7.5 mg/kg q12h IV
Preferred regimen (2): Cefotaxime 2-3 g q6-8h OR Ceftriaxone 2 g/day IV ± Amikacin

2.2 Mild

Preferred regimen: Minocycline 100 mg bid for at least 6 months (initial treatment of local disease or maintenance)
Alternative regimen: Amoxicillin clavulanate 875/125 mg bid OR Doxycycline OR Erythromycin OR Clarithromycin OR Linezolid OR Fluoroquinolone OR combinations for at least 6 months

Propionibacterium acnes Return to Top

Propiobacterium acnes ^[93]

1. Systemic infection

Preferred regimen: Penicillin G 2 MU IV q4h for 2-4 weeks
Alternative regimen (1): Clindamycin 600 mg IV q8h for 2-4 weeks

Alternative regimen (2): Vancomycin 15 mg/kg IV q12h for 2-4 weeks

2. Shoulder prosthesis infection

Preferred regimen: Amoxicillin AND Rifampin for 3-6 months

3. Acne vulgaris

Topical antibiotics: Erythromycin OR Clindamycin
Systemic antibiotics: Minocycline OR Doxycycline OR Trimethoprim-Sulfamethoxazole

Rhodococcus equi Return to Top

Rhodococcus equi ^[94]

First line:

Preferred regimen: Vancomycin 1 g IV q12h (15 mg/kg q12 for >70 kg) OR Imipenem 500 mg IV q6h AND Rifampin 600 mg PO qd OR Ciprofloxacin 750 mg PO bid OR Erythromycin 500 mg PO qid for at least 4 weeks or until infiltrate disappears
Note: Should be administrated at least 8 weeks in immunocompromised patients

Oral/maintenance therapy (after infiltrate clears):

Preferred regimen (1): Ciprofloxacin 750 mg PO bid

Preferred regimen (2): Erythromycin 500 mg PO qid

Alternative regimen: Azithromycin OR TMP-SMX OR Chloramphenicol OR Clindamycin
Note: Avoid Penicillins/Cephalosporins due to development of resistance; Linezolid effective in vitro, but no clinical reports of use

Rickettsia prowazekii Return to Top
Rickettsia rickettsii Return to Top

1. Adult ^[95] ^[96]

Preferred regimen: Doxycycline 100 mg q12h
Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement. Standard duration of treatment is 7-14 days
Alternative regimen: Chloramphenicol 500 mg PO qid for 7 days or stop 3 days after defervescence

2. Pediatric (under 45 kg (100 lbs))

Preferred regimen: Doxycycline 2.2 mg/kg bid
Note: The recommended dose and duration of medication needed to treat RMSF has not been shown to cause staining of permanent teeth, even when five courses are given before the age of eight. Healthcare providers should use doxycycline as the first-line treatment for suspected Rocky Mountain spotted fever in patients of all ages

Rickettsia typhi Return to Top

Bacteria – Gram-Negative Cocci and Coccobacilli

Aggregatibacter aphrophilus Return to Top

1. Endocarditis^[97]

1.1 Adults

Preferred regimen (1): Ceftriaxone 2 g/day TV/IM q24h for 4 weeks
Preferred regimen (2): Ampicillin-sulbactam 12 g/day TV q6h for 4 weeks
Preferred regimen (3): Ciprofloxacin 1000 mg PO q24h OR 800 mg/day IV q12h for 4 weeks

1.2 Pediatrics

Preferred regimen (1): Ceftriaxone 100 mg/kg/day TV/IM q24h for 4 weeks
Preferred regimen (2): Ampicillin-sulbactam 300 mg/kg/day TV q6h/q4h for 4 weeks
Preferred regimen (3): Ciprofloxacin 20-30 mg/kg/day IV/PO bid for 4 weeks
Note (1): Floroquinolone therapy recommended for patients unable to tolerate Cephalosporin and ampicillin thearpy
Note (2): For patients < 18 years, Flourouinolones are generally not recommended
Note (3): For patients with endocarditis involving the prosthetic cardiac valve or other prosthetic cardiac material should be treated for 6 weeks

2. Abscess ^[98]

Note: The small number of patients reported and the variety of antibiotics used, do not permit identification of the optimal therapeutic regimen for this organism.

Bordetella pertusis

Bordetella pertussis Return to Top

Bordetella pertussis^[99]

1. Whooping cough

1.1. Adults

Preferred regimen (1): Azithromycin 500 mg PO single dose on day 1 THEN 250 mg PO qd on 2-5 days
Preferred regimen (2): Erythromycin 2 g/day PO qid for 14 days
Preferred regimen (3): Clarithromycin 1 g PO bid for 7 days.
Alternative regimen (intolerant of macrolides): Trimethoprim 320 mg/day AND Sulfamethoxazole 1600 mg/day PO bid for 14 days

1.2. Infants <6 months of age

1.2.1. Infants <1 month

Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
Preferred regimen (2) (if azithromycin unavailable): Erythromycin 40-50 mg/kg/day PO q6h for 14 days
Note: TMP-SMX contraindicated for infants aged < 2 months

1.2.2. Infants of 1-5 months of age

Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
Preferred regimen (2): Erythromycin 40-50 mg/kg/day PO qid for 14 days
Preferred regimen (3): Clarithromycin 15 mg/kg PO bid for 7 days
Alternative regimen: For infants aged ≥ 2 months TMP 8 mg/kg q24h AND SMX 40 mg/kg/day PO bid for 14 days

1.3. Infants ≥6 months of age-children

Preferred regimen (1): Azithromycin 10 mg/kg single dose THEN 5 mg/kg (500 mg Maximum) qd for 2-5 days
Preferred regimen (2): Erythromycin 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days
Preferred regimen (3): Clarithromycin 15 mg/kg PO (1 g daily Maximum) bid for 7 days
Preferred regimen (4): TMP 8 mg/kg/day AND SMX 40 mg/kg/day bid for 14 days

2. Post exposure prophylaxis^[100]

Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
Note (1): Post exposure prophylaxis to an asymptomatic contacts within 21 days of onset of cough in the index patient can potentially prevent symptomatic infection
Note (2): Close contacts include persons who have direct contact with respiratory, oral or nasal secretions from a symptomatic patient (eg: cough, sneeze, sharing food, eating utensils, mouth to mouth resuscitation, or performing a medical examination of the mouth, nose, throat.
Note (3): Some close contacts are at high risk for acquiring severe disease following exposure to pertussis. These contacts include infants aged < 1 year , persons with some immunodeficiency conditions, or other underlying medical conditions such as chronic lung disease, respiratory insufficiency and cystic fibrosis.

Brucella

Brucella Return to Top

Brucellosis ^[101],^[102]

1.Uncomplicated brucellosis in adults and children ≥8yrs of age

Preferred regimen: Doxycycline 100 mg PO bid for 6 weeks AND Streptomycin 1 g/day IM for 2-3 weeks
Alternative regimen (1): Doxycycline 100 mg/day PO for six weeks AND Gentamicin 5mg/kg IM for 7-days
Alternative regimen (2): Gentamicin 5mg/kg/day IV/ IM for 7-10 days AND Rifampicin 600–900 mg/day PO for six weeks

2. Complications of brucellosis

2.1 Spondylitis

Preferred regimen:Doxycycline for 3 months AND Streptomycin for 2 to 3 weeks.

2.2 Neurobrucellosis

Preferred regimen: Ceftriaxone 2 mg IV q12h for 1 month AND Doxycycline 100 mg PO bid for 4-5 month AND Rifampicin 600–900 mg/day PO for 4-5 month

2.3 Brucella endocarditis

Preferred regimen: Doxycycline AND an Aminoglycoside for at least 8 weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
Note: Rifampicin OR Trimethoprim/sulfamethoxazole are used for their ability to penetrate cell membranes

3. Pregnancy

Preferred regimen: Rifampin 900 mg PO qd for 6 weeks
Note: Adding Trimethoprim-sulfamethoxazole can be considered, but this option should probably be avoided preceding the 13th week and after the 36th week of gestation because of concern about teratogenicity and kernicterus.

4.For children < 8 yrs of age

Preferred regimen (1): TMP/SMZ 8/40 mg/ kg/day PO bid for 6 weeks AND Streptomycin 30 mg/kg/day IM q24h for 3 weeks
Preferred regimen (2): Gentamicin 5 mg/kg/day IM/ IV q24h for 7-10 days
Alternative regimen (1): TMP/SMZ AND Rifampicin 15 mg/kg/day PO for 6 weeks
Alternative regimen (2): Rifampicin AND an Aminoglycoside

Eikenella corrodens Return to Top

1. Human bite/soft tissue infections ^[103]

1.1 Severe

Preferred regimen: Ampicillin sulbactam 1.5-3 g IV q6h
Alternative regimen (1): Doxycycline 100 mg IV bid

Alternative regimen (2): Moxifloxacin 400 mg IV q24h

Alternative regimen (3): Levofloxacin 500 mg IV q24h

1.2 Mild

Preferred regimen: Amoxicillin clavulanate 250-500 mg tid or 875/125 mg PO bid
Alternative regimen (1): Doxycycline 100 mg PO bid

Alternative regimen (2): Moxifloxacin 400 mg PO qd

Alternative regimen (3): Levofloxacin 500 mg PO qd

2. Head and neck infections

2.1 Severe

Preferred regimen: Ampicillin sulbactam 1.5-3 g IV q6h
Alternative regimen (1): Doxycycline 100 mg IV bid

Alternative regimen (2): Moxifloxacin 400 mg IV q24h

Alternative regimen (3): Levofloxacin 500 mg IV q24h

2.2 Mild

Preferred regimen: Amoxicillin clavulanate 250-500 mg tid or 875/125 mg PO bid
Alternative regimen (1): Doxycycline 100 mg PO bid

Alternative regimen (2): Moxifloxacin 400 mg PO qd

Alternative regimen (3): Levofloxacin 500 mg PO qd

3. Endocarditis

Preferred regimen (1): Ceftriaxone 1 g IV q12h

Preferred regimen (1): Cefotaxime 1-2 g IV q8h

Preferred regimen (1): Cefepime 1-2g IV q8h

Haemophilus ducreyi

Haemophilus ducreyi Return to Top

1. Chancroid^[104]

Preferred Regimen (1): Azithromycin 1 g PO in a single dose
Preferred Regimen (2): Ceftriaxone 250 mg IM in a single dose
Preferred Regimen (3): Ciprofloxacin 500 mg PO bid for 3 days
Preferred Regimen (4): Erythromycin base 500 mg PO tid for 7 days
Note: Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed 3 months after the diagnosis of chancroid.
1.1 Follow-up

Patients should be re-examined 3–7 days after initiation of therapy. If treatment is successful, ulcers usually improve symptomatically within 3 days and objectively within 7 days after therapy. If no clinical improvement is evident, the clinician must consider whether 1) the diagnosis is correct, 2) the patient is coinfected with another STD, 3) the patient is infected with HIV, 4) the treatment was not used as instructed, or 5) the H. ducreyi strain causing the infection is resistant to the prescribed antimicrobial.
Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might require needle aspiration or incision and drainage, despite otherwise successful therapy. Although needle aspiration of buboes is a simpler procedure, incision and drainage might be preferred because of reduced need for subsequent drainage procedures.

1.2 Management of sex partners

Regardless of whether symptoms of the disease are present, sex partners of patients who have chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patient’s onset of symptoms.

1.3 Pregnancy

Ciprofloxacin presents a low risk to the fetus during pregnancy, with a potential for toxicity during breastfeeding. Alternative drugs should be used during pregnancy and lactation

1.4 HIV Infection

Persons with HIV infection who have chancroid should be monitored closely because they are more likely to experience treatment failure and to have ulcers that heal slowly. Persons with HIV infection might require repeated or longer courses of therapy, and treatment failures can occur with any regimen.

Haemophilus influenzae

Haemophilus influenzae Return to Top

Haemophilus influenzae^[105]

1. Non- life threatening infections^[106]

1.1 Adults

Preferred regimen (1): Amoxicillin-clavulanate 500 mg PO tid or 875 mg PO bid
Preferred regimen (2): Amoxicillin 500 mg PO tid
Preferred regimen (3): TMP-SMX DS PO bid
Preferred regimen (4): Cefuroxime 250-500 mg PO bid
Preferred regimen (5): Moxifloxacin 400 mg PO qd
Preferred regimen (6): Levofloxacin 500 mg PO qd
Preferred regimen (7): Azithromycin 500 mg PO single dose then 250 mg for 4 days

Preferred regimen (8): Clarithromycin 500 mg PO bid or XL 500 mg PO q24h
Note: Treatment duration of otitis media is 10-14 days, acute exacerbation of chronic bronchitis is 5 days (quinolone - 14 days), sinusitis is 10-14 days.

2. Meningitis^[107]

Dexamethasone 0.15 mg/kg 15-20 mins before first dose of antibiotic and then q6h for 4 days

2.1 Adults

Preferred regimen (1): Ceftriaxone 2 g IV q12h (4 g maximum)
Preferred regimen (2): Cefotaxime 2 g IV q4-6h (12 g maximum)
Preferred regimen (3): Ampicillin 2 g IV q4h if sensitive
Alternative regimen: Ciprofloxacin 400 mg IV q8h OR other Fluoroquinolones

2.2 Pediatric

2.2.1 Neonates < 7 days

2.2.1.1 Weight < 2 kg

Preferred regimen: Cefotaxime 50 mg/kg IV q12h for 10-14 days

2.2.1.2 Weight > 2 kg

Preferred regimen (1): Cefotaxime 50 mg/kg IV q8h

Preferred regimen (2): Ceftriaxone 50 mg/kg IV q24h for 10-14 days

2.2.2 Neonates >7 days

2.2.2.1 Weight > 2 kg

Preferred regimen (1): Cefotaxime 50 mg/kg IV q6-8h
Preferred regimen (2): Ceftriaxone 75 mg/kg IV q24h for 10-14 days

2.2.3 Children

Preferred regimen (1): Cefotaxime 200 mg/kg/day IV q6h
Preferred regimen (2): Ceftriaxone 100 mg/kg IV q12-24h for 10-14 days

2.3 Post-meningitis exposure prophylaxis^[108]

Preferred regimen (1): Rifampin 600 mg PO qd for 4 days

3. Severe infections^[109]

3.1 Adults

Preferred regimen (1): Ceftriaxone 1-2 g IV q24 or q12h
Preferred regimen (2): Cefotaxime 2 g IV q6h
Alternative regimen (1): Ciprofloxacin 400 mg IV q8h or other Fluoroquinolones

Alternative regimen (2): Ampicillin 2 g IV q6h if sensitive

Neisseria gonorrhoeae

Neisseria gonorrhoeae Return to Top

Neisseria gonorrhoeae treatment^[110]

1. Gonococcal infections in adolescents and adults

1.1 Uncomplicated gonococcal infections of the cervix, urethra, and rectum

Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
Alternative regimen: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose (if ceftriaxone is not available)

1.2 Uncomplicated gonococcal infections of the pharynx

Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose

1.2.1 Management of sex partners

Expedited partner therapy: Cefixime 400 mg PO in a single dose AND Azithromycin 1 g PO in a single dose
Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.

1.2.2 Allergy, intolerance, and adverse reactions

Preferred regimen (1): Gemifloxacin 320 mg PO in a single dose AND Azithromycin 2 g PO in a single dose
Preferred regimen (2): Gentamicin 240 mg IM in a single dose AND Azithromycin 2 g PO in a single dose
Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).

1.2.3 Pregnancy

Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose

1.2.4 Suspected cephalosporin treatment failure

Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose
Alternative regimen (1): Gemifloxacin 320 mg PO single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
Alternative regimen (2): Gentamicin 240 mg IM single dose AND Azithromycin 2 g PO single dose (when isolates have elevated cephalosporin MICs)
Alternative regimen (3): Ceftriaxone 250 mg IM as a single dose AND Azithromycin 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.

1.3 Gonococcal conjunctivitis

Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1 g PO in a single dose

Note: Consider one-time lavage of the infected eye with saline solution.

1.3.1 Management of sex partners

Patients should be instructed to refer their sex partners for evaluation and treatment.

1.4 Disseminated gonococcal infection

1.4.1 Arthritis and arthritis-dermatitis syndrome

Preferred regimen: Ceftriaxone 1 g IM/IV q24h for 7 days AND Azithromycin 1 g PO in a single dose
Alternative regimen (1): Cefotaxime 1 g IV q8h for 7 days
Alternative regimen (2): Ceftizoxime 1 g IV q8h for 7 days AND Azithromycin 1 g PO in a single dose

1.4.2 Gonococcal meningitis and endocarditis

Preferred regimen: Ceftriaxone 1-2 g IV q 12-24 h for 10-14 days AND Azithromycin 1 g PO in a single dose

2. Gonococcal infections among neonates

2.1 Ophthalmia neonatorum caused by N. gonorrhoeae

Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg

2.1.1 Management of mothers and their sex partners

Mothers of infants with ophthalmia neonatorum caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).

2.2 Disseminated gonococcal infection and gonococcal scalp abscesses in neonates

Preferred regimen (1): Ceftriaxone 25-50 mg/kg/day IM/IV q24h for 7 days
Preferred regimen (2): Cefotaxime 25 mg/kg IM/IV q12h for 7 days.
Note (1): The duration of treatment is 10-14 days if meningitis is documented.
Note (2): Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely.

2.2.1 Management of mothers and their sex partners

Mothers of infants who have DGI or scalp abscesses caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).

2.3 Neonates born to mothers who have gonococcal infection

Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg

2.3.1 Management of mothers and their sex partners

Mothers who have gonorrhea and their sex partners should be evaluated, tested, and presumptively treated for gonorrhea.

3. Gonococcal infections among infants and children

3.1 Infants and children who weigh ≤ 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis

Preferred regimen: Ceftriaxone 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg

3.2 Children who weigh > 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis

Preferred regimen: Ceftriaxone 250 mg IM in a single dose AND Azithromycin 1g PO in a single dose
Alternative regimen: Cefixime 400 mg PO single dose AND Azithromycin 1 g PO single dose.(If ceftriaxone is not available)

3.3 Children who weigh ≤ 45 kg and who have bacteremia or arthritis

Preferred regimen: Ceftriaxone 50 mg/kg (maximum dose: 1 g) IM/IV q24h for 7 days

3.4 Children who weigh > 45 kg and who have bacteremia or arthritis

Preferred regimen: Ceftriaxone 1 g IM/IV q24h for 7 days

Neisseria meningitidis

Neisseria meningitidis Return to Top

1. Meningococcal meningitis or meningococcemia, treatment^[4]^[111]

1.1 Adults

1.1.1 Penicillin MIC < 0.1 mcg/mL

Preferred regimen (1): Penicillin G 4 MU IV q4h for 7 days
Preferred regimen (2): Ampicillin 2 g IV q4h for 7 days
Alternative regimen (1): Ceftriaxone 4 g/day IV q12-24h for 7 days
Alternative regimen (2): Cefotaxime 8-12 g/day IV q4-6h for 7 days
Alternative regimen (3): Chloramphenicol 4-6 g/day IV q6h for 7 days

1.1.2 Penicillin MIC 0.1-1.0 mcg/mL

Preferred regimen (1): Ceftriaxone 4 g/day IV q12-24h for 7 days
Preferred regimen (2): Cefotaxime 8-12 g/day IV q4-6h for 7 days
Alternative regimen (1): Cefepime 2 g IV q8h for 7 days
Alternative regimen (2): Chloramphenicol 4-6 g/day IV q6h for 7 days
Alternative regimen (3): Moxifloxacin 400 mg IV q24h for 7 days
Alternative regimen (4): Meropenem 2 g IV q8h for 7 days

1.2 Neonates (birth-7 days old)

1.2.1 Penicillin MIC < 0.1 mcg/mL

Preferred regimen (1): Penicillin G 0.15 MU/kg/day IV q8-12h for 7 days
Preferred regimen (2): Ampicillin 150 mg/kg/day IV q8h for 7 days
Alternative regimen (1): Cefotaxime 100-150 mg/kg/day IV q8-12h for 7 days
Alternative regimen (2): Chloramphenicol 25 mg/kg/day IV q24h for 7 days

1.2.2 Penicillin MIC 0.1-1.0 mcg/mL

Preferred regimen: Cefotaxime 100-150 mg/kg/day IV q8-12h for 7 days
Alternative regimen: Chloramphenicol 25 mg/kg/day IV q24h for 7 days

1.3 Neonates (8-28 days old)

1.3.1 Penicillin MIC < 0.1 mcg/mL

Preferred regimen (1): Penicillin G 0.2 MU/kg/day IV q6-8h for 7 days
Preferred regimen (2): Ampicillin 200 mg/kg/day IV q6-8h for 7 days
Alternative regimen (1): Cefotaxime 150-200 mg/kg/day IV q6-8h for 7 days
Alternative regimen (2): Chloramphenicol 50 mg/kg/day IV q12-24h for 7 days

1.3.2 Penicillin MIC 0.1-1.0 mcg/mL

Preferred regimen : Cefotaxime 150-200 mg/kg/day IV q6-8h for 7 days
Alternative regimen : Chloramphenicol 50 mg/kg/day IV q12-24h for 7 days

1.4 Infants and children

1.4.1 Penicillin MIC < 0.1 mcg/mL

Preferred regimen (1): Penicillin G 0.3 MU/kg/day IV q4-6h for 7 days
Preferred regimen (2): Ampicillin 300 mg/kg/day IV q6h for 7 days
Alternative regimen (1): Ceftriaxone 80-100 mg/kg/day IV q12-24h for 7 days
Alternative regimen (2): Cefotaxime 225-300 mg/kg/day IV q6-8h for 7 days
Alternative regimen (3): Chloramphenicol 75-100 mg/kg/day IV q6h for 7 days

1.4.2 Penicillin MIC 0.1-1.0 mcg/mL

Preferred regimen (1): Ceftriaxone 80-100 mg/kg/day IV q12-24h for 7 days
Preferred regimen (2): Cefotaxime 225-300 mg/kg/day IV q6-8h for 7 days
Alternative regimen (1): Cefepime 150 mg/kg/day IV q8h for 7 days
Alternative regimen (2): Chloramphenicol 75-100 mg/kg/day q6h for 7 days
Alternative regimen (3): Meropenem 120 mg/kg/day IV q8h for 7 days

Note (1): Dexamethasone has not been shown to be beneficial in meningococcal meningitis and should be discontinued once this diagnosis is established.^[112]^[113]
Note (2): Clinical data are limited on the use of fluoroquinolones for therapy for meningococcal meningitis but may be considered in patients not responding to standard therapy or when disease is caused by resistant organisms.

2. Meningococcal meningitis, prophylaxis for household and close contacts^[114]

2.1 Adults

Preferred regimen (1): Rifampin 600 mg PO bid for 2 days
Preferred regimen (2): Ciprofloxacin 500 mg PO single dose
Preferred regimen (3): Ceftriaxone 250 mg IM single dose

2.2 Children < 15 years

Preferred regimen: Ceftriaxone 12 mg IM single dose

2.3 Children ≥ 1 month

Preferred regimen: Rifampin 10 mg /kg PO bid for 2 days

2.4 Children < 1 month

Preferred regimen: Rifampin 5 mg/kg PO bid for 2 days

Moraxella catarrhalis Return to Top

Moraxella catarrhalis ^[115]

Preferred regimen(1): TMP-SMX 1DS PO bid
Preferred regimen(2): Erythromycin 500 mg PO qid
Preferred regimen(3): Clarithromycin 500 mg PO bid or XL 1 g PO qd
Preferred regimen(4): Azithromycin 500 mg PO single dose THEN 250 mg PO qd
Preferred regimen(5): Doxycycline 100 mg PO/IV bid/q12h
Preferred regimen(6): Cefprozil 200-500 mg PO bid

Preferred regimen(7): Cefpodoxime 200-400 mg PO bid

Preferred regimen(8): Cefuroxime 250-500 mg PO bid

Preferred regimen(9): Cefdinir 300 mg PO bid
Preferred regimen(10): Moxifloxacin 400 mg IV/PO qd

Preferred regimen(11): Levofloxacin 500 mg IV/PO qd
Preferred regimen(12): Amoxicillin clavulanate 875/125 mg PO bid or XL 2000/125 PO bid

Pasteurella multocida Return to Top

Pasteurella multocida ^[116]

Preferred regimen (1): Amoxicillin clavulanate 500 mg PO tid or 875 mg PO bid with food
Note: Its also a preferred empirical coverage of animal bite wounds
Preferred regimen (2): Ampicillin sulbactam 3 g IV q6h
Preferred regimen (3): Ciprofloxacin 500 mg PO bid or 400 mg IV q12h
Preferred regimen (4): Levofloxacin 500 mg PO qd or IV q24h
Alternative regimen (1): Doxycycline 100 mg PO bid
Alternative regimen (2): TMP-SMX DS PO bid (for beta-lactam allergic patients )
Alternative regimen (3): Penicillin 500 mg PO qid or 4 MU IV q4h (use only if isolate known to be susceptible)

Bacteria – Spirochetes

Borrelia burgdorferi Return to Top

Lyme disease ^[117]

1. Early Lyme Disease

1.1 Erythema migrans

1.1.1 Adult

Preferred regimen (1): Doxycycline 100 mg PO bid for 10-21 days
Preferred regimen (2): Amoxicillin 500 mg PO tid for 14-21 days
Preferred regimen (3): Cefuroxime axetil 500 mg bid for 14-21 days
Alternatie regimen (1): Azithromycin 500 mg PO qd for 7–10 days
Alternatie regimen (2): Clarithromycin 500 mg PO bid for 14–21 days (if the patient is not pregnant)

Alternatie regimen (3): Erythromycin 500 mg PO qid for 14–21 days

1.1.2 Pediatric

1.1.2.1 children <8 years of age

Preferred regimen (1): Amoxicillin 50 mg/kg/day PO q8h (Maximum of 500 mg per dose)

Preferred regimen (2): Cefuroxime axetil 30 mg/kg/day PO q12h（Maximum, 500 mg per dose)

1.1.2.2 children ≥8 years of age

Preferred regimen (1): Doxycycline 4 mg/kg/day PO q12h（Maximum, 100 mg per dose）
Preferred regimen (2): Azithromycin 10 mg/kg PO qd (Maximum, 500 mg qd)

Preferred regimen (3): Clarithromycin 7.5 mg/kg PO bid (Maximum, 500 mg per dose)

Preferred regimen (4): Erythromycin 12.5 mg/kg PO qid (Maximum, 500 mg per dose)

1.2 When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis

Preferred regimen: Amoxicillin-Clavulanate 500 mg PO tid
Pediatric regimen: Amoxicillin-Clavulanate 50 mg/kg/day q8h (Maximum, 500 mg per dose)

1.3 Lyme meningitis and other manifestations of early neurologic Lyme disease

1.3.1 Adult

Preferred regimen: Ceftriaxone 2 g IV q24h for 10–28 days
Alternative regimen (1): Cefotaxime 2 g IV q8h
Alternative regimen (2): Penicillin G 18–24 MU q4h (for patients with normal renal function)
Alternative regimen (3): Doxycycline 200–400 mg/day PO bid for 10–28 days

1.3.2 Pediatric

Preferred regimen (1): Ceftriaxone 50–75 mg/kg IV single dose (Maximum, 2 g)
Preferred regimen (2): Cefotaxime 150–200 mg/kg/day IV q6-8h (Maximum, 6 g per day)
Alternative regimen (1): Penicillin G 200,000–400,000 units/kg/day IV q4h (for normal renal function) (maximum, 18–24 MU per day)
Alternative regimen (2): Doxycycline 4–8 mg/kg/day PO bid (maximum, 100–200 mg per dose) (≥8 years old)

1.4 Lyme carditis

Preferred regimen: Ceftriaxone 2 g IV q24h for 10–28 days
Note: patients with advanced heart block, a temporary pacemaker may be required; expert consultation with a cardiologist is recommended; Use of the pacemaker may be discontinued when the advanced heart block has resolved; An oral antibiotic treatment regimen should be used for completion of therapy and for outpatients, as is used for patients with erythema migrans without carditis (see above)

1.5 Borrelial lymphocytoma

Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)

2. Late Lyme Disease

2.1 Lyme arthritis

Preferred regimen (1): Doxycycline 100 mg PO bid

Preferred regimen (2): Amoxicillin 500 mg PO tid
Alternative regimen: Cefuroxime axetil 500 mg PO bid for 28 days
Pediatric regimen: Amoxicillin 50 mg/kg/day tid (Maximum, 500 mg per dose); Cefuroxime axetil 30 mg/kg/day bid (Maximum,500 mg per dose); (≥8 years of age) Doxycycline 4 mg/kg/day bid (Maximum, 100 mg per dose)
Note: For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4 weeks course of Ceftriaxone IV

2.2 patients with arthritis and objective evidence of neurologic disease

Preferred regimen: Ceftriaxone IV for 2–4 weeks
Alternative regimen (1): Cefotaxime IV

Alternative regimen (1): Penicillin G IV
Pediatric regime: Ceftriaxone; Cefotaxime; Penicillin G IV

2.3 Late neurologic Lyme disease

Preferred regimen: Ceftriaxone IV for 2 to 4 weeks
Alternative regimen (1): Cefotaxime IV

Alternative regimen (2): Penicillin G IV
Pediatric regimen: Ceftriaxone; Cefotaxime; Penicillin G

2.4 Acrodermatitis chronica atrophicans

Preferred regimen (1): Doxycycline 100 mg PO bid for 21 days
Preferred regimen (2): Amoxicillin 500 mg PO tid for 21 days
Preferred regimen (3): Cefuroxime axetil 500 mg PO bid for 21 days

3. Post–Lyme Disease Syndromes

Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing)

Borrelia recurrentis Return to Top

1. Tick-Borne Relapsing Fever ^[118]

Preferred regimen: Doxycycline 100 mg PO bid for 5-10 days
Alternative regimen: Erythromycin 500 mg PO qid for 5-10 days
Note: If meningitis/encephalitis present, use Ceftriaxone 2 g IV q12h for 14 days

2. Louse-Borne Relapsing Fever

Preferred regimen: Tetracycline 500 mg PO single dose
Alternative regimen: Erythromycin 500 mg PO single dose

Leptospira Return to Top

1. Severe ^[119] ^[120]

Preferred regimen: Penicillin 1.5 MU IV q6h for 5-7 days

2. Less severe

Preferred regimen (1): Amoxycillin

Preferred regimen (2): Ampicillin

Preferred regimen (3): Doxycycline 100 mg IV/PO q12h/bid for 5-7 days

Preferred regimen (4): Erythromycin

Preferred regimen (5): Ceftriaxone 1 g IV q24h for 5-7 days

Preferred regimen (6): Cefotaxime

Preferred regimen (7): Quinolone PO

Treponema pallidum Return to Top

1. Syphilis Among non-HIV-Infected Persons ^[121]

1.1 Primary and Secondary Syphilis

Preferred regimen: Benzathine penicillin G 2.4 MU IM single dose
Pediatric regimen: Benzathine penicillin G 50,000 U/kg (Maximum, 2.4 MU) IM single dose

1.2 Latent Syphilis

1.2.1 Early Latent Syphilis

Preferred regimen: Benzathine penicillin G 2.4 MU IM in a single dose
Pediatric regimen: Benzathine penicillin G 50,000 U/kg (Maximum, 2.4 MU) IM single dose

1.2.2 Late Latent Syphilis or Latent Syphilis of Unknown Duration

Preferred regimen: Benzathine penicillin G 7.2 MU total, administered as 3 doses of 2.4 MU IM each at 1 week intervals
Pediatric regimen: Benzathine penicillin G 50,000 U/kg IM (Maximum, 2.4 MU), administered as 3 doses at 1 week intervals (total 150,000 U/kg up to the adult total dose of 7.2 MU)

1.3 Tertiary Syphilis

Preferred regimen: Benzathine penicillin G 7.2 MU total, administered as 3 doses of 2.4 MU IM each at 1 week intervals

1.4 Neurosyphilis and ocular syphilis

Preferred regimen: Aqueous crystalline penicillin G 18-24 MU per day, administered as 3-4 MU IV q4h or continuous infusion, for 10-14 days
Alternative regimen: Procaine penicillin 2.4 MU IM q24h AND Probenecid 500 mg PO qid for 10-14 days

2. Syphilis Among HIV-Infected Persons

2.1 Primary and Secondary Syphilis Among HIV-Infected Persons

Preferred regimen: Benzathine penicillin G 2.4 MU IM single dose

2.2 Latent Syphilis Among HIV-Infected Persons

2.2.1 early latent

Preferred regimen: Benzathine penicillin G 2.4 MU IM single dose

2.2.2 late latent

Preferred regimen: Benzathine penicillin G 2.4 MU once a week for 3 weeks

2.3 Neurosyphilis Among HIV-Infected Persons

Preferred regimen: Aqueous crystalline penicillin G 18-24 MU per day, administered as 3-4 MU IV q4h or continuous infusion, for 10-14 days
Alternative regimen: Procaine penicillin 2.4 MU IM q24h AND Probenecid 500 mg PO qid for 10-14 days

3. Syphilis During Pregnancy

Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection

4. Congenital Syphilis in neonates

4.1 condition1: Infants with proven or highly probable disease and (1) an abnormal physical examination that is consistent with congenital syphilis;（2）a serum quantitative nontreponemal serologic titer that is fourfold higher than the mother's titer; or（3）a positive darkfield test of body fluid(s).

Preferred regimen (1): Aqueous crystalline penicillin G 100,000-150,000 U/kg/day, administered as 50,000 U/kg/dose IV q12h during the first 7 days of life and q8h thereafter for a total of 10 days

Preferred regimen (2): Procaine penicillin G 50,000 U/kg/dose IM q24h for 10 days
Note: If more than 1 day of therapy is missed, the entire course should be restarted. Data are insufficient regarding the use of other antimicrobial agents (e.g., ampicillin). When possible, a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis. The use of agents other than penicillin requires close serologic follow-up to assess adequacy of therapy. In all other situations, the maternal history of infection with T. pallidum and treatment for syphilis must be considered when evaluating and treating the infant.

4.2 condition2: Infants who have a normal physical examination and a serum quantitive nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1) mother was not treated, inadequately treated, or has no documentation of having received treatment; (2) mother was treated with erythromycin or another nonpenicillin regimen; or (3) mother received treatment <4 weeks before delivery.

Preferred regimen (1): Aqueous crystalline penicillin G 100,000-150,000 U/kg/day, administered as 50,000 U/kg/dose IV q12h during the first 7 days of life and q8h thereafter for a total of 10 days

Preferred regimen (2): Procaine penicillin G 50,000 U/kg/dose IM q24h for 10 days

Preferred regimen (3): Benzathine penicillin G 50,000 U/kg/dose IM single dose
Note: If the mother has untreated early syphilis at delivery, 10 days of parenteral therapy can be considered

4.3 condition3: Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1) mother was treated during pregnancy, treatment was appropriate for the stage of infection, and treatment was administered >4 weeks before delivery and (2) mother has no evidence of reinfection or relapse.

Preferred regimen: Benzathine penicillin G 50,000 U/kg/dose IM single dose

4.4 condition4: Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1) mother's treatment was adequate before pregnancy; and (2) mother's nontreponemal serologic titer remained low and stable before and during pregnancy and at delivery (VDRL <1:2; RPR <1:4).

No treatment is required
Benzathine penicillin G 50,000 U/kg IM single dose might be considered, particularly if follow-up is uncertain.

5. Congenital Syphilis in infants and children

Preferred regimen: Aqueous crystalline penicillin G 50,000 U/kg q4–6h for 10 days

Bacteria – Gram-Negative Bacilli

Achromobacter xylosoxidans Return to Top

Achromobacter xylosoxidans treatment^[122],^[123],^[124],^[125],^[126],^[127]

Preferred regimen: most active agents are Piperacillin-Tazobactam, Meropenem AND Trimethoprim–Sulfamethoxazole whereas Ceftazidime is more active than Cefepime
Alternative regimen: Colistin inhaled, could also be considered
Note : Achromobacter (formerly Alcaligenes) xylosoxidans is a newly emerging microorganism isolated with increased frequency from the lungs of patients with cystic fibrosis. Combination therapy has been recommended for the treatment of Achromobacter xylosoxidans pulmonary exacerbations in cystic fibrosis

Acinetobacter baumannii

Acinetobacter baumannii Return to Top

Acinetobacter baumannii^[128]

Preferred regimen (1): Imipenem 0.5-1 g IV q6h
Preferred regimen (2): Ampicillin/sulbactam 3 g IV q4h
Preferred regimen (3): Cefepime 1-2 g IV q8h
Preferred regimen (4): Colistin 2.5 mg/kg IV q12h
Preferred regimen (5): Tigecycline 100 mg IV single dose THEN 50 mg IV q12h
Preferred regimen (6): Amikacin 7.5 mg/kg IV q12h or 15 mg/kg IV q24h
Preferred regimen (7) (pan-resistant isolates): Colistin 5 mg/kg/day IV q12h ± Imipenem
Preferred regimen (8) (pan-resistant isolates): Ampicillin-sulbactam 3 g IV q4h
Alternative regimen (1): Ceftriaxone 1-2 g IV qd
Alternative regimen (2): Cefotaxime 2-3 g IV q6-8h
Alternative regimen (3): Ciprofloxacin 400 mg IV q8-12h or 750 mg PO bid
Alternative regimen (4): TMP-SMX 15-20 mg (TMP)/kg/day IV q6-8h or 2 DS PO bid

Aeromonas hydrophila

Aeromonas hydrophila Return to Top

Aeromonas hydrophila ^[129]

1. Diarrhea

Preferred regimen (if not self-limiting, or if severe): Ciprofloxacin 500 mg PO bid.
Alternate regimen: TMP-SMX 1 DS PO bid
Note: High resistance to sulfa agents described in Taiwan and Spain

2. Skin and soft tissue infection

2.1 Mild infection

Preferred regimen (1): Ciprofloxacin 500 mg PO bid
Preferred regimen (2): Levofloxacin 500 mg qd

2.2 Severe infection or sepsis

Preferred regimen (1): Ciprofloxacin 400 mg IV q8h
Preferred regimen (2): Levofloxacin 750 mg IV q24h
Note (1): For suspicion of water-based injury,empiric coverage for Vibrio doxycycline 100 mg bid, although flouroquinolones may also cover and vancomycin 15 mg/kg IV q12h with or without clindamycin or linezolid for inhibition of gram-positive toxin production
Note (2): Alternatives to fluoroquinolones for Aeromonas coverage include carbapenems (ertapenem, doripenem, imipenem or meropenem), ceftriaxone, cefepime and aztreonam

3. Prevention

Preferred regimen: Frequent recommendations include using a Cephalosporin (e.g.,cefuroxime,ceftriaxone or cefixime) OR a Fluoroquinolone (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches
Note (1): Duration of antibiotic use is 3-5 days, some recommend continuing until wound or eschar resolves
Note (2): Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones

Bartonella

Bartonella Return to Top

Bartonella^[130]

1. Bartonella quintana

1.1 Acute or chronic infections without endocarditis^[131]

Preferred regimen: Doxycycline 200 mg PO qd or 100 mg bid for 4 weeks AND Gentamicin 3 mg/kg IV qd for the first 2 weeks

1.2 Endocarditis^[11]

Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks ± Doxycycline 100 mg PO bid for 6 weeks

2. Bartonella elizabethae

2.1 Endocarditis^[11]

Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks ± Doxycycline 100 mg PO bid for 6 weeks

3. Bartonella bacilliformis

3.1 Oroya fever

Preferred regimen: Ciprofloxacin 500 mg PO bid for 14 days
Note: If severe disease, add Ceftriaxone 1 g IV qd for 14 days

3.2 Verruga peruana^[132]

Preferred regimen: Azithromycin 500 mg PO qd for 7 days
Alternative regimen (1): Rifampin 600 mg PO qd for 14-21 days
Alternative regimen (2): Ciprofloxacin 500 mg bid for 7-10 days

4. Bartonella henselae^[133]

4.1 Cat scratch disease

No treatment recommended for typical cat scratch disease, consider treatment if there is an extensive lymphadenopathy
4.1.1 If extensive lymphadenopathy

Preferred regimen (1) (pediatrics): Azithromycin 500 mg PO on day 1 THEN 250 mg PO qd on days 2 to 5
Preferred regimen (2) (adults): Azithromycin 1 g PO at day 1 THEN 500 mg PO for 4 days

4.2 Endocarditis

Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g/day IV for 6weeks ± Doxycycline 100 mg PO bid for 6 weeks

4.3 Retinitis

Preferred regimen: Doxycycline 100 mg bid AND Rifampin 300 mg bid PO for 4-6 weeks

4.4 Bacillary angiomatosis^[134]

Preferred regimen (1): Erythromycin 500 mg PO qid for 2 months at least
Preferred regimen (2): Doxycycline 100 mg PO bid for 2 months at least

4.5 Bacillary Pelliosis^[134]

Preferred regimen (1): Erythromycin 500 mg PO qid for 4 months at least
Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months at least

Bordetella pertussis

Bordetella pertussis Return to Top

Bordetella pertussis^[135]

1. Whooping cough

1.1 Adults

Preferred regimen (1): Azithromycin 500 mg PO single dose on day 1 THEN 250 mg PO qd on 2-5 days
Preferred regimen (2): Erythromycin 2 g/day PO qid for 14 days
Preferred regimen (3): Clarithromycin 1 g PO bid for 7 days.
Alternative regimen (intolerant of macrolides): Trimethoprim 320 mg/day AND Sulfamethoxazole 1600 mg/day PO bid for 14 days

1.2 Infants <6 months of age

1.2.1 Infants <1 month

Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
Preferred regimen (2) (if azithromycin unavailable): Erythromycin 40-50 mg/kg/day PO q6h for 14 days
Note: TMP-SMX contraindicated for infants aged < 2 months

1.2.2 Infants of 1-5 months of age

Preferred regimen (1): Azithromycin 10 mg/kg PO qd for 5 days
Preferred regimen (2): Erythromycin 40-50 mg/kg/day PO qid for 14 days
Preferred regimen (3): Clarithromycin 15 mg/kg PO bid for 7 days
Alternative regimen: For infants aged ≥ 2 months TMP 8 mg/kg q24h AND SMX 40 mg/kg/day PO bid for 14 days

1.3 Infants ≥6 months of age-children

Preferred regimen(1): Azithromycin 10 mg/kg single dose THEN 5 mg/kg (500 mg Maximum) qd for 2-5 days
Preferred regimen(2): Erythromycin 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days
Preferred regimen(3): Clarithromycin 15 mg/kg PO (1 g daily Maximum) bid for 7 days
Preferred regimen(4): TMP 8 mg/kg/day AND SMX 40 mg/kg/day bid for 14 days

2. Post exposure prophylaxis^[136]

Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
Note (1): Post exposure prophylaxis to an asymptomatic contacts within 21 days of onset of cough in the index patient can potentially prevent symptomatic infection
Note (2): Close contacts include persons who have direct contact with respiratory, oral or nasal secretions from a symptomatic patient (eg: cough, sneeze, sharing food, eating utensils, mouth to mouth resuscitation, or performing a medical examination of the mouth, nose, throat.
Note (3): Some close contacts are at high risk for acquiring severe disease following exposure to pertussis. These contacts include infants aged < 1 year , persons with some immunodeficiency conditions, or other underlying medical conditions such as chronic lung disease, respiratory insufficiency and cystic fibrosis.

Burkholderia cepacia

Burkholderia cepacia Return to Top

Burkholderia cepacia complex^[137]

Preferred regimen (1): Ceftazidime 2 g IV q8h
Preferred regimen (2): Imipenem 1 g IV q6h
Preferred regimen (3): Meropenem 1-2 g IV q8h
Preferred regimen (4): Minocycline 100 mg IV/PO bid

Burkholderia pseudomallei

Burkholderia pseudomallei Return to Top

Burkholderia pseudomallei

1. Melioidosis^[138]

1.1 Intial intensive therapy (Minimum of 10-14 days)

Preferred regimen (1): Ceftazidime 50 mg/kg upto 2 g q6h
Preferred regimen (2): Meropenem 25 mg/kg upto 1 g q8h
Preferred regimen (3): Imipenem 25 mg/kg upto 1 g q6h
Note: Any one of the three may be combined with TMP-SMX 6/30 mg/kg upto 320/1600 mg/kg q12h (recommended for neurologic, bone, joint, cutaneous and prostatic melioidosis)

1.2 Eradication therapy (Minimum of 3 months)

Preferred regimen: TMP-SMX 6/30 mg/kg upto 320/1600 mg/kg q12h

Campylobacter fetus

Campylobacter fetus Return to Top

Campylobacter fetus^[139]

1. Gastroenteritis

Preferred regimen: Gentamicin 5 mg/kg IV q24h
Alternative regimen (1): Ampicillin 100 mg/kg IV q6h

Alternative regimen (2): Imipenem 500 mg IV q6h

Campylobacter jejuni Return to Top

Campylobacter jejuni

1. Gastroenteritis^[140]

Most patients donot require antibiotics and symptoms last < 1 week
1.1 Indications for the treatment

Highfevers
Bloodystools
Prolonged illness > 1 week
Pregnancy
HIV and other immunosuppressed states

1.2 Treatment regimen ^[141]

Preferred regimen (1):Erythromycin stearate 500 mg PO bid for 5 days
Preferred regimen (2): Ciprofloxacin 500 mg PO bid for 3–5 days
Alternative regimen (1): TMP-SMX DS PO bid for 3–5 days
Note (1): Campylobacter resistance to TMP-SMX common in tropics
Note (2): Extraintestinal infections should be treated for longer duration (e.g.,2-4 weeks)

Capnocytophaga canimorsus

Capnocytophaga canimorsus Return to Top

Capnocytophaga canimorsus^[142]

1. Severe cellulitis/sepsis or endocarditis

Preferred regimen (1) (Beta-lactam/beta-lactamase inhibitor): Ampicillin/sulbactam 3 g IV q6h
Preferred regimen (2) (Non-beta-lactamase producing): Penicillin G 2-4 MU IV q24h
Alternative regimen (1): Ceftriaxone 1-2 g IV q24h
Alternative regimen (2): Meropenem 1 g IV q8h
Alternative regimen (3) (complicated infections or immunocompromise): Clindamycin 600 mg IV q8h may be combined with above agents
Note (1): Resistance to aztreonam described, and variable susceptibility reported to TMP-SMX and aminoglycosides
Note (2): For endocarditis, alternatives to penicillins not well established, treated for duration of 6 weeks
Note (3): For non-endocarditis infections, duration not well established, but most authorities recommend at least 14-21 days of therapy

2. Mild cellulitis/dog or cat bites

Preferred regimen (1): Amoxicillin/clavulanate 500 mg PO q8h or 875 mg PO bid
Preferred regimen (2): Amoxicillin 500 mg PO q8h
Alternative regimen (1): Clindamycin 300 mg PO q6h
Alternative regimen (2): Doxycycline 100 mg PO bid
Alternative regimen (3): Clarithromycin 500 mg PO bid
Alternative regimen (4): Moxifloxacin 400 mg PO qd

3. Meningitis or brain abscess

Preferred regimen (1): Ceftriaxone 2 g IV q12h AND Ampicillin 2 g IV q4h
Preferred regimen (2) (if beta-lactamase producing or polymicrobial brain abscess): Imipenem/Cilastin 1000 mg q6-8h AND Clindamycin 600 mg IV q8h

4. Prevention

Although no firm data supports this recommendation, many clinicians do give prophylaxis for dog and cat bites in asplenic patients with Amoxicillin/clavulanate for 7-10 days.

Citrobacter freundii

Citrobacter freundii Return to Top

Citrobacter freundii^[143]

Preferred regimen (1): Meropenem 1-2 g IV q8h
Preferred regimen (2): Imipenem 1 g IV q6h
Preferred regimen (3): Doripenem 500 mg IV q8h
Preferred regimen (4): Cefepime 1-2 g IV q8h
Preferred regimen (5): Ciprofloxacin 400 mg IV q12h or 500 mg PO bid for UTI
Preferred regimen (6): Gentamicin 5 mg/kg IV q24h
Alternate regimen (1): Piperacillin-tazobactam 3.375 mg IV q6h
Alternate regimen (2): Aztreonam 1-2 g IV q6h
Alternate regimen (3): TMP-SMX 5 mg/kg q6h IV or DS PO bid for UTI
Note: Usually carbenicillin sensitive, cephalothin resistant

Citrobacter koseri

Citrobacter koseri Return to Top

Citrobacter koseri^[144]

Preferred regimen (1): Ceftriaxone 1-2 g IV q12-24h
Preferred regimen (2): Cefotaxime 1-2 g IV q6h
Preferred regimen (3): Cefepime 1-2 IV q8h
Alternate regimen (1): Ciprofloxacin 400 mg IV q12h or 500 mg PO q12h for UTI
Alternate regimen (2): Imipenem 1 g IV q6h
Alternate regimen (3): Doripenem 500 mg IV q8h
Alternate regimen (4): Meropenem 1-2 g IV q8h
Alternate regimen (5): Aztreonam 1-2 g IV q6h
Alternate regimen (6): TMP-SMX 5 mg/kg IV q6h or DS PO bid for UTI
Note: Usually Ampicillin resistant, but may be sensitive to first generation cephalosporins

Elizabethkingia meningoseptica Return to Top

1. Bacteremia^[145]^[146]

Preferred regimen (1): Levofloxacin 750 mg IV/PO q24h
Preferred regimen (2): TMP-SMX 8–10 mg/kg/day IV divided q6–8h
Alternative regimen (1): Ciprofloxacin 400 mg IV q12h
Alternative regimen (2): TMP-SMX 8–10 mg/kg/day IV divided q6–8h

Enterobacter

Enterobacter Return to Top

Enterobacter species including E. aerogenes and E. cloacae^[147]^[148]^[149]^[150]^[151]

1. Empiric antimicrobial therapy pending in vitro susceptibility

1.1 Non–life-threatening infections or MDR-GNB prevalence < 20%

Preferred regimen: Piperacillin-Tazobactam 3.375 g IV q6h ± Aminoglycosides
Alternative regimen: Ciprofloxacin 400 mg IV q8–12h

1.2 Life-threatening infections or MDR-GNB prevalence > 20%

Preferred regimen: Meropenem 0.5–1 g IV q8h
Alternative regimen (1): Colistin AND Meropenem 0.5–1 g IV q8h
Alternative regimen (2): Colistin AND Imipenem 500 mg IV q6h
Alternative regimen (3): Colistin AND Doripenem 500 mg IV q8h
Alternative regimen (4): Colistin AND Ertapenem 1 g IV q24h
Alternative regimen (5): Colistin AND Fosfomycin 6 g IV q6h

2. In vitro susceptibility available

2.1 Susceptible to all tested agents

Preferred regimen: Piperacillin-Tazobactam 3.375 g IV q6h
Alternative regimen (1): Ciprofloxacin 400 mg IV q8–12h
Alternative regimen (2): Cefepime 2 g IV q8h (if MIC ≤ 1 μg/mL)

2.2 Extended spectrum beta-lactamase (ESBL)-producing Enterobacter spp.

Preferred regimen: Meropenem 0.5–1 g IV q8h
Alternative regimen (1): Imipenem 500 mg IV q6h
Alternative regimen (2): Doripenem 500 mg IV q8h
Alternative regimen (3): Ertapenem 1 g IV q24h
Alternative regimen (4): Cefepime 2 g IV q8h (if MIC ≤ 1 μg/mL)

2.3 Resistant to all tested agents

Preferred regimen: Colistin AND Meropenem 0.5–1 g IV q8h
Alternative regimen (1): Colistin AND Imipenem 500 mg IV q6h
Alternative regimen (2): Colistin AND Doripenem 500 mg IV q8h
Alternative regimen (3): Colistin AND Ertapenem 1 g IV q24h
Alternative regimen (4): Colistin AND Minocycline 100 mg IV q12h

Escherichia coli

Escherichia coli Return to Top

Escherichia coli^[152]

1. Meningitits

Preferred regimen (1): Ceftriaxone 4 g IV q12–24h
Preferred regimen (2): Cefotaxime 8–12 g/day IV q4–6h
Alternative regimen (1): Aztreonam 6–8 g/day IV q6–8h
Alternative regimen (2): Gatifloxacin 400 mg/day IV q24h
Alternative regimen (3): Moxifloxacin 400 mg/day IV q24h
Alternative regimen (4): Meropenem 6 g/day IV q8h
Alternative regimen (5): Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day IV q6–12h
Alternative regimen (6): Ampicillin 12 g/day IV q4h

2. Uncomplicated urinary tract infection^[153]

Preferred agents (IDSA/AUA Guidelines): TMP-SMX DS PO bid for 3 days
Alternative regimen (1): Ciprofloxacin 250 mg PO bid
Alternative regimen (2): Ciprofloxacin 500 mg XR qd for 3 days
Alternative regimen (3): Levofloxacin 250 mg PO qd for 3 days.
Alternative regimen (4): Nitrofurantoin 100 mg PO q6h
Alternative regimen (5): Nitrofurantoin macrocrystals 100 mg PO bid for 7 days
Alternative regimen (6): Fosfomycin 3 g sachet PO single dose
Note: For older patients, those with comorbidities (e.g., diabetes mellitus) use 7-10 days course.

3. Pyelonephritis

3.1 Acute uncomplicated pyelonephritis^[154]

Preferred regimen (1): Ciprofloxacin 500 mg bid PO for 5-7 days
Preferred regimen (2): Ciprofloxacin-Erythromycin 1000 mg q24h
Preferred regimen (3): Levofloxacin 750 mg q24h
Preferred regimen (4): Ofloxacin 400 mg bid
Preferred regimen (5): Moxifloxacin 400 mg q24h
Alternative regimen (1): Amoxicillin-Clavulanic acid 875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid
Alternative regimen (2): Oral Cephalosporins
Alternative regimen (3): TMP-SMX 2 mg/kg IV q6h PO for 14 days

3.2 Acute pyelonephritis (Hospitalized)^[155]

Preferred regimen (1): Ciprofloxacin 400 mg IV q12h
Preferred regimen (2): Ampicillin and Gentamicin
Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q4-6h for 14 days
Alternative regimen (1): Ticarcillin-Clavulanate 3.1 g IV q6h
Alternative regimen (2): Ampicillin-Sulbactam 3 g IV q6h
Alternative regimen (3): Piperacillin-Tazobactam 3.375 g IV q4-6h
Alternative regimen (4): Ertapenem 1 g IV q24h
Alternative regimen (5): Doripenem 500 mg q8h for 14 days

4. Traveler’s diarrhea^[156]

4.1 Prophylaxis

Preferred regimen (1): Bismuth subsalicylate two chewable tablets qid

Preferred regimen (2): Norfloxacin 400 mg PO qd

Preferred regimen (3): Ciprofloxacin 500 mg PO qd

Preferred regimen (4): Rifaximin 200 mg PO qd or bid

4.2 Symptomatic treatment

Preferred regimen (1): Bismuth subsalicylate 1 oz PO every 30 min for 8 doses

Preferred regimen (2): Loperamide 4 mg PO then 2 mg after each loose stool not to exceed 16 mg daily

4.3 Antibiotic treatment

Preferred regimen (1): Fluoroquinolones, Norfloxacin 400 mg PO bid

Preferred regimen (2): Ciprofloxacin 500 mg PO bid

Preferred regimen (3): Ofloxacin 200 mg PO bid

Preferred regimen (4): Levofloxacin 500 mg PO qd

Preferred regimen (5): Azithromycin 1000 mg PO single dose

Preferred regimen (6): Rifaximin 200 mg PO tid

5. Malacoplakia^[157]

Preferred regimen (1): Bethanechol chloride AND Ciprofloxacin 400 mg IV q12h
Preferred regimen (2): Bethanechol chloride AND TMP-SMX 2 mg/kg (TMP component IV q6h)

6. Bacteremia/pneumonia^[158]

Preferred regimen (1): Ceftriaxone 1-2 g IV q24h
Preferred regimen (2): Ciprofloxacin 400 mg IV q12h or 500 mg PO q12h
Preferred regimen (3): Levofloxacin 500 mg PO/IV q24h
Preferred regimen (4): Moxifloxacin 400 mg IV/PO q24h
Preferred regimen (5): Ampicillin 2 g IV q6h (if sensitive)
Preferred regimen (6): TMP-SMX 5-10 mg/kg/day for q6-8h IV (if sensitive)
Alternative regimen (1): Imipenem, Meropenem, Ertapenem, Doripenem; Ceftazidime, Cefepime; Cefazolin or Cefuroxime (if sensitive); Aztreonam; Ticarcillin, Piperacillin; Piperacillin-Tazobactam
Alternative regimen (2): Ampicillin-sulbactam 3 g IV q6h AND (Gentamicin 1.5 mg/kg IV q8h or 5-7 mg/kg/day IV OR Tobramycin 5 mg/kg/day IV)
Note (1): A 7- to 14-day course of antibiotic therapy is usually recommended.
Note (2): The choice of antimicrobial agents should be based on susceptibility results.
Note (3): Monotherapy with aminoglycosides is generally not recommended for bacteremia or pneumonia.

Francisella tularensis

Francisella tularensis Return to Top

Francisella tularensis^[159]

1. Tularemia

Preferred regimen (1): Streptomycin 1 g IM bid
Preferred regimen (2): Gentamicin 5 mg/kg IV q24h for 10 days
Preferred regimen (3) (pregnancy): Gentamicin 5 mg/kg IV q24h for 10 days
Alternative regimen (1): Doxycycline 100 mg IV bid
Alternative regimen (2): Chloramphenicol 1 g IV q6h
Alternative regimen (3): Ciprofloxacin 400 mg IV bid until stable THEN PO for 14-21 days (total)

Helicobacter pylori

Helicobacter pylori Return to Top

1. Peptic ulcer disease^[160]

In patients aged 55 years or younger with no alarm features, two management options may be considered:
1.1 Indications for eradication therapy

In moderate to high prevalence of H. pylori infection (≥ 10%): Test-and-treat strategy using a validated noninvasive test (urea breathing test or stool antigen test)
In low prevalence situations: Treatment indicated after the empiric trial of acid suppression with a proton pump inhibitor for 4–8 weeks

1.2 Proton pump inhibitors (PPI)

Preferred regimen (1): Lansoprazole 30 mg q12h
Preferred regimen (2): Omeprazole 20 mg q12h
Preferred regimen (3): Esomeprazole 40 mg q24h
Preferred regimen (4): Rabeprazole 20 mg q12h

1.3 Regimens for Initial Treatment

1.3.1 Triple therapy

Preferred regimen (1): Proton pump inhibitor standard dose bid AND Amoxicillin 1 g bid AND Clarithromycin 500 mg bid for 7-14 days
Preferred regimen (2): Proton pump inhibitor standard dose bid AND Amoxicillin 1 g bid AND Metronidazole 500 mg bid for 7-14 days
Preferred regimen (3) (Levofloxacin triple therapy): Proton pump inhibitor standard dose bid AND Amoxicillin 1 g bid AND Levofloxacin 500 mg bid for 10 days
Preferred regimen (4) (Rifabutin triple therapy): Proton pump inhibitor standard dose bid AND Amoxicillin 1 g bid AND Rifabutin 150-300 mg/day for 10 days

1.3.2 Quadruple therapy

Preferred regimen (1): Proton pump inhibitor standard dose bid AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
Preferred regimen (2) non-bismuth quadruple therapy (concomitant therapy): Proton pump inhibitor (standard dose twice daily) for 7–14 days AND Clarithromycin 500 mg bid for 7–14 days AND Amoxicillin 1 g bid for 10 days AND Metronidazole 250 mg qid for 7–14 days

1.3.3 Sequential therapy

Preferred regimen: Proton pump inhibitor standard dose bid AND Amoxicillin 1 g bid for 1-5 days followed by Proton pump inhibitor standard dose bid AND Clarithromycin 500 mg bid AND Tinidazole 500 mg bid for 6-10 days

Note: Alternative triple therapies appropriate for patients with an allergy to Amoxicillin include (Proton pump inhibitor and Clarithromycin and Metronidazole) or (Proton pump inhibitor and Tetracycline and Metronidazole)

1.5 Clarithromycin resistance

1.5.1 Clarithromycin resistance ≥ 20%

Preferred regimen (1) (bismuth quadruple therapy): Proton pump inhibitor standard dose bid AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
Preferred regimen (2) (sequential therapy): Proton pump inhibitor standard dose bid AND Amoxicillin 1 g bid for 1-5 days followed by Proton pump inhibitor standard dose bid AND Clarithromycin 500 mg bid AND Tinidazole 500 mg bid for 6-10 days
Preferred regimen (3) non-bismuth quadruple therapy (concomitant therapy): Proton pump inhibitor (standard dose twice daily) for 7–14 days AND Clarithromycin 500 mg bid for 7–14 days AND Amoxicillin 1 g bid for 10 days AND Metronidazole 250 mg qid for 7–14 days
Alternative regimen: Proton pump inhibitor standard dose bid AND Amoxicillin 1 g bid AND Levofloxacin 500 mg bid for 10 days

1.5.2 Clarithromycin resistance < 20%

Preferred regimen (1): Proton pump inhibitor standard dose bid for 7-14 days AND Clarithromycin 500 mg bid for 7–14 days AND Amoxicillin 1 g bid for 7–14 days OR Metronidazole 250 mg qid for 7–14 days
Preferred regimen (2): Proton pump inhibitor standard dose bid AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
Alternative regimen (1):Proton pump inhibitor standard dose bid AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
Alternative regimen (2): Proton pump inhibitor standard dose bid for 10 days AND Levofloxacin 500 mg bid for 10 days AND Amoxicillin 1 g bid for 10 days

Klebsiella granulomatis

Klebsiella granulomatis Return to Top

Klebsiella granulomatis (formly known as Calymmatobacterium granulomatis)

1. Granuloma inguinale (donovanosis)^[161]

Preferred regimen: Azithromycin 1 g PO once a week or 500 mg qd for 3 weeks THEN until all lesions have completely healed
Alternative regimen (1): Doxycycline 100 mg PO bid for 3 weeks THEN until all lesions have completely healed
Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks THEN until all lesions have completely healed
Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks THEN until all lesions have completely healed
Alternative regimen (4): Trimethoprim-sulfamethoxazole DS (160 mg/800 mg) tablet PO bid for at least 3 weeks THEN until all lesions have completely healed

Klebsiella pneumoniae

Klebsiella pneumoniae Return to Top

Klebsiella pneumoniae^[162]

1. Severe, nosocomial infections

1.1 Non-ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections

Preferred regimen (1): Cefepime 2 g IV q8h
Preferred regimen (2): Ceftazidime 2 g IV q8h
Preferred regimen (3): Imipenem 500 mg IV q6h
Preferred regimen (4): Meropenem 1 g IV q8h
Preferred regimen (5): Piperacillin-tazobactam 4.5 g IV q6h AND Aminoglycoside
Alternative regimen (1): Ceftriaxone 1 g IV q24h AND Metronidazole 500 mg IV q6h or 1 g IV q12h
Alternative regimen (2): Moxifloxacin 400 mg IV/PO q24h

1.2 ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections

Preferred regimen (1): Imipenem 500 mg IV q6h
Preferred regimen (2): Meropenem 1 g IV q8h
Preferred regimen (3): Ertapenem 1 g IV q24h
Preferred regimen (4): Doripenem 500 mg IV q8h
Note: In ESBLs, inconsistent activity is seen with aminoglycosides, fluoroquinolones, and piperacillin-tazobactam. Avoid cephalosporins.

Klebsiella rhinoscleromatis

Klebsiella rhinoscleromatis Return to Top

1. Rhinoscleroma^[163]^[164]^[165]

Preferred regimen (1): Ciprofloxacin 500–750 mg PO bid for 2–3 months
Preferred regimen (2): Levofloxacin 750 mg PO qd for 2–3 months
Preferred regimen (3): Trimethoprim-Sulfamethoxazole 1 DS tab PO bid for 3 months AND Rifampicin 300 mg PO bid for 3 months
Alternative regimen: Tetracycline OR Streptomycin OR Doxycycline OR Ceftriaxone OR Ofloxacin
Note (1): The optimal duration of antimicrobial therapy remains unclear. A 6-week to 6-month course of antibiotics until histology exams and cultures are negative may be required.
Note (2): Use of topical antiseptics such as Acriflavinium and Rifampin ointment has been reported with resolution of symptoms.^[166]

Legionella pneumophila

Legionella pneumophila Return to Top

1.Atypical pneumonia (Legionnaires' disease )^[167]

1.1 Mild pneumonia inpatient or outpatient, non immunocompromised

Preferred regimen (1): Azithromycin 500 mg PO qd for 3-5 days
Preferred regimen (2): Levofloxacin 500 mg PO qd for 7-10 days
Preferred regimen (3): Ciprofloxacin 500 mg PO bid for 7-10 days
Preferred regimen (4): Moxifloxacin 400 mg PO qd for 7-10 days
Preferred regimen (5): Clarithromycin 500 mg PO bid for 10-14 days
Alternative regimen (1): Doxycycline 200 mg PO loading dose, then 100 mg PO bid for 10-14 days
Alternative regimen (2): Erythromycin 500 mg PO qid for 10-14 days
Note: Patients with mild disease may be treated entirely with oral therapy.

1.2 Moderate to severe pneumonia or immunocompromised

Preferred regimen (1): Azithromycin 500 mg PO/IV q24h for 5-7 days
Preferred regimen (2): Levofloxacin 500 mg PO/IV q24h for 7-10 days OR 750 mg PO/IV q24h for 5-7 days
Alternative regimen (1): Ciprofloxacin 750 mg PO bid for 14 days
Alternative regimen (2): Moxifloxacin 400 mg PO qd for 14 days
Alternative regimen (3): Erythromycin 750-1000 mg IV q6h for 3-7 days, then 500 mg PO qid for a total course of 21 days
Alternative regimen (4): Clarithromycin 500 mg IV q12h for 3-7 days, and then 500 mg PO bid for a total course of 21 days
Note: Severely ill patients parenteral therapy is advised until improvement is seen and oral absorption is sufficient.

2 Pontiac fever

Pontiac fever is febrile, self-limited form of Legionella infection which requires only symptomatic therapy, such as analgesics for headache. Antibiotics are not indicated.

Moraxella catarrhalis

Moraxella catarrhalis Return to Top

Moraxella catarrhalis^[168]

Preferred regimen (1): TMP-SMX 1DS PO bid
Preferred regimen (2): Erythromycin 500 mg PO q6h
Preferred regimen (3): Clarithromycin 500 mg bid or XL 1 g PO qd
Preferred regimen (4): Azithromycin 500 mg single dose THEN 250 mg PO qd
Preferred regimen (5): Doxycycline 100 mg PO/IV bid
Preferred regimen (6): Parenteral cephalosporins such as Cefuroxime OR Cefotaxime OR Ceftriaxone
Preferred regimen (7): Cefprozil 200-500 mg PO bid
Preferred regimen (8): Cefpodoxime 200-400 mg PO bid
Preferred regimen (9): Cefuroxime 250-500 mg PO bid
Preferred regimen (10): Cefdinir 300 mg bid
Preferred regimen (11): Moxifloxacin 400 mg IV/PO qd
Preferred regimen (12): Levofloxacin 500 mg IV/PO qd
Preferred regimen (13): Amoxicillin-Clavulanate 875/125 mg PO bid or XL 2000/125 PO bid

Morganella morganii

Morganella morganii Return to Top

Morganella morganii^[169]

Preferred regimen (1): Imipenem 500 mg IV q6h
Preferred regimen (2): Meropenem 1.0 g IV q8h (adjust dose if necessary for renal function).
Note (1): Carbapenems are considered first line therapy due to inducible cephalosporinases, and presence of extended-spectrum beta-lactamases in some isolates
Note (2): Duration of treatment for UTI (generally complicated) is 7 days and duration of treatment for bacteremia is 14 days
Note (3): Tigecycline is not reliably effective
Alternative Regimen (1): Cefepime 2.0 g IV q8-12h
Alternative Regimen (2): Ciprofloxacin 500 mg PO/400 mg IV q12h
Alternative Regimen (3): Piperacillin 3 g IV q6h
Alternative Regimen (4): Ticarcillin 3 g IV q4h
Alternative Regimen (5): Gentamicin
Alternative Regimen (6): Tobramycin 1 mg/kg IV q24h
Alternative Regimen (7): Amikacin 3 mg/kg IV q24h
Note: Aminoglycosides can be used alone for treatment of UTI

Plesiomonas shigelloides

Plesiomonas shigelloides Return to Top

Plesiomonas shigelloides^[170]

1. Immunocompetent hosts or severe Infection

Preferred regimen: Ciprofloxacin 500 mg PO bid or 400 mg IV q12h
Alternative regimen (1): Ofloxacin 300 mg PO bid
Alternative regimen (2): Norfloxacin 400 mg PO bid
Alternative regimen (3): TMP-SMX DS PO bid for 3 days
Alternative regimen (4): Ceftriaxone 1-2 g IV qd in severe cases

2. Immunocompromised hosts

Preferred regimen: Ciprofloxacin 500 mg PO bid for 3 days
Alternative regimen (1): Ofloxacin 300 mg PO bid
Alternative regimen (2): Norfloxacin 400 mg PO bid
Alternative regimen (3): TMP-SMX DS PO bid for 3 days if susceptible

Proteus mirabilis

Proteus mirabilis Return to Top

Proteus mirabilis^[171]

Preferred regimen (1): Ampicillin 500 mg PO q6h or 2 g IV q6h
Preferred regimen (2): Cefuroxime 250 mg PO bid or 750 mg IV q8h
Preferred regimen (3): Ciprofloxacin 250-500 mg PO bid or 400 mg IV q12h
Preferred regimen (4): Levofloxacin 500 mg PO OD or 500 mg IV q24h
Note: Duration of treatment for uncomplicated UTI 3 days, pyelonephritis 7-14 days, complicated UTI 10-21 days and bacteremia is 7-14 days

Indole positive Proteus species

Indole positive Proteus species^[172]

Preferred regimen (1): Ceftriaxone 1 g IV q24h
Preferred regimen (2): Imipenem 500 mg IV q6h
Preferred regimen (3): Ciprofloxacin 400 mg IV q12h or 250-500 mg PO bid
Preferred regimen (4): Levofloxacin 500 mg IV/PO q24h

Providencia

Providencia Return to Top

Providencia^[173]

1. Complicated uti/bacteremia/acute prostatitis

Preferred regimen (1): Ciprofloxacin 500-750 mg PO q12h or 400 mg IV q8-12h
Preferred regimen (2): Levofloxacin 500 mg IV/PO q24h
Preferred regimen (3): Piperacillin-Tazobactam 3.375 mg IV q6h
Preferred regimen (4): Ceftriaxone 1-2 g IV q24h (donot use if ESBL suspected or critically ill)
Preferred regimen (5): Meropenem 1 g IV q8h (consider if critically ill or ESBL suspected)
Preferred regimen (6): Amikacin 7.5 mg/kg IV q12h
Preferred regimen (7): Gentamicin
Preferred regimen (8): Tobramycin acceptable if susceptible but many species are resistant
Note (1): Duration of treatment for (UTI) is 7 days common or 3-5 days after defervescence or control/elimination of complicating factors (e.g.,removal of foreign material catheter).
Note (2): Duration of treatment for (bacteremia) is 10-14 days or 3-5 days after defervescence or control/elimination of complicating factors
Note (3): Duration for acute prostatitis (2 weeks), shorter than chronic prostatitis (4-6 weeks)
Alternative regimen: TMP-SMX DS PO q12h for 10-14 days or TMP 5-10 mg/kg/day IV q6h

Pseudomonas aeruginosa

Pseudomonas aeruginosa Return to Top

Pseudomonas aeruginosa^[174]

Preferred regimen (1): Cefepime 2 g IV q8h
Preferred regimen (2): Ceftazidime 2 g IV q8h
Preferred regimen (3): Piperacillin 3-4 g IV q4h in (no benefit for pseudomonas from beta-lactamase inhibitor)
Preferred regimen (4): Ticarcillin 3-4 g IV q4h (no benefit for pseudomonas from beta-lactamase inhibitor)
Preferred regimen (5): Imipenem 500 mg—1 g IV q6h
Preferred regimen (6): Meropenem 1 g IV q8h
Preferred regimen (7): Doripenem 500 mg IV q8h
Preferred regimen (8): Ciprofloxacin 400 mg IV q8h or 750 mg PO q12h (for less serious infections)
Preferred regimen (9): Aztreonam 2 g IV q6-8h
Preferred regimen (10): Colistin 2.5 mg/kg IV q12h
Preferred regimen (11): Polymyxin B 0.75-1.25 mg/kg IV q12h
Preferred regimen (12): Gentamicin
Preferred regimen (13): Tobramycin 1.7-2.0 mg/Kg IV q8h or 5-7 mg/kg IV
Preferred regimen (14): Amikacin 2.5 mg/kg IV q12h
Note: Amikacin > Tobramycin > Gentamicin with respect to P.aeruginosa susceptibility percentages at most institutions.

Salmonella

Salmonella Return to Top

1. Salmonellosis in immunocompetent hosts^[175]

1.1 Gastroenteritis

Antimicrobial therapy is usually not recommended for uncomplicated diarrheal illness.
1.1.1 Indications for antimicrobial therapy

severedisease,
Age > 50 yrs
Prosthesis
Presence of valvular heart disease
Severe atherosclerosis
Cancer
Uremia
Immunosuppression

1.1.2 Treatment regimens

Preferred regimen (1): TMP-SMX DS PO bid for 5-7 days
Preferred regimen (2): Ciprofloxacin 500 mg PO bid for 5-7 days
Preferred regimen (3): Ceftriaxone 2 g IV q24h for 5-7 days

1.2 Typhoid fever^[176]

1.2.1 Uncomplicated typhoid

Preferred regimen (1) (fully susceptible): Fluoroquinolone (e.g., Ofloxacin 15 mg/kg PO qd for 5–7 days)
Preferred regimen (2) (multi drug-resistant): Fluoroquinolone (Ofloxacin 15 mg/kg PO qd for 5–7 days)
Preferred regimen (3) (quinolone-resistant): Azithromycin 8–10 mg/kg PO qd for 7 days
Preferred regimen (4) (quinolone-resistant): Fluoroquinolone 20 mg/kg PO qd for 10-14 days
Alternative regimen (1) (fully susceptible): Chloramphenicol 50–75 mg/kg PO qd for 14-21 days
Alternative regimen (2) (fully susceptible): Amoxicillin 75–100 mg/kg PO qd for 14 days
Alternative regimen (3) (fully susceptible): Trimethoprim–Sulfamethoxazole, 8 mg/kg (trimethoprim)– 40 mg/kg (sulfamethoxazole) PO qd for 14 days
Alternative regimen (4) (multi drug-resistant): Azithromycin 8–10 mg/kg PO for 7 days
Alternative regimen (5) (multi drug-resistant): Third-generation cephalosporin, e.g., Cefixime 20 mg/kg PO qd for 7-14 days
Alternative regimen (6) (quinolone-resistant): Third-generation cephalosporin, e.g., Cefixime 20 mg/kg PO qd for 7-14 days

1.2.2 Severe typhoid

Preferred regimen (1) (fully susceptible): Fluoroquinolone (e.g., Ofloxacin 15 mg/kg IV qd for 10-14 days)
Preferred regimen (2) (multi drug-resistant): Fluoroquinolone (Ofloxacin 15 mg/kg IV qd for 10-14 days)
Preferred regimen (3) (quinolone-resistant): Ceftriaxone 60 mg/kg IV qd for 10-14 days
Preferred regimen (4) (quinolone-resistant): Cefotaxime 80 mg/kg IV qd for 10-14 days
Alternative regimen (1) (fully susceptible): Chloramphenicol 100 mg/kg PO qd for 14-21 days
Alternative regimen (2) (fully susceptible): Ampicillin 100 mg/kg PO qd for 14-21 days
Alternative regimen (3) (fully susceptible): Trimethoprim–Sulfamethoxazole, 8 mg/kg (trimethoprim)– 40 mg/kg (sulfamethoxazole) IV qd for 10-14 days
Alternative regimen (4) (multi drug-resistant): Ceftriaxone 60 mg/kg IV qd for 10-14 days
Alternative regimen (5) (multi drug-resistant): Cefotaxime 80 mg/kg IV qd for 10-14 days
Alternative regimen (6) (quinolone-resistant): Fluoroquinolone 20 mg/kg IV qd for 10-14 days

1.3 Non-typhoid (serious infection)^[177]

Preferred regimen (1): 3rd generation cephalosporin (Ceftriaxone/Cefotaxime)
Preferred regimen (2): Fluoroquinolone (Ciprofloxacin, Levofloxacin)

1.4 Bacteremia^[178]

Preferred regimen (1): Ceftriaxone 2 g IV q24h
Preferred regimen (2): Cefotaxime 2 g IV q6-8h for 7-14 days
Preferred regimen (3): Ciprofloxacin 400 mg IV q12h for 7-14 days

1.5 Vascular prosthesis infection^[179]

Preferred regimen (1): Ceftriaxone
Preferred regimen (2): Cefotaxime
Preferred regimen (3): Ciprofloxacin 400 mg IV q12h for 6 weeks

1.6 Osteomyelitis^[180]

Preferred regimen (1): Ceftriaxone 2 g IV q24h
Preferred regimen (2): Cefotaxime 2 g IV q6-8h
Preferred regimen (3): Ciprofloxacin 750 mg PO bid for ≥ 4 weeks

1.7 Arthritis^[181]

Preferred regimen (1): Ceftriaxone 2 g IV q24h
Preferred regimen (2): Cefotaxime 2 g IV q6-8h for 6 weeks

1.8 Endocarditis^[182]

Preferred regimen (1): Ceftriaxone 2 g IV q24h
Preferred regimen (2): Cefotaxime 2 g IV q6-8h for 6 weeks

1.9 UTI^[183]

Preferred regimen (1): Ceftriaxone
Preferred regimen (2): Cefotaxime
Preferred regimen (3): Ciprofloxacin IV for 1-2 weeks THEN (oral Ciprofloxacin OR TMP-SMX for 6 weeks)

1.10 Carrier state^[184]

Preferred regimen (1): Ciprofloxacin 500 mg PO bid for 4-6 weeks
Preferred regimen (2): TMP-SMX 1DS bid PO for 6 weeks
Preferred regimen (3): Amoxicillin 500 mg PO for 6 weeks

2. Salmonellosis in immunocompromised hosts

2.1 HIV and salmonellosis^[185]

2.1.1 Gastroenteritis

Preferred regimen: Ciprofloxacin 500-750 mg PO bid or 400 mg IV q12h, if susceptible
Alternative regimen (1): Levofloxacin 750 mg PO/IV q24h
Alternative regimen (2): Moxifloxacin 400 mg PO/IV q24h
Alternative regimen (3): TMP 160 mg AND SMX 800 mg PO/IV q12h
Alternative regimen (4): Ceftriaxone 1 g IV q24h
Alternative regimen (5): Cefotaxime 1 g IV q8h
Duration of treatment for gastroenteritis without bacteremia

If CD4 count ≥ 200 cells/μL: Duration of treatment is 7–14 days
If CD4 count < 200 cells/μL: Duration of treatment is 2–6 weeks

Duration of treatment for gastroenteritis with bacteremia

If CD4 count ≥ 200/μL: Duration of treatment is 14 days; longer duration if bacteremia persists or if the infection is complicated (e.g., if metastatic foci of infection are present)
If CD4 count < 200 cells/μL: Duration of treatment is 2–6 weeks

Note: Secondary prophylaxis should be considered for

Patients with recurrent Salmonella gastroenteritis with or without bacteremia
Patients with CD4 < 200 cells/μL with severe diarrhea

Serratia marcescens

Serratia marcescens Return to Top

Serratia marcescens^[186]

1. Bacteremia, pneumonia or serious infections

Preferred regimen (1): Cefepime 1-2 g IV q8h
Preferred regimen (2): Imipenem 0.5-1.0 g IV q6h
Preferred regimen (3): Ciprofloxacin 400 mg IV q8h
Alternative regimen (1): Aztreonam
Alternative regimen (2): Gentamicin
Alternative regimen (3): Amikacin
Alternative regimen (4): Piperacillin-tazobactam also often effective
Note: Duration depends on clinical response, usually 7-14 days

2. Endocarditis

Note: Choice dictated by sensitivities, 4 to 6 week duration of parenteral therapy.

3. Osteomyelitis

Note (1): Choice dictated by sensitivity profile, treat for 6-12 weeks depending upon response.
Note (2): Use IV treatment until stable/clinically improved (10-14 days Minimum) then may convert to oral therapy if appropriate.

4. UTI

Preferred regimen (1): Ciprofloxacin 250 mg PO bid or 400 mg IV q12h
Preferred regimen (2): Levofloxacin 250 mg PO qd or 500mg IV q24h
Note: Fluoroquinolones often sensitive but in seriously ill patient consider empiric coverage with two drugs (e.g.,beta-lactam and aminoglycoside or fluoroquinolones and carbapenem) until susceptibilities known.

Shigella

Shigella Return to Top

1. Shigellosis ^[187]

1.1 Adults

Preferred regimen (1): Ciprofloxacin 500 mg PO bid for 3 days
Alternative regimen (1): Pivmecillinam 100 mg PO qid for 5 days
Alternative regimen (2): Azithromycin 1-1.5 g PO qd for 1 to 5 days

1.2 Pediatrics

Preferred regimen (1): Ciprofloxacin 15 mg/kg PO bid for 3 days
Alternative regimen (1): Pivmecillinam 20 mg/kg PO qid for 5 days
Alternative regimen (2): Ceftriaxone 50-100 mg/kg IM qd for 2 to 5 days
Alternative regimen (3): Azithromycin 6-20 mg/kg PO qd for 1 to 5 days

Stenotrophomonas maltophilia

Stenotrophomonas maltophilia Return to Top

Stenotrophomonas maltophilia^[188]

Preferred treatment: TMP-SMX 15-20 mg/kg/day (TMP component) IV/PO q8h
Alternative treatment (1): Ceftazidime 2 g IV q8h
Alternative treatment (2): Ticarcillin-clavulanate 3.1 g IV q4h
Alternative treatment (3): Tigecycline 100 mg IV single dose THEN 50 mg IV q12h
Alternative treatment (4): Ciprofloxacin 500-750 mg PO /400 mg IV q12h
Alternative treatment (5): Moxifloxacin 400 mg PO/IV
Alternative treatment (6): Levofloxacin 750 mg PO/IV .
Alternative treatment (7) (Multiply-resistantance): Colistin 2.5 mg/kg q12h IV
Note: Treatment duration uncertain, but usually ≥ 14 days

Vibrio cholerae Return to Top

1. WHO ^[189] ^[190]

Note: Antibiotic treatment for cholera patients with severe dehydration only
Adults

Preferred regimen: Doxycycline 300 mg po single dose
Alternative regimen: Tetracycline 12.5 mg/kg PO qid for 3 days

Pediatric

Under 12 years old

Preferred regimen: Erythromycin 12.5 mg/kg PO qid for 3 days

Over 12 years old

Preferred regimen: Doxycycline 300 mg po single dose
Alternative regimen: Tetracycline 12.5 mg/kg PO qid for 3 days

2. Pan American Health Organization ^[191]

Note: Antibiotic treatment for cholera patients with moderate or severe dehydration
2.1 Adult

Preferred regimen: Doxycycline 300 mg po single dose
Alternative regimen (1): Ciprofloxacin 1 g PO single dose
Alternative regimen (2): Azithromycin 1 g PO single dose

2.2 Pediatric

2.2.1 Children over 3 year, who can swallow tablets

Preferred regimen (1): Erythromycin 12.5 mg/kg/ PO qid for 3 days
Preferred regimen (2): Azithromycin 20 mg/kg PO in a single dose
Alternative regimen (1): Ciprofloxacin suspension or tablets 20 mg/kg PO single dose
Alternative regimen (2): Doxycycline suspension or tablets 2-4 mg/kg PO single dose
Note: Although doxycycline has been associated with a low risk of yellowing of the teeth in children, its benefits outweigh its risks

2.2.2 Children under 3 year, or infants who cannot swallow tablets

Preferred regimen (1): Erythromycin suspension 12.5 mg/kg/ PO qid for 3 days
Preferred regimen (2): Azithromycin suspension 20 mg/kg PO single dose
Alternative regimen (1): Ciprofloxacin suspension 20 mg/kg PO single dose
Alternative regimen (2): Doxycycline syrup 2-4 mg/kg PO single dose

2.3 Pregnancy

Preferred regimen (!): Erythromycin 500 mg/ PO qid for 3 days
Preferred regimen (2): Azithromycin 1 g PO single dose

Vibrio parahaemolyticus Return to Top

Vibrio parahaemolyticus ^[192]

1. Mild to Moderate

Treatment is not necessary in most cases of V. parahaemolyticus infection
There is no evidence that antibiotic treatment decreases the severity or the length of the illness
Patients should drink plenty of liquids to replace fluids lost through diarrhea

2. Severe or prolonged illnesses

Preferred regimen: Tetracycline OR Ciprofloxacin

Vibrio vulnificus Return to Top

Vibrio vulnificus ^[193]

Note: If V. vulnificus is suspected, treatment should be initiated immediately because antibiotics improve survival
Preferred regimen: Doxycycline 100 mg PO/IV bid for 7-14 days AND Ceftazidime 1-2 g IV/IM q8h
Note: A single agent regimen with a fluoroquinolone such as Levofloxacin, Ciprofloxacin or Gatifloxacin, has been reported to be at least as effective in an animal model as combination drug regimens with Doxycycline and a Cephalosporin
Pediatric regimen: Doxycycline AND Fluoroquinolones; trimethoprim-sulfamethoxazole AND an Aminoglycoside

Bacteria – Atypical Organisms

Chlamydophila pneumoniae

Chlamydophila pneumoniae Return to Top

1. Atypical pneumonia ^[194]

1.1 Adult

Preferred regimen (1): Doxycycline 100 mg PO bid for 14-21 days
Preferred regimen (2): Tetracycline 250 mg PO qid for 14-21 days
Preferred regimen (3): Azithromycin 500 mg PO as a single dose, followed by 250 mg PO qd for 4 days
Preferred regimen (4): Clarithromycin 500 mg PO bid for 10 days
Preferred regimen (5): Levofloxacin 500 mg IV OR PO qd for 7 to 14 days
Preferred regimen (6): Moxifloxacin 400 mg PO qd for 10 days.

1.2 Pediatric

Preferred regimen (1): Erythromycin suspension PO 50 mg/kg/day for 10 to 14 days
Preferred regimen (2): Clarithromycin suspension PO 15 mg/kg/day for 10 days
Preferred regimen (3): Azithromycin suspension PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days

2. Upper respiratory tract infection^[195]

2.1 Bronchitis

Antibiotic therapy for C. pneumoniae is not required.

2.2 Pharyngitis

Antibiotic therapy for C. pneumoniae is not required.

2.3 Sinusitis

Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.

Chlamydia trachomatis

Chlamydia trachomatis Return to Top

1 Chlaymydial infections ^[196]

1.1 Chlamydial Infections in Adolescents and Adults

Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
Preferred regimen (2): Azithromycin 1 g PO in a single dose
Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.

1.2 Chlamydial Infections in patients with HIV Infection

Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
Preferred regimen (2): Azithromycin 1 g PO in a single dose
Preferred regimen (3): Azithromycin 1 g PO in a single dose
Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.

1.3 Pregancy

Preferred regimen: Azithromycin 1 g PO in a single dose
Alternative regimen (1): Amoxicillin 500 mg PO tid for 7 days
Alternative regimen (2): Erythromycin base 500 mg PO qid for 7 days
Alternative regimen (3): Erythromycin base 250 mg PO qid for 14 days
Alternative regimen (4): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
Alternative regimen (5): Erythromycin ethylsuccinate 400 mg PO qid for 14 days
Note:Doxycycline, Ofloxacin, and Levofloxacin are contraindicated in pregnant women

1.4 Management of sex partners

Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
Preferred regimen (2): Azithromycin 1 g PO in a single dose
Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present

2. Chlamydial infection among neonates

2.1 Ophthalmia Neonatorumcaused by C. trachomatis

Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days
Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days
Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.

2.2 Infant Pneumonia

Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days
Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days

3.Chlamydial infection among infants and childern

3.1 Infants and childern who weigh < 45 kg

Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days

3.2 Infants and childern who weigh ≥45 kg but who are aged <8 years

Preferred regimen: Azithromycin 1 g PO in a single dose

3.3 Infants and childern aged ≥8 years

Preferred regimen (1): Azithromycin 1 g PO in a single dose
Preferred regimen (2): Doxycycline 100 mg PO bid for 7 days

4. Lymphogranuloma venereum (LGV) ^[197]

Preferred regimen: Doxycycline 100 mg PO bid for 21 days
Alternative regimen: Erythromycin base 500 mg PO qid for 21 days
Note (1): Azithromycin 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
Note (2): Pregnant and lactating women should be treated with Erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
Note (4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).

Chlamydophila psittaci

Chlamydophila psittaci Return to Top

1. ' Psittacosis ^[198]

1.1 Adult

Preferred regimen (1): Doxycycline 100 mg PO bid for 10-21 days
Preferred regimen (2): Tetracycline 500 mg PO qid for 10-21 days
Alternative regimen: Minocycline

1.2 Pediatric

1.2.1 Mild infection, Infants >3 months

Preferred regimen: Azithromycin 10 mg/kg PO qd on day 1 THEN 5 mg/kg PO q24h for 4 days; (Maximum, 500 mg for 1st dose, 250 mg for subsequent doses)

1.2.2 Moderate-severe infection, Infants >3 months

Preferred regimen: Azithromycin 10 mg/kg IV q24h for 2 days THEN 5 mg/kg PO qd for 3 days; (Maximum, 500 mg/dose IV; 250 mg/dose PO)

1.3 Pregnant Patients

Preferred regimen: Azithromycin 500 mg PO on day 1 THEN by 250 mg qd on days 2-5 OR 500 mg IV as a single dose for at least 2 days, followed by 500 mg PO qd for 7- 10 days

Coxiella burnetii

Coxiella burnetii Return to Top

1. Acute Q fever ^[199]

1.1 Adults

Preferred Regimen: Doxycycline 100 mg PO bid for 14 days

1.2 Pediatric

1.2.1 ≥ 8 years old

Preferred regimen:Doxycycline 2.2 mg/kg PO bid for 14 days (Maximum, 100 mg per dose)

1.2.2 < 8 years old with high risk criteria

Preferred regimen:Doxycycline 2.2 mg/kg PO bid for 14 days (Maximum, 100 mg per dose)

1.2.3 < 8 years old with mild or uncomplicated illness

Preferred regimen:Doxycycline 2.2 mg/kg PO bid for 5 days (Maximum, 100 mg per dose)
Alternative regimen: (If patient remains febrile past 5 days of treatment) Trimethoprim/Sulfamethoxazole 4-20 mg/kg PO bid for 14 days (Maximum, 800 mg per dose)

1.3 Pregnant women

Preferred regimen: Trimethoprim/sulfamethoxazole 160 mg/800 mg PO bid
Note: Should be given throughout pregnancy

2. Chronic Q fever

2.1 Endocarditis or vascular infection

Preferred regimen: Doxycycline 100 mg PO bid AND hydroxychloroquine 200 mg PO tid for ≥18 months
Note: Childern and pregnant women consultation recommended

2.2 Non-cardiac organ disease

Preferred regimen: Doxycycline 100 mg PO bid AND hydroxychloroquine 200 mg PO tid
Note: childern and pregnant women consultation recommended

2.3 Postpartumwith serologic profile for chronic Q fever

Preferred regimen: Doxycycline 100 mg PO bid AND hydroxychloroquine 200 mg PO tid for 12 months
Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024); Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
Note (2): Post-Q fever fatigue syndrome- no current recommendation

Mycoplasma pneumoniae

Mycoplasma pneumoniae Return to Top

1. Atypical pneumonia^[200]^[201]

Preferred regimen (1): Azithromycin 500 mg PO qd on day 1 and 250 mg PO qd on days 2 to 5
Preferred regimen (2): Clarithromycin 500 mg PO qd for 14 days
Preferred regimen (3): Moxifloxacin 400 mg PO qd for 14 days
Preferred regimen (4): Levofloxacin 750 mg PO qd for 14 days
Alternative regimen : Doxycycline 100 mg PO bid for 14 days

Mycoplasma genitalium

Mycoplasma genitalium Return to Top

1. Urethritis and cervicitis^[202]

Preferred regimen (macrolide-susceptible strains) (1): Azithromycin 1 g PO as a single dose
Preferred regimen (macrolide-susceptible strains) (2): Azithromycin 500 mg PO as a dose followed by 250 mg PO qd for 4 days
Preferred regimen (for patients with previous treatment failures): Moxifloxacin 400 mg PO qd for 7–14 days

2. Pelvic inflammatory disease (PID)^[203]

Preferred regimen: Moxifloxacin 400 mg PO qd for 14 days

3. Specific considerations^[204]

3.1 Management of sex partners
Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.
3.2 HIV infection
Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.

Bacteria – Miscellaneous

Gardnerella vaginalis Return to Top

1.Bacterial Vaginosis^[205]

Gardnerella vaginalis is one of the anaerobic bacteria causing Bacterial Vaginosis,which is a polymicrobial clinical syndrome

Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
Preferred regimen (3): Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
Alternative regimen (1): Tinidazole 2 g PO qd for 2 days
Alternative regimen (2): Tinidazole 1 g PO qd for 5 days
Alternative regimen (3): Clindamycin 300 mg PO bid for 7 days
Alternative regimen (4): Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days
Note: Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended.

2. Management of Sex Partners

Routine treatment of sex partners is not recommended.

3. Special Considerations

3.1 Allergy, Intolerance, or Adverse Reactions
Intravaginal Clindamycin cream is preferred in case of allergy or intolerance to Metronidazole or Tinidazole. Intravaginal Metronidazole gel can be considered for women who are not allergic to Metronidazole but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.

3.2 Pregnancy

Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
Note: Tinidazole should be avoided during pregnancy

3.3 HIV Infection

Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection.

Eikenella corrodens Return to Top
Bordetella pertussis Return to Top
Bartonella Return to Top
Stenotrophomonas maltophilia Return to Top
Acinetobacter baumannii Return to Top

Yersinia enterocolitica Return to Top

Yersinia enterocolitica infection (yersiniosis)

1. Enterocolitis and mesenteric adenitis^[206]

Preferred regimen: Enterocolitis and adenitis usually self-limited. No antibiotic therapy is required unless clinically indicated.

2. Septicemia^[207]

Preferred regimen (1): Doxycycline 100 mg IV q12h AND Tobramycin 5 mg/kg IV q24h
Preferred regimen (2): Doxycycline 100 mg IV q12h AND Gentamicin 5 mg/kg IV q24h
Alternative regimen (1): Ciprofloxacin 500 mg IV q12h
Alternative regimen (2): TMP-SMX TMP 8 mg/kg/day and SMX 40 mg/kg/day IV q12h

3. Peritonitis^[208]

Preferred regimen: Fluoroquinolones

Yersinia pestis Return to Top

Yersinia pseudotuberculosis Return to Top

Bacteria – Anaerobic Gram-Negative Bacilli

Bacteroides fragilis Return to Top

Bacteroides fragilis ^[209]

1. Monotherapy

Preferred regimen (1): Imipenem

Preferred regimen (2): Ertapenem

Preferred regimen (3): Meropenem

Preferred regimen (4): Doripenem 0.5-1.0 g IV q6h

Preferred regimen (5): Piperacillin-tazobactam 3.375 g IV q6h

Preferred regimen (6): Ampicillin-sulbactam 1-2 g IV q6h

Preferred regimen (7): Tigecycline 100 mg IV THEN 50 mg IV q12h

2. Combination therapy

Preferred regimen: Metronidazole 0.75-1.0 g IV q12h AND Cefotaxime 1.5-2 g IV q6h OR Aztreonam 1-2 g IV q8h OR Ceftriaxone 1 g IV q12h

Fusobacterium necrophorum Return to Top

Fungi

Aspergillosis Return to Top
^[210]
1. Invasive pulmonary aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

2. Invasive sinus aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

3. Tracheobronchial aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

4. Chronic necrotizing pulmonary aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

5. Aspergillosis of the CNS

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

Note: There are drug interactions with anticonvulsant therapy.

6. Aspergillus infections of the heart (endocarditis, pericarditis, and myocarditis)

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
Note: endocardial lesions generally require surgical treatment. Aspergillus pericarditis usually requires pericardiectomy.

7. Aspergillus osteomyelitis and septic arthritis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
Note: Surgical resection of devitalized bone and cartilage is important for curative intent.

8. Aspergillus infections of the eye (endophthalmitis and keratitis)

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
Note: Topical therapy is indicated for keratitis, ophthalmologic intervention and management is recommended for all forms of ocular infection. Systemic therapy may be beneficial when treating aspergillus endophthalmitis.

9. Cutaneous aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
Note: Surgical resection is indicated when feasible.

10. Aspergillus peritonitis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

11. Prophylaxis against invasive aspergillosis

Preferred regimen: Posaconazole PO 200 mg tid
Alternative regimen: (1) Itraconazole 200 mg IV bid for 2 days then 200 mg IV qd OR Itraconazole PO 200mg bid
Alternative regimen: (2) Micafungin 50 mg/day PO qd

12. Aspergilloma

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen: Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd

13. Chronic cavitary pulmonary aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[211]^[210]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

Note: long-term therapy might be needed.

14. Allergic bronchopulmonary Itraconazole aspergillosis

Preferred regimen: Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (1): Voriconazole PO 200 mg bid
Alternative regimen (2): Posaconazole PO 400 mg bid
Note: Corticosteroids are a cornerstone of the therapy.

15. Allergic aspergillus sinusitis

Preferred regimen: None or Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Note: Few data available for other agents.

16. Relative indications for surgical treatment of invasive aspergillosis

Pulmonary lesion in proximity to great vessels or pericardium;
Pericardial infection;
Invasion of chest wall from contiguous pulmonary lesion;
Aspergillus empyema;
Persistent hemoptysis from a single cavitary lesion;
Infection of skin and soft tissues;
Infected vascular catheters and prosthetic devices;
Endocarditis;
Osteomyelitis;
Sinusitis;
Cerebral lesions.

Blastomycosis Return to Top
Blastomycosis^[212]

1. Mild to moderate pulmonary blastomycosis

Preferred regimen: Itraconazole 200 mg PO qd or bid for 6–12 months
Note: Oral Itraconazole, 200 mg tid PO for 3 days and THEN 200 mg PO qd or bid for 6–12 months

2. Moderately severe to severe pulmonary blastomycosis

Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV qd for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
Preferred regimen (2): Amphotericin B deoxycholate 0.7–1 mg/kg IV qd for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
Note: Oral Itraconazole, 200 mg tid PO for 3 days THEN 200 mg PO bid, for a total of 6–12 months

3. Mild to moderate disseminated blastomycosis

Preferred regimen: Itraconazole 200 mg PO qd or bid for 6–12 months
Note (1): Treat osteoarticular disease for 12 months
Note (2): Oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 6–12 months

4. Moderately severe to severe disseminated blastomycosis

Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV qd, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
Preferred regimen (2): Amphotericin B deoxycholate 0.7–1 mg/kg IV qd, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
Note: oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 6–12 months

5. CNS disease

Preferred regimen: Lipid Amphotericin B 5 mg/kg IV qd for 4–6 weeks AND an oral azole for at least 1 year
Note (1): Step-down therapy can be with Fluconazole, 800 mg/day PO qd or bid OR Itraconazole, 200 mg bid or tid OR voriconazole, 200–400 mg bid.
Note (2): Longer treatment may be required for immunosuppressed patients.

6. Immunosuppressed patients

Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV qd, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
Preferred regimen (2): Amphotericin B deoxycholate, 0.7–1 mg/kg IV qd, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
Note (1): Oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 12 months
Note (2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.

7. Pregnant women

Preferred regimen: Lipid Amphotericin B 3–5 mg/kg IV qd
Note (1): Azoles should be avoided because of possible teratogenicity
Note (2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg IV qd

8. Children with mild to moderate disease

Preferred regimen: Itraconazole 10 mg/kg PO qd for 6–12 months
Note: Maximum dose 400 mg/day

9. Children with moderately severe to severe disease

Preferred regimen (1): Amphotericin B deoxycholate 0.7–1 mg/kg IV qd for 1–2 weeks AND Itraconazole 10 mg/kg PO qd to a maximum of 400 mg/day for 6–12 months
Preferred regimen (2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg IV qd for 1–2 weeks AND Itraconazole 10 mg/kg PO qd to a maximum of 400 mg/day for 6–12 months
Note: Children tolerate Amphotericin B deoxycholate better than adults do.

Paracoccidioidomycosis Return to Top

Preferred regimen (1): ^[213]

Adults: Itraconazole 200 mg/day PO
Children: Itraconazole (<30/kg and >5 yr) 5-10 mg/kg/day PO
Note: Treatment duration based on organ involvement:

Mild involvement: 6-9 months
Moderate involvement: 12-18 months

Preferred regimen (2): ^[213]

Adults Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid
Children Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid
Note (1): Treatment duration based on organ involvement:

Minor involvement: 12 months
Moderate involvement: 18-24 months

Note (2): Preferred treatment in children due to larger experience.
Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.

Preferred regimen (3): Amphotericin B deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.^[213]

Note: Preferred in severe forms of the disease.^[213]

Alternative regimen (4): Ketoconazole 200-400 mg/day PO for 9-12 months^[214]
Alternative regimen (5): Voriconazole initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months^[215]

Note: Diminish the dose to 50% if weight is <40 kg.

Candidiasis Return to Top

1. Candidemia^[216]

1.1. Nonneutropenic adults

Preferred regimen (1): Fluconazole 800 mg (12 mg/kg) loading dose, THEN 400 mg (6 mg/kg) qd
Preferred regimen (2): Caspofungin 70 mg loading dose, THEN 50 mg qd
Preferred regimen (3): Micafungin 100 mg qd
Preferred regimen (4): Anidulafungin 200 mg loading dose, THEN 100 mg qd
Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg qd
Alternative regimen (2): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg qd
Alternative regimen (3): Voriconazole 400 mg (6 mg/kg) PO/IV bid for 2 doses, THEN 200 mg (3 mg/kg) bid
Note (1): Echinocandin includes Anidulafungin, Micafungin and Caspofungin.
Note (2): Choose an echinocandin for moderately severe to severe illness and for patients with recent azole exposure.
Note (3): Treat for 14 days after first negative blood culture result and resolution of signs and symptoms associated with candidemia.
Note (4): Ophthalmological examination recommended for all patients.

1.2. Neutropenic patients

Preferred regimen (1): Caspofungin 70 mg loading dose, THEN 50 mg qd
Preferred regimen (2): Micafungin 100 mg qd
Preferred regimen (3): Anidulafungin 200 mg loading dose, THEN 100 mg qd
Preferred regimen (4): Lipid formulation of Amphotericin B (LFAmB) 3–5 mg/kg qd
Alternative regimen (1): Fluconazole 800 mg (12 mg/kg) loading dose, THEN 400 mg (6 mg/kg) qd
Alternative regimen (2): Voriconazole 400 mg (6 mg/kg) bid for 2 doses, THEN 200 mg (3 mg/kg) bid
Note: Fluconazole is recommended for patients without recent azole exposure and who are not critically ill.

2. Suspected candidiasis treated with empiric antifungal therapy^[216]

2.1. Nonneutropenic patients

Preferred regimen (1): Fluconazole 800 mg (12 mg/kg) loading dose, THEN 400 mg (6 mg/kg) daily
Preferred regimen (2): Caspofungin 70 mg loading dose, THEN 50 mg daily
Preferred regimen (3): Micafungin 100 mg daily
Preferred regimen (4): Anidulafungin 200 mg loading dose, THEN 100 mg daily
Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily
Alternative regimen (2): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg daily
Note (1): Duration of therapy is uncertain, but should be discontinued if cultures and/or serodiagnostic tests have negative results.
Note (2): Echinocandin includes Anidulafungin, Micafungin and Caspofungin.
Note (3): Echinocandin is preferred for patients with recent azole exposure, patients with moderately severe to severe illness, or patients who are at high risk of infection due to C. glabrata or C. krusei.
Note (4): Empirical antifungal therapy should be considered in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever and should be based on clinical assessment of risk factors, serologic markers for invasive candidiasis, and/or culture data from nonsterile sites

2.2. Neutropenic patients

Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily
Preferred regimen (2): Caspofungin 70 mg loading dose, THEN 50 mg daily
Preferred regimen (3): Voriconazole 400 mg (6 mg/kg) bid for 2 doses, THEN 200 mg (3 mg/kg) bid
Alternative regimen (1): Fluconazole 800 mg (12 mg/kg) loading dose, THEN 400 mg (6 mg/kg) daily
Alternative regimen (2): Itraconazole 200 mg (3 mg/ kg) bid
Note (1): In most neutropenic patients, it is appropriate to initiate empiric antifungal therapy after 4 days of persistent fever despite antibiotics.
Note (2): Do not use an azole in patients with prior azole prophylaxis.

3. Urinary tract infection^[216]

3.1. Asymptomatic cystitis

Preferred regimen: Therapy not usually indicated, unless patients are at high risk (e.g., neonates and neutropenic adults) or undergoing urologic procedures.
Note (1): Elimination of predisposing factors recommended
Note (2): For high-risk patients, treat as for disseminated candidiasis
Note (3): For patients undergoing urologic procedures, fluconazole, 200–400 mg (3–6 mg/kg) daily or Amphotericin B deoxycholate (AmB-d) 0.3–0.6 mg/kg daily for several days before and after the procedure.

3.2. Symptomatic cystitis

Preferred regimen: Fluconazole 200 mg (3 mg/kg) daily for 2 weeks
Alternative regimen (1): Amphotericin B deoxycholate(AmB-d) 0.3–0.6 mg/kg for 1–7 days
Alternative regimen (2): Flucytosine 25 mg/kg qid for 7–10 days
Note: Amphotericin B deoxycholate (AmB-d) bladder irrigation is recommended only for patients with refractory fluconazole -resistant organisms (e.g., Candida krusei and Candida glabrata).

3.3 Pyelonephritis

Preferred regimen (1): Fluconazole 200–400 mg (3–6 mg/kg) daily for 2 weeks
Alternative regimen (1): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily ± Flucytosine (5-FC) 25 mg/kg qid
Alternative regimen (2): Flucytosine (5-FC) 25 mg/kg qid for 2 weeks
Note: For patients with pyelonephritis and suspected disseminated candidiasis, treat as for candidemia.

4. Urinary fungus balls^[216]

Preferred regimen (1): Surgical removal strongly recommended
Preferred regimen (2): Fluconazole 200–400 mg (3–6 mg/kg) daily
Preferred regimen (3): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily ± Flucytosine (5-FC) 25 mg/kg qid
Note (1): Local irrigation with Amphotericin B deoxycholate(AmB-d) may be a useful adjunct to systemic antifungal therapy.
Note (2): Treatment duration should be until symptoms have resolved and urine cultures no longer yield Candida species.

5. Vulvovaginal candidiasis^[216]

Preferred regimen (1): Butoconazole 2% cream 5 g intravaginally for 3 days
Preferred regimen (2): Butoconazole 2% cream 5 g (butoconazole1-sustained release), single intravaginal application
Preferred regimen (3): Clotrimazole 1% cream 5 g intravaginally for 7–14 days
Preferred regimen (4): Clotrimazole 100-mg vaginal tablet for 7 days
Preferred regimen (5): Clotrimazole 100-mg vaginal tablet, 2 tablets for 3 days
Preferred regimen (6): Miconazole 2% cream 5 g intravaginally for 7 days
Preferred regimen (7): Miconazole 100-mg vaginal suppository, 1 suppository for 7 days
Preferred regimen (8): Miconazole 200-mg vaginal suppository, 1 suppository for 3 days
Preferred regimen (9): Miconazole 1200-mg vaginal suppository, 1 suppository for 1 day
Preferred regimen (10): Nystatin 100,000-unit vaginal tablet, 1 tablet for 14 days
Preferred regimen (11): Tioconazole 6.5% ointment 5 g intravaginally in a single application
Preferred regimen (12): Terconazole 0.4% cream 5 g intravaginally for 7 days
Preferred regimen (13): Terconazole 0.4% cream 5 g intravaginally for 3 days
Preferred regimen (14): Terconazole 80-mg vaginal suppository, 1 suppository for 3 days
Preferred regimen (15): Fluconazole 150 mg single dose for uncomplicated vaginitis
Note: For recurring Candida Vulvovaginal candidiasis (VVC), 10–14 days of induction therapy with a topical or oral azole, followed by fluconazole at a dosage of 150 mg once per week for 6 months, is recommended

6. Chronic disseminated candidiasis^[216]

Preferred regimen (1): Fluconazole 400 mg (6 mg/kg) daily for stable patients
Preferred regimen (2): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily for severely ill patients
Preferred regimen (3): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily for severely ill patients
Alternative regimen (1): Caspofungin 70 mg loading dose, THEN 50 mg daily, followed by oral Fluconazole when clinically appropriate
Alternative regimen (2): Micafungin 100 mg daily, followed by oral Fluconazole when clinically appropriate
Alternative regimen (3): Anidulafungin 200 mg loading dose, THEN 100 mg daily, followed by oral Fluconazole when clinically appropriate
Note (1): Transition from Lipid formulation of amphotericin B(LFAmB) or Amphotericin B deoxycholate(AmB-d) to fluconazole is favored after several weeks in stable patients.
Note (2): Duration of therapy is until lesions have resolved (usually months) and should continue through periods of immunosuppression (e.g., chemotherapy and transplantation).
Note (3): Therapy should be continued for weeks to months, until calcification occurs or lesions resolve.

7. Candida osteoarticular infection^[216]

7.1. Osteomyelitis

Preferred regimen (1): Fluconazole 400 mg (6 mg/kg) daily for 6–12 months
Preferred regimen (2): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily for at least 2 weeks, then Fluconazole 400 mg daily for 6–12 months
Alternative regimen (1): Caspofungin 70 mg loading dose, THEN 50 mg daily for at least 2 weeks followed by Fluconazole at a dosage of 400 mg daily for 6–12 months
Alternative regimen (2): Micafungin 100 mg daily for at least 2 weeks followed by Fluconazole at a dosage of 400 mg daily for 6–12 months
Alternative regimen (3): Anidulafungin 200 mg loading dose, THEN 100 mg daily for at least 2 weeks followed by Fluconazole at a dosage of 400 mg daily for 6–12 months
Alternative regimen (4): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg daily followed by Fluconazole at a dosage of 400 mg daily for 6–12 months
Note (1): Duration of therapy usually is prolonged (6–12 months)
Note (2): Surgical debridement is frequently necessary

7.2. Septic arthritis

Preferred regimen (1): Fluconazole 400 mg (6 mg/kg) for at least 6 weeks
Preferred regimen (2): Lipid formulation of amphotericin B (LFAmB) 3–5 mg/kg daily for at least 2 weeks followed by Fluconazole at a dosage of 400 mg daily
Alternative regimen (1): Caspofungin 70 mg loading dose, THEN 50 mg daily for at least 2 weeks followed by Fluconazole at a dosage of 400 mg daily
Alternative regimen (2): Micafungin 100 mg daily for at least 2 weeks followed by Fluconazole at a dosage of 400 mg daily
Alternative regimen (3): Anidulafungin 200 mg loading dose, THEN 100 mg daily for at least 2 weeks followed by Fluconazole at a dosage of 400 mg daily
Note (1): Duration of therapy usually is for at least 6 weeks, but few data are available.
Note (2): Surgical debridement is recommended for all cases.
Note (3): For infected prosthetic joints, removal is recommended for most cases.

8. CNS candidiasis^[216]

Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily ± Flucytosine at a dosage of 25 mg/kg qid for several weeks followed by Fluconazole 400–800 mg (6–12 mg/kg) daily
Alternative regimen (1): Fluconazole 400–800 mg (6–12 mg/ kg) daily for patients unable to tolerate Lipid formulation of amphotericin B (LFAmB)
Note (1): Treat until all signs and symptoms, CSF abnormalities, and radiologic abnormalities have resolved.
Note (2): Removal of intraventricular devices is recommended.

9. Candida endophthalmitis^[216]

Preferred regimen (1): Amphotericin B deoxycholate(AmB-d) 0.7–1 mg/kg AND Flucytosine 25 mg/ kg qid
Preferred regimen (2): Fluconazole 400–800 mg daily (loading dose of 12 mg/kg then 6–12 mg/kg daily) is an acceptable alternative for less severe endophthalmitis
Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily
Alternative regimen (2): Voriconazole 6 mg/kg q12h for 2 doses, then 3–4 mg/kg q12h
Alternative regimen (3): Caspofungin 70 mg loading dose, THEN 50 mg daily
Alternative regimen (4): Micafungin 100 mg daily
Alternative regimen (5): Anidulafungin 200 mg loading dose, THEN 100 mg daily
Note (1): Alternative therapy is recommended for patients intolerant of or experiencing failure of Amphotericin B and Flucytosine therapy
Note (2): Duration of therapy is at least 4–6 weeks as determined by repeated examinations to verify resolution.
Note (3): Diagnostic vitreal aspiration should be done if etiology unknown.
Note (4): Fluconazole at a dosage of 400–800 mg daily (loading dose of 12 mg/kg then 6–12 mg/kg daily) is an acceptable alternative for less severe endophthalmitis
Note (5): Surgical intervention for patients with severe endophthalmitis or vitreitis

10. Candida infection of the cardiovascular system^[216]

10.1. Endocarditis

Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily ± Flucytosine at a dosage of 25 mg/kg qid
Preferred regimen (2): Amphotericin B deoxycholate AmB-d 0.6–1 mg/kg daily ± Flucytosine 25 mg/kg qid
Preferred regimen (3): Caspofungin 50–150 mg daily
Preferred regimen (4): Micafungin 100–150 mg daily
Preferred regimen (5): Anidulafungin 100–200 mg daily
Alternative regimen (1): Step-down therapy to Fluconazole 400–800 mg (6–12 mg/kg) daily for susceptible organism in stable patient with negative blood culture results
Note (1): Valve replacement is strongly recommended.
Note (2): For those who are unable to undergo surgical removal of the valve, chronic suppression with fluconazole 400–800 mg (6–12 mg/kg) daily is recommended.
Note (3): Lifelong suppressive therapy for prosthetic valve endocarditis if valve cannot be replaced is recommended.

10.2. Pericarditis or myocarditis

Preferred regimen (1): Lipid formulation of amphotericin B (LFAmB) at a dosage of 3–5 mg/kg daily
Preferred regimen (2): Fluconazole 400–800 mg (6–12 mg/kg) daily
Preferred regimen (3): Caspofungin 50–150 mg daily
Preferred regimen (4): Micafungin 100–150 mg daily
Preferred regimen (5): Anidulafungin 100–200 mg daily
Alternative regimen (1): After stable, step-down therapy to Fluconazole 400–800 mg (6–12 mg/kg) daily
Note(1): Therapy is often for several months, but few data are available
Note(2): A pericardial window or pericardiectomy is recommended.

10.3. Suppurative thrombophlebitis

Preferred regimen (1): Lipid formulation of amphotericin B (LFAmB) at a dosage of 3–5 mg/kg daily
Preferred regimen (2): Fluconazole 400–800 mg (6–12 mg/kg) daily
Preferred regimen (3): Caspofungin 50–150 mg daily
Preferred regimen (4): Micafungin 100–150 mg daily
Preferred regimen (5): Anidulafungin 100–200 mg daily
Alternative regimen (1): After stable, step-down therapy to Fluconazole 400–800 mg (6–12 mg/kg) daily
Note(1): Surgical incision and drainage or resection of the vein is recommended if feasible.
Note(2): Treat for at least 2 weeks after candidemia has cleared.

10.4. Infected pacemaker, ICD, or VAD

Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily ± Flucytosine at a dosage of 25 mg/kg qid
Preferred regimen (2): Amphotericin B deoxycholate (AmB-d) 0.6–1 mg/kg daily ± Flucytosine 25 mg/kg qid
Preferred regimen (3): Caspofungin 50–150 mg daily
Preferred regimen (4): Micafungin 100–150 mg daily
Preferred regimen (5): Anidulafungin 100–200 mg daily
Alternative regimen (1): Step-down therapy to Fluconazole 400–800 mg (6–12 mg/kg) daily for susceptible organism in stable patient with negative blood culture results
Note(1): Removal of pacemakers and ICDs strongly recommended.
Note(2): Treat for 4–6 weeks after the device removed.
Note(3): For VAD that cannot be removed, chronic suppressive therapy with fluconazole is recommended.

11. Neonatal candidiasis^[216]

Preferred regimen (1): Amphotericin B deoxycholate (AmB-d) 1 mg/kg daily for 3 weeks
Preferred regimen (2): Fluconazole 12 mg/kg daily for 3 weeks
Alternative regimen (1): Lipid formulation of amphotericin B (LFAmB) 3–5 mg/kg daily for 3 weeks
Note (1): A lumbar puncture and dilated retinal examination should be performed on all neonates with suspected invasive candidiasis.
Note (2): Intravascular catheter removal is strongly recommended.
Note (3): Duration of therapy is at least 3 weeks.
Note (4): Lipid formulation of amphotericin B (LFAmB) used only if there is no renal involvement.
Note (5): Echinocandins should be used with caution when other agents cannot be used.

12. Candida isolated from respiratory secretions^[216]

Preferred regimen (1): Therapy not recommended
Note (1): Candida lower respiratory tract infection is rare and requires histopathologic evidence to confirm a diagnosis.

13. Nongenital mucocutaneous candidiasis^[216]

13.1. Oropharyngeal

Preferred regimen (1): Clotrimazole troches 10 mg 5 times daily
Preferred regimen (2): Nystatin suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL qid OR 1–2 Nystatin pastilles (200,000 U each) administered qid for 7–14 days
Preferred regimen (3): Fluconazole 100–200 mg PO (3 mg/kg) daily for 7–14 days
Alternative regimen (1): Itraconazole solution 200 mg daily
Alternative regimen (2): Posaconazole suspension at a dosage of 400 mg twice daily for 3 days, THEN 400 mg daily for up to 28 days
Alternative regimen (3): Voriconazole 200 mg bid
Alternative regimen (4): Amphotericin B deoxycholate (AmB-d) 1-mL oral suspension administered at a dosage of 100 mg/mL qid
Alternative regimen (5): Caspofungin 70 mg IV loading dose, THEN 50 mg daily
Alternative regimen (6): Micafungin 100 mg IV daily
Alternative regimen (7): Anidulafungin 200 mg IV loading dose, THEN 100 mg daily
Alternative regimen (8): Amphotericin B deoxycholate (AmB-d) 0.3 mg/kg daily
Note(1): Fluconazole is recommended for moderate-to-severe disease, and topical therapy with clotrimazole or nystatin is recommended for mild disease.
Note(2): Treat uncomplicated disease for 7–14 days.
Note(3): For refractory disease, itraconazole, voriconazole, posaconazole, or AmB suspension is recommended.

13.2. Esophageal

Preferred regimen (1): Fluconazole 200–400 mg (3–6 mg/kg) PO daily
Preferred regimen (2): Caspofungin 70 mg IV loading dose, THEN 50 mg daily
Preferred regimen (3): Micafungin 100 mg IV daily
Preferred regimen (4): Anidulafungin 200 mg IV loading dose, THEN 100 mg daily
Preferred regimen (4): AmB-d 0.3–0.7 mg/kg daily
Alternative regimen (1): Itraconazole oral solution 200 mg daily
Alternative regimen (2): Posaconazole 400 mg bid
Alternative regimen (3): Voriconazole 200 mg bid
Note(1): Oral fluconazole is preferred.
Note(2): For patients unable to tolerate an oral agent,Fluconazole IV, an echinocandin, or AmB-d is appropriate.
Note(3): Treat for 14–21 days.
Note(4): For patients with refractory disease, the alternative therapy as listed or AmB-d or an echinocandin is recommended.

Chromoblastomycosis Return to Top
^[217]

Preferred regimen: Itraconazole 200-400 mg PO q24h OR 400 mg pulse therapy once daily for 1 week monthly for 6-12 months
Note: Pulse therapy reduces cost but it is questionable if it produces resistance to the drug.
Alternative regimen (1): Terbinafine 500-1000 mg PO qd for 6-12 months
Alternative regimen (2): Posaconazole 800 mg PO qd for 6-12 months
Alternative regimen (3): 5-fluorocytosine 100-150 mg/kg/day PO qd for 6-12 months
Note: This disease has a low cure ratio and high relapse ratio. Physical treatment is needed to achieve better results:

Cryosurgery with liquid nitrogen - most used physical therapy, it's used in localized lesions and it has a very good treatment response, probably achieved by immune mechanisms since fungi are eliminated from lesions as late as 1-2 weeks after the therapy.
Thermotherapy - used in conjunction with systemic therapy, was developed by Japanese authors and consists in placing "pocket warmers" in the lesions for 24h/day for some months, as the fungi is sensible to heat.
Laser vaporization - studied in Germany as an alternative therapy, reported to successfully treat relapsing lesions.

Coccidioidomycosis Return to Top

1. Primary pulmonary infection ^[218]

1.1 Indications for antifungal therapy

Immunosupression (AIDS, therapy with high dose corticosteroids, receiptients of TNF-alpha, receiptients of an organ transplant)
Diabetes
Preexisting cardiomyopathy
Pregnancy (third trimester)
Filipino or African
Weight loss of > 10%
Intense night sweats persisting longer than 3 weeks
Infiltrates involving more than one-half of one lung or portions of both lungs
Prominent or persistent hilar adenopathy
Anticoccidiodial complement-fixing antibody concentrations in excess of 1:16

1.2 Patients with low risk of complications or dissemination

For many (if not most) patients, management may rely on periodic reassessment of symptoms and radiographic findings to assure resolution without antifungal treatment.

1.3 Patients with high risk of complications or dissemination

1.3.1 Mild to moderate pneumonia

Preferred regimen (1): Itraconazole solution 200 mg PO bid or IV q12h
Preferred regimen (2): Fluconazole 400 mg PO q24h for 3–12 months

1.3.2 Locally severe or disseminated pneumonia

Preferred regimen: (Amphotericin B 0.6–1 mg/kg PO qd every 7 days THEN 0.8 mg/kg PO every other day OR Liposomal Amphotericin B 3-5 mg/kg IV q24 hrs OR Amphotericin B lipid complex 5 mg/kg IV q24 hrs until clinical improvement) followed by Itraconazole OR Fluconazole for at least 1 year.
Note (1): Some use combination of Amphotericin B and Fluconazole for progressive severe disease; controlled series lacking.
Note (2): Consultation with specialist recommendation, surgery may be required.

2. Meningitis

2.1 Adult

Preferred regimen: Fluconazole 400–1,000 mg PO q24h indefinitely.
Alternative regimen: Amphotericin B 3-5 mg/kg IV q24 hrs PLUS 0.1–0.3 mg qd intrathecal (intraventricular) via reservoir device OR Itraconazole 400–800 mg q24h OR Voriconazole
Note: Some use combination of Amphotericin B and Fluconazole for progressive severe disease; controlled series lacking.

2.2 Child

Preferred regimen: Fluconazole PO (Pediatric dose not established, 6 mg per kg q24h used)
Alternative regimen: Amphotericin B 3-5 mg/kg IV q24 hrs PLUS 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device OR itra 400–800 mg q24h OR Voriconazole

3. Special considerations for HIV/AIDS patients^[219]

3.1 Clinically mild infections (e.g., focal pneumonia)

Preferred regimen: Fluconazole 400 mg PO daily OR Itraconazole 200 mg PO bid
Alternative regimen (unresponsive to Fluconazole or Itraconazole): Posaconazole 200 mg PO bid OR Voriconazole 200 mg PO bid
Note: Itraconazole, posaconazole, and voriconazole may have significant interactions with certain antiretro viral agents. These interactions are complex and can be bi-directional

3.2 Severe, non-meningeal infection (diffuse pulmonary infection or severely ill patients with extrathoracic, disseminated disease)

Preferred regimen: Amphotericin B deoxycholate 0.7–1.0 mg/kg IV q12hrs OR Lipid formulation Amphotericin B 4–6 mg/kg IV q24hrs. Duration of therapy: continue until clinical improvement, then switch to an azole.
Alternative regimen: Some specialists will add a triazole (Fluconazole or Itraconazole, with Itraconazole (preferred for bone disease) 400 mg per day to Amphotericin B therapy and continue triazole once Amphotericin B is stopped
Note (1): Therapeutic drug monitoring and dosage adjustment may be necessary to ensure triazole antifungal and antiretroviral efficacy and reduce concentration-related toxicities.
Note (2): Therapy should be continued indefinitely in patients with diffuse pulmonary or disseminated diseases because relapse can occur in 25%–33% of HIV-negative patients. It can also occur in HIV-infected patients with CD4 counts >250 cells/μL

3.3 Meningeal Infections

Preferred regimen: Fluconazole 400–800 mg IV or PO daily
Alternative regimen: Itraconazole 200 mg PO tid for 3 days THEN 200 mg PO bid OR Posaconazole 200 mg PO bid OR Voriconazole 200–400 mg PO bid OR Intrathecal Amphotericin B deoxycholate when triazole antifungals are ineffective.
Note (1): Intrathecal amphotericin B should only be given in consultation with a specialist and administered by an individual with experience with the technique.
Note (2): Some patients with meningitis may develop hydrocephalus and require CSF shunting
Note (3): Therapy should be lifelong in patients with meningeal infections because relapse occurs in 80% of HIV-infected patients after discontinuation of triazole therapy

3.4 Chronic Suppressive Therapy

Preferred regimen (1): Fluconazole 400 mg PO qd
Preferred regimen (2): Itraconazole 200 mg PO bid
Alternative regimen (1): Posaconazole 200 mg PO bid
Alternative regimen (2): Voriconazole 200 mg PO bid

Cryptococcosis Return to Top
Cryptococcus Return to Top

1. Cryptococcus neoformans

1.1 Cryptococcus neoformans meningitis in HIV infected patients^[220]

Preferred regimen for induction and consolidation: (Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction) OR Liposomal AmB 3-4mg/kg IV qd OR Amphotericin B lipid complex (ABLC) 5mg/kg IV qd) PLUS Flucytosine 100mg/kg/day PO or IV qid for at least 2 weeks followed by Fluconazole 400mg (6mg/kg) PO qd for at least 8 weeks.
Alternative regimen for induction and consolidation (1): Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd OR Liposomal AmB 3-4 mg/kg IV qd OR AmB lipid complex 5mg/kg IV qd for 4-6 weeks
Alternative regimen for induction and consolidation (2): Amphotericin B deoxycholate 0.7 mg/kg IV qd PLUS Fluconazole 800mg PO qd for 2 weeks, followed by Fluconazole 800mg PO qd for at least 8 weeks
Alternative regimen for induction and consolidation (3): Fluconazole (>800 mg PO qd, 1200mg PO qd is favored) PLUS Flucytosine (100mg/kg/day PO qid) for 6 weeks
Alternative regimen for induction and consolidation (4): Fluconazole PO 800-2000mg qd for 10-12 weeks
Preferred regimen for maintenance and prophylactic therapy: Initiate HAART 2-10 weeks after commencing initial antifungal therapy AND Fluconazole 200mg PO qd
Alternative regimen for maintenance and prophylactic therapy: Itraconazole 200mg PO bid - monitor drug-level OR Amphotericin B deoxycholate (1 mg/kg) per week IV (should be used in azole-intolerant patients).
Note (1): Consider discontinuing supressive therapy if CD4 count is higher than 100 cells/uL AND undetectable OR very low HIV RNA level for more than 3 months. Consider reinstitution of maintenance therapy if CD4 count <100 cels/uL.
Note (2): Do not use acetazolamide OR mannitol OR corticosteroids to treat increased intracranial pressure, instead it should be used lombar puncture in the absence of focal neurologic signs or impaired mentation (which, if present, patient must be submitted to CT or MRI scan first).

1.2. Cerebral cryptococcomas

Preferred regimen for induction and consolidation: (Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction) OR Liposomal AmB 3-4mg/kg IV qd OR Amphotericin B lipid complex (ABLC) 5mg/kg IV qd) PLUS Flucytosine 100mg/kg/day PO or IV qid for at least 2 weeks followed by Fluconazole 400mg (6mg/kg) PO qd for at least 8 weeks
Note: Consider surgery if lesions are larger than 3cm, accessible lesions with mass effect or lesions that are enlarging and not explained by IRIS.

1.3. Cryptococcus neoformans meningitis in HIV negative patients

Preferred regimen: Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd PLUS Flucytosine 100mg/kg/day PO or IV qid for at least 4 weeks (which may be extended to 6 weeks if there is any neurological complication) followed by Fluconazole 400mg PO qd for 8 weeks. If there's toxicity to AmBd, consider changing to LFAmB in the second 2 weeks.
Note (1): After induction and consolidation therapy, start Fluconazole 200mg (3mg/kg) PO qd for 6-12 months.
Note (2): If Flucytosine is not given, consider lengthening the induction therapy for at least 2 weeks.

1.4. Cryptococcus neoformans pulmonary disease - immunosupressed

Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:

Preferred regimen: Fluconazole 400mg PO qd for 6-12 months

Severe pneumonia or disseminated disease or CNS infection:

Preferred regimen: treat like CNS cryptococcosis.

Note (1): In HIV- infected patients, treatment should be stopped after 1 year if CD4 count is >100 and a cryptococcal antigen titer is <1:512 and not increasing.
Note (2): Consider corticosteroid if ARDS is present in a context which it might be attributed to IRIS.

1.5 Cryptococcus neoformans pulmonary disease - non-immunosupressed

Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:

Preferred regimen: Fluconazole 400mg PO qd for 6-12 months
Alternative regimen: if Fluconazole is unavailable or contraindicated, Itraconazole 200mg PO bid, Voriconazole 200 mg PO bid, and Posaconazole 400mg PO bid

If there's severe pneumonia, disseminated disease or CNS infection:

Preferred regimen: treat like CNS cryptococcosis for 6-12 months.

1.6 Cryptococcus neoformans non-lung, non-CNS infection

Cryptococcemia or disseminated cryptococcic disease (involvement of at least 2 noncontiguous sites or cryptococcal antigen titer >1:512):

Preferred regimen: treat like CNS infection.

If infection occurs at a single site and no immunosupressive risk factors

Preferred regimen: Fluconazole 400mg PO qd for 6-12 months

1.7. Cryptococcosis in Children

Preferred regimen for induction and consolidation: Amphotericin B deoxycholate 1.0 mg/kg qd IV PLUS Flucytosine 100mg/kg PO or IV qid for 2 weeks followed by Fluconazole 10-12mg/kg PO qd for 8 weeks
Alternative regimen: patients with renal dysfunction: change Amphotericin B deoxycholate by Liposomal AmB 5mg/kg IV qd or Amphotericin B lipid complex (ABLC) 5mg/kg IV qd
Preferred regimen for maintenance: Fluconazole 6mg/kg PO qd. Discontinuation of maintenance therapy is poorly studied and should be individualized.

Cryptococcal pneumonia:

Preferred regimen Fluconazole 6-12mg/kg PO qd for 6-12 months

1.8. Cryptococcosis in Pregnant Women

Preferred regimen for induction and consolidation: Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction - Liposomal AmB 3-4mg/kg IV qd OR Amphotericin B lipid complex (ABLC) 5mg/kg IV qd. Consider using Flucytosine in relationship to benefit risk basis, since it is a Category C drug for pregnancy. Start Fluconazole after delivery. Avoid use during first trimester and consider use in the last 2 trimesters with the need for continuous antifungal therapy during pregnancy.
Note: If pulmonary cryptococcosis: perform close follow-up and administer fluconazole after delivery.

2. Cryptococcus gatti

Disseminated cryptococcosis or CNS disease:

Preferred regimen: treatment is the same as C. neoformans.

Pulmonary disease: single and small cryptococcoma:

Preferred regimen: Fluconazole 400mg per day PO for 6-18months

Pulmonary disease: Very large or multiple cryptococcomas:

Preferred regimen: administer Flucytosine AND AmB deocycholate for 4-6 weeks, followed by fluconazole for 6-18 months.
Note: Surgery should be considered if there is compression of vital structures OR failure to reduce the size of the cryptococcoma after 4 weeks of therapy

Tinea cruris Return to Top

Tinea Cruris^[221]

1. Topical cream/ointment

Preferred regimen (1): Butenafine cream applied qd for 14 days
Preferred regimen (2): Terbinafine cream applied bid for 14 days

2. Oral antifungal

Preferred regimen: Fluconazole 200 mg qd for 10 days AND Terbinafine 250 mg qd for 30 days
Note: Oral antifungal therapy is generally reserved for cases unresponsive to topical agents or can be used along with topical agents in severe cases.

Tinea corporis Return to Top
Tinea corporis^[222]

Small, well-defined lesions

Preferred regimen: Topical cream/ointment like Terbinafine OR Miconazole OR Econazole OR Clotrimazole

Larger lesionss

Preferred regimen: Terbinafine 250 mg/day PO for 2 weeks OR Itraconazole 200 mg/day PO for 1 wk OR Fluconazole 250 mg PO weekly for 2-4 weeks

Tinea pedis Return to Top
1. Tinea pedis^[223]

1.1 Athlete's foot

1.1.1 Interdigital

Preferred regimen: Topical cream/ointment Terbinafine OR Miconazole OR Econazole OR Clotrimazole

1.1.2 Dry type

Preferred regimen (1): Terbinafine 250 mg/day PO for 2-4 weeks
Preferred regimen (2): Itraconazole 400 mg/day PO for 1 week per month (repeated if necessary)
Preferred regimen (3): Fluconazole 200 mg PO weekly for 4-8 weeks

Tinea capitis Return to Top
Tinea capitis^[224]

Preferred regimen (1): Griseofulvin 10-20 mg/kg/day for minimum 6 weeks
Preferred regimen (2): Itraconazole 4-6 mg/kg pulsed dose weekly
Preferred regimen (3): Terbinafine if <20 kg: 62.5 mg/day, if 20-40 kg: 125 mg/day, if >40 kg: 250 mg/day

Tinea barbae Return to Top

Tinea Barbae

Preferred regimen: Terbinafine PO 250mg/day for 4 weeks.
Alternative regimen: Itraconazole PO 200mg/day for 2 weeks.

Tinea incognito Return to Top

Tinea Incognito

Preferred regimen: Stop topical steroids and treat with topical 1% terbinafine cream for 6 weeks.

Tinea manuum Return to Top

Tinea Manuum

Preferred regimen: topical or systemic terbinafine PO 250 mg/day por 2-4 weeks.

Tinea versicolor Return to Top

Tinea versicolor^[225]

Preferred regimen: Ketoconazole 400 mg PO single dose OR 200 mg q24h for 7 days OR 2% cream once q24h for 2 weeks
Alternative regimen: Fluconazole 400 mg PO single dose OR Itraconazole 400 mg PO q24h for 3–7 days

Majocchi's granuloma Return to Top

Majocchi's Granuloma

Preferred regimen: Terbinafine PO 250mg/day for 2-4 weeks.
Alternative regimen: Itraconazole 200mg PO bid for 1 week, per month for 2 months.

Onychomycosis Return to Top

Onychomycosis^[226]

10.1 Fingernails

Preferred regimen: Terbinafine PO 250mg/day for 6 weeks OR Itraconazole PO 200mg twice a day for a week a month for 2 months (European guidelines).

10.2 Toenails

Preferred regimen: Toenails Terbinafine PO 250mg/day for 12 weeks OR Itraconazole PO 200mg/day for 12 weeks (U.S. guidelines) OR Itraconazole PO 200mg twice a day for a week a month for 3 months (European guidelines).

Note (1): There is no evidence that combining systemic and topic treatments has any benefit to the patient.

Histoplasmosis Return to Top

1. Adult treatment: ^[227]

1.1 Pulmonary

1.1.1 Acute pulmonary histoplasmosis

1.1.1.1 Moderate severe or severe

Preferred regimen (1): Lipid formulation of Amphotericin B (3.0–5.0 mg/kg IV q12h for 1–2 weeks) THEN Itraconazole (200 mg tid for 3 days THEN 200 mg bid for a total of 12 weeks).
Preferred regimen (2): Methylprednisolone (0.5–1.0 mg/kg IV q24h) during the first 1–2 weeks of antifungal therapy is recommended for patients who develop respiratory complications, including hypoxemia or significant respiratory distress
Alternative regimen: The deoxycholate formulation of Amphotericin B (0.7–1.0 mg/kg q24h IV) is an alternative to a lipid formulation in patients who are at a low risk for nephrotoxicity.
Note (1): In severe cases, cases accompanied by respiratory insufficiency, or hypoxemia, anecdotal reports suggest that corticosteroid therapy may hasten recovery
Note (2): The pulmonary infiltrates should be resolved on the chest radiograph before antifungal therapy is stopped.

1.1.1.2 Mild to moderate:

Treatment is usually unnecessary
Preferred regimen for patients who continue to have symptoms for >1 month: Itraconazole (200 mg tid for 3 days {{then} 200 mg qd OR bid for 6–12 weeks)
Note (1): Antifungal treatment is unnecessary in patients with mild symptoms caused by acute pulmonary histoplasmosis

1.1.2 Chronic cavitary pulmonary histoplasmosis:

Preferred regimen: Itraconazole (200 mg tid for 3 days and THEN qd or bid for at least 1 year) is recommended
Note (1): Blood levels of itraconazole should be obtained after the patient has been receiving this agent for at least 2 weeks to ensure adequate drug exposure
Note (2): Patients with underlying emphysema often develop progressive pulmonary disease, which is characterized by cavities with surrounding inflammation after infection with hysotplasma capsulatum

1.1.3 Broncholithiasis

Antifungal treatment is not recommended
Note: Bronchoscopic or surgical removal of the broncholith is recommended

1.1.4 Pulmonary nodules (Histoplasmomas)

Antifungal treatment is not recommended**
Note: There is no evidence that antifungal agents have any effect on histoplasmomas or that histoplasmomas contain viable organisms.

1.2 Mediastinitis

1.2.1 Mediastinal lymphadenitis

1.2.1.1 Asymptomatic cases

Treatment is usually unnecessary

1.2.1.2 Patients who have symptoms that warrant treatment with corticosteroids and in those who continue to have symptoms for > 1 month

Itraconazole (200 mg 3 tid for 3 days and THEN 200 mg qd or bid for 6–12 weeks)

1.2.1.2 Severe cases with obstruction or compression of contiguous structures

Preferred regimen: Prednisone (0.5–1.0 mg/kg qd [maximum 80 mg qd] in tapering doses over 1–2 weeks)
Note (1): Antifungal treatment is unnecessary in most patients with symptoms due to mediastinal lymphadenitis
Note (2): Itraconazole is recommended for 6–12 weeks to reduce the risk of progressive disseminated disease caused by corticosteroid-induced immunosuppression in patients who are given corticosteroids and in patients whose symptoms last longer than 1 month.

1.2.2 Mediastinal granuloma

1.2.2.1 Asymptomatic cases

Treatment is usually unnecessary

1.2.2.2 Symptomatic cases

Preferred regimen: Itraconazole (200 mg 3 times qd for 3 days and THEN qd or bid for 6–12 weeks)
Note (1): Itraconazole is appropriate for symptomatic cases but there are no controlled trials to prove its efficacy.
Note (2): There is no evidence that mediastinal granuloma evolves into mediastinal fibrosis. Thus treatment with either surgery or itraconazole should not be used to prevent the development of mediastinal fibrosis

1.2.3 Mediastinal fibrosis

Antifungal treatment is not recommended**

1.2.3.1 If clinical findings cannot differentiate mediastinal fibrosis from mediastinal granuloma

Preferred regimen: Itraconazole (200 mg qd or bid for 12 weeks)
Note: The placement of intravascular stents is recommended for selected patients with pulmonary vessel obstruction
Note (2): Mediastinal fibrosis is characterized by invasive fibrosis that encases mediastinal or hilar nodes and that is defined by occlusion of central vessels and airways

1.3 Pericarditis:

1.3.1 Mild cases

Preferred regimen: Nonsteroidal anti-inflammatory therapy

1.3.2 Patients with evidence of hemodynamic compromise or unremitting symptoms after several days of therapy with nonsteroidal anti-inflammatory therapy

Prednisone (0.5–1.0 mg/kg qd [maximum, 80 mg qd] in tapering doses over 1–2 weeks)

1.3.3 If corticosteroids are administered

Preferred regimen: Itraconazole (200 mg tid for 3 days and THEN qd or bid for 6–12 weeks)
Note (1): Pericardial fluid removal is indicated for patients with hemodynamic compromise.
Note (2): Pericarditis occurs as a complication of inflammation in adjacent mediastinal lymph nodes in patients with acute pulmonary histoplasmosis.

1.4 Central nervous system histoplasmosis

Preferred regimen: Liposomal Amphotericin B (5.0 mg/kg qd for a total of 175 mg/kg given over 4–6 weeks) followed by Itraconazole (200 mg 2 or 3 times qd) for at least 1 year and until resolution of cerebro spinal fluid abnormalities including Histoplasma antigen levels.
Note: Blood levels of Itraconazole should be obtained to ensure adequate drug exposure

1.5 Rheumatologic syndromes

1.5.1 Mild cases

Preferred regimen: Nonsteroidal anti-inflammatory therapy

1.5.2 Severe cases

Preferred regimen: Prednisone (0.5–1.0 mg/kg qd [maximum, 80 mg qd] in tapering doses over 1–2 weeks)

1.5.3 Corticosteroids administration

Itraconazole (200 mg 3 times tid for 3 days and THEN qd or bid for 6–12 weeks)
Note (1): If corticosteroids are used, concurrent itraconazole treatment is recommended to reduce the risk of progressive infection
Note (2): Bone or joint involvement is very rare in progressive disseminated histoplasmosis but it should not be overlooked.

1.6 Progressive disseminated histoplasmosis

1.6.1 Moderately severe to severe disease

Preferred regimen: Liposomal Amphotericin B (3.0 mg/kg qd) is recommended for 1–2 weeks followed by oral Itraconazole (200 mg 3 times qd for 3 days and THEN 200 mg bid for a total of at least 12 months)
Note (1): Substitution of another lipid formulation at a dosage of 5.0 mg/kg qd may be preferred in some patients because of cost or tolerability
Note (2): The deoxycholate formulation of Amphotericin B (0.7–1.0 mg/kg qd) is an alternative to a lipid formulation in patients who are at a low risk for nephrotoxicity

1.6.2 Immunosupressed patients

Lifelong suppressive therapy with Itraconazole (200 mg qd)

1.6.3 Mild to moderate disease

Itraconazole (200 mg tid for 3 days and then bid qid for at least 12 months)
Note (1): Lifelong suppressive therapy with itraconazole (200 mg daily) may be required in immunosuppressed patients if immunosuppression cannot be reversed and in patients who relapse despite receipt of appropriate therapy
Note (2): Blood levels of itraconazole should be obtained to ensure adequate drug exposure
Note (3): Antigen levels should be measured during therapy and for 12 months after therapy is ended to monitor for relapse. Persistent low-level antigenuria may not be a reason to prolong treatment in patients who have completed appropriate therapy and have no evidence of active infection.
Note (4): Progressive disseminated histoplasmosis is fatal without therapy and treatment with either Amphotericin B or Itraconazole is highly effective. Among patients with AIDS and moderately severe to severe disseminated histoplasmosis, the rate of response was higher (88% vs. 64%) and the mortality rate was lower (2% vs. 13%) among recipients of liposomal amphotericin B (3 mg/kg qd for 1–2 weeks) than among recipients of the deoxycholate formulation.

1.7 Prophylaxis recommended for immunosuppressed patients

Preferred regimen: Itraconazole (200 mg qd) in patients with HIV infection with CD4 cell counts <150 cells/mm3 in specific areas of endemicity where the incidence of histoplasmosis is >10 cases per 100 patient-years
Note: Prophylaxis with Itraconazole (200 mg qd) may be appropriate in specific circumstances in other immunosuppressed patients

1.8 Performance Measures

Preferred regimen: Itraconazole is the preferred azole for initial therapy for patients with mild-to-moderate histoplasmosis and as step-down therapy after receipt of Amphotericin B
Note: When other azole agents are used, the medical record should document the specific reasons that Itraconazole was not used and why other azoles were used.
14.1 Severe or moderately severe histoplasmosis
Preferred regimen: Amphotericin B
Note: When Amphotericin B is used the patient's electrolyte level renal function and blood cell count should be monitored several times per week and documented in the medical record.
Note (2): Itraconazole drug levels should be measured during the first month in patients with disseminated or chronic pulmonary histoplasmosis and these levels should be documented in the medical record as well as the physician's response to levels that are too low.
Note (3): Itraconazole should not be given to patients receiving contraindicated medications (i.e., pimozide, quinidine, dofetilide, lovastatin, simvastatin, midazolam, and triazolam). Reasons for deviation from this practice should be documented in the medical record.

2. Pregnancy treatment

Preferred regimen: Lipid formulation Amphotericin B (3.0–5.0 mg/kg qd for 4–6 weeks) is recommended
Prefered regimen low risk for nephrotoxicity: The deoxycholate formulation of Amphotericin B (0.7–1.0 mg/kg qd) is an alternative to a lipid formulation
Note (1): If the newborn shows evidence for infection, treatment is recommended with Amphotericin B deoxycholate (1.0 mg/kg daily for 4 weeks)
Note (2): Unique issues in pregnancy include the risk of teratogenic complications of azole therapy and of transplacental transmission of Histoplasma capsulatum to the fetus

3. Children treatment

3.1 Acute pulmonary histoplasmosis
Treatment indications and regimens are similar to those for adults, except that Amphotericin B deoxycholate (1.0 mg/kg daily) is usually well tolerated and the lipid preparations are not preferred
Note: Itraconazole dosage: 5.0–10.0 mg/kg daily in 2 divided doses (not to exceed 400 mg daily), generally using the solution formulation

Progressive disseminated histoplasmosis
Prefered regimen: Amphotericin B deoxycholate (1.0 mg/kg qd for 4–6 weeks)
Alternative regimen: Amphotericin B deoxycholate (1.0 mg/kg qd for 2–4 weeks) followed by itraconazole (5.0–10.0 mg/kg qd in 2 divided doses) to complete 3 months of therapy.
Immunosuppressed patients if immunosuppression cannot be reversed and patients in relapse despite appropiate therapy

Preferred regimen: Lifelong suppressive therapy with Itraconazole (5.0 mg/kg qd up to 200 mg qd)

Note (1): Longer therapy may be needed for patients with severe disease, immunosuppression, or primary immunodeficiency syndromes
Note (2): Blood levels of itraconazole should be obtained to ensure adequate drug exposure
Note (3): Antigen levels should be monitored during therapy and for 12 months after therapy is ended to monitor for relapse. Persistent low-level antigenuria may not be a reason to prolong treatment in patients who have completed appropriate therapy and have no evidence of active infection.

Mucormycosis Return to Top
Mucormycosis^[228]

Treatment include surgical debridement of involved tissues, antifungal therapy, use of growth factors to accelerate recovery from neutropenia, provision of granulocyte transfusions with sustained circulating neutrophils until the patient recovers from neutropenia, and discontinuation or reduction in the dose of glucocorticoids, correction of metabolic acidosis and hyperglycemia.
Preferred regimen (1): Amphotericin B Deoxycholate 1.0-1.5 mg/kg/day IV q24h
Preferred regimen (2): Lipid Amphotericin B 5-10 mg/kg/day IV q24h
Preferred regimen (3): Amphotericin B lipid complex 5-7.5 mg/kg/day IV q24h
Alternative regimen (1):Caspofungin 70 mg IV load dose, 50 mg/day for >2 weeks PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h

Pediatric dose: Caspofungin 50 mg/m² IV q24h PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h

Alternative regimen (2): Micafungin OR Anidulafungin 100 mg/day for 2 weeks PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h

Pediatric dose: Micafungin 4 mg/kg/day; Micafungin 10mg/kg/day for low-birth weight infants; Anidulafungin 1.5 mg/kg/day

Alternative regimen (3): Deferasirox 20 mg/kg PO qd for 2–4 weeks PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h
Alternative regimen (4): Posaconazole 800 mg/day PO qid or bid
Alternative regimen (5): Initial: Isavuconazole 200 mg PO/IV q8h for 6 doses; maintenance: 200 mg PO/IV qd
Note (1): start maintenance dose 12 to 24 hours after the last loading dose.
Note (2): For salvage therapy: (Posaconazole 800 mg/day PO qid or bid ± Lipid Amphotericin B 5-10 mg/kg/day IV q24h) OR (Deferasirox 20 mg/kg PO qd for 2–4 weeks PLUS Lipid Amphotericin B 5-10 mg/kg/day IV q24h) OR Granulocyte transfusions (for persistently neutropenic patients) ∼10ˆ9 cells/kg OR Recombinant cytokines G-CSF 5 μg/kg/day, GM-CSF 100–250 μg/m², or IFN-g at 50 μg/m² for those with body surface area ≥ 0.5 m² and 1.5 μg/kg for those with body surface area <0.5 m²

Penicilliosis Return to Top

Penicilliosis treatment

1. Mild disease

Preferred regimen: Itraconazole 200 mg PO bid for 8 to 12 weeks without amphotericin B induction therapy^[229]
Alternative regimen: Voriconazole 400 mg PO bid on day 1 THEN 200 mg PO bid for 12 weeks^[230]

2. Moderate-severe disease

Preferred regimen: Liposomal Amphotericin B 3-5 mg/kg/day IV qd OR Amphotericin B lipid complex 5 mg/kg/day IV qd for 2 weeks THEN Itraconazole 200 mg PO bid for 10 weeks^[231]
Alternative regimen: Voriconazole 6 mg/kg IV q12h on day 1 THEN 4 mg/kg q12h for at least 3 days THEN Voriconazole 200 mg PO bid for a total of 12 weeks^[230]

3. Maintenance therapy^[232]

Preferred regimen Itraconazole 200 mg PO qd
Alternative regimen: Voriconazole 200 mg PO bid

Note: Voriconazole and Itraconazole use require serum levels to be monitored to ensure adequate absorption.

Sporotrichosis Return to Top

^[233]

Lymphocutaneous/cutaneous

Preferred regimen: Itraconazole 200mg PO qd
Alternative regimen: Itraconazole 200 mg PO bid OR Terbinafine 500 mg PO bid OR Saturated solution potassium iodide with increasing doses OR Fluconazole 400–800 mg PO qd OR local hyperthermia
Note (1): Treat for 2–4 weeks after lesions resolved
Note (2): SSKI initiated at a dosage of 5 drops (using a standard eyedropper) q8h, increasing as tolerated to 40–50 drops q8h

Osteoarticular

Preferred regimen: Itraconazole 200mg PO bid for 12 months
Alternative regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day IV OR Amphotericin B deoxycholate 0.7–1 mg/kg/day IV
Note (1): Switch to Itraconazole after favorable response if AmB used
Note (2): Treat for a total of at least 12 months

Pulmonary

Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day IV for severe or life-threatening pulmonary sporotrichosis, then Itraconazole 200 mg PO bid
Preferred regimen(2): Itraconazole 200 mg PO bid for 12 months for less severe disease
Alternative regimen: Amphotericin B deoxycholate 0.7–1 mg/kg/d IV THEN Itraconazole 200 mg PO bid OR surgical removal
Note (1): Treat severe disease with an AmB formulation followed by Itraconazole
Note (2): Treat less severe disease with Itraconazole
Note (3): Treat for a total of at least 12 monthsSurgery combined with amphotericin B therapy is rec- ommended for localized pulmonary disease

Meningitis

Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg daily for 4–6 weeks, then Itraconazole 200 mg PO bid
Alternative regimen: Amphotericin B deoxycholate 0.7–1 mg/kg/d, then Itraconazole 200 mg PO bid
Note (1): Length of therapy with AmB not established, but therapy for at least 4–6 weeks is recommended.
Note (2): Treat for a total of at least 12 months.
Note (3): May require long-term suppression with Itraconazole.

Disseminated

Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day, then Itraconazole 200 mg PO bid
Alternative regimen: Amphotericin B deoxycholate 0.7–1 mg/kg/day, then Itraconazole 200 mg PO bid
Note(1): Therapy with AmB should be continued until the patient shows objective evidence of improvement.
Note(2): Treat for a total of at least 12 months.
Note(3): May require long-term suppression with Itraconazole.

Pregnant women

Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day IV OR Amphotericin B deoxycholate 0.7–1 mg/kg/day IV for severe sporotrichosis
Preferred regimen(2): Local hyperthermia for cutaneous disease.
Note (1): It is preferable to wait until after delivery to treat non–life-threatening forms of sporotrichosis.
Note (2): Azoles should be avoided.

Children

Preferred regimen:

Mild disease: Itraconazole 6–10 mg/kg/day PO (400 mg/day maximum)
Severe disease: Amphotericin B deoxycholate 0.7 mg/kg/day IV followed by Itraconazole 6–10 mg/kg PO up to a maximum of 400 mg PO daily, as step-down therapy

Alternative regimen: Saturated solution potassium iodide with increasing doses for mild disease initiated at a dosage of 1 drop (using a standard eyedropper) q8h and increased as tolerated up to a maximum of 1 drop/kg or 40–50 drops q8h, whichever is lowest

Pneumocystis jiroveci Return to Top

1. Preventing First Episode of PCP (Primary Prophylaxis)^[234]

Preferred regimen: TMP-SMX 1 Double-Strength(DS) PO daily OR TMP-SMX 1 Single-Strength(SS) PO daily
Alternative regimen (1): TMP-SMX 1 Double-Strength(DS) tid weekly OR Dapsone 100 mg PO daily or 50 mg PO bid
Alternative regimen (2): Dapsone 50 mg PO AND (Pyrimethamine 50 mg PO AND Leucovorin 25 mg) PO weekly
Alternative regimen (3): Dapsone 200 mg PO AND Pyrimethamine 75 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
Alternative regimen (5): Atovaquone 1500 mg PO qd with food
Alternative regimen (6): Atovaquone 1500 mg PO AND Pyrimethamine 25 mg PO AND Leucovorin 10 mg PO daily with food

2. Treatment of Pneumocystis Pneumonia^[235]

2.1. Moderate to Severe PCP

Preferred regimen: TMP-SMX (TMP 15–20 mg and SMX 75–100 mg)/kg/day IV given q6h or q8h
Note: May switch to PO after clinical improvement
Alternative regimen (1): Pentamidine 4 mg/kg IV once daily infused over at least 60 minutes
Note: May reduce the dose to 3 mg/kg IV once daily because of toxicities.
Alternative regimen (2): Primaquine 30 mg (base) PO once daily AND (Clindamycin [IV 600 mg q6h or 900 mg q8h] or [PO 450 mg q6h or 600 mg q8h])

Note (1): Duration of PCP treatment is 21 days
Note (2): Adjunctive corticosteroid may be indicated in some moderate to severe cases.Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy) (AI):
Note (3): Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy)

Days 1–5 40 mg PO BID
Days 6–10 40 mg PO daily
Days 11–21 20 mg PO daily

2.2. Mild to Moderate PCP

Preferred regimen: TMP-SMX (TMP 15–20 mg/kg/day and SMX 75–100 mg/kg/day), given PO in 3 divided doses OR TMP-SMX Double-Strength(DS) - 2 tablets tid
Alternative regimen (1): Dapsone 100 mg PO daily AND TMP 15 mg/kg/day PO (3 divided doses)
Alternative regimen (2): Primaquine 30 mg (base) PO daily AND Clindamycin PO (450 mg q6h or 600 mg q8h)
Alternative regimen (3): Atovaquone 750 mg PO BID with food

Note: Duration of PCP treatment is 21 days

3. Preventing Subsequent Episode of PCP (Secondary Prophylaxis)^[236]

Preferred regimen: TMP-SMX 1 Double-Strength(DS) PO daily OR TMP-SMX 1 Single-Strength(SS) PO daily
Alternative regimen (1): TMP-SMX 1 Double-Strength(DS) tid weekly OR Dapsone 100 mg PO daily or 50 mg PO BID
Alternative regimen (2): Dapsone 50 mg PO daily AND (Pyrimethamine 50 mg + Leucovorin 25 mg) PO weekly
Alternative regimen (3): Dapsone 200 mg AND Pyrimethamine 75 mg AND Leucovorin 25 mg PO weekly
Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
Alternative regimen (5): Atovaquone 1500 mg PO daily with food
Alternative regimen (6): Atovaquone 1500 mg AND Pyrimethamine 25 mg AND Leucovorin 10 mg PO daily with food

Mycobacteria

Mycobacterium tuberculosis Return to Top

1. Standard Regimens for new patients ^[237]

1.1 Adult

1.1.1 Initial phase

Preferred regimen: Isoniazid 300 mg PO (5 mg/kg/day) qd for 8 weeks AND Rifampicin 600 mg PO (10 mg/kg/day) qd for 8 weeks AND Pyrazinamide 2 g PO (25 mg/kg/day) qd for 8 weeks AND Ethambutol 1.6 g PO (15 mg/kg/day) qd for 8 weeks
Alternative regimen (1): Isoniazid 300 mg/day PO for 2 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO for 2 weeks (10 mg/kg/day) AND Pyrazinamide 2 g/day PO for 2 weeks (25 mg/kg/day) AND Ethambutol 1.6 g PO for 2 weeks (15 mg/kg/day), followed by Isoniazid 300 mg/day PO twice weekly for 6 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly for 6 weeks (10 mg/kg/day) AND Pyrazinamide 2 g/day PO twice weekly for 6 weeks AND Ethambutol 1.6 g PO for 2 weeks (15 mg/kg/day)
Alternative regimen (2): Isoniazid 300 mg/day PO thrice weekly for 8 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO thrice weekly for 8 weeks (10 mg/kg/day) AND Pyrazinamide 2g/day PO thrice weekly for 8 week (25 mg/kg/day) AND Ethambutol 1.6 g PO thrice weekly for 8 weeks (15 mg/kg/day)

1.1.2 Continuation phase

Preferred regimen (1): Isoniazid 300 mg PO (5 mg/kg/day) qd AND Rifampicin 600 mg PO (10 mg/kg/day) qd for 18 weeks
Preferred regimen (2): Isoniazid 300 mg PO twice weekly (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly (10 mg/kg/day) for 18 weeks
Alternative regimen (1): Isoniazid 300 mg/day PO biweekly for 18 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO biweekly for 18 weeks (10 mg/kg/day)
Alternative regimen (2): Isoniazid 300 mg/day PO thrice weekly for 18 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO thrice weekly for 18 weeks (10 mg/kg/day)

1.2 Pediatric

1.2.1 Initial phase

Preferred regimen: Isoniazid 10 mg/kg PO (Maximum, 300 mg/day) AND Rifampicin 15 mg/kg PO (Maximum, 600 mg/day) AND Pyrazinamide 35 mg/kg PO (Maximum, 2 g/day) AND Ethambutol 20 mg/kg PO (Maximum, 1.6 g/day), each for 8 weeks

1.2.2 Continuation phase

Preferred regimen: Isoniazid 10 mg/kg PO (Maximum, 300 mg/day) AND Rifampicin 15 mg/kg PO (Maximum, 600 mg/day), each drug daily for 18 weeks

2. MDR Tuberculosis ^[238]

2.1 Adult

Preferred regimen: 4 agents combination

Agent 1: Pyrazinamide 20–30 mg/kg OR Ethambutol 15–25 mg/kg OR Rifabutin 5 mg/kg
Agent 2: Capreomycin 15 mg/kg OR Kanamycin 15 mg/kg OR Amikacin 7.5-10 mg/kg OR Streptomycin 12–18 mg/kg
Agent 3: Levofloxacin 500-1000 mg OR Moxifloxacin 400 mg OR Ofloxacin 400 mg
Agent 4: Ethionamide 15-20 mg/kg OR Protionamide 15-20 mg/kg OR Cycloserine 10-15 mg/kg OR Terizidone 10-20 mg/kg OR Para-aminosalicylic acid 8-12 g/day IV q8-12h

2.2 Pediatric

Preferred regimen: 4 agents combination

Agent 1: Pyrazinamide 20-30 mg/kg (Maximum: 600 mg) OR Ethambutol 15-20 mg/kg OR Rifabutin 5 mg/kg
Agent 2: Capreomycin 15-30 mg/kg (Maximum: 1000 mg) OR Kanamycin 15-30 mg/kg (Maximum: 1000 mg) OR Amikacin 15-22.5 mg/kg (Maximum: 1000 mg) OR Streptomycin 12-18 mg/kg AND
Agent 3: Levofloxacin 7.5-10 mg/kg OR Moxifloxacin 7.5-10 mg/kg OR Ofloxacin 15-20 mg/kg/day q12h (Maximum: 800 mg)
Agent 4: Ethionamide 15-20 mg/kg/day q12h (Maximum: 1000 mg) OR Protionamide 15-20 mg/kg/day q12h (Maximum: 1000 mg) OR Cycloserine 10-20 mg/kg (Maximum: 1000 mg) OR Terizidone 10-20 mg/kg (Maximum: 1000 mg) OR Para-aminosalicylic acid 150 mg/kg/day q8-12h(Maximum: 12,000 mg)

3. XDR Tuberculosis ^[239]

3.1 Adult

Preferred regimen: 3 agents combination

Agent 1: Pyrazinamide 20–30 mg/kg OR Ethambutol 15–25 mg/kg OR Rifabutin 5 mg/kg
Agent 2: Ethionamide 15-20 mg/kg OR Protionamide 15-20 mg/kg OR Cycloserine 10-15 mg/kg OR Terizidone 10-20 kg/mg OR Para-aminosalicylic acid 8-12 g/day q8-12h
Agent 3: Clofazimine 50 mg/d AND 300 mg once a month OR Amoxicillin/clavulanate 500 mg/125 mg q12h OR Linezolid 300-600 mg OR Imipenem 500mg q6h OR Clarithromycin 500-1000 mg q12h OR Thioacetazone 2.5 mg/kg OR Isoniazid (high-dose) 16–20 mg/kg

3.2 Pediatric

Preferred regimen: 3 agents combination

Agent 1: Pyrazinamide 20-30 mg/kg (Maximum: 600 mg) OR Ethambutol 15 mg/kg OR Rifabutin 5 mg/kg

Agent 2: Ethionamide 15-20 mg/kg (Maximum: 1000 mg) OR Protionamide 15-20 mg/kg (Maximum: 1000 mg) OR Cycloserine 10-20 mg/kg (Maximum: 1000 mg) OR Terizidone 10-20 mg/kg (Maximum: 1000 mg) OR Para-aminosalicylic acid 150 mg/kg/day q8-12h

Agent 3: Clofazimine 50 mg/d AND 300 mg once a month OR Amoxicillin/clavulanate OR Linezolid 300-600 mg OR Imipenem 500mg q6h OR Clarithromycin 500-1000 mg q12h OR Thioacetazone 2.5 mg/kg OR Isoniazid (high-dose) 16–20 mg/kg

Mycobacterium abscessus Return to Top
1.Limited, localized extrapulmonary disease ^[240]

Preferred regimen: Clarithromycin 500 mg PO bid ± Amikacin 10-15 mg/kg/day IV or 25 mg/kg three times weekly for 4 months

Alternative regimen (1): Amikacin AND Cefoxitin 12 g/day PO for two weeks
Note: until clinical improvement in severe cases

Alternative regimen (2): Amikacin AND Imipenem 500 mg IV q6-8h for two weeks
Note(1): Until clinical improvement in severe cases
Note(2): Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed

2.Pulmonary or serious extrapulmonary disease

Preferred regimen: Clarithromycin 500 mg PO bid AND Amikacin 15 mg/kg/day IV AND Cefoxitin 2g IV q4h OR Imipenem 1g IV q6h for at least 2-4 months
Note: If limited by adverse effects THEN Clarithromycin 500 mg PO bid or 1000 mg XR qd OR Azithromycin 250 mg PO qd
Alternative regimen(1): Tigecycline 100 mg IV loading dose THEN 50 mg IV q12h
Note: could be substituted as one of the injectables
Alternative regimen(2): Linezolid 600 mg PO bid or 600 mg PO qd AND Clarithromycin
Note: Could replace parental tx if not tolerated or feasible

Mycobacterium bovis Return to Top

Mycobacterium bovis ^[241]

Note: Is intrinsically resistant to Pyrazinamide (PZA). The treatment of M. bovis is extrapolated from experience with the treatment of PZA-resistant M. tuberculosis
1. Pulmonary and most extrapulmonary disease

Preferred regimen: Isoniazid AND Rifampin AND Ethambutol for 2 months, followed by Isoniazid AND Rifampin for 7 months

2. Meningitis

Preferred regimen: Isoniazid AND Rifampin AND Ethambutol for 2 months, followed by Isoniazid AND Rifampin for 10 months

Mycobacterium avium-intracellulare Return to Top

1. Treatment of MAC pulmonary disease ^[242]

1.1 Patients with nodular/bronchiectatic disease

Preferreday regimen: Clarithromycin 1,000 mg three times weekly OR Azithromycin 500–600 mg three times weekly AND Ethambutol 25 mg/kg three times weekly AND Rifampin 600 mg three times weekly
Note: Patients should be treated until culture negative on therapy for 1 year

1.2 Patients with fibrocavitary or severe nodular/bronchiectatic disease

Preferreday regimen: Clarithromycin 500–1,000 mg/day OR Azithromycin 250–300 mg/day OR Rifampin 600 mg/day OR Rifabutin 150–300 mg/day AND Ethambutol 15 mg/kg/day
Note(1): Amikacin OR Streptomycin threetimes-weekly can be used early in therapy
Note(2): Patients should be treated until culture negative on therapy for 1 year

2. Disseminateday MAC disease

Preferreday regimen: Clarithromycin 1,000 mg/day OR Azithromycin 250 mg/day AND Ethambutol 15 mg/kg/day ± Rifabutin 150–350 mg/day

Mycobacterium celatum Return to Top

Mycobacterium celatum ^[243]

Preferred regimen: Clarithromycin AND Ethambutol AND Ciprofloxacin ± Rifabutin

Mycobacterium chelonae Return to Top

Mycobacterium chelonae ^[244]
1. Localized infections

Preferred regimen: Clarithromycin 500 mg PO bid
Alternative regimen: Azithromycin

2. Disseminated or extensive disease

2.1 monotherapy

Preferred regimen: Clarithromycin 500 mg PO bid for 6 months

2.2 multidrug therapy

preferred regimen: Clarithromycin 500 mg PO bid AND Tobramycin 5 mg/kg IV q24h OR Imipenem 0.5-1 g IV q6h OR Linezolid 600 mg IV/PO q12h/bid for 4-8 weeks
Alternative regimen: Moxifloxacin 400 mg PO qd AND Linezolid 600 mg PO bid
Note(1): During initial treatment, multidrug therapy may prevent development of acquired resistance
Note(2): Total treatment duration is 6 months

3. Keratitis (LASIK-related)

Preferred regimen: Clarithromycin 500 mg PO bid AND Tobramycin 0.3% 2 gtts q4h AND Gatifloxacin 0.3% 1 gtt q4h OR Moxifloxacin 0.5% 1 gtt q4h

Mycobacterium foruitum Return to Top

Mycobacterium foruitum ^[245]

1. In vitro isolates

Susceptible agents: Amikacin (100%), Ciprofloxacin and Ofloxacin (100%), Sulfonamides (100%), Cefoxitin (50%), Imipenem (100%), Clarithromycin (80%), and Doxycycline (50%)

2. Disease

2.1 M. fortuitum lung disease

At least two agents with in vitro activity against the clinical isolate should be given for at least 12 months of negative sputum cultures

2.2 Serious skin, bone, and soft tissue M fortuitum disease

At least two agents with in vitro activity against the clinical isolate should be given for a minimum of 4 months; For bone infections, 6 months of therapy is recommended

Mycobacterium haemophilum Return to Top

Mycobacterium haemophilum ^[246]

1. In vitro

Susceptible: Amikacin, Clarithromycin, Ciprofloxacin, Rifampin, and Rifabutin
Less susceptible: Doxycycline and Sulfonamides

2. Infection

2.1 Disseminated disease

Preferred regimen: Clarithromycin AND Rifampin AND Rifabutin AND Ciprofloxacin

Mycobacterium genavense Return to Top

Mycobacterium genavense ^[247]

Susceptibility: Amikacin, Rifamycin, Fluoroquinolones, Streptomycin, and Macrolides
Note(1): Ethambutol has limited activity
Note(2): Optimal therapy is not determined, but multidrug therapies including Clarithromycin appear to be more effective than those without Clarithromycin

Mycobacterium gordonae Return to Top

Mycobacterium gordonae ^[248]

Preferred regimen: Ethambutol OR Rifabutin OR Clarithromycin OR Linezolid OR Fluoroquinolones

Mycobacterium kansasii Return to Top

Mycobacterium kansasii ^[249]

1. pulmonary disease

Preferred regimen: Rifampin 10 mg/kg/day (Maximum, 600 mg) PO AND Ethambutol 15 mg/kg/ day PO AND Isoniazid 5 mg/kg/day (Maximum 300 mg) PO AND Pyridoxine 50 mg/day PO
Note: Treatment duration for M. kansasii lung disease should include 12 months of negative sputum cultures

2. Rifampin-resistant M. kansasii disease

Preferred regimen: Clarithromycin OR Azithromycin OR Moxifloxacin OR Ethambutol OR Sulfamethoxazole OR Streptomycin
Note(1): Use three-drug regimen
Note(2): Patients undergoing therapy for M. kansasii lung disease should have close clinical monitoring with frequent sputum examinations for mycobacterial culture throughout therapy

3. Disseminated M. kansasii disease

Note: The treatment regimen for disseminated disease should be the same as for pulmonary disease

Mycobacterium marinum Return to Top

Mycobacterium marinum ^[250]

1. In vitro M. marinum isolates

Susceptible: Rifampin, Rifabutin, Ethambutol, Clarithromycin, Sulfonamides, and Trimethoprim sulfamethoxazole
Intermediately susceptible: Streptomycin, Doxycycline, and Minocycline
Resistant: Isoniazid and Pyrazinamide
Note: Two active agents for 1 to 2 months after resolution of symptoms, typically 3 to 4 months in total

2. Infection

2.1 skin and soft tissue infections

Preferred regimen (1): Clarithromycin AND Ethambutol
Preferred regimen (2): Ethambutol AND Rifampin
Note: Azithromycin can replace Clarithromycin

2.2 osteomyelitis or deep structure infection

Preferred regimen: Clarithromycin AND Ethambutol AND Rifampin

Mycobacterium scrofulaceum Return to Top

Mycobacterium scrofulaceum ^[251]

Susceptibility data are lacking and standard treatment regimens for M. scrofulaceum are controversial, emphasizing the need to perform susceptibility testing on confirmed disease-producing isolates of M. scrofulaceum

Mycobacterium simiae Return to Top

Mycobacterium simiae ^[252]

Preferred regimen: Clarithromycin AND Moxifloxacin AND Trimethoprim/sulfamethoxazole

Mycobacterium ulcerans Return to Top

Mycobacterium ulcerans ^[253]

1. Preulcerative lesions

Excision and primary closure, Rifampin monotherapy, or heat therapy

2. Established ulcers

Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice

3. Control complications of the ulcer

Preferred regimen: Clarithromycin AND Rifampin

Mycobacterium xenopi Return to Top

Mycobacterium xenopi ^[254]

1. The cornerstone of therapy for M. xenopi

Preferred regimen: Clarithromycin AND Rifampin AND Ethambutol
Note: Therapy should be continued until the patient has maintained negative sputum cultures while on therapy for 12 months

2. Pulmonary disease

Preferred regimen: INH AND Rifabutin OR Rifampin AND Ethambutol AND Clarithromycin ± Streptomycin
Note: A quinolone, preferably Moxifloxacin, could be substituted for one of the antituberculous drugs

3. Extrapulmonary disease

Note: Therapy for extrapulmonary disease would include the same agents as for pulmonary disease

Mycobacterium leprae Return to Top

Mycobacterium leprae ^[255]

1. Multibacillary Leprosy (Skin smear positive)

1.1 Adult

Preferred regimen: Dapsone 100 mg/day PO AND Rifampin 600 mg PO 4 times per week AND Clofazimine 50 mg PO qd for 12-24 months
Note: Clofazimine should be supplemented by loading dose 300 mg PO monthly

1.2 Pediatric

1.2.1 < 35 kg

Preferred regimen: Dapsone 1-2 mg/kg/day PO AND Rifampin 450 mg PO for 12-24 months

1.2.2 < 20 kg

Preferred regimen: Dapsone 1-2 mg/kg/day PO AND Rifampin 300 mg PO for 12-24 months

1.2.3 < 12 kg

Preferred regimen: Dapsone 1-2 mg/kg/day PO AND Rifampin 150 mg PO for 12-24 months

2. Paucibacillary Leprosy (Skin Smear negative)

Preferred regimen: Rifampin 600 mg PO once a month for 6 months AND Dapsone 100 mg PO qd for 6 months

3. Erythema Nodosum Leprosum (ENL)

3.1 Mild

Preferred regimen: Rest affect limb, analgesics, follow-up twice a week, check for iridocyclitis; Chloroquine OR Aspirin may be useful

3.2 Severe (numerous nodules + fever, ulcerating/pustular ENL, visceral involvement, nodules + neuritis, recurrent ENL)

Preferred regimen: Prednisolone 30-40 mg/day PO for 1-2 weeks THEN taper over 12 weeks
Alternative regimen (1): (If unresponsive to corticosteroids or if risk of corticosteroids prevent administration) Clofazimine 100 mg PO tid for maximum of 12 weeks THEN taper the dose to 100 mg PO bid for 12 weeks THEN 100 mg qd for 12-24 weeks
Alternative regimen (2): (if not contraindicated) Thalidomide 200-400 mg/day PO THEN 50-100 mg/day after 1-2 weeks

4. Reversal Reaction

Preferred regimen: Prednisolone start with 40 mg/day PO THEN taper by 10 mg twice a week for 12 weeks

Mycobacterium smegmatis Return to Top

Mycobacterium smegmatis ^[256]

1. Mild disease

Preferred regimen: Doxycycline PO AND Trimethoprim sulfamethoxazole PO

2. Severe disease

Preferred regimen: Amikacin IV OR Imipenem IV

Mycobacterium immunogenum Return to Top

Mycobacterium immunogenum ^[257]

In vitro

Susceptible: Amikacin and Clarithromycin
Resistant: Ciprofloxacin, Doxycycline, Cefoxitin, Tobramycin, and Sulfamethoxazole
Note: The optimal therapy for this organism is unknown; however, successful therapy is likely difficult due to the extensive antibiotic resistance of the organism

Mycobacterium malmoense Return to Top

Mycobacterium malmoense^[258]

1. In vitro

Susceptible: Ethambutol, Ethionamide, Kanamycin, and Cycloserine
Resistant: INH, Streptomycin, Rifampin, and Capreomycin

2. Pulmonary M. malmoense infection

Preferred regimen: INH AND Rifampin AND Ethambutol ± Quinolones AND Macrolides

Mycobacterium mucogenicum Return to Top

Mycobacterium mucogenicum ^[259]

In vitro susceptible agents: Aminoglycosides, Cefoxitin, Clarithromycin, Minocycline, Doxycycline, Quinolones, Trimethoprim/sulfamethoxazole, and Imipenem

Mycobacterium szulgai Return to Top

Mycobacterium szulgai ^[260]^[261]

1. in vitro susceptibility

M. szulgai is susceptible in vitro to most antituberculous drugs including Quinolones and newer Macrolides

2. Infection

2.1 Pulmonary infection

Three- or four-drug regimen based on susceptibility that includes 12 months of negative sputum cultures while on therapy

2.2 Extrapulmonary infection

Combination anti-tuberculous medications based on in vitro susceptibilities for 4-6 months

Mycobacterium terrae Return to Top

Mycobacterium terrae ^[262]

1. In vitro susceptibility

All six of the isolates from a single center and 90% or more of an additional 22 isolates of M. terrae complex were susceptible to Ciprofloxacin and Sulfonamides. Recently, 11 isolates of M. terrae complex were also shown to be susceptible to Linezolid

2. Antimicrobial therapy

Based on in vitro susceptibility results

Parasites – Intestinal Protozoa

Balantidium coli treatment^[263]

Adult dosage:

Preferred regimen: Metronidazole 750 mg PO tid for 5 days, Tetracycline 500 mg PO qid for 10 days
Alternative regimen: Iodoquinol 650 mg PO tid for a 20-days

Pediatric dosage:

Preferred regimen: Metronidazole 35-50 mg/kg/day PO in three doses (maximum dosage: 2 g) for 5 days, Tetracycline 40 mg/kg/dose PO in four doses for 10 days.
Alternative regimen: Iodoquinol 40 mg/kg/dose PO in three doses for 20 days AND Doxycycline.
Note: Nitazoxanide, a broad-spectrum antiparasitic and antihelminthic drug, may be another treatment for balantidiosis.

Blastocystis hominis Return to Top

Blastocystis^[264]

Preferred regimen (1): Metronidazole 750 mg PO tid or 1.5 g qd for 10 days

Preferred regimen (2): Trimethoprim-sulfamethoxazole 1 DS PO bid or 2 DS PO qd for 7 days

Preferred regimen (3): Iodoquinol 650 mg PO tid for 20 days

Preferred regimen (4): Nitazoxanide 500 mg PO bid for 3 days

Preferred regimen (5): Paromomycin 25-35 mg/kg/day PO tid for 7 days
Note (1): Treatment of asymptomatic infections is unnecessary
Note (2): One double strength tablet contains 160 mg trimethoprim/800 mg sulfamethoxazole

Cryptosporidium parvum Return to Top

1. Immunocompetent^[265]

Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: Nitazoxanide 500 mg PO bid for 3 days.

2. HIV^[266]

Preferred regimen: Nitazoxanide 500 mg PO bid for 3 days

3. HIV and Immunodeficiency^[267]

Preferred regimen: Effective antiretroviral therapy
Note: Nitazoxanide is not licensed for immunodeficient patients

Cryptosporidium hominis Return to Top

1. Immunocompetent^[268]

Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: Nitazoxanide 500 mg PO bid for 3 days.^[269]

2. HIV^[270]

Preferred regimen: Nitazoxanide 500 mg PO bid for 3 days

3. HIV and Immunodeficiency^[271]

Preferred regimen: Effective antiretroviral therapy
Note: Nitazoxanide is not licensed for immunodeficient patients

Cyclospora cayetanensis Return to Top
Cyclospora cayetanensis^[272]

Preferred regimen: Trimethoprim-sulfamethoxazole one double-strength tablet PO bid for 7-10 days
Alternative regimen(1): Ciprofloxacin 500 mg PO bid for 7 days
Alternative regimen(2): Nitazoxanide 500 mg PO bid for 7 days
Note(1): One double-strength tablet (160 mg TMP/800 mg SMX) .
Note(2): Treatment is continued for 7 days in immunocompetent hosts and for 7 to 10 days in patients with HIV infection.

Dientamoeba fragilis Return to Top

Dientamoebiasis^[273]^[274]^[275]

Preferred regimen: Iodoquinol 650 mg PO tid for 20 days
Alternative regimen (1): Paromomycin 25–35 mg/kg/day PO in three divided doses for 7 days
Alternative regimen (2): Metronidazole 500–750 mg PO tid for 10 days
Alternative regimen (3): Tetracycline 500 mg PO qid for 10 days

1.1 Treatment in pregnancy

The use of Iodoquinol in pregnancy is limited, and risk to the embryo-fetus is unknown, should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Oral dose of Paromomycin generally is poorly absorbed from the gastrointestinal tract, with minimal, if any, systemic availability.
Metronidazole is in pregnancy category B. Data on the use of this drug in pregnant women are conflicting. The available evidence suggests use during pregnancy has a low risk of congenital anomalies. May be used during pregnancy in those patients who will clearly benefit from the drug, although its use in the first trimester is generally not advised.

1.2 Treatment during lactation

Iodoquinol should be used with caution in breastfeeding women.
Oral dose of Paromomycin is unlikely to be excreted in breast milk, and the drug generally is poorly absorbed from the gastrointestinal tract.
Metronidazole should be used during lactation only if the potential benefit of therapy to the mother justifies the potential risk to the infant.

1.3 Treatment in pediatric patients

Iodoquinol 30–40 mg/kg/day (maximum 2 g) PO in 3 doses for 􏰄20 days. The safety of iodoquinol in children has not been established.
Paromomycin 25–35 mg/kg/day PO in 3 doses􏰄 for 7 days. The safety of oral dose in children has not been formally evaluated. However, the safety profiles likely are comparable in children and adults.
Metronidazole 35–50 mg/kg/day PO in 3 doses for􏰄 10 days. The safety in children has not been established, is listed as an antiamebic and antigiardiasis medicine on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
Tetracycline 40 mg/kg/day (maximum 2 g) PO in 4 doses for􏰄 10 days

Entamoeba histolytica Return to Top

1. Amebic Liver Abscess^[276]

Preferred regimen: (Metronidazole 750 mg PO tid for 10 days OR Tinidazole 2 g PO qd for 5 days) AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
Alternative regimen (1): Nitazoxanide 500 mg bid for 10 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
Alternative regimen (2): Tinidazole 2 g PO qd for 5 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
Alternative regimen (2): Tinidazole 2 g PO qd for 5 days

2. Amebic Colitis^[277]

Preferred regimen: Metronidazole 500-750 mg PO tid for 7-10 days. Pediatric dose: 35-50 mg/kg per day tid AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
Alternative regimen: Tinidazole 2 g PO qd for 5 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)

3. Asymptomatic Intestinal Colonization^[278]

Preferred regimen: Paromomycin 30 mg/kg/day PO tid for 5-10 days
Alternative regimen (1): Diloxanide furoate 500 mg PO tid for 10 days
Alternative regimen (2): Diiodohydroxyquin 650 mg PO tid for 20 days for adults and 30 to 40 mg/kg per day tid for 20 days for children

Giardia lamblia Return to Top

1. Giardiasis^[279]^[280]

1.1 Adult

Preferred regimen (1): Metronidazole 250 mg tid 5–7 days
Preferred regimen (2): Tinidazole 2 g single dose
Preferred regimen (3): Nitazoxanide 500 mg PO bid (with food)
Alternative regimen (1): Paromomycin 500 mg tid 3 5–10 days
Alternative regimen (2): Quinacrine 100 mg tid 3 5–7 days
Alternative regimen (3): Furazolidone 100 mg qid 3 7–10 days

1.2 Pediatric

Preferred regimen (1): Metronidazole 5 mg/kg tid 3 5–7 days
Preferred regimen (2): Tinidazole 50 mg/kg single dose (max, 2 g)
Preferred regimen (3): Nitazoxanide 100 mg PO bid for age 1-3 years or 200 mg PO bid for age 4-11 years (with food)
Alternative regimen (1): Paromomycin 30 mg/kg/day in 3 doses 3 5–10 days
Alternative regimen (2): Quinacrine 2 mg/kg tid 3 7 days
Alternative regimen (3): Furazolidone 2 mg/kg qid 3 10 days

Cystoisospora belli Return to Top

1. Cystoisospora belli treatment^[281]

1.1 Immunocompetent hosts

In the immunocompetent hosts, symptoms of Cystoisospora infection are usually self-limited.
Antimicrobial therapy to immunocompetent patients may be considered if symptoms do not start to resolve spontaneously after 5 to 7 days (depending upon severity)
Prefered regimen: Trimethoprim-sulfamethoxazole 160 mg/800 mg PO bid for 7-10 days
Alternative regimen (1) (for patients who are allergic to or intolerant of TMP-SMX): Pyrimethamine 50-75 mg/day PO qd or divided in 2 equal doses AND Leucovorin 10–25 mg PO qd
Alternative regimen (2): Ciprofloxacin 500 mg PO bid for 7 days (second-line alternative)

1.1.1 In pregnancy

TMP-SMX should be avoided near-term because of the potential for hyperbilirubinemia and kernicterus in the newborn.
Ciprofloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

1.1.2 During lactation

TMP-SMX generally should be avoided by women when nursing infants who are premature, jaundiced, ill, or stressed, or who have glucose-6-phosphate dehydrogenase deficiency.
The American Academy of Pediatrics classifies Ciprofloxacin as usually compatible with breastfeeding, whereas the World Health Organization recommends avoiding Ciprofloxacin while breastfeeding and CDC recommends Ciprofloxacin should be used during lactation only if the potential benefit justifies the potential risk to the fetus.

1.1.3 In pediatric patients

The use of TMP-SMX in children less than 2 months of age generally is not recommended.
Available evidence is conflicting regarding the potential for growth defects and arthropathies in exposed children. Use of Ciprofloxacin in children requires assessment of potential risks and benefits.

1.2 Immunocompromised hosts

Preferred regimen (1): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO/IV qid for 10 days
Preferred regimen (2): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO/IV bid for 7-10 days
Note (1): One approach is to start with TMP-SMX (160 mg/800 mg) bid regimen first, and increase daily dose and/or duration (up to 3–4 weeks) if symptoms worsen or persist.
Note (2): IV therapy is recommended for patients with potential or documented malabsorption.
Alternative regimen (1): Pyrimethamine 50–75 mg PO qd AND Leucovorin 10–25 mg PO qd
Alternative regimen (2): Ciprofloxacin 500 mg PO bid for 7 days

2. Cystoisospora belli prophylaxis^[282]

2.1 Primary prophylaxis

Insufficient evidence is available to support a general recommendation for primary prophylaxis for Cystoisosporiasis per se, especially for U.S. travelers in isoporiasis-endemic areas.

2.2 Secondary prophylaxis (preventing recurrence in patients with CD4 count < 200 cells/mm³)

Prefered regimen: Trimethoprim-sulfamethoxazole 160 mg/800 mg PO 3 times weekly
Alternative regimen (1): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO qd
Alternative regimen (2): Trimethoprim-sulfamethoxazole 320 mg/1600 mg PO 3 times weekly
Alternative regimen (3): Pyrimethamine 25 mg PO qd AND Leucovorin 5–10 mg PO qd
Alternative regimen (4): Ciprofloxacin 500 mg PO 3 times weekly (second-line alternative)
Note (1): Criteria for discontinuation of chronic maintenance therapy: sustained increase in CD4 count > 200 cells/mm³ for > 6 months in response to ART and without evidence of active Cystoisospora belli infection
Note (2): Because of concerns about possible teratogenicity associated with first-trimester drug exposure, clinicians may withhold secondary prophylaxis during the first trimester and treat only symptomatic infection.

Microsporidiosis Return to Top

1. Ocular^[283]

Preferred regimen: Albendazole 400 mg PO bid for 3 weeks AND Fumagillin eye drops.

2. Intestinal (diarrhea)^[284]

Preferred regimen:

Adult: Albendazole 400 mg PO bid for 3 weeks for E. intestinalis.
Pediatric: Albendazole 15 mg/kg per day divided into 2 daily doses for 7 days for E. intestinalis.

Note: Fumagillin 20 mg PO tid is the only reported effective treatment for E. bieneusi.

3. Disseminated^[285]

Preferred regimen: Albendazole 400 mg po bid for 3 weeks.

Parasites – Extraintestinal Protozoa

Acanthamoeba

Acanthamoeba Return to Top

1. Granulomatous amoebic encephalitis, meningitis, and disseminated Acanthamoeba disease^[286]^[287]

Preferred regimen (1): Pentamidine AND Itraconazole AND Sulfadiazine AND Flucytosine
Preferred regimen (2): Sulfadiazine AND Fluconazole AND Pyrimethamine
Preferred regimen (3): Sulfadiazine AND Flucytosine AND TMP-SMX
Preferred regimen (4): TMP-SMX AND Rifampin AND Ketoconazole
Preferred regimen (5): Miltefosine AND Amikacin
Preferred regimen (6): Miltefosine AND Voriconazole
Preferred regimen (7): Pentamidine AND Itraconazole AND Flucytosine AND Levofloxacin AND Amphotericin B AND Rifampin
Preferred regimen (8): Pentamidine AND Fluconazole AND Miltefosine
Note: The mainstay of successful treatment includes early diagnosis and combination therapy with pentamidine, azole, sulfonamide, miltefosine, and possibly flucytosine.

2. Cutaneous acanthamoebiasis^[288]^[289]^[290]

Preferred regimen: Pentamidine AND Sulfadiazine AND Flucytosine AND (Itraconazole OR Fluconazole) AND Chlorhexidine topical AND Ketoconazole topical

3. Acanthamoeba keratitis^[291]

Preferred regimen: (Polyhexamethylene biguanide topical OR Chlorhexidine topical) ± (Propamidine topical OR Hexamidine topical)
Note (1): Azole antifungal drugs (Ketoconazole, Itraconazole, Voriconazole) may be considered as oral or topical adjuncts.
Note (2): The duration of therapy for Acanthamoeba keratitis may last six months to a year.
Note (3): Pain control can be helped by topical cyclopegic solutions and oral nonsteroidal medications.
Note (4): The use of corticosteroids to control inflammation is controversial.
Note (5): Penetrating keratoplasty may help restore visual acuity.

Balamuthia mandrillaris

Balamuthia mandrillaris Return to Top

1. Granulomatous Amebic Encephalitis^[292]^[293]

Preferred regimen (1): Pentamidine AND Flucytosine AND Fluconazole AND Sulfadiazine AND (Azithromycin OR Clarithromycin)
Preferred regimen (2): Pentamidine AND Albendazole AND (Itraconazole OR Fluconazole) AND Miltefosine

Naegleria fowleri

Naegleria fowleri Return to Top

Primary amoebic meningoencephalitis^[294]^[295]

Preferred regimen: Amphotericin B 1.5 mg/kg/day bid for 3 days; then 1 mg/kg/day for 6 days AND 1.5 mg/day intrathecal for 2 days; then 1 mg/day intrathecal qd for 8 days.
Note: Investigational drug called miltefosine also available for treatment.

Babesia microti

Babesia microti Return to Top

Babesiosis

1. Mild/moderate disease^[296]

Preferred regimen: Atovaquone 750 mg PO bid AND Azithromycin 600 mg PO qd for 7-10 days

2. Severe disease:

Preferred regimen: Clindamycin 600 mg PO tid AND Quinine 650 mg PO tid for 7–10 days
Preferred regimen: Clindamycin 1.2 g IV q12h
Note (1): For overwhelming infection in asplenic patients and immunocompromised patients, treat for 6 or more weeks.
Note (2): Consider transfusion if 􀂕10% parasitemia.

Leishmania

Leishmania Return to Top

Leishmaniasis

1. Cutaneous Leishmaniasis^[297]

Different Leishmania species cause Old World versus New World (American) cutaneous leishmaniasis. In the Old World (the Eastern Hemisphere), the etiologic agents include Leishmania tropica, L. major, and L. aethiopica, as well as L. infantum and L. donovani. The main species in the New World (the Western Hemisphere) are either in the L. mexicana species complex (L. mexicana, L. amazonensis, and L. venezuelensis) or the subgenus Viannia (L. [V.] braziliensis, L. [V.] guyanensis, L. [V.] panamensis, and L. [V.] peruviana). The Viannia subgenus is also referred to as the L. (V.) braziliensis species complex.

1.1 Systemic Therapy (Parenteral)

Preferred Regimen (1): Sodium stibogluconate 20 mg/kg IV/IM q24h for 10-20 days
Preferred Regimen (2): Meglumine antimoniate 20 mg/kg IV/IM q24h for 10-20 days
Alternative Regimen (1): Liposomal amphotericin B 3 mg/kg/day IV infusion for 6-10 days
Alternative Regimen (2): Pentamidine 2-3 mg/kg/day IV/IM for 4-7 days
Note: Data supporting the use of amphotericin B for treatment of cutaneous and mucosal leishmaniasis are anecdotal; standard dosage regimens have not been established. In the United States, pentamidine isethionate is uncommonly used for treatment of cutaneous leishmaniasis. Its limitations include the potential for irreversible toxicity and variable effectiveness.

1.2 Systemic Therapy (Oral)

1.2.1 Adults and adolescents at least 12 years of age, who weigh from 33-44 kg

Preferred Regimen:Miltefosine 50 mg PO q12h for 28 days

1.2.2 Adults and adolescents at least 12 years of age, who weigh >45 kg

Preferred Regimen:Miltefosine 50 mg PO q8h for 28 days
Alternative Regimen (1): Ketoconazole 600 mg qd for 28 days OR qd for 6 weeks
Alternative Regimen (2): Fluconazole 200 mg qd for 6 weeks
Note:The FDA-approved indications are limited to infection caused by three particular species, all three of which are New World species in the Viannia subgenus—namely, Leishmania (V.) braziliensis, L. (V.) panamensis, and L. (V.) guyanensis. The "azoles" showed modest activity against some Leishmania species in some cases, but are not FDA approved

1.3 Local Therapy

List of possible local therapies
Cryotherapy (with liquid nitrogen OR Thermotherapy (use of localized current field radiofrequency heat) OR Intralesional administration of SbV OR Topical application of Paromomycin (such as an ointment containing 15% Paromomycin/12% methylbenzethonium chloride in soft white paraffin)

2. Visceral Leishmaniasis

Visceral leishmaniasis usually is caused by the species L. donovani and L. infantum (L. chagasi generally is considered synonymous with L. infantum)

2.1 Systemic Therapy (Parenteral)

Preferred Regimen (1): Liposomal amphotericin B 3 mg/kg/day IV for 5 days, then once on day 14 and once on day 21 (Total dose: 21 mg/kg)
Preferred Regimen (2): Sodium stibogluconate 20 mg/kg IV/IM q24h for 28 days
Preferred Regimen (3): Meglumine antimoniate 20 mg/kg IV/IM q24h for 28 days
Alternative Regimen: Amphotericin B deoxycholate 0.5-1 mg/kg IV q24h (Total dose: 15-20 mg/kg)
Note: In immunosuppressed patients, dose is 4 mg/kg/day for 5 days, then once on day 10, 17, 24, 31, and 38 (Total dose: 40 mg/kg)

2.2 Systemic Therapy (Oral)

2.2.1 Adults and adolescents at least 12 years of age, who weigh from 33-44 kg

Preferred Regimen: Miltefosine 50 mg PO q12h for 28 days

2.2.2 Adults and adolescents at least 12 years of age, who weigh >45 kg

Preferred Regimen: Miltefosine 50 mg PO q8h for 28 days

Plasmodium

Plasmodium Return to Top

1. Plasmodium falciparum^[298]

1.1 Treatment of uncomplicated P. falciparum malaria

1.1.1 Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)

Preferred regimen (1): Artemether 5–24 mg/kg/day PO bid AND Lumefantrine 29–144 mg/kg/day PO bid for 3 days.

Note: The first two doses should, ideally, be given 8 h apart.
Dosage regimen based on Body weight (kg)
Body weight (kg)-5 to < 15- Artemether 20 mg PO bid AND Lumefantrine 120 mg PO bid for 3 days
Body weight (kg)-15 to < 25- Artemether 40 mg PO bid AND Lumefantrine 240 mg PO bid for 3 days
Body weight (kg)-25 to < 35- Artemether 60 mg PO bid AND Lumefantrine 360 mg PO bid for 3 days
Body weight (kg) ≥ 35- Artemether 80 mg PO bid AND Lumefantrine 480 mg PO bid for 3 days

Preferred regimen (2): Artesunate 2–10 mg/kg/day PO qd AND Amodiaquine 7.5–15 mg/kg/day PO qd for 3 days

Note: A total therapeutic dose range of 6–30 mg/kg/day artesunate and 22.5–45 mg/kg/day per dose amodiaquine is recommended.
Dosage regimen based on Body weight (kg)
Body weight (kg)-4.5 to < 9- Artesunate 25 mg PO qd AND Amodiaquine 67.5 mg PO qd for 3 days
Body weight (kg)-9 to < 18 - Artesunate 50 mg PO qd AND Amodiaquine 135 mg PO qd for 3 days
Body weight (kg)-18 to < 36- Artesunate 100 mg PO qd AND Amodiaquine 270 mg PO qd for 3 days
Body weight (kg) ≥ 36 - Artesunate 200 mg PO qd AND Amodiaquine 540 mg PO qd for 3 days

Preferred regimen (3): Artesunate 2–10 mg/kg/day PO qd AND Mefloquine 2–10 mg/kg/day PO qd for 3 days

Dosage regimen based on Body weight (kg)
Body weight (kg)-5 to < 9- Artesunate 25 mg PO qd AND Mefloquine 55 mg PO qd for 3 days
Body weight (kg)-9to < 18- Artesunate 50 mg PO qd AND Mefloquine 110 mg PO qd for 3 days
Body weight (kg)-18 to < 36- Artesunate 100 mg PO qd AND Mefloquine 220 mg PO qd for 3 days
Body weight (kg)- ≥ 36 - Artesunate 200 mg PO qd AND Mefloquine 440 mg PO qd for 3 days

Preferred regimen (4): Artesunate 2–10 mg/kg/day PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1.25 (25–70 / 1.25–3.5) mg/kg/day PO given as a single dose on day 1

Dosage regimen based on Body weight (kg)
Body weight (kg)-5 to < 10- Artesunate 25 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 250/12 mg PO given as a single dose on day 1
Body weight (kg)-10 to < 25- Artesunate 50 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 500/25 mg PO given as a single dose on day 1
Body weight (kg)-25 to < 50- Artesunate 100 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1000/50 mg PO given as a single dose on day 1
Body weight (kg)- ≥50- Artesunate 200 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1500/75 mg PO given as a single dose on day 1

Preferred regimen (5): Dihydroartemisinin 2–10 mg/kg/day PO qd AND Piperaquine16–27 mg/kg/day PO qd for 3 days

Dosage regimen based on Body weight (kg)
Body weight (kg)-5 to < 8- Dihydroartemisinin 20 mg PO qd AND Piperaquine 160 mg PO qd for 3 days
Body weight (kg)-8 to < 11- Dihydroartemisinin 30 mg PO qd AND Piperaquine 240 mg PO qd for 3 days
Body weight (kg)-11 to < 17 - Dihydroartemisinin 40 mg PO qd AND Piperaquine 320 mg PO qd for 3 days
Body weight (kg)-17 to < 25- Dihydroartemisinin 60 mg PO qd AND Piperaquine 480 mg PO qd for 3 days
Body weight (kg)-25 to < 36- Dihydroartemisinin 80 mg PO qd AND Piperaquine 640 mg PO qd for 3 days
Body weight (kg)-36 to < 60- Dihydroartemisinin 120 mg PO qd AND Piperaquine 960 mg PO qd for 3 days
Body weight (kg)-60 < 80 - Dihydroartemisinin 160 mg PO qd AND Piperaquine 1280 mg PO qd for 3 days
Body weight (kg)- >80- Dose of Dihydroartemisinin 200 mg PO qd AND Piperaquine 1600 mg PO qd for 3 days

1.1.2 Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)

Preferred regimen: Single dose of 0.25 mg/kg Primaquine with ACT

1.2 Recurrent Falciparum Malaria

1.2.1 Failure within 28 days

Note:The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens (with artesunate or quinine both of which should be co-administered with + tetracycline, or doxycycline or clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.

1.2.2 Failure after 28 days

Note: all presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used.

1.3 Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)

Note: Single dose of 0.25 mg/kg bw Primaquine with ACT

1.4 Treating uncomplicated P. falciparum malaria in special risk groups

1.4.1 Pregnancy

First trimester of pregnancy : Quinine AND Clindamycin 10mg/kg/day PO bid for 7 days
Second and third trimesters : Mefloquine is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
Note (1): Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
Note (2): Primaquine and tetracyclines should not be used in pregnancy.

1.4.2 Infants less than 5kg body weight : with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
1.4.3 Patients co-infected with HIV: should avoid Artesunate + SP if they are also receiving Co-trimoxazole, and avoid Artesunate AND Amodiaquine if they are also receiving efavirenz or zidovudine.
1.4.4 Large and Obese adults: For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
1.4.5 Patients co-infected with TB: Rifamycins, in particular rifampicin, are potent CYP3A4 inducers with weak antimalarial activity. Concomitant administration of rifampicin during quinine treatment of adults with malaria was associated with a significant decrease in exposure to quinine and a five-fold higher recrudescence rate
1.4.6 Non-immune travellers : Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
1.4.7 Uncomplicated hyperparasitaemia: People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT.

2. Treatment of uncomplicated malaria caused by P. vivax, P. ovale, P. malariae or P. knowlesi

2.1 Blood Stage infection

2.1.1. Uncomplicated malaria caused by P. vivax

2.1.1.1 In areas with chloroquine-sensitive P. vivax

Preferred regimen: Chloroquine total dose of 25 mg/kg PO. Chloroquine is given at an initial dose of 10 mg/kg, followed by 10 mg/kg on the second day and 5 mg/kg on the third day.

2.1.1.2 In areas with chloroquine-resistant P. vivax

Note: ACTs containing Piperaquine, Mefloquine OR Lumefantrine are the recommended treatment, although Artesunate + Amodiaquine may also be effective in some areas. In the systematic review of ACTs for treating P. vivax malaria, Dihydroartemisinin + Piperaquine provided a longer prophylactic effect than ACTs with shorter half-lives (Artemether + Lumefantrine, Artesunate + Amodiaquine), with significantly fewer recurrent parasitaemias during 9 weeks of follow-up.

2.1.2 Uncomplicated malaria caused by P. ovale, P. malariae or P. knowlesi malaria

Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to chloroquine. In only one study, conducted in Indonesia, was resistance to chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or Chloroquine, as for vivax malaria.

2.1.3 Mixed malaria infections

Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.

2.2 Liver stages (hypnozoites) of P. vivax and P. ovale

Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.]

2.2.1 Primaquine for preventive relapse

Preferred regimen: Primaquine 0.25–0.5 mg/kg/day PO qd for 14 days

2.2.2 Primaquine and glucose-6-phosphate dehydrogenase deficiency

Preferred regimen: Primaquine 0.75 mg base/kg/day PO once a week for 8 weeks.
Note: The decision to give or withhold Primaquine should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.

2.2.3 Prevention of relapse in pregnant or lacating women and infants

Note: Primaquine is contraindicated in pregnant women, infants < 6 months of age and in lactating women (unless the infant is known not to be G6PD deficient).

3. Treatment of severe malaria

3.1 Treatment of severe falciparum infection with Artesunate

3.1.1 Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women):-

Preferred regimen: Artesunate IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT (add single dose Primaquine in areas of low transmission).

3.1.2 Young children weighing < 20 kg

Preferred regimen:Artesunate 3 mg/kg per dose IV/IM q24h
Alternatives regimen: use Artemether in preference to quinine for treating children and adults with severe malaria

3.2.Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)

3.2.1 Adults and children

Preferred regimen: Artesunate IM q24h
Alternative regimen: Artemether IM OR Quinine IM

3.2.2 Children < 6 years

Preferred regimen: Where intramuscular injections of artesunate are not available, treat with a single rectal dose (10 mg/kg) of Artesunate, and refer immediately to an appropriate facility for further care.
Note: Do not use rectal artesunate in older children and adults.

3.3 Pregancy

Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed.

3.4 Treatment of severe P. Vivax infection

Note: parenteral artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). A full course of radical treatment with primaquine should be given after recovery.

3.5 Additional aspects of management in severe malaria

Fluid therapy: It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit.
Blood Transfusion :In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended.
Exchange blood transfusion: Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.

Toxoplasma gondii

Toxoplasma gondii Return to Top

Toxoplasma gondii (treatment)

1. Lymphadenopathic toxoplasmosis^[299]

Preferred regimen: Treatment of immunocompetent adults with lymphadenopathic toxoplasmosis is rarely indicated; this form of the disease is usually self-limited.

2. Ocular disease^[300]

2.1 Adults

Preferred regimen: Pyrimethamine 100 mg PO for 1 day as a loading dose, then 25 to 50 mg/day AND Sulfadiazine 1 g PO qid AND folinic acid (Leucovorin 5-25 mg PO with each dose of Pyrimethamine

2.2 Pediatric

Preferred regimen: Pyrimethamine 2 mg/kg PO first day then 1 mg/kg each day AND Sulfadiazine 50 mg/kg PO bid AND folinic acid (Leucovorin 7.5 mg/day PO ) for 4 to 6 weeks followed by reevaluation of the patient's condition
Alternative regimen: The fixed combination of Trimethoprim with Sulfamethoxazole has been used as an alternative.
Note: If the patient has a hypersensitivity reaction to sulfa drugs, Pyrimethamine AND Clindamycin can be used instead.

3. Maternal and fetal infection^[301]

3.1 First and early second trimesters

Preferred regimen: Spiramycin is recommended

3.2 Late second and third trimesters

Preferred regimen: Pyrimethamine/Sulfadiazine AND Leucovorin for women with acute T. gondii infection diagnosed at a reference laboratory during gestation.

3.3 Infant

Note: If the infant is likely to be infected, then treatment with drugs such as Pyrimethamine, Atovaquone, Sulfadiazine, Leucovorin is typical. Congenitally infected newborns are generally treated with pyrimethamine, a sulfonamide, and leucovorin for 1 year.

4. Toxoplasma gondii Encephalitis in AIDS^[302]

4.1 Treatment for acute infection

4.1.1 Patients with weight <60 kg
Preferred regimen: Pyrimethamine 200 mg PO 1 time, followed by Pyrimethamine 50 mg PO qd AND Atovaquone AND Sulfadiazine 1000 mg PO q6h AND Leucovorin 10–25 mg PO qd,
4.1.2 Patients with weight ≥60 kg

Preferred regimen: Pyrimethamine 200 mg PO 1 time, followed by Pyrimethamine 75 mg PO qd AND Sulfadiazine 1500 mg PO q6h AND Leucovorin 10–25 mg PO qd and Leucovorin dose can be increased to 50 mg qd or bid
Alternative regimen (1): Pyrimethamine AND Leucovorin AND Clindamycin 600 mg IV/ PO q6h
Alternative regimen (2): TMP-SMX (TMP 5 mg/kg and SMX 25 mg/kg ) IV/PO bid
Alternative regimen (3): Atovaquone 1500 mg PO bid AND Pyrimethamine AND Leucovorin
Alternative regimen (4): Atovaquone1500 mg PO bid AND sulfadiazine 1000–1500 mg PO q6h (weight-based dosing, as in preferred therapy)
Alternative regimen (5): Atovaquone 1500 mg PO bid
Alternative regimen (6): Pyrimethamine AND Leucovorin AND Azithromycin 900–1200 mg PO qd
Note: Treatment for at least 6 weeks; longer duration if clinical or radiologic disease is extensive or response is incomplete at 6 weeks.

4.2 Chronic maintenance therapy

Preferred regimen: Pyrimethamine 25–50 mg PO qd AND sulfadiazine 2000–4000 mg PO qd (in 2–4 divided doses) AND Leucovorin 10–25 mg PO qd
Alternative regimen (1): Clindamycin 600 mg PO q8h AND (Pyrimethamine 25–50 mg AND Leucovorin 10–25 mg) PO qd
Alternative regimen (2): TMP-SMX DS 1 tablet bid
Alternative regimen (3): Atovaquone 750–1500 mg PO bid AND (Pyrimethamine 25 mg AND Leucovorin 10 mg) PO qd
Alternative regimen (4): Atovaquone 750–1500 mg PO bid
Alternative regimen (5): Sulfadiazine 2000–4000 mg PO bid/qid
Alternative regimen (6): Atovaquone 750–1500 mg PO bid Pyrimethamine and Leucovorin doses are the same as for preferred therapy
Note: Adjunctive corticosteroids (e.g., Dexamethasone) should only be administered when clinically indicated to treat mass effect associated with focal lesions or associated edema; discontinue as soon as clinically feasible. Anticonvulsants should be administered to patients with a history of seizures and continued through acute treatment, but should not be used as seizure prophylaxis . If Clindamycin is used in place of Sulfadiazine, additional therapy must be added to prevent PCP.

Toxoplasma gondii (prophylaxis)

1. Prophylaxis to prevent first episode of encephalitis in AIDS^[303]

1.1 Indications

Toxoplasma IgG-positive patients with CD4 count <100 cells/µL
Seronegative patients receiving PCP prophylaxis not active against toxoplasmosis should have toxoplasma serology retested if CD4 count decline to <100 cells/µL. Prophylaxis should be initiated if seroconversion occurred.

1.2 Prophylactic therapy

Preferred regimen: TMP-SMX 1 DS PO daily
Alternative regimen (1): TMP-SMX 1 DS PO three times weekly
Alternative regimen (2): TMP-SMX 1 SS PO qd
Alternative regimen (3): Dapsone 50 mg PO qd AND (Pyrimethamine 50 mg PO AND Leucovorin 25 mg) PO weekly
Alternative regimen (4): Dapsone 200 mg PO AND Pyrimethamine 75 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (5): Atovaquone 1500 mg PO qd
Alternative regimen (6): Atovaquone 1500 mg PO AND Pyrimethamine 25 mg PO AND Leucovorin 10 mg PO qd

Trichomonas vaginalis

Trichomonas vaginalis Return to Top

1. T. vaginalis infection in adults ^[304]

Preferred regimen (1): Metronidazole 2 g PO in a single dose
Preferred regimen (2): Tinidazole 2 g PO in a single dose
Alternative regimen: Metronidazole 500 mg PO bid for 7 days

2. T. vaginalis infection in pregnant and lactating Women

2.1 Pregnant women

Preferred regimen: Metronidazole 2 g PO in a single dose.

2.2 Post-partum and Breastfeeding

Preferred regimen (1): Metronidazole 2 g PO in a single dose.
Preferred regimen (2): Tinidazole 2 g PO in a single dose
Note (1): Do not breastfeed for 12-24 hrs following Metronidazole and 72 hrs following Tinidazole
Note (2): Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment. Pregnant women should be advised of the risk and benefits to treatment as infection (definitely) and treatment (possibly)
Note (3): Pregnant women with HIV who are treated for T. vaginalis infection should be retested 3 months after treatment.

3. T. vaginalis infection in patients with HIV

Preferred regimen: Metronidazole 500 mg PO bid for 7 days

4. Persistent or recurrent trichomoniasis

4.1 Treatment failure

Preferred regimen: Metronidazole 500 mg PO bid for 7 days

4.2 Treatment failure again

Preferred regimen (1): Metronidazole 2 g PO for 7 days
Preferred regimen (2): Tinidazole 2 g PO for 7 days

4.3 Nitroimidazole-resistant cases

Preferred regimen: Tinidazole 2-3 g PO for 14 days

African trypanosomiasis

African trypanosomiasis Return to Top

Sleeping sickness^[305]

1. East african trypanosomiasis

1.1 T. b. rhodesiense, hemolymphatic stage

1.1.1 Adult

Preferred regimen: Suramin 1 gm IV on days 1,3,5,14, and 21

1.1.2 Pediatric

Preferred regimen: Suramin 20 mg/kg IV on days 1, 3, 5, 14, and 21

1.2 T. b. rhodesiense, CNS involvement

1.2.1 Adult

Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days. After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days.

1.2.2 Pediatric

Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days. After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days

2. West african trypanosomiasis

2.1 T. b. gambiense, hemolymphatic stage

2.1.1 Adult

Preferred regimen: Pentamidine 4 mg/kg/day IM/ IV for 7-10 days

2.1.2 Pediatric

Preferred regimen: Pentamidine 4 mg/kg/day IM/IV for 7-10 days
Note (1): Pentamidine should be used during pregnancy and lacation only if the potential benefit justifies the potential risk
Note (2): IM/IV Pentamidine have a similar safety profile in children age 4 months and older as in adults. Pentamidine is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (Trypanosoma brucei gambiense) on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.

2.2 T. b. gambiense, CNS involvement

2.2.1 Adult

Preferred regimen: Eflornithine 400 mg/kg/day IV qid for 14 days

2.2.2 Pediatric

Preferred regimen: Eflornithine 400 mg/kg/day IV qid for 14 days
Note (1): Eflornithine should be used during pregnancy and lactation, only if the potential benefit justifies the potential risk
Note (2): The safety of Eflornithine in children has not been established. Eflornithine is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. Eflornithine is listed for the treatment of 1st stage African trypanosomiasis inTrypanosoma brucei gambiense infection on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.

American trypanosomiasis

American trypanosomiasis Return to Top

Chagas disease^[306]

1. Preferred regimen(1):

Patients of age < 12 years- Benznidazole 5-7.5 mg/kg/ day PO bid for 60 days
Patients of age 12 years or older- Benznidazole 5-7 mg/kg/day PO bid for 60 days

2. Preferred regimen(2):

Patients of age ≤ 10 years- Nifurtimox 15-20 mg/kg/day PO tid/ qid for 90 days
Patients of age 11-16 years- Nifurtimox 12.5-15 mg/kg/day PO tid/ qid for 90 days
Patients of age 17 years or older- Nifurtimox 8-10 mg/kg/day PO tid/ qid for 90 days

Note: In the United States, Nifurtimox and Benznidazole are not FDA approved and are available only from CDC under investigational protocols.

Parasites – Intestinal Nematodes (Roundworms)

Gnathostoma spinigerum Return to Top

Eosinophilic Meningitis
- Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.^[307]
Cutaneous disease:

Preferred regimen: Albendazole 400 mg bid for 21 days OR Ivermectin 200 mcg/kg qd for 2 days^[308]
Alternative regimen: Albendazole 400 mg qd for 21 days OR Ivermectin 200 mcg/kg qd single dose^[309]

Ancylostoma braziliense Return to Top

Cutaneous larva migrans treatment^[310]

1.1 In adults

Preferred regimen: Albendazole 400 mg PO qd for 3-7 days
Alternative regimen: Ivermectin 200 mcg/kg PO qd for 1-2 days

1.2 In children

Preferred regimen: Albendazole > 2 years then 400 mg PO qd for 3 days
Alternative regimen: Ivermectin > 15 kg give 200 mcg/kg single dose
Note: Albendazole is contraindicated in children younger than 2 years age

Angiostrongylus cantonensis Return to Top

Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60 mg qd for 2 weeks) and analgesics.^[311]
Note: Albendazole and Mebendazole are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.^[312]

Ascaris lumbricoides Return to Top

Preferred regimen: Albendazole 400 mg PO qd OR Mebendazole 500 mg PO qd or 100 mg bid for 3 days^[313]

Note: Albendazole dose for children of 1-2 years is 200 mg instead of 400 mg.

Alternative regimen (1): Ivermectin 150 to 200 µg/kg PO single dose^[314]
Alternative regimen (2): Nitazoxanide 500 mg bid for 3 days ^[315]
Alternative regimen (3): Levamisole 120 mg PO single dose
Note: Pediatric dose: 2.5 mg/kg ^[316]
Alternative regimen (4): Pyrantel Pamoate 11 mg/kg single dose PO - maximum 1.0 g^[316]
Alternative regimen (5): Piperazine citrate 75 mg/kg qd for 2 days - maximum 3.5 g^[316]

Capillaria philippinensis Return to Top

1. Intestinal capillariasis^[317]^[318]^[319]

Preferred regimen: Albendazole 400 mg/day PO for 10-30 days
Alternative regimen: Mebendazole 200 mg PO bid for 20-30 days

Enterobius vermicularis Return to Top
1. Enterobius vermicularis^[320]

Preferred regimen (1): Albendazole 400 mg PO single dose
Preferred regimen (2): Mebendazole 100 mg PO single dose
Preferred regimen (3): Ivermectin 200 µg/kg PO single dose
Preferred regimen (4): Pyrantel pamoate 11 mg/kg up to 1.0 g PO single dose
Note: A second dose is given 2 weeks later because of the frequency of reinfection and autoinfection.

Necator americanus Return to Top

Preferred regimen: Albendazole 400 mg PO single dose^[321]
Alternative regimen (1): Mebendazole 100 mg PO bid or 500 mg daily for 3 days
Alternative regimen (2): Pyrantel pamoate 11 mg/kg PO qd (maximum 1 g/day) for 3 days^[322]

Ancylostoma duodenale Return to Top

Preferred regimen: Albendazole 400 mg PO single dose^[321]
Alternative regimen (1): Mebendazole 100 mg PO bid or 500 mg daily for 3 days
Alternative regimen (2): Pyrantel pamoate 11 mg/kg PO qd (maximum 1 g/day) for 3 days^[323]

Strongyloides stercoralis Return to Top

Preferred regimen: Ivermectin 200 mcg/kg/day PO qd for 2 days or two doses 2 weeks apart from each other^[324]
Alternative regimen: Albendazole 400 mg PO bid for 3-7 days^[325]

Trichuris trichiura Return to Top

Preferred regimen: Albendazole 400 mg PO qd for 3 days
Alternatie regimen (1): Mebendazole 100 mg PO bid for 3 days
Alternative regimen (2): Ivermectin 200 mcg/kg/day PO qd for 3 days^[326]

Parasites – Extraintestinal Nematodes (Roundworms)

Ancylostoma braziliense Return to Top

Preferred regimen^[327]

Adult: Albendazole 400mg PO qd for 3-7 days.
Pediatric: Albendazole > 2 years 400mg PO qd for 3 days
Note: This drug is contraindicated in children younger than 2 years.

Alternative regimen^[328]

Adult: Ivermectin 200 mcg/kg PO qd for one or two days.
Pediatric: Ivermectin >15 kg give 200mcg/kg single dose.

Angiostrongylus cantonensis Return to Top

Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60mg qd for 2 weeks) and analgesics^[329]
Note: Albendazole and Mebendazole are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.^[312]

Filariasis Return to Top

Filariasis^[330]^[331]^[332]

1. Lymphatic filariasis caused by Wuchereria bancrofti, Brugia malayi, Brugia timori

Preferred regimen: Diethylcarbamazine 6 mg/kd/day PO tid for 12 days (single dose if patient will continue to live in endemic area or is younger than 9 years old)

2. Loa loa filariasis^[333]

2.1 Symptomatic loiasis with < 8,000 microfilariae/mL

Preferred regimen: Diethylcarbamazine 8–10 mg/kd/day PO tid for 21 days

2.2 Symptomatic loiasis, with < 8,000 microfilariae/mL and failed 2 rounds DEC

Preferred regimen: Albendazole 200 mg PO bid for 21 days

2.3 Symptomatic loiasis, with ≥ 8,000 microfilariae/ml to suppress microfilaremia prior to treatment with DEC

Preferred regimen: Albendazole 200 mg PO bid for 21 days

2.4 Symptomatic loiasis, with ≥ 8,000 microfilariae/mL

Preferred regimen: Apheresis followed by Diethylcarbamazine
Note: Apheresis should be performed at an institution with experience in using this therapeutic modality for loiasis.

3. River blindness (onchocerciasis) caused by Onchocerca volvulus

Preferred regimen: Ivermectin 150 μg/kg PO single dose, repeated every 6-12 mos until asymptomatic
Alternative regimen: Doxycycline 100 mg PO qd for 6 weeks, alone or followed by Ivermectin 150 μg/kg PO single dose
Note: Do NOT administer Diethylcarbamazine where onchocerciasis is endemic due to increased risk for severe local inflammation in patients with ocular microfilariae.

4. Mansonella ozzardi

Preferred regimen: Ivermectin 200 μg/kg PO single dose
Note: Endosymbiotic Wolbachia are essential to filarial growth, development, embryogenesis and survival and represent an additional target for therapy. Doxycycline 100–200 mg PO qd for 6–8 weeks results in loss of Wolbachia and decrease in both micro- and macrofilariae.

5. Mansonella perstans

Preferred regimen: Doxycycline 100–200 mg PO qd for 6–8 weeks

6. Mansonella streptocerca

Preferred regimen (1): Diethylcarbamazine 6 mg/kd/day PO tid for 12 days
Preferred regimen (2): Ivermectin 150 μg/kg PO single dose

7. Tropical pulmonary eosinophilia caused by Wuchereria bancrofti

Preferred regimen: Diethylcarbamazine 6 mg/kd/day PO tid for 12–21 days

Gnathostoma spinigerum Return to Top

1. Eosinophilic Meningitis
- Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.^[307]
2. Cutaneous disease:

Preferred regimen (1): Albendazole 400 mg bid for 21 days^[334]

Preferred regimen (2): Ivermectin 200 mcg/kg once daily for 2 days^[335]
Alternative regimen (1): Albendazole 400 mg daily for 21 days^[336]

Alternative regimen (2): Ivermectin 200 mcg/kg once daily for 1 day^[337]

Toxocariasis Return to Top

1.1 Visceral toxocariasis

Preferred regimen: Albendazole 400 mg PO bid for five days (both adult and pediatric dosage)^[338]
Alternative regimen: Mebendazole 100-200 mg PO bid for five days (both adult and pediatric dosage)^[339]
Note: Treatment is indicated for moderate-severe cases. Patients with mild symptoms of toxocariasis may not require anthelminthic therapy as symptoms are limited.^[340]

1.2 Ocular toxocariasis

Preferred regimen: Prednisone 0.5-1mg/kg/day PO q24h AND Albendazole 400mg PO bid for 2 to 4 weeks (pediatric dose: 400mg PO qd)^[341]
Note: Surgical therapy might be neeeded.

Trichinella spiralis Return to Top

Trichinella spiralis^[342]

Preferred regimen (1): Albendazole 400 mg PO bid for 8-14 days
Preferred regimen (2): Mebendazole 200-400 mg PO tid for 3 days THEN 400-500 mg PO tid for 10 days
Note (1): Both treatment schemes are suitable for adult and pediatric dosages
Note (1): Albendazole and Mebendazole are contraindicated during pregnancy and not recommended in children aged 2 years.
Alternative regimen (1): (severe symptoms) Prednisone 30 mg/day-60 mg/day for 10-15 days
Alternative regimen (2): Pyrantel 10-20 mg/kg single dose for 2-3 days

Parasites – Trematodes (Flukes)

Clonorchis sinensis Return to Top

Preferred regimen: Praziquantel 75mg/kg/day PO tid for 2 days^[343]
Alternative regimen (1): Albendazole 10mg/kg/day PO qd for 7 days^[344]
Alternative regimen (2): Tribendimidine 400mg PO single dose^[345]
This regimen is still under investigation, but it appears to be as effective as Praziquantel.
Note: Urgent biliary decompression might be required for patients with acute cholangitis.

Dicrocoelium dendriticum Return to Top

Preferred regimen: Praziquantel 25 mg/kg PO tid for 2 days^[346]
Note: Praziquantel is not approved for treatment of children less than 4 years old.^[347]
Alternative regimen (1): Myrrh (commiphora molmol) 12 mg/kg/day PO for 6 days^[348]
Alternative regimen (2): Triclabendazole 10 mg/kg PO single dose^[348]

Fasciola hepatica Return to Top

Preferred regimen: Triclabendazole 10 mg/kg PO one dose^[349]
Note: Two-dose (double-dose) triclabendazole therapy can be given to patients who have severe or heavy Fasciola infections (many parasites) or who did not respond to single-dose therapy.
Alternative regimen: Nitazoxanide 500mg PO bid for 7 days

Paragonimus westermani Return to Top

Preferred regimen (1): Praziquantel 25 mg/kg PO tid for 3 days^[350]
Preferred regimen (2): Triclabendazole 10 mg/kg PO qd or bid
Alternative regimen (1): Bithinol 30-50mg/kg PO on alternate days for 10-15 doses
Alternative regimen (2): Niclosamide 2mg/kg PO single dose

Schistosomiasis Return to Top

1. Schistosoma mansoni, S. haematobium, S. intercalatum^[351]

Preferred regimen: Praziquantel 40 mg/kg per day PO in qd or bid for one day
Alternative regimen (1): Oxamniquine 20 mg/kg PO single dose^[352]^[353]
Alternative regimen (2): Artemisinin no dose is established yet^[351]
Alternative regimen (3): Mefloquine 250 mg PO single dose
Note: There is no benefit in associating the alternative therapies to Praziquantel.
Note: Praziquantel is not effective against larval/egg stages of the disease.^[211]

2. S. japonicum, S. mekongi^[351]

Preferred regimen: Praziquantel 60 mg/kg per day PO bid for one day
Alternative regimen (1): Artemisinin no dose is established yet
Alternative regimen (2): Mefloquine 250 mg PO single dose
Note: There is no benefit in associating the alternative therapies to Praziquantel.

3. Katayama Fever

Preferred regimen: Prednisone 20-40 mg/day PO for 5 days, THEN Praziquantel^[354]
Note: Praziquantel should be used after 4-6 weeks of exposure, because it cannot kill the larvae stages of the Schistosoma. Praziquantel should be used after acute schistosomiasis syndrome symptoms have resolved always together with corticosteroids, only when ova are detected in stool or urine samples.^[355]

4. Neuroschistosomiasis

Preferred regimen: prednisone 1-2 mg/kg
Note: Praziquantel should only be introduced after a few days of the initiation of corticosteroid therapy, due to the risk of increasing the inflammatory response.

Parasites – Cestodes (Tapeworms)

Echinococcus Return to Top
Echinococcus treatment^[356]

1.1 Echinococcus granulosus (hydatid disease) treatment^[357]

Preferred regimen: Albendazole ≥ 60 kg 400 mg PO bid or < 60 kg 10-15 mg/kg/day PO bid with meals for 3-6 months
Alternative regimen: Mebendazole 40-50mg/kg/day PO tid for 3-6 months
Note: Percutaneous aspiration-injection-reaspiration (PAIR). Puncture & needle aspirate cyst content. Instill hypertonic saline (15–30%) or absolute alcohol, wait 20–30 min, then re-aspirate with final irrigation. Administer Albendazole at least 4 hours before PAIR.
Note: If surgery is needed, make sure to administer Albendazole for at least a week before the surgery, and to keep the medication for at least 4 weeks after the procedure.

1.2 Echinococcus multilocularis (alveolar cyst disease) treatment^[358]

Preferred regimen: Albendazole ≥ 60 kg 400 mg PO bid or < 60 kg 15 mg/kg/day PO bid with meals for at least 2 years. Long-term follow up needed to evaluate progression of the lesions.

Note: Wide surgical resection only reliable treatment; technique evolving.

Neurocysticercosis

Neurocysticercosis Return to Top

Neurocysticercosis treatment

1. Parenchymal neurocysticercosis

1.1 Single lesions^[359]

Preferred regimen: Albendazole 15 mg/kg/day PO bid for 3-8 days AND Prednisone 1 mg/kg/day PO qid for 8-10 days followed by a taper

1.2 Multiple cysts

Preferred regimen: Albendazole 15 mg/kg/day PO bid for 8-15 days and high-dose steroids
Preferred regimen: Praziquantel 50 mg/kg/day PO tid AND Albendazole 15 mg/kg/day PO bid

1.3 Cysticercal encephalitis ^[359]

Cysticercal encephalitis (diffuse cerebral edema associated with multiple inflamed cysticerci) is a contraindication for antiparasitic therapy, since enhanced parasite killing can exacerbate host inflammatory response and lead to diffuse cerebral edema and potential transtentorial herniation. Most cases of cysticercal encephalitis improve with corticosteroid therapy

1.4 Calcified cysts

Radiographic evidence of parenchymal calcifications is a significant risk factor for recurrent seizure activity; these lesions are present in about 10 percent of individuals in regions where neurocysticercosis is endemic. Seizures in these patients should be treated with antiepileptic therapy.

2. Extraparenchymal NCC

2.1 Subarachnoid cysts

Preferred regimen: Albendazole 15 mg/kg/day PO bid for 28 days AND (Prednisone up to 60 mg/day PO OR Dexamethasone (up to 24 mg/day)) along with the antiparasitic therapy. The dose can often be tapered after a few weeks. However, in cases for which more prolonged steroid therapy is required, methotrexate can be used as a steroid-sparing agent

2.2 Giant cysts

Giant cysticerci are usually accompanied by cerebral edema and mass effect, which should be managed with high-dose corticosteroids (with or without mannitol).

2.3 Intraventricular cysts

Emergent management with CSF diversion via a ventriculostomy or placement of a ventriculo-peritoneal shunt
Treatment of residual hydrocephalus may be managed with endoscopic foraminotomy and endoscopic third ventriculostomy; this approach may also allow debulking of cisternal cysticerci

2.4 Ocular cysticercosis

Surgical excision is warranted in the setting of intraocular cysts
Cysticercal involvement of the extraocular muscles should be managed with albendazole and corticosteroids.

2.5 Spinal cysticercosis

Medical therapy with corticosteroids and antiparasitic drugs

Sparganosis Return to Top

Sparganosis (Spirometra mansonoides) treatment ^[360]

Preferred treatment: Surgical resection or ethanol injection of subcutaneous masses
Note: Praziquantel 75 mg/kg/day PO qd for 3 days is controversial. It's been innefective in some cases, but has had some results in patients when surgical therapy wasn't an option.^[361]

Parasites – Ectoparasites

Body lice Return to Top

Pediculus humanus, corporis treatment^[362]

A body lice infestation is treated by improving the personal hygiene of the infested person, including assuring a regular (at least weekly) change of clean clothes.
Clothing, bedding, and towels used by the infested person should be laundered using hot water (at least 130°F) and machine dried using the hot cycle.
Sometimes the infested person also is treated with a pediculicide Ivermectin Lotion; however, a pediculicide Ivermectin generally is not necessary if hygiene is maintained and items are laundered appropriately at least once a week. A pediculicide Ivermectin should be applied exactly as directed on the bottle or by your physician.

Head lice Return to Top

Pediculus humanus, capitis treatment^[363]

Preferred regimen (1): Permethrin 1% lotion apply to shampooed dried hair for 10 min.; repeat in 9-10 days
Preferred regimen (2): Malathion 0.5% lotion (Ovide) apply to dry hair for 8–12hrs, then shampoo (2 doses 7-9 days apart)
Alternative regimen: Ivermectin 200 μg/kg PO once; 3 doses at 7 day intervals reported effective.

Pubic lice Return to Top

Phthirus pubis treatment^[364]

Preferred regimen (1): Permethrin 1% cream rinse applied to affected areas and washed off after 10 minutes
Preferred regimen (2): Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes
Alternative regimen (1): Malathion 0.5% lotion applied to affected areas and washed off after 8–12 hours
Alternative regimen (2): Ivermectin 250 ug/kg PO, repeated in 2 weeks

Myiasis Return to Top

Preferred regimen: No medications approved by the FDA are available for treatment^[365]
Note: Fly larvae need to be surgically removed.

Fly larvae treatment ^[366]
Preferred treatment (1): Occlude punctum to prevent gas exchange with petrolatum, fingernail polish, makeup cream or bacon.
Preferred treatment (2): When larva migrates, manually remove.
Note (1): Myiasis is due to larvae of flies.
Note (2): Usually cutaneous/subcutaneous nodule with central punctum.

Scabies Return to Top

Sarcoptes scabiei treatment^[367]

1. Adult

Preferred regimen (1): Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
Preferred regimen (2): Ivermectin 200 ug/kg PO qd and repeated in 2 weeks
Alternative regimen: Lindane (1%) 1 oz of lotion or 30 g of cream applied in a thin layer to all areas of the body from the neck down and thoroughly washed off after 8 hours

2. Infants and young children

Preferred regimen: Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
Note: Infants and young children aged< 10 years should not be treated with lindane.

3. Crusted Scabies

Crusted scabies (i.e., Norwegian scabies) is an aggressive infestation that usually occurs in immunodeficient, debilitated, or malnourished persons, including persons receiving systemic or potent topical glucocorticoids, organ transplant recipients, persons with HIV infection or human T-lymphotrophic virus-1-infection, and persons with hematologic malignancies.

Preferred regimen: (Topical scabicide 5% topical Benzyl benzoate 5% OR topical Permethrin 5% cream (full-body application to be repeated daily for 7 days then twice weekly until discharge or cure) AND treatment with Ivermectin 200 ug/kg PO on days 1,2,8,9, and 15. Additional Ivermectin treatment on days 22 and 29 might be required for severe cases

4.Pregnant or Lactating Women

Preferred regimen: Permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours

Viruses

Adenovirus Return to Top

Adenovirus^[368]

1. In severe cases of pneumonia or post hematopoietic stem cell transplantation

Preferred regimen (1): Cidofovir 5 mg/kg/week IV for 2 weeks, then every 2 weeks AND Probenecid 1.25 g/M² PO given 3 hours before Cidofovir and 3 & 9 hours after each infusion
Preferred regimen (2): Cidofovir 1 mg/kg IV 3 times per week
Note: Ganciclovir, Foscarnet and Ribavirin are not recommended for use on adenovirus infection.^[369]

2. For hemorrhagic cystitis

Preferred regimen: Cidofovir (5 mg/kg in 100 mL saline instilled into bladder) intravesical^[370]

3. Pink eye (viral conjunctivitis)

Preferred regimen: No specific treatment available. If symptomatic, cold artificial tears may help.

4.Bronchitis

Preferred regimen: No specific therapy recommended, treatment is symptomatic.

SARS Return to Top
Severe acute respiratory distress syndrome- coronavirus infection treatment^[371]^[372]^[373]

Preferred regimen: supportive therapy
Note: New therapies were studied for SARS during the last outbreaks which concluded:

Ribavirin ineffective and probably harmful due to haemolytic anaemia
Lopinavir AND Ritonavir is still controversial and need further investigation
Interferon has no benefit and its studies are inconclusive
Corticosteroids increases risk of fungal infections, some studies showed a higher incidence of psychosis, diabetes, avascular necrosis and osteoporosis
Inhaled Nitric oxide potent mediator of airway inflammation, its has improved oxygenation in some studies

Cytomegalovirus Return to Top

Cytomegalovirus treatment^[374]

1. Immunocompetent patients

1.1 Mononucleosis syndrome

Preferred regimen: supportive therapy

1.2 CMV in pregnancy

Preferred regimen: Hyperimmune 200 IU/kg of maternal weight as single-dose during pregnancy

2. Immunocompromised patients

2.1 Retinitis

Preferred regimen (1): Ganciclovir intraocular implant PLUS Valganciclovir 900 mg PO bid for 14-21 days THEN Valganciclovir 900mg PO qq for maintenance therapy - for immediate sight-threatening lesions
Preferred regimen (2): Valganciclovir 900 mg PO bid for 14-21 days THEN Valganciclovir 900 mg PO qq for maintenance therapy - for peripheral lesions
Alternative regimen (1): Foscarnet 60 mg/kg IV q8h OR Foscarnet 90 mg/kg IV q12h for 14-21 days THEN Foscarnet 90-120 mg/kg IV q24h
Alternative regimen (2): Cidofovir 5 mg/kg IV for 2 weeks THEN Cidofovir 5 mg/kg IV every other week - each dose should be admnistered with IV saline hydration and probenecid
Alternative regimen (3): Ganciclovir 5 mg/kg IV q12h for 14-21 days THEN Valganciclovir 900 mg PO bid
Alternative regimen (4): Fomivirsen intravitreal injection - for relapses
Note: keep a maintenance dose of Valganciclovir 900 mg PO qd until CD4 >100/mm³

2.2 Transplant patients

Preferred regimen: Valganciclovir 900 mg PO bid OR Ganciclovir 5 mg/kg IV q12h for at least 2-3 weeek
Note: Use Valganciclovir 900 mg PO qd for 1-3 months if high dose of immunosuppression.

2.3 Colitis, esophagitis, gastritis

Preferred regimen: Ganciclovir 5 mg/kg/dose IV q12h for 3-6 weeks weeks for induction. There is no agreement on the use of maintenance.
Alternative regimen: Cidofovir 5 mg/kg IV for 2 weeks, then 5 mg/kg every other week; each dose should be administered with IV saline hydration and oral probenecid 2 g PO 3h before each dose and further 1 g doses after 2h and 8h.
Note: Switch to oral Valganciclovir when PO tolerated & when symptoms not severe enough to interfere with absorption.

2.4 Pneumonia

Preferred regimen: Valganciclovir 900 mg PO bid for 14–21 days, then 900 mg PO qd for maintenance therapy
Alternative regimen for retinitis: Ganciclovir 5 mg/kg IV q12h for 14–21 days, then Valganciclovir 900 mg PO qd
Note: In bone marrow transplant patients, combine therapy with CMV immune globulin.

2.5 Encephalitis, ventriculitis

Note: Treatment not defined, but should be considered the same as retinitis. Disease may develop while taking Ganciclovir as suppressive therapy.

2.6 Lumbosacral polyradiculopathy

Preferred regimen: Ganciclovir, as with retinitis
Alternative regimen: Foscarnet 40 mg/kg IV q12h another option
Alternative regimen: Cidofovir 5 mg/kg IV for 2 weeks, then 5 mg/kg every other week; each dose should be administered with IV saline hydration and oral probenecid 2 g PO 3h before each dose and further 1 g doses after 2h and 8h.
Note (1): Switch to Valganciclovir when possible.
Note (2): Suppression continued until CD4 remains >100/mm³ for 6 months.

2.7 Peri/postnatal severe CMV infection in very low birth weight infants

Preferred regimen: Ganciclovir 6 mg/kg/dose IV q12h for 3 weeks^[375]

Enterovirus D68 Return to Top

Enterovirus treatment^[376]

Preferred regimen: supportive therapy
Note: A new drug Pleconaril designed to affect Rhinovirus is being suggested to be effective against Enterovirus D68 but further investigation is required^[377]

Ebola virus Return to Top

Ebola virus treatment^[378]^[379]

Preferred regimen: supportive therapy. There is no specific antiviral drug available for Ebola thus far. For information of investigational therapies including Favipiravir, Brincidofovir, ZMapp, TKM-Ebola, AVI-6002, and BCX4430, see here.

Isolate patient
Provide intravenous fluids (IV) (patients need large volumes in some cases) and maintain electrolytes at normal levels
Maintain oxygen saturation and blood pressure
Administer blood products if coagulopathy or bleeding, antiemetics if vomiting , antipyretics if fever, analgesics, anti-motility if severe diarrhea, total parenteral nutrition if patient has poor oral intake and dialysis if there's renal failure
Treat other infections if they occur. Provide adequate Gram-negative coverage and gram-positive if the patient has any catheter or hospital-acquired pneumonia.
If there's respiratory failure, invasive mechanical ventilation may be the best option to offer respiratory support

Note (1): Recovery from Ebola depends on good supportive care and the patient’s immune response.
Note (2): While there is no proven treatment available for Ebola virus disease, human convalescent whole blood has been used as an empirical treatment with promising results in a small group of EVD cases.^[380]^[381]
Note (3): People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola.
Note (4): Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.

Marburg virus Return to Top

Marburg virus treatment

Preferred regimen: supportive therapy including maintenance of blood volume and electrolyte balance, as well as analgesics and standard nursing care^[382]^[383]

Hantavirus Return to Top

Hantavirus cardiopulmonary syndrome treatment^[384]

Preferred regimen: Supportive therapy, there is no specific treatment for hantavirus cardiopulmonary syndrome
Note (1): ICU management should include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed
Note (2): Fluids should be administered carefully due to the potential for capillary leakage
Note (3): Supplemental oxygen should be administered if patients become hypoxic
Note (4): Equipment and materials for intubation and mechanical ventilation should be readily available since onset of respiratory failure may be precipitous
Note (5): Extracorporeal membrane oxygenation was used with survival rates of 50% in some studies in patients with cardiac index output <2.5L/min/m²^[385]

Dengue virus Return to Top

Dengue virus ^[386]

1. Patients who may be sent home

These are patients who are able to tolerate adequate volumes of oral fluids and pass urine at least once every six hours, and do not have any of the warning signs, particularly when fever subsides
Patients who are sent home should be monitored daily by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, signs of plasma leakage and bleeding, haematocrit, and white blood cell and platelet counts

2. Ambulatory patients with stable haematocrit can be sent home

Encourage oral intake of oral rehydration solution (ORS), fruit juice and other fluids containing electrolytes and sugar to replace losses from fever and vomiting
Give Paracetamol for high fever if the patient is uncomfortable. The interval of paracetamol dosing should not be less than six hours. Tepid sponge if the patient still has high fever
Should be brought to hospital immediately if any of the following occur: no clinical improvement, deterioration around the time of defervescence, severe abdominal pain, persistent vomiting, cold and clammy extremities, lethargy or irritability/restlessness, bleeding (e.g. black stools or coffee-ground vomiting), not passing urine for more than 4–6 hours

3. Patients who should be referred for in-hospital management

Patients may need to be admitted to a secondary health care centre for close observation, particularly as they approach the critical phase. These include patients with warning signs (Abdominal pain or tenderness, Persistent vomiting, Clinical fluid accumulation, Mucosal bleed, Lethargy, restlessness, Liver enlargment >2cm, Laboratory:increase in HCT concurrent with rapid decrease in platelet count), those with co-existing conditions that may make dengue or its management more complicated (such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, chronic haemolytic diseases), and those with certain social circumstances (such as living alone, or living far from a health facility without reliable means of transport)

3.1 With warning signs

Obtain a reference haematocrit before fluid therapy. Give only isotonic solutions such as 0.9% saline, Ringer’s lactate, or Hartmann’s solution. Start with 5–7 ml/ kg/hour for 1–2 hours, then reduce to 3–5 ml/kg/hr for 2–4 hours, and then reduce to 2–3 ml/kg/hr or less according to the clinical response
Reassess the clinical status and repeat the haematocrit. If the haematocrit remains the same or rises only minimally, continue with the same rate (2–3 ml/kg/hr) for another 2–4 hours. If the vital signs are worsening and haematocrit is rising rapidly, increase the rate to 5–10 ml/kg/hour for 1–2 hours. Reassess the clinical status, repeat the haematocrit and review fluid infusion rates accordingly
Give the minimum intravenous fluid volume required to maintain good perfusion and urine output of about 0.5 ml/kg/hr. Intravenous fluids are usually needed for only 24–48 hours. Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase. This is indicated by urine output and/or oral fluid intake that is/are adequate, or haematocrit decreasing below the baseline value in a stable patient
Patients with warning signs should be monitored by health care providers until the period of risk is over. A detailed fluid balance should be maintained. Parameters that should be monitored include vital signs and peripheral perfusion (1–4 hourly until the patient is out of the critical phase), urine output (4–6 hourly), haematocrit (before and after fluid replacement, then 6–12 hourly), blood glucose, and other organ functions (such as renal profile, liver profile, coagulation profile, as indicated)

3.2 Without warning signs

Encourage oral fluids. If not tolerated, start intravenous fluid therapy of 0.9% saline or Ringer’s lactate with or without dextrose at maintenance rate. For obese and overweight patients, use the ideal body weight for calculation of fluid infusion. Patients may be able to take oral fluids after a few hours of intravenous fluid therapy. Thus, it is necessary to revise the fluid infusion frequently. Give the minimum volume required to maintain good perfusion and urine output. Intravenous fluids are usually needed only for 24–48 hours
Patients should be monitored by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, haematocrit, and white blood cell and platelet counts. Other laboratory tests (such as liver and renal functions tests) can be done, depending on the clinical picture and the facilities of the hospital or health centre

4. Severe dengue

Severe dengue: Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress; severe haemorrhages; severe organ impairment (hepatic damage, renal impairment, cardiomyopathy, encephalopathy or encephalitis)
4.1 Treatment of shock

4.1.1 Compensated shock

Start intravenous fluid resuscitation with isotonic crystalloid solutions at 5–10 ml/kg/hour over one hour. Then reassess the patient’s condition (vital signs, capillary refill time, haematocrit, urine output). The next steps depend on the situation
If the patient’s condition improves, intravenous fluids should be gradually reduced to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, then to 2–3 ml/kg/hr, and then further depending on haemodynamic status, which can be maintained for up to 24–48 hours
If vital signs are still unstable (i.e. shock persists), check the haematocrit after the first bolus. If the haematocrit increases or is still high (>50%), repeat a second bolus of crystalloid solution at 10–20 ml/kg/hr for one hour. After this second bolus, if there is improvement, reduce the rate to 7–10 ml/ kg/hr for 1–2 hours, and then continue to reduce as above. If haematocrit decreases compared to the initial reference haematocrit (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible
Further boluses of crystalloid or colloidal solutions may need to be given during the next 24–48 hours

4.1.2 Hypotensive shock

Initiate intravenous fluid resuscitation with crystalloid or colloid solution (if available) at 20 ml/kg as a bolus given over 15 minutes to bring the patient out of shock as quickly as possible
If the patient’s condition improves, give a crystalloid/colloid infusion of 10 ml/kg/hr for one hour. Then continue with crystalloid infusion and gradually reduce to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, and then to 2–3 ml/kg/hr or less, which can be maintained for up to 24–48 hours
If vital signs are still unstable (i.e. shock persists), review the haematocrit obtained before the first bolus. If the haematocrit was low (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross- match and transfuse blood as soon as possible (see treatment for haemorrhagic complications)
If the haematocrit was high compared to the baseline value (if not available, use population baseline), change intravenous fluids to colloid solutions at 10–20 ml/kg as a second bolus over 30 minutes to one hour. After the second bolus, reassess the patient. If the condition improves, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above. If the condition is still unstable, repeat the haematocrit after the second bolus
If the haematocrit decreases compared to the previous value (<40% in children and adult females, less than 45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible (see treatment for haemorrhagic complications). If the haematocrit increases compared to the previous value or remains very high ( more than 50%), continue colloid solutions at 10–20 ml/kg as a third bolus over one hour. After this dose, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above when the patient’s condition improves
Further boluses of fluids may need to be given during the next 24 hours. The rate and volume of each bolus infusion should be titrated to the clinical response. Patients with severe dengue should be admitted to the high-dependency or intensive care area

4.2 Treatment of haemorrhagic complications

Blood transfusion required

Give 5–10ml/kg of fresh-packed red cells or 10–20 ml/kg of fresh whole blood at an appropriate rate and observe the clinical response. It is important that fresh whole blood or fresh red cells are given. Oxygen delivery at tissue level is optimal with high levels of 2,3 di-phosphoglycerate (2,3 DPG). Stored blood loses 2,3 DPG, low levels of which impede the oxygen-releasing capacity of haemoglobin, resulting in functional tissue hypoxia. A good clinical response includes improving haemodynamic status and acid-base balance
Consider repeating the blood transfusion if there is further blood loss or no appropriate rise in haematocrit after blood transfusion. There is little evidence to support the practice of transfusing platelet concentrates and/or fresh-frozen plasma for severe bleeding. It is being practised when massive bleeding can not be managed with just fresh whole blood/fresh-packed cells, but it may exacerbate the fluid overload
Great care should be taken when inserting a naso-gastric tube which may cause severe haemorrhage and may block the airway. A lubricated oro-gastric tube may minimize the trauma during insertion. Insertion of central venous catheters should be done with ultra-sound guidance or by a very experienced person

5. Treatment of complications and other areas of treatment

5.1 Fluid overload

Oxygen therapy should be given immediately
When the following signs are present, intravenous fluids should be discontinued or reduced to the minimum rate necessary to maintain euglycaemia

signs of cessation of plasma leakage; stable blood pressure, pulse and peripheral perfusion; haematocrit decreases in the presence of a good pulse volume; afebrile for more than 24–48 days (without the use of antipyretics); resolving bowel/abdominal symptoms; improving urine output

The management of fluid overload varies according to the phase of the disease and the patient’s haemodynamic status. If the patient has stable haemodynamic status and is out of the critical phase (more than 24–48 hours of defervescence), stop intravenous fluids but continue close monitoring. If necessary, give oral or intravenous furosemide 0.1–0.5 mg/kg/dose once or twice daily, or a continuous infusion of furosemide 0.1 mg/kg/hour. Monitor serum potassium and correct the ensuing hypokalaemia
If the patient has stable haemodynamic status but is still within the critical phase, reduce the intravenous fluid accordingly. Avoid diuretics during the plasma leakage phase because they may lead to intravascular volume depletion
Patients who remain in shock with low or normal haematocrit levels but show signs of fluid overload may have occult haemorrhage. Further infusion of large volumes of intravenous fluids will lead only to a poor outcome. Careful fresh whole blood transfusion should be initiated as soon as possible. If the patient remains in shock and the haematocrit is elevated, repeated small boluses of a colloid solution may help

5.2 Other complications of dengue

Both hyperglycaemia and hypoglycaemia may occur, even in the absence of diabetes mellitus and/or hypoglycaemic agents. Electrolyte and acid-base imbalances are also common observations in severe dengue and are probably related to gastrointestinal losses through vomiting and diarrhoea or to the use of hypotonic solutions for resuscitation and correction of dehydration. Hyponatraemia, hypokalaemia, hyperkalaemia, serum calcium imbalances and metabolic acidosis (sodium bicarbonate for metabolic acidosis is not recommended for pH ≥ 7.15) can occur. One should also be alert for co-infections and nosocomial infections.

5.3 Supportive care and adjuvant therapy

renal replacement therapy, with a preference to continuous veno-venous haemodialysis (CWH), since peritoneal dialysis has a risk of bleeding;
vasopressor and inotropic therapies as temporary measures to prevent life- threatening hypotension in dengue shock and during induction for intubation, while correction of intravascular volume is being vigorously carried out;
further treatment of organ impairment, such as severe hepatic involvement or encephalopathy or encephalitis;
further treatment of cardiac abnormalities, such as conduction abnormalities, may occur (the latter usually not requiring interventions)

West Nile virus Return to Top

West nile virus

1.1. Prevention

No WNV vaccines are licensed for use in humans. In the absence of a vaccine, prevention of WNV disease depends on community-level mosquito control programs to reduce vector densities, personal protective measures to decrease exposure to infected mosquitoes, and screening of blood and organ donors.
Personal protective measures include use of mosquito repellents, wearing long-sleeved shirts and long pants, and limiting outdoor exposure from dusk to dawn. Using air conditioning, installing window and door screens, and reducing peridomestic mosquito breeding sites, can further decrease the risk for WNV exposure.
Blood and some organ donations in the United States are screened for WNV infection; health care professionals should remain vigilant for the possible transmission of WNV through blood transfusion or organ transplantation. Any suspected WNV infections temporally associated with blood transfusion or organ transplantation should be reported promptly to the appropriate state health department.

1.2. Treatment

There is no specific treatment for WNV disease; clinical management is supportive. Patients with severe meningeal symptoms often require pain control for headaches and antiemetic therapy and rehydration for associated nausea and vomiting. Patients with encephalitis require close monitoring for the development of elevated intracranial pressure and seizures. Patients with encephalitis or poliomyelitis should be monitored for inability to protect their airway. Acute neuromuscular respiratory failure may develop rapidly and prolonged ventilatory support may be required.

Yellow Fever Return to Top

Yellow fever^[387]^[388]

Preferred regimen: No specific treatment is available for yellow fever. In the toxic phase, supportive treatment includes therapies for treating dehydration and fever. Ribavirin has failed in several studies in the monkey model.

Note: An international seminar held by WHO in 1984 recommended maintenance of nutrition, prevention of hypoglycemia, maintenance of the blood pressure with fluids and vasoactive drugs, prevention of bleeding with fresh-frozen plasma, dialysis if renal failure, correction of metabolic acidosis, administration of cimetidine IV to avoid gastric bleeding and oxygen if needed.

Chikungunya virus Return to Top

Chikungunya Fever ^[389]

Preferred regimen: no specific therapeutics agents are available and there are no licensed vaccines to prevent Chikungunya Fever.

Note: Anti inflammatory drugs can be used to control joint swelling and arthritis.

Hepatitis A virus Return to Top

Preferred regimen: No therapy recommended. If within 2 wks of exposure, IVIG 0.02 mL per kg IM times 1 protective.

Hepatitis B virus Return to Top
Acute Hepatitis B

Chronic Hepatitis B

1. Patients with HBeAg-positive chronic hepatitis B^[390]

1.1. HBV DNA >20,000, ALT <2 times upper limit normal (ULN)^[390]

Observe; consider treatment when ALT becomes elevated.
Consider biopsy in persons 40 years, ALT persistently high normal >2 times upper limit normal (ULN), or with family history of HCC.
Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.

1.2. HBV DNA >20,000, ALT >2 times upper limit normal (ULN)^[390]

Preferred regimen (1): Pegylated IFN-alpha 180 mcg weekly SC for 48 weeks
Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
If creatinine clearance 30–49 give 300 mg q48 hrs
If creatinine clearance 10–29 give 300 mg q72-96 hrs
If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
If creatinine clearance <10 without dialysis there is no recommendation
Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion

Preferred regimen (3): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion

Alternative regimen (1): Interferon alpha (IFNα) 5 MU daily or 10 MU thrice weekly SC for 16 weeks
Alternative regimen (2): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 100 mg PO qd
If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion

Alternative regimen (3): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis
Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion

Alternative regimen (4): Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 600 mg PO once daily
If creatinine clearance 30–49 600 give mg PO once every 48 hours
If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis

Note (1): duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
Note (2): Observe for 3-6 months and treat if no spontaneous HBeAg loss.
Note (3): Consider liver biopsy prior to treatment if compensated.
Note (4): Immediate treatment if icteric or clinical decompensation.
Note (5): Interferon alpha (IFNα)/ pegylated interferon-alpha (peg-IFNα), Lamivudine (LAM), Adefovir (ADV), Entecavir (ETV), tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) may be used as initial therapy.
Note (6): Adefovir (ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
Note (7): Lamivudine (LAM) and Telbivudine (LdT) not preferred due to high rate of drug resistance.
Note (8): End-point of treatment – Seroconversion from HBeAg to anti-HBe.
Note (9): Interferon alpha (IFNα) non-responders / contraindications to IFNα change to Tenofovir (TDF)/Entecavir (ETV).

1.3. Children with elevated ALT greater than 2 times normal^[390]

Preferred regimen(1): Interferon alpha (IFNα) 6 MU/m2 SC thrice weekly with a maximum of 10 MU
Preferred regimen(2): Lamivudine (LAM) 3 mg/kg/d PO with a maximum of 100 mg/d.

2. Patients with HBeAg-negative chronic hepatitis B^[390]

2.1. HBV DNA >2,000 IU/mL and elevated ALT >2 times normal

Preferred regimen (1): Pegylated IFN-alpha 180 mcg weekly SC for 1 year
Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
If creatinine clearance 30–49 give 300 mg q48 hrs
If creatinine clearance 10–29 give 300 mg q72-96 hrs
If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
If creatinine clearance <10 without dialysis there is no recommendation
Note: duration of treatment is more than 1 year

Preferred regimen (3): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine
If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine
If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine
If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
Note: duration of treatment is more than 1 year

Alternative regimen (1): Interferon alpha (IFNα) 5 MU daily or 10 MU thrice weekly SC for 1 year
Alternative regimen (2): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 100 mg PO qd
If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
Note: duration of treatment is more than 1 year

Alternative regimen (3): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis
Note: duration of treatment is more than 1 year

Alternative regimen (4): Telbivudine (LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 600 mg PO once daily
If creatinine clearance 30–49 600 give mg PO once every 48 hours
If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis

Note (1): duration of treatment is more than 1 year
Note (2): Interferon alpha (IFNα)/ pegylated interferon-alpha (peg-IFNα), Lamivudine (LAM), Adefovir (ADV), Entecavir (ETV), tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) may be used as initial therapy.
Note (3): Adefovir (ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
Note (4): Lamivudine (LAM) and Telbivudine (LdT) not preferred due to high rate of drug resistance.
Note (5): End-point of treatment – not defined
Note (6): Interferon alpha (IFNα) non-responders / contraindications to IFNα change to Tenofovir (TDF)/Entecavir (ETV).

3. HBV DNA >2,000 IU/mL and elevated ALT 1->2 times normal^[390]

Consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.

4. HBV DNA <2,000 IU/mL and ALT < upper limit normal (ULN)^[390]

Observe, treat if HBV DNA or ALT becomes higher.

5. +/- HBeAg and detectable HBV DNA with Cirrhosis^[390]

5.1. Compensated Cirrhosis and HBV DNA >2,000

Preferred regimen (1): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.

Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
If creatinine clearance 30–49 give 300 mg q48 hrs
If creatinine clearance 10–29 give 300 mg q72-96 hrs
If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
If creatinine clearance <10 without dialysis there is no recommendation

Alternative regimen (1): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 100 mg PO qd
If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.

Alternative regimen (2): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 give 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis

Alternative regimen (3): Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 600 mg PO once daily
If creatinine clearance 30–49 600 give mg PO once every 48 hours
If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis

Note (1): LAM and LdT not preferred due to high rate of drug resistance.
Note (2): ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.
Note (3): These patients should receive long-term treatment. However, treatment may be stopped in HBeAg-positive patients if they have confirmed HBeAg seroconversion and have completed at least 6 months of consolidation therapy and in HBeAg-negative patients if they have confirmed HBsAg clearance.

5.2. Compensated Cirrhosis and HBV DNA <2,000

Consider treatment if ALT elevated.

5.3. Decompensated Cirrhosis

Preferred regimen (1): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
If creatinine clearance 30–49 give 300 mg q48 hrs
If creatinine clearance 10–29 give 300 mg q72-96 hrs
If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
If creatinine clearance <10 without dialysis there is no recommendation

Preferred regimen (2): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.

Preferred regimen (3): Lamivudine (LAM) AND Adefovir (ADV)

Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 100 mg PO qd
If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.

Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 give 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis

Preferred regimen (4): Telbivudine (LdT) AND Adefovir (ADV)

Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 600 mg PO once daily
If creatinine clearance 30–49 600 give mg PO once every 48 hours
If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis

Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 give 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis

Note: coordinate treatment with transplant center and refer for liver transplant.
Life-long treatment is recommended.

6. +/- HBeAg and undetectable HBV DNA with Cirrhosis^[390]

Compensated Cirrhosis: Observe
Uncompensated Cirrhosis: Refer for liver transplant

Hepatitis C virus Return to Top

Chronic Hepatitis C

1. Treatment regimens for chronic hepatitis C virus genotype 1^[391]

1.1. Treatment regimens for genotype 1a:

Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
Preferred regimen (2): Paritaprevir 150 mg PO qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND Dasabuvir 250 mg PO bid AND weight-based Ribavirin PO qd ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) OR 24 weeks (cirrhosis)
Preferred regimen (3): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd ± weight-based Ribavirin PO qd ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
Note: these regimens are recommended for treatment-naive patients with HCV genotype 1a infection.

1.2. Treatment regimens for genotype 1b:

Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
Preferred regimen (2): Paritaprevir PO 150 mg qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND Dasabuvir 250 mg PO bid for 12 weeks. The addition of weight-based Ribavirin PO qd (1000 mg [<75kg] to 1200 mg [>75 kg]) is recommended in patients with cirrhosis
Preferred regimen (3): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
Note: these regimens are recommended for treatment-naive patients with HCV genotype 1b infection.

2. Treatment regimens for chronic hepatitis C virus genotype 2^[392]

Preferred regimen: Sofosbuvir 400 mg PO qd AND weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
Note (1): This regimen are recommended for treatment-naive patients with HCV genotype 2 infection.
Note (2): Extending treatment to 16 weeks is recommended in patients with cirrhosis.

3. Treatment regimens for chronic hepatitis C virus genotype 3^[393]

Preferred regimen: Sofosbuvir 400 mg PO qd and weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) PO qd for 24 weeks
Alternative regimen: Sofosbuvir 400 mg and weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) PO qd AND weekly PEG-IFN for 12 weeks is an acceptable regimen for IFN-eligible, treatment-naive patients with HCV genotype 3 infection.
Note: These regimens are recommended for treatment-naive patients with HCV genotype 3 infection.

4. Treatment regimens for chronic hepatitis C virus genotype 4

Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
Preferred regimen (2): Paritaprevir 150 mg PO qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
Preferred regimen (3): Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks
Alternative regimen (1): Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks
Alternative regimen (2): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd ± weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
Note: These regimens are accpetable for treatment-naive patients with HCV genotype 3 infection.

5. Treatment regimens for chronic hepatitis C virus genotype 5^[394]

Preferred regimen: Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd(1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks is recommended for treatment-naive patients with HCV genotype 5 infection.
Alternative regimen: Weekly PEG-IFN AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 48 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 5 infection.

6. Treatment regimens for chronic hepatitis C virus genotype 6^[395]

Preferred regimen: Ledipasvir 90 mg PO qd AND Sofosbuvir PO qd 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 6 infection.
Alternative regimen: Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 6 infection.

Hepatitis D virus Return to Top
Preferred regimen: Interferon alpha(IFNα) 5 MU daily OR 9 MU three times a week for 6–12 months ^[396]

Hepatitis E virus Return to Top
Hepatitis E treatment^[397]

Preferred regimen: supportive therapy. There is no specific treatment available.

Note (1): Hepatitis E is usually self-limiting, hospitalization is generally not required.
Note (2): Hospitalization is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant women.

Epstein-Barr virus Return to Top

Epstein-Barr Virus (EBV) ^[398]

There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection.
There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including

drinking fluids to stay hydrated
getting plenty of rest
taking over-the-counter medications for pain and fever

Human herpesvirus 6 Return to Top

Human herpesvirus 6 treatment^[399]^[400]

Preferred regimen: supportive therapy
Note: If patient is immunocompromised, there are no antiviral regimens stablished as there are no clinical trials to validate their use on these cases. Consider administering Ganciclovir, Acyclovir, Foscarnet OR Cidofovir.^[401]^[400]

Roseola Return to Top

Human herpesvirus 7 (roseola virus) treatment

Preferred regimen: Supportive therapy
Note (1): Immunocompetent hosts with uncomplicated skin manifestations associated with HHV-7, particularly roseola infantum and pityriasis rosea, need only symptomatic management^[401]
Note (2): For HIV-positive patients, antiretroviral therapy may be advisable^[402]
Note (3): The most active antiviral compounds against HHV-7 are Cidofovir and Foscarnet^[403]^[401]

Human herpesvirus 8 (KSHV) Return to Top

1. Mild to moderate Kaposi sarcoma^[404]

Preferred regimen: initiate or optimize ART

2. Advanced Kaposi sarcoma (ACTG Stage T1, including disseminated cutaneous or visceral Kaposi sarcoma)

Preferred regimen: chemotherapy (per oncology consult) AND ART

3. Primary effusion lymphoma

Preferred regimen: chemotherapy (per oncology consult) AND ART
Note: Valganciclovir PO or Ganciclovir IV can be used as adjunctive therapy.

4. Multicentric Castleman's disease

Preferred regimen (1): Valganciclovir 900 mg PO bid for 3 weeks
Preferred regimen (2): Ganciclovir 5 mg/kg IV q12h for 3 weeks
Preferred regimen (3): Valganciclovir 900 mg PO BID AND Zidovudine 600 mg PO q6h for 7–21 days
Alternative regimen: Rituximab 375 mg/m2 given weekly for 4–8 weeks (may be an alternative to or used adjunctively with antiviral therapy)

Herpes simplex virus Return to Top

Genital Herpes^[405]

1.First Clinical Episode of Genital Herpes

Preferred Regimen (1): Acyclovir 400 mg PO tid for 7–10 days
Preferred Regimen (2): Acyclovir 200 mg PO five times a day for 7–10 days
Preferred Regimen (3): Valacyclovir 1 g PO bid for 7–10 days
Preferred Regimen (4): Famciclovir 250 mg PO tid for 7–10 days
Note:Treatment can be extended if healing is incomplete after 10 days of therapy.

2.Established HSV-2 Infection

2.1 Suppressive Therapy for Recurrent Genital Herpes

Preferred Regimen (1): Acyclovir 400 mg PO bid
Preferred Regimen (2): Valacyclovir 500 mg PO qd
Preferred Regimen (3): Valacyclovir 1 g PO qd
Preferred Regimen (4): Famciclovir 250 mg PO bid
Note(1):Daily therapy with Acyclovir for as long as 6 years and with Valacyclovir OR Famciclovir for 1 year
Note(2):Valacyclovir 500 mg qd might be less effective than other Valacyclovir OR Acyclovir dosing regimens in persons who have very frequent recurrences (i.e., ≥10 episodes per year).

2.2 Episodic Therapy for Recurrent Genital Herpes

Preferred Regimen (1): Acyclovir 400 mg PO tid for 5 days
Preferred Regimen (2): Acyclovir 800 mg PO bid for 5 days
Preferred Regimen (3): Acyclovir 800 mg PO tid for 2 days
Preferred Regimen (4): Valacyclovir 500 mg PO bid for 3 days
Preferred Regimen (5): Valacyclovir 1 g PO qd for 5 days
Preferred Regimen (6): Famciclovir 125 mg PO bid for 5 days
Preferred Regimen (7): Famciclovir 1 g PO bid for 1 day
Preferred Regimen (8): Famciclovir 500 mg once, followed by 250 mg PO bid for 2 days

3. Severe Disease (disseminated infection, pneumonitis, or hepatitis) or CNS complications (e.g., meningoencephalitis).

Preferred Regimen: Acyclovir 5–10 mg/kg IV q8h for 2–7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy. HSV encephalitis requires 21 days of intravenous therapy. Impaired renal function warrants an adjustment in acyclovir dosage.

4. Special Considerations

4.1 HIV Infection

4.1.1 Daily Suppressive Therapy in Persons with HIV

Preferred Regimen (1): Acyclovir 400–800 mg PO bid /tid
Preferred Regimen (2): Valacyclovir 500 mg PO bid
Preferred Regimen (3): Famciclovir 500 mg PO bid

4.1.2 Episodic Infection in Persons with HIV

Preferred Regimen (1): Acyclovir 400 mg PO tid for 5–10 days
Preferred Regimen (2): Valacyclovir 1 g PO bid for 5–10 days
Preferred Regimen (3): Famciclovir 500 mg PO bid for 5–10 days
Note: For severe HSV disease, initiating therapy with Acyclovir 5–10 mg/kg IV q8 h might be necessary.

4.2 Genital Herpes in Pregnancy

Suppressive therapy of pregnant women with recurrent genital herpes
Preferred Regimen (1): Acyclovir 400–800 mg PO bid /tid
Preferred Regimen (2): Valacyclovir 500 mg PO bid
Note:Treatment recommended starting at 36 weeks of gestation.

4.3 Neonatal Herpes

Known or suspected neonatal herpes

Preferred Regimen: Acyclovir 20 mg/kg IV q 8 h
Note (1): Treatment for 14 days if disease is limited to the skin and mucous membranes, or
Note (2): Treatment for 21 days for disseminated disease and that involving the central nervous system.

4.4 Acyclovir-resistant genital herpes

Preferred Regimens: Foscarnet 40–80 mg/kg IV q8 h until clinical resolution is attained
Alternative Regimen (1): Cidofovir 5 mg/kg IV once weekly might also be effective.
Alternative Regimen (2): Imiquimod topical preparations should be applied to the lesions qd for 5 consecutive days.

4.5 Management of Sex Partners

Preferred Regimen (1): Acyclovir 400 mg PO tid for 7–10 days
Preferred Regimen (2): Acyclovir 200 mg PO five times a day for 7–10 days
Preferred Regimen (3): Valacyclovir 1 g PO bid for 7–10 days
Preferred Regimen (4): Famciclovir 250 mg PO tid for 7–10 days
Note:The sex partners of persons who have genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated

4.6 Allergy, Intolerance, and Adverse Reactions

Allergic and other adverse reactions to oral Acyclovir, Valacyclovir, and Famciclovir are rare. Desensitization to acyclovir has been described.

vzv

Varicella-zoster virus Return to Top

1. Varicella zoster treatment^[406]

1.1 Non Immunocompromised person

Preferred regimen (1): Acyclovir 500 mg PO five times a dayfor 7-10 days
Preferred regimen (2): Famciclovir 500 mg PO tid for 7 days
Preferred regimen (3): Valacyclovir 1 g PO tid for 7 days
Preferred regimen (4): Brivudin 125 mg PO qd for 7 days

1.2 Immunocompromised person requiring hospitalization or persons with sever neurologic complications

Preferred regimen (1): Acyclovir 10 mg/ kg IV q8h for 7-10 days
Preferred regimen (2): Foscarnet 40 mg/ kg IV q8h until lesions are healed
Note: Brivudin is not available in USA and has not been approved by FDA. Foscarnet is not approve by FDA

2. Treatment of VZV complications^[407]

2.1 VZV ophthalmicus

Treatment includes the following

(1) Famciclovir OR Valacyclovir for 7–10 days, preferably started within 72 h of rash onset (with Acyclovir IV given as needed for retinitis), to resolve acute disease and inhibit late inflammatory recurrences, AND Prednisone 20 mg PO tid for 4 days or bid for 6 days, and then qd for 4 day
(2) Bacitracin-Polymyxin ophthalmic ointment administered bid ,to protect the ocular surface;
(3) Topical Prednisolone 0.125%–1% 2–6 times daily prescribed and managed only by an ophthalmologist for corneal immune disease, episcleritis, scleritis, or iritis;
(4) Homatropine 5% bid as needed for iritis
(5) Latanaprost qd and/or Timolol maleate ophthalmic gel forming solution every morning)ocular pressure–lowering drugs given as needed for glaucoma
Note (1): Systemic steroids are indicated in the presence of moderate to severe pain or rash, particularly if there is significant edema, which may cause orbital apex syndrome through pressure on the nerves entering the orbit.
Note (2): pain medications and cool to tepid wet compresses (if tolerated) and no topical antivirals, because they are ineffective

2.2 VZV retinitis

Preferred regimen: Acyclovir IV 10–15 mg/kg q8h for 10–14 days followed by Valacyclovir PO 1 g tid daily for 4–6 weeks

3 Recommendations for treating varicella zoster virus (VZV) Infections in HIV-Infected adults and adolescents^[408]

3.1 Primary Varicella Infection (Chickenpox)

3.1.1 Uncomplicated Cases

Preferred regimen (1):Valacyclovir 1 g PO tid for 5–7 days
Preferred regimen (2): Famciclovir 500 mg PO tid for 5–7 days
Alternative regimen: Acyclovir 800 mg PO 5 times daily for 5–7 days

3.1.2 Severe or Complicated Cases

Preferred regimen: Acyclovir 10–15 mg/kg IV q8h for 7–10 days
Note: May switch to oral Famciclovir, Valacyclovir, or Acyclovir after defervescence if no evidence of visceral involvement is evident

3.2 Herpes Zoster (Shingles)

3.2.1 Acute Localized Dermatomal

Preferred regimen (1): Valacyclovir 1000 mg PO tid for 7–10 days
Preferred regimen (2): Famciclovir 500 mg PO tid for 7–10 days
Alternative Therapy: Acyclovir 800 mg PO 5 times daily for 7–10 days
Note: Longer duration should be considered if lesions resolve slowly

3.2.2 Extensive Cutaneous Lesion or Visceral Involvement

Preferred regimen: Acyclovir 10–15 mg/kg IV q8h until clinical improvement is evident, then switch to (Valacyclovir 1 g PO tid, Famciclovir 500 mg PO tid, or Acyclovir 800 mg PO 5 times daily)—to complete a 10–14 day course, when formation of new lesions has ceased and signs and symptoms of visceral VZV infection are improving

3.3 PORN (Progressive outer retinal necrosis)

Preferred regimen: Ganciclovir 5 mg/kg and/or Foscarnet 90 mg/kg IV q12h AND Ganciclovir 2 mg/0.05mL and/or foscarnet 1.2 mg/0.05mL intravitreal twice weekly.
Note: Duration of therapy is not well defined and should be determined based on clinical, virologic, and immunologic response in consultation with experienced ophthalmologist and optimize ART regimen.
Note: Ganciclovir ocular implants are no longer commercially available

3.4 ARN (Acute retinal necrosis)

Preferred regimen: Acyclovir 10-15 mg/kg IV q8h for 10–14 days, followed by Valacyclovir 1 g PO tid for 6 weeks AND Ganciclovir 2 mg/0.05mL intravitreal qd/bid twice weekly
Note: Duration of therapy is not well defined and should be determined based on clinical, virologic, and immunologic response in consultation with experienced ophthalmologist

4 Prevention of varicella zoster virus (VZV) Infections in HIV-Infected Adults and Adolescents

4.1 Pre-Exposure Prevention of VZV Primary Infection

Indications

Adult and adolescent patients with CD4 count ≥200 cells/mm3 without documentation of vaccination, health-care provider diagnosis or verification of a history of varicella or herpes zoster, laboratory confirmation of disease, or persons who are seronegative for VZV. Routine VZV serologic testing in HIV-infected adults and adolescents is not recommended.
Vaccination
Primary varicella vaccination (Varivax™), 2 doses (0.5 mL SQ) administered 3 months apart
If vaccination results in disease because of vaccine virus, treatment with acyclovir is recommended.
VZV-susceptible household contacts of susceptible HIV-infected persons should be vaccinated to prevent potential transmission of VZV to their HIV-infected contacts.
If post-exposure VariZIG has been administered, wait at least 5 months before varicella vaccination.
If post-exposure acyclovir has been administered, wait at least 3 days before varicella vaccine.

4.2 Post-Exposure Prophylaxis

Indication

Close contact with a person who has active varicella or herpes zoster, and
Is susceptible to VZV (i.e., has no history of vaccination or of either condition, or is known to be VZV seronegative)

Preferred regimen: VariZIG 125 IU /10 kg (maximum of 625 IU) IM, administered as soon as possible and within 10 days after exposure to a person with active varicella or herpes zoster
Alternative regimen (Begin 7–10 Days After Exposure): Acyclovir 800 mg PO 5 times/day for 5–7 days OR Valacyclovir 1 g PO tid for 5–7 days
If post-exposure VariZIG has been administered, wait at least 5 months before varicella vaccination.
Note: Patients receiving monthly high dose IVIG (i.e., >400 mg/kg) are likely to be protected against VZV and probably do not require VariZIG if the last dose of IVIG was administered <3 weeks before VZV exposure.
Note: Neither these pre-emptive interventions nor post-exposure varicella vaccination have been studied in HIV-infected adults and adolescents.
If acyclovir or valacyclovir is used, varicella vaccines should not be given until at least 72 hours after the last dose of the antiviral drug.

hpv

Human papillomavirus Return to Top

Anogenital Warts^[409]

1.Preferred regimen for External Anogenital Warts(i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)

1.1 Patient-Applied: Imiquimod 3.75% or 5% cream OR Podofilox 0.5% solution or gel OR Sinecatechins 15% ointment
1.2 Provider-Administered: Cryotherapy with liquid nitrogen or cryoprobe OR Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser,or electrosurgery OR Trichloroacetic acid (TCA) OR Bichloroacetic acid (BCA) 80%-90% solution
Note (1): Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.
Note (2): Might weaken condoms and vaginal diaphragms.

2.Alternative Regimens for External Genital Warts

2.1 Urethral Meatus Warts

Preferred regimen: Cryotherapy with liquid nitrogen OR Surgical removal

2.2 Vaginal Warts

Preferred regimen: Cryotherapy with liquid nitrogen OR Surgical removal OR (TCA OR BCA 80%–90% solution)
Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation

2.3 Cervical Warts

Preferred regimen: Cryotherapy with liquid nitrogen OR Surgical removal OR (TCA OR BCA 80%–90% solution)
Note: Management of cervical warts should include consultation with a specialist.For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated.

2.4 Intra-anal Warts

Preferred regimen: Cryotherapy with liquid nitrogen OR Surgical removal OR (TCA OR BCA 80%–90% solution)
Note: Management of intra-anal warts should include consultation with a specialist.

3. Specific considerations

3.1 Follow-up

Most anogenital warts respond within 3 months of therapy. Factors that might affect response to therapy include immunosuppression and treatment compliance. In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment. A new treatment modality should be selected when no substantial improvement is observed after a complete course of treatment or in the event of severe side effects; treatment response and therapy-associated side effects should be evaluated throughout the course of therapy.

3.2 Management of sex partners

Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can be passed on to partners. Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.

3.3 Pregnancy

Podofilox (podophyllotoxin), Podophyllin, and Sinecatechins should not be used during pregnancy. Imiquimod appears to pose low risk but should be avoided until more data are available.
Cesarean delivery is indicated for women with anogenital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
Pregnant women with anogenital warts should be counseled concerning the low risk for warts on the larynx of their infants or children (recurrent respiratory papillomatosis).

3.4 HIV infection

Data do not support altered approaches to treatment for persons with HIV infection.
Squamous cell carcinomas arising in or resembling anogenital warts might occur more frequently among immunosuppressed persons, therefore requiring biopsy for confirmation of diagnosis for suspicious cases

3.5 High-grade squamous intraepithelial lesions

Biopsy of an atypical wart might reveal HSIL or cancer of the anogenital tract. In this instance, referral to a specialist for treatment is recommended.

influenza A& B

Influenza A & B Return to Top

Antiviral Medications Recommended for Treatment of Influenza

1. Adults

Preferred regimen (1): Oseltamivir (Tamiflu®) 75 mg PO bid for 5 days
Preferred regimen (2): Zanamivir (Relenza®) 10 mg (two 5-mg inhalations) bid for 5 days
Preferred regimen (3): Peramivir (Rapivab®) 600 mg IV for 15-30 minutes (single dose)
Note: FDA approved and recommended Peramivir (Rapivab®) for use in adults ≥18 yrs

2. Children

2.1 Children < 1 yr

Preferred regimen: Oseltamivir (Tamiflu®) 3 mg/kg/dose PO bid for 5 days

2.2 Children > 1 yr

2.2.1 Children ≤ 15 kg

Preferred regimen: Oseltamivir (Tamiflu®) 30 mg PO bid for 5 days

2.2.2 Children > 15 to 23 kg

Preferred regimen: Oseltamivir (Tamiflu®) 45 mg PO bid for 5 days

2.2.3 Children > 23 to 40 kg

Preferred regimen: Oseltamivir (Tamiflu®) 60 mg PO bid for 5 days

2.2.4 Children > 40 kg

Preferred regimen (1): Oseltamivir (Tamiflu®) 75 mg PO bid for 5 days
Preferred regimen (2): Zanamivir (Relenza®) 10 mg (two 5-mg inhalations) bid for 5 days, may be considered for children > 7 yrs old

3. Adult Patients with Renal Impairment or End Stage Renal Disease (ESRD) on Dialysis

3.1 Oseltamivir

Creatinine clearance 61 to 90 mL/min-75 mg PO bid for 5 days
Creatinine clearance 31 to 60 mL/min-30 mg PO bid for 5 days
Creatinine clearance 10 to 30 mL/min-30 mg PO qd for 5 days
ESRD Patients on Hemodialysis
Creatinine clearance ≤10 mL/min-30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days
ESRD Patients on Continuous Ambulatory Peritoneal Dialysis-A single 30 mg dose administered immediately after a dialysis exchange

3.2 Peramivir

Creatinine clearance >50 mL/min-600mg IV single dose
Creatinine clearance 30 to 49 mL/min-200mg IV single dose
Creatinine clearance 10 to 29 mL/min-100mg IV single dose
ESRD Patients on Hemodialysis-Dose administered after dialysis at a dose adjusted based on creatinine clearance
Note: No dose adjustment is recommended for inhaled zanamivir for a 5-day course of treatment for patients with renal impairment.

4. Antiviral Medications Recommended for Chemoprophylaxis of Influenza

4.1. Adults

Preferred regimen (1): Oseltamivir (Tamiflu®) 75 mg PO qd for 7days
Preferred regimen (2): Zanamivir (Relenza®) 10 mg (two 5-mg inhalations) qd for 7 days

4.2. Children

4.2.1 Children < 1 yr

Preferred regimen: Oseltamivir (Tamiflu®) 3 mg/kg/dose PO qd for 7 days

4.2.2 Children > 1 yr

4.2.2.1 Children ≤ 15 kg

Preferred regimen: Oseltamivir (Tamiflu®) 30 mg PO qd for 7 days

4.2.2.2 Children > 15 to 23 kg

Preferred regimen: Oseltamivir (Tamiflu®) 45 mg PO qd for 7 days

4.2.2.3 Children > 23 to 40 kg

Preferred regimen: Oseltamivir (Tamiflu®) 60 mg PO qd for 7 days

4.2.2.4 Children > 40 kg

Preferred regimen (1): Oseltamivir (Tamiflu®) 75 mg PO qd for 7 days
Preferred regimen (2): Zanamivir (Relenza®) 10 mg (two 5-mg inhalations) qd for 7 days, may be considered for children > 7 yrs older
Note: If child is < 3 months old, use of Oseltamivir for chemoprophylaxis is not recommended unless situation is judged critical due to limited data in this age group.

Avian influenza

Avian influenza Return to Top

1. Preferred regimen:Oseltamivir 75 mg PO qd for a minimum 10 days ^[410]^[411]

Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently

2. Patients with Avian Influenza who have diarrhea and malabsorption

Preferred regimen (1): Zanamivir 10 mg inhaled bid for minimum 5 days
Preferred regimen (2): Peramivir 600 mg IV as a single dose for 1 day
Note(1): Preliminary evidence demonstrates that Neuraminidase inhibitor can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.
Note(2): The use of Corticosteroids is not recommended.
Note(3): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
Note(4): The use of Amantadine is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.^[412]
Note(5): Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.

Swine influenza Return to Top

Swine influenza ^[413]

1. Condition1: Patients who have severe or progressive clinical illness

Preferred regimen: Oseltamivir 150 mg PO bid
Note (1): Treatment duration depends on clinical response
Note (2): Where the clinical course remains severe or progressive, despite 5 or more days of antiviral treatment, monitoring of virus replication and shedding, and antiviral drug susceptibility testing is desirable
Note (3): Antiviral treatment should be maintained without a break until virus infection is resolved or there is satisfactory clinical improvement
Note (4): Patients who have severe or progressive clinical illness, but who are unable to take oral medication may be treated with oseltamivir administered by nasogastric or orogastric tube

2. Condition2: In situations where oseltamivir is not available, or not possible to use, patients who have severe or progressive clinical illness

Preferred regimen: Zanamivir inhaled
Note: Zanamivir IV should be considered where available and is recommended for those with serious or progressive illness. If not available, Peramivir IV may be considered

3. Condition3: Severely immunosuppressed patients

Preferred regimen: Antiviral chemoprophylaxis by using Oseltamivir OR Zanamivir

Measles Return to Top

Measles

1.1. Prevention

1.1.1. Vaccines

Note (1): Measles can be prevented with measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. The combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella and varicella. Single-antigen measles vaccine is not available.
Note (2): Vaccination recommendations

Children: CDC recommends routine childhood immunization for MMR vaccine starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age or at least 28 days following the first dose.
Students at post-high school educational institutions: Students at post-high school educational institutions without evidence of measles immunity need two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose.
Adults: People who are born during or after 1957 who do not have evidence of immunity against measles should get at least one dose of MMR vaccine.
International travelers: People 6 months of age or older who will be traveling internationally should be protected against measles. Before travelling internationally,

Infants 6 through 11 months of age should receive one dose of MMR vaccine
Children 12 months of age or older should have documentation of two doses of MMR vaccine (the first dose of MMR vaccine should be administered at age 12 months or older; the second dose no earlier than 28 days after the first dose)
Teenagers and adults born during or after 1957 without evidence of immunity against measles should have documentation of two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose

1.1.2. Post-exposure Prophylaxis

1.1.2.1. Indication

People exposed to measles who cannot readily show that they have evidence of immunity against measles should be offered post-exposure prophylaxis (PEP) or be excluded from the setting (school, hospital, childcare). MMR vaccine, if administered within 72 hours of initial measles exposure, or immunoglobulin (IG), if administered within six days of exposure, may provide some protection or modify the clinical course of disease.

Note (1): If MMR vaccine is not administered within 72 hours of exposure as PEP, MMR vaccine should still be offered at any interval following exposure to the disease in order to offer protection from future exposures. People who receive MMR vaccine or IG as PEP should be monitored for signs and symptoms consistent with measles for at least one incubation period.
Note (2): If many measles cases are occurring among infants younger than 12 months of age, measles vaccination of infants as young as 6 months of age may be used as an outbreak control measure. Note that children vaccinated before their first birthday should be revaccinated when they are 12 through 15 months old and again when they are 4 through 6 years of age.
Note (3): People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive IG. Intramuscular IG (IGIM) should be given to all infants younger than 12 months of age who have been exposed to measles.
Note (4): For infants aged 6 through 11 months, MMR vaccine can be given in place of IG, if administered within 72 hours of exposure. Because pregnant women might be at higher risk for severe measles and complications, intravenous IG (IGIV) should be administered to pregnant women without evidence of measles immunity who have been exposed to measles. People with severely compromised immune systems who are exposed to measles should receive IGIV regardless of immunologic or vaccination status because they might not be protected by MMR vaccine.
Preferred regimen: The recommended dose of IGIM is 0.5 mL/kg of body weight (maximum dose = 15 mL) and the recommended dose of IGIV is 400 mg/kg.
Note (5): If a healthcare provider without evidence of immunity is exposed to measles, MMR vaccine should be given within 72 hours, or IG should be given within 6 days when available. Exclude healthcare personnel without evidence of immunity from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine.

1.2. Treatment

Note (1): There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections.
Note (2): Severe measles cases among children, such as those who are hospitalized, should be treated with vitamin A. Vitamin A should be administered immediately on diagnosis and repeated the next day. The recommended age-specific daily doses are

50,000 IU for infants younger than 6 months of age
100,000 IU for infants 6–11 months of age
200,000 IU for children 12 months of age and older

Middle East respiratory syndrome Return to Top

Middle East Respiratory Syndrome treatment

Preferred regimen: supportive care. There is no antiviral recommended for this infection at this moment, even though experimental therapies are at research (IFNs, Ribavirin, Lopinavir, Mycophenolic acid, Cyclosporine, Chloroquine, Chlorpromazine, Loperamide, 6-mercaptopurine and 6-thioguanine). Supportive care include: administer oxygen to patients with severe acute pulmonary infection with signs of respiratory distress, hypoxaemia or shock; use conservative fluids management, avoid administering high-dose systemic glucocorticoids, use non-invasive ventilation, but, if its nor effective, do not delay endotracheal intubation; use lung-protective strategy for intubated patients, recognize sepsis as early as possible and treat it accordingly.^[414]

Parainfluenza virus

Parainfluenza virus Return to Top

Parainfluenza virus^[415]

1. Adults

Preferred regimen: Ribavirin PO/IV 10 mg/kg q8h

Day 1: Start with 600 mg loading dose,then 200 mg q8h
Day 2: 400 mg q8h
Day 3: Increase the dose to a maximum of 10 mg/kg q8h

1.1 In case of adverse events

Preferred regimen: Decrease dose or discontinue Ribavirin

1.2 Creatinine clearance

30–50 mL/min: Ribavirin PO/IV maximal 200 mg q8h
10–30 mL/ min: No recommendation can be given

Parvovirus B19 Return to Top

Parvovirus B19^[416]

1. Erythema infectiosum

Supportive therapy: Symptomatic treatment only

2. Arthritis/arthalgia

Preferred regimen: Nonsteroidal anti-inflammatory drugs (NSAID)

3.Transient aplastic crisis

Supportive therapy: Transfusions and oxygen

4. Fetal hydrops

Supportive therapy: Intrauterine blood transfusion

5. Chronic infection with anemia

Preferred regimen: IVIG and transfusion

6.Chronic infection without anemia

Preferred regimen: IVIG

Note (1): Diagnostic tools are IgM and Igb antibody titers.Perhaps better is blood Parvovirus PCR.

Note (2): Dose of IVIG not standardized; suggest 400 mg/kg IV of commercial IVIG for 5 or 10 days or 1000 mg/kg IV for 3 days.

Note (3): Most dramatic anemias in pts with pre-existing hemolytic anemia.

Note (4): Bone marrow shown erythrocyte maturation arrest with giant pronormoblasts.

BK virus Return to Top

Human polyomavirus (BK virus) treatment

Maintenance regimen consisting of triple immunosuppression therapy: Calcineurin inhibitor (Cyclosporine or Tacrolimus) AND an antimetabolite (Azathioprine, Mycophenolate mofetil, or Mycophenolate sodium), AND Prednisone is to discontinue completely the antimetabolite (usually Mycophenolate) and decrease the dose of the Calcineurin inhibitor.
Alternative regimen (1): Decrease the Mycophenolate dose by 50 percent, followed by a 50 percent decrease in the Calcineurin inhibitor at three months if decoy cells persist. If using this approach, the target serum Tacrolimus trough level is 4 to 6, and the target serum Cyclosporine trough level is 60 to 100 ng/mL. Mycophenolate may be discontinued completely if viral activation persists. Maintenance immunosuppression then consists of Tacrolimus and low-dose Prednisone.
Alternative regimen (2): Reduce both the Calcineurin inhibitor and the Mycophenolate, which allows both the targeting of two pathways and lower total immunosuppression.

Note (1): For those who are hypogammaglobulinemic, we administer intravenous immunoglobulins (IV IG) in replacement doses of 500 mg/kg. Quantitative immunoglobulins should be checked two to three months later to determine whether hypogammaglobulinemia has recurred. Intravenous immunoglobulins (IV IG) is also an option in certain settings, based upon polymerase chain reaction (PCR) and kidney biopsy results. IVIG may contain antibodies against BK and JC virus since these viruses are ubiquitous in the general population.
Note (2): The goals of decreased immunosuppressive therapy are to restrain viral replication without triggering rejection.
Note (3): Reduced immunosuppression (defined as lowering mean doses of Mycophenolate and Tacrolimus) resulted in the successful elimination of viremia (mean period of six months) and allograft survival.
Note (4): Alternative approaches to reducing immunosuppression have also been effective

4.1 Changing from Tacrolimus to low-dose Cyclosporine not only reduces the effect of the Calcineurin inhibitor, but also reduces Mycophenolate concentrations.
4.2 Replacing the Calcineurin inhibitor with Sirolimus, with or without discontinuation of the antimetabolite, has the advantage of avoiding the long-term Calcineurin inhibitor-related nephrotoxic effects.
4.3 Lowering the dose of Calcineurin inhibitors may slow the loss of renal function.

Primary Regimens

Decrease immunosuppression if possible. (Cornerstone of Treatment)
Suggested antiviral therapy is based on anecdotal data. If progressive renal dysfunction:
Fluoroquinolone AND IVIG 500 mg/kg IV AND Leflunomide 100 mg for daily for 3 days, then 10-20 mg PO daily
If refractory to all of the above, add Cidofovir 5 mg/kg once per week for 2 weeks, then once every other week if refractory to all of the above

Ancillary Therapies in BK Virus Nephropathy

Cidofovir 0.25-1.0 mg/kg IV biweekly for 8 wk without Probenecid, prehydration recommended
Leflunomide 100 mg loading dose for 3 days, 20-60 mg/day, goal Leflunomide trough 50-100 ng/mL (consider lower trough goals of 20-40 ng/mL given hemolysis risk)
IV Ig 1-2 g/kg IV for 1-2 doses or 150 mg/kg IV biweekly for 8 wk
Fluoroquinolones-Ciproflaxacin 500 mg/day, duration dependent on virological response.

JC virus Return to Top

Progressive Multifocal Leukoencephalopathy (PML) caused by JC Virus ( John Cunningham virus) infections^[417]

There is no specific antiviral therapy for JC virus infection.

The main treatment approach is to reverse the immunosuppression caused by HIV.

Initiate anti retroviral therapy (ART) immediately in ART-naive patients .

Optimize ART in patients who develop Progressive Multifocal Leukoencephalopathy in phase of HIV viremia on ART .

Corticosteroids may be used for Progressive Multifocal Leukoencephalopathy- immune reconstitution inflammatory syndrome (IRIS) characterized by contrast enhancement, edema or mass effect, and with clinical deterioration

Rabies Return to Top

Rabies treatment

Preferred regimen: no specific therapetics agents are available once the disease is established.
Note: There are vaccines and immunoglobulins available for postexposure prophylaxis

Postexposure prophylaxis

1. For non immunized individuals

Wound cleansing, human rabies immunoglobulin - administer full dose infiltrated around any wound. Administer any remaining volume IM at other site anatomically distant from the wound. Administer vaccine 1.0 ml, IM at deltoid area one each on days 0, 3, 7 and 14.

2. For immunized individuals

Wound cleansing, do not administer human rabies immune globulin. Administer vaccine 1,0ml, IM at deltoid area one each on days 0 and 3.

Respiratory Syncytial Virus Return to Top
Respiratory syncytial virus treatment

Supportive therapy

Hydration and supplemental oxygen.
Routine use of Ribavirin not recommended. Ribavirin therapy associated with small increases in O2 saturation.
No consistent decrease in need for mechanical ventilation or ICU stays. High cost, aerosol administration and potential toxicity^[418]

Note (1): In adults, Respiratory syncytial virus accounted for 10.6% of hospitalizations for pneumonia, 11.4% for COPD, 7.2% for asthma & 5.4% for CHF in pts >65 yrs of age ^[419]. Respiratory syncytial virus caused 11% of clinically important respiratory illnesses in military recruits^[420]
Note (2): Respiratory Syncytial Virus major cause of morbidity in neonates/infants.
Note (3): Nucleic acid test now approved to detect 12 respiratory viruses (xTAG Respiratory Viral Panel, Luminex Molecular Diagnostics).

Prevention of Respiratory syncytial virus

1. In children <24 months old with chronic lung disease of prematurity (formerly broncho-pulmonary dysplasia) requiring supplemental oxygen or
2. In premature infants (<32 wks gestation) and <6 months old at start of Respiratory syncytial virus season or
3. In children with selected congenital heart diseases.

Preferred regimen for prevention of Respiratory syncytial virus: Palivizumab (Synagis) 15 mg per kg IM q month Nov.-April^[418]

Note : Significant reduction in Respiratory syncytial virus hospitalization among children with congenital heart disease^[421]

Rhinovirus Return to Top
Rhinovirus treatment (commom cold)

Supportive therapy

1. Symptomatic treatment-Ipratropium bromide intranasal (2 sprays tid) AND Clemastine 1.34 mg 1–2 tab PO bid–tid (over the counter)
2. Symptomatic relief by Ipratropium nasal spray decreases rhinorrhea and sneezing vs placebo.^[422] AND Clemastine (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.^[423]OR Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).^[424]

Note (1): No antiviral treatment indicated . ^[425]
Note (2): Found in half of children with community-acquired pneumonia; role in pathogenesis unclear (CID 39:681, 2004). ^[426]
Note (3): High rate of rhinovirus identified in children with significant lower resp tract infections ^[427]

Rotavirus Return to Top
Rotavirus treatment^[428], ^[429]

Treatment of diarrhoea caused by rotavirus

Rehydration with oral rehydration salts (ORS) solution. oral rehydration salts (ORS) solution is a mixture of clean water, salt and sugar. It costs a few cents per treatment. oral rehydration salts (ORS) solution is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.

Zinc supplements-with zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
Rehydration with intravenous fluids in case of severe dehydration or shock.
Nutrient-rich foods the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods including breast milk during an episode, and by giving a nutritious diet including exclusive breastfeeding for the first six months of life to children when they are well.
Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.

Note (1): Rotavirus and Escherichia coli are the two most common etiological agents of diarrhoea in developing countries.

Note (2): There is no antiviral drug to treat rotavirus infection. Antibiotic drugs will not help because antibiotics fight against bacteria not viruses.

Note (3): Rotavirus infection can cause severe vomiting and diarrhea. This can lead to dehydration (loss of body fluids). During rotavirus infection, infants and young children, older adults, and people with other illnesses are most at risk becoming dehydrated.

Note (4): Symptoms of dehydration include decrease in urination, dry mouth and throat, feeling dizzy when standing up. A dehydrated child may also cry with few or no tears and be unusually sleepy or fussy.

Prevention

Access to safe drinking-water
Use of improved sanitation
Hand washing with soap

Exclusive breastfeeding for the first six months of life

Good personal and food hygiene
Health education about how infections spread; and Rotavirus vaccination.

Smallpox

Smallpox Return to Top

Smallpox ^[430]

Supportive care is the mainstay of therapy.
Currently, there are no anti-viral drugs of proven efficacy.
Recently, animal studies suggest that cidofovir and its cyclic analogues, given at the time of or immediately after exposure, have promise for the prevention of cowpox, vaccinia, and monkeypox.
Patients need adequate hydration and nutrition, because substantial amounts of fluid and protein can be lost by febrile persons with dense, often weeping lesions.

1. Secondary bacterial infection

Penicillinase-resistant antimicrobial agents should be used

If smallpox lesions are secondarily infected,

If bacterial infection endangers the eyes

Daily eye rinsing is required in severe cases.

Topical idoxuridine should be considered for the treatment of corneal lesions, although its efficacy is unproved for smallpox.

If the eruption is very dense and widespread.

HIV/AIDS

HIV/AIDS Return to Top

]* 1. Antiretroviral regimen options for treatment-naive patients^[431]

1.1. Integrase strand transfer inhibitor-based regimens

Preferred regimen (1): Dolutegravir 50 mg PO qd AND Abacavir 600 mg-Lamivudine 300 mg PO qd in patients who are HLA-B*5701-negative
Preferred regimen (2): Dolutegravir 50 mg PO qd AND Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Preferred regimen (3): Elvitegravir 150 mg-Cobicistat 150 mg-Tenofovir 300 mg-Emtricitabine 200 mg PO qd in patients with estimated CrCl ≥ 70 mL/min/1.73
Preferred regimen (4): Raltegravir 400 mg PO bid AND Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (1): Efavirenz 600 mg PO qd OR Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (2): Rilpivirine 25 mg PO qd AND (Tenofovir 300 mg PO qd OR Emtricitabine 200 mg PO qd) for patients with CD4 count >200 cells/microL
Alternative regimen (3): Raltegravir 400 mg PO bid AND (Abacavir 600 mg PO qd OR Lamivudine 300 mg PO qd) in patients who are HLA-B*5701-negative

1.2. Protease inhibitor-based regimen

Preferred regimen: Darunavir 800 mg-Ritonavir 100 mg PO qd AND Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (1): Atazanavir 300 mg-Cobicistat 150 mg PO qd AND Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd only for patients with pre-treatment estimated CrCl ≥70 mL/min
Alternative regimen (2): Atazanavir 300 mg-Ritonavir 100 mg PO qd AND Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (3): (Darunavir 800 mg-Cobicistat 150 mg PO qd OR Darunavir 800 mg-Ritonavir 100 mg PO qd) AND Abacavir 600 mg-Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative
Alternative regimen (4): Darunavir 800 mg-Cobicistat 150 mg PO qd AND Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd only for patients with pre-treatment estimated CrCl ≥70 mL/min
Alternative regimen (5): Atazanavir 300 mg-Ritonavir 100 mg PO qd AND Abacavir 600 mg-Lamivudine 300 mg PO qd in patients who are HLA-B*5701-negative and with pre-treatment HIV RNA <100,000 copies/mL
Alternative regimen (6): Lopinavir 400 mg-Ritonavir 100 mg PO qd or bid AND Abacavir 600 mg-Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative
Alternative regimen (7): Lopinavir 400 mg-Ritonavir 100 mg PO qd or bid AND Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd

1.3. A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen

Alternative regimen (1): Efavirenz 600 mg-Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (2): Rilpivirine 25 mg-Tenofovir 300 mg-Emtricitabine 200 mg PO qd

1.4. Other regimen options

1.4.1. A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen

Preferred regimen (1): Efavirenz 600 mg PO qd AND Abacavir 600 mg-Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative and with pre-treatment HIV RNA <100,000 copies/mL.

1.4.2. Other regimens when tenofovir or abacavir cannot be used

Preferred regimen (1): Darunavir 800 mg-Ritonavir 100 mg PO qd AND Raltegravir 400 mg PO qd only for patients with pre-treatment HIV RNA <100,000 copies/mL and CD4 cell count >200 cells/mm3.
Preferred regimen (2): Lopinavir 400 mg-Ritonavir 100 mg PO bid AND Lamivudine 300 mg PO bid

1.5. Pediatric doses

Abacavir 300 mg PO bid
Lamivudine 4 mg/kg/dose PO bid; maximum 150 mg PO bid
Stavudine 1 mg/kg/dose PO bid
Tenofovir 8 mg/kg/dose PO bid
Zidovudine 180-240 mg/m²/dose PO bid or 160 mg/m²/dose PO tid (range 90 mg/m²/dose-180 mg/m²/dose)
Lopinavir 400 mg PO bid
Nelfinavir 50 mg/kg/dose PO bid
Raltegravir 300 mg PO bid
Didanosine

20 to < 25 kg: 200 mg PO qd
25 to < 60 kg: 250 mg PO qd
≥60 kg: 400 mg PO qd

Efavirenz

10 to < 15 kg: 200 mg PO qd
15 to <20 kg: 250 mg PO qd
20 to < 25 kg: 300 mg PO qd
25 to < 32.5 kg: 350 mg PO qd
32.5 to <40 kg: 400 mg PO qd
≥ 40 kg: 600 mg PO qd

Nevirapine maximum 200 mg per dose

Between 1 day and 8 years: 200 mg/m²/dose PO qd for 14 days, then 200 mg/m²/dose PO bid
8 years and above: 120-150 mg/m²/dose PO qd for 14 days, then 120-150 mg/m²/dose PO bid

Note (1): Anti retroviral therapy for treatment naive patients is a life long therapy.
Note (2): Tenofovir disoproxil fumarate should be avoided in patients with a creatinine clearance <50 mL/min.
Note (3): Rilpivirine should be used in patients with a CD4 cell count >200 copies/mL and should not be used with proton pump inhibitors.
Note (4): Efavirenz should not be used in pregnant women.

2. Pre-exposure prophylaxis (PrEP)

Preferred regimen: Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd for ≤90-days
Note (1): People with high risk behavior such as men who have sex with men, intravenous drug abusers, HIV-positive sexual partner, recent bacterial STI, high number of sex partners, history of inconsistent or no condom use, commercial sex work, people in high-prevalence area or network are advised to take pre-exposure prophylaxis of drugs.
Note (2): Follow-up visits at least every 3 months to provide the following: HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STI symptom assessment, pregnancy testing.
Note (3): At 3 months and every 6 months thereafter, assess renal function.
Note (4): Every 6 months, test for bacterial STIs.

3. Post- exposure prophylaxis

Preferred regimen: Raltegravir 400 mg PO bid AND Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd
Preferred basic regimen for low-risk exposures (Eg: mucus membrane):
- Zidovudine 100 mg PO qd AND Lamivudine 300 mg PO qd
- Zidovudine 100 mg PO qd AND Emtricitabine 200 mg PO qd
- Tenofovir 300 mg PO qd AND Lamivudine 300 mg PO qd
- Tenofovir 300 mg PO qd AND Emtricitabine 200 mg PO qd
Preferred expanded regimen for high-risk exposure (Eg: percutaneous needle stick)
- Zidovudine 100 mg PO qd AND Lamivudine 300 mg PO qd AND Lopinavir 400 mg-Ritonavir 100 mg PO qd
- Zidovudine 100 mg PO qd AND Emtricitabine 200 mg PO qd AND Lopinavir 400 mg-Ritonavir 100 mg PO qd
- Tenofovir 300 mg PO qd AND Lamivudine 300 mg PO qd AND Lopinavir 400 mg-Ritonavir 100 mg PO qd
- Tenofovir 300 mg PO qd AND Emtricitabine 200 mg PO qdAND Lopinavir 400 mg-Ritonavir 100 mg PO qd
Note: Ideally therapy should be started within hours of exposure and continued for 28 days.

4. Perinatal antiretroviral regimen

4.1. Antepartum

4.1.1. Protease inhibitor-based regimen

Preferred regimen: (Tenofovir 300 mg-Emtricitabine 200 mg PO qd (fixed dose combination) OR Tenofovir 300 mg-Lamivudine 300 mg PO qd OR Abacavir 600 mg-Lamivudine 300 mg PO qd OR Zidovudine 100 mg-Lamivudine 300 mg PO qd) AND (Atazanavir 300 mg-Ritonavir 100 mg PO qd OR Lopinavir 400 mg-Ritonavir 100 mg PO qd)

4.1.2. A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen:

Preferred regimen (1): Efavirenz 600 mg-Tenofovir 300 mg-Emtricitabine 200 mg (fixed dose combination) PO qd
Preferred regimen (2): Efavirenz 600 mg-Tenofovir 300 mg-Lamivudine 300 mg PO qd
Alternative regimen: (Abacavir 600 mg-Lamivudine 300 mg PO qd OR Zidovudine 100 mg-Lamivudine 300 mg PO qd) AND Efavirenz 600 mg PO qd

4.2. Intrapartum

Note (1): HIV RNA <1000 copies/mL and good adherance-Continue the regimen during delivery or cessarean section.
Note (2): HIV RNA >1000 copies/mL near delivery, possible poor adherence, or unknown HIV RNA levels- Intravenous Zidovudine 2 mg/kg IV over 1 hr should be given three hours before cesarean section or delivery and then 1 mg/kg/hr IV continuous infusion until umbilical cord clamping.

4.3. Postpartum

Note: Initiate anti retroviral therapy (ART) and continue after delivery and cessation of breastfeeding.

5. Infant antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV

5.1 Prophylaxis for HIV-exposed infants of women who received antepartum antiretroviral prophylaxis

Preferred regimen: Zidovudine (ZDV) 100 mg PO given at birth and continued till six weeks
Note (1): Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
Note (2): ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
Note (3): ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
Note (4): <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.

5.2. Prophylaxis for HIV-exposed infants of women who received no antepartum antiretroviral prophylaxis

Nevirapine

Dose based on birth weight, initiated as soon after birth as possible.
Birth weight 1.5 to 2 kg: 8 mg/dose orally.
Birth weight >2 kg: 12 mg/dose orally.

AND

Zidovudine (ZDV)

Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.

≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
<30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.

Note (1): Three doses in the first week of life.
Note (2): First dose within 48 hours of birth (birth to 48 hrs).
Note (3): Second dose 48 hours after first.
Note (4): Third dose 96 hours after second.

6. Treatment and prevention of opportunistic infections

6.1. Pneumocystis pneumonia (PCP)

6.1.1. Prevention

Indication

CD4 count <200 cells/mm3
Oropharyngeal candidiasis
CD4 <14%
History of AIDS-defining illness
CD4 count >200 but <250 cells/mm3 if monitoring CD4 cell count every 3 months is not possible.

Preferred regimen: Trimethoprim/sulfamethoxazole 160 mg/800 mg PO qd or 80 mg/400 mg PO qd
Alternative regimen (1): Trimethoprim/sulfamethoxazole 160 mg/800 mg PO three times weekly
Alternative regimen (2): Dapsone 100 mg PO qd or 50 mg PO bid
Alternative regimen (3): Dapsone 50 mg PO qd AND (Pyrimethamine 50 mg-Leucovorin 25 mg) PO weekly
Alternative regimen (4): Dapsone 200 mg PO qd AND (Pyrimethamine 75 mg-Leucovorin 25 mg) PO weekly
Alternative regimen (5): Aerosolized Pentamidine 300 mg via Respigard nebulizer every month
Alternative regimen (6): Atovaquone 1500 mg PO qd
Alternative regimen (7): Atovaquone 1500 mg AND (Pyrimethamine 25 mg AND Leucovorin 10 mg) PO qd

6.1.2. Treatment

6.1.2.1. For Moderate-to-Severe PCP'

Preferred regimen: Trimethoprim 15–20 mg AND Sulfamethoxazole 75–100 mg/kg/day IV given q6h or q8h, may switch to PO after clinical improvement
Alternative regimen (1): Pentamidine 4 mg/kg IV daily infused over ≥60 minutes
Note: Reduce dose to 3 mg/kg IV daily if toxic.
Alternative regimen (2): Primaquine 30 mg (base) PO qd AND (Clindamycin 600 mg q6h IV OR 900 mg IV q8h OR Clindamycin 450 mg PO qid or 600 mg PO tid)

6.1.2.2. For Mild-to-Moderate PCP

Preferred regimen: Trimethoprim 15–20 mg AND Sulfamethoxazole 75–100 mg/kg/day PO in TID OR Trimethoprim/sulfamethoxazole 160 mg/800 mg 2 tablets PO tid
Alternative regimen (1): Dapsone 100 mg PO qd AND TMP 5 mg/kg PO tid
Alternative regimen (2): Primaquine 30 mg (base) PO qd AND (Clindamycin 450 mg PO qid or 600 mg PO tid OR Atovaquone 750 mg PO bid with food)

6.1.3. Secondary prophylaxis, after completion of PCP treatment

Preferred regimen (1): Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO qd OR Trimethoprim/Sulfamethoxazole 80 mg/400 mg PO qd
Alternative regimen (1): Trimethoprim/sulfamethoxazole 160 mg/800 mg PO three times weekly
Alternative regimen (2): Dapsone 100 mg PO qd
Alternative regimen (3): Dapsone 50 mg PO qd AND Pyrimethamine 50 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (4): Dapsone 200 mg PO AND Pyrimethamine 75 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (5): Dapsone 100 mg PO qd
Alternative regimen (6): Dapsone 50 mg PO qd AND Pyrimethamine 50 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (7): Dapsone 200 mg PO AND Pyrimethamine 75 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (8): Aerosolized Pentamidine 300 mg monthly via Respirgard nebulizer
Alternative regimen (9): Atovaquone 1500 mg PO qd
Alternative regimen (10): Atovaquone 1500 mg PO AND Pyrimethamine 25 mg PO AND Leucovorin 10 mg PO qd

6.1.4. Adjunctive corticosteroids

Indications- PaO2 <70 mmHg at room air OR Alveolar-arterial O2 gradient >35 mmHg.
Preferred regimen:

Days 1–5: 40 mg PO bid
Days 6–10: 40 mg PO qd
Days 11–21: 20 mg PO qd

Note (1): Trimethoprim/sulfamethoxazole should be permanently discontinued in patients with possible or definite stevens johnson syndrome or toxic epidermal necrosis.
Note (2): Whenever possible, patients should be tested for G6PD before use of Dapsone or Primaquine. Alternative regimen should be used in patients found to have G6PD deficiency.

6.2. Toxoplasma gondii encephalitis

6.2.1. Prevention

6.2.1.1. Indication

Toxoplasma IgG-positive patients with CD4 count <100 cells/µL.
Seronegative patients receiving PCP prophylaxis not active against toxoplasmosis should have toxoplasma serology retested if CD4 count decline to <100 cellsµL.
Prophylaxis should be initiated if seroconversion occurred.

Preferred regimen: Trimethoprim/sulfamethoxazole 160 mg/800 mg PO qd
Alternative regimen (1): Trimethoprim/sulfamethoxazole 160 mg/800 mg PO three times weekly
Alternative regimen (2): Trimethoprim/sulfamethoxazole 80 mg/400 mg PO qd
Alternative regimen (3): Dapsone 50 mg PO qd AND Pyrimethamine 50 mg PO weekly AND Leucovorin 25 mg PO weekly
Alternative regimen (4): Dapsone 200 mg PO weekly AND Pyrimethamine 75 mg PO weekly AND Leucovorin 25 mg PO weekly
Alternative regimen (5): Atovaquone 1500 mg PO qd
Alternative regimen (6): Atovaquone 1500 mg PO qd AND Pyrimethamine 25 mg PO qd AND Leucovorin 10 mg PO qd

6.2.2. Treatment

6.2.2.1. Treatment of acute infection

Preferred regimen: Pyrimethamine 200 mg PO single dose, followed by weight-based therapy:

If <60 kg, Pyrimethamine 50 mg PO qd AND Sulfadiazine 1000 mg PO qid AND Leucovorin 10–25 mg PO qd
If ≥60 kg, Pyrimethamine 75 mg PO qd AND Sulfadiazine 1500 mg PO qid AND Leucovorin 10–25 mg PO qd
Note: At least 6 weeks; longer duration if clinical or radiologic disease is extensive or response is incomplete at 6 weeks.

Alternative regimen (1): Pyrimethamine 50 mg PO qdAND Leucovorin 10–25 mg PO qd AND Clindamycin 600 mg IV or PO q6h
Alternative regimen (2): Trimethoprim 5 mg/kg-Sulfamethoxazole 25 mg/kg IV or PO bid
Alternative regimen (3): Atovaquone 1500 mg PO bid with food AND Pyrimethamine 50 mg PO qd AND Leucovorin 10–25 mg PO qd
Alternative regimen (4): Atovaquone 1500 mg PO bid with food AND Sulfadiazine 1000–1500 mg PO qid (weight-based dosing, as in preferred therapy)
Alternative regimen (5): Atovaquone 1500 mg PO bid with food
Alternative regimen (6): Pyrimethamine 50 mg-Leucovorin 10–25 mg PO qd AND Azithromycin 900–1200 mg PO qd

6.2.2.2. Chronic maintenance therapy

Preferred regimen: Pyrimethamine 25–50 mg PO qd AND Sulfadiazine 2000–4000 mg PO qd (in 2–4 divided doses) AND Leucovorin 10–25 mg PO qd
Alternative regimen (1): Clindamycin 600 mg PO tid AND Pyrimethamine 25–50 mg-Leucovorin 10–25 mg PO qd
Alternative regimen (2): Trimethoprim/sulfamethoxazole 160 mg/800 mg bid
Alternative regimen (3): Atovaquone 750–1500 mg PO bid AND Pyrimethamine 25 mg-Leucovorin 10 mg PO qd
Alternative regimen (4): Atovaquone 750–1500 mg PO bid AND Sulfadiazine 2000–4000 mg PO qd in 2–4 divided doses
Alternative regimen (5): Atovaquone 750–1500 mg PO bid with food

6.3. Mycobacterium tuberculosis infection

6.3.1. Prevention

6.3.1.1. Indication

Positive screening test for latent tuberculosis infection, with no evidence of active tuberculosis, and no prior treatment for active tuberculosis or latent tuberculosis infection.
Close contact with a person with infectious tuberculosis, with no evidence of active tuberculosis, regardless of screening test results.
Preferred regimen: (Isoniazid 300 mg PO qd AND Pyridoxine 25 mg PO qd for 9 months) OR (Isoniazid 900 mg PO two times a week (by DOT) AND Pyridoxine 25 mg PO qd for 9 months)
Alternative regimen (1): Rifampin 600 mg PO qd for 4 months
Alternative regimen (2): Rifabutin (dose adjusted based on concomitant ART) PO qd for 4 months

6.3.2. Treatment

Preferred regimen

Initiation phase: Isoniazid 300 mg PO qd AND (Rifampin 600 mg PO qd OR Rifabutin 300 mg PO qd) AND Pyrazinamide (upto 2000 mg) PO qd AND Ethambutol (upto 1600 mg) PO qd for initial phase for 2 months.

Continuation phase: Isoniazid 300 mg PO qd AND (Rifampin 600 mg PO qd OR Rifabutin 300 mg PO qd) (5–7 times/week) or three times a week.
Duration of therapy:

Pulmonary tuberculosis: 6 months
Pulmonary tuberculosis and culture positive after 2 months of tuberculosis treatment: 9 months
Extra-pulmonary tuberculosis w/CNS infection: 9–12 months
Extra-pulmonary tuberculosis with bone or joint involvement: 6 to 9 months
Extra-pulmonary tuberculosis in other sites: 6 months
Total duration of therapy should be based on number of doses received, not on calendar time

6.3.1.3. Treatment for drug-resistant tuberculosis

Resistant to Isoniazid:

Preferred regimen (1): (Rifampin 600 mg PO qd OR Rifabutin 300mg PO qd) AND Ethambutol (upto 1600 mg) PO qd AND Pyrazinamide (upto 2000 mg) PO qd AND (Moxifloxacin 400 mg PO or IV qd OR Levofloxacin 500-1000 mg PO or IV qd) for 2 months; followed by Rifampin 600 mg PO qd for 7 months.
Preferred regimen (2): Rifabutin 300mg PO qd AND Ethambutol (upto 1600 mg) PO qd AND (Moxifloxacin 400 mg PO or IV qdOR Levofloxacin 500-1000 mg PO or IV qd) for 7 months

6.4. Disseminated mycobacterium avium complex (MAC) disease

6.4.1. Prevention

6.4.1.1. Indication-CD4 count <50 cells/µL—after ruling out active disseminated MAC disease based on clinical assessment

Preferred regimen (1): Azithromycin 1200 mg PO once weekly
Preferred regimen (2): Clarithromycin 500 mg PO bid
Preferred regimen (3): Azithromycin 600 mg PO twice weekly.

6.4.2. Treatment

Preferred regimen: Clarithromycin 500 mg PO bid AND Ethambutol 15 mg/kg PO qd OR Azithromycin 500–600 mg PO qd for at least 12 months of therapy
Note (1): Treatment can be discontinued if no signs and symptoms of MAC disease and sustained (>6 months) CD4 count >100 cells/µL in response to anti retroviral therapy.
Note (2): Addition of a third or fourth drug should be considered for patients with advanced immunosuppression (CD4 counts <50 cells/µL), high mycobacterial loads (>2 log CFU/mL of blood), or in the absence of effective anti retroviral therapy which include Amikacin 10–15 mg/kg IV qd, Streptomycin 1 g IV or IM qd, Moxifloxacin 400 mg PO qd, Levofloxacin 500 mg PO qd.

6.5. Streptococcus pneumoniae infection

6.5.1. Prevention

6.5.1.1. Indication

6.5.1.1.1. For individuals who have not received any pneumococcal vaccine, regardless of CD4 count

Preferred regimen: PCV13 0.5ml IM single dose
Alternative regimen: PPV23 0.5 mL IM or SQ single dose
Note (1): If CD4 count ≥200 cells/µL, administer PPV23 0.5 mL IM or SQ at least 8 weeks after the PCV13 vaccine.
Note (2): If CD4 count <200 cells/µL, PPV23 can be offered at least 8 weeks after receiving PCV13 or can wait until CD4 count increased to ≥200 cells/µL.

6.5.1.1.2. For individuals who have previously received PPV23

Note: One dose of PCV13 should be given atleast 1 year after the last receipt of PPV23

6.5.1.1.3. Re-vaccination

If age 19–64 years and ≥5 years since the first PPV23 dose PPV23 0.5 mL IM or SQ
If age ≥65 years, and if ≥5 years since the previous PPV23 dose PPV23 0.5 mL IM or SQ
If age ≥65 years, and if ≥5 years since the previous PPV23 dose PPV23 0.5 mL IM or SQ

6.6. Influenza A and B virus infection

6.6.1. Prevention

6.6.1.1. Indication

All HIV-infected patients
Note (1): Inactivated influenza vaccine annually (per recommendation for the season).
Note (2): Live-attenuated influenza vaccine is contraindicated in HIV-infected patients.

6.7. Syphilis

6.7.1. Prevention

6.7.1.1. Indication

For individuals exposed to a sex partner with a diagnosis of primary, secondary, or early latent syphilis within past 90 days.
For individuals exposed to a sex partner >90 days before syphilis diagnosis in the partner, if serologic test results are not available immediately and the opportunity for follow-up is uncertain.
Preferred regimen: Benzathine penicillin G 2.4 million units IM single dose
Alternative regimen (1): Doxycycline 100 mg PO bid for 14 days
Alternative regimen (2): Ceftriaxone 1 g IM or IV q24h for 8– 10 days
Alternative regimen (3): Azithromycin 2 g PO single dose
Note: Azithromycin is not recommended for MSM or pregnant women.

6.7.2. Treatment

6.7.2.1. Early stage (primary, secondary, and early-latent syphilis)

Preferred regimen: Benzathine penicillin G 2.4 million units IM single dose
Alternative regimen (1): Doxycycline 100 mg PO bid for 14 days
Alternative regimen (2): Ceftriaxone 1 g IM or IV q24h for 10–14 days
Alternative regimen (3): Azithromycin 2 g PO single dose

6.7.2.2. Late-stage (tertiary–cardiovascular or gummatous disease)

Preferred regimen: Benzathine penicillin G 2.4 million units IM weekly for 3 doses
Alternative regimen: Doxycycline 100 mg PO bid for 28 days

6.7.2.3. Neurosyphilis (including otic or ocular disease)

Preferred regimen: Aqueous crystalline Penicillin G 18– 24 million units per day (administered as 3–4 million units IV q4h or by continuous IV infusion) for 10–14 days with or without Benzathine penicillin G 2.4 million units IM weekly for 3 doses after completion of IV therapy
Alternative regimen: Procaine penicillin 2.4 million units IM q24h AND Probenecid 500 mg PO qid for 10–14 days with or without Benzathine penicillin G 2.4 million units IM weekly for 3 doses after completion
Note (1): The Jarisch-Herxheimer reaction is an acute febrile reaction accompanied by headache and myalgia that can occur within the first 24 hours after therapy for syphilis.
Note (2): This reaction occurs most frequently in patients with early syphilis, high nontreponemal titers and prior penicillin treatment.

6.8. Histoplasma capsulatum infection

6.8.1. Prevention

6.8.1.1. Indication

CD4 count ≤150 cells/µL and at high risk because of occupational exposure or live in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years).
Preferred regimen: Itraconazole 200 mg PO qd

6.8.2. Treatment

6.8.2.1. Moderately severe to severe disseminated disease

Induction therapy (for at least 2 weeks or until clinically improved)

Preferred regimen: Liposomal Amphotericin B 3 mg/kg IV q24h

Maintenance therapy:

Preferred regimen: Itraconazole 200 mg PO tid for 3 days, then 200 mg PO bid

6.8.2.2. Less severe disseminated disease

Induction therapy:

Preferred regimen: Liposomal Amphotericin B 3 mg/kg IV q24h
Alternative regimen: Amphotericin B lipid complex 3 mg/kg IV q24h OR Amphotericin B cholesteryl sulfate complete 3 mg/kg IV q24h
Note: Induction therapy should be for at least 2 weeks or until clinically improved.

Maintenance therapy:

Preferred regimen: Itraconazole 200 mg PO tid for 3 days and then Itraconazole 200 mg PO bid for 12 months
Alternative regimen (1): Voriconazole 400 mg PO bid for 1 day, then 200 mg bid
Alternative regimen (2): Posaconazole 400 mg PO bid
Alternative regimen (3): Fluconazole 800 mg PO qd

6.8.2.3. Meningitis

Induction therapy:

Preferred regimen: Liposomal amphotericin B 5 mg/kg/day for 4–6 weeks

Maintenance therapy:

Preferred regimen: Itraconazole 200 mg PO bid to tid for ≥1 year

Note: Treatment continued until resolution of abnormal CSF findings.
Long-Term Suppression Therapy

Preferred regimen: Itraconazole 200 mg PO qd
Alternative regimen: Fluconazole 400 mg PO qd
Note: Therapeutic drug monitoring and dosage adjustment may be necessary to ensure Triazole antifungal and ARV efficacy and reduce concentration-related toxicities.

6.9. Coccidioidomycosis

6.9.1. Prevention
6.9.1.1. Indication

A new positive IgM or IgG serologic test in patients who live in a disease-endemic area and with CD4 count <250 cells/µL.
Preferred regimen: Fluconazole 400 mg PO qd

6.9.2. Treatment

6.9.2.1. Clinically mild infections (e.g., focal pneumonia)

Preferred regimen: Fluconazole 400 mg PO qd OR Itraconazole 200 mg PO bid
Alternative regimen: Posaconazole 200 mg PO bid OR Voriconazole 200 mg PO bid

6.9.2.2. Severe, non-meningeal infection (diffuse pulmonary infection or severely ill patients with extrathoracic, disseminated disease)

Preferred regimen: Amphotericin B deoxycholate 0.7–1.0 mg/kg IV qd OR Lipid formulation Amphotericin B 4–6 mg/kg IV qd
Alternative regimen: Fluconazole or Itraconazole, with Itraconazole preferred for bone disease 400 mg per day to Amphotericin B therapy and continue triazole once Amphotericin B is stopped.

6.9.2.3. Meningeal infections

Preferred regimen: Fluconazole 400–800 mg IV or PO qd
Alternative regimen: Itraconazole 200 mg PO tid for 3 days, then 200 mg PO bid OR Posaconazole 200 mg PO bid OR Voriconazole 200–400 mg PO bid

6.9.2.4. Chronic suppressive therapy

Preferred regimen: Fluconazole 400 mg PO qd OR Itraconazole 200 mg PO bid
Alternative regimen: Posaconazole 200 mg PO bid OR Voriconazole 200 mg PO bid
Note (1): Therapy should be continued indefinitely in patients with diffuse pulmonary or disseminated diseases because relapse can occur in 25%–33% of HIV-negative patients. It can also occur in HIV-infected patients with CD4 counts >250 cells/µL.
Note (2): Therapy should be lifelong in patients with meningeal infections because relapse occurs in 80% of HIV-infected patients after discontinuation of triazole therapy.

6.10. Herpes simplex virus (HSV) Disease

6.10.1. Orolabial lesions (For 5–10 Days)

Preferred regimen (1): Valacyclovir 1 g PO bid
Preferred regimen (2): Famciclovir 500 mg PO bid
Preferred regimen (3): Acyclovir 400 mg PO tid

6.10.2. Initial or recurrent genital HSV (For 5–14 Days)

Preferred regimen (1): Valacyclovir 1 g PO bid
Preferred regimen (2): Famciclovir 500 mg PO bid
Preferred regimen (3): Acyclovir 400 mg PO tid

6.10.3. Severe mucocutaneous HSV

Preferred regimen: Initial therapy Acyclovir 5 mg/kg IV q8h.
Note: After lesions begin to regress, change to PO therapy as above. Continue until lesions are completely healed.

6.10.4. Chronic suppressive therapy

Preferred regimen (1): Valacyclovir 500 mg PO bid
Preferred regimen (2): Famciclovir 500 mg PO bid
Preferred regimen (3): Acyclovir 400 mg PO bid

6.10.4. For acyclovir-resistant HSV

Preferred therapy: Foscarnet 80–120 mg/kg/day IV q12h-q8h
Alternative regimen: Cidofovir IV OR Topical Trifluridine OR Topical Imiquimod for 21-28 days
Note: Continue indefinitely regardless of CD4 cell count.

6.11. Varicella-zoster virus (VZV) infection

6.11.1. Varicella-zoster virus (VZV) infection

6.11.1.2 Prevention

6.11.1.1. Pre-exposure prevention

Indication: Patients with CD4 counts ≥200 cells/µL who have not been vaccinated, have no history of varicella or herpes zoster, or who are seronegative for VZV.
Preferred regimen: Primary varicella vaccination, 2 doses (0.5 mL SQ each) administered 3 months apart
Alternative regimen: VZV-susceptible household contacts of susceptible HIV-infected persons should be vaccinated to prevent potential transmission of VZV to their HIV-infected contacts
Note (1): Routine VZV serologic testing in HIV-infected adults and adolescents is not recommended.
Note (2): If vaccination results in disease because of vaccine virus, treatment with Acyclovir is recommended.

6.11.1.2. Post-exposure prevention

Indication: Close contact with a person with chickenpox or herpes zoster; and is susceptible (i.e., no history of vaccination or of either condition, or known to be VZV seronegative).
Preferred regimen: Varicella-zoster immune globulin (VariZIG™) 125 international units per 10 kg (maximum 625 international units) IM, administered as soon as possible and within 10 days after exposure.
Alternative regimen (1): Acyclovir 800 mg PO qd for 5– 7 days
Alternative regimen (2): Valacyclovir 1 g PO tid for 5–7 days
Note (1): Individuals receiving monthly high-dose IVIG (>400 mg/kg) are likely to be protected if the last dose of IVIG was administered <3 weeks before exposure.
Note (2): If antiviral therapy is used, varicella vaccines should not be given until at least 72 hours after the last dose of the antiviral drug.

6.11.1.2. Treatment

6.11.1.2.1 Primary varicella infection (chickenpox)

6.11.1.2.1. Uncomplicated cases (For 5–7 Days)

Preferred regimen (1): Valacyclovir 1 g PO tid
Preferred regimen (2): Famciclovir 500 mg PO tid

6.11.1.2.1. Severe or complicated Cases

Preferred regimen: Acyclovir 10–15 mg/kg IV q8h for 7–10 days.
Alternative regimen: Acyclovir 800 mg PO 5 times/day for 5-7 days.

6.11.1.2.2. Herpes zoster (Shingles)

6.11.1.2.2.1. Acute localized dermatomal

Preferred regimen (1): Valacyclovir 1 g PO tid for 7–10 days; consider longer duration if lesions are slow to resolve
Preferred regimen (2): Famciclovir 500 mg tid for 7–10 days; consider longer duration if lesions are slow to resolve

6.11.1.2.2.2. Extensive cutaneous lesion or visceral involvement

Preferred regimen: Acyclovir 10–15 mg/kg IV q8h until clinical improvement is evident.
Note: Treatment may switch to PO therapy (Valacyclovir, Famciclovir, or Acyclovir) after clinical improvement (i.e., when no new vesicle formation or improvement of signs and symptoms of visceral VZV), to complete a 10–14 day course.
Alternative regimen: Acyclovir 800 mg PO 5 times/day for 7–10 days; consider longer duration if lesions are slow to resolve.

6.11.1.2.2.3. Progressive outer retinal necrosis (PORN)

Preferred regimen: (Ganciclovir 5 mg/kg with or without Foscarnet 90 mg/kg) IV q12h AND (Ganciclovir 2 mg/0.05mL with or without Foscarnet 1.2 mg/0.05 ml) intravitreal injection biweekly.

6.11.1.2.2.4. Acute retinal necrosis (ARN)

Preferred regimen: Acyclovir 10-15 mg/kg IV q8h AND (Ganciclovir 2 mg/0.05mL intravitreal injection 1-2 doses biweekly for 10-14 days, followed by Valacyclovir 1g PO tid for 6 weeks

6.12. Cytomegalovirus (CMV) Disease

6.12.1. Treatment

6.12.1.1. CMV retinitis

Induction therapy

Preferred regimen (1): Ganciclovir 2mg OR Foscarnet 2.4mg intravitreal injections for 1-4 doses over a period of 7-10 days to achieve high intraocular concentration faster
Preferred regimen (2): Valganciclovir 900 mg PO bid for 14–21 days
Alternative regimen (1): Ganciclovir 5 mg/kg IV q12h for 14–21 days
Alternative regimen (2): Foscarnet 90 mg/kg IV q12h or 60 mg/kg q8h for 14–21 days
Alternative regimen (3): Cidofovir 5 mg/kg/week IV for 2 weeks
Note: Saline hydration before and after therapy should be given and Probenecid, 2 g PO 3 hours before dose, followed by 1 g PO 2 hours and 8 hours after the dose (total of 4 g) is recommended.

Chronic maintenance (secondary prophylaxis):

Preferred regimen: Valganciclovir 900 mg PO qd
Alternative regimen (1): Ganciclovir 5 mg/kg IV 5–7 times weekly
Alternative regimen (2): Foscarnet 90–120 mg/kg IV once daily
Alternative regimen (3): Cidofovir 5 mg/kg/week IV for 2 weeks; saline hydration before and after therapy AND Probenecid, 2 g PO 3 hours before dose, followed by 1 g PO 2 hours and 8 hours after the dose (total of 4 g)

6.12.1.2. CMV esophagitis or colitis

6.12.1.2.1. Severe condition

Preferred regimen: Ganciclovir 5 mg/kg IV q12h; may switch to Valganciclovir 900 mg PO bid once the patient can tolerate oral therapy for 21-42 days or till the symptoms are resolved
Alternative regimen: Foscarnet 90 mg/kg IV q12h or 60 mg/kg q8h for 21-42 days
Note: For patients with treatment-limiting toxicities to Ganciclovir or with Ganciclovir resistance, above regimen is recommended.

6.12.1.2.2. Mild disease and able to tolerate oral therapy

Preferred regimen: Valganciclovir 900 mg PO bid 21-42 days

6.12.1.3. CMV neurological disease

Preferred regimen: Ganciclovir 5 mg/kg IV q12h AND (Foscarnet 90 mg/kg IV q12h or 60 mg/kg IV q8h) to stabilize disease

6.13. HHV-8 Diseases (kaposi sarcoma [KS], primary effusion lymphoma [PEL], multicentric castleman’s disease [MCD])

6.13.1. Treatment

Mild to moderate KS (ACTG Stage T0)

Note: Initiate or optimize anti retroviral therapy.

Advanced KS [ACTG Stage T1, Including Disseminated Cutaneous (AI) Or Visceral KS]

Note: Chemotherapy (per oncology consult) AND anti retroviral therapy.

Primary effusion lymphoma

Preferred regimen (1): Valganciclovir 900 mg PO bid for 3 weeks
Preferred regimen (2): Ganciclovir 5 mg/kg IV q12h for 3 weeks
Preferred regimen (3): Valganciclovir 900 mg PO bid AND Zidovudine 600 mg PO qid for 7– 21 days
Alternative regimen: Rituximab (375 mg/m² given weekly for 4–8 weeks) may be an alternative to or used adjunctively with antiviral therapy
Note: Valganciclovir PO OR Ganciclovir IV can be used as adjunctive therapy

6.14. Human papillomavirus (HPV) infection

6.14.1. Prevention

For females aged 13–26 years

Preferred regimen (1): HPV quadrivalent vaccine 0.5 mL IM at months 0, 1–2, and 6 OR HPV bivalent vaccine 0.5 mL IM at months 0, 1–2, and 6

Males aged 13–26 years

Preferred regimen (1): HPV quadrivalent vaccine 0.5 mL IM at months 0, 1–2, and 6

6.14.2. Treatment

6.14.2.1. Patient-applied therapy for uncomplicated external warts that can be easily identified by patients

Preferred regimen (1): Podophyllotoxin (e.g., podofilox 0.5% solution or 0.5% gel)
Note: Apply to all lesions bid for 3 consecutive days, followed by 4 days of no therapy, repeat weekly for up to 4 cycles, until lesions are no longer visible)
Preferred regimen (2): Imiquimod 5% cream
Note: Apply to lesion at bedtime and remove in the morning on 3 nonconsecutive nights weekly for up to 16 weeks, until lesions are no longer visible. Each treatment should be washed with soap and water 6–10 hours after application.
Preferred regimen (3): Sinecatechins 15% ointment
Note: Apply to affected areas tid for up to 16 weeks, until warts are completely cleared and not visible

6.14.2.2. Provider-applied therapy for complex or multicentric lesions, or lesions inaccessible to patient

Note (1): Cryotherapy (liquid nitrogen or cryoprobe): Apply until each lesion is thoroughly frozen. Repeat every 1–2 weeks for up to 4 weeks, until lesions are no longer visible. Some providers allow the lesion to thaw, then freeze a second time in each session.
Note (2): Trichloroacetic acid or bichloroacetic acid cauterization: 80%–90% aqueous solution, apply to wart only, allow to dry until a white frost develops. Repeat weekly for up to 6 weeks, until lesions are no longer visible.
Note (3): Surgical excision or laser surgery to external or anal warts.
Note (4): Podophyllin resin 10%–25% in tincture of benzoin: Apply to all lesions (up to 10 cm2 ), then wash off a few hours later, repeat weekly for up to 6 weeks until lesions are no longer visible.

6.15. Hepatitis A virus (HAV) infection

6.15.1. Prevention

Indication: HAV-susceptible patients with chronic liver disease, or who are injection-drug users or homosexuals
Preferred regimen: Hepatitis A vaccine 1 mL IM 2 doses at 0 and 6–12 months.
Alternative regimen: Combined HAV and HBV vaccine 1 mL IM as a 3-dose (0, 1, and 6 months) or 4-dose series (days 0, 7, 21 to 30, and 12 months).
Note (1): For patients susceptible to both HAV and hepatitis B virus (HBV) infection, alternative regimen is recommended.
Note (2): IgG antibody response should be assessed 1 month after vaccination; nonresponders should be revaccinated when CD4 count >200 cells/µL.

6.16. Hepatitis B virus (HBV) infection

6.16.1. Prevention

6.16.1.1. Indication

Patients without chronic HBV or without immunity to HBV (i.e., anti-HBs <10 international units/mL).
Patients with isolated anti-HBc and negative HBV DNA.
Early vaccination is recommended before CD4 count falls below 350 cells/µL.
However, in patients with low CD4 cell counts, vaccination should not be deferred until CD4 count reaches >350 cells/µL, because some patients with CD4 counts <200 cells/µL do respond to vaccination.
Preferred regimen (1): HBV vaccine IM (Engerix-B 20 µg/mL or Recombivax HB 10 µg/mL), 0, 1, and 6 months
Preferred regimen (2): HBV vaccine IM (Engerix-B 40 µg/mL or Recombivax HB 20 µg/mL) 0, 1, 2 and 6 months
Preferred regimen (3): Combined HAV and HBV vaccine, 1 mL IM as a 3-dose (0, 1, and 6 months) or 4-dose series (days 0, 7, 21 to 30, and 12 months)
Alternative regimen: Some experts recommend vaccinating with 40-µg doses of either HBV vaccine
Note: Anti-HBs should be obtained 1 month after completion of the vaccine series. Patients with anti-HBs <10 international units/mL at 1 month are considered nonresponders.
Vaccine Non-Responders:

Preferred regimen (1): HBV vaccine IM (Engerix-B 40 µg/mL or Recombivax HB 20 µg/mL), 0, 1, 2 and 6 months.
Note (1): Vaccination non-responders have anti-HBs <10 international units/mL 1 month after vaccination series.
Note (2): For patients with low CD4 counts at time of first vaccine series, some experts might delay revaccination until after a sustained increase in CD4 count with anti retroviral therapy.

6.16.2. Treatment

Preferred regimen: Tenofovir 300 mg PO qdAND Emtricitabine 200 mg PO qd OR Lamivudine 300 mg PO qd AND additional drug(s) for HIV
Note: Anti retroviral therapy regimen should include 2 drugs that are active against both HBV and HIV.
Alternative regimen: Peginterferon alfa-2a 180 μg SQ once weekly for 48 weeks OR Peginterferon alfa 2b 1.5 μg/kg SQ once weekly for 48 weeks.
Note: For HBV treatment is indicated for patients with elevated ALT and HBV DNA >2,000 IU/mL significant liver fibrosis, advanced liver disease or cirrhosis, above regimen is indicated.

6.17. Penicilliosis marneffei

6.17.1. Prevention

6.17.1.1. Indication

Patients with CD4 cell counts <100 cells/µL who live or stay for a long period in rural areas in northern Thailand, Vietnam, or Southern China.
Preferred regimen: Itraconazole 200 mg PO qd
Alternative regimen: Fluconazole 400 mg PO once weekly

6.17.2. Treatment

6.17.2.1. For acute infection in severely ill patients

Preferred regimen: Liposomal amphotericin B 3–5 mg/kg/day IV for 2 weeks, followed by Itraconazole 200 mg PO bid for 10 weeks, followed by chronic maintenance therapy
Alternative regimen: Voriconazole 6 mg/kg IV q12h for 1 day, then 4 mg/kg IV q12h for at least 3 days, followed by 200 mg PO bid for a maximum of 12 weeks, followed by maintenance therapy

6.17.2.2. For mild disease

Preferred regimen: Itraconazole 200 mg PO bid for 8 weeks; followed by chronic maintenance therapy
Alternative regimen: Voriconazole 400 mg PO bid for 1 day, then 200 mg bid for a maximum of 12 weeks, followed by chronic maintenance therapy

6.17.2.3. Chronic Maintenance Therapy (Secondary Prophylaxis)

Preferred regimen: Itraconazole 200 mg PO qd
Note (1): Anti retroviral therapy should be initiated simultaneously with treatment for penicilliosis to improve treatment outcome.
Note (2): Itraconazole and Voriconazole may have significant interactions with certain ARV agents. These interactions are complex and can be bi-directional.
Note (3): Therapeutic drug monitoring and dosage adjustment may be necessary to ensure triazole antifungal and ARV efficacy and reduce concentration-related toxicities.

6.18. Isosporiasis

6.18.1. Treatment

For Acute Infection:

Preferred regimen (1): Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO (or IV) qid for 10 days
Preferred regimen (2): Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO (or IV) bid for 7–10 days
Alternative regimen (1): Pyrimethamine 50–75 mg PO daily AND Leucovorin 10–25 mg PO qd
Alternative regimen (2): Ciprofloxacin 500 mg PO bid for 7 days as a second line alternative

Chronic Maintenance Therapy (Secondary Prophylaxis):

Preferred regimen (1): In patients with CD4 count <200/µL, Trimethoprim/sulfamethoxazole 160 mg/800 mg PO three times a week
Alternative regimen (1): Trimethoprim/sulfamethoxazole 160 mg/800 mg PO qd or (320 mg/1600 mg) three times a week
Alternative regimen (2): Pyrimethamine 25 mg PO qd AND Leucovorin 5–10 mg PO qd
Alternative regimen (3): Ciprofloxacin 500 mg three times a week as a second-line alternative
Note (1): Fluid and electrolyte management in patients with dehydration.
Note (2): Immune reconstitution with anti retroviral therapy may result in fewer relapses.
Note (3): IV therapy may be used for patients with potential or documented mal-absorption.

6.19. Chagas disease (American trypanosomiasis)

6.19.1. Treatment

For acute, earlychronic, and reactivated Disease:

Preferred regimen: Benznidazole 5–8 mg/kg/day PO in 2 divided doses for 30–60 days
Alternative regimen: Nifurtimox 8–10 mg/kg/day PO for 90–120 days.

6.20. Leishmaniasis, visceral

6.20.1. Leishmaniasis, visceral

6.20.1.1. Treatment

For initial infection:

Preferred regimen (1): Liposomal amphotericin B 2–4 mg/kg IV qd
Preferred regimen (2): Liposomal amphotericin B interrupted schedule (e.g., 4 mg/kg on days 1–5, 10, 17, 24, 31, 38)
Alternative regimen (1): Amphotericin B deoxycholate 0.5–1.0 mg/kg IV q24h for total dose of 1.5–2.0 g
Alternative regimen (2): Sodium stibogluconate (pentavalent antimony) 20 mg/kg IV or IM q24h for 28 days
Alternative regimen (3): Miltefosine 100 mg PO qd for 4 weeks

Chronic maintenance therapy (secondary prophylaxis); Especially in Patients with CD4 Count <200 cells/µL:

Preferred regimen (1): Liposomal amphotericin B 4 mg/kg every 2–4 weeks
Preferred regimen (2): Amphotericin B lipid complex 3 mg/kg every 21 days
Alternative regimen: Sodium stibogluconate 20 mg/kg IV or IM every 4 weeks

6.20.2. Leishmaniasis, cutaneous

Preferred regimen (1): Liposomal amphotericin B 2–4 mg/kg IV daily for 10 days
Preferred regimen (2): Liposomal amphotericin B interrupted schedule (e.g., 4 mg/kg on days 1–5, 10, 17, 24, 31, 38) to achieve total dose of 20–60 mg/kg
Preferred regimen (3): Sodium stibogluconate 20 mg/kg IV or IM daily for 3–4 weeks

6.21. Aspergillosis, invasive

6.21.1. Treatment

Preferred regimen: Voriconazole 6 mg/kg IV q12h for 1 day, then 4 mg/kg IV q12h, followed by Voriconazole 200 mg PO q12h after clinical improvement until CD4 cell count >200 cells/µL and the infection appears to be resolved.
Alternative regimen (1): Lipid formulation of Amphotericin B 5 mg/kg IV q24h
Alternative regimen (2): Amphotericin B deoxycholate 1mg/kg IV q24h
Alternative regimen (3): Caspofungin 70 mg IV single dose, then 50 mg IV q24h
Alternative regimen (4): Micafungin 100–150 mg IV q24h
Alternative regimen (5): Anidulafungin 200 mg IV single dose, then 100 mg IV q24h
Alternative regimen (6): Posaconazole 200 mg PO qid, then, after condition improved, 400 mg PO bid

6.22. Malaria

6.22.1. Prevetion

6.22.1.1. Prophylaxis in all areas

Preferred regimen (1): Atovaquone 250 mg and Proguanil hydrochloride 100 mg PO qd
Pediatric doses: Pediatric tablets contain 62.5 mg atovaquone and 25 mg proguanil hydrochloride

5–8 kg: 1/2 pediatric tablet daily
>8–10 kg: 3/4 pediatric tablet daily
>10–20 kg: 1 pediatric tablet daily
>20–30 kg: 2 pediatric tablets daily
>30–40 kg: 3 pediatric tablets daily

Note (1): Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Contraindicated in people with severe renal impairment (creatinine clearance <30 mL/min).
Note (2): Atovaquone-proguanil should be taken with food or a milky drink. Not recommended for prophylaxis for children weighing <5 kg, pregnant women, and women breastfeeding infants weighing <5 kg. Partial tablet doses may need to be prepared by a pharmacist and dispensed in individual capsules.
Preferred regimen (2): Doxycycline 100 mg PO qd
Pediatric dose: ≥8 years of age: 2.2 mg/kg up to adult dose of 100 mg/day
Note: Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 4 weeks after leaving such areas. Contraindicated in children <8 years of age and pregnant women.

6.22.1.2. Prophylaxis only in areas with chloroquine-sensitive malaria

Preferred regimen: Chloroquine phosphate 300 mg base (500 mg salt) PO once a week
Note: Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. May exacerbate psoriasis.
Alternative regimen: Hydroxychloroquine sulfate 400 mg salt PO once a week
Note: Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas.
Pediatric doses: Chloroquine phosphate 5 mg/kg base (8.3 mg/kg salt) orally, once/week, up to maximum adult dose of 300 mg base; Hydroxychloroquine sulfate 5 mg/kg base (6.5 mg/kg salt) orally, once/week, up to a maximum adult dose of 310 mg base

6.22.1.3. Prophylaxis in areas with mefloquine-sensitive malaria

Preferred regimen: Mefloquine 250 mg PO once a week
Note (1): Begin ≥2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. Contraindicated in people allergic to mefloquine or related compounds (quinine, quinidine) and in people with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures.
Note (2): Use with caution in persons with psychiatric disturbances or a previous history of depression. Not recommended for persons with cardiac conduction abnormalities.
Pediatric dose: Mefloquine ≤9 kg: 4.6 mg/kg base (5 mg/kg salt) orally, once/week

>9–19 kg: 1/4 tablet once/week
>19–30 kg: 1/2 tablet once/week
>30–45 kg: 3/4 tablet once/week
>30–45 kg: 3/4 tablet once/week

6.22.1.4. Prophylaxis for short-duration travel to areas with principally Plasmodium vivax

Preferred regimen: Primaquine 52.6 mg PO qd
Note: Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and lactation, unless the infant being breastfed has a documented normal G6PD level.
Pediatric dose: Primaquine 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose orally, daily

6.22.1.5. Terminal prophylaxis to decrease the risk for relapses of Plasmodium vivax and Plasmodium ovale

Preferred regimen: Primaquine 52.6 mg PO qd for 14 days after departure from the malarious area
Note: Indicated for people who have had prolonged exposure to P. vivax, P. ovale, or both. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and lactation, unless the infant being breastfed has a documented normal G6PD level.
Pediatric dose: Primaquine 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose orally, daily for 14 days after departure from the malarious area

6.22.2. Treatment

Note (1): Patients coinfected with HIV should avoid Artesunate AND Sulfadoxine-Pyrimethamine if they are also receiving Co-trimoxazole, and avoid Artesunate AND Amodiaquine if they are also receiving Efavirenz OR Zidovudine.
Note (2): Because Plasmodium falciparum malaria can progress within hours from mild symptoms or low-grade fever to severe disease or death, all HIV-infected patients with confirmed or suspected P. falciparum infection should be hospitalized for evaluation, initiation of treatment, and observation.
6.22.2.1. Plasmodium falciparum^[432]

6.22.2.1.1. Treatment of uncomplicated Plasmodium falciparum malaria

6.22.2.1.1.1. Treat children and adults with uncomplicated Plasmodium falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)

Preferred regimen (1): Artemether 5–24 mg/kg/day PO bid AND Lumefantrine 29–144 mg/kg/day PO bid for 3 days
Note: The first two doses should, ideally, be given 8 hours apart.
Dosage regimen based on Body weight (kg)

Body weight (kg)-5 to < 15- Artemether 20 mg PO bid AND Lumefantrine 120 mg PO bid for 3 days
Body weight (kg)-15 to < 25- Artemether 40 mg PO bid AND Lumefantrine 240 mg PO bid for 3 days
Body weight (kg)-25 to < 35- Artemether 60 mg PO bid AND Lumefantrine 360 mg PO bid for 3 days
Body weight (kg) ≥ 35- Artemether 80 mg PO bid AND Lumefantrine 480 mg PO bid for 3 days

Preferred regimen (2): Artesunate 2–10 mg/kg/day PO qd AND Amodiaquine 7.5–15 mg/kg/day PO qd for 3 days
Note: A total therapeutic dose range of 6–30 mg/kg/day Artesunate and 22.5–45 mg/kg/day per dose Amodiaquine is recommended.
Dosage regimen based on body weight (kg)

Body weight (kg)-4.5 to < 9- Artesunate 25 mg PO qd AND Amodiaquine 67.5 mg PO qd for 3 days
Body weight (kg)-9 to < 18 - Artesunate 50 mg PO qd AND Amodiaquine 135 mg PO qd for 3 days
Body weight (kg)-18 to < 36- Artesunate 100 mg PO qd AND Amodiaquine 270 mg PO qd for 3 days
Body weight (kg) ≥ 36 - Artesunate 200 mg PO qd AND Amodiaquine 540 mg PO qd for 3 days

Preferred regimen (3): Artesunate 2–10 mg/kg/day PO qd AND Mefloquine 2–10 mg/kg/day PO qd for 3 days
Dosage regimen based on body weight (kg)

Body weight (kg)-5 to < 9- Artesunate 25 mg PO qd AND Mefloquine 55 mg PO qd for 3 days
Body weight (kg)-9to < 18- Artesunate 50 mg PO qd AND Mefloquine 110 mg PO qd for 3 days
Body weight (kg)-18 to < 36- Artesunate 100 mg PO qd AND Mefloquine 220 mg PO qd for 3 days
Body weight (kg)- ≥ 36 - Artesunate 200 mg PO qd AND Mefloquine 440 mg PO qd for 3 days

Preferred regimen (4): Artesunate 2–10 mg/kg/day PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1.25 (25–70 / 1.25–3.5) mg/kg/day PO given as a single dose on day 1
Dosage regimen based on body weight (kg)

Body weight (kg)- 5 to < 10- Artesunate 25 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 250/12 mg PO given as a single dose on day 1
Body weight (kg)- 10 to < 25- Artesunate 50 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 500/25 mg PO given as a single dose on day 1
Body weight (kg)- 25 to < 50- Artesunate 100 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1000/50 mg PO given as a single dose on day 1
Body weight (kg)- ≥50- Artesunate 200 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1500/75 mg PO given as a single dose on day 1

Preferred regimen (5): Dihydroartemisinin 2–10 mg/kg/day PO qd AND Piperaquine16–27 mg/kg/day PO qd for 3 days
Dosage regimen based on Body weight (kg)

Body weight (kg)-5 to < 8: Dihydroartemisinin 20 mg PO qd AND Piperaquine 160 mg PO qd for 3 days
Body weight (kg)-8 to < 11: Dihydroartemisinin 30 mg PO qd AND Piperaquine 240 mg PO qd for 3 days
Body weight (kg)-11 to < 17: Dihydroartemisinin 40 mg PO qd AND Piperaquine 320 mg PO qd for 3 days
Body weight (kg)-17 to < 25: Dihydroartemisinin 60 mg PO qd AND Piperaquine 480 mg PO qd for 3 days
Body weight (kg)-25 to < 36: Dihydroartemisinin 80 mg PO qd AND Piperaquine 640 mg PO qd for 3 days
Body weight (kg)-36 to < 60: Dihydroartemisinin 120 mg PO qd AND Piperaquine 960 mg PO qd for 3 days
Body weight (kg)-60 < 80: Dihydroartemisinin 160 mg PO qd AND Piperaquine 1280 mg PO qd for 3 days
Body weight (kg)- >80: Dose of Dihydroartemisinin 200 mg PO qd AND Piperaquine 1600 mg PO qd for 3 days

6.22.2.1.1.2 Reducing the transmissibility of treated Plasmodium falciparum infections In low-transmission areas in patients with Plasmodium falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)

Preferred regimen: Primaquine 0.25 mg/kg PO single dose with ACT

6.22.2.1.2. Recurrent falciparum malaria

6.22.2.1.2.1. Failure within 28 days

Note: The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens with Artesunate or Quinine both of which should be co-administered with Tetracycline, or Doxycycline or Clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.

6.22.2.1.2.2. Failure after 28 days

Note: All presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of Mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used.

6.22.2.1.3. Reducing the transmissibility of treated Plasmodium falciparum infections in low-transmission areas in patients with Plasmodium falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)

Note: Single dose of 0.25 mg/kg biweekly Primaquine with ACT

6.22.2.1.4. Treating uncomplicated Plasmodium falciparum malaria in special risk groups

6.22.2.1.4.1. Pregnancy

First trimester of pregnancy : Quinine AND Clindamycin 10 mg/kg/day PO bid for 7 days
Second and third trimesters : Mefloquine is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
Note (1): Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
Note (2): Primaquine and Tetracyclines should not be used in pregnancy.

6.22.2.1.4.2. Infants less than 5kg body weight

Note: They should be treated with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.

6.22.2.1.4.4. Large and obese adults

Note: For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.

6.22.2.1.4.5. Non-immune travellers

Note: Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.

6.22.2.1.4.6. Uncomplicated hyperparasitaemia

Note: People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT.

6.22.2.2. Treatment of uncomplicated malaria caused by Plasmodium vivax, Plasmodium ovale, Plasmodium malariae or Plasmodium knowlesi

6.22.2.2.1. Blood Stage infection

6.22.2.2.1.1. Uncomplicated malaria caused by Plasmodium vivax

6.22.2.2.1.1.1. In areas with chloroquine-sensitive Plasmodium vivax

Preferred regimen: Chloroquine total dose of 25 mg/kg PO. Chloroquine is given at an initial dose of 10 mg/kg, followed by 10 mg/kg on the second day and 5 mg/kg on the third day PO

6.22.2.2.1.1.2. In areas with chloroquine-resistant Plasmodium vivax

Note: ACTs containing Piperaquine, Mefloquine OR Lumefantrine are the recommended treatment, although Artesunate AND Amodiaquine may also be effective in some areas. In the systematic review of ACTs for treating P. vivax malaria, Dihydroartemisinin AND Piperaquine provided a longer prophylactic effect than ACTs with shorter half-lives (Artemether ANDLumefantrine) OR (Artesunate AND Amodiaquine), with significantly fewer recurrent parasitaemias during 9 weeks of follow-up.

6.22.2.2.1.2. Uncomplicated malaria caused by Plasmodium ovale, Plasmodium malariae or Plasmodium knowlesi malaria

Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to Chloroquine. In only one study, conducted in Indonesia, was resistance to Chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or Chloroquine, as for vivax malaria.

6.22.2.2.1.3. Mixed malaria infections

Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.

6.22.2.2.2. Liver stages (hypnozoites) of Plasmodium vivax and Plasmodium ovale

Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of Primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.

6.22.2.2.2.1. Primaquine for preventive relapse

Preferred regimen: Primaquine 0.25–0.5 mg/kg/day PO qd for 14 days

6.22.2.2.2.2. Primaquine and glucose-6-phosphate dehydrogenase deficiency

Preferred regimen: Primaquine 0.75 mg base/kg/day PO once a week for 8 weeks
Note: The decision to give or withhold Primaquine should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.

6.22.2.2.2.3. Prevention of relapse in pregnant or lacating women and infants

Note: Primaquine is contraindicated in pregnant women, infants < 6 months of age and in lactating women (unless the infant is known not to be G6PD deficient)

6.22.2.3. Treatment of severe malaria

6.22.2.3.1. Treatment of severe falciparum infection with Artesunate

6.22.2.3.1.1. Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women)

Preferred regimen: Artesunate IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT (add single dose Primaquine in areas of low transmission).

6.22.2.3.1.2. Young children weighing < 20 kg

Preferred regimen:Artesunate 3 mg/kg per dose IV/IM q24h
Alternative regimen: use Artemether in preference to quinine for treating children and adults with severe malaria

6.22.2.3.2.Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)

6.22.2.3.2.1. Adults and children

Preferred regimen: Artesunate IM q24h
Alternative regimen: Artemether IM OR Quinine IM

6.22.2.3.2.2. Children < 6 years

Preferred regimen: Where intramuscular injections of artesunate are not available, treat with a single rectal dose (10 mg/kg) of Artesunate, and refer immediately to an appropriate facility for further care.
Note: Do not use rectal artesunate in older children and adults.

6.22.2.3.3. Pregancy

Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed.

6.22.2.3.4. Treatment of severe Plasmodium Vivax infection

Note: Parenteral Artesunate, treatment can be completed with a full treatment course of oral ACT or Chloroquine (in countries where Chloroquine is the treatment of choice). A full course of radical treatment with Primaquine should be given after recovery.

6.22.2.3.5. Additional aspects of management in severe malaria

Fluid therapy: It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit.
Blood Transfusion: In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended.
Exchange blood transfusion: Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.

6.23. Cryptococcosis

6.23.1. Treatment

6.23.1.1. Cryptococcal meningitis

6.23.1.1.1. Induction therapy

Preferred regimen: Liposomal amphotericin B 3–4 mg/kg IV q24h AND Flucytosine 25 mg/kg PO qid for at least 2 weeks, followed by consolidation therapy
Alternative regimen (1): Amphotericin B deoxycholate 0.7 mg/kg IV q24h AND Flucytosine 25 mg/kg PO qid
Alternative regimen (2): Amphotericin B lipid complex 5 mg/kg IV q24h AND Flucytosine 25 mg/kg PO qid
Alternative regimen (3): Liposomal Amphotericin B 3-4 mg/kg IV q24h AND Fluconazole 800 mg PO or IV q24h
Alternative regimen (4): Amphotericin B deoxycholate 0.7 mg/kg IV q24h AND Fluconazole 800 mg PO or IV q24h
Alternative regimen (5): Fluconazole 400–800 mg PO or IV qd AND Flucytosine 25 mg/kg PO qid
Alternative regimen (6): Fluconazole 1200 mg PO or IV qd

6.23.1.1.2. Consolidation therapy

Preferred regimen: Fluconazole 400 mg PO (or IV) qd for atleast 8 weeks
Note: Preferred therapy followed by maintenance therapy.
Maintenance therapy: Fluconazole 200 mg PO qd for at least 12 months
Alternative regimen: Itraconazole 200 mg PO bid for 8 weeks

6.23.1.2. Non-CNS cryptococcosis with mild-to-moderate symptoms and focal pulmonary infiltrates

Preferred regimen: Fluconazole, 400 mg PO qd for 12 months
Note: Patients receiving Flucytosine should have either blood levels monitored (peak level 2 hours after dose should be 30–80 mcg/mL) or close monitoring of blood counts for development of cytopenia. Dosage should be adjusted in patients with renal insufficiency.

6.24. Mucocutaneous candidiasis

6.24.1. Treatment

6.24.1.1. For oropharyngeal candidiasis

Oral Therapy

Preferred regimen: Fluconazole 100 mg PO qd for 7-14 days.
Alternative regimen: Itraconazole oral solution 200 mg PO qd for 7-14 days OR Posaconazole oral suspension 400 mg PO bid for 1 day, then 400 mg qd 7-14 days

Topical therapy

Preferred regimen: Clotrimazole troches, 10 mg PO 5 times daily OR Miconazole mucoadhesive buccal 50-mg tablet
Note: Apply to mucosal surface over the canine fossa once daily (do not swallow, chew, or crush).
Alternative regimen: Nystatin suspension 4–6 mL qid or 1–2 flavored pastilles 4– 5 times daily

6.24.1.2. For esophageal candidiasis

Preferred regimen: Fluconazole 100 mg (up to 400 mg) PO or IV qd for 14-21 days OR Itraconazole oral solution 200 mg PO qd for 14-21 days
Alternative regimen (1): Voriconazole 200 mg PO or IV bid for 14-21 days
Alternative regimen (2): Anidulafungin 100 mg IV single dose, then 50 mg IV qd for 14-21 days
Alternative regimen (3): Caspofungin 50 mg IV qd for 14-21 days
Alternative regimen (4): Micafungin 150 mg IV qd for 14-21 days
Alternative regimen (5): Amphotericin B deoxycholate 0.6 mg/kg IV qd for 14-21 days
Alternative regimen (6): Lipid formulation of amphotericin B 3–4 mg/kg IV qd for 14-21 days

6.24.1.3. For uncomplicated vulvo-vaginal candidiasis

Preferred regimen: Oral Fluconazole 150 mg for 1 dose OR Topical azoles (Clotrimazole, Butoconazole, Miconazole, Tioconazole, or Terconazole) for 3– 7 days
Alternative regimen: Itraconazole oral solution 200 mg PO qd for 3–7 days

6.24.1.4. For severe or recurrent vulvovaginal candidiasis

Preferred regimen: Fluconazole 100–200 mg PO qd for ≥7 days OR Topical antifungal ≥7 days

6.25. Bartonellosis

6.25.1. Treatment

6.25.1.1. For bacillary angiomatosis, peliosis hepatis, bacteremia, and osteomyelitis

Preferred regimen (1): Doxycycline 100 mg PO or IV q12h for 3 months
Preferred regimen (2): Erythromycin 500 mg PO or IV q6h for 3 months
Alternative regimen (1): Azithromycin 500 mg PO qd
Alternative regimen (2):} Clarithromycin 500 mg PO bid

6.25.1.2. Confirmed bartonella endocarditis

Preferred regimen: Doxycycline 100 mg IV q12h AND Gentamicin 1 mg/kg IV q8h) for 2 weeks, then continue with Doxycycline 100 mg IV or PO q12h
Altered regimen: Doxycycline 100 mg IV AND Rifabutin 300 mg PO or IV q12h for 2 weeks, then continue with Doxycycline 100 mg IV or PI q12h

6.25.1.3. CNS infections

Preferred regimen: (Doxycycline 100 mg with or without Rifabutin 300 mg PO or IV q12h

6.25.1.4. Other severe infections

Preferred regimen (1): Doxycycline 100 mg PO or IV with or without Rifabutin 300 mg PO or IV) q12h for 3 months
Preferred regimen (2): Erythromycin 500 mg PO or IV q6h) with or without Rifabutin) 300 mg PO or IV q12h for 3 months.

Note: If relapse occurs after initial (>3 month) course of therapy, longterm suppression with Doxycycline or a macrolide is recommended as long as CD4 count <200 cells/µL.

6.26. Campylobacteriosis

6.26.1. Treatment

6.26.1.1. For mild-to-moderate disease (If Susceptible)

Preferred regimen: Ciprofloxacin 500–750 mg PO or 400 mg IV q12h OR Azithromycin 500 mg PO qd
Alternative regimen: Levofloxacin 750 mg PO or IV q24h OR Moxifloxacin 400 mg (PO or IV) q24h

6.26.1.2. For campylobacter bacteremia

Preferred regimen: Ciprofloxacin 500–750 mg PO or 400 mg IV q12h AND an aminoglycoside.
Duration of Therapy:

Gastroenteritis: 7–10 days (5 days with Azithromycin)
Bacteremia: ≥14 days
Recurrent bacteremia: 2–6 weeks.

6.27. Shigellosis

6.27.1. Treatment

Preferred regimen: Ciprofloxacin 500–750 mg PO or 400 mg IV q12h
Duration of Therapy:

Gastroenteritis: 7–10 days
Bacteremia: ≥14 days
Recurrent Infections: 2–6 weeks

Alternative regimen (1): Levofloxacin 750 mg PO or IV q24h for 5 days
Alternative regimen (2): Moxifloxacin 400 mg PO or IV q24h for 5 days
Alternative regimen (3): Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO or IV q12h for 5 days
Alternative regimen (4): Azithromycin 500 mg PO qd for 5 days
Note: Antimotility agents should be avoided.

6.28. Salmonellosis

6.28.1. Treatment

Preferred regimen: Ciprofloxacin 500–750 mg PO or 400 mg IV q12h
Alternative regimen (1): Levofloxacin 750 mg PO or IV q24h
Alternative regimen (2): Moxifloxacin 400 mg PO or IV q24h
Alternative regimen (3): Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO or IV q12h
Alternative regimen (4): Cefotaxime 1 g IV q8h
Alternative regimen (5): Ceftriaxone 1 g IV q24h
Duration of therapy:

For gastroenteritis without bacteremia:

If CD4 count ≥200 cells/µL: 7–14 days.
If CD4 count <200 cells/µL: 2–6 weeks.

For gastroenteritis with bacteremia:

If CD4 count ≥200/µL: 14 days; longer duration if bacteremia persists or if the infection is complicated (e.g., if metastatic foci of infection are present)
If CD4 count <200 cells/µL: 2–6 weeks

Note (1): The role of long-term secondary prophylaxis in patients with recurrent Salmonella bacteremia is not well established. Must weigh benefit against risks of long-term antibiotic exposure.
Note (2): Secondary Prophylaxis Should Be Considered For:

Patients with recurrent Salmonella gastroenteritis +/- bacteremia.
Patients with CD4 <200 cells/µL with severe diarrhea.

6.29. Bacterial enteric infections

6.29.1. Empiric therapy

Preferred regimen: Ciprofloxacin 500–750 mg PO or 400 mg IV q12h
Alternative regimen: Ceftriaxone 1 g IV q24h OR Cefotaxime 1 g IV q8h
Note: Antimotility agents should be avoided if there is concern about inflammatory diarrhea, including Clostridium-difficile-associated diarrhea.

6.30.Bacterial respiratory diseases

6.30.1. Treatment

6.30.1.1. Empiric outpatient therapy

Preferred regimen: Amoxicillin 500 mg PO AND (Azithromycin 500 mg PO OR Clarithromycin 500 mg PO) qd for 7-10 days
Alternative regimen: Amoxicillin 500 mg PO AND Doxycycline 100mg PO qd
Note: Therapy should be adjusted based on the results of diagnostic workup.

6.30.1.2. For penicillin-allergic patients

Preferred regimen: Ceftriaxone 1 g IV q24h AND (Azithromycin 500 mg PO OR Clarithromycin 500 mg PO) qd for 7-10 days
Alternative regimen: Aztreonam 1 g IV q24h AND Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg IV q24h

6.30.1.3. Empiric therapy for non-ICU hospitalized patients

Preferred regimen: Ceftriaxone 1 g IV q24h AND (Azithromycin 500 mg PO OR Clarithromycin 500 mg PO) qd

6.30.1.3. Empiric therapy for patients at risk of pseudomonas pneumonia

Preferred regimen: : Piperacillin-Tazobactam 2 g-0.25 g IV q24h AND (Ciprofloxacin 400 mg IV q8–12h OR Levofloxacin 750 mg IV) q24h

6.30.1.4. Empiric therapy for patients at risk for methicillin-resistant staphylococcus aureus pneumonia

Preferred regimen: Amoxicillin 500 mg PO AND (Azithromycin 500 mg PO OR Clarithromycin 500 mg) PO AND Linezolid 600 mg (IV or PO).
Note (1): Empiric therapy with a macrolide alone is not routinely recommended, because of increasing pneumococcal resistance.
Note (2): Chemoprophylaxis can be considered for patients with frequent recurrences of serious bacterial pneumonia.

6.31. Cryptosporidiosis

6.31.1. Treatment

Note (1): Initiate or optimize ART for immune restoration to CD4 count >100 cells/µL. Aggressive oral or IV rehydration and replacement of electrolyte loss and symptomatic treatment of diarrhea with anti-motility agents.
Preferred regimen (1): Nitazoxanide 500–1000 mg PO bid for 14 days
Preferred regimen (2): Paromomycin 500 mg PO qid for 14–21 days
Note (2): With optimized anti retroviral therapy, symptomatic treatment and rehydration and electrolyte replacement is recommended. Tincture of opium may be more effective than Loperamide in management of diarrhea.

6.32. Microsporidiosis

6.32.1. Treatment

6.32.1.1. For GI infections caused by enterocytozoon bienuesi

Note: Initiate or optimize anti retroviral therapy as immune restoration to CD4 count >100 cells/µL AND manage severe dehydration, malnutrition, and wasting by fluid support.
Preferred therapy (1): Fumagillin 60 mg/day PO bid
Preferred therapy (2): TNP-470 PO bid
Preferred therapy (3): Nitazoxanide 1000 mg PO bid

6.32.1.2. For intestinal and disseminated (not ocular) infections caused by microsporidia other than E. bienuesi and vittaforma corneae

Preferred regimen: Albendazole 400 mg PO bid, continue until CD4 count >200 cells/µL for >6 months after initiation of anti retroviral therapy
Alternative regimen: Itraconazole 400 mg PO qd AND Albendazole 400 mg PO bid

6.32.1.3. For ocular infection

Preferred regimen: Topical fumagillin bicylohexylammonium (Fumidil B) eye drops: 3 mg/mL in saline (fumagillin 70 µg/mL)—2 drops q2h for 4 days, then 2 drops qid AND Albendazole 400 mg PO bid, for management of systemic infection
Note: Therapy should be continued until resolution of ocular symptoms and CD4 count increase to >200 cells/µL for >6 months in response to anti retroviral therapy.

6.33. Progressive Multifocal Leukoencephalopathy (PML)

Note (1): There is no specific antiviral therapy for JC virus infection. The main treatment approach is to reverse the immunosuppression caused by HIV.
Note (2): Initiate anti retroviral therapy immediately in anti retroviral therapy naive patients.
Note (3): Optimize anti retroviral therapy in patients who develop PML in phase of HIV viremia on anti retroviral therapy.
Note (4): Corticosteroids may be used for PML-IRIS characterized by contrast enhancement, edema or mass effect, and with clinical deterioration.

References

↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ ^2.0 ^2.1 Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)
↑ "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".
↑ ^4.0 ^4.1 ^4.2 ^4.3 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ ^11.0 ^11.1 ^11.2 ^11.3 ^11.4 ^11.5 Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
↑ ^12.0 ^12.1 ^12.2 ^12.3 ^12.4 ^12.5 ^12.6 Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.
↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America". Clin Infect Dis. 59 (2): e10–52. doi:10.1093/cid/ciu444. PMID 24973422.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
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↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
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↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
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↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
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↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
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↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Hsu, M.-S.; Liao, C.-H.; Huang, Y.-T.; Liu, C.-Y.; Yang, C.-J.; Kao, K.-L.; Hsueh, P.-R. (2011-10). "Clinical features, antimicrobial susceptibilities, and outcomes of Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteremia at a medical center in Taiwan, 1999-2006". European Journal of Clinical Microbiology & Infectious Diseases: Official Publication of the European Society of Clinical Microbiology. 30 (10): 1271–1278. doi:10.1007/s10096-011-1223-0. ISSN 1435-4373. PMID 21461847. Check date values in: |date= (help)
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Sanders, W. E.; Sanders, C. C. (1997-04). "Enterobacter spp.: pathogens poised to flourish at the turn of the century". Clinical Microbiology Reviews. 10 (2): 220–241. ISSN 0893-8512. PMC 172917. PMID 9105752. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Jacoby, George A. (2009-01). "AmpC beta-lactamases". Clinical Microbiology Reviews. 22 (1): 161–182. doi:10.1128/CMR.00036-08. ISSN 1098-6618. PMC 2620637. PMID 19136439. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Paterson, David L.; Bonomo, Robert A. (2005-10). "Extended-spectrum beta-lactamases: a clinical update". Clinical Microbiology Reviews. 18 (4): 657–686. doi:10.1128/CMR.18.4.657-686.2005. ISSN 0893-8512. PMC 1265908. PMID 16223952. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ "The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America" (PDF).
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Lua error: expandTemplate: template "citation error" does not exist.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Mukara, B. K.; Munyarugamba, P.; Dazert, S.; Löhler, J. (2014-07). "Rhinoscleroma: a case series report and review of the literature". European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 271 (7): 1851–1856. doi:10.1007/s00405-013-2649-z. ISSN 1434-4726. PMID 23904142. Check date values in: |date= (help)
↑ de Pontual, Loïc; Ovetchkine, Philippe; Rodriguez, Diana; Grant, Audrey; Puel, Anne; Bustamante, Jacinta; Plancoulaine, Sabine; Yona, Laurent; Lienhart, Pierre-Yves; Dehesdin, Danièle; Huerre, Michel; Tournebize, Régis; Sansonetti, Philippe; Abel, Laurent; Casanova, Jean Laurent (2008-12-01). "Rhinoscleroma: a French national retrospective study of epidemiological and clinical features". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (11): 1396–1402. doi:10.1086/592966. ISSN 1537-6591. PMID 18947330.
↑ Gaafar, Hazem A.; Gaafar, Alaa H.; Nour, Yasser A. (2011-04). "Rhinoscleroma: an updated experience through the last 10 years". Acta Oto-Laryngologica. 131 (4): 440–446. doi:10.3109/00016489.2010.539264. ISSN 1651-2251. PMID 21198342. Check date values in: |date= (help)
↑ Mukara, B. K.; Munyarugamba, P.; Dazert, S.; Löhler, J. (2014-07). "Rhinoscleroma: a case series report and review of the literature". European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 271 (7): 1851–1856. doi:10.1007/s00405-013-2649-z. ISSN 1434-4726. PMID 23904142. Check date values in: |date= (help)
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ "TYPHOID FEVER".
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents" (PDF).
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ "Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1" (PDF).
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ "WHO. Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness" (PDF).
↑ "Prevention and control of cholera outbreaks: WHO policy and recommendations".
↑ [file:///Users/censhanshan/Desktop/cholera_clin_management_ENG_rev_JUN%201.pdf "PAHO. Recommendations for clinical management of cholera"] Check |url= value (help) (PDF).
↑ "Vibrio parahaemolyticus CDC".
↑ "Vibrio vulnificus CDC".
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ "q fever".
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Reed, R. P.; Robins-Browne, R. M.; Williams, M. L. (1997-12). "Yersinia enterocolitica peritonitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 25 (6): 1468–1469. ISSN 1058-4838. PMID 9431397. Check date values in: |date= (help)
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ ^210.00 ^210.01 ^210.02 ^210.03 ^210.04 ^210.05 ^210.06 ^210.07 ^210.08 ^210.09 ^210.10 ^210.11 Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA; et al. (2008). "Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America". Clin Infect Dis. 46 (3): 327–60. doi:10.1086/525258. PMID 18177225.
↑ ^211.00 ^211.01 ^211.02 ^211.03 ^211.04 ^211.05 ^211.06 ^211.07 ^211.08 ^211.09 ^211.10 ^211.11 Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G (2014). "Invasive fungal infections in the ICU: how to approach, how to treat". Molecules. 19 (1): 1085–119. doi:10.3390/molecules19011085. PMID 24445340.
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↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ ^216.00 ^216.01 ^216.02 ^216.03 ^216.04 ^216.05 ^216.06 ^216.07 ^216.08 ^216.09 ^216.10 ^216.11 ^216.12 Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE; et al. (2009). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clin Infect Dis. 48 (5): 503–35. doi:10.1086/596757. PMID 19191635.
↑ Krzyściak PM, Pindycka-Piaszczyńska M, Piaszczyński M (2014). "Chromoblastomycosis". Postepy Dermatol Alergol. 31 (5): 310–21. doi:10.5114/pdia.2014.40949. PMC 4221348. PMID 25395928.
↑ Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA; et al. (2005). "Coccidioidomycosis". Clin Infect Dis. 41 (9): 1217–23. doi:10.1086/496991. PMID 16206093.
↑ "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents" (PDF).
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↑ Ferri, Fred F. (2015). Ferri's Clinical Advisor 2016: 5 Books in 1, 1e (Ferri's Medical Solutions). Elsevier/Saunders. ISBN 978-0323280471.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ de Berker D (2009). "Clinical practice. Fungal nail disease". N Engl J Med. 360 (20): 2108–16. doi:10.1056/NEJMcp0804878. PMID 19439745.
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↑ Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J, Ibrahim AS (2009). "Recent advances in the management of mucormycosis: from bench to bedside". Clin Infect Dis. 48 (12): 1743–51. doi:10.1086/599105. PMC 2809216. PMID 19435437.
↑ Supparatpinyo K, Chiewchanvit S, Hirunsri P, Baosoung V, Uthammachai C, Chaimongkol B; et al. (1992). "An efficacy study of itraconazole in the treatment of Penicillium marneffei infection". J Med Assoc Thai. 75 (12): 688–91. PMID 1339213.
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↑ Sirisanthana T, Supparatpinyo K (1998). "Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients". Int J Infect Dis. 3 (1): 48–53. PMID 9831676.
↑ Supparatpinyo K, Perriens J, Nelson KE, Sirisanthana T (1998). "A controlled trial of itraconazole to prevent relapse of Penicillium marneffei infection in patients infected with the human immunodeficiency virus". N Engl J Med. 339 (24): 1739–43. doi:10.1056/NEJM199812103392403. PMID 9845708.
↑ Kauffman, C. A.; Bustamante, B.; Chapman, S. W.; Pappas, P. G. (2007). "Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America". Clinical Infectious Diseases. 45 (10): 1255–1265. doi:10.1086/522765. ISSN 1058-4838.
↑ "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".
↑ "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".
↑ "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".
↑ Treatment of tuberculosis guidelines. Geneva: World Health Organization. 2010. ISBN 9789241547833.
↑ "The use of delamanid in the treatment of multidrug-resistant tuberculosis" (PDF).
↑ "WHO".
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ American Thoracic Society. CDC. Infectious Diseases Society of America (2003). "Treatment of tuberculosis". MMWR Recomm Rep. 52 (RR-11): 1–77. PMID 12836625.
↑ Griffith, Daviday E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richarday J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, anday prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory anday Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. Unknown parameter |pmiday= ignored (help)
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Tortoli, E.; Besozzi, G.; Lacchini, C.; Penati, V.; Simonetti, M. T.; Emler, S. (1998-04). "Pulmonary infection due to Mycobacterium szulgai, case report and review of the literature". The European Respiratory Journal. 11 (4): 975–977. ISSN 0903-1936. PMID 9623706. Check date values in: |date= (help)
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
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↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
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↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Template:Citeweb
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
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↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
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↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
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↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Visvesvara, Govinda S.; Moura, Hercules; Schuster, Frederick L. (2007-06). "Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea". FEMS immunology and medical microbiology. 50 (1): 1–26. doi:10.1111/j.1574-695X.2007.00232.x. ISSN 0928-8244. PMID 17428307. Check date values in: |date= (help)
↑ "Acanthamoeba Keratitis Fact Sheet (CDC)".
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↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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↑ Template:Citeweb
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[247] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[248] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[249] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[250] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[251] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[252] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

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@@ Line 2: / Line 2: @@
 ====Bacteria – Gram-Positive Cocci====
- {{PBI|Enterococcus faecalis}}
-:*1. '''Bacteremia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+----
-::*1.1 '''Ampicillin or Penicillin susceptible'''
+==Enterococcus faecalis==
+----
+{{PBI|Enterococcus faecalis}}
+:* 1. '''Bacteremia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1.1 '''Ampicillin or penicillin susceptible'''
 :::* Preferred regimen (1): [[Ampicillin]] 2 g IV q4-6h
-:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4-6h {{and}} [[Gentamicin]] 1 mg/kg q8h
+:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4-6h {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h
-::*1.2 '''Ampicillin resistant and vancomycin susceptible or Penicillin allergy'''
+::* 1.2 '''Ampicillin resistant and vancomycin susceptible or penicillin allergy'''
-:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg q8h
+:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h
-:::* Preferred regimen (2): [[Linezolid]] 600 mg q12h
+:::* Preferred regimen (2): [[Linezolid]] 600 mg IV q12h
-:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg/day.
+:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV q24h
-::*1.3 '''Ampicillin and Vancomycin resistant'''
+::* 1.3 '''Ampicillin and vancomycin resistant'''
-:::* Preferred regimen (1): [[Linezolid]] 600 mg q12h
+:::* Preferred regimen (1): [[Linezolid]] 600 mg IV q12h
-:::* Preferred regimen (2): [[Daptomycin]] 6 mg/kg/day IV
+:::* Preferred regimen (2): [[Daptomycin]] 6 mg/kg IV q24h
-:*2. '''Endocarditis'''<ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref><ref>{{Cite web | title =Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association| url =http://circ.ahajournals.org/content/111/23/e394.full.pdf+html}}</ref>
+:* 2. '''Endocarditis'''<ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref><ref>{{Cite web | title =Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association| url =http://circ.ahajournals.org/content/111/23/e394.full.pdf+html}}</ref>
-::*2.1 '''Endocarditis in Adults'''
+::* 2.1 '''Endocarditis in adults'''
-:::*2.1.1 '''Strains Susceptible to Penicillin, Gentamicin, and Vancomycin'''
+:::* 2.1.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
-::::*Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g/day IV for 4–6weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU/day IV for 4–6weeks) {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 4–6 weeks
+::::* Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU IV q24h for 4–6 weeks) {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 4–6 weeks
-::::*'''Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended '''
+::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
-::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
+::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
-:::*2.1.2 '''Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin'''
+::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
-::::* Preferred regimen: ([[Ampicillin]] 12 g/day IV for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU/day IV for 4–6weeks){{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg/day IV/IM for 4–6weeks
+::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
-::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV 6weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg per 24 h IV/IM for 6weeks
+:::* 2.1.2 '''Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
-:::*2.1.3 '''Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin'''
+::::* Preferred regimen: ([[Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU IV q24h for 4–6 weeks) {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 4–6 weeks
-::::*2.1.3.1 '''β Lactamase–producing strain'''
+::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h  for 6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks
-:::::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM 6weeks
+:::* 2.1.3 '''Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin'''
-:::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
+::::* 2.1.3.1 '''β Lactamase–producing strain'''
+:::::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h 6 weeks
+:::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
 ::::*2.1.3.2 '''Intrinsic penicillin resistance'''
-:::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
+:::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
-:::*2.1.4 '''Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin'''
+:::*2.1.4 '''Strains resistant to penicillin, aminoglycoside, and vancomycin'''
-::::* Preferred regimen (1): ([[Imipenem]] {{or}} [[Cilastatin]] 2 g/day IV for ≥ 8weeks {{and}} [[Ampicillin|Ampicillin]] 12 g/day IV for ≥ 8weeks)
+::::* Preferred regimen (1): ([[Imipenem]] {{or}} [[Cilastatin]] 2 g/day IV for ≥ 8weeks) {{and}} [[Ampicillin|Ampicillin]] 12 g/day IV for ≥ 8 weeks
-::::* Preferred regimen (2): ([[Ceftriaxone sodium]] 4 g/day IV/IM for ≥ 8weeks {{and}} [[ampicillin|Ampicillin]] 12 g/day IV for ≥ 8weeks)
+::::* Preferred regimen (2): [[Ceftriaxone sodium]] 4 g IV/IM q24h for ≥ 8weeks {{and}} [[ampicillin|Ampicillin]] 12 g IV q24h for ≥ 8 weeks
-::*2.2 '''Endocarditis in Pediatrics'''
+::* 2.2 '''Endocarditis in pediatrics'''
-:::*2.2.1 '''Strains Susceptible to Penicillin, Gentamicin, and Vancomycin'''
+:::* 2.2.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
-::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg/day IV for 4–6weeks {{or}}  [[Penicillin]] 300,000 U/kg/day IV for 4–6 weeks) {{and}}  [[Gentamicin]] 3 mg/kg q24h IV/IM 4–6weeks
+::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{or}} [[Penicillin]] 0.3 MU/kg IV q24h for 4–6 weeks) {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h 4–6 weeks
-::::*'''Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended '''
+::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
-::::* Alternate regimen : [[Vancomycin]] 40 mg/kg/day IV for 6weeks {{and}}  [[Gentamicin]] 3 mg/kg/day IV/IM for 6weeks
+::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
-:::*2.2.2 '''Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin'''
+::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
-::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg/day IV for 4–6weeks {{or}}  [[Penicillin]] 300,000 U/kg/day IV for 4–6weeks) {{and}}  [[Streptomycin]] 20–30 mg/kg/day IV/IM for 4–6 weeks
+::::* Alternate regimen : [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
-::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg/day IV for 6weeks {{and}}  [[Streptomycin|Streptomycin sulfate]] 15 mg/kg/day IV/IM for 6weeks
+:::* 2.2.2 '''Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
-:::*2.2.3 '''Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin'''
+::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{or}} [[Penicillin]] 0.3 MU/kg IV q24h for 4–6 weeks) {{and}} [[Streptomycin]] 20–30 mg/kg IV/IM q24h for 4–6 weeks
-::::*2.2.3.1 '''β Lactamase–producing strain'''
+::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks
-:::::* Preferred regimen: [[Ampicillin-sulbactam]] 300 mg/kg/day IV for 6weeks {{and}}  [[Gentamicin]] 3 mg/kg/day IV/IM for 6weeks
+:::* 2.2.3 '''Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin'''
-:::::* Alternate regimen: [[Vancomycin]] 40 mg/kg/day IV for 6weeks {{and}}  [[Gentamicin]] 3 mg/kg/day IV/IM for 6weeks
+::::* 2.2.3.1 '''β Lactamase–producing strain'''
-::::*2.2.3.2 '''Intrinsic penicillin resistance'''
+:::::* Preferred regimen: [[Ampicillin-sulbactam]] 300 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
-:::::*Preferred regimen: [[Vancomycin]] 40 mg/kg/day IV {{and}}  [[Gentamicin]] 3 mg/kg/day IV/IM for 6weeks
+:::::* Alternate regimen: [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
-:::*2.2.4 '''Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin'''
+::::* 2.2.3.2 '''Intrinsic penicillin resistance'''
-::::*Preferred regimen: [[Imipenem]]/[[Cilastatin]] 60–100 mg/kg/day IV for ≥ 8weeks {{and}}  [[Ampicillin]] 300 mg/kg/day IV for ≥ 8weeks
+:::::*Preferred regimen: [[Vancomycin]] 40 mg/kg IV q24h {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
-::::*Alternate regimen: [[Ceftriaxone]] 100 mg/kg/day IV/IM  {{and}}  [[Ampicillin]] 300 mg/kg/day IV for ≥ 8weeks
+:::* 2.2.4 '''Strains resistant to penicillin, aminoglycoside, and vancomycin'''
-:*3. '''Meningitis'''<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>
+::::* Preferred regimen: [[Imipenem]]/[[Cilastatin]] 60–100 mg/kg IV q24h for ≥ 8 weeks {{and}} [[Ampicillin]] 300 mg/kg IV q24h for ≥ 8 weeks
-::*3.1 '''Ampicillin susceptible'''
+::::* Alternate regimen: [[Ceftriaxone]] 100 mg/kg IV/IM q24h {{and}} [[Ampicillin]] 300 mg/kg IV q24h for ≥ 8 weeks
-:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}}  [[Gentamicin]] 5 mg/kg/day IV q8h
+:* 3. '''Meningitis'''<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }}</ref>
-::*3.2 '''Ampicillin resistant'''
+::* 3.1 '''Ampicillin susceptible'''
-:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}}  [[Gentamicin]] 5 mg/kg/day IV q8h
+:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
-::*3.3 '''Ampicillin and vancomycin resistant'''
+::* 3.2 '''Ampicillin resistant'''
+:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
+::* 3.3 '''Ampicillin and vancomycin resistant'''
 :::* Preferred regimen: [[Linezolid]] 600 mg IV q12h
-:*4. '''Urinary tract infections''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:* 4. '''Urinary tract infections''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
 ::* Preferred regimen (1): [[Nitrofurantoin]] 100 mg PO q6h for 5 days
+::* Preferred regimen (2): [[Fosfomycin]] 3 g PO single dose
+::* Preferred regimen (3): [[Amoxicillin]] 875 mg to 1 g PO q12h for 5 days
+:* 5. '''Intra abdominal or wound infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Penicillin]]
+::* Preferred regimen (2): [[Ampicillin]]
+::* Alternative regimen (Penicillin allergy or high-level Penicillin resistance): [[Vancomycin]]
+::* Alternative regimen (For complicated skin-skin structure and intra-abdominal infection): [[Tigecycline]] 100 mg IV single dose and 50 mg IV q12h
-::* Preferred regimen (2): [[Fosfomycin]] 3 g PO single dose
+----
-::* Preferred regimen (3): [[Amoxicillin]] 875 mg to 1 g PO q12h for 5 days
-:*5. '''Intra abdominal or Wound infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen(1): [[Penicillin]]
-::* Preferred regimen(2): [[Ampicillin]]
-::* Alternative regimen(Penicillin allergy or high-level Penicillin resistance): [[Vancomycin]]
-::* Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): [[Tigecycline]] 100 mg IV single dose and 50 mg IV q12h
 {{PBI|Enterococcus faecium}}
-:*1. '''Bacteremia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:* 1. '''Bacteremia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1.1 '''Ampicillin or Penicillin susceptible'''
+::* 1.1 '''Ampicillin or penicillin susceptible'''
 :::* Preferred regimen (1): [[Ampicillin]] 2 g IV q4-6h
-:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4-6h {{and}} [[Gentamicin]] 1 mg/kg q8h
+:::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4-6h {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h
-::*1.2 '''Ampicillin resistant and vancomycin susceptible or Penicillin allergy'''
+::* 1.2 '''Ampicillin resistant and vancomycin susceptible or penicillin allergy'''
-:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg q8h
+:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h
-:::* Preferred regimen (2): [[Linezolid]] 600 mg q12h
+:::* Preferred regimen (2): [[Linezolid]] 600 mg IV q12h
-:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg/day.
+:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV q24h.
-::*1.3 '''Ampicillin and Vancomycin resistant'''
+::* 1.3 '''Ampicillin and vancomycin resistant'''
-:::* Preferred regimen (1): [[Linezolid]] 600 mg q12h
+:::* Preferred regimen (1): [[Linezolid]] 600 mg IV q12h
-:::* Preferred regimen (2): [[Daptomycin]] 6 mg/kg/day IV
+:::* Preferred regimen (2): [[Daptomycin]] 6 mg/kg IV q24h
-:*2. '''Endocarditis'''<ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref>
+:* 2. '''Endocarditis'''<ref name="Baddour-2005">{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref><ref>{{Cite web | title =Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association| url =http://circ.ahajournals.org/content/111/23/e394.full.pdf+html}}</ref>
+::* 2.1 '''Endocarditis in adults'''
+:::* 2.1.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
+::::* Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU IV q24h for 4–6 weeks) {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 4–6 weeks
+::::* Alternative regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
+::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
-::*2.1 '''Endocarditis in Adults'''
+::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
-:::*2.1.1 '''Strains Susceptible to Penicillin, Gentamicin, and Vancomycin'''
+::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
-::::*Preferred regimen: ([[Ampicillin|Ampicillin]] 12 g/day IV for 4–6weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU/day IV for 4–6weeks) {{and}}[[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 4–6 weeks
+::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
-::::*'''Note : In case of native valve endocarditis, 4-week therapy recommended for patients with symptoms of illness ≤3 months and 6-week therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 week of therapy recommended '''
+:::* 2.1.2 '''Strains susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
-::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
+::::* Preferred regimen: ([[Ampicillin]] 12 g IV q24h for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU/day IV q24h for 4–6 weeks) {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 4–6 weeks
-:::*2.1.2 '''Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin'''
+::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks
-::::* Preferred regimen: ([[Ampicillin]] 12 g/day IV for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU/day IV for 4–6weeks){{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg/day IV/IM for 4–6weeks
+:::* 2.1.3 '''Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin'''
-::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV 6weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg per 24 h IV/IM for 6weeks
+::::* 2.1.3.1 '''β Lactamase–producing strain'''
-:::*2.1.3 '''Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin'''
+:::::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
-::::*2.1.3.1 '''β Lactamase–producing strain'''
+:::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
-:::::* Preferred regimen: [[Ampicillin-sulbactam]] 12 g/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM 6weeks
+::::* 2.1.3.2 '''Intrinsic penicillin resistance'''
-:::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
+:::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg IV/IM q24h for 6 weeks
-::::*2.1.3.2 '''Intrinsic penicillin resistance'''
+:::* 2.1.4 '''Strains resistant to penicillin, aminoglycoside, and vancomycin'''
-:::::* Preferred regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6weeks {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 6weeks
+::::* Preferred regimen (1): [[Linezolid]] 1200 mg IV/PO q24h ≥ 8 weeks
-:::*2.1.4 '''Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin'''
+::::* Preferred regimen (2): [[Quinupristin]]-[[Dalfopristin]] 22.5 mg/kg IV q24h ≥ 8 weeks
-::::*Preferred regimen(1): [[Linezolid]] 1200 mg/day IV/PO ≥8weeks
+::* 2.2 '''Endocarditis in pediatrics'''
-::::*Preferred regimen(2): [[Quinupristin]]-[[Dalfopristin]] 22.5 mg/kg/day IV ≥8weeks
+:::* 2.2.1 '''Strains susceptible to penicillin, gentamicin, and vancomycin'''
-::*2.2 '''Endocarditis in Pediatrics'''
+::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{or}} [[Penicillin]] 0.3MU/kg IV q24h for 4–6 weeks) {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h 4–6 weeks
-:::*2.2.1 '''Strains Susceptible to Penicillin, Gentamicin, and Vancomycin'''
+::::* Alternate regimen: [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
-::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg/day IV for 4–6weeks {{or}} [[Penicillin]] 300,000 U/kg/day IV for 4–6 weeks) {{and}}[[Gentamicin]] 3 mg/kg q24h IV/IM 4–6weeks
+::::* Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
-::::*'''Note : In case of native valve endocarditis, 4-week therapy recommended for patients with symptoms of illness ≤3 months and 6-week therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 week of therapy recommended '''
+::::* Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
-::::* Alternate regimen : [[Vancomycin]] 40 mg/kg/day IV for 6weeks {{and}} [[Gentamicin]] 3 mg/kg/day IV/IM for 6weeks
+::::* Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
-:::*2.2.2 '''Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin'''
+:::* 2.2.2 '''Strains Susceptible to penicillin, streptomycin, and vancomycin and resistant to gentamicin'''
-::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg/day IV for 4–6weeks {{or}} [[Penicillin]] 300,000 U/kg/day IV for 4–6weeks) {{and}}[[Streptomycin]] 20–30 mg/kg/day IV/IM for 4–6 weeks
+::::* Preferred regimen: ([[Ampicillin]] 300 mg/kg IV q24h for 4–6 weeks {{or}} [[Penicillin]] 0.3MU/kg IV q24h for 4–6 weeks) {{and}} [[Streptomycin]] 20–30 mg/kg IV/IM q24h for 4–6 weeks
-::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg/day IV for 6weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg/day IV/IM for 6weeks
+::::* Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg IV/IM q24h for 6 weeks
-:::*2.2.3 '''Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin'''
+:::* 2.2.3 '''Strains resistant to penicillin and susceptible to aminoglycoside and vancomycin'''
-::::*2.2.3.1 '''β Lactamase–producing strain'''
+::::* 2.2.3.1 '''β Lactamase–producing strain'''
-:::::* Preferred regimen: [[Ampicillin-sulbactam]] 300 mg/kg/day IV for 6weeks {{and}} [[Gentamicin]] 3 mg/kg/day IV/IM for 6weeks
+:::::* Preferred regimen: [[Ampicillin-sulbactam]] 300 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
-:::::* Alternate regimen: [[Vancomycin]] 40 mg/kg/day IV for 6weeks {{and}} [[Gentamicin]] 3 mg/kg/day IV/IM for 6weeks
+:::::* Alternate regimen: [[Vancomycin]] 40 mg/kg IV q24h for 6 weeks {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
-::::*2.2.3.2 '''Intrinsic penicillin resistance'''
+::::* 2.2.3.2 '''Intrinsic penicillin resistance'''
-::::*Preferred regimen: [[Vancomycin]] 40 mg/kg/day IV {{and}} [[Gentamicin]] 3 mg/kg/day IV/IM for 6weeks
+::::* Preferred regimen: [[Vancomycin]] 40 mg/kg IV q24h {{and}} [[Gentamicin]] 3 mg/kg IV/IM q24h for 6 weeks
-:::*2.2.4 '''Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin'''
+:::* 2.2.4 '''Strains resistant to penicillin, aminoglycoside, and vancomycin'''
-::::*Preferred regimen(1): [[Linezolid]] 30 mg/kg/day IV/PO ≥ 8weeks
+::::* Preferred regimen (1): [[Linezolid]] 30 mg/kg IV/PO q24h ≥ 8 weeks
-::::*Preferred regimen(2): [[Quinupristin]]-[[Dalfopristin]]22.5 mg/kg/day IV ≥ 8weeks
+::::* Preferred regimen (2): [[Quinupristin]]-[[Dalfopristin]] 22.5 mg/kg IV q24h ≥ 8 weeks
-:*3. '''Meningitis'''<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }}</ref>
+:* 3. '''Meningitis'''<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }}</ref>
-::*3.1 '''Ampicillin susceptible'''
+::* 3.1 '''Ampicillin susceptible'''
 :::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
-::*3.2 '''Ampicillin resistant'''
+::* 3.2 '''Ampicillin resistant'''
 :::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
-::*3.3 '''Ampicillin and vancomycin resistant'''
+::* 3.3 '''Ampicillin and vancomycin resistant'''
 :::* Preferred regimen: [[Linezolid]] 600 mg IV q12h
-:*4. '''Urinary tract infections'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:* 4. '''Urinary tract infections'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* Preferred regimen (1): [[Nitrofurantoin]] 100  mg PO q6h for 5 days
+::* Preferred regimen (1): [[Nitrofurantoin]] 100 mg PO q6h for 5 days
 ::* Preferred regimen (2): [[Fosfomycin]] 3 g PO single dose
 ::* Preferred regimen (3): [[Amoxicillin]] 875 mg to 1 g PO q12h for 5 days
-:*5. '''Intra abdominal or Wound infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:* 5. '''Intra abdominal or wound infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen(1): [[Penicillin]]
+::* Preferred regimen (1): [[Penicillin]]
-::* Preferred regimen(2): [[Ampicillin]]
+::* Preferred regimen (2): [[Ampicillin]]
-::* Alternative regimen(Penicillin allergy or high-level Penicillin resistance): [[Vancomycin]]
+::* Alternative regimen (penicillin allergy or high-level penicillin resistance): [[Vancomycin]]
-::* Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): [[Tigecycline]] 100 mg IV single dose and 50 mg IV q12h
+::* Alternative regimen (for complicated skin-skin structure and intra-abdominal infection): [[Tigecycline]] 100 mg IV single dose and 50 mg IV q12h
+----
 {{PBI|Staphylococcus aureus}}
 :* [[Staphylococcus aureus]] treatment
-::* 1. '''Infectious endocarditis'''
+::* 1. '''Infectious endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
 :::* 1.1 In adults
 ::::* Preferred regimen (1): [[Vancomycin]] 15-20 mg/kg IV q8-12h
@@ Line 149: / Line 169: @@
 ::::* Alternative regimen (1): [[Cefazolin]] 2 g IV q8h
 ::::* Alternative regimen (2): [[Vancomycin]] 15 mg/kg IV q12h
-:::::* 2.1.1 Pediatric dose
+:::::* 2.1.1 '''Pediatric dose of Nafcillin'''
-::::::* 2.1.1.1 [[Nafcillin]]
+::::::* 2.1.1.1 '''Neonates (< 4 weeks)'''
-:::::::* 2.1.1.1.1 Neonates
+:::::::* For < 1200 g: [[Nafcillin]] 50 mg/kg/day q12h
-::::::::* 0–4 weeks of age and 1200 g- 50 mg/kg/day  q12h
+:::::::* For ≤ 7 days of age and 1200–2000 g: [[Nafcillin]] 50 mg/kg/day q12h
-::::::::* ≤7 days and 1200–2000 g- 50 mg/kg/day  q12h
+:::::::* For ≤ 7 days of age and > 2000 g: [[Nafcillin]] 75 mg/kg/day q8h
-::::::::* >7 days of age and <2000g- 75 mg/kg/day  q8h
+:::::::* For > 7 days of age and 1200–2000 g: [[Nafcillin]] 75 mg/kg/day q8h
-::::::::* >7 days of age and >1200 g - 100 mg/kg/day  q6h
+:::::::* For > 7 days of age and > 2000 g: [[Nafcillin]] 100 mg/kg/day q6h
-:::::::* 2.1.1.1.2 Infants and children is [[Nafcillin]] 100–200 mg/kg/day q4–6h
+::::::* 2.1.1.2 '''Infants and children (> 4 weeks)'''
-::::::* 2.1.1.2 [[Oxacillin]]
+:::::::* [[Nafcillin]] 100–200 mg/kg/day q4–6h
-:::::::* 2.1.1.2.1 Neonates
+:::::* 2.1.2 '''Pediatric dose of Oxacillin'''
-::::::::* 0–4 weeks of age and 1200 g is 50 mg/kg/day q12h
+::::::* 2.1.2.1 '''Neonates (< 4 weeks)'''
-::::::::* Postnatal age <7 days and 1200–2000 g is 50–100 mg/kg/day q12h
+:::::::* For < 1200 g: [[Oxacillin]] 50 mg/kg/day q12h
-::::::::* Postnatal age <7 days and >2000 g is 75–150 mg/kg/day q8h
+:::::::* For Postnatal age < 7 days and 1200–2000 g: [[Oxacillin]] 50–100 mg/kg/day q12h
-::::::::* Postnatal age ≥7 days and 1200–2000 g is 75–150 mg/kg/day q8h
+:::::::* For Postnatal age < 7 days and > 2000 g: [[Oxacillin]] 75–150 mg/kg/day q8h
-::::::::* Postnatal age ≥7 days and >2000 g is 100–200 mg/kg/day q6h
+:::::::* For Postnatal age ≥ 7 days and 1200–2000 g: [[Oxacillin]] 75–150 mg/kg/day q8h
-::::::* 2.1.1.3 [[Cefazolin]]
+:::::::* For Postnatal age ≥ 7 days and > 2000 g: [[Oxacillin]] 100–200 mg/kg/day q6h
-:::::::* 2.1.1.3.1 Neonates
+::::::* 2.1.2.2 '''Infants and children'''(> 4weeks)
-::::::::* Postnatal age ≤7 days is 40 mg/kg/day q12h
+:::::::* [[Oxacillin]] 150–200 mg/kg/day q4–6h
-::::::::* Postnatal age >7 days and 2000 g is 40 mg/kg/day q12h
+:::::* 2.1.3 '''Pediatric dose of Cefazolin'''
-::::::::* Postnatal age >7 days and 12000 g is 60 mg/kg/day q8h
+::::::* 2.1.3.1 '''Neonates (< 4 weeks)'''
-:::::::* 2.1.1.3.2 Infants and children is 50 mg/kg/day q8h
+:::::::* Postnatal age ≤ 7 days: [[Cefazolin]] 40 mg/kg/day q12h
-::::::* 2.1.1.4 [[Vancomycin]]
+:::::::* Postnatal age > 7 days and ≤ 2000 g: [[Cefazolin]] 40 mg/kg/day q12h
-:::::::* 2.1.1.4.1 Neonates
-::::::::* Postnatal age ≤7 days and <1200 g is 15 mg/kg/day q24h
+:::::::* Postnatal age > 7 days and > 2000 g: [[Cefazolin]] 60 mg/kg/day q8h
-::::::::* Postnatal age ≤7 days and 1200–2000 g is 10–15 mg/kg q12–18h
+::::::* 2.1.3.2 '''Infants and children (> 4 weeks)'''
-::::::::* Postnatal age ≤7 days and >2000 g is 10–15 mg/kg q8–12h
+:::::::* [[Cefazolin]] 50 mg/kg/day q8h.
-::::::::* Postnatal age >7 days and <1200 g is 15 mg/kg/day q24h
+:::::* 2.1.4 '''Pediatric dose of Vancomycin'''
-::::::::* Postnatal age >7 days and 1200–2000 g is 10–15 mg/kg q8–12h
+::::::* 2.1.4.1 '''Neonates (< 4 weeks)'''
-::::::::* Postnatal age >7 days and >2000 g is 15–20 mg/kg q8h
+:::::::* Postnatal age ≤ 7 days and < 1200 g: [[Vancomycin]] 15 mg/kg/day q24h.
-:::::::* 2.1.1.4.2 Infants and children is 40 mg/kg/day q6–8h
+:::::::* Postnatal age ≤ 7 days and 1200–2000 g: [[Vancomycin]] 10–15 mg/kg q12–18h.
+:::::::* Postnatal age ≤ 7 days and > 2000 g: [[Vancomycin]] 10–15 mg/kg q8–12h.
+:::::::* Postnatal age > 7 days and < 1200 g: [[Vancomycin]] 15 mg/kg/day q24h.
+:::::::* Postnatal age > 7 days and 1200–2000 g: [[Vancomycin]] 10–15 mg/kg q8–12h.
+:::::::* Postnatal age > 7 days and > 2000 g: [[Vancomycin]] 15–20 mg/kg q8h.
+::::::* 2.1.4.2 '''Infants and children (> 4 weeks)'''
+:::::::* [[Vancomycin]] 40 mg/kg/day q6–8h.
 :::* 2.2 '''Methicillin resistant Staphylococcus aureus (MRSA)'''
 ::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h
 ::::* Preferred regimen (2): [[Daptomycin]] 6–8 mg/kg/day IV
-::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg q12h IV or PO
+::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg IV/PO q12h
 ::::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg IV q12h {{and}} ([[Rifampicin]] IV or [[Gentamycin]] IV)
-::::* Preferred regimen (5): [[Trimethoprim-Sulfamethoxazole]] 6–12 mg TMP/kg/day in divided doses q12h alone (if susceptible)
+::::* Preferred regimen (5): [[Trimethoprim-Sulfamethoxazole]] 6–12 mg TMP/kg/day q12h alone (if susceptible)
-:::::* 2.2.1 Pediatric dose
+:::::* 2.2.1 '''Pediatric dose of Linezolid'''
-::::::* 2.2.1.1 [[Linezolid]] 10 mg/kg IV or PO q12h
+::::::* 2.2.1.1 '''Neonates (< 4 weeks)'''
-:::::::* 2.2.1.1.1 Neonates
+:::::::* For < 1200 g: [[Linezolid]] 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
-::::::::* 0–4 weeks of age and birthweight <1200 g is 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age)
+:::::::* For < 7 days of age and ≥ 1200 g: [[Linezolid]] 10 mg/kg q8–12h (note: q12h in patients < 34 weeks gestation and < 1 week of age).
-::::::::* <7 days of age and birthweight >1200 g is 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age)
+:::::::* For ≥ 7 days and ≥ 1200 g: [[Linezolid]] 10 mg/kg q8h
-::::::::* 7 days and birthweight >1200 g is 10 mg/kg q8h
-:::::::* 2.2.1.1.2 Infants and children <12 years of age is 10 mg/kg q8h Children 12 years of age and adolescents is 10 mg/kg q12h
+::::::* 2.2.1.2 '''Infants and children < 12 years (> 4 weeks)'''
-::::::* 2.2.1.2 [[Gentamycin]]
+:::::::* [[Linezolid]] 10 mg/kg q8h
-:::::::* 2.2.1.2.1 Neonates
+::::::* 2.2.1.3 '''Children ≥ 12 years and adolescents'''
-::::::::* Premature neonates and <1000 g is 3.5 mg/kg q24h; 0–4 weeks and <1200 g is 2.5 mg/kg q18-24h
-::::::::* Postnatal age 7 days is 2.5 mg/kg q12h
+:::::::* [[Linezolid]] 10 mg/kg q12h
-::::::::* Postnatal age 17 days and 1200–2000 g is 2.5 mg/kg q8-12h
+:::::* 2.2.2 '''Pediatric dose of Gentamycin'''
-::::::::* Postnatal age 17 days and 12000 g is 2.5 mg/kg q8h
+::::::* 2.2.2.1 '''Neonates (< 4 weeks)'''
-::::::::* Premature neonates with normal renal function is 3.5–4 mg/kg q24h
+:::::::* Premature neonates and < 1000 g: [[Gentamycin]] 3.5 mg/kg q24h
-::::::::* Term neonates with normal renal function is 3.5–5 mg/kg q24h
+:::::::* < 1200 g: [[Gentamycin]] 2.5 mg/kg q18-24h.
-:::::::* 2.2.1.2.2 Infants and children <5 years of age is 2.5 mg/kg q8h; qd dosing in patients with normal renal function, 5–7.5 mg/kg q24h
+:::::::* Postnatal age ≤ 7 days: [[Gentamycin]] 2.5 mg/kg q12h.
-:::::::* 2.2.1.2.3 Children >5 years of age is 2–2.5 mg/kg q8h; qd with normal renal function, 5–7.5 mg/kg q24h
+:::::::* Postnatal age > 7 days and 1200–2000 g: [[Gentamycin]] 2.5 mg/kg q8-12h.
-::::::* 2.2.1.3 [[Trimethoprim-Sulfamethoxazole]]
+:::::::* Postnatal age > 7 days and > 1200 g: [[Gentamycin]] 2.5 mg/kg q8h.
-:::::::* 2.2.1.3.1 Infants 12 months of age and children of mild-to-moderate infections is 6–12 mg TMP/kg/day  q12h; serious infection, 15–20 mg TMP/kg/day  q6-8h
+:::::::* Premature neonates with normal renal function: [[Gentamycin]] 3.5–4 mg/kg q24h.
+:::::::* Term neonates with normal renal function: [[Gentamycin]] 3.5–5 mg/kg q24h.
+::::::* 2.2.2.2 '''Infants and children < 5 years (> 4 weeks)'''
+:::::::* [[Gentamycin]] 2.5 mg/kg q8h; qd dosing in patients with normal renal function, [[Gentamycin]] 5–7.5 mg/kg q24h.
+::::::* 2.2.2.3 '''Children ≥ 5 years '''
+:::::::* [[Gentamycin]] 2–2.5 mg/kg q8h; qd with normal renal function, [[Gentamycin]] 5–7.5 mg/kg q24h.
+:::::* 2.2.3 '''Pediatric dose of Trimethoprim-Sulfamethoxazole'''
+::::::* 2.2.3.1 '''Infants > 2 months of age and children of mild-to-moderate infections '''
+:::::::* [[Trimethoprim-Sulfamethoxazole]] 6–12 mg TMP/kg/day q12h; serious infection- [[Trimethoprim-Sulfamethoxazole]] 15–20 mg TMP/kg/day  q6-8h.
-::* 3. '''Cellulitis'''
+::* 3. '''Cellulitis'''<ref name="pmid24973422">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= e10-52 | pmid=24973422 | doi=10.1093/cid/ciu444 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24973422  }} </ref>
 ::: 3.1 '''Purulent cellulitis''' (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)
-::::* 3.1.1 In adults
+::::* 3.1.1 '''In adults'''
 :::::* Preferred regimen (1): [[Clindamycin]] 300–450 mg PO tid
-:::::* Preferred regimen (2): [[Trimethoprim-Sulfamethoxazole]] 1–2 DS tab PO bid
+:::::* Preferred regimen (2): [[Trimethoprim-Sulfamethoxazole]] 1–2 DS (double strength) tab PO bid
 :::::* Preferred regimen (3): [[Doxycycline]] 100 mg PO bid
-:::::* Preferred regimen (4): [[Minocycline]] 200 mg as a single dose, then 100 mg PO bid
+:::::* Preferred regimen (4): [[Minocycline]] 200 mg as a single dose {{then}} 100 mg PO bid
 :::::* Preferred regimen (5): [[Linezolid]] 600 mg PO bid
-:::* 3.1.2 In children
+:::* 3.1.2 '''In children'''
 ::::* Preferred regimen (1): [[Clindamycin]] 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
 ::::* Preferred regimen (2): [[Trimethoprim]] 4–6 mg/kg, [[Sulfamethoxazole]] 20–30 mg/kg PO q12h
 ::::* Preferred regimen (3)
-:::::* 3.1 If patient body weight <45kg then [[Doxycycline]] 2 mg/kg PO q12h
+:::::* 3.1 If patient body weight < 45kg then [[Doxycycline]] 2 mg/kg PO q12h
 :::::* 3.2 If patient body weight 45kg then [[Doxycycline]] adult dose
-::::* Preferred regimen (4): [[Minocycline]] 4 mg/kg PO 200 mg as a single dose, then 2 mg/kg PO q12h
+::::* Preferred regimen (4): [[Minocycline]] 4 mg/kg PO 200 mg as a single dose, {{then}} [[Minocycline]] 2 mg/kg PO q12h
-::::* Preferred regimen (5): [[Linezolid]] 10 mg/kg PO q8h, not to exceed 600 mg
+::::* Preferred regimen (5): [[Linezolid]] 10 mg/kg PO q8h, (max: 600 mg)
 ::* 3.2 '''Nonpurulent cellulitis''' (defined as cellulitis with no purulent drainage or exudate and no associated abscess)
-:::* 3.2.1 In adults
+:::* 3.2.1 '''In adults'''
 ::::* Preferred regimen (1): Beta-lactam (eg, [[Cephalexin]] and [[Dicloxacillin]]) 500 mg PO qid
 ::::* Preferred regimen (2): [[Clindamycin]] 300–450 mg PO tid
 ::::* Preferred regimen (3): [[Amoxicillin]] 500 PO mg tid
 ::::* Preferred regimen (4): [[Linezolid]] 600 mg PO bid
-::::: Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity
+::::* Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity.
-::::: Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, [[Amoxicillin]]) with or without [[Trimethoprim-Sulfamethoxazole]] or a [[Tetracycline]]
+::::* Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, [[Amoxicillin]]) with or without [[Trimethoprim-Sulfamethoxazole]] or a [[Tetracycline]]
-:::* 3.2.2 In children
+:::* 3.2.2 '''In children'''
 ::::* Preferred regimen (1): [[Clindamycin]] 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
 ::::* Preferred regimen (2): [[Trimethoprim]] 4–6 mg/kg, [[Sulfamethoxazole]] 20–30 mg/kg PO q12h
 ::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg PO q8h, not to exceed 600 mg
-::::: Note (1): [[Clindamycin]] causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents
+::::* Note (1): [[Clindamycin]] causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents.
-::::: Note (2): [[Trimethoprim-Sulfamethoxazole]] not recommended for women in the third trimester of pregnancy and for children ,2 months of age
+::::* Note (2): [[Trimethoprim-Sulfamethoxazole]] not recommended for women in the third trimester of pregnancy and for children ,2 months of age.
-::::: Note (3): [[Tetracyclines]] are not recommended for children under 8 years of age and are pregnancy category D
+::::* Note (3): [[Tetracyclines]] are not recommended for children under 8 years of age and are pregnancy category D.
 ::* 4. '''Brain abscess'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
 :::* 4.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::* 4.1.1 In adults
+::::* 4.1.1 '''In adults'''
 :::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
 :::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
 :::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
-::::* 4.1.2 In children
+::::* 4.1.2 '''In children'''
 :::::* Preferred regimen (1): [[Vancomycin]]15 mg/kg/dose IV q6h
 :::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg/dose PO/IV q8h
-:::::: Note: Consider the addition of [[Rifampin]] 600 mg qd {{or}} 300–450 mg bid to [[Vancomycin]].
+:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd {{or}} 300–450 mg bid to [[Vancomycin]].
-:::* 4.2 Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+:::* 4.2 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
 ::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h
 ::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
 ::::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
-::* 5. '''Cerebrospinal fluid shunt infection''' <ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 5. '''Cerebrospinal fluid shunt infection'''<ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
 :::* 5.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
 ::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h with or without [[Rifampin]] 600 mg IV or PO q24h
-::::: Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.
+::::* Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.
 :::* 5.2 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
-:::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h with or without [[Rifampin]] 600 mg IV/PO q24h
+::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q4h with or without [[Rifampin]] 600 mg IV/PO q24h
-:::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
+::::* Preferred regimen (2): [[Oxacillin]] 2 g IV q4h
-::* 6. '''Spinal epidural abscess''' <ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1056/NEJMra055111| issn = 1533-4406| volume = 355| issue = 19| pages = 2012–2020| last = Darouiche| first = Rabih O.| title = Spinal epidural abscess| journal = The New England Journal of Medicine| date = 2006-11-09| pmid = 17093252}}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
+::* 6. '''Spinal epidural abscess'''<ref>{{cite book | last = Kasper | first = Dennis | title = Harrison's principles of internal medicine | publisher = McGraw Hill Education | location = New York | year = 2015 | isbn = 978-0071802154 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1056/NEJMra055111| issn = 1533-4406| volume = 355| issue = 19| pages = 2012–2020| last = Darouiche| first = Rabih O.| title = Spinal epidural abscess| journal = The New England Journal of Medicine| date = 2006-11-09| pmid = 17093252}}</ref><ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
 :::* 6.1 '''Penicillin-susceptible Staphylococcus aureus or Streptococcus'''
-::::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
+::::* Preferred regimen: [[Penicillin G]] 4 MU IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
 :::* 6.2 '''Methicillin-susceptible Staphylococcus aureus or Streptococcus'''
-::::* Preferred regimen (1): [[Cefazolin]] 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks
+::::* Preferred regimen (1): [[Cefazolin]] 2 g IV q8h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
-::::* Preferred regimen (2): [[Nafcillin]] 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
+::::* Preferred regimen (2): [[Nafcillin]] 2 g IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
-::::* Preferred regimen (3): [[Oxacillin]] 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
+::::* Preferred regimen (3): [[Oxacillin]] 2 g IV q4h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks
+::::* Alternative regimen: [[Clindamycin]] 600 mg IV q6h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
 :::* 6.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::* 6.3.1 In adults
+::::* 6.3.1 '''In adults'''
-:::::* Preferred regimen: [[Vancomycin]] loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks
+:::::* Preferred regimen: [[Vancomycin]] loading dose 25–30 mg/kg IV {{then}} [[Vancomycin]] 15–20 mg/kg IV q8–12h for 2–4 weeks, {{then}} PO to complete 6–8 weeks
-::::* Alternative regimen (1): [[Linezolid]] 600 mg PO or IV q12h for 4–6 weeks
+:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
-::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO or IV q8–12h for 4–6 weeks
+:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
-:::* 6.3.2 Pediatric dose
+::::* 6.3.2 '''Pediatric dose'''
-::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
+:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
-::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO or IV q8h
+:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
-::::: Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.
+:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.
-:* 7. ''' Bacterial meningitis'''
+::* 7. ''' Bacterial meningitis'''
-::* 7.1 '''Methicillin susceptible Staphylococcus aureus (MSSA)'''
+:::* 7.1 '''Methicillin susceptible Staphylococcus aureus (MSSA)'''
-:::* Preferred regimen (1): [[Nafcillin]] 9–12 g/day IV q4h
+::::* Preferred regimen (1): [[Nafcillin]] 9–12 g/day IV q4h
-:::* Preferred regimen (2): [[Oxacillin]] 9–12 g/day IV q4h
+::::* Preferred regimen (2): [[Oxacillin]] 9–12 g/day IV q4h
-:::* Alternative regimen (1): [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
+::::* Alternative regimen (1): [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
-:::* Alternative regimen (2): [[Meropenem]] 6 g/day IV q8h
+::::* Alternative regimen (2): [[Meropenem]] 6 g/day IV q8h
-::* 7.2 '''Methicillin resistant Staphylococcus aureus (MRSA)'''
+:::* 7.2 '''Methicillin resistant Staphylococcus aureus (MRSA)'''
-:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
+::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
-:::* Alternative regimen (1): [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h
+::::* Alternative regimen (1): [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h
-:::* Alternative regimen (2): [[Linezolid]] 600 mg IV q12h
+::::* Alternative regimen (2): [[Linezolid]] 600 mg IV q12h
-:::: Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.
+::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.
 ::* 8. '''Septic thrombosis of cavernous or dural venous sinus'''<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
 :::* 8.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::* 8.1.1 In adults
+::::* 8.1.1 '''In adults'''
 :::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h for 4–6 weeks
-:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO or IV q12h for 4–6 weeks
+:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
-:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg/dose PO or IV q8–12h for 4–6 weeks
+:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
-:::* 8.1.2 Pediatric dose
+::::* 8.1.2 '''Pediatric dose'''
-::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
+:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
-::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO or IV q8h
+:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
-::::: Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
+:::::* Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
-::::: Note (2): Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]].
+:::::* Note (2): Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]].
 ::* 9. '''Subdural empyema'''
 :::* 9.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''<ref>{{Cite journal| doi = 10.1093/cid/ciq146| issn = 1537-6591| volume = 52| issue = 3| pages = –18-55| last1 = Liu| first1 = Catherine| last2 = Bayer| first2 = Arnold| last3 = Cosgrove| first3 = Sara E.| last4 = Daum| first4 = Robert S.| last5 = Fridkin| first5 = Scott K.| last6 = Gorwitz| first6 = Rachel J.| last7 = Kaplan| first7 = Sheldon L.| last8 = Karchmer| first8 = Adolf W.| last9 = Levine| first9 = Donald P.| last10 = Murray| first10 = Barbara E.| last11 = J Rybak| first11 = Michael| last12 = Talan| first12 = David A.| last13 = Chambers| first13 = Henry F.| last14 = Infectious Diseases Society of America| title = Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2011-02-01| pmid = 21208910}}</ref>
-::::* 9.1.1 In adults
+::::* 9.1.1 '''In adults'''
-::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
+:::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h for 4–6 weeks
-::::* Alternative regimen (1): [[Linezolid]] 600 mg PO or IV q12h for 4–6 weeks
+:::::* Alternative regimen (1): [[Linezolid]] 600 mg PO/IV q12h for 4–6 weeks
-::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO or IV q8–12h for 4–6 weeks
+:::::* Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 5 mg/kg PO/IV q8–12h for 4–6 weeks
-:::* 9.1.2 In children
+::::* 9.1.2 '''In children'''
-::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
+:::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
-::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO or IV q8h
+:::::* Preferred regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h
-::::: Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]].
+:::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]].
-::* 10. ''' Acute conjunctivitis''' <ref>{{Cite journal| doi = 10.1001/jama.2013.280318| issn = 1538-3598| volume = 310| issue = 16| pages = 1721–1729| last1 = Azari| first1 = Amir A.| last2 = Barney| first2 = Neal P.| title = Conjunctivitis: a systematic review of diagnosis and treatment| journal = JAMA| date = 2013-10-23| pmid = 24150468| pmc = PMC4049531}}</ref>
+::* 10. ''' Acute conjunctivitis'''<ref>{{Cite journal| doi = 10.1001/jama.2013.280318| issn = 1538-3598| volume = 310| issue = 16| pages = 1721–1729| last1 = Azari| first1 = Amir A.| last2 = Barney| first2 = Neal P.| title = Conjunctivitis: a systematic review of diagnosis and treatment| journal = JAMA| date = 2013-10-23| pmid = 24150468| pmc = PMC4049531}}</ref>
 :::* 10.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
 ::::* Preferred regimen: [[Vancomycin]] ointment 1% qid
 ::* 11. '''Appendicitis'''
-::: 11.1 '''Health Care–Associated Complicated Intra-abdominal Infection''' <ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
+:::* 11.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
-:::: 11.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* 11.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::: Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
+:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
 ::* 12. '''Diverticulitis'''
-::: 12.1 '''Health Care–Associated Complicated Intra-abdominal Infection''' <ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
+:::* 12.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
-:::: 12.1.1'''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* 12.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
 :::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h.
-::* 13. '''Peritonitis secondary to bowel  perforation, peritonitis secondary to ruptured  appendix, peritonitis secondary to ruptured  appendix, typhlitis'''
+::* 13. '''Peritonitis secondary to bowel perforation, peritonitis secondary to ruptured appendix, peritonitis secondary to ruptured  appendix, typhlitis'''
-::: 13.1 '''Health Care–Associated Complicated Intra-abdominal Infection''' <ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
+:::* 13.1 '''Health care–associated complicated intra-abdominal infection'''<ref name="pmid20034345">{{cite journal| author=Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ et al.| title=Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 2 | pages= 133-64 | pmid=20034345 | doi=10.1086/649554 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20034345  }} </ref>
 ::::* 13.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
 :::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
-::* 14. '''Cystic fibrosis''' <ref name="pmid23540878">{{cite journal| author=Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB et al.| title=Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. | journal=Am J Respir Crit Care Med | year= 2013 | volume= 187 | issue= 7 | pages= 680-9 | pmid=23540878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23540878  }} </ref>
+::* 14. '''Cystic fibrosis'''<ref name="pmid23540878">{{cite journal| author=Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB et al.| title=Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health. | journal=Am J Respir Crit Care Med | year= 2013 | volume= 187 | issue= 7 | pages= 680-9 | pmid=23540878 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23540878  }} </ref>
-:::* 14.1 Adults
+:::* 14.1 '''Adults'''
-::::* 14.1.1 If '''methicillin sensitive staphylococcus aureus'''
+::::* 14.1.1 '''If methicillin sensitive staphylococcus aureus'''
 :::::* Preferred Regimen (1): [[Nafcillin]] 2 gm IV q4h
 :::::* Preferred Regimen (2): [[Oxacillin]] 2 gm IV q4h
-::::* 14.1.2 If '''methicillin resistant staphylococcus aureus'''
+::::* 14.1.2 '''If methicillin resistant staphylococcus aureus'''
 :::::* Preferred Regimen (1): [[Vancomycin]] 15-20 mg/kg IV q8-12h
-:::::* Preferred Regimen (2): [[Linezolid]] 600 mg PO or IV q12h
+:::::* Preferred Regimen (2): [[Linezolid]] 600 mg PO/IV q12h
-::* 14.2 Pediatric
+:::* 14.2 '''Pediatric'''
-:::* 14.2.1 If '''methicillin sensitive staphylococcus aureus'''
+::::* 14.2.1 '''If methicillin sensitive staphylococcus aureus'''
 :::::* Preferred Regimen (1): [[Nafcillin]] 5 mg/kg q6h (Age >28 days)
 :::::* Preferred Regimen (2): [[Oxacillin]] 75 mg/kg q6h (Age >28 days)
-:::* 14.2.2 If '''methicillin resistant staphylococcus aureus'''
+::::* 14.2.2 '''If methicillin resistant staphylococcus aureus'''
 :::::* Preferred Regimen (1): [[Vancomycin]] 40 mg/kg  q6-8h (Age >28 days)
-:::::* Preferred Regimen (2): [[Linezolid]] 10 mg/kg PO or IV q8h (up to age 12)
+:::::* Preferred Regimen (2): [[Linezolid]] 10 mg/kg PO/IV q8h (up to age 12)
-::* 15. '''Bronchiectasis''' <ref name="pmid20627931">{{cite journal| author=Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group| title=British Thoracic Society guideline for non-CF bronchiectasis. | journal=Thorax | year= 2010 | volume= 65 Suppl 1 | issue=  | pages= i1-58 | pmid=20627931 | doi=10.1136/thx.2010.136119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20627931  }} </ref>
+::* 15. '''Bronchiectasis'''<ref name="pmid20627931">{{cite journal| author=Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group| title=British Thoracic Society guideline for non-CF bronchiectasis. | journal=Thorax | year= 2010 | volume= 65 Suppl 1 | issue=  | pages= i1-58 | pmid=20627931 | doi=10.1136/thx.2010.136119 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20627931  }} </ref>
-:::* 15.1 In adults
+:::* 15.1 '''In adults'''
 ::::* 15.1.1 '''Recommended first-line treatment and length of treatment'''
-::::: 15.1.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+:::::* 15.1.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
-::::::* Preferred regimen: [[Flucloxacillin]] 500 mg oral qds for 14 days
+::::::* Preferred regimen: [[Flucloxacillin]] 500 mg PO qds for 14 days
-::::* 15.1.1.2  '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::::* 15.1.1.2  '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-:::::* 15.1.1.2.1 Patient's body weight is <50 kg
+::::::* '''Patient's body weight is < 50 kg'''
-::::::* Preferred regimen: [[Rifampicin]] 450 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bd for 14 days
+:::::::* Preferred regimen: [[Rifampicin]] 450 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bd for 14 days
-:::::* 15.1.1.2.2 Patient's body weight is >50 kg
+::::::* '''Patient's body weight is > 50 kg'''
-::::::* Preferred regimen: [[Rifampicin]] 600 mg PO qd{{and}} [[Trimethoprim]] 200 mg PO bd for 14 days
+:::::::* Preferred regimen: [[Rifampicin]] 600 mg PO qd {{and}} [[Trimethoprim]] 200 mg PO bd for 14 days
-::::* 15.1.1.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::::* 15.1.1.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-:::::* Preferred regimen (1): [[Vancomycin]] 1 g IV bd (monitor serum levels and adjust dose accordingly)
+::::::* Preferred regimen (1): [[Vancomycin]] 1 g IV bd (monitor serum levels and adjust dose accordingly)
-:::::* Preferred regimen (2): [[Teicoplanin]] 400 mg qd for 14 days
+::::::* Preferred regimen (2): [[Teicoplanin]] 400 mg qd for 14 days
 ::::* 15.1.2 '''Recommended second-line treatment and length of treatment'''
 :::::* 15.1.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
-::::::* Preferred regimen: [[Clarithromycin]] 500 mg oral bd 14 days
+::::::* Preferred regimen: [[Clarithromycin]] 500 mg PO bd 14 days
 :::::* 15.1.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::::* 15.1.2.2.1 Patient's body weight is <50 kg
+::::::* '''Patient's body weight is < 50 kg '''
-:::::::* Preferred regimen: [[Rifampicin]] 450 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd 14 days,
+:::::::* Preferred regimen: [[Rifampicin]] 450 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
-::::::* 15.1.2.2.2 Patient's body weight is >50 kg
+::::::* '''Patient's body weight is > 50 kg'''
-:::::::* Preferred regimen: [[Rifampicin]] 600 mg PO {{and}} [[Doxycycline]] 200 mg PO qd 14 days
+:::::::* Preferred regimen: [[Rifampicin]] 600 mg PO qd {{and}} [[Doxycycline]] 200 mg PO qd for 14 days
-::::::* Third-line is [[Linezolid]] 600 mg bd 14 days
+::::::* '''Third-line''': [[Linezolid]] 600 mg bd for 14 days
 :::::* 15.1.2.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::::* Preferred regimen: [[Linezolid]] 600 mg IV bd 14 days
+::::::* Preferred regimen: [[Linezolid]] 600 mg IV bd for 14 days
-:::* 15.2 In children
+:::* 15.2 '''In children'''
 ::::* 15.2.1 '''Recommended first-line treatment and length of treatment'''
 :::::* 15.2.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
 ::::::* Preferred regimen: [[Flucloxacillin]]
 :::::* 15.2.1.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::::* 15.2.1.2.1 Children (< 12 yr)
+::::::* 15.2.1.2.1 '''Children''' (< 12 yr)
-:::::::* Preferred regimen: [[Trimethoprim]] 4-6 mg/kg/day divided q12h PO
+:::::::* Preferred regimen: [[Trimethoprim]] 4-6 mg/kg/day PO q12h
-::::::* 15.2.1.2.2 Children (> 12 yr)
+::::::* 15.2.1.2.2 '''Children''' (> 12 yr)
-:::::::* Preferred regimen (1): [[Trimethoprim]] 100-200 mg q12hr PO
+:::::::* Preferred regimen (1): [[Trimethoprim]] 100-200 mg PO q12h
-:::::::* Preferred regimen (2): [[Rifampicin]] 450 mg PO od
+:::::::* Preferred regimen (2): [[Rifampicin]] 450 mg PO od (or [[Rifampicin]] 600 mg PO od)
 :::::* 15.2.1.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::::* Preferred regimen (1): [[Vancomycin]] 45-60 mg/kg/day divided q8-12h IV
+::::::* Preferred regimen (1): [[Vancomycin]] 45-60 mg/kg/day IV q8-12h
-::::::* Preferred regimen (2): [[Teicoplanin]]
+::::::* Preferred regimen (2): [[Teicoplanin]] 400 mg qd for 14 days
 ::::* 15.2.2 '''Recommended second-line treatment and length of treatment'''
 :::::* 15.2.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
-::::::* Preferred regimen: [[Clarithromycin]] 15 mg/kg/24 hr divided q12h PO
+::::::* Preferred regimen: [[Clarithromycin]] 15 mg/kg/day PO q12h
-::::: 15.2.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::::* 15.2.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::::* Preferred regimen (1): [[Rifampicin]] {{and}} [[Doxycycline]] 2-5 mg/kg/day divided q12-24h PO or IV (max dose: 200 mg/24 hr)
+::::::* Preferred regimen (1): [[Rifampicin]] {{and}} [[Doxycycline]] 2-5 mg/kg/day PO/IV q12-24h  (max dose: 200 mg/24 hr)
-::::::* Preferred regimen (2): [[Rifampicin]] {{and}} [[Doxycycline]] 2-5 mg/kg/day divided q12-24h PO or IV (max dose: 200 mg/24 hr)
+::::::* Preferred regimen (2): [[Rifampicin]] {{and}} [[Doxycycline]] 2-5 mg/kg/day PO/IV q12-24h  (max dose: 200 mg/24 hr)
-::::::* Third-line: [[Linezolid]] 10 mg/kg q12h IV or PO
+::::::* '''Third-line''': [[Linezolid]] 10 mg/kg PO/IV q12h
 :::::* 15.2.2.3 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::::* Preferred regimen: [[Linezolid]] 10 mg/kg q12h IV or PO
+::::::* Preferred regimen: [[Linezolid]] 10 mg/kg PO/IV q12h
 :::*  15.3 '''Long-term oral antibiotic treatment'''
-::::* 15.3.1 In adults
+::::* 15.3.1 '''In adults'''
-:::::* 15.3.1.1  '''Recommended first-line treatment and length of treatment'''
+:::::* 15.3.1.1 '''Recommended first-line treatment and length of treatment'''
 ::::::* 15.3.1.1.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
 :::::::* Preferred regimen: [[Flucloxacillin]] 500 mg PO bd
-:::::* 15.3.1.2  '''Recommended second-line treatment and length of treatment'''
+:::::* 15.3.1.2 '''Recommended second-line treatment and length of treatment'''
 ::::::* 15.3.1.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
 :::::::* Preferred regimen: [[Clarithromycin]] 250 mg PO bd
 ::* 16. '''Empyema'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: [[Nafcillin]]  2 gm IV q4h {{or}} [[oxacillin]]  2 gm IV q4h if MSSA
+:::* Preferred regimen (1): [[Nafcillin]]  2 gm IV q4h
-:::* Alternate regimen: [[Vancomycin]]  1 gm IV q12h {{or}} [[Linezolid]]  600 mg PO bid if MRSA
+:::* Preferred regimen (2): [[oxacillin]]  2 gm IV q4h (if MSSA)
+:::* Alternative regimen (1): [[Vancomycin]]  1 gm IV q12h
+:::* Alternative regimen (2): [[Linezolid]]  600 mg PO bid (if MRSA)
 ::* 17. '''Community-acquired pneumonia'''<ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
@@ Line 415: / Line 451: @@
 ::::* Alternative Regimen (2): [[Clindamycin]] 150-450 mg PO q6-8h
 :::* 17.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::* Preferred Regimen (1): [[Vancomycin]] 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days
+::::* Preferred Regimen (1): [[Vancomycin]] 45-60 mg/kg/day q8-12h (max: 2000 mg/dose) for 7-21 days
 ::::* Preferred Regimen (2): [[Linezolid]] 600 mg PO/IV q12h for 10-14 days
 ::::* Alternative Regimen: [[Trimethoprim-Sulfamethoxazole]] 1-2 double-strength tablets (800/160 mg) q12-24h
@@ Line 427: / Line 463: @@
 ::::* Preferred regimen (1): [[Vancomycin]] 1 g IV q12h
 ::::* Preferred regimen (2): [[Linezolid]] 600 mg PO qd
-::::: Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.
+::::* Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.
 ::* 19. '''Septic arthritis'''
-:::* 19.1 In adults
+:::* 19.1 '''In adults'''
-:::* 19.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* 19.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
+:::::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
-::::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h in adults
+:::::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h in adults
-::::* Alternative regimen (2): [[Linezolid]] 600 mg PO or IV q12h
+:::::* Alternative regimen (2): [[Linezolid]] 600 mg PO/IV q12h
-::::* Alternative regimen (3): [[Clindamycin]] 600 mg PO or IV q8h
+:::::* Alternative regimen (3): [[Clindamycin]] 600 mg PO/IV q8h
-::::* Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO or IV q8–12h
+:::::* Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h
-:::* 19.2 In childern
+::::* 19.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+:::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
+:::::* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h
+:::::* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+:::::* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
+:::* 19.2 '''In childern'''
 ::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q6h
 ::::* Preferred regimen (2): [[Daptomycin]] 6–10 mg/kg IV q24h
-::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg PO or IV q8h
+::::* Preferred regimen (3): [[Linezolid]] 10 mg/kg PO/IV q8h
-::::* Preferred regimen (4): [[Clindamycin]] 10–13 mg/kg PO or IV q6–8h
+::::* Preferred regimen (4): [[Clindamycin]] 10–13 mg/kg PO/IV q6–8h
-::::*''' 19.2.1 '''Methicillin-susceptible Staphylococcus aureus (MSSA)'''
-::::* Preferred regimen (1): [[Nafcillin]] 2 g IV q6h
-::::* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h
-::::* Alternative regimen (1): [[Cefazolin]] 0.25–1 g IV/IM q6–8h
-::::* Alternative regimen (2): [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
 ::* 20. '''Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)'''
@@ Line 455: / Line 491: @@
 ::::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q24h
 ::::* Alternative regimen (if allergic to penicillins) (3): [[Clindamycin]] 900 mg IV q8h
-::::* Alternative regimen (if allergic to penicillins) (4): [[Vancomycin]] 15–20 mg/kg IV q8–12h, not to exceed 2 g per dose
+::::* Alternative regimen (if allergic to penicillins) (4): [[Vancomycin]] 15–20 mg/kg IV q8–12h, (max: 2 g per dose)
-::* 20.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+:::* 20.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-:::* Early-onset (2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
+::::* Early-onset (2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
 ::::* Preferred regimen: [[Vancomycin]] {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
 ::::* Alternative regimen (1): [[Daptomycin]] 6 mg/kg IV q24h {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
 ::::* Alternative regimen (2): [[Linezolid]] 600 IV q8h {{and}} [[Rifampin]] 600 mg PO qd or 300–450 mg PO bid for 2 weeks
-::::: Note: The above regimen should be followed by [[Rifampin]] and [[Fluoroquinolone]], [[Trimethoprim]]/[[Sulfamethoxazole]], a [[Tetracycline]] or [[Clindamycin]] for 3 or 6 months for hips and knees, respectively.
+::::* Note: The above regimen should be followed by [[Rifampin]] and a [[Fluoroquinolone]], TMP/SMX, a [[Tetracycline]] or [[Clindamycin]] for 3-6 months for hips and knees, respectively.
 ::* 21. '''Hematogenous osteomyelitis'''
-:::* 21.1 Adult (>21 yrs)
+:::* 21.1 '''Adult''' (> 21 yrs)
-:::* 21.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
+::::* 21.1.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
-::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
+:::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
-:::* 21.1.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
+::::* 21.1.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
-::::* Preferred regimen (1): [[Nafcillin]]
+:::::* Preferred regimen (1): [[Nafcillin]]
-::::* Preferred regimen (2): [[Oxacillin]] 2 gm IV q4h
+:::::* Preferred regimen (2): [[Oxacillin]] 2 gm IV q4h
-::* 21.2 Children (>4 months)-Adult
+:::* 21.2 '''Children''' (> 4 months)-Adult
-:::* 21.2.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
+::::* 21.2.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
-::::* Preferred regimen: [[Vancomycin]] 40 div q6–8h
+:::::* Preferred regimen: [[Vancomycin]] 40 mg IV q6–8h
-:::* 21.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
+::::* 21.2.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
-::::* Preferred regimen (1): [[Nafcillin]]
+:::::* Preferred regimen (1): [[Nafcillin]]
-::::* Preferred regimen (2): [[Oxacillin]] q6h (to max. 8–12 gm per day)
+:::::* Preferred regimen (2): [[Oxacillin]] q6h (max. 8–12 gm per day)
-::::: Note: Add [[Ceftazidime]] 50 mg q8h or [[Cefepime]] 150 mg q8h if gram negative bacilli on Gram stain
+:::::* Note: Add [[Ceftazidime]] 50 mg q8h or [[Cefepime]] 150 mg q8h if Gram negative bacilli on Gram stain
-::* 21.3 Newborn (<4 months.)
+:::* 21.3 '''Newborn''' (< 4 months.)
-:::* 21.3.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
+::::* 21.3.1 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' possible
-::::* Preferred regimen (1): [[Vancomycin]] {{and}} [[Ceftazidime]] 2 gm IV q8h
+:::::* Preferred regimen (1): [[Vancomycin]] {{and}} [[Ceftazidime]] 2 gm IV q8h
-::::* Preferred regimen (2): [[Vancomycin]] {{and}} [[Cefepime]] 2 gm IV q12h
+:::::* Preferred regimen (2): [[Vancomycin]] {{and}} [[Cefepime]] 2 gm IV q12h
-:::* 21.3.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
+::::* 21.3.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)''' unlikely
-::::* Preferred regimen (1): [[Nafcillin]]  {{and}} [[Ceftazidime]]
+:::::* Preferred regimen (1): [[Nafcillin]]  {{and}} [[Ceftazidime]]
-::::* Preferred regimen (2): [[Oxacillin]] {{and}} [[Cefepime]]
+:::::* Preferred regimen (2): [[Oxacillin]] {{and}} [[Cefepime]]
-::* 21.4 '''Specific therapy'''
+:::* 21.4 '''Specific therapy'''
-:::* 21.4.1 ''' Methicillin-susceptible Staphylococcus aureus (MSSA)'''
+::::* 21.4.1 ''' Methicillin-susceptible Staphylococcus aureus (MSSA)'''
-::::* Preferred regimen (1): [[Nafcillin]]
+:::::* Preferred regimen (1): [[Nafcillin]]
-::::* Preferred regimen (2): [[Oxacillin]] 2 gm IV q4h
+:::::* Preferred regimen (2): [[Oxacillin]] 2 gm IV q4h
-::::* Preferred regimen (3): [[Cefazolin]] 2 gm IV q8h
+:::::* Preferred regimen (3): [[Cefazolin]] 2 gm IV q8h
-::::* Alternative regimen: [[Vancomycin]] 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
+:::::* Alternative regimen: [[Vancomycin]] 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
-:::* 21.4.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
+::::* 21.4.2 '''Methicillin-resistant Staphylococcus aureus (MRSA)'''
-::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h
+:::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h
-::::* Alternative regimen: [[Linezolid]] 600 mg q12h IV or PO with or without [[Rifampin]] 300 mg PO or IV bid
+:::::* Alternative regimen: [[Linezolid]] 600 mg q12h PO/IV with or without [[Rifampin]] 300 mg PO/IV bid
 ::* 22. '''Diabetic foot osteomyelitis'''
@@ Line 501: / Line 537: @@
 ::* 23. ''' Necrotizing fasciitis'''<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530  }} </ref>
-:::* 23.1 In adult
+:::* 23.1 '''In adult'''
-::::* Preferred regimen (1): [[Nafcillin]] 1–2 g IV  q4h (Severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], daptomycin)
+::::* Preferred regimen (1): [[Nafcillin]] 1–2 g IV  q4h (severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], daptomycin)
 ::::* Preferred regimen (2): [[Oxacillin]] 1–2 g IV  q4h
 ::::* Preferred regimen (3): [[Cefazolin]] 1 g IV  q8h
 ::::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg IV bid
 ::::* Preferred regimen (5): [[Clindamycin]] 600–900 mg IV  q8h
-:::* 23.2 In childern
+:::* 23.2 '''In childern'''
-::::* Preferred regimen (1): [[Nafcillin]] 50 mg/kg/dose IV  q6h  (Severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], [[daptomycin]])
+::::* Preferred regimen (1): [[Nafcillin]] 50 mg/kg/dose IV  q6h  (severe Pencillin allergy: [[Vancomycin]], [[linezolid]], [[quinupristin]]/[[dalfopristin]], [[daptomycin]])
 ::::* Preferred regimen (2): [[Oxacillin]] 50 mg/kg/dose IV q6h
 ::::* Preferred regimen (3): [[Cefazolin]] 33 mg/kg/dose IV q8h
@@ Line 514: / Line 550: @@
 ::::* Preferred regimen (5): [[Clindamycin]] 10–13 mg/kg/dose IV q8h  ([[Bacteriostatic]]; potential cross-resistance and emergence of resistance in [[erythromycin]]-resistant strains; inducible resistance in methicillin resistent staphylococcus aureus)
-::* 24. '''Staphylococcal toxic shock syndrome''' <ref name="pmid19393958">{{cite journal| author=Lappin E, Ferguson AJ| title=Gram-positive toxic shock syndromes. | journal=Lancet Infect Dis | year= 2009 | volume= 9 | issue= 5 | pages= 281-90 | pmid=19393958 | doi=10.1016/S1473-3099(09)70066-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19393958  }} </ref>
+::* 24. '''Staphylococcal toxic shock syndrome'''<ref name="pmid19393958">{{cite journal| author=Lappin E, Ferguson AJ| title=Gram-positive toxic shock syndromes. | journal=Lancet Infect Dis | year= 2009 | volume= 9 | issue= 5 | pages= 281-90 | pmid=19393958 | doi=10.1016/S1473-3099(09)70066-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19393958  }} </ref>
 :::* 24.1 '''Methicillin sensitive Staphylococcus aureus'''
 ::::* Preferred regimen (1): [[Cloxacillin]]  250-500 mg PO q6h (max dose: 4 g/24 hr)
-::::* Preferred regimen (2): [[Nafcillin]]  4-12 g/24 hr divided IV q4-6hr (max dose: 12 g/24 hr)
+::::* Preferred regimen (2): [[Nafcillin]]  4-12 g/24 hr IV q4-6hr (max dose: 12 g/24 hr)
-::::* Preferred regimen (3): [[Cefazolin]] 0.5-2g  IV or IM q8h (max dose: 12 g/24 hr), {{and}} [[Clindamycin]] 150-600 mg IV, IM, or PO q6-8h  (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
+::::* Preferred regimen (3): [[Cefazolin]] 0.5-2g IV/IM q8h (max dose: 12 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h  (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
-::::* Alternative regimen (1): [[Clarithromycin]] 250-500 mg PO q12h (max dose: 1 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg IV, IM, or PO q6-8h  (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
+::::* Alternative regimen (1): [[Clarithromycin]] 250-500 mg PO q12h (max dose: 1 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h  (max dose: 5 g/24 hr IV/IM or 2 g/24h PO)
-::::* Alternative regimen (2): [[Rifampicin]], {{and}} [[Linezolid]] 600 mg IV or PO q12h
+::::* Alternative regimen (2): [[Rifampicin]] {{and}} [[Linezolid]] 600 mg IV/PO q12h
-::::* Alternative regimen (3): [[Daptomycin]] ::::* Alternative regimen (4): [[Tigecycline]] 100 mg loading dose followed by 50 mg  IV q12h
+::::* Alternative regimen (3): [[Daptomycin]]
+::::* Alternative regimen (4): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h
 :::* 24.2 '''Methicillin resistant Staphylococcus  aureus'''
-::::* Preferred regimen (1): [[Clindamycin]] 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
+::::* Preferred regimen (1): [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24h IV/IM or 2 g/24h PO)
-::::* Preferred regimen (2): [[Linezolid]] 600 mg IV or PO q12h {{and}} [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
+::::* Preferred regimen (2): [[Linezolid]] 600 mg IV/PO q12h {{and}} [[Vancomycin]] 15-20 mg/kg IV q8-12h, (max: 2 g per dose)
 ::::* Preferred regimen (3): [[Teicoplanin]]
-::::* Alternative regimen (1): [[Rifampicin]], {{and}} [[Linezolid]] 600 mg q12h IV or PO
+::::* Alternative regimen (1): [[Rifampicin]] {{and}} [[Linezolid]] 600 mg IV/PO q12h
 ::::* Alternative regimen (2): [[Daptomycin]]
-::::* Alternative regimen (3): [[Tigecycline]] 100 mg loading dose followed by 50 mg q12h IV
+::::* Alternative regimen (3): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h
 :::* 24.3 '''Glycopeptide resistant or intermediate Staphylococcus aureus'''
-::::* Preferred regimen: [[Linezolid]] 600 mg IV or PO q12h {{and}} [[Clindamycin]] 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) (if sensitive)
+::::* Preferred regimen: [[Linezolid]] 600 mg IV/PO q12h {{and}} [[Clindamycin]] 150-600 mg IV, IM/PO q6-8h (max dose: 5 g/24 hr IV/IM or 2 g/24h PO) (if sensitive)
 ::::* Alternative regimen (1): [[Daptomycin]]
-::::* Alternative regimen (2): [[Tigecycline]] 100 mg loading dose followed by 50 mg IV q12h
+::::* Alternative regimen (2): [[Tigecycline]] 100 mg loading dose {{then}} 50 mg IV q12h
-:::: Note: Incidence increasing. Geographical patterns highly variable.
 ::* '''Staphylococcus aureus ,prophylaxis'''
 :::* 1. '''Prophylaxis for coronary artery bypass graft-associated acute mediastinitis'''<ref name="pmid22070836">{{cite journal| author=Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG et al.| title=2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol | year= 2011 | volume= 58 | issue= 24 | pages= e123-210 | pmid=22070836 | doi=10.1016/j.jacc.2011.08.009 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22070836  }} </ref>
 ::::* 1.1 '''Methicillin susceptible staphylococcus aureus (MSSA)'''
-:::::* Preferred regimen: A first- or second-generation [[Cephalosporin]] is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization.
+:::::* Preferred regimen: A first- or second-generation [[Cephalosporin]] is recommended for prophylaxis in patients without MRSA colonization.
 ::::* 1.2 '''Methicillin resistant staphylococcus aureus (MRSA)'''
-:::::* Preferred regimen: [[Vancomycin]] alone or in combination with other antibiotics to achieve broader coverage is recommended for prophylaxis in patients with proven or suspected methicillin-resistant S. aureus colonization
+:::::* Preferred regimen: [[Vancomycin]] alone or in combination with other antibiotics to achieve broader coverage is recommended for prophylaxis in patients with proven or suspected MRSA colonization
-:::::: Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.
+:::::* Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.
-:::::: Note (2): The use of intranasal [[Mupirocin]] is reasonable in nasal carriers of Staphylococcus aureus.
+:::::* Note (2): The use of intranasal [[Mupirocin]] is reasonable in nasal carriers of Staphylococcus aureus.
-{{PBI|Staphylococcus epidermidis}} {{PBI|Staphylococcus haemolyticus}}
+----
-:* [[CoNS|Staphylococcus, coagulase-negative species (CoNS)]]
-::* [[Staphylococcus epidermidis group (Staphylococcus epidermidis, Staphylococcus haemolyticus) ]]
-:::* 1. '''Bacteremia''': most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h {{and}} [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
-::::: Note: Site sepcific recommendation for  peripheral line is to remove line, antibiotics for 5-7 days and for central line may often keep line and systemic antibiotics for 2 wks with antibiotics lock.
-:::* 2. '''CSF shunt''': meningitis
+{{PBI|Staphylococcus haemolyticus}}
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg IV/PO q8h for prosthetic valve IE.
+:* 1. '''Methicillin-susceptible strain'''<ref>{{cite book | last = Abramowicz | first = Mark | title = Handbook of antimicrobial therapy : selected articles from Treatment guidelines with updates from The medical letter | publisher = The Medical Letter | location = New Rochelle, N.Y | year = 2011 | isbn = 978-0981527826 }}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg IV/PO q8h.
+::* Preferred regimen (1): [[Nafcillin]] 1–2 g IV q4-6h (maximum 12 g/day)
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
+::* Preferred regimen (2): [[Oxacillin]] 1–2 g IVq4-6h (maximum 12 g/day)
-::::: Note: Shunt removal usually recommended but variable. [[Vancomycin]] 22.5 mg/kg IV q12h and [[rifampin]] PO/IV and possible intraventricular antibiotics: [[Vancomycin]] 20 mg/day with or without [[Gentamicin]] 4-8 mg/day is recommended.
+::* Preferred regimen (3): [[Cefazolin]] 0.5–2 g IV q6-8h
+::* Alternative regimen (1): [[TMP-SMX]] 4–5 mg/kg IV q6–12h
+::* Alternative regimen (2): [[Doxycycline]] 100–200 mg IV q12-24h
+:* 2. '''Methicillin-resistant, Glycopeptide-susceptible strain'''
+::* Preferred regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
+:* 3. '''Methicillin-resistant, Glycopeptide-resistant strain'''
+::* Preferred regimen (1): [[Daptomycin]] 4–6 mg/kg IV q24h
+::* Preferred regimen (2): [[Linezolid]] 600 mg PO/IV q12h
-:::* 3. '''Peritoneal dialysis catheter''': peritonitis
+----
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
-::::: Note: Site sepcific recommendation is to keep dialysis catheter (at least for first effort) and IV [[Vancomycin]] (usually 2 g IV/wk and redose when level <15 mcg/mL) with antibiotics lock for 10-14 days.
-:::* 4. '''Prosthetic joint''': septic arthritis
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
-::::: Note: Site sepcific recommendation is typically remove joint (two stage more common than single stage replacement), antibiotics for 6 wks. If very early infection (less than 3 wks post-op, debridement and retention an option).
-:::* 5. '''Prosthetic or natural cardiac valve''': endocarditis
+{{PBI|Staphylococcus epidermidis}}
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
+:*Staphylococcus epidermidis<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
+:*1. '''Methicillin-sensitive Staphylococcus epidermidis'''
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
+::* Preferred regimen (1): [[Oxacillin]] 1-2 g IV q4h
-::::: Note: Site sepcific recommendation is consider valve replacement and antibiotics for 6 wks.
+::* Preferred regimen (2): [[Nafcillin]] 1-2 g IV q4h
+::* Preferred regimen (3): [[Cephalothin]]
+::* Alternative regimen: [[Rifampin]] 600 mg/day PO qd {{and}} [[Sulfamethoxazole]] and [[Trimethoprim]] ((or) [[Fluoroquinolones]]) {{and}} [[Daptomycin]] 600 mg PO or IV q12h<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Note: 75% of the S. epidermidis are methicillin-resistant.
+:*2. '''Methicillin-resistant Staphylococcus epidermidis'''
+::* Preferred regimen: [[Vancomycin]] 1 g IV q12h with or without [[Rifampin]] 600 mg/day PO qd
+::* Note: For deep-seated infections consider adding [[Gentamicin]] with or without [[Rifampin]] 600 mg/day PO qd to the regimen<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
+:*3. '''Prosthetic device infections'''
+::* Preferred regimen: [[Oxacillin]] 1-2 g IV q4h ((or) [[Vancomycin]] 1 g IV q12h) {{and}} [[Rifampin]] 600 mg/day PO qd {{and}} [[Gentamicin]] 3 mg/kg/day IV/IM q8-24h is appropriate<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
+::* Note: Duration depends on site of infection and severity.
-:::* 6. '''Post-sternotomy''': osteomyelitis
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
-:::* 7. '''Implants (breast, penile, pacemaker) and other prosthetic devices''': local infection
+----
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
-::::: Note: Site sepcific recommendation for vascular graft is to remove graft, antibiotics for 6 wks.
-:::* 8. '''Post-ocular surgery''': endophthalmitis
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
-:::* 9. '''Surgical site infections'''
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h with or without [[Rifampin]] 300 mg q8h IV/PO {{or}} [[Gentamicin]] 3 mg/kg/day IV q8h added to [[Vancomycin]] {{and}} [[Rifampin]] 300 mg q8h IV/PO for prosthetic valve IE.
-::::* Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): [[Linezolid]] 600 mg IV/PO bd {{or}} [[Daptomycin]] IV 6 mg/kg/day with or without [[Rifampin]] 300 mg q8h IV/PO.
-::::* Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): ([[Oxacillin]] 1.5-3 g IV q6h {{or}} [[Nafcillin]] 1.5-3 g IV q6h), {{or}} [[Cefazolin]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]].
-::::: Note: only assume [[Methicillin]] susceptible if multiple isolates are so identified.
 {{PBI|Staphylococcus lugdunensis}}
-:* [[Staphylococcus lugdunensis]]
+:* Staphylococcus lugdunensis treatment
-:* 1. '''Postpartum mastitis with or without abscess <ref>'''{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* 1. '''Skin and soft tissue infections'''<ref name="pmid172078">{{cite journal| author=Tashima Y, Hasegawa M| title=Specific inhibition of ouabain sensitive and K+-dependent p-nitrophenylphosphatase by polyamines. | journal=Biochem Biophys Res Commun | year= 1975 | volume= 66 | issue= 4 | pages= 1344-8 | pmid=172078 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=172078  }} </ref>
-::* Preferred regimen: In outpatient is [[Dicloxacillin]] 500 mg po qid {{or}} [[Cephalexin]] 500 mg po qid and in inpatient is  [[Oxacillin]] {{or}} [[Nafcillin]] 2 gm IV q4h
+:::* Preferred regimen: [[Oxacillin]] 1-2 g IV q4h for 1-2 weeks
-::* Alternative regimen: In outpatient is [[Trimethoprim]]-[[Sulfamethoxazole]]-DS tabs 1-2 po bid or, if susceptible, [[Clindamycin]] 300 mg po qid and in inpatient is [[Vancomycin]] 1 gm IV q12h; if over 100 kg, 1.5 gm IV q12h.
+:::* Note:  Abscesses should be drained if possible.
-::: Note (1): Mastitis with no abscess- increase frequency of nursing may hasten response.
+::* 2. ''' Endocarditis'''<ref name="pmid15657200">{{cite journal| author=Anguera I, Del Río A, Miró JM, Matínez-Lacasa X, Marco F, Gumá JR et al.| title=Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles. | journal=Heart | year= 2005 | volume= 91 | issue= 2 | pages= e10 | pmid=15657200 | doi=10.1136/hrt.2004.040659 | pmc=PMC1768720 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15657200  }} </ref>
-::: Note (2): Mastitis with abscess- needle aspiration reported successful. Resume breast feeding from affected breast as soon as pain allows.
+:::* 2.1 '''Native valve infectious endocarditis'''
+::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
+::::* Preferred regimen (for most patients with normal renal function) (2): [[Vancomycin]] 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
+::::* Note: should consist of 6 weeks of parenteral beta-lactam therapy or [[Vancomycin]] (depending on susceptibility testing and beta-lactam hypersensitivity).
+:::* 2.2 '''Prosthetic valve infective endocarditis'''
+::::* Preferred regimen: Combination therapy including a beta-lactam (or [[Vancomycin]]) with an [[Aminoglycoside]]- [[Gentamicin]] 3 mg/kg/day in 1-3 divided doses and [[Rifampin]] 300 mg PO/IV q8h for at least 6 weeks
+::::* Note (1): Combine with [[Vancomycin]] for the entire duration of therapy and [[Gentamicin]] for the first 2 weeks.
+::::* Note (2): The [[Gentamicin]] should be administered for the first 2 weeks of therapy; the beta-lactam (or [[Vancomycin]]) and [[Rifampin]] should be continued for 6 weeks.
+:::::* Note (3): Surgery must be considered given the frequency of valvular compromise in the setting of Staphylococcus lugdunensis infective endocarditis.
+:::::* Note (4): The treatment of Staphylococcus lugdunensis pacemaker endocarditis includes antibiotic therapy as well as removal of the pacer system
+::* 3. '''Bacteremia'''<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
+:::* Preferred regimen: [[Oxacillin]] 1-2 g IV q4h for 1-2 weeks
+::::* Note (1): Bacteremia without endocarditis (often related to an intravascular catheter) appears to have a good prognosis.
+::::* Note (2): For intravascular catheter-related Staphylococcus lugdunensis bacteremia, the catheter should be removed, followed by 14 days of antibiotics, provided that all of the following are applicable
+:::::* 2.1 The patient is not diabetic or immunosuppressed.
+:::::* 2.2 There is no prosthetic material, thrombophlebitis, infective endocarditis, evidence of metastatic infection.
+:::::* 2.3 The patient’s fever and bacteremia resolve within 72 hours after initiation of appropriate antibiotic therapy.
+::* 4. '''Prosthetic devices'''<ref name="pmid21208910">{{cite journal| author=Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al.| title=Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 3 | pages= e18-55 | pmid=21208910 | doi=10.1093/cid/ciq146 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21208910  }} </ref>,<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
+:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
+:::* Preferred regimen (for most patients with normal renal function) (2): [[Vancomycin]] 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
+:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV qd for 3 to 4 weeks
+:::* Preferred regimen (4): [[Linezolid]] 600 mg IV q12h
+::* 5. '''Vertebral osteomyelitis, discitis'''
+:::* Preferred regimen: [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
+::* 6. '''Septic arthritis in adults'''
+:::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV bd, not to exceed 2 g per 24 hours (unless cncentrations in serum are inappropriately low) for 4 weeks.
+:* Staphylococcus lugdunensis treatment
+::* 1. '''Skin and soft tissue infections'''<ref name="pmid172078">{{cite journal| author=Tashima Y, Hasegawa M| title=Specific inhibition of ouabain sensitive and K+-dependent p-nitrophenylphosphatase by polyamines. | journal=Biochem Biophys Res Commun | year= 1975 | volume= 66 | issue= 4 | pages= 1344-8 | pmid=172078 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=172078  }} </ref>
+:::* Preferred regimen: [[Oxacillin]] 1-2 g IV q4h for 1-2 weeks
+:::* Note:  Abscesses should be drained if possible.
+::* 2. ''' Endocarditis'''<ref name="pmid15657200">{{cite journal| author=Anguera I, Del Río A, Miró JM, Matínez-Lacasa X, Marco F, Gumá JR et al.| title=Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles. | journal=Heart | year= 2005 | volume= 91 | issue= 2 | pages= e10 | pmid=15657200 | doi=10.1136/hrt.2004.040659 | pmc=PMC1768720 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15657200  }} </ref>
+:::* 2.1 '''Native valve infectious endocarditis'''
+::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
+::::* Preferred regimen (for most patients with normal renal function) (2): [[Vancomycin]] 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
+::::* Note: should consist of 6 weeks of parenteral beta-lactam therapy or [[Vancomycin]] (depending on susceptibility testing and beta-lactam hypersensitivity).
+:::* 2.2 '''Prosthetic valve infective endocarditis'''
+::::* Preferred regimen: Combination therapy including a beta-lactam (or [[Vancomycin]]) with an [[Aminoglycoside]]- [[Gentamicin]] 3 mg/kg/day in 1-3 divided doses and [[Rifampin]] 300 mg PO/IV q8h for at least 6 weeks
+::::* Note (1): Combine with [[Vancomycin]] for the entire duration of therapy and [[Gentamicin]] for the first 2 weeks.
+::::* Note (2): The [[Gentamicin]] should be administered for the first 2 weeks of therapy; the beta-lactam (or [[Vancomycin]]) and [[Rifampin]] should be continued for 6 weeks.
+:::::* Note (3): Surgery must be considered given the frequency of valvular compromise in the setting of Staphylococcus lugdunensis infective endocarditis.
+:::::* Note (4): The treatment of Staphylococcus lugdunensis pacemaker endocarditis includes antibiotic therapy as well as removal of the pacer system
+::* 3. '''Bacteremia'''<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
+:::* Preferred regimen: [[Oxacillin]] 1-2 g IV q4h for 1-2 weeks
+::::* Note (1): Bacteremia without endocarditis (often related to an intravascular catheter) appears to have a good prognosis.
+::::* Note (2): For intravascular catheter-related Staphylococcus lugdunensis bacteremia, the catheter should be removed, followed by 14 days of antibiotics, provided that all of the following are applicable
+:::::* 2.1 The patient is not diabetic or immunosuppressed.
+:::::* 2.2 There is no prosthetic material, thrombophlebitis, infective endocarditis, evidence of metastatic infection.
+:::::* 2.3 The patient’s fever and bacteremia resolve within 72 hours after initiation of appropriate antibiotic therapy.
+::* 4. '''Prosthetic devices'''<ref name="pmid21208910">{{cite journal| author=Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al.| title=Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 3 | pages= e18-55 | pmid=21208910 | doi=10.1093/cid/ciq146 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21208910  }} </ref>,<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
+:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
+:::* Preferred regimen (for most patients with normal renal function) (2): [[Vancomycin]] 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
+:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV qd for 3 to 4 weeks
+:::* Preferred regimen (4): [[Linezolid]] 600 mg IV q12h
+::* 5. '''Vertebral osteomyelitis, discitis'''
+:::* Preferred regimen: [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
+::* 6. '''Septic arthritis in adults'''
+:::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV bd, not to exceed 2 g per 24 hours (unless cncentrations in serum are inappropriately low) for 4 weeks.
+:* Staphylococcus lugdunensis treatment
+::* 1. '''Skin and soft tissue infections'''<ref name="pmid172078">{{cite journal| author=Tashima Y, Hasegawa M| title=Specific inhibition of ouabain sensitive and K+-dependent p-nitrophenylphosphatase by polyamines. | journal=Biochem Biophys Res Commun | year= 1975 | volume= 66 | issue= 4 | pages= 1344-8 | pmid=172078 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=172078  }} </ref>
+:::* Preferred regimen: [[Oxacillin]] 1-2 g IV q4h for 1-2 weeks
+:::* Note:  Abscesses should be drained if possible.
+::* 2. ''' Endocarditis'''<ref name="pmid15657200">{{cite journal| author=Anguera I, Del Río A, Miró JM, Matínez-Lacasa X, Marco F, Gumá JR et al.| title=Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles. | journal=Heart | year= 2005 | volume= 91 | issue= 2 | pages= e10 | pmid=15657200 | doi=10.1136/hrt.2004.040659 | pmc=PMC1768720 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15657200  }} </ref>
+:::* 2.1 '''Native valve infectious endocarditis'''
+::::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
+::::* Preferred regimen (for most patients with normal renal function) (2): [[Vancomycin]] 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
+::::* Note: should consist of 6 weeks of parenteral beta-lactam therapy or [[Vancomycin]] (depending on susceptibility testing and beta-lactam hypersensitivity).
+:::* 2.2 '''Prosthetic valve infective endocarditis'''
+::::* Preferred regimen: Combination therapy including a beta-lactam (or [[Vancomycin]]) with an [[Aminoglycoside]]- [[Gentamicin]] 3 mg/kg/day in 1-3 divided doses and [[Rifampin]] 300 mg PO/IV q8h for at least 6 weeks
+::::* Note (1): Combine with [[Vancomycin]] for the entire duration of therapy and [[Gentamicin]] for the first 2 weeks.
+::::* Note (2): The [[Gentamicin]] should be administered for the first 2 weeks of therapy; the beta-lactam (or [[Vancomycin]]) and [[Rifampin]] should be continued for 6 weeks.
+:::::* Note (3): Surgery must be considered given the frequency of valvular compromise in the setting of Staphylococcus lugdunensis infective endocarditis.
+:::::* Note (4): The treatment of Staphylococcus lugdunensis pacemaker endocarditis includes antibiotic therapy as well as removal of the pacer system
+::* 3. '''Bacteremia'''<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
+:::* Preferred regimen: [[Oxacillin]] 1-2 g IV q4h for 1-2 weeks
+::::* Note (1): Bacteremia without endocarditis (often related to an intravascular catheter) appears to have a good prognosis.
+::::* Note (2): For intravascular catheter-related Staphylococcus lugdunensis bacteremia, the catheter should be removed, followed by 14 days of antibiotics, provided that all of the following are applicable
+:::::* 2.1 The patient is not diabetic or immunosuppressed.
+:::::* 2.2 There is no prosthetic material, thrombophlebitis, infective endocarditis, evidence of metastatic infection.
+:::::* 2.3 The patient’s fever and bacteremia resolve within 72 hours after initiation of appropriate antibiotic therapy.
+::* 4. '''Prosthetic devices'''<ref name="pmid21208910">{{cite journal| author=Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ et al.| title=Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 3 | pages= e18-55 | pmid=21208910 | doi=10.1093/cid/ciq146 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21208910  }} </ref>,<ref name="pmid19489710">{{cite journal| author=Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP et al.| title=Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 49 | issue= 1 | pages= 1-45 | pmid=19489710 | doi=10.1086/599376 | pmc=PMC4039170 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19489710  }} </ref>
+:::* Preferred regimen (1): [[Vancomycin]] 15 mg/kg IV q12h (target trough concentration, 10 to 15 mcg/mL)
+:::* Preferred regimen (for most patients with normal renal function) (2): [[Vancomycin]] 15 to 20 mg/kg (actual body weight) IV q8-12h -for trough concentration of 15 to 20 mcg/mL (minimum inhibitory concentration, 1 mcg/mL or less)
+:::* Preferred regimen (3): [[Daptomycin]] 6 mg/kg IV qd for 3 to 4 weeks
+:::* Preferred regimen (4): [[Linezolid]] 600 mg IV q12h
+::* 5. '''Vertebral osteomyelitis, discitis'''
+:::* Preferred regimen: [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
+::* 6. '''Septic arthritis in adults'''
+:::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV bd, not to exceed 2 g per 24 hours (unless cncentrations in serum are inappropriately low) for 4 weeks.
+eeks
-:* 2. ''' Non-puerperal mastitis with abscess'''
+----
-::* Preferred regimen: In outpatient is [[Dicloxacillin]] 500 mg po qid {{or}} [[Cephalexin]] 500 mg po qid and in inpatient is  [[Oxacillin]] {{or}} [[Nafcillin]] 2 gm IV q4h
-::* Alternative regimen: In outpatient is [[Trimethoprim]]-[[Sulfamethoxazole]]-DS tabs 1-2 po bid or, if susceptible, [[Clindamycin]] 300 mg po qid and in inpatient is [[Vancomycin]] 1 gm IV q12h; if over 100 kg, 1.5 gm IV q12h.
-::: Note (1): If subareolar & odoriferous, most likely anaerobes; need to add [[Metronidazole]] 500 mg IV/po tid.
-::: Note (2): If not subareolar, staph. Need pretreatment aerobic/anaerobic cultures. Surgical drainage for abscess.
-::: Note (3):Staphylococcus lugdunensis usually susceptible to gentamicin. 75% are penicillin-susceptible.
 {{PBI|Staphylococcus saprophyticus}}
-:* [[Staphylococcus saprophyticus]] treatment
+:* '''Urinary tract infections'''<ref>{{cite book | last = Abramowicz | first = Mark | title = Handbook of antimicrobial therapy : selected articles from Treatment guidelines with updates from The medical letter | publisher = The Medical Letter | location = New Rochelle, N.Y | year = 2011 | isbn = 978-0981527826 }}</ref>
-:* 1. '''Urinary tract infection''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen (1): [[Cephalexin]] 500 mg PO qid
-::* 1.1 '''Acute uncomplicated urinary tract infection (cystitis-urethritis) in females'''
+::* Preferred regimen (2): [[Amoxicillin-Clavulanate]] 875/125 mg PO bid
-:::* Preferred regimen :  [[Cephalosporin]] PO {{or}}  [[Amoxicillin]]-[[Clavulanate]] 625 mg PO {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]]-DS bid for 3 days; if sulfa allergy, [[Nitrofurantoin]] 100 mg po bid for 5 days {{or}} [[Fosfomycin]] 3 gm po as a single dose {{and}} [[Pyridium]].
+::* Preferred regimen (3): [[TMP-SMX]] 160–800 mg PO bid
-:::* Alternative regimen (in sulfa allergy): then 3 days of [[Ciprofloxacin]] 250 mg bid {{or}} [[Ciprofloxacin]]-[[Erythromycin]] 500 mg q24h {{or}} [[Levofloxacin]] 250 mg q24h {{or}} [[Moxifloxacin]] 400 mg q24h {{or}} [[Nitrofurantoin]] 100 mg bid {{or}} [[Fosfomycin]] single 3 gm dose {{and}} [[Phenazopyridine]] [[Pyridium]] 200 mg po tid times 2 days.
+::* Alternative regimen: [[Levofloxacin]] 500 mg PO qd
-:::: Note (1): [[Pyridium]] non-prescription—may relieve dysuria. Hemolysis if G6PD deficient.
-:::: Note (2): >7-day treatment recommended in pregnancy [discontinue or do not use sulfonamides ([[Trimethoprim]]-[[Sulfamethoxazole]])  near term (2 weeks before EDC) because of potential increase in kernicterus]. If failure on 3-day course, culture and treat for 2 weeks.
+----
-::* 1.2 '''Recurrent urinary tract infection in postmenopausal women'''
-:::* Preferred regimen : [[Trimethoprim]]-[[Sulfamethoxazole]]-DS bid for 3 days; if sulfa allergy, [[Nitrofurantoin]] 100 mg po bid for 5 days {{or}} [[Fosfomycin]] 3 gm po as a single dose {{and}} [[Pyridium]].
-:::* Alternative regimen (in sulfa allergy): then 3 days of [[Ciprofloxacin]] 250 mg bid {{or}} [[Ciprofloxacin]]-[[Erythromycin]] 500 mg q24h {{or}} [[Levofloxacin]] 250 mg q24h {{or}} [[Moxifloxacin]] 400 mg q24h {{or}} [[Nitrofurantoin]] 100 mg bid {{or}} [[Fosfomycin]] single 3 gm dose {{and}} [[Phenazopyridine]] [[Pyridium]] 200 mg po tid times 2 days.
-:::: Note (1): Recurrent urinary tract infection definition is ≥3 culture and symptomatic urinary tract infection in 1 year or 2 urinary tract infection in 6 months. Evaluate for potentially correctable urologic factors like (1) cystocele (2) incontinence (3) increased residual urine volume (≥50 mL).
-:::: Note (2): Nitrofurantoin more effective than vaginal cream in decreasing frequency, but adverse effect is pulmonary fibrosis with long-term [[Nitrofurantoin]] treatment.
 {{PBI|Streptobacillus moniliformis}}
-:* Streptococcus moniliformis treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:* Streptobacillus moniliformis treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
 ::* 1. '''Migratory arthropathy and arthritis'''
@@ Line 660: / Line 755: @@
 ::* 9. '''Renal abscess'''
 :::* Preferred regimen (uncomplicated disease): [[Penicillin G]] 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral [[Amoxicillin]] {{or}} Penicillin Vk complete 14 days.
+----
 {{PBI|Streptococcus anginosus}}
-:* Streptococcus anginosus treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:* 1. '''Dental abscess'''<ref>{{cite book | last = Abramowicz | first = Mark | title = Handbook of antimicrobial therapy : selected articles from Treatment guidelines with updates from The medical letter | publisher = The Medical Letter | location = New Rochelle, N.Y | year = 2011 | isbn = 978-0981527826 }}</ref>
-:::* Preferred regimen: [[Penicillin G]] 2-4 MU IV q4h .
+::* Preferred regimen: [[Penicillin V]] 500 mg PO qid
-:::* Alternative regimen: [[Ceftriaxone]] 2 g IV qd; [[Clindamycin]] 600-900 mg IV q8h or 300-450 mg PO qid {{or}} [[Vancomycin]] 15 mg/kg IV q12h ([[Penicillin-allergic)
+::* Alternative regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
-:::: Note (1): Endocarditis caused by Steptococcus anginosus module for management is follow viridans Streptococci recommendations.
+:* 2. '''Brain abscess'''
+::* Preferred regimen (1): [[Penicillin G]] 18–24 MU/day IV q4–6h
-:::: Note (2): Dental abscesses,sinusitis,fasciitis of head and neck caused by Steptococcus anginosus can be life threatening and require aggressive surgical management and appropriate HEENT module for specific management.
+::* Preferred regimen (2): [[Ceftriaxone]] 2 g IV q12h
+::* Alternative regimen: [[Vancomycin]] 15–20 mg/kg IV q8–12h
-:::: Note (3): Bacteremia caused by Steptococcus anginosus often associated with deep-seated abscess—most often intraabdominal investigation for abscess is required.Drainage is usually recommended.
-:::: Note (4): Brain abscesses caused by Steptococcus anginosus is often polymicrobial,but S.intermedius found in 50-80%.
-:::: Note (5): Infection caused by Steptococcus anginosus is implicated in aspiration pneumonia,lung abscess and empyema.
+----
 {{PBI|Streptococcus pneumoniae}}
 :* Streptococcus pneumonia treatment
+::* 1. '''Lung (Community-acquired pneumonia)'''<ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
-::* 1. '''Lung (pneumonia)'''
+:::* 1.1 '''Penicillin sensitive (minimum inhibitory concentration < 2 mcg/ml)'''
-:::* Community-acquired  pneumonia <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
+::::* Preferred regimen: [[Penicillin G]] 5 to 24 MU IV in equally divided doses q4-6h, [[Amoxicillin]] 1 g PO tid (+/- macrolide)
-::::* 1.1 '''[[Penicillin]] sensitive (minimum inhibitory concentration ≤ 2)'''
+::::* Alternative regimen:  Macrolides ([[Azithromycin]] (IV) 500 mg IV qd for at least 2 days followed by 500 mg PO qd 7 to 10 days or [[Clarithromycin]] extended-release tablets 1000 mg PO qd for 7 days) and Oral Cephalosporins-[[Cefpodoxime]] 200 mg PO bd, ([[Cefprozil]] 500 mg PO bd, [[Cefditoren]] 400 mg PO bd, [[Cefdinir]] 300 mg PO bd), {{or}} parenteral Cephalosporins-[[Ceftriaxone]] 2 g IV q24h (or [[Cefotaxime]] 1-2 g IV q6-8h), [[Clindamycin]] 600 to 1200 mg IV or IM q6-12h, do not give single IM doses >600 mg; IV infusion rates should not exceed 30 mg/min , [[Doxycycline]] 100 mg PO bd, respiratory flouroquniolones.
-:::::* Preferred regimen: [[Penicillin G]] 1-2 MU q6h IV {{or}} [[Amoxicillin]] 500-1000 mg PO tid
+:::* 1.2 '''[[Penicillin]]-resistant ([[Penicillin]] minimum inhibitory concentration ≥2)'''
-:::::* Alternative regimen:  Macrolides and Oral Cephalosporins-[[Cefpodoxime]] 200 mg PO bd, ([[Cefprozil]] 500 mg PO bd, [[Cefditoren]] 400 mg PO bd, [[Cefdinir]] 300 mg PO bd), {{or}} parenteral Cephalosporins-[[Ceftriaxone]] 2 g IV q24h (or [[Cefotaxime]] 1-2 g IV q6-8h), [[Clindamycin]], [[Doxycycline]] 100 mg PO bd, respiratory flouroquniolones.
+::::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h (or [[Cefotaxime]] 1-2 g IV q6-8h), respiratory [[Flouroquniolones]] [[Levofloxacin]] (Levaquin) 500 mg IV/PO q24h for 7 to 14 days or 750 mg IV/PO q24h for 5 days  (or [[Moxifloxacin]] (Avelox) 400 mg PO/IV over 60 minutes q24h for 7 to 14 days)
-::::* 1.2 '''[[Penicillin]]-resistant ([[Penicillin]] minimum inhibitory concentration >8)'''
+::::* Alternative regimen: [[Vancomycin]] 2 g/day IV q6-12h over at least 60 minutes, [[Linezolid]]  600 mg IV/PO q12h for 7 to 21 days , high-dose [[Amoxicillin]] (3 g qd with [[Penicillin]] minimum concentration of inhibitory <4 mcg/mL).
-:::::* Preferred regimen:: [[Ceftriaxone]] 2 g IV q24h (or [[Cefotaxime]] 1-2 g IV q6-8h) {{or}} respiratory flouroquniolones [[Levofloxacin]] (Levaquin) 750 mg {{or}} [[Moxifloxacin]] (Avelox) 400 mg IV/PO q24h,{{or}} [[Doxycycline]] 100 mg PO bd
+::* 2.'''Endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145 }}</ref>
-::::* Alternative regimen: [[Vancomycin]] 15 mg/kg IV q12h {{or}} [[Linezolid]] 600 mg IV/PO q12h, high-dose [[Amoxicillin]] (3 g qd with [[Penicillin]] minimum concentration of inhibitory 4 mcg/mL).
-::* 2.'''Endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
 :::* Preferred regimen (1):  Aqueous crystalline [[Penicillin-G]]  6 MU q4-6h IV  for 4 weeks
+:::* Preferred regimen (2) (who are unable to tolerate beta lactams therapy): [[Vancomycin]] 15 mg/kg IV every 12 hours (target trough concentration, 10 to 15 mcg/mL) [9]; for troughs of 15 to 20 mcg/mL (MIC, 1 mcg/mL or less), dose 15 to 20 mg/kg (actual body weight) IV every 8 to 12 hours for most patients with normal renal function
-:::* Preferred regimen (2) (who are unable to tolerate beta lactams therapy): [[Vancomycin]] 15 mg/kg/day IV q12h
+:::* Preferred regimen (3) (If the isolate is resistant (MIC 2 g/mL) to cefotaxime): [[Cefotaxime]] 1-2 g q8-12h IV or IM (max dose: 12 g/24 hr) {{and}} [[Vancomycin]] 15 mg/kg/day IV q12h {{and}} [[Rifampin]] 300 mg IV/PO q8h for 6 weeks, in combination with appropriate antimicrobial therapy
+:::* Alternative regimen (1): [[Cefazolin]]  0.5-2 g q8h IV or IM (max dose: 12 g/24 hr)
-:::* Preferred regimen (3) (If the isolate is resistant (MIC 2 g/mL) to cefotaxime): [[Cefotaxime]] 1-2 g q8-12h IV or IM (max dose: 12 g/24 hr) {{and}} [[Vancomycin]] 15 mg/kg/day IV q12h {{and}} [[Rifampin]]
+:::* Alternative regimen (2): [[Ceftriaxone]] 2 g IV q12h
+::::* Note : Streptococcus pneumoniae with intermediate doses minimum inhibitory concentration (MIC) 0.12 g/mL–0.5 g/mL [[Penicillin]] resistance (MIC 0.1 to 1.0 g/mL) or high [[Penicillin]] resistance (MIC 2.0 g/mL) is being recovered from patients with bacteremia.
-:::* Alternative regimen: [[Cefazolin]]  0.5-2 g q8h IV or IM (max dose: 12 g/24 hr) {{or}} [[Ceftriaxone]] 2 g IV q12h
+::* 3. '''Sinuses (sinusitis)'''<ref name="pmid22438350">{{cite journal| author=Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA et al.| title=IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. | journal=Clin Infect Dis | year= 2012 | volume= 54 | issue= 8 | pages= e72-e112 | pmid=22438350 | doi=10.1093/cid/cir1043 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22438350  }} </ref>
+:::* Empiric therapy
-::::: Note : S pneumoniae with intermediate doses Minimum inhibitory concentration (MIC) 0.12 g/mL–0.5 g/mL penicillin resistance (MIC 0.1 to 1.0 g/mL) or high penicillin resistance (MIC 2.0 g/mL) is being recovered from patients with bacteremia.
+::::* 3.1 '''For initial empiric treatment of acute bacterial rhinosinusitis in adults'''
+:::::* Preferred regimen: [[Amoxicillin]] 500 mg/[[Clavulanate]] 125 mg PO tid or [[Amoxicillin]] 875 mg/[[Clavulanate]] 125 mg PO bid for 5 to 7 days recommended by the Infectious Disease Society of America (IDSA)
-::* 3. '''Sinuses (sinusitis)'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::::* Alternative regimen (1): [[Doxycycline]] 100 mg PO q12h
-:::* Sinusitis (empiric therapy)
+::::::* Note: [[Doxycycline]] can be used in patients with [[Penicillin]] allergy.
-::::* Preferred regimen: [[amoxicillin]] 500-1000 mg PO tid {{or}} [[Amoxicillin]]/[[Clavulanate]] 875/125 mg PO bd.
+:::::* Alternative regimen (2): A respiratory [[Fluoroquinolone]] ([[Levofloxacin]] or [[Moxifloxacin]]) is another recommended drug for [[Penicillin]]-allergic patients.
+::::* 3.2 '''For second-line high-dose therapy for acute bacterial rhinosinusitis in adults'''
+:::::* Preferred regimen: [[Amoxicillin]] 2 g/[[Clavulanate]] 125 mg PO bid recommended by the Infectious Disease Society of America (IDSA).
+:::::* Note: The second line high dose therapy  is recommended in adults who have failed initial therapy, in regions of high endemic rates (10% or greater) of invasive [[Penicillin]]-nonsusceptible Streptococcus pneumoniae, severe infection.
 ::* 4. '''Bronchi (acute exacerbation of chronic bronchitis)'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[amoxicillin]] 2-3 PO g/day {{or}} [[Doxycycline]] 100 mg PO bd.
+:::* Preferred regimen (1): [[Amoxicillin]] 875 mg PO q12h or 500 mg PO q8h
+:::* Preferred regimen (2): [[Doxycycline]] 100 mg PO q12h
 ::* 5. '''CNS (meningitis)'''<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref>
 :::* Empiric therapy
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg/day IV q12h {{and}} a third-generation cephalosporin ([[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2 g IV q4h or 3 g q6h).
+::::* Preferred regimen: [[Vancomycin]] 15 mg/kg/day IV q12h {{and}} a third-generation cephalosporin ([[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2 g IV q4h or 3 g q6h) {{and}} [[Rifampin]] 600 mg IV qd in combination with [[Vancomycin]]
 ::::* Alternative regimen: [[Meropenem]], fluoroquinolones
 ::::: Note: Middle ear infections (otitis media), peritoneum infections (spontaneous bacterial peritonitis), pericardium infections (purulent pericarditis), skin infections (cellulitis) and eye infections (conjunctivitis) caused by Streptococcus pneumonia.
 ::* '''Prevention'''
 :::* 1. Pneumovax (23-valent) prevents bacteremia; impact on rates of CAP are modest or nil.
@@ Line 718: / Line 808: @@
 :::* 3. Risk for bacteremia in splenectomy, HIV, smokers, black race, multiple myeloma, asthma.
-{{PBI|Streptococcus pyogenes}}
+----
-:* [[Streptococcus pyogenes]] treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* 1. '''Pharynx'''
-:::* 1.1 '''Pharyngitis'''
-::::* Preferred regimen: [[Penicillin]]-benzathine]] [[Penicillin]] 1.2 mU IM  once {{or}}  Penicillin VK 500 mg PO bd or tid for 10 days.
-::::* Alternative regimen (1): [[Amoxicillin]] 750 PO bd or tid for 10 days.
-::::* Alternative regimen (Penicillin allergy) (2): [[Erythromycin]] 500 mg PO bd or tid for 10 days {{or}} ([[Azithromycin]] 500 mg, then 250 mg for 5 days, [[Clarithromycin]] (Biaxin) 1 g XR/day or 500 mg bd for 10 days. Note: 5-10% isolates are macrolide resistant) {{or}} [[Cefpodoxime proxetil]] (Vantin) 200 mg bd for 5 days {{or}} [[Cefdinir]] 300 mg bd PO for 5 days {{or}} [[Cefadroxil]] 500 mg bd PO for 5 days {{or}} [[Loracarbef]] 200 mg PO bd for 5 days.
-::* 1.2 '''Epiglottitis in childern'''
-:::* Preferred regimen: [[Cefotaxime]] 50 mg/kg IV q8h {{or}} [[Ceftriaxone]] 50 mg/kg IV q24h
-:::* alternative regimen: [[Amoxicillin]]-SB 100–200 mg/kg qd q6h {{or}} [[Trimethoprim-Sulfamethoxazole]] 8–12 mg [[Trimethoprim]]/kg qd div q12h
-:::: Note: Have tracheostomy set “at bedside.” Chloro is effective, but potentially less toxic alternative agents available.
-::* 2. '''Skin'''
-:::* 2.1 ''' Erysipelas, lymphangitis, cellulitis'''
-::::* Preferred regimen (1): [[Clindamycin]] 600 mg IV q8h {{and}} [[Penicillin G]] G 4 mU IV q4h. (clindamycin to stop toxin production).
-::::* Preferred regimen (2) topical antimicrobials: [[Retapamulin]] (Altabax) 1% ointment 5, 10 & 15 gm bid  tubes.
-::::: Note: Microbiologic success with [[Retapamulin]] (Altabax) 1% ointment in 90% S. aureus infections and 97% of S. pyogenes infections(do not use for MRSA)
-::::* Alternative regimen: [[Penicillin G]] 2-4 mU IV q4h {{or}} [[Clindamycin]] 600 mg IV q8h {{or}} [[Cefazolin]] 1-2 g IV q6-8h {{or}} [[Cefotaxime]] 2-3 g IV q6-8h {{or}} [[Ceftriaxone]] 2 g/day IV {{or}} [[Vancomycin]] 15 mg/kg IV q12h.
-:::* 2.2 '''Burn wound sepsis'''
-::::* Preferred regimen: [[Vancomycin]] 1 gm IV q12h) {{and}} ([[Amikacin]] 10 mg/kg IV loading dose then 7.5 mg/kg IV q12h) {{and}} [ [[Piperacillin]] 4 gm IV q4h (give ½ q24h dose of [[Piperacillin]] into subeschar tissues with surgical eschar removal within 12 hours)]. Can use [[Piperacillin]]-[[Tazobactam]] if [[Piperacillin]] not available.
-::::: Note: Erythema multiformedue to Herpes simplex type 1, mycoplasma, Streptococcus pyogenes, drugs (sulfonamides, phenytoin, penicillins)
-::* 3. '''Soft tissue'''
+{{PBI|Streptococcus pyogenes}}
-::: Note: For necrotizing fasciitis, surgical consultation for emergent fasciotomy and debridement; repeat debridements usually necessary.
+*1. '''Streptococcus pyogenes tonsilitis'''<ref name="pmid8215292">{{cite journal| author=Betriu C, Sanchez A, Gomez M, Cruceyra A, Picazo JJ| title=Antibiotic susceptibility of group A streptococci: a 6-year follow-up study. | journal=Antimicrob Agents Chemother | year= 1993 | volume= 37 | issue= 8 | pages= 1717-9 | pmid=8215292 | doi= | pmc=PMC188051 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8215292  }} </ref>
+:*Preferred regimen (1): [[Penicillin V]] 250 mg PO bid or tid (for children) 250 mg PO qid or 500 mg PO bid (for adults) for 10 days<ref name="pmid19246689">{{cite journal| author=Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST et al.| title=Prevention of rheumatic fever and diagnosis and treatment of acute Streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Academy of Pediatrics. | journal=Circulation | year= 2009 | volume= 119 | issue= 11 | pages= 1541-51 | pmid=19246689 | doi=10.1161/CIRCULATIONAHA.109.191959 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19246689  }} </ref>
+:*Preferred regimen (2): [[Benzathine penicillin G]] if <27kg: 600,000 U, if >27kg 1,200,000 U IM single-dose<ref name="pmid23091044">{{cite journal| author=Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al.| title=Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2012 | volume= 55 | issue= 10 | pages= 1279-82 | pmid=23091044 | doi=10.1093/cid/cis847 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23091044  }} </ref>
+:*Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day PO qd for 10 days {{or}} 25 mg/kg/day PO bid for 10 days. Its oral suspension is more tolerable to children and it is better absorbed by the GI tract<ref name="pmid12739920">{{cite journal| author=Curtin-Wirt C, Casey JR, Murray PC, Cleary CT, Hoeger WJ, Marsocci SM et al.| title=Efficacy of penicillin vs. amoxicillin in children with group A beta hemolytic streptococcal tonsillopharyngitis. | journal=Clin Pediatr (Phila) | year= 2003 | volume= 42 | issue= 3 | pages= 219-25 | pmid=12739920 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12739920  }} </ref>
+:*Alternative regimen (2): first generation [[Cephalosporins]] are acceptable for treating recurrent group A streptococcus infection but not as first-line therapy<ref name="pmid15805383">{{cite journal| author=Pichichero ME| title=A review of evidence supporting the American Academy of Pediatrics recommendation for prescribing cephalosporin antibiotics for penicillin-allergic patients. | journal=Pediatrics | year= 2005 | volume= 115 | issue= 4 | pages= 1048-57 | pmid=15805383 | doi=10.1542/peds.2004-1276 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15805383  }} </ref><ref name="pmid23091044">{{cite journal| author=Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al.| title=Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2012 | volume= 55 | issue= 10 | pages= 1279-82 | pmid=23091044 | doi=10.1093/cid/cis847 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23091044  }} </ref>
+:*Alternative regimen (3): [[Clarithromycin]] 250 mg PO bid for 10 days {{or}} [[Azithromycin]] 12 mg/kg maximum 500 mg PO on day 1 {{then}} 6 mg/kg maximum 250 mg PO qd on days 2 through 5 {{or}} [[Erythromycin]] 20 mg/kg/day PO or 40 mg/kg/day (ethylsuccinate) PO bid for 10 days.
+:*Alternative regimen (4): [[Clindamycin]] for penicillin-intolerant patients with erythromycin-resistant strains.
+:*Note: Intramuscular penicillin is the only therapy that has been shown to prevent initial attacks of rheumatic fever in controlled studies<ref name="pmid14837911">{{cite journal| author=WANNAMAKER LW, RAMMELKAMP CH, DENNY FW, BRINK WR, HOUSER HB, HAHN EO et al.| title=Prophylaxis of acute rheumatic fever by treatment of the preceding streptococcal infection with various amounts of depot penicillin. | journal=Am J Med | year= 1951 | volume= 10 | issue= 6 | pages= 673-95 | pmid=14837911 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14837911  }} </ref>
+*2. '''Recurrent Streptococcus pyogenes tonsilitis'''<ref name="pmid12087516">{{cite journal| author=Bisno AL, Gerber MA, Gwaltney JM, Kaplan EL, Schwartz RH, Infectious Diseases Society of America| title=Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2002 | volume= 35 | issue= 2 | pages= 113-25 | pmid=12087516 | doi=10.1086/340949 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12087516  }} </ref>
+:*Preferred regimen (1): [[Clindamycin]] 20-30 mg/kg/day PO tid (for children), 600 mg/day bid, tid or qid (for adults) for 10 days
+:*Preferred regimen (2): [[Amoxicillin-clavulanic acid]] 40 mg/kg/day PO tid (for children), 500 mg bid (for adults) for 10 days
+:*Alternative regimen: [[Benzathine penicillin G]] if <27kg: 600,000 U, if >27kg 1,200,000 U IM single-dose {{withorwithout}} [[Rifampin]] 20 mg/kg/day PO bid for 4 days
+*3. '''Secondary prophylaxis for rheumatic fever'''<ref name="pmid23091044">{{cite journal| author=Shulman ST, Bisno AL, Clegg HW, Gerber MA, Kaplan EL, Lee G et al.| title=Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2012 | volume= 55 | issue= 10 | pages= 1279-82 | pmid=23091044 | doi=10.1093/cid/cis847 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23091044  }} </ref>
+:*Preferred regimen (1): [[Benzathine penicillin G]] if <27kg: 600,000 U, if >27kg 1,200,000 U IM every 4 weeks
+:*Alternative regimen (1): [[Penicillin V]] potassium 250 mg PO bid
+:*Alternative regimen (2): [[Sulfadiazine]] if <27kg 0.5 g PO qd, if >27kg 1 g PO qd
+:*Duration of treatment: if residual cardiac disease, keep treatment until 40 patient is 40 years old or for 10 years (whichever is longer); if there's no residual cardiac disease keep treatment for 10 years or until age 21 years (whichever is longer); if there's rheumatic fever without carditis keep it for 5 years or until age 21 years (whichever is longer).
+:*Note: For patients allergic to penicillin and sulfadiazine, consider a macrolide or azalide antibiotic
+*4. '''Streptococcus pyogenes bacteremia'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*Preferred regimen: [[Penicillin G]] 4 million units IV q4h {{and}} [[Clindamycin]] 900 mg IV q8h for at least 14 days
+:* [[Penicillin]] is added to the regimen to cover any other group A streptococcus which might be resistant to [[Clindamycin]].
+:*Alternative regimen (1): [[Erythromycin]]
+:*Alternative regimen (2): [[Azithromycin]]
+:*Alternative regimen (3): [[Clarithromycin]]
+:*Alternative regimen (4): any other β-lactam<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*Note (1): Macrolide resistance is increasing.
+:*Note (2): Consider using intravenous immune globulin in patients with invasive infection and signs of shock. Immunoglobulin-G IV 1 g/kg day 1, then 0.5 g/kg days 2 & 3.
+:*Note (3): If shock, administer massive IV fluids (10-20 L/day), [[Albumin]] if <2 g/dL, debridement of necrotic tissue.
+*5. '''Streptococcus pyogenes celulitis'''
+:*Preferred regimen: treat as Streptococcus pyogenes bacteremia
+*6 '''Epiglottitis in childern'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*Preferred regimen (1): [[Cefotaxime]] 50 mg/kg IV q8h
+:*Preferred regimen (2): [[Ceftriaxone]] 50 mg/kg IV q24h
+:*Alternative regimen (1): [[Amoxicillin]]-SB 100–200 mg/kg qd q6h
+:*Alternative regimen (2): [[Trimethoprim-Sulfamethoxazole]] 8–12 mg/kg bid
+:*Note: Have tracheostomy set “at bedside.” Chloro is effective, but potentially less toxic alternative agents available.
+*7 '''Burn wound sepsis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*Preferred regimen: [[Vancomycin]] 1 gm IV q12h {{and}} ([[Amikacin]] 10 mg/kg IV loading dose then 7.5 mg/kg IV q12h) {{and}} [ [[Piperacillin]] 4 g IV q4h (give ½ q24h dose of [[Piperacillin]] into subeschar tissues with surgical eschar removal within 12 hours]. Can use [[Piperacillin]]-[[Tazobactam]] if [[Piperacillin]] not available.
+*8. '''Soft tissue'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*Note: For necrotizing fasciitis, surgical consultation for emergent fasciotomy and debridement; repeat debridements usually necessary.
+*9. '''Muscle'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*Note: For myositis-debirdement is recommended.
+*10.''' Eye'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*10.1 '''Keratitis '''
+::*10.1.1 '''Acute bacterial keratitis'''
+:::*Preferred regimen: [[Moxifloxacin]] eye gtts. 1 gtt tid for 7 days
+:::*Alternative therapy: [[Gatifloxacin]] eye gtts. 1-2 gtts q2h while awake for 2 days, then q4h for 3-7 days.
+:::*Note: Prefer [[Moxifloxacin]] due to enhanced lipophilicity and penetration into aqueous humor (1 gtt = 1 drop).
+::*10.1.2 '''Keratitis due to dry cornea, diabetes, immunosuppression'''
+:::*Preferred regimen: [[Cefazolin]] (50 mg/mL) {{and}} ([[Gentamicin]] {{or}} [[Tobramycin]] (14 mg/mL) q15–60 min around clock for  24–72 hrs, then slow reduction)
+:::*Alternative therapy: [[Vancomycin]] (50 mg/mL) {{and}} [[Ceftazidime]] (50 mg/mL) q15–60 min around clock for 24–72 hrs, then slow reduction.
+:::*Note: Specific therapy guided by results of alginate swab culture and sensitivity. [[Ciprofloxacin]] 0.3% found clinically equivalent to [[Cefazolin]]{{and}} [[Tobramycin]]; only concern was efficacy of [[Ciprofloxacin]] vs S. pneumoniae
+:*10.2 '''Dacryocystitis (lacrimal sac)'''
+::*Preferred regimen: [[Moxifloxacin]] 1 gtt tid for 7 days {{or}} [[Cefazolin]] (50 mg/mL) (1 gtt = 1 drop)
+*11.''' Suppurative phlebitis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h (normal weight)
+:*Alternative regimen: [[Daptomycin]] 6 mg/kg IV q12h
+:*Note: Retrospective study for suppurative phlebitis recommends 2-3 weeks IV therapy and 2 weeks PO therapy.
+*12. ''' Infected prosthetic joint'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*Preferred regimen: [[Penicillin G]] 2 million units IV q4h {{or}} [[Ceftriaxone]] 2 g IV q24h for 4 weeks
+:*Note: Debridement & prosthesis retention with intravenous antibiotics.
+*13. ''' “Hot” tender parotid swelling'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*Preferred regimen: [[Nafcillin]] {{or}} [[Oxacillin]] 2 g IV q4h
+:*Note: Predisposing factors are stone(s) in Stensen’s duct, dehydration. Therapy depends on ID of specific etiologic organism.
+*14. '''Diabetic foot ulcer (ulcer with <2 cm of superficial inflammation)'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:*Preferred regimen: ([[Trimethoprim-Sulfamethoxazole]] 800/160 mg 1-2 tabs PO bid {{or}} [[Minocycline]] 100 mg PO bid) {{and}} ([[Penicillin VK]] 500 mg PO qid {{or}} selected  [[Cephalosporins]] 2nd, 3rd generation - cefprozil 500 mg PO bid {{or}} cefuroxime axetil 500 mg PO bid {{or}} cefdinir 300 mg PO bid or 600 mg PO qd {{or}} cefpodoxime 200 mg PO bid {{or}} [[Fluoroquinolones]] Levofloxacin 750 mg PO qd).
+*15. ''' Recurrent cellulitis, chronic lymphedema prophylaxis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:* Preferred regimen: [[Clindamycin]] 150 mg PO qd {{or}} [[Trimethoprim]]-[[Sulfamethoxazole]] 800/160 mg 1 tablet PO qd {{or}} “stand-by therapy” immediate treatment with [[Penicillin V]] {{or}} [[Amoxicillin]] 500-750 mg PO bd at onset of symptoms.
-::* 4. '''Muscle'''
-::: Note: For myositis-debirdement is recommended.
-::* 5. '''Toxin mediated'''
+----
-:::* 5.1 '''Toxic shock syndrome'''
-::::* Preferred regimen (1): [[Penicillin G]] 24 MU qd IV {{and}} [[Clindamycin]] 900 mg IV q8h
-::::* Preferred regimen (2): Immunoglobulin-G IV 1 gm/kg day 1, then 0.5 gm/kg days 2 & 3.,massive IV fluids (10-20 L/day), [[Albumin]] if <2 g/dL, debridement of necrotic tissue
-::::* Alternative regimen: [[Ceftriaxone]] 2 gm IV q24h {{and}} [[Clindamycin]] 900 mg IV q8h
-::::: Note (1): Surgery usually required.
-::::: Note (2): Mortality with fasciitis 30–50%, myositis 80% even with early treatment.
-::::: Note (3): [[Clindamycin]] decreases toxin production.
-::::: Note (4): Use of NSAID may predispose to TSS.
-::::: Note (5): For reasons [[Penicillin G]] may fail in fulminant Streptococcus pyogenes infections
-::::: Note (6):Immunoglobulin-G IV associated with decreased in sepsis-related organ failure.  IVIG preparations vary in neutralizing antibody content.
-::* 6. '''Breast implant infection'''
+{{PBI|Streptococcus agalactiae}}
-:::* Preferred regimen for acute infection: [[Vancomycin]] 1 gm IV q12h; if over 100 kg, 1.5 gm q12h.
+:*'''Streptococcus agalactiae treatment''' (GBS-group B Streptococcus)
-:::: Note: Acute infection caused by Staphylococcus aureus, Sreptococcus pyogenes. Toxic shock syndrome reported.
+::* 1. '''Early onset group B streptococcal infections'''<ref>{{cite web|title=group B Streptococcus infections|url=http://redbook.solutions.aap.org/book.aspx?bookid=1484}}</ref>
-:::* Preferred regimen for chronic infection:
+:::* 1.1 '''Bacteremia or sepsis or pneumonia'''
-:::: Note (1): For chronic infections look for rapidly growing Mycobacteria
+::::* 1.1.1 '''Empiric therapy'''
-:::: Note (2): For chronic infections wait for culture results.
+:::::* Preferred regimen: [[Ampicillin]] 150 mg/kg IV q12h for 10 days {{and}} [[Gentamicin]] 4 mg/kg IV q12h for 10 days-for infants born at ≥ 35 weeks gestation; [[Gentamicin]] 3 mg/kg IV q24h for 10 days-for infants born at < 35 weeks gestation
+::::* 1.1.2 '''Definitive therapy'''
+:::::* Preferred regimen: [[Penicillin G]] 50,000-100,000 units/kg per day IV divided q12h for 10 days
+:::* 1.2 '''Meningitis'''
+::::* 1.2.1 '''Empiric therapy'''
+:::::* Preferred regimen: [[Ampicillin]] 100-150 mg/kg IV q8h for 14-21 days {{and}} [[Gentamicin]] 4 mg/kg IV q24h for 14-21 days-for infants born at ≥ 35 weeks gestation; [[Gentamicin]] 3 mg/kg IV q24h for 14-21 days-for infants born at < 35 weeks gestation
+::::* 1.2.2 '''Definitive therapy'''
+:::::* Preferred regimen: [[Penicillin G]] 250,000-450,000 units/kg per day IV divided q8h for 14-21 days
+:::::* Note: Cellulitis is the most frequent clinical manifestation of GBS-associated skin and soft tissue infections.
+::* 2. '''Late onset group b streptococcus infections in neonates and young infants (age > 1 week and body weight ≥ 1 kg with normal renal function)'''<ref>{{cite web|title=group B Streptococcus infections|url=http://redbook.solutions.aap.org/book.aspx?bookid=1484}}</ref>
+:::* 2.1 Bacteremia without a focus
+::::* 2.1.1 '''Empiric therapy'''
+:::::* Preferred regimen: [[Ampicillin]] IV for 10 days, [[Nafcillin]] IV for 10 days, ({{or}} [[Vancomycin]] IV for 10 days) {{and}} [[Gentamicin]] IV for 10 days ({{or}} [[Cefotaxime]] IV for 10 days)
+::::* 2.1.2 '''Definitive therapy'''
+:::::* Preferred regimen: [[Penicillin G]] 75,000-150,000 units/kg per day IV divided q8h for 10 days
+:::* 2.2 '''Meningitis'''
+::::* 2.2.1 '''Empiric therapy'''
+:::::* Preferred regimen: [[Ampicillin]] IV for 14-21 days with or without [[Vancomycin]] IV for 14-21 day {{and}} [[Gentamicin]] IV for 14-21 days {{or}} [[Cefotaxime]] IV for 14-21 day
+::::* 2.2.2 '''Definitive therapy'''
+:::::* Preferred regimen: [[Penicillin G]] 450,000-500,000 units/kg per day IV divided q6h for 14-21 days
+:::* 2.3 '''Cellulitis or adenitis'''
+::::* 2.3.1 '''Empiric therapy'''
+:::::* Preferred regimen: [[Nafcillin]] IV for 10-14 days ({{or}} [[Vancomycin IV for 10-14 days) {{and}} [[Gentamicin]] IV for 10-14 days ({{or}} [[Cefotaxime]] IV for 10-14 days)
+::::* 2.3.2 '''Definitive therapy'''
+:::::* Preferred regimen: [[Penicillin-G]] 75,000-150,000 units/kg per day IV divided q8h for 10-14 days
+:::* 2.4 '''Septic arthritis'''
+::::* 2.4.1 '''Empiric therapy'''
+:::::* Preferred regimen: [[Nafcillin]] IV for 14-21 days {{or}} [[Vancomycin]] IV for 14-21 days {{and}} [[Cefotaxime]] IV for 14-21 days
+::::* 2.4.2 '''Definitive therapy'''
+:::::* Preferred regimen: [[Penicillin-G]] 75,000-150,000 units/kg per day IV divided q8h for 14-21 days
+:::* 2.5 Osteomyelitis
+::::* 2.5.1 '''Empiric therapy'''
+:::::* Preferred regimen: [[Nafcillin]] IV for 21-28 days {{or}} [[Vancomycin]] IV for 21-28 days {{and}} [[Cefotaxime]] IV for 21-28 days
+::::* 2.5.2 '''Definitive therapy'''
+:::::* Preferred regimen: [[Penicillin-G]] 75,000-150,000 units/kg per day IV divided q8h for 21-28 days
+:::* 2.6 Urinary tract infection
+::::* 2.6.1 '''Empiric therapy'''
+:::::* Preferred regimen: [[Ampicillin]] IV for 10 days, [[Nafcillin]] IV for 10 days, ({{or}} [[Vancomycin]] IV for 10 days) {{and}} [[Gentamicin]] IV for 10 days ({{or}} [[Cefotaxime]] IV for 10 days)
+::::* 2.6.2 '''Definitive therapy'''
+:::::* Preferred regimen: [[Penicillin-G]] 75,000-150,000 units/kg per day IV divided q8h for 10 days
-::* 7.''' Acute mastoiditis'''
+:* '''Neonatal prophylaxis'''<ref name="pmid24446442">{{cite journal| author=Mukhopadhyay S, Dukhovny D, Mao W, Eichenwald EC, Puopolo KM| title=2010 perinatal GBS prevention guideline and resource utilization. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 2 | pages= 196-203 | pmid=24446442 | doi=10.1542/peds.2013-1866 | pmc=PMC3904275 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24446442  }} </ref>
-:::* 7.1 '''Outpatient  treatment'''
+::* '''Group B streptococcus infection (maternal dose for neonatal prophylaxis)'''
-::::* 7.1.1 '''Adult doses for sinusitis'''
+:::* Preferred regimen: [[Penicillin-G]], [[Ampicillin]] 2 g IV initial dose, {{then}} 1 g q4h until delivery, [[Cefazolin]] ≥ 4h prior to delivery
-:::::* Preferred regimen: [[Amoxicillin-Clavulanate-ES]] 2000/125 mg PO bid {{or}} [[Amoxicillin HD]] high dose 1 gm PO tid {{or}} [[Clarithromycin]] 500 mg PO bid or [[Clarithromycin]] ext. release 1 gm PO q24h {{or}} [[Doxycycline]] 100 mg PO bid, respiratory [[Fluoroquinolones]] ([[Gatifloxacin]] 400 mg PO q24h (not available in USA) due to hypo/hyperglycemia {{or}} [[Gemifloxacin]] 320 mg PO q24h (not FDA indication but should work) {{or}} [[Levofloxacin]] 750 mg PO q24h for 5 days {{or}} [[Moxifloxacin]] 400 mg PO q24h) {{or}} [[Cephalosporins]] ([[Cefdinir]] 300 mg PO q12h or 600 mg PO q24h {{or}} [[Cefpodoxime]] 200 mg PO bid {{or}} [[Cefprozil]] 250–500 mg PO bid {{or}} [[Cefuroxime]] 250 mg PO bid),  {{or}} [[Trimethoprim-Sulfamethoxazole]] 1 double-strength ([[Trimethoprim]] 160 mg PO) bid (results after 3- and 10-day treatment  similar).
-::::* 7.1.2 '''Pediatric doses for sinusitis '''
-:::::* Preferred regimen: [[Amoxicillin HD]] high dose 90 mg/kg PO q8h or q12h {{or}} [[Amoxicillin-Clavulanate-ES]] (extra strength) pediatric susp 90 mg [[Amoxicillin]]/kg/day PO qd q12h {{or}} [[Azithromycin]] 10 mg/kg PO qd, then 5 mg/kg PO qd 3 days {{or}} [[Clarithromycin]] 15 mg/kg PO qd q12h {{or}} [[Cefpodoxime]] 10 mg/kg PO qd (max. 400 mg) q12–24h {{or}} [[Cefuroxime axetil]] 30 mg/kg PO qd q12h {{or}} [[Cefdinir]] 14 mg/kg PO qd q24h or bid {{or}} [[Trimethoprim-Sulfamethoxazole]] 8–12 mg [[Trimethoprim]]/40–60 mg [[Sulfamethoxazole]]/kg PO qd q12h
-:::::: Note: need [[Vancomycin]] {{or}} [[Nafcillin]]/[[Oxacillin]] if culture positive for Staphylococcus aureus.
-:::*7.2 '''Hospitalized treatment'''
-::::* Preferred regimen: [[ Cefotaxime]] 1–2 gm IV q4–8h (depends on severity) {{or}} [[Ceftriaxone]] 1 gm IV q24h)
-::* 8.''' Eye'''
+====Bacteria – Gram-Positive Bacilli====
-:::* 8.1 '''Keratitis '''
-::::* 8.1.1 '''Acute bacterial keratitis'''
-:::::* Preferred regimen: [[Moxifloxacin]] eye gtts. 1 gtt tid for 7 days
-:::::* Alternative therapy: [[Gatifloxacin]] eye gtts. 1-2 gtts q2h while awake for 2 days, then q4h for 3-7 days.
-:::::: Note: Prefer [[Moxifloxacin]] due to enhanced lipophilicity and penetration into aqueous humor (1 gtt = 1 drop).
-::::* 8.1.2 '''Keratitis due to dry cornea, diabetes, immunosuppression'''
-:::::* Preferred regimen: [[Cefazolin]] (50 mg/mL) {{and}} ([[Gentamicin]] {{or}} [[Tobramycin]] (14 mg/mL) q15–60 min around clock for  24–72 hrs, then slow reduction)
-:::::* Alternative therapy: [[Vancomycin]] (50 mg/mL) {{and}} [[Ceftazidime]] (50 mg/mL) q15–60 min around clock for 24–72 hrs, then slow reduction.
-:::::: Note: Specific therapy guided by results of alginate swab culture and sensitivity. [[Ciprofloxacin]] 0.3% found clinically equivalent to [[Cefazolin]]{{and}} [[Tobramycin]]; only concern was efficacy of [[Ciprofloxacin]] vs S. pneumoniae
-:::*  8.2 Dacryocystitis (lacrimal sac)
-:::::* Preferred regimen: [[Moxifloxacin]] eye gtts. 1 gtt tid for 7 days {{or}} [[Cefazolin]] (50 mg/mL) (1 gtt = 1 drop)
-::* 9.''' Suppurative phlebitis'''
-:::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h (normal weight):::* Alternative regimen: [[Daptomycin]] 6 mg/kg IV q12h:::: Note: Retrospective study for suppurative phlebitis recommends 2-3 weeks IV therapy and 2 weeks PO therapy.
-::* 10. ''' Infected prosthetic joint'''
+{{PBI|Actinomycosis}}
-:::* Preferred regimen: [[Penicillin G]] 2 MU IV q4h {{or}} [[Ceftriaxone]] 2 gm IV q24h for 4 wks.
+*'''Actinomyces species including A. israeli'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-:::: Note: Debridement & prosthesis retention with intravenous antibiotics.
+:*Preferred regimen: [[Penicillin]] 3-4 million units IV q4h for 2-6 weeks {{then}} [[Penicillin V]] 2-4 g/day PO qid for 6-12 months
+:*Alternative regimen (1): [[Erythromycin]] 500-1000 mg IV q6h {{or}} 500 mg PO qid
+:*Alternative regimen (2): [[Tetracyclin]] 500 mg PO qid
+:*Alternative regimen (3): [[Doxycycline]] 100 mg IV q12h {{or}} 100 mg PO bid
+:*Alternative regimen (4): [[Clindamycin]] 900 mg IV q8h {{or}} 300-450 mg PO qd
+:*Alternative regimen (5): [[Minocycline]] 100 mg IV q12h {{or}} 100 mg PO bid
-::* 11. ''' “Hot” tender parotid swelling'''
-:::* Preferred regimen: [[Nafcillin]] {{or}} [[Oxacillin]] 2 gm IV q4h
-:::: Note: Predisposing factors are stone(s) in Stensen’s duct, dehydration. Therapy depends on ID of specific etiologic organism.
-::* 12. '''Diabetic foot ulcer (ulcer with <2 cm of superficial inflammation)'''
+{{PBI|Arcanobacterium haemolyticum}}
-:::* Preferred regimen: ([[Trimethoprim-Sulfamethoxazole]]-DS 1-2 tabs PO bid {{or}} [[Minocycline]] 100 mg PO bid) {{and}} ([[Penicillin VK 500 mg PO qid{{or}} selected  [[Cephalosporins]] 2, 3 generation - cefprozil 500 mg PO q12h {{or}} cefuroxime axetil 500 mg PO q12h {{or}} cefdinir 300 mg PO q12h or 600 mg PO q24h {{or}} cefpodoxime 200 mgPO  q12h {{or}} [[Fluoroquinolones]] Levo 750 mg po q24h).
+:* Arcanobacterium haemolyticum treatment
+::* Preferred regimen: [[Erythromycin]] Base: 333 mg PO q8h; estolate/stearate/base: 250-500 mg q6h PO
+::* Alternative regimen: [[Benzathine Penicillin G]] 1.2 MU IM q3-4 weeks
+::: Note: Arcanobacterium haemolyticum is sensitivity to most drugs but resistent to [[Trimethoprim]]-[[Sulfamethoxazole]]
-:::: Note (1): Common infections are bacterial pharyngitis and cellulitis. Rare but devastating are toxic shock syndrome, necrotizing fasciitis.
+==Anthracis==
-:::: Note (2): Diagnosis recovery from normally sterile site, ASO antibody response (rheumatic fever),anti-DNAase B (pyoderma). Supportive are positive throat culture or rapid strep antigen test.
+{{PBI|Bacillus anthracis}}
-:::: Note (3): Cellulitis is very hard to detect Group A streptococcus by culture (needle aspiration or blood culture).
-:::: Note (4): Ecologic niche is pharynx. 2-3% of adults colonized, 15-20% school children. Virulence depends on proteins that represent toxins, mimic host macromolecules and after immune responses.
-:::: Note (5): Predisposing factors: soft tissue (IDU, diabetes, surgery, trauma, varicella, vein donor, lymphedema); pneumonia (influenza), contacts w/ gas (pharyngitis and fasciitis).
-:::: Note (6): Mastoiditis has become a rare entity, presumably as result of the aggressive treatment of acute otitis media.
-*'''[[Streptococcus pyogenes]] prophylaxis'''
+:*  '''Bacillus anthracis treatment'''
-:* 1. ''' Acute rheumatic fever prophylaxis'''
-::* Preferred regimen: [[Benzathine Penicillin]] 1.2 mu IM q mo, [[Penicillin V]] 250 mg PO bd, [[Erythromycin]] 250 mg PO bd until >5 yrs post-acute rheumatic fever and age in 20years.
-:* 2. ''' Recurrent cellulitis, chronic lymphedema prophylaxis'''
+::* 1. '''Treatment for cutaneous anthrax, without systemic involvement'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-::* Preferred regimen: [[Clindamycin]] 150 mg PO qd {{or}} [[Trimethoprim]]-[[Sulfamethoxaole]] 1 DS PO qd {{or}} “stand-by therapy” immediate treatment with [[Penicillin V]] {{or}} [[Amoxicillin]] 500-750 mg PO bd at onset of symptoms.
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (1): [[Ciprofloxacin]] 500 mg PO bid for 7-10 days
-{{PBI|Streptococcus agalactiae}}
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (2): [[Doxycycline]] 100 mg PO bid for 7-10 days
-:*Streptococcus agalactiae treatment <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*  1. '''Bacteremia, soft tissue infections'''
-:::* Preferred regimen: [[Penicillin G]] 10-12 MU/day for 10 days [e.g., give 2 MU q4h or six divided doses/day].
-::* 2. '''Meningitis (Adult)'''
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (3): [[Levofloxacin]] 750 mg PO qd for 7-10 days
-:::* Preferred regimen: [[Penicillin G]] 20-24 MU/day for 14-21 days.
-::* 3. '''Osteomyelitis'''
+:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown) (4): [[Moxifloxacin]] 400 mg PO qd for 7-10 days
-:::* Preferred regimen: [[Penicillin G]] 10-20 MU/d for 21-28 days.
-::* 4. '''Endocarditis'''
+:::* Alternative regimen (1): [[Clindamycin]] 600 mg PO tid for 7-10 days
-:::* Preferred regimen: [[Penicillin G]] 20-24 MU/day for 4-6 wks {{and}} [[Gentamicin]] 1 mg/kg q8h for first 2 wks.
-:::: Note (1):[[Gentamicin]] 1 mg/kg q8h IV additionally for any serious group B Streptococcus infection.
+:::* Alternative regimen (2): [[Amoxicillin]] 1 g PO tid (for penicillin-susceptible strains) for 7-10 days
-:::: Note (2): [[Penicillin]] allergic may substitute [[Vancomycin]] 15 mg/kg IV q12h for [[Penicillin]].
-:::: Note (3): [[Clindamycin]] can be considered, but rates of resistance vary. Consider confirming absence of inducible [[Clindamycin]] resistance (typically associated with macrolide resistance) before using as monotherapy.
-:::: Note (4): Streptococcus agalactiae causes neonatal sepsis or meningitis, puerperal sepsis, chorioamnionitis; also bacteremia (often without clear source), skin and soft-tissue infections, septic arthritis. Found in gastrointestinal,genitourinary tracts. More common in adults >65 years and those with comorbidities.
-====Bacteria – Gram-Positive Bacilli====
+:::* Alternative regimen (3): [[Penicillin VK]] 500 mg PO qid (for penicillin-susceptible strains) for 7-10 days
-{{PBI|Actinomyces israelii}}
-:* Actinomyces israelii treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Penicillin G]] 6 MU q4-6h IV or IM {{or}} [[Ampicillin]] 250-500 mg q4-8h IV or IM / [[Amoxicillin]] 250-500 mg q8-12h PO {{or}} antipseudomonal [[Penicillin]] {{or}}  most [[Cephalosporins]] {{or}} [[Macrolides]] {{or}} [[Tetracycline]] {{or}} [[Imipenem]] {{or}} [[Clindamycin]]
+:::* Note: Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.
-{{PBI|Arcanobacterium haemolyticum}}
+::* 2. '''Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-:* Arcanobacterium haemolyticum treatment
-::* Preferred regimen: [[Erythromycin]] Base: 333 mg PO q8h; estolate/stearate/base: 250-500 mg q6h PO
-::* Alternative regimen: [[Benzathine Penicillin G]] 1.2 MU IM q3-4 weeks
-::: Note: Arcanobacterium haemolyticum is sensitivity to most drugs but resistent to [[Trimethoprim]]-[[Sulfamethoxazole]]
-{{PBI|Bacillus anthracis}}
-:* [[Bacillus anthracis]], treatment
-::* 1. '''Treatment for cutaneous anthrax, without systemic involvement'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-:::* Preferred regimen (regardless of penicillin susceptibility or if susceptibility is unknown): [[Ciprofloxacin]] 500 mg PO q12h {{or}} [[Doxycycline]] 100 mg PO q12h {{or}} [[Levofloxacin]] 750 mg PO q24h {{or}} [[Moxifloxacin]] 400 mg PO q24h
-:::* Alternative regimen: [[Clindamycin]] 600 mg PO q8h {{or}} [[Amoxicillin]] 1 g PO q8h (for penicillin-susceptible strains) {{or}} [[Penicillin VK]] 500 mg PO q6h (for penicillin-susceptible strains)
-:::: Note: Duration of treatment is 60 days for bioterrorism-related cases and 7-10 days for naturally acquired cases.
-::* 2. '''Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
 :::* 2.1 '''Systemic anthrax with possible/confirmed meningitis'''
-::::* 2.1.1 '''Bactericidal agent''' (fluoroquinolone): '''[[Ciprofloxacin]] 400 mg IV q8h''' ({{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h) {{and}}
-::::* 2.1.2 '''Bactericidal agent (ß-lactam) for all strains, regardless of penicillin susceptibility or if susceptibility is unknown''': '''[[Meropenem]] 2 g IV q8h''' {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Penicillin G]] 4 MU IV q4h (for penicillin-susceptible strains) {{or}} [[Ampicillin]] 3 g IV q6h (for penicillin-susceptible strains) {{and}}
-::::* 2.1.3 '''Protein synthesis inhibitor''': '''[[Linezolid]] 600 mg IV q12h''' {{or}} [[Clindamycin]] 900 mg IV q8h {{or}} [[Rifampin]] 600 mg IV q12h {{or}} [[Chloramphenicol]] 1 g IV q6-8h
-::::: Note (1): Duration of treatment= 2-3 weeks until clinical criteria for stability are met (Preferred drugs are indicated in boldface).
-::::: Note (2): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
-::::: Note (3): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable.
-::::: Note (4): Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
-::::: Note (5): [[Linezolid]] should be used with caution in patients with thrombocytopenia because it might exacerbate it. [[Linezolid]] use for > 14 days has additional hematopoietic toxicity.
-::::: Note (6): [[Rifampin]] is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.
-::::: Note (7): [[Chloramphenicol]] should only be used if other options are not available because of toxicity concerns.
-:::* 2.2 '''Systemic anthrax when meningitis has been excluded'''
+::::* 2.1.1 '''Bactericidal agent''' (fluoroquinolone)
-::::* 2.2.1 '''Bactericidal agent''': '''[[Ciprofloxacin]] 400 mg IV q8h''' {{or}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg q24h {{or}} [[Meropenem]] 2 g IV q8h {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Vancomycin]] 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 µg/mL) {{or}} [[Penicillin G]] 4 MU IV q4h (penicillin-susceptible strains) {{or}} [[Ampicillin]] 3 g IV q6h (penicillin-susceptible strains) {{and}}
-::::* 2.2.2 '''Protein synthesis inhibitor''': '''[[Clindamycin]] 900 mg IV q8h''' {{or}} '''[[Linezolid]] 600 mg IV q12h''' {{or}} [[Doxycycline]] 200 mg IV initially, then 100 mg IV q12h {{or}} [[Rifampin]] 600 mg IV q12h
-::::: Note (1): Duration of treatment: for 2 weeks until clinical criteria for stability are met (Preferred drugs are indicated in boldface).
-::::: Note (2): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
-::::: Note (3): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment, or if first-line treatment is unavailable.
-::::: Note (4): Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
-::::: Note (5): [[Linezolid]] should be used with caution in patients with thrombocytopenia because it might exacerbate it. [[Linezolid]] use for > 14 days has additional hematopoietic toxicity.
-::::: Note (6): [[Rifampin]] is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.
-::::: Note (7): A single 10-14 days course of [[Doxycycline]] is not routinely associated with tooth staining.
-::* 3. '''Specific considerations'''
+:::::* Preferred regimen (1): [[Ciprofloxacin]] 400 mg IV q8h for 2-3 weeks
-:::* 3.1 '''Treatment of anthrax for pregnant Women'''
-::::* 3.1.1 '''Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis''' <ref name="pmid24457117">{{cite journal| author=Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA et al.| title=Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24457117 | doi=10.3201/eid2002.130611 | pmc=PMC3901460 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24457117  }} </ref>
-:::::* 3.1.1.1 ''' A Bactericidal Agent (Fluoroquinolone)''': '''[[Ciprofloxacin]]''' 400 mg IV q8h is preferred, {{or}}  [[Levofloxacin]] 750 mg IV q24h, {{or}}
-:::::* 3.1.1.2 ''' A Bactericidal Agent (ß-lactam)'''
-::::::* 3.1.1.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''': '''[[Meropenem]] 2 g q8h''',{{or}}
-::::::* 3.1.1.2.2 '''Alternatives for penicillin-susceptible strains''': [[Ampicillin]] 3 g IV q6h,{{or}} [[Penicillin G]] 4 million units IV q4h, {{or}}
-:::::* 3.1.1.3 ''' A Protein Synthesis Inhibitor''': '''[[Clindamycin]] 900 IV mg q8h''',{{or}}  [[Rifampin]] 600 IV mg q12h
-:::::: Note (1): At least one antibiotic with transplacental passage is recommended.
-:::::: Note (2): Duration of treatment is for =2–3 weeks until clinical criteria for stability are met. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
-::::* 3.1.2 '''Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded'''
+:::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h for 2-3 weeks
-:::::* 3.1.2.1 ''' A Bactericidal Antimicrobial''': '''[[Ciprofloxacin]] 400 mg IV q8h''' is preferred, {{or}}  [[Levofloxacin]] 750 mg IV q24h, {{or}}
-:::::* 3.1.2.2 ''' A Bactericidal Agent (ß-lactam)'''
-::::::* 3.1.2.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''': '''[[Meropenem]] 2 g q8h''',{{or}}
-::::::* 3.1.2.2.2 '''Alternatives for penicillin-susceptible strains''':[[Ampicillin]] 3 g IV q6h,{{or}} [[Penicillin G]] 4 million units IV q4h, {{or}}
-:::::* 3.1.2.3 ''' A Protein Synthesis Inhibitor''':[[Clindamycin]] 900 IV mg q8h,{{or}}  [[Rifampin]] 600 IV mg q12h
-::::::Note (1): At least one antibiotic with transplacental passage is recommended.
-::::::Note (2):Duration of treatment: for =2 weeks until clinical criteria for stability are met. Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness
-::::* 3.1.3 '''Oral antimicrobial treatment for cutaneous anthrax without systemic involvement'''
+:::::* Preferred regimen (3): [[Moxifloxacin]] 400 mg IV q24h for 2-3 weeks {{and}}
-:::::* 3.1.3.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''': '''[[Ciprofloxacin]] 400 mg IV q8h''' is preferred.
-::::::Note (1): duration of treatment is 60 days
-::::::Note (2): Recommendations are specific to cutaneous anthrax in the setting of bioterrorism.
-:::* 3.2 '''Treatment for anthrax in childern''' <ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
+::::* 2.1.2 '''Bactericidal agent (ß-lactam) for all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::::* 3.2.1 '''Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)'''
-:::::* 3.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''' : '''[[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose)''' {{or}} [[Doxycycline]], <45 kg: 4.4 mg/kg/day, PO, divided q12h (not to exceed 100 mg/dose) =45 kg: 100 mg/dose, PO, given q12h {{or}} [[Clindamycin]], 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) {{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given q24h {{or}}
-:::::* 3.2.1.2 '''Alternatives for penicillin-susceptible strains''': '''[[Amoxicillin]], 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose)''' {{or}} [[Penicillin VK]], 50-75 mg/kg/day, PO, divided q6h to q8h
+:::::* Preferred regimen (1): [[Meropenem]] 2 g IV q8h for 2-3 weeks
-:::::: Note (1): Duration of therapy for naturally acquired infection: 7-10 days and for a biological weapon-related event: will require additional prophylaxis for inhaled spores, to complete an antimicrobial course of up to 60 days from onset of illness.
-:::::: Note (2): Bold font for preferred antimicrobial agent.
-:::::: Note (3): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or first-line therapy is unavailable.
-:::::: Note (4): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-:::::: Note (5): Italicized font indicates FDA approval for the indication in the pediatric population.
-:::::: Note (6): A single 10- to 14-day course of doxycycline is not routinely associated with tooth staining.
-:::::: Note (7): Be aware of the possibility of emergence of penicillin-resistance during monotherapy with amoxicillin or penicillin.
-::::* 3.2.2 ''' Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)'''
+:::::* Preferred regimen (2): [[Imipenem]] 1 g IV q6h for 2-3 weeks
-:::::* 3.2.2.1 '''A bactericidal antimicrobial'''
-::::::* 3.2.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''': '''[[Ciprofloxacin]], 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose)''' {{or}} [[Meropenem]], 60 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) {{or}} [[Levofloxacin]] <50 kg: 20 mg/kg/day, IV, divided q12h (not to exceed 250 mg/dose >50 kg: 500 mg, IV, q24h {{or}} [[Imipenem]]/[[Cilastatin]],a 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) {{or}} [[Vancomycin]], 60 mg/kg/day, IV, divided q8h (follow serum concentrations)
-::::::* 3.2.2.1.2 '''Alternatives for penicillin-susceptible strains''': '''[[Penicillin G]], 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose)''' {{or}} [[Ampicillin]], 200 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) {{and}}
-:::::* 3.2.2.2 '''A Protein Synthesis Inhibitor''': '''[[Clindamycin]], 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose)''' {{or}} [[Linezolid]] (non-CNS infection dose): <12 y old: 30 mg/kg/day, IV, divided q8h =12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) {{or}} [[Doxycycline]] <45 kg: 4.4 mg/kg/day, IV, loading dose (not to exceed 200 mg); =45 kg: 200 mg, IV, loading dose then <45 kg: 4.4 mg/kg/day, IV, divided q12h   (not to exceed 100 mg/dose); =45 kg: 100 mg, IV, given q12h {{or}} Rifampin,d 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)
+:::::* Preferred regimen (3): [[Doripenem]] 500 mg IV q8h for 2-3 weeks
-:::::: Note (1): Duration of therapy for 14 days or longer until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-:::::: Note (2): Systemic anthrax includes inhalation anthrax; injection, gastrointestinal, or cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-:::::: Note (3): Children with altered mental status, signs of meningeal inflammation, or focal neurologic deficits should be considered to have CNS infection if CSF examination is not possible. A normal CSF may not completely exclude deep brain hemorrhage/abscess.
-:::::: Note (4): Bold font for preferred antimicrobial agent.
-:::::: Note (5): Normal font for  alternative selections are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable.
-:::::: Note (6): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-:::::: Note (7): Increased risk of seizures associated with [[Imipenem]]/[[Cilastatin]] therapy.
-:::::: Note (8): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it.[[Linezolid]] use for >14 days carries additional hematopoietic toxicity.
-:::::: Note (9): A single 14-day course of [[Doxycycline]] is not routinely associated with tooth staining.
-:::::: Note (10): [[Rifampin]] is not a protein synthesis inhibitor; it may also be used in combination therapy based on in vitro synergy
-::::* 3.2.3 '''Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older'''
+:::::* Preferred regimen (4): [[Penicillin G]] 4 MU IV q4h (for penicillin-susceptible strains) for 2-3 weeks
-:::::* 3.2.3.1 '''A bactericidal antimicrobial''' (fluoroquinolone): [[Ciprofloxacin]], 30 mg/kg/day, intravenously (IV), divided q8h (not to exceed 400 mg/dose){{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, IV, divided q12h (not to exceed 250 mg/dose); >50 kg: 500 mg, IV, q24h {{or}} [[Moxifloxacin]] 3 months to <2 years: 12 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
-:::::: 2-5 years: 10 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
-:::::: 6–11 years: 8 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose)
-:::::: 12–17 years, =45 kg body weight: 400 mg, IV, once daily
-:::::: 12–17 years, <45 kg body weight: 8 mg/kg/day, IV, divided q12h (not to exceed 200 mg/dose) {{and}}
-:::::* 3.2.3.2 '''A bactericidal antimicrobial (ß-lactam or glycopeptide)'''
+:::::* Preferred regimen (5): [[Ampicillin]] 3 g IV q6h (for penicillin-susceptible strains) for 2-3 weeks {{and}}
-::::::* 3.2.3.2.1 '''For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown''': [[Meropenem]], 120 mg/kg/day, IV, divided q8h (not to exceed 2 g/dose) {{or}} [[Imipenem]]/[[Cilastatin]], 100 mg/kg/day, IV, divided q6h (not to exceed 1 g/dose) {{or}} [[Doripenem]], 120 mg/kg/day, IV, divided q8h (not to exceed 1 g/dose) {{or}} [[Vancomycin]], 60 mg/kg/day, IV, divided q8h
-::::::* 3.2.3.2.2 '''Alternatives for penicillin-susceptible strains''': [[Penicillin G]], 400 000 U/kg/day, IV, divided q4h (not to exceed 4 MU/dose) {{or}} [[Ampicillin]], 400 mg/kg/day, IV, divided q6h (not to exceed 3 g/dose) {{and}}
-::::::* 3.2.3.3 '''A Protein Synthesis Inhibitor''': [[Linezolid]] <12 y old: 30 mg/kg/day, IV, divided every 8 h=12 y old: 30 mg/kg/day, IV, divided q12h (not to exceed 600 mg/dose) {{or}} [[Clindamycin]], 40 mg/kg/day, IV, divided q8h (not to exceed 900 mg/dose)  {{or}} [[Rifampin]], 20 mg/kg/day, IV, divided q12h (not to exceed 300 mg/dose)  {{or}} [[Chloramphenicol]], 100 mg/kg/day, IV, divided q6h
+::::* 2.1.3 '''Protein synthesis inhibitor'''
-::::::: Note (1): Duration of therapy for 2–3 wk or greater, until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-::::::: Note (2): Systemic anthrax includes anthrax meningitis; inhalation anthrax; or injection, gastrointestinal, and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-::::::: Note (3): Children with altered mental status, signs of meningeal inflammation, or focal neurologic deficits should be considered to have CNS infection if CSF examination is not possible. Normal CSF may not completely exclude deep brain hemorrhage/abscess.
-::::::: Note (4): Bold font for preferred antimicrobial agent.
-::::::: Note (5): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot tolerate first-line therapy or if first-line therapy is unavailable.
-::::::: Note (6): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-::::::: Note (7):  A 400-mg dose of [[Ciprofloxacin]], IV, provides an equivalent exposure to that of a 500-mg ciprofloxacin oral tablet.
-::::::: Note (8): Increased risk of seizures associated with [[Imipenem]]/[[Cilastatin]] therapy.
-::::::: Note (9): [[Doripenem]] is approved in Japan at this dose for the treatment of community-acquired bacterial meningitis.
-::::::: Note (10): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it. Linezolid use for >14 days carries additional hematopoietic toxicity.
-::::::: Note (11): [[Rifampin]] is not a protein synthesis inhibitor; it may also be used in combination therapy based on in vitro synergy for some strains of staphylococci. Not evaluated for Bacillus anthracis.
-::::::: Note (12) : [[Chloramphenicol]] Should be used only if other options are not available, because of toxicity concerns.
-::::* 3.2.4 '''Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)'''
+:::::* Preferred regimen (1): [[Linezolid]] 600 mg IV q12h for 2-3 weeks
-:::::* 3.2.4.1 '''A bactericidal antimicrobial'''
-:::::: (a). For all strains, regardless of penicillin susceptibility or if susceptibility is unknown: [[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose) {{or}} [[Levofloxacin]] <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) =50 kg: 500 mg, PO, given q24h {{or}}
-:::::: (b). Alternatives for penicillin-susceptible strains: [[Amoxicillin]], 75 mg/kg/day, PO, divided q8h (not to exceed 1 g/dose) {{or}} [[Penicillin VK]], 50–75 mg/kg/day, PO, divided q6h-q8h {{and}}
-:::::* 3.2.4.2 '''A protein synthesis inhibitor''': [[Clindamycin]] 30 mg/kg/day, PO, divided q8h (not to exceed 600 mg/dose) {{or}} [[Doxycycline]] <45 kg: 4.4 mg/kg/day, PO, divided q12h (not exceed 100 mg/dose) =45 kg: 100 mg, PO, given q12h {{or}} [[Linezolid]] (non-CNS infection dose):
+:::::* Preferred regimen (2): [[Clindamycin]] 900 mg IV q8h for 2-3 weeks
-:::::: <12 y old: 30 mg/kg/day, PO, divided q8h
-:::::: =12 years old: 30 mg/kg/day, PO, divided q12h (not to exceed 600 mg/dose)
-::::::: Note (1): Duration of therapy to complete a treatment course of 14 days or greater. May require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-::::::: Note (2): Severe anthrax includes inhalation anthrax; injection, gastrointestinal, or cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck.
-::::::: Note (3): Bold font for  preferred antimicrobial agent.
-::::::: Note (4): Normal font for alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.
-::::::: Note (5): Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-::::::: Note (6):  A single 14-day course of doxycycline is not routinely associated with tooth staining.
-::::::: Note (7): [[Linezolid]] should be used with caution in patients with thrombocytopenia, as it may exacerbate it. [[Linezolid]] use for >14 days carries additional hematopoietic toxicity.
-::::* 3.2.5 ''' Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)'''
+:::::* Preferred regimen (3): [[Rifampin]] 600 mg IV q12h for 2-3 weeks
-:::::* 3.2.5.1 '''Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)'''
-::::::* 3.2.5.1.1 '''Bactericidal antimicrobial (fluoroquinolone) therapy'''
-:::::::*  3.2.5.1.1.1 '''For 32–34 weeks gestational age '''
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
-:::::::: For 1–4 weeks of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
-:::::::*  3.2.5.1.1.2 '''For 34–37 week gestational age '''
-:::::::: For 0–1 wk of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
-:::::::: For 1–4 wk of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 5 mg/kg/day, q24h
-:::::::*  3.2.5.1.1.3 '''Term Newborn Infant'''
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 10 mg/kg/day, q24h
-:::::::: For 1–4 weeks of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day, divided q12h''' {{or}} [[Moxifloxacin]] IV 10 mg/kg/day, q24h {{and}}
-::::::* 3.2.5.1.2 '''A bactericidal antimicrobial (ß-lactam)'''
+:::::* Preferred regimen (4): [[Chloramphenicol]] 1 g IV q6-8h for 2-3 weeks
-:::::::* 3.2.5.1.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''':
-::::::::* 3.2.5.1.2.1.1 '''For 32–34 weeks gestational age'''
-::::::::: For 0–1 week of Age : '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
-::::::::: For 1–4 wk of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h
-::::::::* 3.2.5.1.2.1.2 '''For 34–37 week gestational age'''
-::::::::: For 0–1 week of Age : '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
-::::::::: For 1–4 week of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h
-::::::::* 3.2.5.1.2.1.3 '''Term Newborn Infant'''
-::::::::: For 0–1 week of Age : '''[[Meropenem]]''' IV 60 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 50 mg/kg/day, divided q12h {{or}} [[Doripenem]] IV 20 mg/kg/day, divided q12h
-::::::::: For 1–4 week of Age : '''[[Meropenem]]''' IV 90 mg/kg/day, divided q8h {{or}} [[Imipenem]] IV 75 mg/kg/day, divided q8h {{or}} [[Doripenem]] IV 30 mg/kg/day,divided q8h {{or}}
-:::::::* 3.2.5.1.2.2 ''' Alternatives for penicillin-susceptible strains'''
-::::::::* 3.2.5.1.2.2.1 '''For 32–34 weeks gestational age'''
-::::::::: For 0–1 week of Age : '''[[Penicillin G]]''' 200000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 100 mg/kg/day divided q12h,
-::::::::: For 1–4 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
-::::::::* 3.2.5.1.2.2.2 '''For 34–37 week gestational age'''
-::::::::: For 0–1 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
-::::::::: For 1–4 week of Age : '''[[Penicillin G]]''' 400000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 200 mg/kg/day divided q12h,
-::::::::* 3.2.5.1.2.2.3 '''Term Newborn Infant'''
-::::::::: For 0–1 week of Age : '''[[Penicillin G]]''' 300000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 150 mg/kg/day divided q12h,
-::::::::: For 1–4 week of Age : '''[[Penicillin G]]''' 400000 Units/kg/day divided q12h,{{or}} [[Ampicillin]] 200 mg/kg/day divided q12h, {{and}}
-::::::* 3.2.5.1.3 '''A protein synthesis inhibitor'''
+:::::* Note (1): Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
-:::::::* 3.2.5.1.3.1 '''For 32–34 weeks gestational age'''
-:::::::: For 0–1 week of Age : '''[[Linezolid]]''' 20 mg/kg/day,divided q12h, {{or}} [[Clindamycin]] 10 mg/kg/day,divided q12h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h , {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
-:::::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
-:::::::* 3.2.5.1.3.2 '''For 34–37 week gestational age'''
-:::::::: For 0–1 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
-:::::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 20 mg/kg/day,divided q6h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
-:::::::* 3.2.5.1.3.3 '''Term Newborn Infant'''
-:::::::: For 0–1 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 15 mg/kg/day,divided q8h {{or}} [[Rifampin]] 10 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 25 mg/kg/day,q24h
-:::::::: For 1–4 week of Age : '''[[Linezolid]]''' 30 mg/kg/day,divided q8h, {{or}} [[Clindamycin]] 20 mg/kg/day,divided q6h {{or}} {[Rifampin]] 20 mg/kg/day,divided q12h, {{or}} [[Chloramphenicol]] 50 mg/kg/day,q12h
-:::::::: Note :Duration of therapy For =2–3 week, until clinical criteria for stability are met. Will require prophylaxis to complete an antibiotic course of upto 60 days from onset of illness.
-:::::* 3.2.5.2 '''Therapy for severe anthrax when meningitis can be ruled out'''
+:::::* Note (2): Increased risk for seizures associated with [[Imipenem]]/[[Cilastatin]] treatment.
-::::::* 3.2.5.2.1 '''A bactericidal antimicrobial'''
-:::::::* 3.2.5.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::::::::* 3.2.5.2.1.1.1 '''For 32–34 weeks gestational age'''
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}} [[Meropenem]] IV 40 mg/kg/day,divided q8h {{or}} [[Imipenem]] IV 40 mg/kg/day,divided q12h
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h'''  {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 50 mg/kg/day,divided q12h
-::::::::* 3.2.5.2.1.1.2 '''For 34–37 week gestational age'''
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 50 mg/kg/day,divided q12h
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 20 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}}  [[Imipenem]] 75 mg/kg/day,divided q8h
-::::::::* 3.2.5.2.1.1.3 '''Term Newborn Infant'''
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day,divided q12h''' {{or}}   [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}}  [[Imipenem]] 50 mg/kg/day,divided q12h
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] IV 30 mg/kg/day,divided q12h''' {{or}}  [[Meropenem]] IV 60 mg/kg/day,divided q8h {{or}} [[Imipenem]] 75 mg/kg/day,divided q8h {{or}}
-::::::::: [[Vancomycin]] IV (dosing based on serum creatinine for infants =32 wk gestational age). Follow vancomycin serum concentrations to modify dose.
-:::::::::: If  Serum creatinine <0.7 then [[Vancomycin]] IV 15 mg/kg/dose q12h
-:::::::::: If Serum creatinine 0.7 -0.9 then  [[Vancomycin]] IV 20 mg/kg/dose q24h
-:::::::::: If Serum creatinine 1–1.2 then [[Vancomycin]] IV 15 mg/kg/dose q24h
-:::::::::: If Serum creatinine 1.3–1.6 then  [[Vancomycin]] IV 10 mg/kg/dose q24h
-:::::::::: If Serum creatinine >1.6 15 then [[Vancomycin]] IV mg/kg/dose q48h
-::::::::::: Note : Begin treatment with a 20-mg/kg loading dose {{or}}
-::::::::* 3.2.5.2.1.2 '''Alternatives for penicillin-susceptible strains'''
-:::::::::* 3.2.5.2.1.2.1 '''For 32–34 weeks gestational age'''
-:::::::::: For 0–1 week of Age : [[Penicillin G]] IV 200000 U/kg/day,divided q12h, {{or}} [[Ampicillin]] IV 100 mg/kg/day,divided q12h
-:::::::::: For 1–4 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}} [[Ampicillin]] IV 150 mg/kg/day,divided q8h
-:::::::::* 3.2.5.2.1.2.2 '''For 34–37 week gestational age'''
-:::::::::: For 0–1 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}}  [[Ampicillin]] IV 150 mg/kg/day,divided q8h
-:::::::::: For 1–4 week of Age : [[Penicillin G]] IV 400000 U/kg/day,divided q6h, {{or}} [[Ampicillin]] IV 200 mg/kg/day,divided q6h
-:::::::::* 3.2.5.2.1.2.3 '''Term Newborn Infant'''
-:::::::::: For 0–1 week of Age : [[Penicillin G]] IV 300000 U/kg/day,divided q8h, {{or}} [[Ampicillin]] IV 150 mg/kg/day,divided q8h
-:::::::::: For 1–4 week of Age : [[Penicillin G]] IV 400000 U/kg/day,divided q6h, {{or}} [[Ampicillin]] IV 200 mg/kg/day,divided q6h {{and}}
-::::::* 3.2.5.2.2 '''A protein synthesis inhibitor'''
+:::::* Note (3): [[Linezolid]] should be used with caution in patients with thrombocytopenia because it might exacerbate it. [[Linezolid]] use for > 14 days has additional hematopoietic toxicity.
-:::::::* 3.2.5.2.2.1 '''For 32–34 weeks gestational age'''
-:::::::: For 0–1 week of Age : [[Clindamycin]] IV 10 mg/kg/day, divided q12h, {{or}} [[Linezolid]] IV 20 mg/kg/day, divided q12h, {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::: For 1–4 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}}  [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::* 3.2.5.2.2.2 '''For 34–37 week gestational age'''
-:::::::: For 0–1 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::: For 1–4 week of Age : [[Clindamycin]] IV 20 mg/kg/day, divided q6h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}}  [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::* 3.2.5.2.2.3 '''Term Newborn Infant'''
-:::::::: For 0–1 week of Age : [[Clindamycin]] IV 15 mg/kg/day, divided q8h, {{or}}  [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}} [[Doxycycline]] IV 4.4 mg/kg/day, divided q12h, (loading dose 4.4 mg/kg)  {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
-:::::::: For 1–4 week of Age : [[Clindamycin]] IV 20 mg/kg/day, divided q6h, {{or}} [[Linezolid]] IV 30 mg/kg/day, divided q8h, {{or}} [[Doxycycline]] IV 4.4 mg/kg/day, divided q12h, (loading dose 4.4 mg/kg)  {{or}} [[Rifampin]] IV 10 mg/kg/day, q24h
-::::::::: Note: Duration of therapy: For =2–3 wk, until clinical criteria for stability are met (see text). Will require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness
-:::::* 3.2.5.3 '''Oral follow-up combination therapy for severe anthrax'''
+:::::* Note (4): [[Rifampin]] is not a protein synthesis inhibitor. However, it may be used in combination with other antimicrobial drugs on the basis of its in vitro synergy.
-::::::* 3.2.5.3.1 '''A bactericidal antimicrobial'''
-:::::::* 3.2.5.3.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
+:::* 2.2 '''Systemic anthrax when meningitis has been excluded'''
-::::::::* 3.2.5.3.1.1.1 '''For 32–34 weeks gestational age'''
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
-::::::::* 3.2.5.3.1.1.2 '''For 34–37 week gestational age'''
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 20 mg/kg/day, divided q12h'''
-::::::::* 3.2.5.3.1.1.3 '''Term Newborn Infant'''
-::::::::: For 0–1 week of Age : '''[[Ciprofloxacin]] PO 30 mg/kg/day, divided q12h'''
-::::::::: For 1–4 week of Age : '''[[Ciprofloxacin]] PO 30 mg/kg/day, divided q12h''' {{or}}
-:::::::* 3.2.5.3.1.2 '''Alternatives for penicillin-susceptible strains'''
-::::::::* 3.2.5.3.1.2.1 '''For 32–34 weeks gestational age'''
-::::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h, {{or}} Penicillin VK PO 50 mg/kg/day, divided q12h
-::::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
-::::::::* 3.2.5.3.1.2.2 '''For 34–37 week gestational age'''
-::::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} Penicillin VK PO  50 mg/kg/day, divided q12h
-::::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
-::::::::* 3.2.5.3.1.2.3 '''Term Newborn Infant'''
-::::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q8h
-::::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin VK PO 75 mg/kg/day, divided q6–8h  {{and}}
-::::::* 3.2.5.3.2 '''A protein synthesis inhibitor'''
-:::::::* 3.2.5.3.2.1 '''For 32–34 weeks gestational age'''
-:::::::: For 0–1 week of Age : '''[[Clindamycin]] PO 10 mg/kg/day, divided q12h''' {{or}} [[Linezolid]] PO 20 mg/kg/day, divided q12h
-:::::::: For 1–4 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
-:::::::* 3.2.5.3.2.2 '''For 34–37 week gestational age'''
-:::::::: For 0–1 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age : '''[[Clindamycin]] PO 20 mg/kg/day, divided q6h''' {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
-:::::::* 3.2.5.3.2.3 '''Term Newborn Infant'''
-:::::::: For 0–1 week of Age : '''[[Clindamycin]] PO 15 mg/kg/day, divided q8h''' {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (loading dose 4.4 mg/kg)  {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age :'''[[Clindamycin]] PO 20 mg/kg/day, divided q6h''' {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (loading dose 4.4 mg/kg) {{or}} [[Linezolid]] PO 30 mg/kg/day, divided q8h  {{or}}
-::::::::: Note: Duration of therapy: to complete a treatment course of 10–14 days or greater. May require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness.
-:::::* 3.2.5.4 '''Treatment of cutaneous anthrax without systemic involvement'''
+::::* 2.2.1 '''Bactericidal agent'''
-::::::* 3.2.5.4.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-:::::::* 3.2.5.4.1.1 '''For 32–34 weeks gestational age'''
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 10 mg/kg/day, divided q12h
-:::::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-:::::::* 3.2.5.4.1.2 '''For 34–37 week gestational age'''
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
-:::::::* 3.2.5.4.1.3 '''Term Newborn Infant'''
-:::::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
-::::::* 3.2.5.4.2 '''Alternatives for penicillin-susceptible strains'''
-:::::::* 3.2.5.4.2.1 '''For 32–34 weeks gestational age'''
-:::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} Penicillin Vk PO 50 mg/kg/day, divided q12h
-:::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h  {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-:::::::* 3.2.5.4.2.2 '''For 34–37 week gestational age'''
-:::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 50 mg/kg/day, divided q12h {{or}} Penicillin Vk PO 50 mg/kg/day, divided q12h
-:::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-:::::::* 3.2.5.4.2.3 '''Term Newborn Infant'''
-:::::::: For 0–1 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-:::::::: For 1–4 week of Age : '''[[Amoxicillin]]''' PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q6–8h
-::::::::: Note : Duration of therapy for naturally acquired infection is 7–10 days and for a biological weapon–related event,may require additional prophylaxis for inhaled spores to complete an antimicrobial course of up to 60 days from onset of illness.
-:* [[Bacillus anthracis]], postexposure prophylaxis
+:::::* Preferred regimen (1): [[Ciprofloxacin]] 400 mg IV q8h for 2 weeks
-::* 1. '''For adults'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-:::* 1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''': '''[[Ciprofloxacin]], 500 mg q12h''' {{or}} '''Doxycycline, 100 mg q12h''' {{or}} Levofloxacin, 750 mg q24h {{or}} Moxifloxacin, 400 mg q24h {{or}} Clindamycin, 600 mg q8h {{or}}
-:::* 1.2 '''Alternatives for penicillin-susceptible strain''': [[Amoxicillin]] 1 g q8h {{or}} Penicillin VK 500 mg q6h
-:::: Note (1): Preferred drugs are indicated in boldface.
-:::: Note (2): Alternative drugs are listed in order of preference for treatment for patients who cannot take first-line treatment or if first-line treatment is unavailable.
-::* 2. '''For children = 1 month'''<ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
+:::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h for 2 weeks
-:::* 2.1 '''For penicillin-resistant strains or prior to susceptibility testing''': '''[[Ciprofloxacin]], 30 mg/kg/day, by mouth (PO), divided q12h (not to exceed 500 mg/dose)''' {{or}} '''[[Doxycycline]], <45 kg: 4.4 mg/kg/day, PO, divided q12h (not to exceed 100 mg/dose)''' >45 kg: 100 mg/dose, PO, given q12h {{or}} [[Clindamycin]], 30 mg/kg/day, PO, divided q8h (not to exceed 900 mg/dose) {{or}} [[Levofloxacin]], <50 kg: 16 mg/kg/day, PO, divided q12h (not to exceed 250 mg/dose) >50 kg: 500 mg, PO, given q24h {{or}}
-:::* 2.2 '''For penicillin-susceptible strains''': '''[[Amoxicillin]], 75 mg/kg/day, PO, divided every q8h (not to exceed 1 g/dose)''' {{or}} [[Penicillin VK]], 50-75 mg/kg/day, PO, divided q6h to q8h
-:::: Note (1) : '''Duration of Therapy is 60 days after exposure'''
-:::: Note (2) : Bold font are  preferred antimicrobial agent (when 2 bolded antimicrobial agents are present, both are considered equivalent in overall safety and efficacy).
-:::: Note (3) : Normal font are alternative selections are listed in order of preference for therapy for patients who cannot take first-line therapy or if first-line therapy is unavailable.
-:::: Note (4) : Doses are provided for children with normal renal and hepatic function. Doses may vary for those with some degree of organ failure.
-:::: Note (5) : Italicized font: indicates FDA approval for the indication in the pediatric population.
-:::: Note (6) : A single 14-day course of doxycycline is not routinely associated with tooth staining, but some degree of staining is likely for a prolonged treatment course of up to 60 days.
-:::: Note (7) : Safety data for [[Levofloxacin]] in the pediatric population are limited to 14 days for duration therapy.
-:::: Note (8) : Be aware of the possibility of emergence of penicillin-resistance during monotherapy with [[Amoxicillin]] or [[Penicillin]].
-::* 3. '''For children < 1 month'''
+:::::* Preferred regimen (3): [[Moxifloxacin]] 400 mg q24h for 2 weeks
-:::* 3.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::::* 3.1.1 '''For 32–34 weeks gestational age'''
-::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 10 mg/kg/day, divided q12h
-::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-::::* 3.1.2 '''For 34–37 week gestational age'''
-::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 20 mg/kg/day, divided q12h {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h
-::::* 3.1.3 '''Term Newborn Infant'''
-::::: For 0–1 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 15 mg/kg/day, divided q8h
-::::: For 1–4 week of Age : '''[[Ciprofloxacin]]''' PO 30 mg/kg/day, divided q12h {{or}} [[Doxycycline]] PO 4.4 mg/kg/day, divided q12h (Loading dose 4.4 mg/kg) {{or}} [[Clindamycin]] PO 20 mg/kg/day, divided q6h  {{or}}
-:::* 3.2 '''Alternatives for penicillin-susceptible strains'''
-::::* 3.2.1 '''For 32–34 weeks gestational age'''
-::::: For 0–1 week of Age : [[Amoxicillin]] PO 50 mg/kg/day, divided q12h {{or}} Penicillin Vk PO 50 mg/kg/day, divided q12h
-::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-::::* 3.2.2 '''For 34–37 week gestational age'''
-:::::: For 0–1 week of Age : [[Amoxicillin]] PO 50 mg/kg/day, divided q12h {{or}} Penicillin Vk PO 50 mg/kg/day, divided q12h
-:::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-::::* 3.2.3 '''Term Newborn Infant'''
-::::: For 0–1 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q8h
-::::: For 1–4 week of Age : [[Amoxicillin]] PO 75 mg/kg/day, divided q8h {{or}} Penicillin Vk PO 75 mg/kg/day, divided q6–8h
-::::: Note: Duration of therapy is  60 days from exposure
-{{PBI|Bacillus cereus}}
+:::::* Preferred regimen (4): [[Meropenem]] 2 g IV q8h for 2 weeks
-:* [[Bacillus cereus]]
-::*Bacillus cereus treatment<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::::* Preferred regimen (5): [[Imipenem]] 1 g IV q6h for 2 weeks
-:::* 1. '''Food poisoning'''
+:::::* Preferred regimen (6): [[Doripenem]] 500 mg IV q8h for 2 weeks
-::::* Preferred treatment: Food poisoning is self-limited, no antibiotics necessary. Treatment is Supportive therapy, hydration, and anti-emetics. Prevention is by fried/boiled rice should be maintained >60° C or rapidly cooled <8 ° C to avoid room temperature germination of spores and toxin.
-::::: Note (1): Bacillus cereus with two forms.(a) Emetic phase: 1-6 hrs after ingestion contaminated usually starchy food, e.g., fried rice. (b) Diarrheal phase: 10-12 hrs after eating e.g. tainted meats, milk, vegetables, etc. with watery diarrhea, tenesmus lasting <2-10 days.
-:::* 2. '''Bacteremia'''
+:::::* Preferred regimen (7): [[Vancomycin]] 20 mg/kg IV q8h (maintain serum trough concentrations of 15-20 µg/mL) for 2 weeks
-::::* Preferred regimen:  [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
-::::: Note (1): Bacillus cereus often resistant to beta-lactams.
-::::: Note (2): Uncommon, may complicate mixed infections including surgical wounds or infected necrotic tumors.
-::::: Note (3): Source of pseudobacteremia is contaminated blood cultures, gloves, syringes, etc. Often transient bacteremia of no significance in intravenous drug user population.
-:::* 3. '''Meningitis, brain abscess'''
+:::::* Preferred regimen (8): [[Penicillin G]] 4 MU IV q4h (penicillin-susceptible strains) for 2 weeks
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
-::::: Note (1): Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.
-::::: Note(2):  Uncommon presentations, may complicate otitis, mastoiditis, neurosurgical procedures, and shunts.
-:::* 4. '''Endophthalmitis'''
+:::::* Preferred regimen (9): [[Ampicillin]] 3 g IV q6h (penicillin-susceptible strains) for 2 weeks {{and}}
-::::* Preferred regimen: [[Clindamycin]] 450 mcg intravitreal {{and}} [[Gentamicin]] 400 mcg intravitreal {{or}} [[Dexamethasone]] intravitreal {{and}} [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
-::::: Note (1): Prognosis for sight retention poor.
-::::: Note (2): Rapid, massive destruction of vitreous/retina in intravenous drug user or posttraumatic with ringabscess within 48 hrs. Pathognomic Bacillus cereus panophthalmitis.
-::::: Note (3): Early ophthalmological consultation, culture ocular fluids. Early vitrectomy and intravitreal antibiotics is advocated.
-::::: Note (4): Ocular infections devastating and require quick intervention.
-::::: Note (5): primary pathogen of post-traumatic , risk factor also intravenous drug use. May also cause keratitis, orbital abscess, conjunctivitis, dacryocystitis.
-:::* 5. '''Endocarditis'''
+::::* 2.2.2 '''Protein synthesis inhibitor'''
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
-::::: Note (1):  Well-described but rare complication seen in intravenous drug user . Most blood cultures in intravenous drug user positive for bacillus are contaminates or represent transient bacteremia.
-::::: Note (2): Evidence of valvular involvement should be sought by echocardiography to prove endocarditis. Tricuspid valve involvement most common. Course indolent.
-::::: Note (3): Tricuspid valve endocarditis mostly indolent in nature.
-:::* 6. ''' Soft tissue'''
+:::::* Preferred regimen (1): [[Clindamycin]] 900 mg IV q8h for 2 weeks
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
-::::: note:  rare reports of fasciitis.
-:::* 7. '''Pneumonia'''
+:::::* Preferred regimen (2): [[Linezolid]] 600 mg IV q12h for 2 weeks
-::::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h.
-::::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h.
-::::: Note: rare pathogen of compromised host. May mimic Bacillus anthracis-type presentation.
-----
+:::::* Preferred regimen (3): [[Doxycycline]] 200 mg IV initially, then 100 mg IV q12h for 2 weeks
-{{PBI|Bacillus subtilis}}
+:::::* Preferred regimen (4): [[Rifampin]] 600 mg IV q12h for 2 weeks
-:* Bacillus subtilis infection treatment<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref><ref>{{Cite journal| issn = 0305-7453| volume = 49| issue = 6| pages = 1040–1042| last1 = Andrews| first1 = J. M.| last2 = Wise| first2 = R.| title = Susceptibility testing of Bacillus species| journal = The Journal of Antimicrobial Chemotherapy| date = 2002-06| pmid = 12039902}}</ref>
-::* 1. Food poisoning
+:::::* Note: Patients exposed to aerosolized spores will require prophylaxis to complete an antimicrobial drug course of 60 days from onset of illness.
-:::* Preferred regimen: supportive treatment
-::* 2. Other infections
+::* 3. '''Specific considerations'''
-:::* Preferred regimen: [[Vancomycin]] {{or}} [[Clindamycin]]
-:::* Alternative regimen: [[Ciprofloxacin]] {{or}} [[Imipenem]]
-:::* Note: Distinguish clinically significant infection from contamination before administering antibiotics.
-----
+:::* 3.1 '''Treatment of anthrax for pregnant Women'''
-{{PBI|Clostridium botulinum}}
+::::* 3.1.1 '''Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis''' <ref name="pmid24457117">{{cite journal| author=Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA et al.| title=Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24457117 | doi=10.3201/eid2002.130611 | pmc=PMC3901460 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24457117  }} </ref>
-*'''1.Antitoxin''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:* Preferred regimen: Trivalent antitoxin (A 7,500 IU, B 5,000 IU, and E 5,000 IU) 1 vial diluted 1:10, IV infusion over 30 min
-:* Alternative regimen: Equine antitoxin
-*'''2.General Therapy'''
-:* Preferred regimen: Mechanical ventilation; IV hydration; tube feedings
-{{PBI|Clostridium difficile}}
-{{PBI|Clostridium perfringens}}
-:* Clostridium perfringens <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* Preferred regimen: [[Penicillin G]] {{withorwithout}} [[Clindamycin]]
-::* Alternative regimen: [[Doxycycline]]
-{{PBI|Clostridium tetani}}
+:::::* 3.1.1.1 ''' A Bactericidal Agent (Fluoroquinolone)'''
-:* 1. '''General measures''' <ref name=World Health Organization>{{cite web | title = Current recommendations for treatment of tetanus during humanitarian emergencies| url =http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/ }}</ref>
-::* Preferred regimen: Patients should be placed in a quiet shaded area and protected from tactile and auditory stimulation as much as possible; All wounds should be cleaned and debrided as indicated
-:* 2. '''Immunotherapy'''
-::* Preferred regimen: Human TIG 500 units by intramuscular injection or intravenously as soon as possible {{and}} Age-appropriate TT-containing vaccine, 0.5 cc by intramuscular injection at a separate site
-::* NOTE: patients without a history of primary TT vaccination should receive a second dose 1–2 months after the first dose and a third dose 6–12 months later
-:* 3. '''Antibiotic treatment'''
-::* Preferred regimen: [[Metronidazole]] 500 mg intravenously or orally every six hours {{or}} [[Penicillin G]] 100,000–200,000 IU/kg/day intravenously, given in 2–4 divided doses
-::* Alternative regimen: [[Tetracyclines]] {{or}} [[Macrolides]] {{or}} [[Clindamycin]] {{or}} [[Cephalosporins]] {{or}} [[Chloramphenicol]]
-:* 4. '''Muscle spasm control'''
-::* Preferred regimen: [[Diazepam]] 5 mg intravenous {{or}} [[Lorazepam]] 2 mg titrating to achieve spasm control without excessive sedation and hypoventilation
-::* Alternative regimen (1): [[Magnesium]] sulphate 5 gm (or 75mg/kg) intravenous loading dose, then 2–3 grams per hour until spasm control is achieved {{withorwithout}} [[Benzodiazepines]]
-::* NOTE: Monitor patellar reflex as areflexia (absence of patellar reflex) occurs at the upper end of the therapeutic range (4mmol/L). If areflexia develops, dose should be decreased
-::* Alternative regimen (2): [[Baclofen]] {{or}} [[Dantrolene]] 1–2 mg/kg intravenous/orally every 4 hours
-::* Alternative regimen (3): [[Barbiturates]] 100–150 mg every 1–4 hours by any route
-::* Alternative regimen (4): [[Chlorpromazine]] 50–150 mg by intramuscular injection every 4–8 hours
-::* Pediatric regimen: [[Lorazepam]] 0.1–0.2 mg/kg every 2–6 hours, titrating upward as needed; [[Barbiturates]] 6–10 mg/kg in children by any route; [[Chlorpromazine]] 4–12 mg every by intramuscular injection every 4–8 hours
-::* NOTE: As for [[Benzodiazepines]], large amounts may be required (up to 600 mg/day); Oral preparations could be used but must be accompanied by careful monitoring to avoid respiratory depression or arrest
-:* 5. '''Autonomic dysfunction control'''
-::* Preferred regimen: [[Magnesium]] sulphate {{or}} [[Morphine]] {{or}} [[Esmolol]]
-{{PBI|Corynebacterium diphtheriae}}
-:*'''1.Diphtheria treatment'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*'''1.1 Antitoxin '''
-:::* Preferred regimen: 20,000-40,000 U pharyngeal disease <48 hrs; 40-60,000 U nasopharyngeal; 80-120,000 U for extensive disease, brawny neck or sx >72 hrs; Adiminister IV (severe disease) or IM
-::*'''1.2 Antibiotics: '''
-:::* Preferred regimen: [[Penicillin G procaine|Procaine Penicillin G]] (<20 lbs: 300,000 U; >20 lbs: 600,000 U) IM q12h until patient can swallow then [[Penicillin VK]] 125-250 mg PO QID {{or}} [[Erythromycin]] 125-500 mg PO QID for 14 days total.
-:::* Alternative regimen (1): [[Erythromycin]] 20-25mg/kg IV q6h (max 4g/day; β-lactam allergic patients)
-:::* Alternative regimen (2): [[Clindamycin]] 600 mg IV q8h
-:*'''2.C. diphtheriae carrier'''
-::* Preferred regimen: [[Erythromycin]] 250-500 mg PO QID
-::* Alternative regimen: [[Penicillin G benzathine|Benzathine Penicillin G]] 600,000-1,200,000 units IM single dose
-:*'''3.Endocarditis treatment'''
-::* Preferred regimen: [[Penicillin G]] {{or}} [[Ampicillin]] IV for 4-6 weeks {{withorwithout}} [[Aminoglycoside]]
-{{PBI|Corynebacterium jeikeium}}
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 400 mg IV q8h for 2–3 weeks {{or}}
-:*Corynebacterium jeikeium<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen : [[Vancomycin]] 1gm IV q12h
-::*Alternative regimen : [[Penicillin G]] {{and}} Antipseudomonal aminoglycosides like [[Tobramycin]], [[Gentamicin]], [[Amikacin]]
-{{PBI|Corynebacterium urealyticum}}
-:*Corynebacterium urealyticum<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen : [[Vancomycin]] 1gm IV q12h {{or}} [[Teicoplanin]] 6mg/kg/day IV q24h
-{{PBI|Coxiella burnetii}}
-* '''Q fever''' <ref>{{cite web | title =q fever | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm   }}</ref>
-:*1.'''Acute Q fever'''
-::*1.1 Adults
-:::* Preferred Regimen: [[Doxycycline]] 100 mg PO bid for 14 days
-::*1.2 Children
-:::*1.2.1 Children with age  ≥8 years:
-::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 14 days (maximum 100 mg per dose)
-:::*1.2.2 Children with age <8 years with high risk criteria
-::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)
-:::*1.2.3 Children with age <8 years with mild or uncomplicated illness
-::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 5 days (maximum 100 mg per dose). If patient remains febrile past 5 days of treatment: [[Trimethoprim/Sulfamethoxazole]] 4-20 mg/kg bid for 14 days (maximum: 800 mg per dose)
-::*1.3 Pregnant women
-:::* Preferred regimen: [[Trimethoprim/Sulfamethoxazole]] 160 mg/800 mg  PO bid a day throughout pregnancy
-:*2. '''Chronic Q fever'''
+::::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h for 2–3 weeks{{or}}
-::*2.1 '''Endocarditis or vascular infection'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid  for ≥18 months
-:::* Note: childern and pregnant women- consultation  Recommended
-::*2.2 '''Noncardiac organ disease'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid
-:::* Note: childern and pregnant women- consultation  Recommended
-::*2.3 ''' Postpartumwith serologic profile for chronic Q fever'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid for 12 months
-:::* Note: Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
-:::* Note:Post-Q fever fatigue syndrome- no current recommendation
-{{PBI|Ehrlichia}}
+:::::* 3.1.1.2 ''' A Bactericidal Agent (ß-lactam)'''
-:*1. [[Ehrlichiosis|Human Monocytic Ehrlichiosis]] or [[Human Granulocytic Anaplasmosis]] (adult) <ref name=CDC centers for the disease control and prevention>{{cite web | title =Ehrlichiosis CDC centers for the disease control and prevention| url= http://www.cdc.gov/ehrlichiosis/symptoms/index.html#treatment }}</ref> <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Doxycycline]] 100 mg PO/IV q12h for 7-14 days
-::* NOTE: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
-::* Alternative regimen: [[Chloramphenicol]] 500mg QID {{or}} [[Rifampin]] 600 mg PO/IV daily for 7-10 days
-:*2. [[Ehrlichiosis|Human Monocytic Ehrlichiosis]] or [[Human Granulocytic Anaplasmosis]] (pediatric)
-::*2.1 ≥8 years old
-:::* Preferred regimen: [[Doxycycline]] 2 mg/kg IV/PO q12h (max 200 mg/day) for 10 days
-::*2.2 <8 years old without Lyme disease
-:::* Preferred regimen: [[Doxycycline]] 2 mg/kg IV/PO q12h (max 200 mg/day) for 4-5 days (or 3 days after resolution of fever)
-::*2.3 co-infected with Lyme disease
-:::* Preferred regimen: At the conclusion of [[Doxycycline]] then give [[Amoxicillin]] 50 mg/kg in 3 divided doses (max 500 mg/dose) {{or}} [[Cefuroxime]] 30 mg/kg in 2 divided doses (max 500 mg/dose) for 14 days
-{{PBI|Erysipelothrix rhusiopathiae}}
-:*1. Erysipeloid of Rosenbach (localized cutaneous infection)<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): [[Penicillin G benzathine]] 1.2 MU IV as a single dose
-::* Preferred regimen (2): [[Penicillin VK]] 250 mg PO qid for 5-7 days
-::* Preferred regimen (3): [[Procaine penicillin]] 0.6-1.2 MU IM qd for 5-7 days
-::* Alternative regimen (1): [[Erythromycin]] 250 mg PO qid for 5-7 days
-::* Alternative regimen (2): [[Doxycycline]] 100 mg PO bid for 5-7 days
-:*2. Diffuse cutaneous infection
+::::::* 3.1.1.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::* Preferred regimen: As for localized infection
-::: Note: Assess for endocarditis
-:*3. Bacteremia or endocarditis
+:::::::* Preferred regimen: [[Meropenem]] 2 g q8h for 2–3 weeks
-::* Preferred regimen: [[Penicillin G benzathine]] 2-4 MU IV q4h for 4-6 weeks
-::* Alternative regimen (1): [[Ceftriaxone]] 2 g IV q24h for 4-6 weeks
-::* Alternative regimen (2): [[Imipenem]] 500 mg IV q6h for 4-6 weeks
-::* Alternative regimen (3): [[Ciprofloxacin]] 400 mg IV q12h for 4-6 weeks
-::* Alternative regimen (4): [[Daptomycin]] 6 mg/kg IV q24h for 4-6 weeks
-::: Note: Recommended duration of therapy for endocarditis is 4 to 6 weeks, although shorter courses consisting of 2 weeks of intravenous therapy followed by 2 to 4 weeks of oral therapy have been successful.
-{{PBI|Listeria monocytogenes}}
-:*1. Meningitis <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for more than 3 weeks
-::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for more than 3 weeks
-:*2. Bacteremia
-::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for 2 weeks
-::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 2 weeks
-:*3. Brain abscess or rhomboencephalitis
-::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for 4-6 weeks
-::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 4-6 weeks
-:*4. Gastroenteritis
-::* Preferred regimen: [[Amoxicillin]] {{or}} [[TMP-SMX]] for 7 days
-{{PBI|Lactobacillus}}
+::::::* 3.1.1.2.2 '''Alternatives for penicillin-susceptible strains'''
-:*1. Endovascular Infection <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regiemn (1): [[Penicillin G]] 20 Million units/day for 6 weeks
-::* Preferred regiemn (2): [[Gentamicin]] 1.3 mg/kg IV q8h (trough <1.5 mg/L) {{and}} [[Polychlorinated naphthalene]]
-:*2. Odontogenic Infection
-::* Preferred regiemn: [[Clindamycin]] 450 mg PO q6h
-:*3. Intrabdominal Abscess
-::* Preferred regiemn: [[Clindamycin]] 450 mg PO q6h
-{{PBI|Leuconostoc}}
-:* Preferred regimen: [[Penicillin G]] {{or}} [[Ampicillin]]
-:* Alternative regimen: [[Clindamycin]] {{or}} [[Erythromycin]] {{or}}  [[Minocycline]]
-{{PBI|Nocardia}}
+:::::::* Alternative regimen (1): [[Ampicillin]] 3 g IV q6h for 2–3 weeks
-:*1. Sulfonamide-based therapies <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1.1 Pulmonary
-:::* Preferred regimen: [[TMP-SMX]] 10 mg/kg/day (TMP) in 2-4 doses IV for 3-6 weeks, then PO (2 DS BID) for >5 months
-::*1.2 Pulmonary alternatives
-:::* Preferred regimen: [[Sulfisoxazole]] {{or}} [[Sulfadiazine]] {{or}} Trisulfapyrimidine 3-6 g/day PO 2- 4 doses {{or}} [[TMP-SMX]] 2 DS twice daily up to 2 DS TID
-::*1.3 CNS (AIDS, severe or disseminated disease)
-:::* Preferred regimen: [[TMP-SMX]] 15 mg/kg/day (TMP) IV for 3-6 weeks, then PO (3 DS BID) for 6-12 months
-::*1.4 CNS alternatives
-:::* Preferred regimen: [[Imipenem]] 1000 mg IV q8h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2-3 g IV q6h {{and}} [[Amikacin]]
-::*1.5 Severe disease, compromised host, multiple sites
-:::* Preferred regimen: [[TMP-SMX]] IV (above doses) {{and}} [[Amikacin]] 7.5 mg/kg q12h (adjust per levels) {{or}} [[Sulfonamide]] PO 6-12 m/day
-::*1.6 Sporotrichoid (cutaneous)
-:::* Preferred regimen: [[TMP-SMX]] 1 DS BID for 4-6 months
-::* NOTE(1): Immunocompetent medicine use for 6 months; Immunosuppressed medicine for 12 months
-::* NOTE(2): Treat based on host, site of disease and in vitro activity; Sulfonamide usually preferred, must treat for 6-12 months; Preferred drugs for resistant strains are [[Amikacin]] and/or [[Imipenem]]
-::* NOTE(3): Seriously ill usually treated with IV [[Imipenem]] or [[Sulfonamide]] or [[Cefotaxime]] all potentially combined with [[Amikacin]]; less seriously ill treated with oral agents— especially [[TMP-SMX]] or [[Minocycline]]
-:*2. Sulfonamide alternatives
-::*2.1 Severe
-:::* Preferred regimen(1): (AIDS) ([[Imipenem]] 1000mg IV q8h {{or}} [[Meropenem]] (CNS) 2g q8h) {{and}} [[Amikacin]] 7.5 mg/kg q12h IV
-:::* Preferred regimen(2): [[Cefotaxime]] 2-3g q6-8h {{or}} [[Ceftriaxone]] 2 g/day IV {{withorwithout}} [[Amikacin]]
-::*2.2 Mild
-:::* Preferred regimen: [[Minocycline]] 100 mg BID for > 6 months (initial treatment of local disease or maintenance)
-:::* Alternative regimen: [[Amoxicillin]]/[[Clavulanate]] 875/125 mg BID {{or}} [[Doxycycline]] {{or}} [[Erythromycin]] {{or}} [[Clarithromycin]] {{or}} [[Linezolid]] {{or}} [[Fluoroquinolone]] {{or}} combinations for >6 months
-{{PBI|Propionibacterium acnes}}
+:::::::* Alternative regimen (2): [[Penicillin G]] 4 MU IV q4h for 2–3 weeks {{or}}
-:*1. Systemic infection<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Penicillin G]] 2 MU IV q4h for 2-4 weeks
-::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h for 2-4 weeks {{or}} [[Vancomycin]] 15 mg/kg IV q12h for 2-4 weeks
-:*2. Shoulder prosthesis infection
+:::::* 3.1.1.3 ''' A Protein Synthesis Inhibitor'''
-::* Preferred regimen: [[Amoxicillin]] {{and}} [[Rifampin]] for 3-6 months
-:*3. Acne vulgaris
+::::::* Preferred regimen (1): [[Clindamycin]] 900 IV mg q8h for 2–3 weeks
-::*3.1 Topical antibiotics: [[Erythromycin]] {{or}} [[Clindamycin]]
-::*3.2 Systemic antibiotics: [[Minocycline]] {{or}} [[Doxycycline]] {{or}} [[Trimethoprim-Sulfamethoxazole]]
-{{PBI|Rhodococcus equi}}
+::::::* Preferred regimen (2): [[Rifampin]] 600 IV mg q12h for 2–3 weeks
-:* Rhodococcus equi <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1. Preferred regimen:
-:::*1.1 First line: [[vancomycin]] 1 g IV q12h (15 mg/kg q12 for >70 kg) {{or}} [[Imipenem]] 500 mg IV q6h {{and}} [[Rifampin]] 600 mg PO once daily {{or}} [[Ciprofloxacin]] 750 mg PO twice daily {{or}} [[Erythromycin]] 500 mg PO four times a day for at least 4 weeks or until infiltrate disappears (at least 8 weeks in immunocompromised patients)
-:::*1.2 Oral/maintenance therapy (after infiltrate clears): [[Ciprofloxacin]] 750 mg PO twice daily {{or}} [[Erythromycin]] 500 mg PO four times a day
-::*2. Alternative regimen: [[Azithromycin]] {{or}} [[TMP-SMX]] {{or}} [[Chloramphenicol]] {{or}} [[Clindamycin]]
-::* NOTE: Avoid Penicillins/Cephalosporins due to development of resistance; Linezolid effective in vitro, but no clinical reports of use
-{{PBI|Rickettsia prowazekii}}
+::::::* Note: At least one antibiotic with transplacental passage is recommended.
-{{PBI|Rickettsia rickettsii}}
-:* ''Rickettsia rickettsii'' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen: [[Doxycycline]] 200 mg load (severe disease) and then 100 mg PO/IV BID for 3-7 days after defervescence
-::* Alternative regimen: [[Chloramphenicol]] 500 mg PO QID for 3-7 days after defervescence
-::* Pediatric regimen: [[Doxycycline]] 2-4 mg/kg/day (up to 200 mg/day) q12h {{or}} [[Tetracycline]] 25-50 mg/kg/day PO in 4 divided doses {{or}} [[Chloramphenicol]] 50-75 mg/kg/day PO in 4 divided doses
-{{PBI|Rickettsia typhi}}
-====Bacteria – Gram-Negative Cocci and Coccobacilli====
+::::* 3.1.2 '''Intravenous antimicrobial treatment for systemic anthrax when meningitis has been excluded'''
-{{PBI|Aggregatibacter aphrophilus}}
-{{PBI|Bordetella pertussis}}
-{{PBI|Brucella}}
-*'''Brucellosis ''' <ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>, <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-:* 1.'''Uncomplicated brucellosis in adults and children ≥8yrs of age  '''<ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>, <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-:* Preferred regimen: [[Doxycycline]] 100 mg  PO bid for 6 weeks {{and}} [[Streptomycin]] 1 g/day IM  for  2-3 weeks
-:* Alternative regimen (1): [[Doxycycline]] 100 mg/day PO for six weeks {{and}}[[Gentamicin]] 5mg/kg IM  for 7-days
-:* Alternative regimen (2): [[Gentamicin]] 5mg/kg/dayIV/ IM  for 7-10 days  {{and}} [[Rifampicin]] 600–900 mg/day PO for six weeks
-*2.'''Complications of brucellosis'''
+:::::* 3.1.2.1 ''' A Bactericidal Antimicrobial'''
-:*2.1Spondylitis
-::*Preferred regimen:[[ Doxycycline]] for 3 months  {{and}} [[Streptomycin]] for 2 to 3 weeks.
-:*2.2  Neurobrucellosis
-::* Preferred regimen: [[Ceftriaxone]] 2 mg IV bid for 1 month {{and}} Doxycycline 100 mg PO bid for 4-5 month {{and}} [[Rifampicin]] 600–900 mg/day PO for  4-5 month
-:*2.3 Brucella endocarditis
-::* Preferred regimen: [[Doxycycline]] {{and}} an [[Aminoglycoside]] for at least 8 weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
-::* NOTE: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes
-*3. '''Pregnancy'''
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 400 mg IV q8h for 2 weeks
-:* Preferred regimen:[[Rifampin]] 900 mg PO qd  for 6 weeks
-::* NOTE: Adding [[Trimethoprim-sulfamethoxazole]] can be considered, but this option should probably be avoided preceding the 13th week and after the 36th week of gestation because of concern about teratogenicity and kernicterus.
-* 4.'''For children < 8 yrs of age'''
+::::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h for 2 weeks {{or}}
-:* Preferred regimen: [[TMP/SMZ]] 8/40 mg/ kg/day bid PO  for 6 weeks {{and}} [[Streptomycin]] 30 mg/kg/day IM qd  for 3 weeks {{or}} [[Gentamicin]] 5 mg/kg/day IM/ IV qd  for 7-10 days
-:* Alternative regimen (1): [[TMP/SMZ]] {{and}} [[Rifampicin]] 15 mg/kg/day PO for 6 weeks
-:* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
-{{PBI|Eikenella corrodens}}
+:::::* 3.1.2.2 ''' A Bactericidal Agent (ß-lactam)'''
-:*1. '''Human bite/soft tissue infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1.1 Severe
-:::* Preferred regimen: [[Ampicillin]]/[[Sulbactam]] 1.5-3 g IV q6h
-:::* Alternative regimen: [[Doxycycline]] 100 mg IV BID {{or}} [[Moxifloxacin]] 400 mg IV OD {{or}} [[Levofloxacin]] 500 mg IV OD
-::*1.2 Mild
-:::* Preferred regimen: [[Amoxicillin]]/[[Clavulanate]] 250-500 mg TID or 875/125 mg PO BID
-:::* Alternative regimen: [[Doxycycline]] 100 mg PO BID {{or}} [[Moxifloxacin]] 400 mg PO OD {{or}} [[Levofloxacin]] 500 mg PO OD
-:*2. '''Head and neck infections '''
-::*2.1 Severe
-:::* Preferred regimen: [[Ampicillin]]/[[Sulbactam]] 1.5-3 g IV q6h
-:::* Alternative regimen: [[Doxycycline]] 100 mg IV BID {{or}} [[Moxifloxacin]] 400 mg IV OD {{or}} [[Levofloxacin]] 500 mg IV OD
-::*2.2 Mild
-:::* Preferred regimen: [[Amoxicillin]]/[[Clavulanate]] 250-500 mg TID or 875/125 mg PO BID
-:::* Alternative regimen: [[Doxycycline]] 100 mg PO BID {{or}} [[Moxifloxacin]] 400 mg PO OD {{or}} [[Levofloxacin]] 500 mg PO OD
-:*3. '''Endocarditis'''
-::* Preferred regimen: [[Ceftriaxone]] 1g IV q12h {{or}} [[Cefotaxime]] 1-2 g IV q8h {{or}} [[Cefepime]] 1-2g IV q8h
-----
+::::::* 3.1.2.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-{{PBI|Haemophilus ducreyi}}
+:::::::* Preferred regimen: [[Meropenem]] 2 g q8h for 2 weeks  {{or}}
-* 1. '''Chancroid (Haemophlius ducreyi infection)'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:* Preferred Regimen(1): [[Azithromycin]] 1 g PO in a single dose
-:* Preferred Regimen(2): [[Ceftriaxone]] 250 mg IM in a single dose
-:* Preferred Regimen(3): [[Ciprofloxacin]] 500 mg PO bid for 3 days
-:* Preferred Regimen(4): [[Erythromycin]] base 500 mg PO tid for 7 days
-:* Note: Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed 3 months after the diagnosis of chancroid.
-::* 1.1 '''Follow-up'''
-:::* Patients should be re-examined 3–7 days after initiation of therapy. If treatment is successful, ulcers usually improve symptomatically within 3 days and objectively within 7 days after therapy. If no clinical improvement is evident, the clinician must consider whether 1) the diagnosis is correct, 2) the patient is coinfected with another STD, 3) the patient is infected with HIV, 4) the treatment was not used as instructed, or 5) the H. ducreyi strain causing the infection is resistant to the prescribed antimicrobial.
-:::* Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might require needle aspiration or incision and drainage, despite otherwise successful therapy. Although needle aspiration of buboes is a simpler procedure, incision and drainage might be preferred because of reduced need for subsequent drainage procedures.
-::* 1.2 '''Management of sex partners'''
-:::* Regardless of whether symptoms of the disease are present, sex partners of patients who have chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patient’s onset of symptoms.
-::* 1.3 '''Pregnancy'''
-:::* Ciprofloxacin presents a low risk to the fetus during pregnancy, with a potential for toxicity during breastfeeding. Alternative drugs should be used during pregnancy and lactation
-::* 1.4 '''HIV Infection'''
-:::* Persons with HIV infection who have chancroid should be monitored closely because they are more likely to experience treatment failure and to have ulcers that heal slowly. Persons with HIV infection might require repeated or longer courses of therapy, and treatment failures can occur with any regimen.
-----
+::::::* 3.1.2.2.2 '''Alternatives for penicillin-susceptible strains'''
+:::::::* Alternative regimen (1): [[Ampicillin]] 3 g IV q6h for 2 weeks
-{{PBI|Haemophilus influenzae}}
+:::::::* Alternative regimen (2): [[Penicillin G]] 4 MU IV q4h for 2 weeks {{or}}
-*Haemophilus influenzae<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:*'''1.Non-threatening infections'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::1.1.Adults
-:::*Preferred regimen (1) : [[Amoxicillin-clavulanate]] 500mg PO tid or 875mg PO bid.
-:::*Preferred regimen (2) : [[Amoxicillin]] 500mg PO tid.
-:::*Preferred regimen (3) : [[TMP-SMX]] DS PO bid.
-:::*Preferred regimen (4) : [[Cefuroxime]] 250-500mg PO bid.
-:::*Preferred regimen (5) : [[Moxifloxacin]] 400mg PO OD,
-:::*Preferred regimen (6) : [[Levofloxacin]] 500mg PO daily
-:::*Preferred regimen (7) : [[Azithromycin]] 500mg PO single dose then 250mg for 4days {{or}} [[Clarithromycin]] 500mg bid or XL 500mg/day.
-:::*Note: Treatment duration of Otitis media is 10-14days, Acute exacerbation of Chronic Bronchitis is (5days[quinolone]-14days), Sinusitis is 10-14days.
-:*'''2.Meningitis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::::* 3.1.2.3 ''' A Protein Synthesis Inhibitor'''
-::*Preferred regimen : [[Dexamethasone]] (0.15mg/kg)15-20min before first dose of abx and then q6h for 4days.
-:::*2.1.Adults
-::::*Preferred regimen (1) : [[Ceftriaxone]] 2g IV q12h(4gmax).
-::::*Preferred regimen (2) : [[Cefotaxime]] 2g IV q4-6h(12gmax).
-::::*Preferred regimen (3) :[[Ampicillin]] 2g IV q4h if sensitive.
-::::*Beta-lactamalternative : Ciprofloxacin 400mg IV q8h {{or}} other Fluoroquinolones.
-:::*2.2.Pediatric
-::::*2.2.1.Neonates <7days
-:::::*2.2.1.1.<2kg : [[Cefotaxime]] 50mg/kg IVq12h for 10-14days
-:::::*2.2.1.2.>2kg : [[Cefotaxime]] 50mg/kg IVq8h {{or}} [[Ceftriaxone]] 50mg/kg IV q24h for 10-14days
-::::*2.2.2.Neonates >7days
-:::::*2.2.2.1.>2kg: [[Cefotaxime]] 50mg/kg IV q6-8h {{or}} [[Ceftriaxone]] 75mg/kg IV q24h for 10-14days
-::::*2.2.3.Children: [[Cefotaxime]] 200mg/kg/day IV q6h {{or}}  [[Ceftriaxone]] 100mg/kg IV q12-24h for 10-14days
-::*2.3.Post-meningitis exposure prophylaxis : [[Rifampin]] 600mg PO OD for 4days <ref name="pmid6819447">{{cite journal| author=Centers for Disease Control (CDC)| title=Prevention of secondary cases of Haemophilus influenzae type b disease. | journal=MMWR Morb Mortal Wkly Rep | year= 1982 | volume= 31 | issue= 50 | pages= 672-4, 679-80 | pmid=6819447 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6819447  }} </ref>
-:*'''3.Severe infections'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*3.1.Adults
-:::*Preferred regimen : [[Ceftriaxone]] 1-2g IV q24 or q12h {{or}} [[Cefotaxime]] 2g IV q6h.
-:::*Pencillin alternative : [[Ciprofloxacin]] 400mg IV q8h {{or}} other [[Fluoroquinolones]] {{or}}Use [[Ampicillin]] 2g IV q6h if sensitive.
-{{PBI|Neisseria gonorrhoeae}}
-:* '''Neisseria gonorrhoeae, treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::* '''1. Gonococcal infections in adolescents and adults'''
-:::* '''1.1 Uncomplicated gonococcal infections of the cervix, urethra, and rectum'''
-::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::* Alternative regimen: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose (if ceftriaxone is not available)
-:::* '''1.2 Uncomplicated gonococcal infections of the pharynx'''
+::::::* Preferred regimen (1): [[Clindamycin]] 900 IV mg q8h for 2 weeks
-::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-:::::* '''1.2.1 Management of sex partners'''
+::::::* Preferred regimen (2): [[Rifampin]] 600 IV mg q12h for 2 weeks
-::::::* Expedited partner therapy: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::::: Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
-::::::: Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
-::::::: Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.
-:::::* '''1.2.2 Allergy, intolerance, and adverse reactions'''
+::::* 3.1.3 '''Oral antimicrobial treatment for cutaneous anthrax without systemic involvement'''
-::::::* Preferred regimen (1): [[Gemifloxacin]] 320 mg PO in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
-::::::* Preferred regimen (2): [[Gentamicin]] 240 mg IM in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
-::::::: Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).
-:::::* '''1.2.3 Pregnancy'''
+:::::* 3.1.3.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-:::::* '''1.2.4 Suspected cephalosporin treatment failure'''
+::::::* Preferred regimen: [[Ciprofloxacin]] 400 mg IV q8h
-::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::::* Alternative regimen (1): [[Gemifloxacin]] 320 mg PO  single dose  {{and}} [[Azithromycin]] 2 g PO  single dose (when isolates have elevated cephalosporin MICs)
-::::::* Alternative regimen (2): [[Gentamicin]] 240 mg IM  single dose {{and}} [[Azithromycin]] 2 g PO single dose (when isolates have elevated cephalosporin MICs)
-::::::* Alternative regimen (3): [[Ceftriaxone]] 250 mg IM as a single dose {{and}} [[Azithromycin]] 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
-::::::: Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.
-:::* '''1.3 Gonococcal conjunctivitis'''
+::::::* Note: Duration of treatment is 60 days
-::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::: Note: Consider one-time lavage of the infected eye with saline solution.
-:::::* '''1.3.1 Management of sex partners'''
+:::* 3.2 '''Treatment for anthrax in childern''' <ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
-::::::* Patients should be instructed to refer their sex partners for evaluation and treatment.
-:::* '''1.4 Disseminated gonococcal infection'''
+::::* 3.2.1 '''Treatment of cutaneous anthrax without systemic involvement (for children 1 month of age and older)'''
-:::::* '''1.4.1 Arthritis and arthritis-dermatitis syndrome '''
-::::::* Preferred regimen: [[Ceftriaxone]] 1 g IM/IV q24h for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
-::::::* Alternative regimen: [[Cefotaxime]] 1 g IV q8h for 7 days {{or}} [[Ceftizoxime]] 1 g IV q 8 h  for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
-:::::* '''1.4.2 Gonococcal meningitis and endocarditis'''
+:::::* 3.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::::::* Preferred regimen : [[Ceftriaxone]] 1-2 g IV  q 12-24 h  for 10-14 days {{and}} [[Azithromycin]] 1 g PO in a single dose
-::* '''2. Gonococcal infections among neonates'''
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day PO bid (not to exceed 500 mg/dose) for 7-10 days
-:::* '''2.1 Ophthalmia neonatorum caused by N. gonorrhoeae'''
-::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IV or IM in a single dose, not to exceed 125 mg
-:::::* '''2.1.1 Management of mothers and their sex partners'''
+::::::* Preferred regimen (2):
-::::::* Mothers of infants with ophthalmia neonatorum caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
-:::* '''2.2 Disseminated gonococcal infection and gonococcal scalp abscesses in neonates'''
+:::::::* If patients body weight is < 45 kg: [[Doxycycline]] 4.4 mg/kg/day PO bid (not to exceed  100 mg/dose) for 7-10 days
-::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg/day  IM/IV qd for 7 days {{or}} [[Cefotaxime]] 25 mg/kg IV /IM  q12h for 7 days.
-::::: Note (1): The duration of treatment is 10-14 days if meningitis is documented.
-::::: Note (2): Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely.
-:::::* '''2.2.1 Management of mothers and their sex partners'''
+:::::::* If patients body weight is = 45 kg: [[Doxycycline]] 100 mg/dose PO bid for 7-10 days
-::::::* Mothers of infants who have DGI or scalp abscesses caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
-:::* '''2.3 Neonates born to mothers who have gonococcal infection'''
+::::::* Preferred regimen (3): [[Clindamycin]] 30 mg/kg/day PO tid (not to exceed  600 mg/dose) for 7-10 days
-::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
-:::::* '''2.3.1 Management of mothers and their sex partners'''
+::::::* Preferred regimen (4):
-::::::* Mothers who have gonorrhea and their sex partners should be evaluated, tested, and presumptively treated for gonorrhea.
-::* '''3. Gonococcal infections among infants and children'''
+:::::::* If patients body weight is < 50 kg: [[Levofloxacin]] 16 mg/kg/day PO bid (not to exceed  250 mg/dose) for 7-10 days
-:::* '''3.1 Infants and children who weigh ≤ 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis'''
-::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
-:::* '''3.2 Children who weigh > 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis'''
+:::::::* If patients body weight is > 50 kg: [[Levofloxacin]] 500 mg PO qd for 7-10 days
-::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1g PO in a single dose
-::::* Alternative regimen: [[Cefixime]] 400 mg PO  single dose {{and}} [[Azithromycin]] 1 g PO single dose.(If ceftriaxone is not available)
-:::* '''3.3 Children who weigh ≤ 45 kg and who have bacteremia or arthritis'''
+:::::* 3.2.1.2 '''Alternatives for penicillin-susceptible strains'''
-::::* Preferred regimen: [[Ceftriaxone]] 50 mg/kg (maximum dose: 1 g) IM/IV q24h for 7 days
-:::* '''3.4 Children who weigh > 45 kg and who have bacteremia or arthritis'''
+::::::* Alternative regimen (1):[[Amoxicillin]] 75 mg/kg/day PO tid (not to exceed 1 g/dose) for 7-10 days
-::::* Preferred regimen: [[Ceftriaxone]] 1 g IM/IV q24h for 7 days
-{{PBI|Neisseria meningitidis}}
+::::::* Alternative regimen (2): [[Penicillin VK]] 50-75 mg/kg/day PO tid or qid for 7-10 days
-:*''' Meningococcal Meningitis or Bacteremia''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 7-10 days.
-::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q4-6h for 7-10 days.
-::* Alternatives regimen (1): [[Chloramphenicol]]  4-6 g/day for 7-10 days
-::* Alternatives regimen (2): [[Penicillin]] 18-24 MU/day IV
-::* Alternatives regimen (3): [[Ampicillin]] 12 g/day IV
-::* Alternatives regimen (4): [[ Aztreonam]] 6-8 g/day IV
-::* Alternatives regimen (5): [[Moxifloxacin]] 400 mg/day IV.
-::* Steroids: [[Dexamethasone]] 10 mg IV q6h for 2-4 days starting before or with first dose.
-{{PBI|Moraxella catarrhalis}}
-{{PBI|Pasteurella multocida}}
-:* [[Pasteurella multocida]] <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): [[Amoxicillin]]/clavulanate 500 mg PO TID or 875 mg PO BID with food (also preferred empirical coverage of animal bite wounds)
-::* Preferred regimen (2): [[Ampicillin]]/sulbactam 3g IV q6h
-::* Preferred regimen (3): [[Ciprofloxacin]] 500 mg PO BID or 400 mg IV q12h {{or}} [[Levofloxacin]] 500 mg PO qd or IV q24h
-::* Alternative regimen (1): [[Doxycycline]] 100 mg PO BID {{or}} [[TMP-SMX]] DS PO BID (for beta-lactam allergic patients )
-::* Alternative regimen (2): [[Penicillin]] 500 mg PO QID or 4 million units IV q4h (use only if isolate known to be susceptible)
-====Bacteria – Spirochetes====
+::::* 3.2.2 ''' Combination therapy for systemic anthrax when meningitis can be ruled out (for children 1 month of age and older)'''
-{{PBI|Borrelia burgdorferi}}
-::* Lyme disease
-:::* 1. Early Lyme Disease
-::::* 1.1 Erythema migrans
-:::::* Preferred regimen: [[Doxycycline]] 100 mg twice per day for 10-21 days {{or}} [[Amoxicillin]] 500 mg 3 times per day for 14-21 days {{or}} [[Cefuroxime axetil]] 500 mg twice per day for 14-21 days
-:::::* Alternatie regimen: : [[Azithromycin]] 500 mg PO per day for 7–10 days {{or}} [[Clarithromycin]] 500 mg PO twice per day for 14–21 days (if the patient is not pregnant) {{or}} [[Erythromycin]] 500 mg PO 4 times per day for 14–21 days
-:::::* Pediatric regimen (1): (children <8 years of age) [[Amoxicillin]] 50 mg/kg per day in 3 divided doses [maximum of 500 mg per dose] {{or}} [[Cefuroxime axetil]] 30 mg/kg per day in 2 divided doses （maximum of 500 mg per dose)
-:::::* Pediatric regimen (2):（children ≥8 years of age）[[Doxycycline]] 4 mg/kg per day in 2 divided doses（maximum of 100 mg per dose）
-:::::* Pediatric regimen (3): [[Azithromycin]] 10 mg/kg per day (maximum of 500 mg per day) {{or}} [[Clarithromycin]] 7.5 mg/kg twice per day (maximum of 500 mg per dose) {{or}} [[Erythromycin]] 12.5 mg/kg 4 times per day (maximum of 500 mg per dose)
-::::* 1.2 When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis
-:::::* Preferred regimen: [[Amoxicillin]]–clavulanic acid 500 mg 3 times per day;
-:::::* Pediatric regimen；[[Amoxicillin]]–clavulanic acid 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose)
-::::* 1.3 Lyme meningitis and other manifestations of early neurologic Lyme disease
-:::::* Preferred regimen: [[Ceftriaxone]] 2g once per day IV for 10–28 days
-:::::* Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h {{or}} [[Penicillin G]] 18–24 million U q4h per day for patients with normal renal function
-:::::* Alternative regimen (2): [[Doxycycline]] 200–400 mg per day in 2 divided doses PO for 10–28 days
-:::::* Pediatric regimen (1): [[Ceftriaxone]] 50–75 mg/kg per day in a single daily intravenous dose (maximum, 2g)
-:::::* Pediatric regimen (2): [[Cefotaxime]] 150–200 mg/kg per day divided into 3 or 4 intravenous doses per day (maximum, 6 g per day)
-:::::* Pediatric regimen (3): [[Penicillin G]] 200,000–400,000 units/kg per day (maximum, 18–24 million U per day) divided into doses given intravenously q4h for those with normal renal function
-:::::* Pediatric regimen (4): (≥8 years old) [[Doxycycline]] 4–8 mg/kg PO per day in 2 divided doses (maximum, 100–200 mg per dose)
-::::* 1.4 Lyme carditis
-:::::* Preferred regimen: [[Ceftriaxone]] 2g once per day IV for 10–28 days
-:::::* NOTE: patients with advanced heart block, a temporary pacemaker may be required; expert consultation with a cardiologist is recommended; Use of the pacemaker may be discontinued when the advanced heart block has resolved; An oral antibiotic treatment regimen should be used for completion of therapy and for outpatients, as is used for patients with erythema migrans without carditis (see above)
-::::* 1.5 Borrelial lymphocytoma
-:::::* Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)
-:::* Late Lyme Disease
-::::* 1.6 Lyme arthritis
-:::::* Preferred regimen: [[Doxycycline]] 100 mg twice per day {{or}} [[Amoxicillin]] 500 mg 3 times per day
-:::::* Alternative regimen: [[Cefuroxime axetil]] 500 mg twice per day for 28 days
-:::::* Pediatric regimen: [[Amoxicillin]] 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose) {{or}} [[Cefuroxime axetil]] 30 mg/kg per day in 2 divided doses (maximum of 500 mg per dose) {{or}} (≥8 years of age) [[Doxycycline]] 4 mg/ kg per day in 2 divided doses (maximum of 100 mg per dose)
-:::::* NOTE: For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of [[Ceftriaxone]] IV
-::::* 1.7 patients with arthritis and objective evidence of neurologic disease
-:::::* Preferred regimen: [[Ceftriaxone]] IV for 2–4 weeks
-:::::* Alternative regimen: [[Cefotaxime]] {{or}} [[Penicillin G]] IV
-:::::* Pediatric regime: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]] IV
-::::* 1.8 Late neurologic Lyme disease
-:::::* Preferred regimen: [[Ceftriaxone]] IV for 2 to 4 weeks
-:::::* Alternative regimen: [[Cefotaxime]] {{or}} [[Penicillin G]] IV
-:::::* Pediatric regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]]
-::::* 1.9 Acrodermatitis chronica atrophicans
-:::::* Preferred regimen: [[Doxycycline]] 100 mg twice per day {{or}} [[Amoxicillin]] 500 mg 3 times per day {{or}} [[Cefuroxime axetil]] 500 mg twice per day for 21 days
-:::* 2. Post–Lyme Disease Syndromes
-:::::* Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing)
-{{PBI|Borrelia recurrentis}}
+:::::* 3.2.2.1 '''A bactericidal antimicrobial'''
-::* 1. Tick-Borne Relapsing Fever <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Doxycycline]] 100 mg PO twice daily for 5-10 days
-:::* Alternative regimen: [[Erythromycin]] 500 mg PO four times a day for 5-10 days
-:::* NOTE: If meningitis/encephalitis present, use [[Ceftriaxone]] 2 g IV q12h for 14 days
-::* 2. Louse-Borne Relapsing Fever
-:::* Preferred regimen: single dose [[Tetracycline]] 500 mg PO
-:::* Alternative regimen: single dose [[Erythromycin]] 500 mg PO
-{{PBI|Leptospira}}
+::::::* 3.2.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::* 1. Treatment
-:::* 1.1 Severe <ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::::* Preferred regimen: [[Penicillin]] 1.5 million units IV q6hr for 5-7 days
-:::* 1.2 Less severe
-::::* Preferred regimen: [[Amoxycillin]] {{or}} [[Ampicillin]] {{or}} [[Doxycycline]] 100 mg BID IV or PO for 5-7 days {{or}} [[Erythromycin]] {{or}} [[Ceftriaxone]] 1g IV per day for 5-7 days {{or}} [[Cefotaxime]] {{or}} [[Quinolone]] PO
-::* 2. Prophylaxis
-:::* ''Leptospira interrogans'' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::::* Preferred regimen: [[Doxycycline]] 200 mg PO once per week
-{{PBI|Treponema pallidum}}
+:::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day IV divided q8h (not to exceed 400 mg/dose) for 14 days
-::* 1. '''Syphilis Among non-HIV-Infected Persons'''<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports / Centers for Disease Control |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm |issn=}}</ref>
-:::* 1.1 Primary and Secondary Syphilis
-::::* Preferred regimen (adult): Benzathine penicillin G 2.4 million units IM in a single dose
-::::* Preferred regimen (pediatric): Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose
-:::* 1.2 Latent Syphilis
-::::* 1.2.1 Early Latent Syphilis
-:::::* Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose
-:::::* Pediatric regimen: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose
-::::* 1.2.2 Late Latent Syphilis or Latent Syphilis of Unknown Duration
-:::::* Preferred regimen: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervalspediatric
-:::::* Pediatric regimen: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units, administered as 3 doses at 1-week intervals (total 150,000 units/kg up to the adult total dose of 7.2 million units)
-:::* 1.3 Tertiary Syphilis
-::::* Preferred regimen: Benzathine penicillin G 7.2 million units total, administered as 3 doses of 2.4 million units IM each at 1-week intervals
-:::* 1.4 Neurosyphilis and ocular syphilis
-::::* Preferred regimen: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
-::::* Alternative regimen: Procaine penicillin 2.4 million units IM once daily {{and}} Probenecid 500 mg orally four times a day, both for 10--14 days
-::* 2. '''Syphilis Among HIV-Infected Persons'''
+:::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h (not to exceed 2 g/dose) for 14 days
-:::* 2.1 Primary and Secondary Syphilis Among HIV-Infected Persons
-::::* Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
-:::* 2.2 Latent Syphilis Among HIV-Infected Persons
-::::* 2.2.1 early latent
-:::::* Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
-::::* 2.2.2 late latent
-:::::* Preferred regimen: Benzathine penicillin G at weekly doses of 2.4 million units for 3 weeks.
-:::* 2.3 Neurosyphilis Among HIV-Infected Persons
-::::* Preferred regimen: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
-::::* Alternative regimen: Procaine penicillin 2.4 million units IM once daily {{and}} Probenecid 500 mg orally four times a day, both for 10--14 days
-::* 3. '''Syphilis During Pregnancy'''
+:::::::* Preferred regimen (3):
-:::* Preferred regimen: Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection
-::* 4. '''Congenital Syphilis in neonates'''
+::::::::* If patients body weight is < 50 kg: [[Levofloxacin]] 20 mg/kg/day IV divided q12h (not to exceed 250 mg/dose) for 14 days
-:::* 4.1 condition 1 : Infants with proven or highly probable disease and (1)an abnormal physical examination that is consistent with congenital syphilis;（2）a serum quantitative nontreponemal serologic titer that is fourfold higher than the mother's titer;¶ or（3）a positive darkfield test of body fluid(s).
-::::* Preferred regimen: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days {{or}} Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days
-::::* NOTE: If more than 1 day of therapy is missed, the entire course should be restarted. Data are insufficient regarding the use of other antimicrobial agents (e.g., ampicillin). When possible, a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis. The use of agents other than penicillin requires close serologic follow-up to assess adequacy of therapy. In all other situations, the maternal history of infection with T. pallidum and treatment for syphilis must be considered when evaluating and treating the infant.
-:::* 4.2 condition 2: Infants who have a normal physical examination and a serum quantitive nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was not treated, inadequately treated, or has no documentation of having received treatment; (2)mother was treated with erythromycin or another nonpenicillin regimen;†† or (3)mother received treatment &lt; 4 weeks before delivery.
-::::* Preferred regimen: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days {{or}} Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days {{or}} Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
-::::* NOTE:If the mother has untreated early syphilis at delivery, 10 days of parenteral therapy can be considered.
-:::* 4.3 condition 3:Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was treated during pregnancy, treatment was appropriate for the stage of infection, and treatment was administered >4 weeks before delivery and (2)mother has no evidence of reinfection or relapse.
-::::* Preferred regimen: Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
-:::* 4.4 condition 4: Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother's treatment was adequate before pregnancy and (2)mother's nontreponemal serologic titer remained low and stable before and during pregnancy and at delivery (VDRL <1:2; RPR <1:4).
-::::* Preferred regimen: No treatment is required; however, benzathine penicillin G 50,000 units/kg as a single IM injection might be considered, particularly if follow-up is uncertain.
-::* 5.''' Congenital Syphilis in infants and children'''
-::::* Preferred regimen: Aqueous crystalline penicillin G 50,000 U/kg q4–6h for 10 days
-====Bacteria – Gram-Negative Bacilli====
+::::::::* If patients body weight is > 50 kg: [[Levofloxacin]] 500 mg IV q24h for 14 days
-{{PBI|Achromobacter xylosoxidans}}
-{{PBI|Acinetobacter baumannii}}
-::* Preferred regimen (1): [[Imipenem]] 0.5-1 g IV q6h
-::* Preferred regimen (2): [[Ampicillin/sulbactam]] (Unasyn) 3g q4h
-::* Preferred regimen (3): [[Cefepime]] 1-2 g IV q8h
-::* Preferred regimen (4): [[Colistin]] 2.5 mg/kg IV q12h
-::* Preferred regimen (5): [[Tigecycline]] (Tygacil) 100 mg IV, then 50 mg IV q12h
-::* Preferred regimen (6): [[Amikacin]] 7.5 mg/kg q12h IV or 15 mg/kg/day IV
-::* Alternative regimen (1): [[Ceftriaxone]] 1-2g IV every day
-::* Alternative regimen (2): [[Cefotaxime]] 2-3g IV q6-8h
-::* Alternative regimen (3): [[Ciprofloxacin]] 400 mg IV q8-12h or 750 mg PO bid
-::* Alternative regimen (4): [[TMP-SMX]] 15-20 mg (TMP)/kg/day IV divided 3 or 4 doses/day or 2 DS PO bid
-{{PBI|Aeromonas hydrophila}}
-:* Aeromonas hydrophila<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1. '''Diarrhea'''
-:::* Preferred regimen (if not self-limiting, or if severe): [[Ciprofloxacin]] 500 mg PO bid.
-:::* Alternate regimen: [[TMP-SMX]] single dose PO bid
-:::* Note: High resistance to sulfa agents described in Taiwan and Spain
-::*2. '''Skin and soft tissue infection'''
-:::*2.1 '''Mild infection'''
-::::* Preferred regimen (1): [[Ciprofloxacin]] 500 mg PO bid
-::::* Preferred regimen (2): [[Levofloxacin]] 500 mg OD.
-:::*2.2 '''Severe infection or sepsis'''
-::::* Preferred regimen (1): [[Ciprofloxacin]] 400 mg IV q8h
-::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h
-::::* Note (1): For suspicion of water-based injury,empiric coverage for Vibrio [[Doxycycline]] 100mg bid, although Flouroquinolones may also cover {{and}}  [[Vancomycin]] 15mg/kg IV q12h {{with/without}}  [[Clindamycin]] {{or}}  [[Linezolid]] for inhibition of Gram-positive toxin production
-::::* Alternative regimen: Alternatives to [[fluoroquinolones]] for Aeromonas coverage include ([[Carbapenems]] ([[Ertapenem]], [[Doripenem]], [[Imipenem]], [[Meropenem]]), [[Ceftriaxone]], [[Cefepime]] and [[Aztreonam]].
-::*3. '''Prevention'''
-:::* Preferred regimen: Frequent recommendations include using a [[Cephalosporin]] (e.g.,cefuroxime, ceftriaxoneorcefixime) {{or}} a [[Fluoroquinolone]] (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches.
-:::* Note: Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones. Duration of antibiotic use is 3-5days, some recommend continuing until wound or eschar resolves
-{{PBI|Bartonella}}
-:* Bartonella<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::*1. '''Cat scratch disease'''
-:::*1.1 '''If extensive adenopathy'''
-::::* Preferred regimen: [[Azithromycin]] 500 mg single dose
-::*2. '''Retinitis'''
-:::* Preferred regimen: [[Doxycycline]] 100 mg bid {{and}}  [[Rifampin]] 300 mg bid PO for 4-6 weeks.
-::*3. '''Bacillary angiomatosis'''
-:::* Preferred regimen (1): [[Erythromycin]] 500 mg PO qid
-:::* Preferred regimen (2): [[Doxycycline]] 100mg PO bid for >3 months.
-::*4. '''Peliosis hepatitis'''
-:::* Preferred regimen (1): [[Erythromycin]] 500 mg PO qid
-:::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 4 months.
-::*5. '''Oroya fever'''
-:::* Preferred regimen: [[Ciprofloxacin]] 500 mg PO bid for 10 days.
-::*6. '''Endocarditis'''
-:::* Preferred regimen: [[Gentamicin]] 3 mg/kg/day IV q8h for 14 days {{and}}  [[Ceftriaxone]] 2 g/day IV for 6weeks {{with/without}} [[Doxycycline]] 100 mg PO bid for 6 weeks.
-{{PBI|Bordetella pertussis}}
-:*Bordetella pertussis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> ::*1. '''Whooping cough'''
-::::*1.1 '''Adults'''
-:::::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose then 250 mg PO qd for 2-5days
-:::::* Preferred regimen (2): [[Clarithromycin]] 500 mg bid for 7 days.
-:::::* Alternative regimen(Intolerant of macrolides): [[Trimethoprim-sulfamethoxazole]] DS bid PO for 14 days
-:::::* Alternative regimen (2): [[Erythromycin]] 250 mg PO qid for 14 days
-::::*1.2 '''Infants <6 months of age'''
-:::::*1.2.1 '''Infants <1 month'''
-::::::* Preferred regimen: [[Azithromycin]] 10 mg/kg/day for 5 days
-::::::* Note: [[Erythromycin]], [[Clarithromycin]] and [[TMP-SMX]] not recommended
-:::::*1.2.2 '''Infants of 1-5 months of age'''
-::::::* Preferred regimen(1): [[Azithromycin]] 10 mg/kg/day for 5 days
-::::::* Preferred regimen(2): [[Clarithromycin]] 15mg/kg bid for 7 days
-::::::* Preferred regimen(3): [[Erythromycin]] 10 mg/kg PO qid for 14 days,
-::::::* Note: [[TMP-SMX]] contraindicated.
-::::*1.3 '''Infants >6 months of age-children'''
-::::::* Preferred regimen(1): [[Azithromycin]] 10 mg/kg (500 mg max) qd for 5 days
-::::::* Preferred regimen(2): [[Clarithromycin]] 15 mg/kg (1 g daily max) bid for 7 days
-::::::* Preferred regimen(3): [[Erythromycin]] 10mg/kg PO (2g daily max) qid for 14 days
-::::::* Preferred regimen(4): [[TMP-SMX]] 4 mg/40 mg/kg bid for 14 days.
-::::::* Note(1): [[TMP-SMX]] should only be used in patients ≥2 months of age who are allergic or intolerant of macrolides or who have a macrolide-resistant strain.
-::::::* Note(2): Although fluoroquinolones have excellent in vitro sensitivity profiles, clinical experience for B. pertussis is limited.
-{{PBI|Burkholderia cepacia}}
+:::::::* Preferred regimen (4): [[Imipenem]]/[[Cilastatin]] 100 mg/kg/day IV divided q6h (not to exceed 1 g/dose) for 14 days
-::* Burkholderia cepacia<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen : [[Ceftazidime]] 2 g IV q8h {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Meropenem]] 1-2g IV q8h {{or}} [[Minocycline]] 100 mg IV/PO bid.
-{{PBI|Burkholderia pseudomallei}}
+:::::::* Preferred regimen (5): [[Vancomycin]] 60 mg/kg/day IV divided q8h (follow serum concentrations) for 14 days
-::* Burkholderia pseudomallei
-:::*'''1.Melioidosis'''<ref name="pmid22970946">{{vcite2 journal |vauthors=Wiersinga WJ, Currie BJ, Peacock SJ |title=Melioidosis |journal=N. Engl. J. Med. |volume=367 |issue=11 |pages=1035–44 |year=2012 |pmid=22970946 |doi=10.1056/NEJMra1204699 |url= |issn=}}</ref>
-::::*1.1.Intial intensive therapy (Minimum of 10-14 days)
-:::::* Preferred regimen : [[Ceftazidime]] 50 mg/kg upto 2 g q6h {{or}} [[Meropenem]] 25mg/kg upto 1g q8h {{or}} [[Imipenem]] 25 mg/kg upto 1g
-:::::* Note : Any one of the three may be combined with [[TMP-SMX]]6/30 mg/kg upto 320/1600 mg/kg q12h (recommended for neurologic, bone, joint, cutaneous and prostatic melioidosis)
-::::*1.2.Eradication therapy (Minimum of 3months)
-:::::* Preferred regimen : [[TMP-SMX]]6/30 mg/kg upto 320/1600 mg/kg q12h
-{{PBI|Campylobacter}}
-{{PBI|Campylobacter fetus}}
-::*Campylobacter fetus<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Serious infections
-::::*Preferred regimen : [[Gentamicin]] 5mg/kg/day IV {{or}} [[Imipenem]] 1mg IV q6h {{or}} [[Ceftriaxone]] 2g IV q12h.
-:::*Endovascular infections
-::::*Preferred regimen : [[Aminoglycoside]]4-6weeks combined with [[Carbapenem]].
-:::*CNS
-::::*preferred regimen : [[Ceftriaxone]] {{or}} [[Chloramphenicol]] for 2-3weeks.
-{{PBI|Campylobacter jejuni}}
-{{PBI|Capnocytophaga canimorsus}}
+::::::* 3.2.2.1.2 '''Alternatives for penicillin-susceptible strains'''
-::*Capnocytophaga canimorsus<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Severe Cellulitis/Sepsis or Endocarditis'''
-::::*Preferred regimen
-:::::*Beta-lactam/beta-lactamase inhibitor : [[Ampicillin]]/[[sulbactam]] 3 g IV q6h
-:::::*Non-beta-lactamase producing : [[Penicillin G]] 2-4MU q4h IV
-::::*Alternative regimen : [[Ceftriaxone]] 1-2 g IV q24h {{or}} [[Meropenem]] 1 g IV q8h.
-:::*'''2.Complicated infections or Immunocompromise'''
-::::*Preferred regimen : [[Clindamycin]] 600 mg IV q8h may be combined with above agents
-::::*Note (1): Resistance to aztreonam described, and variable susceptibility reported to [[TMP-SMX]] and aminoglycosides.
-::::*Note (2): For endocarditis, alternatives to penicillins not well established, treated for duration of 6 weeks. For non-endocarditis infections, duration not well established, but most authorities recommend at least 14-21 days of therapy.
-:::*'''3.Mild Cellulitis/Dog or Cat Bites'''
-::::*Preferred regimen : [[Amoxicillin/clavulanate]] 500 mg PO q8h or 875 mg PO bid {{or}} [[Amoxicillin]] 500 mg PO q8h.
-::::*Alternative regimen : [[Clindamycin]] 300 mg PO q6h {{or}} [[Doxycycline]] 100 mg PO bid {{or}} [[Clarithromycin]] 500 mg PO bid {{or}} [[Moxifloxacin]] 400 mg PO OD.
-:::*'''4.Meningitis or brain abscess'''
-::::*Preferred regimen : Use [[Ceftriaxone]] 2 g IV q12h {{and}} [[Ampicillin]] 2 g IV q4h
-::::*If Beta-lactamase producing or polymicrobial brain abscess : [[Imipenem]]/[[cilastin]] 1000 mg q6-8h {{and}} [[Clindamycin]] 600 mg IV q8h
-:::*'''5.Prevention'''
-::::*Although no firm data supports this recommendation, many clinicians do give prophylaxis for dog and cat bites in asplenic patients with [[amoxicillin/clavulanate]] for 7-10 days.
-{{PBI|Citrobacter freundii}}
-::* Citrobacter freundii<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Meropenem]] 1-2 g IV q8h {{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IVq8h{{or}} [[Cefepime]] 1-2 g IV q8h {{or}} [[Ciprofloxacin]] 400 mg IV q12h(or 500 mg PO bid for UTI) {{or}} [[Gentamicin]] 5 mg/kg/day.
-:::* Alternate regimen: [[Piperacillin]]/[[tazobactam]] 3.375 mg q6h IV {{or}} [[Aztreonam]] 1-2 g IV q6h {{or}} [[TMP-SMX]] 5 mg/kg q6h IV (or DS PO bid for UTI).
-{{PBI|Citrobacter koseri}}
+:::::::* Alternative regimen (1): [[Penicillin G]] 400 000 U/kg/day IV divided q4h (not to exceed 4 MU/dose) for 14 days
-::* Citrobacter koseri<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Ceftriaxone]] 1-2 g IV q12-24 {{or}} [[Cefotaxime]] 1-2 g IV q6h {{or}} [[Cefepime]] 1-2 IV q8h.
-:::* Alternate regimen: [[Ciprofloxacin]] 400 mg IV q12h (or 500 mg PO q12h for UTI){{or}} [[Imipenem]] 1 g IV q6h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Meropenem]] 1-2 g IV q8h {{or}} [[Aztreonam]] 1-2 g IV q6h{{or}} [[TMP-SMX]] 5 mg/kg q6h IV (or DS PO bid for UTI).
-:::*Note: Usually [[Ampicillin]] resistant, but may be sensitive to [[Cephalosporins|first generation cephalosporins]]
-{{PBI|Elizabethkingia meningoseptica}}
-{{PBI|Enterobacter aerogenes}}
-:* [[Enterobacter aerogenes]]
-::*'''1.UTI'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen: [[Ciprofloxacin]] 250 mg PO bid
-{{PBI|Enterobacter cloacae}}
-:* [[Enterobacter cloacae]]
-::*'''1.UTI'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen: [[Ciprofloxacin]] 250 mg PO bid {{PBI|Escherichia coli}}
-::* Escherichia coli<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*1.'''Meningitits'''
-::::*1.1.Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
-::::*1.2.Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Meropenem]] 6 g/day IV q8h {{or}} [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}}  [[Ampicillin]] 12 g/day IV q4h
-:::*'''2.Uncomplicated urinary tract infection'''
-::::*2.1.Preferred agents (IDSA/AUA Guidelines): [[TMP-SMX]] DS PO bid for 3-day
-::::*2.2.Alternative regimen(1): [[Ciprofloxacin]] 250 mg PO bid {{or}} [[Ciprofloxacin]] 500 mg XR once daily for 3 days {{or}} [[Levofloxacin]] 250 mg PO OD for 3 days.
-::::*2.3.Alternative regimen(2): [[Nitrofurantoin]] 100 mg PO q6h {{or}} [[Nitrofurantoin]] macrocrystals (Macrobid) 100 mg PO bid for 7 days.
-::::*2.4.Alternative regimen(3): [[Fosfomycin]] 3 g sachet PO single dose.
-::::: Note: For older patients, those with comorbidities (e.g., diabetes mellitus) use 7-10 days course.
-:::*'''3.Pyelonephritis'''
-::::*3.1.'''Acute uncomplicated pyelonephritis'''
-:::::*Preferred regimen: [[Ciprofloxacin]] 500 mg bid PO for 5-7 days {{or}} [[Ciprofloxacin]]-[[Erythromycin]] 1000 mg q24h {{or}} [[Levofloxacin]] 750 mg q24h {{or}} [[Ofloxacin]] 400 mg bid, [[Moxifloxacin]] 400 mg q24h
-:::::*Alternative regimen: [[Amoxicillin-Clavulanic acid]]875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid {{or}} Oral Cephalosporins {{or}} [[TMP-SMX]] 2 mg/kg IV q6h PO for 14 days
-::::*3.1.'''Acute pyelonephritis (Hospitalized)'''
-:::::*Preferred regimen: [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Ampicillin]] and [[Gentamicin]] {{or}} [[Piperacillin-Tazobactam]] 3.375 gm IV q4-6h for 14 days.
-:::::*Alternative regimen: [[Ticarcillin-Clavulanate]]3.1 gm IV q6h or [[Ampicillin]]-[[Sulbactam]] 3 gm IV q6h or [[Piperacillin-Tazobactam]] 3.375 gm IV q4-6h {{or}} [[Ertapenem]] 1 gm IV q24h or [[Doripenem]] 500 mg q8h for 14 days.
-:::*4.'''Traveler’s diarrhea'''
-::::*Preferred regimen : [[Ciprofloxacin]] 750 mg PO OD for 1-3 days or other Fluoroquinolones
-::::*Pediatrics & pregnancy: [[Azithromycin]] 10 mg/kg/day single dose {{or}} [[Ceftriaxone]] 50 mg/kg/day IV OD for 3 days.
-::::Avoid Fluoroquinolones in Pediatrics and pregnancy.
-:::*5.'''Malacoplakia'''
-::::*[[Bethanechol chloride]] {{and}} ([[Ciprofloxacin]] 400 mg IV q12h {{or}} [[TMP-SMX]] 2 mg/kg (TMP component) IV q6h)
-:::*'''6.Bacteremia/Pneumonia'''
-::::*Preferred regimen : [[Ceftriaxone]] 1-2g IV q24h {{or}} other third or fourth generation cephalosporin {{or}} [[Ciprofloxacin]] 400mg IV q12h or 500mg PO q12h {{or}} [[Levofloxacin]] 500mg PO/IV q24h {{or}} [[Moxifloxacin]] 400mg IV/PO q24h {{or}} [[Ampicillin]](if sensitive) 2g IV q6h {{or}} [[TMP-SMX]](if sensitive) 5-10mg/kg/day for q6-8hIV
-::::*Alternative regimen (1): [[Imipenem]], [[Meropenem]], [[Ertapenem]], [[Doripenem]], [[Ceftazidime]], [[Cefepime]], [[Cefazolin]] or [[Cefuroxime]](if sensitive), [[Aztreonam]], [[Ticarcillin]], [[Piperacillin]], [[Piperacillin]]-[[Tazobactam]], [[Aminoglycosides]], [[Tigecycline]](intra-abd or skin/softtissue).
-::::*Alternative regimen (2): [[Ampicillin-sulbactam]] 3g IV q6h {{and}}[[Gentamicin]] 1.5mg/kg/q8h or 5-7mg/kg/dayIV {{or}} [[Gentamicin]] 5mg/kg/day {{or}} [[Tobramycin]] 5mg/kg/dayIV for 7-14days
-::::*Note: Monotherapy generally not recommended for bacteremia/pneumonia
-{{PBI|Francisella tularensis}}
-::*Francisella tularensis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Tularemia'''
-::::*Preferred regimen : [[Streptomycin]] 1 g IM bid {{or}} [[Gentamicin]] 5 mg/kg/day IV for 10 days.
-::::*Alternative regimen : [[Doxycycline]] 100 mg IV  bid {{or}} [[Chloramphenicol]] 1 g IV q6h {{or}} [[Ciprofloxacin]] 400 mg IV bid until stable then PO for 14-21 days (total).
-::::*1.1.Pregnancy
-:::::*Preferred regimen : [[Gentamicin]] 5 mg/kg/day IV for 10 days.
-:::::*Alternative regimen : [[Ciprofloxacin]].
-{{PBI|Helicobacter pylori}}
-::* Helicobacter pylori<ref name="pmid22491499">{{vcite2 journal |vauthors=Malfertheiner P, Megraud F, O'Morain CA, et al. |title=Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report |journal=Gut |volume=61 |issue=5 |pages=646–64 |year=2012 |pmid=22491499 |doi=10.1136/gutjnl-2012-302084 |url= |issn=}}</ref>
-:::* '''1.Peptic ulcer disease'''
-::::*1.1.Regimens for Initial Treatment
-:::::*1.1.1.Triple therapy : PPI(standard dose twice daily) {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Clarithromycin]] 500 mg bid  for 7-14 days
-:::::*1.1.2.Quadruple therapy: PPI (standard dose twice daily) {{and}} [[Metronidazole]]  250 mg q6h {{and}} [[Tetracycline]] 500 mg q6h {{and}} Bismuth (dose depends on preparation) for 10-14 days
-:::::*1.1.3.Sequential therapy: PPI (standard dose twice daily){{and}} [[Amoxicillin]]  1 g bid for 1-5 days followed by PPI (standard dose twice daily){{and}} [[Clarithromycin]] 500 mg bid {{and}} [[Tinidazole]] 500 mg bid for  6-10 days
-::::*1.2. Second-Line Therapies
-:::::*1.2.1.Triple therapy: PPI (standard dose twice daily) {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Metronidazole]] 500 mg bid
-:::::*1.2.2.Quadruple therapy: PPI (standard dose twice daily){{and}} [[Metronidazole]] 250 mg q6h {{and}} [[Tetracycline]] 500 mg q6h {{and}} Bismuth (dose depends on preparation) for 10-14 days
-:::::*1.2.3.Levofloxacin triple therapy: PPI (standard dose twice daily) {{and}} [[Amoxicillin]] 1 g bid  {{and}}  [[Levofloxacin]] 500 mg bid for 10 days
-:::::*1.2.4.Rifabutin triple therapy: PPI (standard dose twice daily)  and  [[Amoxicillin]]  1 g bid {{and}} [[Rifabutin]] 150-300 mg/day  for 10 days
-::::*1.3.Alternative triple therapies appropriate for patients with an allergy to Amoxicillin include (PPI {{and}} [[Clarithromycin]] {{and}} [[Metronidazole]]){{ or}} ([[PPI]] {{and}} [[Tetracycline]] {{and}} [[Metronidazole]]).
-----
+:::::::* Alternative regimen (2): [[Ampicillin]] 200 mg/kg/day IV divided q6h (not to exceed 3 g/dose) for 14 days {{and}}
-{{PBI|Klebsiella granulomatis}}
+:::::* 3.2.2.2 '''A Protein Synthesis Inhibitor'''
-::* Klebsiella granulomatis (formly known as Calymmatobacterium granulomatis)
-:::*1. '''Granuloma inguinale (donovanosis)'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::::* Preferred regimen: [[Azithromycin]] 1 g PO once a week or 500 mg qd for 3 weeks and until all lesions have completely healed
-::::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid for 3 weeks and until all lesions have completely healed
-::::* Alternative regimen (2): [[Ciprofloxacin]] 750 mg PO bid for at least 3 weeks and until all lesions have completely healed
-::::* Alternative regimen (3): [[Erythromycin]] base 500 mg PO qid for at least 3 weeks and until all lesions have completely healed
+::::::* Preferred regimen (1): [[Clindamycin]], 40 mg/kg/day IV divided q8h (not to exceed 900 mg/dose) for 14 days
-::::* Alternative regimen (4): [[Trimethoprim-sulfamethoxazole]] one double-strength (160 mg/800 mg) tablet PO bid for at least 3 weeks and until all lesions have completely healed
+::::::* Preferred regimen (2):  (non-CNS infection dose)
-----
+:::::::* If patient is < 12 y old: [[Linezolid]] 30 mg/kg/day IV divided q8h for 14 days
-{{PBI|Klebsiella pneumoniae}}
+:::::::* If patient is = 12 y old: [[Linezolid]] 30 mg/kg/day IV divided q12h (not to exceed 600 mg/dose) for 14 days
-::* Klebsiella pneumoniae<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Severe,nosocomial infection'''
-::::*Preferred regimen : [[Cefepime]] 2g IV q8h {{or}} [[Ceftazidime]] 2g IV q8h {{or}} [[Imipenem]] 500mg IV q6h {{or}} [[Meropenem]] 1g IV q8h {{or}} [[Piperacillin]]-[[tazobactam]] 4.5 g IV q6h {{and}} [[Aminoglycoside]] {{or}} Respiratory fluoroquinolone
-::::*For coverage of ESBLs in pneumonia,sepsis,complicated UTI or intra-abdominal infections :[[Imipenem]] 500mg IV q6h {{or}} [[Meropenem]] 1g IV q8h {{or}} [[Ertapenem]] 1g IV q24h {{or}} [[Doripenem]] 500mg IV q8h
-::::*In ESBLs,inconsistent activity seen with aminoglycosides, fluoroquinolones, and piperacillin-tazobactam. Avoid cephalosporins
-::::*Alternate regimen : ([[Ceftriaxone]] 1 gm IV q24h {{and}} [[Metronidazole]] 500 mg IV q6h or 1 gm IV q12h) {{or}} [[Moxifloxacin]] 400 mg IV/po q24h
-----
-{{PBI|Klebsiella rhinoscleromatis}}
+::::::* Preferred regimen (3):
-::* '''1. Rhinoscleroma'''<ref>{{Cite journal| doi = 10.1007/s00405-013-2649-z| issn = 1434-4726| volume = 271| issue = 7| pages = 1851–1856| last1 = Mukara| first1 = B. K.| last2 = Munyarugamba| first2 = P.| last3 = Dazert| first3 = S.| last4 = Löhler| first4 = J.| title = Rhinoscleroma: a case series report and review of the literature| journal = European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery| date = 2014-07| pmid = 23904142}}</ref><ref>{{Cite journal| doi = 10.1086/592966| issn = 1537-6591| volume = 47| issue = 11| pages = 1396–1402| last1 = de Pontual| first1 = Loïc| last2 = Ovetchkine| first2 = Philippe| last3 = Rodriguez| first3 = Diana| last4 = Grant| first4 = Audrey| last5 = Puel| first5 = Anne| last6 = Bustamante| first6 = Jacinta| last7 = Plancoulaine| first7 = Sabine| last8 = Yona| first8 = Laurent| last9 = Lienhart| first9 = Pierre-Yves| last10 = Dehesdin| first10 = Danièle| last11 = Huerre| first11 = Michel| last12 = Tournebize| first12 = Régis| last13 = Sansonetti| first13 = Philippe| last14 = Abel| first14 = Laurent| last15 = Casanova| first15 = Jean Laurent| title = Rhinoscleroma: a French national retrospective study of epidemiological and clinical features| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-12-01| pmid = 18947330}}</ref><ref>{{Cite journal| doi = 10.3109/00016489.2010.539264| issn = 1651-2251| volume = 131| issue = 4| pages = 440–446| last1 = Gaafar| first1 = Hazem A.| last2 = Gaafar| first2 = Alaa H.| last3 = Nour| first3 = Yasser A.| title = Rhinoscleroma: an updated experience through the last 10 years| journal = Acta Oto-Laryngologica| date = 2011-04| pmid = 21198342}}</ref>
-:::* Preferred regimen (1): [[Ciprofloxacin]] 500–750 mg PO bid for 2–3 months {{or}} [[Levofloxacin]] 750 mg PO qd for 2–3 months
-:::* Preferred regimen (2): [[Trimethoprim-Sulfamethoxazole]] 1 DS tab PO bid for 3 months {{and}} [[Rifampicin]] 300 mg PO bid for 3 months
-:::* Alternative regimen: [[Tetracycline]] {{or}} [[Streptomycin]] {{or}} [[Doxycycline]]  {{or}} [[Ceftriaxone]] {{or}} [[Ofloxacin]]
-:::* Note (1): The optimal duration of antimicrobial therapy remains unclear. A 6-week to 6-month cours of antibiotics until histology exams and cultures are negative may be required.
-:::* Note (2): Use of topical antiseptics such as [[Acriflavinium]] and [[Rifampin]] ointment has been reported with resolution of symptoms.<ref>{{Cite journal| doi = 10.1007/s00405-013-2649-z| issn = 1434-4726| volume = 271| issue = 7| pages = 1851–1856| last1 = Mukara| first1 = B. K.| last2 = Munyarugamba| first2 = P.| last3 = Dazert| first3 = S.| last4 = Löhler| first4 = J.| title = Rhinoscleroma: a case series report and review of the literature| journal = European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery| date = 2014-07| pmid = 23904142}}</ref>
-----
+:::::::* If patients body weight is < 45 kg: [[Doxycycline]] 4.4 mg/kg/day IV loading dose (not to exceed 200 mg) {{then}} [[Doxycycline]] 4.4 mg/kg/day IV divided q12h  (not to exceed 100 mg/dose) for 14 days
-{{PBI|Legionella pneumophila}}<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::::::* If patients body weight is =45 kg: [[Doxycycline]] 200 mg IV loading dose {{then}} [[Doxycycline]] 100 mg IV given q12h for 14 days
-:::* Preferred regimen: [[Levofloxacin]] 750mg PO/IV OD for 7-10days {{or}} [[Moxifloxacin]] 400mg PO/IV OD for 7-10 days {{or}} [[Azithromycin]] 500mg PO/IV OD for 7-10days {{or}} [[Rifampin]] 300mg PO/IV bid(optional) {{and}} any other agent listed.
-:::* Alternative regimen: [[Erythromycin]] 1g IV q6h and then 500mg PO q6h for 7-10days {{or}} [[Ciprofloxacin]]400mg IV q12h then 750mg PO bid 7-10days
-{{PBI|Moraxella catarrhalis}}
-:::* Pneumonia
-::::* Preferred regimen:[[Amoxicillin-Clavulanate]](Augmentin)875/125mg PO bid or XL 2000/125 PO bid {{or}}Oral cephalosporins such as [[Cefprozil]](Cefzil)200-500mg bid {{or}} [[Cefpodoxime]](Vantin)200-400mg bid {{or}} [[Cefuroxime]](Ceftin)250-500mg bid {{or}} [[Cefdinir]](Omnicef)300mg bid {{or}} Parenteral cephalosporins such as [[Cefuroxime]] {{or}} [[Cefotaxime]] {{or}} [[Ceftriaxone]] {{or}} Macrolides such as [[Erythromycin]] 500mg PO q6h  {{or}} [[Clarithromycin]] 500mg bid or XL 1g PO {{or}} [[Azithromycin]] 500mg single dose then 250mg PO, {{or}} Flouroquinolones such as [[Moxifloxacin]](Avelox) 400mg IV/PO OD {{or}} [[Levofloxacin]](Levaquin)500mg IV/PO OD {{or}} [[TMP-SMX]] DS PO bid
-{{PBI|Morganella morganii}}
-::*Morganella morganii<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen : [[Imipenem]] 500mg IV q6h {{or}} [[Meropenem]] 1.0g IV q8h (adjustdose if necessary for renalfunction).
-:::*Note (1): [[Carbapenems]] are considered first line therapy due to inducible cephalosporinases, and presence of extended-spectrum beta-lactamases in some isolates.
-:::*Note (2): Duration of treatment for UTI(generallycomplicated) is 7days and Duration of treatment for bacteremia is 14days.
-:::*Note (3): [[Tigecycline]] is not reliably effective
-:::*Alternative Regimen (1) : [[Cefepime]] 2.0 g IV q8-12h {{or}} [[Ciprofloxacin]] 500 mg PO/400mg IV q12h {{or}} [[Piperacillin]] 3g IV q6h {{or}} [[Ticarcillin]] 3g IV q4h
-:::*Alternative Regimen (2) : [[Aminoglycosides]] can be used alone for treatment of UTI,[[Gentamicin]] {{or}} [[Tobramycin]] 1mg/kg/day IV {{or}} [[Amikacin]] 3mg/kg/day
-{{PBI|Plesiomonas shigelloides}}
-::*Plesiomonas shigelloides<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Immunocompetent Hosts or Severe Infection'''
-::::*Preferred regimen : [[Ciprofloxacin]] 500mg PO bid or 400mg IV q12h.
-::::*Alternative regimen (1): [[Ofloxacin]] 300mg PO bid {{or}} [[Norfloxacin]] 400mg PO bid {{or}} [[TMP-SMX]] DS PO bid for 3days.
-::::*Alternative regimen (2): [[Ceftriaxone]] 1-2g IV OD used successfully in severe cases.
-:::*'''2.Immunocompromised Hosts'''
-::::*Preferred regimen : [[Ciprofloxacin]] 500mg PO bid for 3days.
-::::*Alternative regimen : [[Ofloxacin]] 300mg PO bid {{or}} [[Norfloxacin]] 400mg PO bid {{or}} [[TMP-SMX]] DS PO(if susceptible) bid for 3days
-{{PBI|Proteus mirabilis}}
-::*Proteus mirabilis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen (1): [[Ampicillin]] 500 mg PO q6h or 2 g IV q6h.
-:::* Preferred regimen (2): [[Cefuroxime]] 250 mg PO bid or 750 mg IV q8h.
-:::* Preferred regimen (3): [[Ciprofloxacin]] 250-500 mg PO bid or 400 mg IV q12h.
-:::* Preferred regimen (4): [[Levofloxacin]] 500 mg PO OD or 500 mg IV q24h.
-:::* Note: Uncomplicated UTI 3 days, pyelonephritis 7-14 days, complicated UTI 10-21 days and bacteremia 7-14 days.
-{{PBI|Indole positive Proteus species}}
-::*Indole positive Proteus species<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen (1): [[Ceftriaxone]] 1 g IV q24h.
-:::* Preferred regimen (2): [[Imipenem]] 500 mg IV q6h.
-:::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q12h or 250-500 mg PO bid.
-:::* Preferred regimen (4): [[Levofloxacin]] 500 mg IV/PO q24h.
-{{PBI|Providencia}}
+::::::* Preferred regimen (4): [[Rifampin]] 20 mg/kg/day IV divided q12h (not to exceed 300 mg/dose) for 14 days
-::*Providencia<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Complicated UTI/Bacteremia/Acute prostatitis
-::::*Preferred regimen : [[Ciprofloxacin]] 500-750mg PO q12h or 400 mg IV q8-12h {{or}} [[Levofloxacin]] 500mg IV/PO q24h {{or}} [[Piperacillin]]-[[Tazobactam]] 3.375 mg IV q6h {{or}}[[Ceftriaxone]] 1-2g IV q24h (donot use if ESBL suspected or critically ill){{or}} [[Meropenem]] 1g IV q8h (consider if critically ill or ESBL suspected){{or}}[[Amikacin]] 7.5mg/kg IV q12h {{or}} [[Gentamicin]] {{or}} [[Tobramycin]] acceptable if susceptible but many species are resistant.
-::::*Note (1) : Duration of treatment for (UTI)is 7days common or 3-5days after defervescence or control/elimination of complicating factors (e.g.,removal of foreign material catheter).
-::::*Note (2) : Duration of treatment for (bacteremia)is 10-14days or 3-5days after defervescence or control/elimination of complicatingfactors.
-::::*Note (3) : Duration for acute prostatitis(2weeks), shorter than chronic prostatitis(4-6wks)
-::::*Alternative regimen : [[TMP-SMX]](Bactrim)DS1 PO q12h for 10-14days {{or}} TMP 5-10 mg/kg/day IV q6h.
-{{PBI|Pseudomonas aeruginosa}}
-::*Pseudomonas aeruginosa<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen (1) : [[Cefepime]] 2g IV q8h {{or}} [[Ceftazidime]] 2g IV q8h {{or}} [[Piperacillin]] 3-4g IV q4h in (no benefit for pseudomonas from beta-lactamase inhibitor){{or}} [[Ticarcillin]] 3-4g IV q4h(no benefit for pseudomonas from beta-lactamase inhibitor).
-:::*Preferred regimen (2) : [[Imipenem]] 500mg—1g IV q6h {{or}} [[Meropenem]] 1g IV q8h {{or}} [[Doripenem]] 500mg IV q8h {{or}} [[Ciprofloxacin]] 400mg IV q8h {{or}}750mg PO q12h(for less serious infections). [[Aztreonam]] 2g IV q6-8h.[[Colistin]] 2.5 mg/kg IV q12h. [[Polymyxin B]] 0.75-1.25 mg/kg IV q12h [[Gentamicin]] {{or}} [[Tobramycin]] 1.7-2.0 mg/Kg IV q8h or 5-7mg/kg IV {{or}} [[Amikacin]] 2.5mg/kg IV q12h.Usually used in combination with other antimicrobials(preferably beta-lactams).
-::::* Note : [[Amikacin]] > [[Tobramycin]] > [[Gentamicin]] with respect to P.aeruginosa susceptibility percentages at most institutions.
-{{PBI|Salmonella}}
-::*Salmonella<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Gastroenteritis'''
-::::*Preferred treatment
-:::::*Immunocompetent : [[TMP-SMX]] DS PO bid {{or}} [[Ciprofloxacin]] 500mg PO bid {{or}} [[Ceftriaxone]] 2gIV/day for 5-7days.
-:::::*Immunosuppressed : [[TMP-SMX]] DS PO bid {{or}} [[Ciprofloxacin]] 500mg PO bid {{or}} [[Ceftriaxone]] 2gIV/day for ≥14days.
-:::*'''2.Typhoidfever'''
-::::*Preferred regimen : [[Ceftriaxone]] 1-2g IV q24h then [[Cefixime]] 400mg PO for 10-14days {{or}} [[Ciprofloxacin]] 400mg IV q12h or 500mg PO bid.
-:::*'''3.Non-typhoid(seriousinfection)'''
-::::*Preferred regimen : [[Cephalosporin|3rd generation Cephalosporin]] (Ceftriaxone/Cefotaxime){{or}} [[Fluoroquinolone]]([[Ciprofloxacin]], [[Levofloxacin]])
-:::*'''4.Bacteremia'''
-::::*Preferred regimen : [[Ceftriaxone]] 2g IV q24h {{or}} [[Cefotaxime]] 2g IV q6-8h for 7-14days {{or}} [[Ciprofloxacin]] 400mg IV q12h for 7-14days
-:::*'''5.Vascular prosthesis infection'''
-::::*Preferred regimen : [[Ceftriaxone]], [[Cefotaxime]] {{or}} [[Ciprofloxacin]] 400mg IV q12h for 6wks
-:::*'''6.Osteomyelitis'''
-::::*Preferred regimen : [[Ceftriaxone]] 2g IV q24h {{or}} [[Cefotaxime]] 2g IV q6-8h {{or}} [[Ciprofloxacin]] 750mg PO bid for ≥4wks
-:::*'''7.Arthritis'''
-::::*Preferred regimen : [[Ceftriaxone]] 2g IV q24h {{or}} [[Cefotaxime]] 2g IVq 6-8h for 6weeks.
-:::*'''8.Endocarditis'''
-::::*Preferred regimen : [[Ceftriaxone]] 2g IV q24h {{or}} [[Cefotaxime]] 2g IV q6-8h for 6weeks.
-:::*'''9.UTI'''
-::::*Preferred regimen : [[Ceftriaxone]], [[Cefotaxime]] {{or}} [[Ciprofloxacin]] IV for 1-2weeks, then [[Ciprofloxacin|oral Ciprofloxacin]] {{or}} [[TMP-SMX]] for 6weeks
-:::*'''10.HIV and salmonellosis'''
-::::*Preferred regimen : IV [[Cephalosporin]] {{or}} IV [[Fluoroquinolone]], then oral Flouroquinolones([[Ciprofloxacin]] 500-750mg PO bid for 4weeks).
-::::*Note : If relapse occurs within 6weeks give life-long abx or until immune recovery post-ART
-:::*'''11.Carrier state''' : [[Ciprofloxacin]] 500mg PO bid for 4-6weeks {{or}} [[TMP-SMX]] 1DS bid PO for 6weeks{{or}} [[Amoxicillin]] 500mg PO for 6weeks.
-{{PBI|Serratia marcescens}}
-::*Serratia marcescens<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*'''1.Bacteremia,Pneumonia or SeriousInfections'''
-::::*Preferred regimen : [[Cefepime]] 1-2 g IV q8h {{or}} [[Imipenem]] 0.5-1.0 g IV q6h {{or}} [[Ciprofloxacin]] 400mg IV q8h.
-::::*Alternative regimen : [[Aztreonam]], [[Gentamicin]] {{or}} [[Amikacin]] {{or}} [[Piperacillin]]/[[tazobactam]] also often effective.
-::::*Note : Duration depends on clinical response,usually 7-14days.
-:::*'''2.Endocarditis'''
-::::*Preferred regimen : Choice dictated by sensitivities. 4to6 week duration of parenteral therapy.
-:::*'''3.Osteomyelitis'''
-::::*Preferred regimen : Choice dictated by sensitivity profile. Treat for 6-12weeks depending upon response. Use IV treatment until stable/clinically improved(10-14days min)then may convert to PO therapy if appropriate
-:::*'''4.UTI'''
-::::*Preferred regimen : [[Ciprofloxacin]] 250mg PO bid or 400mg IV q12h {{or}} [[Levofloxacin]] 250mg PO everyday or 500mg IV q24h
-::::*Note : Fluoroquinolones often sensitive but in seriously ill patient consider empiric coverage with two drugs(e.g.,[[Beta-lactam]] and [[Aminoglycoside]] {{or}} [[Fluoroquinolones]] {{and}} [[Carbapenem]])until susceptibilities known.
-{{PBI|Shigella}}
+::::::* Note: Duration of therapy for 14 days or longer until clinical criteria for stability are met. Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-::*Shigella<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred regimen
-::::*If known sulfa sensitive : TMP(160mg)/SMX(800mg) PO q12h for 3-5days.
-::::*Pediatric dose :  TMP5mg/SMX 25mg/kg PO bid.
-::::*If TMP/SMX resistant or unknown susceptibility : [[Ciprofloxacin]] 500mg {{or}} [[Norfloxacin]] 400mg {{or}} [[Ofloxacin]] 200mg PO bid for 3-5days.
-:::*Alternative regimen : [[Ceftriaxone]] 1g IV q24h {{or}}} [[Azithromycin]] 500mg PO single dose, then 250mg PO for 4days {{or}} [[Nalidixicacid]] 250mg PO q6h or pediatric dose 55kg/day) {{or}} [[Ampicillin]](500mg PO q6h depending on susceptibility patterns.
-:::*Note : In southeast Asia, growing resistance seen to fluoroquinolones, azithromycin maybe preferred.
-{{PBI|Stenotrophomonas maltophilia}}
-::*Stenotrophomonas maltophilia<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::*Preferred treatment : [[TMP-SMX]] 15-20(TMP component)mg/kg/day IV/PO q8h.
-:::*Alternative treatment (1) : [[Ceftazidime]] 2g IV q8h {{or}} [[Ticarcillin]]/[[clavulanate]] 3.1g IV q4h {{or}} [[Tigecycline]] 100mg IV Single dose,then 50mg IV q12h.
-:::*Alternative treatment (2) : [[Ciprofloxacin]] 500-750mg PO /400mg IV q12h {{or}} [[Moxifloxacin]] 400mg PO/IV {{or}} [[Levofloxacin]] 750mg PO/IV .
-:::*Alternative treatment (3) : Multiply-resistantance [[Colistin]] 2.5mg/kg q12h IV.
-:::*Note : Treatment duration uncertain,but usually ≥14days
-{{PBI|Vibrio cholerae}}
-{{PBI|Vibrio parahaemolyticus}}
-{{PBI|Vibrio vulnificus}}
-----
+::::* 3.2.3 '''Triple therapy for systemic anthrax (anthrax meningitis or disseminated infection and meningitis cannot be ruled out) for Children 1 Month of Age and Older'''
-====Bacteria – Atypical Organisms====
+:::::* 3.2.3.1 '''A bactericidal antimicrobial''' (fluoroquinolone)
-{{PBI|Chlamydophila pneumoniae}}
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day IV divided q8h (not to exceed 400 mg/dose) for 2–3 wks
-::* 1. '''Atypical pneumonia caused by Chlamydophila pneumoniae''' <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-:::* 1.1 ''' Adult'''
-::::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 14-21 days
-::::* Preferred regimen (2): [[Tetracycline]] 250  mg PO qid for 14-21 days
-::::* Preferred regimen (3): [[Azithromycin]] 500 mg PO as a single dose, followed by 250 mg PO qd for 4 days
-::::* Preferred regimen (4): [[Clarithromycin]] 500 mg  PO bid for 10 days
-::::* Preferred regimen (5): [[Levofloxacin]] 500 mg IV or PO qd for 7 to 14 days
-::::* Preferred regimen (6): [[Moxifloxacin]] 400 mg PO qd for 10 days.
-:::* 1.2 '''Pediatric'''
-::::* Preferred regimen (1): [[ Erythromycin]] suspension,PO 50 mg/kg/day for 10 to 14 days
-::::* Preferred regimen (2): [[ Clarithromycin]] suspension, 15 mg/kg/day for 10 days
-::::* Preferred regimen (3): [[Azithromycin ]]suspension, PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days
-::* 2.'''Upper respiratory tract infection'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Bronchitis
-::::* Antibiotic therapy for C. pneumoniae is not required.
-:::* Pharyngitis
-::::* Antibiotic therapy for C. pneumoniae is not required.
-:::* Sinusitis
-::::* Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.
-----
+::::::* Preferred regimen (2):
-{{PBI| Chlamydia trachomatis}}
+:::::::* If patients body weight is < 50 kg: [[Levofloxacin]] 16 mg/kg/day IV divided q12h (not to exceed 250 mg/dose) for 2–3 wks
-* 1 '''Chlaymydial infections ''' '<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:* 1.1 '''Chlamydial Infections in Adolescents and Adults'''
-::* Preferred regimen(1): [[Doxycycline]] 100 mg PO bid for 7 days
-::* Preferred regimen(2): [[Azithromycin]] 1 g PO in a single dose
+:::::::* If patients body weight is > 50 kg: [[Levofloxacin]] 500 mg IV q24h for 2–3 wks
-::* Alternative regimen (1): [[ Erythromycin]] base 500  mg PO qid for 7 days
-::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO  qid for 7 days
+::::::* Preferred regimen (3):
-::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
-::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
-::* Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.
-:* 1.2 '''Chlamydial Infections in patients with HIV Infection'''
-::* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 7 days {{or}} [[Azithromycin]] 1 g PO in a single dose
-::* Preferred regimen: [[Azithromycin]] 1 g PO in a single dose
-::* Alternative regimen (1): [[ Erythromycin]] base 500  mg PO qid for 7 days
-::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO  qid for 7 days
+:::::::* If patients age is 3 months to < 2 years: [[Moxifloxacin]]  12 mg/kg/day IV, divided q12h (not to exceed 200 mg/dose) for 2–3 wks
-::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
-::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
+:::::::* If patients age is 2-5 years: [[Moxifloxacin]] 10 mg/kg/day IV divided q1h (not to exceed 200 mg/dose) for 2–3 wks
-:* 1.3 '''Pregancy'''
-::* Preferred regimen: [[Azithromycin]] 1 g PO in a single dose
-::* Alternative regimen (1): [[ Amoxicillin]]  500  mg PO tid for 7 days
-::* Alternative regimen (2): [[ Erythromycin]] base 500  mg PO qid for 7 days
-::* Alternative regimen (3): [[Erythromycin]] base 250 mg PO  qid for 14 days
+:::::::* If patients age is 6–11 years: [[Moxifloxacin]] 8 mg/kg/day IV divided q12h (not to exceed 200 mg/dose) for 2–3 wks
-::* Alternative regimen (4): [[ Erythromycin]] ethylsuccinate 800  mg PO qid for 7 days
-::* Alternative regimen (5): [[Erythromycin]] ethylsuccinate 400 mg PO qid for 14 days
+:::::::* If patients age is 12–17 years, = 45 kg body weight: [[Moxifloxacin]] 400 mg IV q24h for 2–3 wks
-::* Note:[[ Doxycycline]], [[Ofloxacin]], and [[Levofloxacin]] are contraindicated in pregnant women
-:::* 1.4 '''Management of sex partners'''
-::::* Preferred regimen : [[Doxycycline]] 100 mg PO bid for 7 days {{or}} [[Azithromycin]] 1 g PO in a single dose
-::::* Alternative regimen (1):  [[ Erythromycin]] base 500  mg PO qid for 7 days {{or}}  [[Erythromycin]] ethylsuccinate 800 mg PO  qid for 7 days
-::::* Alternative regimen (2): [[Levofloxacin]] 500 mg  PO qd for 7 days {{or}} [[Ofloxacin]] 300 mg PO bid for 7 days.
-::::::: Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia  diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
-::::::: Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
-::::::: Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present
-:::* 2 '''Chlamydial infection among neonates'''
-:::* 2.1 '''Ophthalmia Neonatorum'''caused by ''C. trachomatis''
-::::* Preferred regimen :[[ Erythromycin]]  base or ethylsuccinate ,PO 50 mg/kg/ day divided into 4 doses daily for 14 days
-::::* Alternative regimen : [[Azithromycin ]]suspension, PO 20 mg/kg /day qd for 3 days
-::::* Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.
-:::* 2.2'''Infant Pneumonia'''
-::::* Preferred regimen :[[ Erythromycin]]  base or ethylsuccinate PO 50 mg/kg/ day divided into 4 doses daily for 14 days
-::::* Alternative regimen : [[Azithromycin ]]suspension, PO 20 mg/kg /day qd for 3 days
-:::* 3.'''Chlamydial infection among infants and childern'''
-:::* 3.1 Infants and childern who weigh < 45 kg
-::::* Preferred regimen :[[ Erythromycin]]  base or ethylsuccinate PO 50 mg/kg/ day divided into 4 doses daily for 14 days
-:::* 3.2 Infants and childern who weigh ≥45 kg but who are aged <8 years
-::::* Preferred regimen :[[Azithromycin]] 1 g PO in a single dose
-:::* 3.3 Infants and childern aged  ≥8 years
-::::* Preferred regimen :[[Azithromycin]] 1 g PO in a single dose {{or}}  [[Doxycycline]] 100 mg PO bid for 7 days
-:::* 3. '''Lymphogranuloma venereum (LGV) '''
+:::::::* If patients age is 12–17 years, < 45 kg body weight: [[Moxifloxacin]] 8 mg/kg/day IV divided q12h (not to exceed 200 mg/dose) for 2–3 wks {{and}}
-:::* Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3   '<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::::* Preferred regimen : [[Doxycycline]] 100 mg PO bid for 21 days
-::::* Alternative regimen: [[ Erythromycin]] base 500  mg PO qid for 21 days
-:::: Note (1): [[azithromycin]] 1 g orally once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
-:::: Note (2): Pregnant and lactating women should be treated with [[erythromycin]]. [[Azithromycin]] might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. [[Doxycycline]] is contraindicated in pregnant women.
-:::: Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
-:::: Note(4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( [[Azithromycin]] 1 g PO single dose {{or}} [[Doxycycline]] 100 mg PO bid for 7 days).
-{{PBI|Chlamydophila psittaci}}
+:::::* 3.2.3.2 '''A bactericidal antimicrobial (ß-lactam or glycopeptide)'''
-::* 1. '''Pneumonia'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-:::* 1.1 '''Adult'''
-::::* Preferred regimen : [[Doxycycline]] 100 mg PO bid daily {{or}}  [[Tetracycline]] 500  mg PO qid for 10-21 days
-::::* Alternative regimen :[[Minocycline]]
-:::* 1.2 '''Pediatric '''
-::::* Preferred regimen: [[Azithromycin ]]
-::::* Alternative  regimen: fluoroquinolones
-:::* 1.3 '''Pregnant Patients'''
-::::* Preferred regimen : [[Azithromycin ]]
-::::* Alternative  regimen: fluoroquinolones
-:::* 2.'''Endocarditis in valve replacement patients'''
-::::* Preferred regimen : [[Doxycycline]]
-::::* Alternative regimen : fluoroquinolones.
-{{PBI|Coxiella burnetii}}
+::::::* 3.2.3.2.1 '''For all strains, regardless of penicillin susceptibility testing or if susceptibility is unknown''':
-:* '''1. Acute Q fever''' <ref>{{cite web | title =q fever | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm   }}</ref>
-::* '''1.1 Adults''':
-:::* Preferred Regimen: [[Doxycycline]] PO 100 mg bid for 14 days
-::* '''1.2 Children'''
-::* 1.2.1 Children with age  ≥8 years:
-:::* Preferred regimen:[[Doxycycline]] PO 2.2 mg/kg per dose bid for 14 days (maximum 100 mg/dose)
-::* 1.2.2 Children with age <8 years with high risk criteria
-:::* Preferred regimen:[[Doxycycline]] PO  2.2 mg/kg per dose bid for 14 days (maximum: 100 mg/dose)
-::* 1.2.3 Children with age < 8 years with mild or uncomplicated illness:
-:::* Preferred regimen:[[Doxycycline]] PO  2.2 mg/kg per dose bid for 5 days (maximum 100 mg/dose). If patient remains febrile past 5 days of treatment: [[Trimethoprim/Sulfamethoxazole]] 4-20 mg/kg bid for 14 days (maximum: 800 mg/dose)
-::* '''1.3 Pregnant women'''
-:::* Preferred regimen: [[Trimethoprim/sulfamethoxazole]] PO 160 mg/800 mg bid a day throughout pregnancy
-:* '''2. Chronic Q fever'''
-::* '''2.1 Endocarditis or vascular infection'''
-:::* Preferred regimen:[[Doxycycline]] PO 100 mg bid and [[hydroxychloroquine]]  PO 200 mg tid  for ≥18 months
-:::* Note: childern and pregnant women- consultation  Recommended
-::* '''2.2 Noncardiac organ disease'''
-:::* Preferred regimen: [[Doxycycline]] PO 100 mg bid and [[hydroxychloroquine]] PO  200 mg tid
-:::* Note: childern and pregnant women- consultation  Recommended
-::* '''2.3 Postpartumwith serologic profile for chronic Q fever'''
-:::* Preferred regimen:[[Doxycycline]] PO 100 mg bid and [[hydroxychloroquine]] PO  200 mg tid for 12 months
-:::* Note(1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
-:::* Note(2):Post-Q fever fatigue syndrome- no current recommendation
-{{PBI|Legionella}}
+:::::::* Preferred regimen (1): [[Meropenem]] 120 mg/kg/day IV divided q8h (not to exceed 2 g/dose) for 2–3 wks
-::* Atypical bacterial pneumonia caused by Legionella <ref name="pmid17278083">{{cite journal| author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC et al.| title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 2 | issue=  | pages= S27-72 | pmid=17278083 | doi=10.1086/511159 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17278083  }} </ref>
-:::* Preferred Regimen: [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h {{or}} [[Azithromycin]] 500 mg PO on day 1 followed by 250 mg q24h
-:::* Alternate Regimen: [[Doxycycline]] 100 mg PO/IV q12h
-----
+:::::::* Preferred regimen (2): [[Imipenem]]/[[Cilastatin]] 100 mg/kg/day IV divided q6h (not to exceed 1 g/dose) for 2–3 wks
-{{PBI|Mycoplasma pneumoniae}}
+:::::::* Preferred regimen (3): [[Doripenem]] 120 mg/kg/day IV divided q8h (not to exceed 1 g/dose) for 2–3 wks
-:* 1. '''Community-acquired pneumonia'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): [[Azithromycin]] 500 mg PO qd on day 1 and 250 mg PO qd on days 2 to 5
-::* Preferred regimen (2): [[Clarithromycin]] 500 mg PO qd for 14 days
-::* Preferred regimen (3): [[Doxycycline]] 100 mg PO bid for 14 days
-::* Preferred regimen (4): [[Moxifloxacin]] 400 mg PO qd for 14 days
-::* Preferred regimen (5): [[Levofloxacin]] 750 mg PO qd for 14 days
-----
+:::::::* Preferred regimen (4): [[Vancomycin]] 60 mg/kg/day IV divided q8h for 2–3 wks
-{{PBI|Mycoplasma genitalium}}
+::::::* 3.2.3.2.2 '''Alternatives for penicillin-susceptible strains'''
-::* '''1. Urethritis and cervicitis'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:::* Preferred regimen (macrolide-susceptible strains): [[Azithromycin]] 1 g PO as a single dose {{or}} [[Azithromycin]] 500 mg PO as a dose followed by 250 mg PO qd for 4 days
-:::* Preferred regimen (for patients with previous treatment failures): [[Moxifloxacin]] 400 mg PO qd for 7–14 days
-::* '''2. Pelvic inflammatory disease (PID)'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+:::::::* Alternative regimen (1): [[Penicillin G]] 400 000 U/kg/day IV divided q4h (not to exceed 4 MU/dose) for 2–3 wks
-:::* Preferred regimen: [[Moxifloxacin]] 400 mg PO qd for 14 days
-::* '''3. Specific considerations'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+:::::::* Alternative regimen (2): [[Ampicillin]] 400 mg/kg/day IV divided q6h (not to exceed 3 g/dose) for 2–3 wks {{and}}
-:::* '''3.1 Management of sex partners'''
-::::* Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.
-:::* '''3.2 HIV infection'''
+::::::* 3.2.3.3 '''A Protein Synthesis Inhibitor'''
-::::* Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.
-====Bacteria – Miscellaneous====
+:::::::* Preferred regimen (1):
-{{PBI|Gardnerella vaginalis}}
-:*'''1.Bacterial Vaginosis''''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-:::*Gardnerella vaginalis is one of the anaerobic bacteria causing Bacterial Vaginosis,which is a polymicrobial clinical syndrome
-:::*Preferred regimen: [[Metronidazole]] 500 mg PO bid for 7 days {{or}} [[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days {{or}} [[Clindamycin]]cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
-:::*Alternative regimen: [[Tinidazole]] 2 g PO qd for 2 days {{or}} [[Tinidazole]] 1 g  PO qd for 5 days {{or}} [[Clindamycin]] 300 mg  PO bid for 7 days {{or}} [[Clindamycin]] ovules 100 mg intravaginally once at bedtime for 3 days
-:::*Note:Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended.
-::*'''2.Management of Sex Partners'''
+::::::::* If patients age is < 12 y old: [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wk
-:::*Routine treatment of sex partners is not recommended.
-::*'''3.Special Considerations'''
+::::::::* If patients age is = 12 y old: [[Linezolid]] 30 mg/kg/day,IV divided q12h (not to exceed 600 mg/dose) for 2–3 wk
-::*'''3.1 Allergy, Intolerance, or Adverse Reactions'''
-:::*Intravaginal clindamycin cream is preferred in case of allergy or intolerance to metronidazole or tinidazole. Intravaginal metronidazole gel can be considered for women who are not allergic to metronidazole but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.
-::*'''3.2 Pregnancy'''
+:::::::* Preferred regimen (2): [[Clindamycin]] 40 mg/kg/day IV divided q8h (not to exceed 900 mg/dose)  for 2–3 wk
-:::*Preferred regimen: [[Metronidazole]] 500 mg PO bid for 7 days {{or}} [[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
-:::*Note: [[Tinidazole]] should be avoided during pregnancy
-::*'''3.3 HIV Infection'''
+:::::::* Preferred regimen (3): [[Rifampin]] 20 mg/kg/day IV divided q12h (not to exceed 300 mg/dose) for 2–3 wk
-:::*Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection.
-{{PBI|Eikenella corrodens}}
+:::::::* Preferred regimen (4): [[Chloramphenicol]] 100 mg/kg/day IV divided q6h for 2–3 wk
-{{PBI|Bordetella pertussis}}
-{{PBI|Bartonella}}
-{{PBI|Stenotrophomonas maltophilia}}
-{{PBI|Acinetobacter baumannii}}
-====Bacteria – Anaerobic Gram-Negative Bacilli====
+::::::: Note (1): Duration of therapy for 2–3 wk or greater, until clinical criteria for stability are met.Will require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-{{PBI|Bacteroides fragilis}}
-::* 1.''' Monotherapy''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Imipenem]] (Primaxin) {{or}} [[Ertapenem]] {{or}} [[Meropenem]] {{or}} [[Doripenem]] 0.5-1.0 g IV q6h {{or}} [[Piperacillin-tazobactam]] (Zosyn) 3.375 g IV q6h {{or}} [[Ampicillin-sulbactam]] (Unasyn) 1-2 g IV q6h {{or}} [[Tigecycline]] (Tygacil) 100 mg IV, then 50 mg IV q12h
-::* 2.''' Combination therapy'''
-:::* Preferred regimen: [[Metronidazole]] 0.75-1.0 g IV q12h {{and}} [[Cefotaxime]] 1.5-2 g IV q6h {{or}} [[Aztreonam]] 1-2 g IV q8h {{or}} [[Ceftriaxone]] 1 g IV q12h
-{{PBI|Fusobacterium necrophorum}}
-====Fungi====
+::::::: Note (2):  A 400-mg dose of [[Ciprofloxacin]] IV, provides an equivalent exposure to that of a 500-mg ciprofloxacin oral tablet.
-{{PBI|Aspergillosis}}<ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
-* '''1. Invasive pulmonary aspergillosis'''
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-* '''2. Invasive sinus aspergillosis'''
+::::* 3.2.4 '''Oral follow-up combination therapy for severe anthrax (for Children 1 Month of Age and Older)'''
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-* '''3. Tracheobronchial aspergillosis'''
+:::::* 3.2.4.1 '''A bactericidal antimicrobial'''
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-* '''4. Chronic necrotizing pulmonary aspergillosis'''
+::::::* 3.2.4.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-* '''5. Aspergillosis of the CNS'''
+:::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day PO bid (not to exceed 500 mg/dose)
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-::*Note (1): There are drug interactions with anticonvulsant therapy.
-* '''6. Aspergillus infections of the heart (endocarditis, pericarditis, and myocarditis)'''
+:::::::* Preferred regimen (2):
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-::*Note (1): endocardial lesions generally require surgical treatment. Aspergillus pericarditis usually requires pericardiectomy.
-* '''7. Aspergillus osteomyelitis and septic arthritis'''
+::::::::* If patients body weight is < 50 kg: [[Levofloxacin]] 16 mg/kg/day PO bid (not to exceed 250 mg/dose)
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-::*Note (1): Surgical resection of devitalized bone and cartilage is important for curative intent.
-* '''8. Aspergillus infections of the eye (endophthalmitis and keratitis)'''
+::::::::* If patients body weight is = 50 kg: [[Levofloxacin]] 500 mg PO qd
-:*Preferred regimen: Intraocular [[Amphotericin B]] indicated with partial vitrectomy
-:*Alternative regimen (1): Liposomal [[amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-:*Alternative regimen (7): [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-::*Note: Topical therapy is indicated for keratitis, ophthalmologic intervention and management is recommended for all forms of ocular infection. Systemic therapy may be beneficial when treating aspergillus endophthalmitis.
-* '''9. Cutaneous aspergillosis'''
+::::::* 3.2.4.1.2 '''Alternatives for penicillin-susceptible strains'''
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-::*Note: Surgical resection is indicated when feasible.
-* '''10. Aspergillus peritonitis'''
+:::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid (not to exceed 1 g/dose)
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-* '''11. Prophylaxis against invasive aspergillosis'''
+:::::::* Alternative regimen (2): [[Penicillin VK]] 50–75 mg/kg/day PO tid or qds {{and}}
-:*Preferred regimen: [[Posaconazole]] PO 200mg tid.
-:*Alternative regimen: (1) [[Itraconazole]] 200mg IV bid for 2 days then 200mg IV q.d. {{or}} [[Itraconazole]] PO 200mg bid
-:*Alternative regimen: (2) [[Micafungin]] 50mg/day.
-* '''12. Aspergilloma'''
+:::::* 3.2.4.2 '''A protein synthesis inhibitor''':
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen: [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-* '''13.Chronic cavitary pulmonary aspergillosis'''
+::::::* Preferred regimen (1):[[Clindamycin]] 30 mg/kg/day PO tid (not to exceed 600 mg/dose)
-:*Preferred regimen: [[Voriconazole]] (6 mg/kg IV every 12 h for 1 day, followed by 4 mg/kg IV every 12 h; oral dosage is 200 mg every 12 h)
-:*Alternative regimen (1): Liposomal [[amphotericin B]] (L-AMB) 3–5 mg/kg/day IV
-:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV
-:*Alternative regimen (3): [[Caspofungin]] (70 mg day 1 IV and 50 mg/day IV thereafter)
-:*Alternative regimen (4): [[Micafungin]] (IV 100–150 mg/day; dose not established )
-:*Alternative regimen (5): [[Posaconazole]] (200 mg QID initially, then 400 mg BID PO after stabilization of disease )
-:*Alternative regimen (6): [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-:*Note: long-term therapy might be needed.
-*'''14.Allergic bronchopulmonary Itraconazole aspergillosis'''
+::::::* Preferred regimen (2):
-:*Preferred regimen: [[Itraconazole]] (dosage depends upon formulation - The dosage for tablets is 600 mg/day for 3 days, followed by 400 mg/day while the dosage for parenteral used in studies is 200 mg every 12h IV for 2 days, followed by 200 mg daily thereafter).
-:*Alternative regimen (1): [[Voriconazole]] PO 200 mg bid.
-:*Alternative regimen (2): [[Posaconazole]] PO 400 mg bid.
-:*Note: Corticosteroids are a cornerstone of the therapy.
-*'''Allergic aspergillus sinusitis'''
+:::::::* If the patients body weight is < 45 kg: [[Doxycycline]] 4.4 mg/kg/day PO bid (not exceed 100 mg/dose)
-:*Preferred regimen: None or [[Itraconazole]]
-:*Note: Few data available for other agents.
-*'''Relative indications for surgical treatment of invasive aspergillosis'''
+:::::::* If the patients body weight is = 45 kg: [[Doxycycline]] 100 mg PO bid
-:*Pulmonary lesion in proximity to great vessels or pericardium;
-:*Pericardial infection;
-:*Invasion of chest wall from contiguous pulmonary lesion;
-:*Aspergillus empyema;
-:*Persistent hemoptysis from a single cavitary lesion;
-:*Infection of skin and soft tissues;
-:*Infected vascular catheters and prosthetic devices;
-:*Endocarditis;
-:*Osteomyelitis;
-:*Sinusitis;
-:*Cerebral lesions.
+::::::* Preferred regimen (3): (non-CNS infection dose):
-{{PBI|Blastomycosis}}
+:::::::* If the patients age is < 12 yrs old: [[Linezolid]] 30 mg/kg/day PO tid
-*[[Blastomycosis]]<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107  }} </ref>
-:* '''1. Mild to moderate pulmonary blastomycosis'''
+:::::::* If the patients age is = 12 yrs old: [[Linezolid]] 30 mg/kg/day PO bid (not to exceed 600 mg/dose)
-::* Preferred regimen: [[Itraconazole]] 200 mg PO once or twice per day for 6–12 months
-::* Note: Oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then once or twice per day for 6–12 months, is recommended
-:* '''2. Moderately severe to severe pulmonary blastomycosis'''
+:::::::* Note: Duration of therapy to complete a treatment course of 14 days or greater. May require prophylaxis to complete an antimicrobial course of up to 60 days from onset of illness.
-::* Preferred regimen (1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
-::* Preferred regimen (2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg per day for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
-::* Note: Oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
-:* '''3. Mild to moderate disseminated blastomycosis'''
+::::* 3.2.5 ''' Dosing in preterm and term neonates 32 to 44 Weeks postmenstrual Age (Gestational Age Plus Chronologic Age)'''
-::* Preferred regimen: [[Itraconazole]] 200 mg PO once or twice per day for 6–12 months
-::* Note (1): Treat osteoarticular disease for 12 months
+:::::* 3.2.5.1 '''Triple therapy for severe anthrax(anthrax meningitis or disseminated infection and meningitis cannot be ruled out)'''
-::* Note (2): Oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
+::::::* 3.2.5.1.1 '''Bactericidal antimicrobial (fluoroquinolone) therapy'''
-:* '''4. Moderately severe to severe disseminated blastomycosis'''
+:::::::*  3.2.5.1.1.1 '''For 32–34 weeks gestational age '''
-::* Preferred regimen (1): Lipid amphotericin B(Lipid AmB) 3–5 mg/kg per day, for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
-::* Preferred regimen (2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg per day, for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
-::* Note: oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
-:* '''5. CNS disease'''
+::::::::* '''For 0–1 week of age'''
-::* Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg per day for 4–6 weeks {{and}} an oral azole for at least 1 year
-::* Note (1): Step-down therapy can be with [[Fluconazole]], 800 mg per day {{or}} [[Itraconazole]], 200 mg 2–3 times per day {{or}} voriconazole, 200–400 mg twice per day.
-::* Note (2): Longer treatment may be required for immunosuppressed patients.
-:* '''6. Immunosuppressed patients'''
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day IV divided q12h for 2–3 weeks
-::* Preferred regimen (1): Lipid amphotericin B (Lipid AmB), 3–5 mg/kg per day, for 1–2 weeks, {{and}} [[Itraconazole]], 200 mg PO bid for 12 months
-::* Preferred regimen (2): [[Amphotericin B]] deoxycholate, 0.7–1 mg/kg per day, for 1–2 weeks, {{and}} [[Itraconazole]], 200 mg PO bid for 12 months
-::* Note (1): Oral [[Itraconazole]], 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 12 months, is recommended
-::* Note (2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.
-:* '''7. Pregnant women'''
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 5 mg/kg/day IV q24h for 2–3 weeks
-::* Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day
-::* Note (1): Azoles should be avoided because of possible teratogenicity
-::* Note (2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg per day
-:* '''8. Children with mild to moderate disease'''
+::::::::* '''For 1–4 weeks of age'''
-::* Preferred regimen: [[Itraconazole]] 10 mg/kg PO per day for 6–12 months
-::* Note: Maximum dose 400 mg per day
-:* '''9. Children with moderately severe to severe disease'''
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day IV divided q12h for 2–3 weeks
-::* Preferred regimen (1): Amphotericin B deoxycholate 0.7–1 mg/kg per day for 1–2 weeks {{and}} [[Itraconazole]] 10 mg/kg PO per day to a maximum of 400 mg per day for 6–12 months
-::* Preferred regimen (2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day for 1–2 weeks {{and}} [[Itraconazole]] 10 mg/kg PO per day to a maximum of 400 mg per day for 6–12 months
-::* Note: Children tolerate Amphotericin B deoxycholate better than adults do.
-{{PBI|Paracoccidioidomycosis}}
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 5 mg/kg/day IV q24h for 2–3 weeks
-:* Preferred regimen (1): <ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
+:::::::*  3.2.5.1.1.2 '''For 34–37 week gestational age '''
-::* Adults: [[Itraconazole]] 200 mg/day PO.
-::* Children: [[Itraconazole]] (<30/kg and >5 yr) 5-10 mg/kg/day PO.
-::*Note: Treatment duration based on organ involvement:
-:::*Mild involvement: 6-9 months.
-:::*Moderate involvement: 12-18 months.
-:* Preferred regimen (2): <ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
+::::::::* '''For 0–1 wk of age'''
-::* Adults [[Trimethoprim/sulfamethoxazole]] (TMP/SMX)  TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV divided into two doses per day.
-::* Children [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, divided into two doses per day.
-::* Note (1): Treatment duration based on organ involvement:
-:::* Minor involvement: 12 months.
-:::* Moderate involvement: 18-24 months.
-::*Note (2): Preferred treatment in children due to larger experience.
-::*Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.
-:* Preferred regimen (3): [[Amphotericin B]] deoxycholate mg/kg/day IV until patient improves and can be treated by the oral route.<ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day IV divided q12h for 2–3 weeks
-::*Note: Preferred in severe forms of the disease.<ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
-:* Alternative regimen (4): [[Ketoconazole]] 200-400 mg/day PO for 9-12 months.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:::::::::* Preferred regimen (2):[[Moxifloxacin]] 5 mg/kg/day IV q24h for 2–3 weeks
-:* Alternative regimen (5): [[Voriconazole]] initial dose 400 mg PO/IV each 12 hr for one day, then 200 mg each 12 hr for 6 months.<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::::::::* '''For 1–4 wk of age'''
-::* Note: Diminish the dose to 50% if weight is <40 kg.
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day IV divided q12h for 2–3 weeks
-{{PBI|Candidiasis}}
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 5 mg/kg/day IV q24h for 2–3 weeks
-{{PBI|Chromoblastomycosis}}
-:*'''1. If lesions small and few'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* surgical excision or cryosurgery with liquid nitrogen.
-:*'''2. If lesions chronic, extensive, burrowing'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen: [[Itraconazole]] 200-400 mg PO q24h {{or}} 400 mg pulse therapy once daily for 1 week monthly for 6-12 months
-{{PBI|Coccidioidomycosis}}
+:::::::*  3.2.5.1.1.3 '''Term newborn infant'''
-{{PBI|Cryptococcosis}}
+::::::::* '''For 0–1 week of age'''
-:* 1. '''Cryptococcus neoformans'''
-::* 1.1 '''Cryptococcus neoformans meningitis in HIV infected patients'''<ref name="pmid20047480">{{cite journal| author=Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ et al.| title=Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 3 | pages= 291-322 | pmid=20047480 | doi=10.1086/649858 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20047480  }} </ref>
-:::*Preferred regimen for induction and consolidation: [[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg per day IV (consider using lipid formulations for patients with renal dysfunction {{or}} [[Liposomal AmB]] 3-4mg/kg per day IV {{or}} [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV per day) {{plus}} [[Flucytosine]] 100mg/kg PO or IV divided in 4 doses for at least 2 weeks followed by [[fluconazole]] 400mg (6mg/kg) per day PO for at least 8 weeks.
-:::*Alternative regimen for induction and consolidation (1): [[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg per day IV {{or}} [[Liposomal AmB]] 3-4 mg/kg per day IV {{or}} AmB lipid complex 5mg/kg IV per day for 4-6 weeks.
-:::*Alternative regimen for induction and consolidation (2): [[Amphotericin B]] deoxycholate 0.7 mg/kg IV per day {{plus}} [[fluconazole]] PO 800mg q.d. for 2 weeks, followed by [[fluconazole]] 800mg PO q.d. for at least 8 weeks.
-:::*Alternative regimen for induction and consolidation (3): [[Fluconazole]] (>800 mg per day PO, 1200mg daily is favored) {{plus}} [[flucytosine]] (100mg/kg PO per day, divided in 4 doses) for 6 weeks.
-:::*Alternative regimen for induction and consolidation (4): [[Fluconazole]] PO 800-2000mg per day for 10-12 weeks.
-:::*Preferred regimen for maintenance and prophylactic therapy: Initiate HAART 2-10 weeks after commencing initial antifungal therapy {{and}} [[Fluconazole]] PO 200mg q.d..
-:::*Alternative regimen for maintenance and prophylactic therapy: [[Itraconazole]] PO 200mg b.i.d. - monitor drug-level {{or}} [[Amphotericin B]] deoxycholate (1 mg/kg) per week IV (should be used in azole-intolerant patients).
-:::* Note (1): Consider discontinuing supressive therapy if CD4 count is higher than 100 cells/uL {{and}} undetectable {{or}} very low HIV RNA level for more than 3 months. Consider reinstitution of maintenance therapy if CD4 count <100 cels/uL.
-:::* Note (2): Do not use [[Acetazolamide]] {{or}} [[mannitol]] {{or}} [[corticosteroids]] to treat increased intracranial pressure, instead it should be used lombar puncture in the absence of focal neurologic signs or impaired mentation (which, if present, patient must be submitted to CT or MRI scan first).
-::'''1.2. Cerebral cryptococcomas'''
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day IV divided q12h for 2–3 weeks
-::*Preferred regimen for induction and consolidation: [[Amphotericin B deoxycholate]] 0.7-1.0 mg/kg per day IV (consider using lipid formulations for patients with renal dysfunction - [[Liposomal AmB]] 3-4mg/kg per day IV {{or}} [[AmB lipid complex]] (ABLC) 5mg/kg IV per day) {{plus}} [[Flucytosine]] 100mg/kg PO {{or}} IV divides in 4 doses for at least 6 weeks followed by [[fluconazole]] 400-800mg per day PO for 6-18 months; corticosteroids might be useful for surrounding edema and mass effect.
-:::*Note (1): Consider surgery if lesions are larger than 3cm, accessible lesions with mass effect or lesions that are enlarging and not explained by IRIS.
-::'''1.3. Cryptococcus neoformans meningitis in HIV negative patients'''
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 10 mg/kg/day IV q24h for 2–3 weeks
-:::*Preferred regimen: [[Amphotericin B deoxycholate]] 0.7-1.0 mg/kg per day IV {{plus}} [[Flucytosine]] 100mg/kg PO {{or}} IV divides in 4 doses for at least 4 weeks (which may be extended to 6 weeks if there is any neurological complications) followed by [[fluconazole]] 400mg per day PO for 8 weeks. If there's toxicity to AmBd, consider changing to LFAmB in the second 2 weeks.
-:::*Note (1): After induction and consolidation therapy, start [[fluconazole]] 200mg (3mg/kg) per day, PO for 6-12 months.
-:::*Note (2): If [[flucytosine]] is not given, consider lengthening the induction therapy for at least 2 weeks.
-::'''1.4. Cryptococcus neoformans pulmonary disease - immunosupressed'''
+::::::::* '''For 1–4 weeks of age'''
-:::*Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:
-::::*Preferred regimen: [[Fluconazole]] 400mg per day orally for 6-12 months.
-:::*Severe pneumonia or disseminated disease or CNS infection:
-::::*Preferred regimen: treat like CNS cryptococcosis.
-:::*Note (1): In HIV- infected patients, treatment should be stopped after 1 year if CD4 count is >100 and a cryptococcal antigen titer is <1:512 and not increasing.
-:::*Note (2): Consider [[corticosteroid]] if [[ARDS]] is present in a context which it might be attributed to [[IRIS]].
-::'''1.5 Cryptococcus neoformans pulmonary disease - non-immunosupressed'''
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day IV divided q12h for 2–3 weeks
-:::*Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:
-::::*Preferred regimen: [[Fluconazole]] 400mg per day orally for 6-12 months.
-::::*Alternative regimen: if [[fluconazole]] is unavailable or contraindicated, [[Itraconazole]] PO 200 mg twice per day, [[voriconazole]] PO 200 mg twice per day, and posaconazole PO 400 mg twice per day.
-:::*If there's severe pneumonia, disseminated disease or CNS infection:
-::::*Preferred regimen: treat like CNS cryptococcosis for 6-12 months.
-::'''1.6 Cryptococcus neoformans non-lung, non-CNS infection'''
+:::::::::* Preferred regimen (2): [[Moxifloxacin]] 10 mg/kg/day IV q24h for 2–3 weeks {{and}}
-:::*Cryptococcemia or disseminated cryptococcic disease  (involvement of at least 2 noncontiguous sites or cryptococcal antigen titer >1:512):
-::::*Preferred regimen: treat like CNS infection.
-:::*If infection occurs at a single site and no immunosupressive risk factors
-::::*Preferred regimen: [[fluconazole]] 400mg PO per day for 6-12 months.
-::'''1.7. Cryptococcosis in Children'''
+::::::* 3.2.5.1.2 '''A bactericidal antimicrobial (ß-lactam)'''
-::::*Preferred regimen for induction and consolidation: [[Amphotericin B]] deoxycholate 1.0 mg/kg per day IV plus [[Flucytosine]] 100mg/kg PO or IV divided in 4 doses for 2 weeks followed by [[fluconazole]] 10-12mg/kg per day PO for 8 weeks.
-::::*Alternative regimen: patients with renal dysfunction: change [[Amphotericin B]] deoxycholate by [[Liposomal AmB]] 5mg/kg per day IV or [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV per day).
-::::*Preferred regimen for maintenance: fluconazole 6mg/kg PO per day
-:::*Cryptococcal pneumonia:
-::::*Preferred regimen fluconazole 6-12mg/kg PO per day for 6-12 months.
-::'''1.8. Cryptococcosis in Pregnant Women'''
+:::::::* 3.2.5.1.2.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown''':
-:::*Preferred regimen for induction and consolidation: [[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg per day IV (consider using lipid formulations for patients with renal dysfunction - [[Liposomal AmB]] 3-4mg/kg per day IV {{or}} [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV per day). Consider using [[flucytosine]] in relationship to benefit risk basis, since it is a Category C drug for pregnancy. Start [[fluconazole]] after delivery. Avoid use during first trimester and consider use in the last 2 trimesters with the need for continuous antifungal therapy during pregnancy.
-:::*Note (1): If pulmonary cryptococcosis: perform close follow-up and administer fluconazole after delivery.
-:'''2. Cryptococcus gatti'''
+::::::::* 3.2.5.1.2.1.1 '''For 32–34 weeks gestational age'''
-::*Disseminated cryptococcosis or CNS disease:
-:::*Preferred regimen: treatment is the same as C. neoformans.
-::*Pulmonary disease: single and small cryptococcoma:
-:::*Preferred regimen: fluconazole 400mg per day PO
+:::::::::* For 0–1 week of Age :
-::*Pulmonary disease: Very large or multiple cryptococcomas:
-:::*Preferred regimen: administer [[flucytosine]] {{and}} [[AmB deocycholate]] for 4-6 weeks, followed by fluconazole for 6-18 months.
-:::*Note (1): Surgery should be considered if there is compression of vital structures {{or}} failure to reduce the size of the cryptococcoma after 4 weeks of therapy.
-----
+::::::::::* Preferred regimen (1): [[Meropenem]] 60 mg/kg/day  IV divided q8h for 2–3 weeks
-{{PBI|Tinea cruris}}
+::::::::::* Preferred regimen (2): [[Imipenem]] 50 mg/kg/day  IV divided q12h for 2–3 weeks
-:*'''Tinea Cruris'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Preferred regimen: Interdigital: Topical cream/ointment: [[terbinafine]], [[imidazoles]] ([[miconazole]], [[econazole]], [[clotrimazole]]), [[Griseofulvin]] 250mg tid PO for 14 days should be used in resistant to topic therapy cases.
+::::::::::* Preferred regimen (3): [[Doripenem]] 20 mg/kg/day  IV divided q12h for 2–3 weeks
-----
-{{PBI|Tinea corporis}}
+:::::::::* For 1–4 wk of Age :
-:* '''Tinea Corporis'''
-::*2.1 Small, well-defined lesions:
-:::* Preferred regimen: Topical cream/ointment: [[terbinafine]], [[imidazoles]] ([[miconazole]], [[econazole]], [[clotrimazole]]).
-::*2.2 Larger lesions:
-:::*Preferred regimen: Larger lesions: [[terbinafine]] PO 250mg/day for 2 weeks; [[itraconazole]] PO 200mg/day for 1 week, [[fluconazole]] PO 250mg weekly for 2-4 weeks.
-----
-{{PBI|Tinea pedis}}
+::::::::::* Preferred regimen (1): [[Meropenem]] 90 mg/kg/day  IV divided q8h for 2–3 weeks
-:*'''1. Tinea Pedis'''
-::*Preferred regimen: Interdigital: Topical cream/ointment: [[terbinafine]], [[imidazoles]] ([[miconazole]], [[econazole]], [[clotrimazole]]), [[undecenoic acid]], [[tolnaftate]].
-::*Note (1): If "Dry type": Oral: [[terbinafine]] PO 250mg/day for 2-4 weeks, [[itraconazole]] PO 400mg/day for 1 week per month (repeat if necessary), [[fluconazole]] PO 200mg weekly for 4-8 weeks.
-----
+::::::::::* Preferred regimen (2): [[Imipenem]] 75 mg/kg/day  IV divided q8h for 2–3 weeks
-{{PBI|Tinea capitis}}
+::::::::::* Preferred regimen (3): [[Doripenem]] 30 mg/kg/day  IV divided q8h for 2–3 weeks
-:*'''Tinea Capitis'''
-::*Preferred regimen: [[Griseofulvin]] PO 10-20mg/kg/day for at least 6 weeks (Preferred for children).
-::*Alternative regimens: [[Terbinafine]] PO 62.5mg/day if <20kg; 125 mg/day if 20-40kg; 250mg/day if >40kg {{or}} [[Itraconazole]] PO 4-6mg/kg pulsed dose weekly.
-:::*Note: [[Nistatin]] is not effective in the treatment of dermatophytosis.
-----
-{{PBI|Tinea barbae}}
+::::::::* 3.2.5.1.2.1.2 '''For 34–37 week gestational age'''
-:*'''Tinea Barbae'''
-::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 4 weeks.
-::*Alternative regimen: [[Itraconazole]] PO 200mg/day for 2 weeks.
-----
-{{PBI|Tinea incognito}}
+:::::::::* For 0–1 week of Age :
-:*'''Tinea Incognito'''
-::*Preferred regimen: Stop topical [[steroids]] and treat with topical 1% [[terbinafine]] cream for 6 weeks.
-----
-{{PBI|Tinea manuum}}
+::::::::::* Preferred regimen (1): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2–3 weeks
-:*'''Tinea Manuum'''
-::*Preferred regimen: topical or systemic [[terbinafine]] PO 250 mg/day por 2-4 weeks.
-----
-{{PBI|Tinea versicolor}}
+::::::::::* Preferred regimen (2): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2–3 weeks
-:*'''Tinea Versicolor'''
-::*Preferred regimen: [[Itraconazole]] 200mg daily for a week.
-::*Alternative regimen: [[Ketoconazole]] 200mg daily for 4 weeks.
-----
-{{PBI|Majocchi's granuloma}}
+::::::::::* Preferred regimen (3): [[Doripenem]]  20 mg/kg/day IV divided q12h for 2–3 weeks
-:*'''Majocchi's Granuloma'''
-::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 2-4 weeks.
-::*Alternative regimen: [[Itraconazole]] 200mg PO bid for 1 week, per month for 2 months.
-----
-{{PBI|Onychomycosis}}
+:::::::::* For 1–4 week of Age :
-:*'''Onychomycosis'''<ref name="pmid19439745">{{cite journal| author=de Berker D| title=Clinical practice. Fungal nail disease. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 20 | pages= 2108-16 | pmid=19439745 | doi=10.1056/NEJMcp0804878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19439745  }} </ref>
-:::*10.1 Fingernails
+::::::::::* Preferred regimen (1): [[Meropenem]] 90 mg/kg/day IV divided q8h for 2–3 weeks
-::::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 6 weeks {{or}} [[Itraconazole]] PO 200mg twice a day for a week a month for 2 months (European guidelines).
-:::*10.2 Toenails
+::::::::::* Preferred regimen (2): [[Imipenem]] 75 mg/kg/day IV divided q8h for 2–3 weeks
-::::*Preferred regimen: Toenails [[Terbinafine]] PO 250mg/day for 12 weeks {{or}} [[Itraconazole]] PO 200mg/day for 12 weeks (U.S. guidelines) {{or}} [[Itraconazole]] PO 200mg twice a day for a week a month for 3 months (European guidelines).
-:::*Note (1): There is no evidence that combining systemic and topic treatments has any benefit to the patient.
+::::::::::* Preferred regimen (3): [[Doripenem]] 30 mg/kg/day IV divided q8h for 2–3 weeks
+::::::::* 3.2.5.1.2.1.3 '''Term newborn infant'''
+:::::::::* '''For < 1 week of age'''
-----
+::::::::::* Preferred regimen (1): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2–3 weeks
-{{PBI|Histoplasmosis}}
+::::::::::* Preferred regimen (2): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2–3 weeks
-{{PBI|Mucormycosis}}
-{{PBI|Penicilliosis}}
-{{PBI|Sporotrichosis}}
-{{PBI|Pneumocystis jiroveci}}
-:*'''1. Preventing First Episode of PCP (Primary Prophylaxis)'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
-}}</ref>
-::*Preferred regimen: [[TMP-SMX]] 1 Double-Strength(DS) PO daily {{or}} [[TMP-SMX]] 1 Single-Strength(SS) PO daily
-::*Alternative regimen (1): [[TMP-SMX]] 1 Double-Strength(DS) tid weekly {{or}} [[Dapsone]] 100 mg PO daily or 50 mg PO BID
-::*Alternative regimen (2): [[Dapsone]] 50 mg PO daily {{and}} ([[Pyrimethamine]] 50 mg + [[Leucovorin]] 25 mg) PO weekly
-::*Alternative regimen (3): [[Dapsone]] 200 mg {{and}} [[Pyrimethamine]] 75 mg {{and}} [[Leucovorin]] 25 mg PO weekly
-::*Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
-::*Alternative regimen (5): [[Atovaquone]] 1500 mg PO daily with food
-::*Alternative regimen (6): [[Atovaquone]] 1500 mg {{and}} [[Pyrimethamine]] 25 mg {{and}} [[Leucovorin]] 10 mg PO daily with food
-:*'''2. Treatment of Pneumocystis Pneumonia'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
+::::::::::* Preferred regimen (3): [[Doripenem]] 20 mg/kg/day IV divided q12h for 2–3 weeks
-}}</ref>
-::*'''2.1. Moderate to Severe PCP'''
+:::::::::* '''For 1–4 week of age'''
-:::*Preferred regimen: [[TMP-SMX]] (TMP 15–20 mg and SMX 75–100 mg)/kg/day IV given q6h or q8h
-:::*Note: May switch to PO after clinical improvement
-:::*Alternative regimen (1): [[Pentamidine]] 4 mg/kg IV once daily infused over at least 60 minutes
-:::*Note: May reduce the dose to 3 mg/kg IV once daily because of toxicities.
-:::*Alternative regimen (2): [[Primaquine]] 30 mg (base) PO once daily {{and}} ([[Clindamycin]] [IV 600 mg q6h or 900 mg q8h] or [PO 450 mg q6h or 600 mg q8h])
-::*Note (1): Duration of PCP treatment is 21 days
-::*Note (2): Adjunctive corticosteroid may be indicated in some moderate to severe cases.Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy) (AI):
-::*Note (3): Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy)
-:::*Days 1–5 40 mg PO BID
-:::*Days 6–10 40 mg PO daily
-:::*Days 11–21 20 mg PO daily
-::*'''2.2. Mild to Moderate PCP'''
+::::::::::* Preferred regimen (1): [[Meropenem]] 90 mg/kg/day IV divided q8h for 2–3 weeks
-:::*Preferred regimen: [[TMP-SMX]] (TMP 15–20 mg/kg/day and SMX 75–100 mg/kg/day), given PO in 3 divided doses {{or}} [[TMP-SMX]] Double-Strength(DS) - 2 tablets tid
-:::*Alternative regimen (1): [[Dapsone]] 100 mg PO daily {{and}} [[TMP]] 15 mg/kg/day PO (3 divided doses)
-:::*Alternative regimen (2): [[Primaquine]] 30 mg (base) PO daily {{and}} [[Clindamycin]] PO (450 mg q6h or 600 mg q8h)
-:::*Alternative regimen (3): [[Atovaquone]] 750 mg PO BID with food
-::*Note: Duration of PCP treatment is 21 days
-:*'''3. Preventing Subsequent Episode of PCP (Secondary Prophylaxis)'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
+::::::::::* Preferred regimen (2): [[Imipenem]] 75 mg/kg/day IV divided q8h for 2–3 weeks
-}}</ref>
-::*Preferred regimen: [[TMP-SMX]] 1 Double-Strength(DS) PO daily {{or}} [[TMP-SMX]] 1 Single-Strength(SS) PO daily
-::*Alternative regimen (1): [[TMP-SMX]] 1 Double-Strength(DS) tid weekly {{or}} [[Dapsone]] 100 mg PO daily or 50 mg PO BID
-::*Alternative regimen (2): [[Dapsone]] 50 mg PO daily {{and}} ([[Pyrimethamine]] 50 mg + [[Leucovorin]] 25 mg) PO weekly
-::*Alternative regimen (3): [[Dapsone]] 200 mg {{and}} [[Pyrimethamine]] 75 mg {{and}} [[Leucovorin]] 25 mg PO weekly
-::*Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
-::*Alternative regimen (5): [[Atovaquone]] 1500 mg PO daily with food
-::*Alternative regimen (6): [[Atovaquone]] 1500 mg {{and}} [[Pyrimethamine]] 25 mg {{and}} [[Leucovorin]] 10 mg PO daily with food
-====Mycobacteria====
+::::::::::* Preferred regimen (3): [[Doripenem]] 30 mg/kg/day IV divided q8h for 2–3 weeks
-{{PBI|Mycobacterium tuberculosis}}
-{{PBI|Mycobacterium abscessus}}
-::* 1.'''Limited, localized extrapulmonary disease ''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Preferred regimen: [[Clarithromycin]] 500 mg PO twice daily {{withorwithout}} [[Amikacin]] 10-15 mg/kg/day IV or 25 mg/kg three times weekly  for 4 months
-:::* Alternative regimen (1): [[Amikacin]] {{and}} [[Cefoxitin]] 12 g/day typically for two weeks until clinical improvement in severe cases
+:::::::* 3.2.5.1.2.2 ''' Alternatives for penicillin-susceptible strains'''
-:::* Alternative regimen (2): [[Amikacin]] {{and}} [[Imipenem]] 500 mg IV q6-8h for two weeks until clinical improvement in severe cases
+::::::::* 3.2.5.1.2.2.1 '''For 32–34 weeks gestational age'''
-:::* NOTE: Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed
-::* 2.'''Pulmonary or serious extrapulmonary disease'''
+:::::::::* '''For 0–1 week of age'''
-:::* Preferred regimen: [[Clarithromycin]] 500 mg PO twice daily {{and}} [[Amikacin]] 15 mg/kg/day IV {{and}} [[Cefoxitin]] 2g q4h IV {{or}} [[Imipenem]] 1g q6h IV for at least 2-4 months, if limited by adverse effects, then switch to[[Clarithromycin]] 500 mg PO BID or 1000 mg XR OD {{or}} [[Azithromycin]] 250 mg PO OD
-:::* Alternative regimen(1): [[Tigecycline]] 100 mg IV load then 50 mg IV q12h could be substituted as one of the injectables
-:::* Alternative regimen(2): [[Linezolid]] 600 mg PO q12h or 600 mg PO OD {{and}} [[Clarithromycin]] could replace parental tx if not tolerated or feasible
-{{PBI|Mycobacterium bovis}}
-{{PBI|Mycobacterium avium-intracellulare}}
-{{PBI|Mycobacterium celatum}}
-{{PBI|Mycobacterium chelonae}}
-*1.''' Localized infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:* Preferred regimen: [[Clarithromycin]] 500 mg PO twice daily
-:* Alternative regimen: [[Azithromycin]]
-*2. '''Disseminated or extensive disease'''
-:*2.1 monotherapy
-::* Preferred regimen: [[Clarithromycin]] 500 mg PO twice daily
-:*2.2 multidrug therapy
-::* preferred regimen: [[Clarithromycin]] 500 mg PO BID {{and}} [[Tobramycin]] 5 mg IV/kg/day {{or}} [[Imipenem]] 0.5-1 g IV q6h {{or}} [[Linezolid]] 600 mg IV/PO BID for 4-8 weeks
-::* Alternative regimen: [[Moxifloxacin]] 400 mg daily {{and}} [[Linezolid]] 600 mg twice daily
-:* NOTE: Total treatment duration is 6 months
+::::::::::* Alternative regimen (1): [[Penicillin G]] 200000 Units/kg/day IV divided q12h for 2–3 weeks
-*3. '''Keratitis (LASIK-related)'''
-:* Preferred regimen: [[Clarithromycin]] 500 mg PO BID {{and}} topicals ([[Tobramycin]] 0.3%, 2 gtts q4h {{and}} [[Gatifloxacin]] 0.3%, 1 gtt q4h {{or}} [[Moxifloxacin]] 0.5%, 1 gtt q4h)
-{{PBI|Mycobacterium foruitum}}
-{{PBI|Mycobacterium haemophilum}}
-{{PBI|Mycobacterium genavense}}
-{{PBI|Mycobacterium gordonae}}
-{{PBI|Mycobacterium kansasii}}
-{{PBI|Mycobacterium marinum}}
-{{PBI|Mycobacterium scrofulaceum}}
-{{PBI|Mycobacterium simiae}}
-:* [[Mycobacterium simiae]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* Preferred regimen: [[Clarithromycin]] {{and}} [[Moxifloxacin]] {{and}} [[Trimethoprim/sulfamethoxazole]]
+::::::::::* Alternative regimen (2): [[Ampicillin]] 100 mg/kg/day IV divided q12h for 2–3 weeks
-{{PBI|Mycobacterium ulcerans}}
+:::::::::* '''For 1–4 week of age''' :
-:* [[Mycobacterium ulcerans]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-:* 1. '''Preulcerative lesions'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 Units/kg/day IV divided q12h for 2–3 weeks
-::* Preferred regimen: Excision and primary closure, [[Rifampin]] monotherapy, or heat therapy
-:* 2. '''Established ulcers'''
-::* Preferred regimen: Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice
-:* 3. '''Control complications of the ulcer'''
-::* Preferred regimen: [[Clarithromycin]] {{and}} [[Rifampin]]
-{{PBI|Mycobacterium xenopi}}
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day divided IV q12h for 2–3 weeks
-:* [[Mycobacterium xenopi]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-:* 1. '''The cornerstone of therapy for M. xenopi'''
-::* Preferred regimen: A combination of [[Clarithromycin]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]]. Therapy should be continued until the patient has maintained negative sputum cultures while on therapy for 12 months
-:* 2. '''Pulmonary disease'''
-::* Preferred regimen: [[INH]] {{and}} [[Rifabutin]] {{or}} [[Rifampin]] {{and}} [[Ethambutol]] {{and}} [[Clarithromycin]] {{withorwithout}} an initial course of [[Streptomycin]]. A quinolone, preferably [[Moxifloxacin]], could be substituted for one of the antituberculous drugs
-:* 3. '''Extrapulmonary disease'''
-::* Therapy for extrapulmonary disease would include the same agents as for pulmonary disease
-{{PBI|Mycobacterium leprae}}
-:* [[Mycobacterium leprae]] <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* 1. '''Multibacillary Leprosy (Skin smear positive) '''
-:::* Preferred regimen: [[Dapsone]] 100 mg/day PO {{and}} [[Rifampin]] 600 mg PO 4 times per week {{and}} [[Clofazimine]] 50 mg/day PO supplemented by [[Clofazimine]] 300 mg PO loading dose monthly
-:::* Pediatric regimen: [[Dapsone]] 1-2 mg/kg/day PO {{and}} [[Rifampin]] 450 mg PO <35 kg, 300 mg PO <20 kg, 150 mg PO <12 kg
-:::* Length of treatment: 12-24 months
-::* 2. '''Paucibacillary Leprosy (Skin Smear negative)'''
-:::* Preferred regimen: [[Rifampin]] 600 mg PO once a month for 6 months {{and}} [[Dapsone]] 100 mg/day PO for 6 months
-::* 3. '''Erythema Nodosum Leprosum (ENL)'''
-:::* Continue anti-leprosy drugs throughout
-:::* 3.1 Mild
-::::* Preferred regimen: Rest affect limb, analgesics, follow-up twice a week, check for iridocyclitis; [[Chloroquine]] {{or}} [[Aspirin]] may be useful
-:::* 3.2 Severe (numerous nodules + fever, ulcerating/pustular ENL, visceral involvement, nodules + neuritis, recurrent ENL)
-::::* Preferred regimen: [[Prednisolone]] 30-40 mg/day PO (not to exceed 1 mg/kg) for 1-2 weeks, then taper over 12 weeks
-::::* Alternative regimen (1): (If unresponsive to corticosteroids or if risk of corticosteroids prevent administration) Start [[Clofazimine]] 100 mg PO TID for maximum of 12 weeks, taper the dose to 100 mg PO BID for 12 weeks and then 100 mg qd for 12-24 weeks
-::::* Alternative regimen (2): (if not contraindicated) [[Thalidomide]] 200-400 mg/day PO, reduced to 50-100 mg/day after 1-2 weeks
-::* 4. '''Reversal Reaction'''
-:::* Preferred regimen: [[Prednisolone]] start with 40 mg/day PO then taper by 10 mg twice a week for 12 weeks
-{{PBI|Mycobacterium smegmatis}}
+::::::::* 3.2.5.1.2.2.2 '''For 34–37 week gestational age'''
-:* [[Mycobacterium smegmatis]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* 1. '''Mild disease'''
+:::::::::* '''For < 1 week of age'''
-:::* Preferred regimen: [[Doxycycline]] PO {{and}} [[ Trimethoprim sulfamethoxazole]] PO
-::* 2. '''Severe disease'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 Units/kg/day IV divided q12h for 2–3 weeks
-:::* Preferred regimen: [[Amikacin]] IV {{or}} [[Imipenem]] IV
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q12h for 2–3 weeks
-{{PBI|Mycobacterium immunogenum}}
+:::::::::* '''For 1–4 week of age'''
-:* [[Mycobacterium immunogenum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* In vitro
-:::* susceptible: [[Amikacin]] {{and}} [[Clarithromycin]] but
-:::* resistant: [[Ciprofloxacin]], [[Doxycycline]], [[Cefoxitin]], [[Tobramycin]], and [[Sulfamethoxazole]]
-:::* NOTE: The optimal therapy for this organism is unknown; however, successful therapy is likely difficult due to the extensive antibiotic resistance of the organism
-{{PBI|Mycobacterium malmoense }}
+::::::::::* Alternative regimen (1): [[Penicillin G]] 400000 Units/kg/day IV divided q12h for 2–3 weeks
-:* [[Mycobacterium malmoense]]<ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* in vitro
-:::* Susceptible: [[Ethambutol]], [[Ethionamide]], [[Kanamycin]], and [[Cycloserine]]
-:::* Resistant: [[INH]], [[Streptomycin]], [[Rifampin]], and [[Capreomycin]]
-::* Pulmonary M. malmoense infection
-:::* Preferred regimen: [[INH]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]] {{withorwithout}} [[Quinolones]] {{and}} [[Macrolides]]
-{{PBI|Mycobacterium mucogenicum}}
+::::::::::* Alternative regimen (2): [[Ampicillin]] 200 mg/kg/day IV divided q12h for 2–3 weeks
-:* [[Mycobacterium mucogenicum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* In vitro susceptible agents: [[Aminoglycosides]], [[Cefoxitin]], [[Clarithromycin]], [[Minocycline]], [[Doxycycline]], [[Quinolones]], [[Trimethoprim/sulfamethoxazole]], and [[Imipenem]]
-{{PBI|Mycobacterium szulgai}}
+::::::::* 3.2.5.1.2.2.3 '''Term newborn infant'''
-:* [[Mycobacterium szulgai]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref><ref>{{Cite journal| issn = 0903-1936| volume = 11| issue = 4| pages = 975–977| last1 = Tortoli| first1 = E.| last2 = Besozzi| first2 = G.| last3 = Lacchini| first3 = C.| last4 = Penati| first4 = V.| last5 = Simonetti| first5 = M. T.| last6 = Emler| first6 = S.| title = Pulmonary infection due to Mycobacterium szulgai, case report and review of the literature| journal = The European Respiratory Journal| date = 1998-04| pmid = 9623706}}</ref>
-::* '''1. in vitro susceptibility'''
+:::::::::* '''For 0–1 week of age'''
-:::* M. szulgai is susceptible in vitro to most antituberculous drugs including [[Quinolones]] and newer [[Macrolides]].
-::* '''2. Pulmonary infection'''
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 Units/kg/day IV divided q12h for 2–3 weeks
-:::* Preferred regimen: three- or four-drug regimen based on susceptibility that includes 12 months of negative sputum cultures while on therapy
-::* '''3. Extrapulmonary infection'''
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q12h for 2–3 weeks
-:::* Preferred regimen: combination anti-tuberculous medications based on in vitro susceptibilities for 4 to 6 months
+:::::::::* '''For 1–4 week of age'''
-{{PBI|Mycobacterium terrae}}
+::::::::::* Alternative regimen (1): [[Penicillin G]] 400000 Units/kg/day IV divided q12h for 2–3 weeks
-:* [[Mycobacterium terrae]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
-::* 1. '''In vitro susceptibility'''
-:::* All six of the isolates from a single center and 90% or more of an additional 22 isolates of M. terrae complex were susceptible to [[Ciprofloxacin]] and [[Sulfonamides]]. Recently, 11 isolates of M. terrae complex were also shown to be susceptible to [[Linezolid]]
-::* 2. '''Antimicrobial therapy'''
-:::* Preferred regimen: [[Macrolide]] {{and}} [[Ethambutol]] or other agent based on in vitro susceptibility results
+::::::::::* Alternative regimen (2): [[Ampicillin]] 200 mg/kg/day IV divided q12h for 2–3 weeks {{and}}
-====Parasites – Intestinal Protozoa====
+::::::* 3.2.5.1.3 '''A protein synthesis inhibitor'''
-{{PBI|Balantidium coli}}
-{{PBI|Blastocystis hominis}}
+:::::::* 3.2.5.1.3.1 '''For 32–34 weeks gestational age'''
-{{PBI|Cryptosporidium parvum}}
-::* '''1. Immunocompetent'''<ref name="pmid11398117">{{cite journal| author=Rossignol JF, Ayoub A, Ayers MS| title=Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. | journal=J Infect Dis | year= 2001 | volume= 184 | issue= 1 | pages= 103-6 | pmid=11398117 | doi=10.1086/321008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11398117  }} </ref>
+::::::::* '''For < 1 week of age'''
-:::* Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: [[Nitazoxanide]] 500 mg PO bid for 3 days.
-::* '''2. HIV'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: [[Nitazoxanide]] 500 mg PO bid for 3 days
-::* '''3. HIV and Immunodeficiency'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: Effective antiretroviral therapy
-:::* Note: Nitazoxanide is not licensed for immunodeficient patients
-{{PBI|Cryptosporidium hominis}}
-::* '''1. Immunocompetent'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: [[Nitazoxanide]] 500 mg PO bid for 3 days.<ref name="pmid15640710">{{cite journal| author=Smith HV, Corcoran GD| title=New drugs and treatment for cryptosporidiosis. | journal=Curr Opin Infect Dis | year= 2004 | volume= 17 | issue= 6 | pages= 557-64 | pmid=15640710 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640710  }} </ref>
-::* '''2. HIV'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: [[Nitazoxanide]] 500 mg PO bid for 3 days
-::* '''3. HIV and Immunodeficiency'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: Effective antiretroviral therapy
-:::* Note: Nitazoxanide is not licensed for immunodeficient patients
-{{PBI|Cyclospora cayetanensis}}
-::* Preferred regimen: [[Trimethoprim-sulfamethoxazole]] one double-strength tablet PO bid for 7-10 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Alternative regimen(1): [[Ciprofloxacin]] 500 mg PO bid for 7 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Alternative regimen(2): [[Nitazoxanide]] 500 mg PO bid for 7 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Note(1): One double-strength tablet (160 mg TMP/800 mg SMX) .
-::* Note(2): Treatment is continued for 7 days in immunocompetent hosts and for 7 to 10 days in patients with HIV infection.
-{{PBI|Dientamoeba fragilis}}
-{{PBI|Entamoeba histolytica}}
+:::::::::* Preferred regimen (1): [[Linezolid]] 20 mg/kg/day IV divided q12h for 2–3 weeks
-:* '''1. Amebic Liver Abscess'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-::* Preferred regimen: [[Metronidazole]] 750 mg PO tid for 10 days {{or}} [[Tinidazole]] 2 g PO once daily for 5 days {{PLUS}} [[Paromomycin]] 30 mg/kg/day PO in three divided doses per day for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days
-::*Alternative regimen (1): [[Nitazoxanide]] 500mg bid for 10 days {{PLUS}} [[Paromomycin]] 30 mg/kg/day PO in three divided doses per day for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days.
-::* Alternative regimen (2): [[Tinidazole]] 2 g PO once daily for 5 days {{PLUS}} [[Paromomycin]] 30 mg/kg/day PO in three divided doses per day for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days.
-::* Alternative regimen (2): [[Tinidazole]] 2 g PO once daily for 5 days
-:* '''2. Amebic Colitis'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:::::::::* Preferred regimen (2): [[Clindamycin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
-::* Preferred regimen: [[Metronidazole]] 500-750mg PO tid for 7-10 days. Pediatric dose: 35-50mg/kg per day tid {{and}} [[Paromomycin]] 30 mg/kg/day PO in three divided doses per day for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days.
-::* Alternative regimen: [[Tinidazole]] 2 g PO once daily for 5 days {{and}} [[Paromomycin]] 30 mg/kg/day PO in three divided doses per day for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days.
-:* '''3. Asymptomatic Intestinal Colonization'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
-::* Preferred regimen: [[Paromomycin]] 30 mg/kg/day PO in three divided doses per day for 5-10 days.
-::* Alternative regimen (1): [[Diloxanide furoate]] 500 mg PO tid for 10 days.
-::* Alternative regimen (2): [[Diiodohydroxyquin]] 650 mg PO tid for 20 days for adults and 30 to 40 mg/kg per day tid for 20 days for children.
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 25 mg/kg/day IV q24h for 2–3 weeks
-{{PBI|Giardia lamblia}}
+::::::::* '''For 1–4 week of age'''
-----
+:::::::::* Preferred regimen (1): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 weeks
-{{PBI|Cystoisospora belli}}
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day IV divided q8h for 2–3 weeks
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
-----
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 50 mg/kg/day IV q12h for 2–3 weeks
-{{PBI|Microsporidiosis}}
+:::::::* 3.2.5.1.3.2 '''For 34–37 week gestational age'''
-:* '''1. Ocular'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* Preferred regimen: [[Albendazole]] 400 mg PO bid for 3 weeks {{and}} [[Fumagillin]] eye drops.
-:* '''2. Intestinal (diarrhea)'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::* Preferred regimen:
-:::* Adult: [[Albendazole]] 400 mg PO bid for 3 weeks  for E. intestinalis.
-:::* Pediatric: [[Albendazole]] 15 mg/kg per day divided into 2 daily doses for 7 days  for E. intestinalis.
-::* Note: [[Fumagillin]] 20 mg PO tid is the only reported effective treatment for E. bieneusi.
-:* '''3. Disseminated'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen: [[Albendazole]] 400 mg po bid for 3 weeks.
-====Parasites – Extraintestinal Protozoa====
+::::::::* '''For < 1 week of age'''
-{{PBI|Acanthamoeba}}
-::*1.'''Keratitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::*Preferred regimen: [[Miltefosine]] {{or}}  [[Voriconazole]].
-::*2. '''Acanthamoeba Granulomatous Amebic Encephalitis and Disseminated Disease'''
-:::*Preferred regimen: Adults: Success with IV [[Pentamidine]] {{and}}  [[Sulfadiazine]] {{and}} [[ Flucytosine]] {{and}} ([[ Fluconazole]]  {{or}}   [[Itraconazole]] )
-:::*Note: 2 children responded to PO rx: [[TMP-SMX]] {{and}} [[ Rifampin]] {{and}} [[ Ketoconazole]]
-{{PBI|Balamuthia mandrillaris}}
-::*'''Chronic granulomatous meningitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::*Preferred regimen: [[Pentamidine]] {{and}} ([[Clarithromycin]]  {{or}} [[Azithromycin]]) {{and}} [[ Fluconazole]] {{and}} [[Sulfadiazine]] {{and}} [[ Flucytosine]]
-{{PBI|Naegleria fowleri}}
+:::::::::* Preferred regimen (1): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 weeks
-::*'''Primary amoebic meningoencephalitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref><ref>{{Citeweb|title=PAM | url=http://www.cdc.gov/parasites/naegleria/index.html }}</ref>
-:::*Preferred regimen: [[Amphotericin B]] 1.5 mg/kg /day bid for 3 days; then 1 mg/kg/day for 6 days {{and}}1.5 mg/day intrathecal x 2 days; then 1 mg/day intrathecal qd for 8 days.
-:::*Note: Investigational drug called miltefosine  also available for treatment.
-{{PBI|Babesia microti}}
-::*'''1. Mild/moderate disease'''.<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::*Preferred regimen: [[Atovaquone]] 750 mg po bid {{and}} [[Azithromycin]] 600 mg po qd for 7-10 days
-::*'''2.Severe babesiosis:'''
-:::* Preferred regimen: [[Clindamycin]] 600 mg po tid {{and}} [[Quinine]] 650 mg po tid  for 7–10 days {{or}} [[Clindamycin]]  1.2 gm  IV bid.
-:::*Note(1) For overwhelming infection in asplenic patients and immunocompromised patients, treat for 6 or more weeks
-:::*Note(2)Consider transfusion if 􀂕10% parasitemia
-{{PBI|Leishmaniasis}}
-:*1.Cutaneous Leishmaniasis<ref>{{Citeweb|title=leishmaniasis | url=http://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html#tx}}</ref>
-::*1.1'''Systemic Therapy (Parenteral)'''
-:::*Preferred Regimen: [[Sodium stibogluconate]] 20 mg/kg IV/IM once qd for 10-20 days  {{or}} [[Meglumine antimoniate]] 20 mg/kg IV/IM once qd for 10-20 days
-:::*Alternative Regimen: [[Liposomal amphotericin B]] 3 mg/kg/day IV infusion for 6-10 days {{or}}  [[Pentamidine]] 2-3 mg/kg/day IV/IM for 4-7 days
-:::*Note: Data supporting the use of amphotericin B for treatment of cutaneous (and mucosal) leishmaniasis are anecdotal; standard dosage regimens have not been established. In the United States, pentamidine isethionate is uncommonly used for treatment of cutaneous leishmaniasis. Its limitations include the potential for irreversible toxicity and variable effectiveness.
-:::*'''1.2 Systemic Therapy (Oral)'''
-:::*Preferred Regimen: In adults and adolescents at least 12 years of age  who weigh from 33-44 kg:-[[Miltefosine]] 50 mg PO q12h for 28 days
-:::*Patients who weigh  >45 kg:-[[Miltefosine]] 50 mg PO q8h for 28 days
-:::*Alternative Regimen:[[Ketoconazole]] 600 mg qd for 28 days  {{or}} [[Fluconazole]] 200 mg qd for 6 weeks
-:::*Note:The FDA-approved indications are limited to infection caused by three particular species, all three of which are New World species in the Viannia subgenus—namely, Leishmania (V.) braziliensis, L. (V.) panamensis, and L. (V.) guyanensis.  The "azoles" showed modest activity against some Leishmania species in some cases, but are not FDA approved
-:::*1.3'''Local Therapy'''
-:::*List of possible local therapies
-:::*[[Cryotherapy]] (with [[liquid nitrogen]] {{or}} [[Thermotherapy]] (use of localized current field radiofrequency heat) {{or}} Intralesional administration of [[SbV]] {{or}} Topical application of [[paromomycin]] (such as an ointment containing 15% [[paromomycin]]/12% methylbenzethonium chloride in soft white paraffin)
-::*2.'''Visceral Leishmaniasis'''
-:::*2.1'''Systemic Therapy (Parenteral)'''
-:::*Preferred Regimen: [[Liposomal amphotericin B]] 3 mg/kg/day IV for 5 days, then once on day 14 and once on day 21  (Total dose: 21 mg/kg)  {{or}}[[Sodium stibogluconate]] 20 mg/kg IV/IM once daily for 28 days {{or}}  [[Meglumine antimoniate]] 20 mg/kg IV/IM once daily for 28 days'
-:::*Alternative Regimen:[[Amphotericin B]] deoxycholate 0.5-1 mg/kg IV once daily (Total dose: 15-20 mg/kg)
-:::*Note: In immunosuppressed patients, dose is 4 mg/kg/day for 5 days, then once on day 10,  17, 24, 31, and 38  (Total dose: 40 mg/kg)
-:::*2.2 '''Systemic Therapy (Oral)'''
-:::*Preferred Regimen:In adults and adolescents at least 12 years of age, who weigh from 33-44 kg:-[[Miltefosine]] 50 mg PO q12h for 28 days Patients who weigh >45 kg:-[[Miltefosine]] 50 mg PO q8h for 28 days
-==={{PBI|Plasmodium}}====
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day IV divided q8h for 2–3 weeks
-* 1. '''Plasmodium falciparum'''<ref>{{cite web | title = Guidelines for the treatment of malaria. Third edition April 2015 | url = http://apps.who.int/iris/bitstream/10665/162441/1/9789241549127_eng.pdf?ua=1&ua=1 }}</ref>
-:* 1.1 '''Treatment of uncomplicated P. falciparum malaria'''
-::* 1.1.1 Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)
-:::* '''Preferred regimen (1)''':  [[Artemether]] 5–24 mg/kg bw  PO {{ and}} [[Lumefantrine]] 29–144 mg/ kg bw PO, Both are  given bid for 3 days (total, six doses). The first two doses should, ideally, be given 8 h apart.
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-5 to < 15-     [[Artemether]] 20 (mg) {{ and}} [[Lumefantrine]] 120(mg)  given bid  for 3 days;
-::::*Body weight (kg)-15 to < 25-    [[Artemether]] 40 (mg) {{ and}} [[Lumefantrine]] 240(mg)  given bid  for 3 days;
-::::*Body weight (kg)-25 to < 35-    [[Artemether]] 60 (mg) {{ and}} [[Lumefantrine]] 360(mg)  given bid  for 3 days;
-::::*Body weight (kg)   ≥ 35-       [[Artemether]] 80 (mg) {{ and}} [[Lumefantrine]] 480(mg)  given bid  for 3 days.
-:::* '''Preferred regimen (2):''' [[Artesunate]] (2–10) mg/kg bw per day  {{ and}} [[Amodiaquine]](7.5–15) mg/kg bw per day ,both are given once a day for 3 days. A total therapeutic dose range of 6–30 mg/kg bw per day artesunate and 22.5–45 mg/kg bw per dose amodiaquine is recommended
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-4.5 to < 9-   [[Artesunate]] 25 (mg) {{ and}} [[Amodiaquine]] 67.5 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-9 to < 18 -   [[Artesunate]] 50 (mg) {{ and}} [[Amodiaquine]] 135 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-18 to < 36-   [[Artesunate]] 100 (mg) {{ and}} [[Amodiaquine]] 270(mg)  given bid  for 3 days;
-::::*Body weight (kg)   ≥ 36 -         [[Artesunate]] 200 (mg) {{ and}} [[Amodiaquine]] 540 (mg)  given bid  for 3 days.
-:::* '''Preferred regimen (3)''': [[Artesunate]] (2–10) mg/kg bw per day{{ and}} [[Mefloquine]] (2–10) mg/kg bw per day both are given once a day for 3 days
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-5 to < 9-      [[Artesunate]] 25 (mg) {{ and}} [[Mefloquine]] 55 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-9to < 18-      [[Artesunate]] 50 (mg) {{ and}} [[Mefloquine]] 110 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-18 to < 36-   [[Artesunate]] 100 (mg) {{ and}} [[Mefloquine]] 220 (mg)  given bid  for 3 days;
-::::*Body weight (kg)- ≥ 36  -      [[Artesunate]] 200 (mg) {{ and}} [[Mefloquine]] 440 (mg)  given bid  for 3 days;
-:::* '''Preferred regimen (4)''': [[Artesunate]] (2–10) mg/kg bw per day given once a day for 3 days {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]]  1.25 (25–70 / 1.25–3.5) mg/kg bw given as a single dose on day 1
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-5 to < 10-      [[Artesunate]] 25 (mg) {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]] 250/12(mg)  given bid  for 3 days;
-::::*Body weight (kg)-10 to < 25-    [[Artesunate]] 50 (mg) {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]] 500 / 25 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-25 to < 50-      [[Artesunate]] 100 (mg) {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]] 1000 / 50 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-    ≥50-         [[Artesunate]] 200 (mg) {{ and}} [[Sulfadoxine]]-[[Pyrimethamine]] 1500 / 75 (mg)  given bid  for 3 days;
-:::* '''Preferred regimen (5)''': [[Dihydroartemisinin]] (2–10) mg/kg bw per day  {{ and}}   [[Piperaquine]](16–27) mg/kg bw per day
-::::*Dosage regimen based on Body weight (kg)
-::::*Body weight (kg)-5 to < 8-     [[Dihydroartemisinin]] 20(mg) {{ and}}  [[Piperaquine]]  160  (mg)  given bid  for 3 days;
-::::*Body weight (kg)-8 to < 11-      [[Dihydroartemisinin]]30 (mg) {{ and}}  [[Piperaquine]] 240 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-11 to < 17 -      [[Dihydroartemisinin]] 40 (mg) {{ and}}  [[Piperaquine]]  320 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-17 to < 25-      [[Dihydroartemisinin]] 60 (mg) {{ and}}  [[Piperaquine]] 480 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-25 to < 36-       [[Dihydroartemisinin]] 80 (mg) {{ and}}  [[Piperaquine]]  640 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-36 to < 60-      [[Dihydroartemisinin]] 120 (mg) {{ and}}  [[Piperaquine]] 960 (mg)  given bid  for 3 days;
-::::*Body weight (kg)-60 < 80 -       [[Dihydroartemisinin]] 160 (mg) {{ and}}  [[Piperaquine]] 1280 (mg)  given bid  for 3 days;
-::::*Body weight (kg)- >80-      Dose of [[Dihydroartemisinin]] 200 (mg) {{ and}}  [[Piperaquine]] 1600 (mg)  given bid  for 3 days;
-::* 1.1.2 '''Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in  patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) '''
-::::*Preferred regimen: single dose of 0.25 mg/kg bw [[Primaquine]] with ACT
-:* 1.2 '''Recurrent Falciparum Malaria'''
-::* 1.2.1 '''Failure within 28 days '''
-:::*Note:The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens (with artesunate or quinine both of which should be co-administered with + tetracycline, or doxycycline or clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.
-::* 1.2.2 '''Failure after 28 days'''
-:::*Note: all presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used
-:* 1.3 '''Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in  patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) '''
-::* Note: a single dose of 0.25 mg/kg bw [[Primaquine]] with ACT
-:* 1.4 '''Treating uncomplicated P. falciparum malaria in special risk groups'''
-::* 1.4.1 '''Pregnancy '''
-:::* First trimester of pregnancy :[[Quinine]] {{ and}} [[Clindamycin]] PO 10mg/kg bw bid for 7 days
-:::* Second and third trimesters : [[Mefloquine]] is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
-:::* Note: Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
-:::* Note: Primaquine and tetracyclines should not be used in pregnancy.
-::*1.4.2 '''Infants less than 5kg body weight''' :  with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
-::*1.4.3 '''Patients co-infected with HIV''': should avoid [[Artesunate]] + SP if they are also receiving [[Co-trimoxazole]], and avoid artesunate + amodiaquine if they are also receiving efavirenz or zidovudine.
-::*1.4.4 '''Large and Obese adults''': For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
-::*1.4.5 '''Patients co-infected with TB''': Rifamycins, in particular rifampicin, are potent CYP3A4 inducers with weak antimalarial activity. Concomitant administration of rifampicin during quinine treatment of adults with malaria was associated with a significant decrease in exposure to quinine and a five-fold higher recrudescence rate
-::*1.4.6 '''Non-immune travellers''' : Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
-::*1.4.7 '''Uncomplicated hyperparasitaemia''': People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT
-* 2. '''Treatment of uncomplicated malaria caused by P. vivax, P. ovale, P. malariae or P. knowlesi'''
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
-:* 2.1  '''Blood Stage infection'''
-::* 2.1.1.  '''Uncomplicated malaria caused by P. vivax'''
-:::* 2.1.1.1 '''In areas with chloroquine-sensitive P. vivax'''
-::::* Preferred regimen: [[Chloroquine]] PO  total dose of 25 mg base/kg bw. [[Chloroquine]] is given at an initial dose of 10 mg base/kg bw, followed by 10 mg/kg bw on the second day and 5 mg/kg bw on the third day.
-:::* 2.1.1.2 '''In areas with chloroquine-resistant P. vivax'''
-::::* Note: ACTs containing [[piperaquine]], [[mefloquine]] or [[lumefantrine]] are the recommended treatment, although [[artesunate]] + [[amodiaquine]] may also be effective in some areas. In the systematic review of ACTs for treating P. vivax malaria, [[dihydroartemisinin]] + [[piperaquine]] provided a longer prophylactic effect than ACTs with shorter half-lives ([[artemether]] + [[lumefantrine]], [[artesunate]] + [[amodiaquine]]), with significantly fewer recurrent parasitaemias during 9 weeks of follow-up.
-::* 2.1.2 '''Uncomplicated malaria caused by P. ovale, P. malariae or P. knowlesi malaria'''
-:::* Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to chloroquine. In only one study, conducted in Indonesia, was resistance to chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or [[chloroquine]], as for vivax malaria.
-::* 2.1.3 '''Mixed malaria infections '''
-:::* Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.
-:* 2.2 '''Liver stages (hypnozoites) of P. vivax and P. ovale'''
-::* Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.]
-::*2.2.1 '''Primaquine for preventive relapse'''
-:::*Preferred regimen: [[Primaquine]] PO 0.25–0.5 mg/kg bw per day qd for 14 days
-::*2.2.2 '''Primaquine and glucose-6-phosphate dehydrogenase deficiency'''
-:::*Preferred regimen:[[Primaquine]] PO 0.75 mg base/kg bw once a week for 8 weeks.
-:::*Note: The decision to give or withhold [[Primaquine]] should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.
-::*2.2.3 '''Prevention of relapse in pregnant or lacating women and infants'''
-:::*Note: Primaquine is contraindicated in pregnant women, infants < 6months of age and in lactating women (unless the infant is known not to be G6PD deficient).
-*3.'''Treatment of severe malaria'''
-:* 3.1 Treatment of severe falciparum infection with Artesunate
-::* 3.1.1 Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women):-
-:::* Preferred regimen: [[Artesunate]] IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oraltherapy, complete treatment with 3 days of an ACT (add single dose [[Primaquine]] in areas of low transmission).
-::* 3.1.2 Young children weighing < 20 kg
-:::* Preferred regimen:[[Artesunate]] (3 mg/kg bw per dose)
-:::* Alternatives regimen: use [[Artemether]] in preference to quinine for treating children and adults with severe malaria
-:* 3.2.'''Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)'''
-::*3.2.1 Adults and children
-:::*Preferred regimen: [[Artesunate]] IM
-:::* Alternative regimen: [[Artemether]] IM {{or}} [[Quinine]] IM
-::*3.2.2  Children < 6 years
-:::*Preferred regimen: Where intramuscular injections of artesunate are not available , treat with a single rectal dose (10 mg/kg bw) of [[Artesunate]], and refer immediately to an appropriate facility for further care.
-:::*Note: Do not use rectal artesunate in older children and adults.
-:*3.3 '''Pregancy'''
-::*Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed
-:*3.4 '''Treatment of severe P.Vivax infection'''
-::*Note: parenteral artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). A full course of radical treatment with primaquine should be given after recovery
-:*3.5 '''Additional aspects of management in severe malaria'''
-::* '''Fluid therapy''':  It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit
-::* '''Blood Transfusion ''':In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended
-::* '''Exchange blood transfusion''': Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.
-{{PBI|Toxoplasma gondii}}
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 25 mg/kg/day IV q24h for 2–3 weeks
-{{PBI|Trichomonas vaginalis}}
-: 1.'''T. vaginalis infection''' <ref>{{cite web | title =trichomoniasis | url =  http://www.cdc.gov/std/tg2015/trichomoniasis.htm  }}</ref>
-:* Preferred regimen:[[Metronidazole]] 2 g PO in a single dose {{or}} [[Tinidazole]] 2 g PO in a single dose
-:* Alternative regimen : [[Metronidazole]] 500  mg PO bid for 7 days
-: 2.'''T. vaginalis infection in Pregnant and Lactating Women'''
+::::::::* '''For 1–4 week of age'''
-:* 2.1 Pregnant women
-:* Preferred regimen:[[Metronidazole]] 2 g PO in a single dose.
-:* 2.2 Post-partum and Breastfeeding
-:* Preferred regimen:[[Metronidazole]] 2 g PO in a single dose.{{or}} [[Tinidazole]] 2 g PO in a single dose
-:* Note(1): do not breastfeed for 12-24 hrs following [[Metronidazole]] and 72 hrs following  [[Tinidazole]]
-:* Note(2)Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment.   Pregnant women should be advised of the risk and benefits to treatment as infection (definitely) and treatment (possibly)
-:* Note(3): Pregnant women with HIV who are treated for T. vaginalis infection should be retested 3 months after treatment.
-: 3.'''T. vaginalis infection in patients with HIV'''
+:::::::::* Preferred regimen (1): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 weeks
-:* Preferred regimen: [[Metronidazole]] 500  mg PO bid for 7 days
-: 4. '''Persistent or Recurrent Trichomoniasis'''
+:::::::::* Preferred regimen (2): [[Clindamycin]] 20 mg/kg/day IV divided q6h for 2–3 weeks
-:* Treatment Failure
-:* Preferred regimen:[[Metronidazole]] 500  mg PO bid for 7 days
-:* Treatment failure again
-:* Preferred regimen:[[Metronidazole]] 2 g PO for 7 days {{or}} [[Tinidazole]] 2 g PO for 7 days
-:* Nitroimidazole-resistant cases
-:* Preferred regimen: [[Tinidazole]] 2-3 g PO for 14 days
-{{PBI|African trypanosomiasis}}
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
-* ''' Sleeping sickness'''<ref>{{cite web|title=African Trypanosomiasis| url=  http://www.cdc.gov/parasites/sleepingsickness/health_professionals/index.html}}</ref>
-:*1. '''East African trypanosomiasis'''
-:* 1.1'''T. b. rhodesiense, hemolymphatic stage'''
-::* Adult
-:::* Preferred regimen: [[Suramin]] 1 gm IV on days 1,3,5,14, and 21
-::*Pediatric
-:::* Preferred regimen: [[Suramin]]  20 mg/kg IV on days 1, 3, 5, 14, and 21
-:*1.2 '''T. b. rhodesiense, CNS involvement'''
-::* Adult
-:::* Preferred regimen: [[Melarsoprol]] 2-3.6 mg/kg/day IV for 3 days.After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days.
-::* Pediatric
-:::* Preferred regimen: [[Melarsoprol]]  2-3.6 mg/kg/day IV for 3 days.After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days
-:* 2. '''West African trypanosomiasis'''
-:* 2.1 '''T. b. gambiense, Hemolymphatic stage'''
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 50 mg/kg/day IV q12h for 2–3 weeks
-::* Adult
-:::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM or IV for 7-10 days
-::* Pediatric
-:::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM or IV for 7-10 days
-::::*  Note(1): Pentamidine should be used during pregnancy and lacation  only if the potential benefit justifies the potential risk
-::::* Note(2): IM/IV Pentamidine have a similar safety profile in children age 4 months and older as in adults. Pentamidine is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (Trypanosoma brucei gambiense) on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
-:*'''2.2 T. b. gambiense, CNS involvement'''
-::* Adult
-:::* Preferred regimen: [[Eflornithine]] 400 mg/kg/day in 4 doses for 14 days
-::* Pediatric
-:::* Preferred regimen: [[Eflornithine]] 400 mg/kg/day in 4 doses for 14 days
-:::*  Note (1): [[Eflornithine]] should be used during pregnancy and lactation, only if the potential benefit justifies the potential risk
-:::*  Note (2): The safety of [[Eflornithine]] in children has not been established. Eflornithine is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. [[Eflornithine]] is listed for the treatment of 1st stage African trypanosomiasis inTrypanosoma brucei gambiense infection on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
-{{PBI|American trypanosomiasis}}
+:::::::* 3.2.5.1.3.3 '''Term newborn infant'''
-*Chagas disease
-::* 1.Preferred regimen(1):Benznidazole  < 12 years5-7.5 mg/kg per day orally in 2 divided doses for 60 days
-years or older5-7 mg/kg per day orally in 2 divided doses for 60 days
-::* 2.Preferred regimen(2): Nifurtimox ≤ 10 years15-20 mg/kg per day orally in 3 or 4 divided doses for 90 days
--16 years12.5-15 mg/kg per day orally in 3 or 4 divided doses for 90 days
-years or older8-10 mg/kg per day orally in 3 or 4 divided doses for 90 days
-:::*Note: In the United States, nifurtimox and benznidazole are not FDA approved and are available only from CDC under investigational protocols.
+::::::::* '''For < 1 week of age'''
-====Parasites – Intestinal Nematodes (Roundworms)====
+:::::::::* Preferred regimen (1): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 weeks
-{{PBI|Ascaris lumbricoides}}
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day IV divided q8h for 2–3 weeks
-::* Preferred regimen: [[Albendazole]] 400 mg PO single dose {{or}} [[Mebendazole]] 500 mg PO single dose or 100 mg twice daily for 3 days<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
-:::*Note: [[Albendazole]] dose for children of 1-2 years is 200mg instead of 400mg.
-::* Alternative regimen (1): [[Ivermectin]] 150 to 200 µg/kg PO once<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
-::* Alternative regimen (2): [[Nitazoxanide]] 500mg bid for 3 days. <ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117  }} </ref>
-::* Alternative regimen (3): [[Levamisole]] 150 mg PO once. Pediatric dose: 2.5mg/kg once. <ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
-::* Alternative regimen (4): [[Pyrantel]] Pamoate 11mg/kg single dose PO - maximum 1.0g.<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
-::* Alternative regimen (5): [[Piperazine citrate]] 75mg/kg qd for 2 days - maximum 3.5g.<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
-{{PBI|Capillaria philippinensis}}
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV divided q12h for 2–3 weeks
-::* '''1. Intestinal capillariasis'''<ref>{{Cite journal| issn = 0893-8512| volume = 5| issue = 2| pages = 120–129| last = Cross| first = J. H.| title = Intestinal capillariasis| journal = Clinical Microbiology Reviews| date = 1992-04| pmid = 1576584| pmc = PMC358231}}</ref><ref>{{Cite journal| doi = 10.4269/ajtmh.2012.11-0321| issn = 1476-1645| volume = 86| issue = 1| pages = 126–133| last1 = Attia| first1 = Rasha A. H.| last2 = Tolba| first2 = Mohammed E. M.| last3 = Yones| first3 = Doaa A.| last4 = Bakir| first4 = Hanaa Y.| last5 = Eldeek| first5 = Hanan E. M.| last6 = Kamel| first6 = Shereef| title = Capillaria philippinensis in Upper Egypt: has it become endemic?| journal = The American Journal of Tropical Medicine and Hygiene| date = 2012-01| pmid = 22232463| pmc = PMC3247121}}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: [[Albendazole]] 400 mg/day PO for 10-30 days.
-:::* Alternative regimen: [[Mebendazole]] 200 mg PO bid for 20-30 days.
-{{PBI|Enterobius vermicularis}}
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 25 mg/kg/day IV q24h for 2–3 weeks
-::* Preferred regimen (1): [[Albendazole]] 400 mg PO single dose - repeat in 2 weeks.<ref name="pmid3130234">{{cite journal| author=Wang BR, Wang HC, Li LW, Zhang XL, Yue JQ, Wang GX et al.| title=Comparative efficacy of thienpydin, pyrantel pamoate, mebendazole and albendazole in treating ascariasis and enterobiasis. | journal=Chin Med J (Engl) | year= 1987 | volume= 100 | issue= 11 | pages= 928-30 | pmid=3130234 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3130234  }} </ref>
-::* Preferred regimen (2): [[Mebendazole]] 100 mg PO single dose - repeat in 2 weeks.
-::* Alternative regimen (1): [[Ivermectin]] 200 µg/kg PO single dose - repeat in 10 days<ref name="pmid15344847">{{cite journal| author=Heukelbach J, Wilcke T, Winter B, Sales de Oliveira FA, Sabóia Moura RC, Harms G et al.| title=Efficacy of ivermectin in a patient population concomitantly infected with intestinal helminths and ectoparasites. | journal=Arzneimittelforschung | year= 2004 | volume= 54 | issue= 7 | pages= 416-21 | pmid=15344847 | doi=10.1055/s-0031-1296993 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15344847  }} </ref>
-::* Alternative regimen (2): [[Pyrantel pamoate]] 11 mg/kg up to 1.0g PO single dose - repeat in 2 weeks. <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-{{PBI|Necator americanus}}
+::::::::* '''For 1–4 week of age'''
-::* Preferred regimen: [[Albendazole]] 400 mg PO single dose.<ref name="pmid18430913">{{cite journal| author=Keiser J, Utzinger J| title=Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. | journal=JAMA | year= 2008 | volume= 299 | issue= 16 | pages= 1937-48 | pmid=18430913 | doi=10.1001/jama.299.16.1937 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18430913  }} </ref>
-::* Alternative regimen (1): [[Mebendazole]] 100 mg PO twice daily or 500 mg daily for 3 days.
-::* Alternative regimen (2): [[Pyrantel pamoate]] 11 mg/kg PO per day (maximum 1 g/day) for 3 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-{{PBI|Ancylostoma duodenale}}
+:::::::::* Preferred regimen (1): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 weeks
-::* Preferred regimen: [[Albendazole]] 400 mg PO single dose.<ref name="pmid18430913">{{cite journal| author=Keiser J, Utzinger J| title=Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. | journal=JAMA | year= 2008 | volume= 299 | issue= 16 | pages= 1937-48 | pmid=18430913 | doi=10.1001/jama.299.16.1937 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18430913  }} </ref>
-::* Alternative regimen (1): [[Mebendazole]] 100 mg PO twice daily or 500 mg daily for 3 days.
-::* Alternative regimen (2): [[Pyrantel pamoate]] 11 mg/kg PO per day (maximum 1 g/day) for 3 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-{{PBI|Strongyloides stercoralis}}
+:::::::::* Preferred regimen (2): [[Clindamycin]] 20 mg/kg/day IV divided q6h for 2–3 weeks
-::* Preferred regimen: [[Ivermectin]] 200 mcg/kg/day PO for 2 days or two doses 2 weeks apart from each other.<ref>{{Cite web | title = WGO Practice Guideline Management of Strongyloidiasis| url = http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/15_management_strongyloidiasis_en.pdf}}</ref>
-::* Alternative regimen: [[Albendazole]]400mg PO bid for 3-7 days.<ref name="pmid8483992">{{cite journal| author=Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR| title=Albendazole is effective treatment for chronic strongyloidiasis. | journal=Q J Med | year= 1993 | volume= 86 | issue= 3 | pages= 191-5 | pmid=8483992 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8483992  }} </ref>
-{{PBI|Trichuris trichiura}}
+:::::::::* Preferred regimen (3): [[Rifampin]] 20 mg/kg/day IV divided q12h for 2–3 weeks
-::* Preferred regimen: [[Albendazole]] 400 mg qd PO for 3 days.
-::* Alternatie regimen (1): [[Mebendazole]] 100 mg PO twice a day for 3 days.
-::* Alternative regimen (2): [[Ivermectin]] 200 mcg/kg/day PO for 3 days.<ref>{{Cite web | title = Parasites - Trichuriasis| url = http://www.cdc.gov/parasites/whipworm/health_professionals/index.html#tx}}</ref>
-====Parasites – Extraintestinal Nematodes (Roundworms)====
+:::::::::* Preferred regimen (4): [[Chloramphenicol]] 50 mg/kg/day IV q12h for 2–3 weeks
-{{PBI|Ancylostoma braziliense}}
-::* Preferred regimen<ref>{{Cite web | title = Parasites - Zoonotic Hookworm | url = http://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html}}</ref>
-:::* Adult: [[Albendazole]] 400 mg per day PO for 3 to 7 days
-:::* Pediatric: [[Albendazole]] > 2 years 400 mg per day PO for 3 days
-:::* Note: This drug is contraindicated in children younger than 2 years age.
-::* Alternative regimen<ref>{{Cite web | title = Parasites - Zoonotic Hookworm | url = http://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html}}</ref>
-:::* Adult: [[Ivermectin]] 200 mcg/kg PO once daily for one or two days.
-:::* Pediatric: [[Ivermectin]] >15 kg give 200 mcg/kg single dose
-{{PBI|Angiostrongylus cantonensis}}
+:::::::::* Note :Duration of therapy for 2–3 weeks, until clinical criteria for stability are met. Will require prophylaxis to complete an antibiotic course of upto 60 days from onset of illness.
-:*Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60mg daily for 2 weeks) and analgesics<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:*Note: [[Albendazole]] and [[Mebendazole]] are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.<ref name="pmid19706911">{{cite journal| author=Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y| title=Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis. | journal=Am J Trop Med Hyg | year= 2009 | volume= 81 | issue= 3 | pages= 443-5 | pmid=19706911 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19706911  }} </ref>
-{{PBI|Filariasis}}
+:::::* 3.2.5.2 '''Therapy for severe anthrax when meningitis can be ruled out'''
-:* '''Filariasis'''
-::* 1. '''Lymphatic filariasis- Wuchereria bancrofti, Brugia malayi Brugia timori'''
-::* 2. '''Cutaneous filariasis- Onchocercia volvulus, Loa loa'''
+::::::* 3.2.5.2.1 '''A bactericidal antimicrobial'''
+:::::::* 3.2.5.2.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-{{PBI|Onchocerciasis}}
+::::::::* 3.2.5.2.1.1.1 '''For 32–34 weeks gestational age'''
-:* '''Onchoceria volvulus cutaneous filariasis (river blindness) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred regimen: [[Ivermectin]] Single dose of 150mcg/kg po; repeat every 6-12 months until asymptomatic.
+:::::::::* '''For < 1 week of age'''
-::* Alternative regimen: If [[Ivermectin]] fails, consider [[Suramin]].
-::: Note (1): Onchocercia and  Loa loa may both be present. Check peripheral smear; if Loa loa microfilaria present, treat onchocercia first with [[Ivermectin]] before [[Diethylcarbamazine]] (DEC) for Loa loa.
-::: Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.
-::: Note (3): Do not use [[Diethylcarbamazine]] (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.
+::::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day IV divided q12h for 2-3 weeks
-::* '''Treatment of endosymbiont Wolbachia (bacteria)''' may help clear infection
-:::* Preferred regimen: [[Doxycycline]] 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.
-{{PBI|Loiasis}}
-:* '''Loa loa cutaneous filariasis (eyeworm disease) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::::::::::* Preferred regimen (2): [[Meropenem]] 40 mg/kg/day IV divided q8h for 2-3 weeks
-::* Preferred regimen: [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-21, 8-10mg/kg/day in 3 divided dose
+::::::::::* Preferred regimen (3): [[Imipenem]] 40 mg/kg/day IV divided q12h for 2-3 weeks
-::* Alternative regimen: [[Albendazole]] 200mg po bid for 21 days
+:::::::::* '''For 1–4 week of age'''
-::: Note: If concomitant onchocercia Loa loa, treat oncho first. Ifover 5,000 microfilaria/mL of blood, [[Diethylcarbamazine]] (DEC) can cause encephalopathy. Might start with albendazole for few days with or without steroids, then [[Diethylcarbamazine]] (DEC).
+::::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day IV divided q12h for 2-3 weeks
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
+::::::::::* Preferred regimen (3): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2-3 weeks
-{{PBI|Wuchereria bancrofti}}
+::::::::* 3.2.5.2.1.1.2 '''For 34–37 week gestational age'''
-:* '''Wuchereria bancrofti lymphatic filariasis (elephantiasis) treatment'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* Preferred regimen (1): Scaled dose [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. ([[Diethylcarbamazine]](DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).
+:::::::::* '''For < 1 week of age'''
-::: Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.
+::::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day IV divided q12h for 2-3 weeks
-::* Preferred regimen (2):  [[Albendazole]] 400 mg PO single dose regimen {{and}} ([[Ivermectin]] 200 mcg/kg PO {{or}} [[Diethylcarbamazine]] 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.
-::: Note (1): Most symptoms with Wuchereria bancrofti  are due to the adultworm.
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
-::: Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.
+::::::::::* Preferred regimen (3): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2-3 weeks
-::: Note (3): Do not use [[Diethylcarbamazine]] (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.
+:::::::::* '''For 1–4 week of age'''
-::: Note (4): Skin snip technique is  skin snips can be obtained using a corneal  scleral punch, or more simply a scalpel and needle. The sample must be allowed to incubate for 30 minutes to 2 hrs in saline or culture medium, and then examined for microfilariae that would have migrated from the tissue to the liquid phase of the specimen.
-::: Note (5): Site of infection
+::::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day IV divided q12h for 2-3 weeks
-:::: 5.1 General: filarial fever includes fever, chills, malaise during acute or recurrent episode.
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
-:::: 5.2 Lymph:localized lymphadenitis, may be painful(red,warm) or painless, unilateral or bilateral groin swelling. May be due to adult worm or complicating bacterial infection.
+::::::::::* Preferred regimen (3): [[Imipenem]] 75 mg/kg/day IV divided q8h for 2-3 weeks
-:::: 5.3 Derm:pruritus,dermatitis,subcutaneous nodules.
+::::::::* 3.2.5.2.1.1.3 '''Term Newborn Infant'''
-:::: 5.4 Genital:scrotal or vulvar swelling/ hydrocele; may be able to visualize adult W.bancrofti worm by ultrasound.
+:::::::::* '''For < 1 week of age'''
-:::: 5.5 Extremities:unilateral or bilateral swelling, acute or chronic. May be extreme (classic elephantiasis) or mild. May be associated with recurrent bacterial cellulitis (abrupt onset of redness ,fever).
+::::::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day IV divided q12h for 2-3 weeks
-:::: 5.6 Lungs:tropical pulmonary eosinophilia (miliary pattern on CXR, nocturnal paroxysmal cough, wheezing, accompanied by marked eosinophilia, responds to DEC, usually amicrofilaremic).
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
-:::: 5.7 Renal: chyluria, hematuria (rupture of dilated lymphatics into urinary excretory system). May see weightloss, hypoproteinemia, lymphopenia, anemia.
+::::::::::* Preferred regimen (3): [[Imipenem]] 50 mg/kg/day IV divided q12h for 2-3 weeks
-:::: 5.8 Musculoskeletal:acute monoarthritis (knee>ankle) which responds to DEC, tenosynovitis (rare), thrombophlebitis (rare).
+:::::::::* '''For 1–4 week of age'''
-::: Note (6)
+::::::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day IV divided q12h for 2-3 weeks
-:::: Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);
+::::::::::* Preferred regimen (2): [[Meropenem]] 60 mg/kg/day IV divided q8h for 2-3 weeks
-:::: Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.
+::::::::::* Preferred regimen (3): [[Imipenem]] 75 mg/kg/day IV divided q8h for 2-3 weeks
-:::: Diagnosis 3.skin snips  (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.
+:::::::::::* [[Vancomycin]] IV (dosing based on serum creatinine for infants of 32 wk gestational age). Follow vancomycin serum concentrations to modify dose.
-::* '''Treatment of endosymbiont Wolbachia (bacteria)''' may help clear infection
+::::::::::::* If  Serum creatinine < 0.7 then [[Vancomycin]] 15 mg/kg/dose IV q12h for 2-3 weeks
-:::* Preferred regimen: [[Doxycycline]] 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.
+::::::::::::* If Serum creatinine 0.7 -0.9 then [[Vancomycin]] 20 mg/kg/dose IV q24h for 2-3 weeks
-{{PBI|Brugia malayi}}
+::::::::::::* If Serum creatinine 1–1.2 then [[Vancomycin]] 15 mg/kg/dose IV q24h for 2-3 weeks
-:* '''Brugia malayi, Brugia timori lymphatic filariasis (elephantiasis) treatment'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::::::::::::* If Serum creatinine 1.3–1.6 then [[Vancomycin]] 10 mg/kg/dose IV q24h for 2-3 weeks
-::* Preferred regimen (1): Scaled dose [[Diethylcarbamazine]] (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. ([[Diethylcarbamazine]](DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).
+::::::::::::* If Serum creatinine > 1.6 then [[Vancomycin]] mg/kg/dose IV q48h for 2-3 weeks
-::: Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.
+::::::::::* Note: Begin treatment with a 20 mg/kg loading dose {{or}}
-::* Preferred regimen (2):  [[Albendazole]] 400 mg PO single dose regimen {{and}} ([[Ivermectin]] 200 mcg/kg PO {{or}} [[Diethylcarbamazine]] 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.
-::: Note
+:::::::* 3.2.5.2.1.2 '''Alternatives for penicillin-susceptible strains'''
-:::: Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);
+::::::::* 3.2.5.2.1.2.1 '''For 32–34 weeks gestational age'''
-:::: Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.
+:::::::::* '''For < 1 week of age'''
-:::: Diagnosis 3.skin snips  (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.
+::::::::::* Alternative regimen (1): [[Penicillin G]] 200000 U/kg/day IV divided q12h for 2-3 weeks
-{{PBI|Gnathostoma spinigerum}}
+::::::::::* Alternative regimen (2): [[Ampicillin]] 100 mg/kg/day IV divided q12h for 2-3 weeks
-:*'''Eosinophilic Meningitis'''
-:**Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.<ref name="pmid19123863">{{cite journal| author=Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J et al.| title=Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 3 | pages= 322-7 | pmid=19123863 | doi=10.1086/595852 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19123863  }} </ref>
-:*'''Cutaneous disease:'''
-::*Preferred regimen: [[Albendazole]] 400 mg bid for 21 days {{or}} [[Ivermectin]] 200 mcg/kg once daily for 2 days<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
-::*Alternative regimen: [[Albendazole]] 400 mg daily for 21 days {{or}} [[Ivermectin]] 200 mcg/kg once daily for 1 day<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
-{{PBI|Toxocariasis}}
+:::::::::* '''For 1–4 week of age'''
-:*'''1.1.Visceral toxocariasis'''<ref>{{Cite web | title = Parasites - Toxocariasis| url = http://www.cdc.gov/parasites/toxocariasis/health_professionals/index.html}}</ref>
-::*Preferred regimen: [[Albendazole]] 400 mg PO bid for five days (both adult and pediatric dosage)
-::*Alternative regimen: [[Mebendazole]] 100-200 mg PO bid for five days (both adult and pediatric dosage)
-:*'''1.2.Ocular toxocariasis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-::*Preferred regimen: First 4 weeks of illness ([[Prednisone]] 30-60mg PO q24h {{and}} subtenon triamcinolone 40mg/week) for 2 weeks
-{{PBI|Trichinella spiralis}}
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 U/kg/day IV divided q8h for 2-3 weeks
-::* Preferred regimen: [[Albendazole]] 400 mg PO bid for 8 to 14 days {{or}} [[Mebendazole]] 200 to 400 mg PO tid for 3 days, then 400 to 500 mg PO tid for 10 days<ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref>
-::* Note(1): Albendazole and Mebendazole are contraindicated during pregnancy and not recommended in children aged 2 years.
-::* Note(2): Prednisone administered at a dose of 30 mg/day to 60 mg/day for 10 to 15 days for severe symptoms
-====Parasites – Trematodes (Flukes)====
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q8h for 2-3 weeks
-{{PBI|Clonorchis sinensis}}
-:*Preferred regimen: [[Praziquantel]] 75mg/kg/day PO tid for 2 days<ref>{{Cite web | title =Clonorchis | url = http://www.cdc.gov/parasites/clonorchis/health_professionals/index.html}}</ref>
-:*Alternative regimen (1): [[Albendazole]] 10mg/kg/day PO for 7 days<ref>{{Cite web | title =Clonorchis | url = http://www.cdc.gov/parasites/clonorchis/health_professionals/index.html}}</ref>
-:*Alternative regimen (2): [[Mebendazole]] 30mg/kg for 20 t0 30 days<ref name="pmid7344109">{{cite journal| author=Jaroonvesama N, Charoenlarp K, Cross JH| title=Treatment of Opisthorchis viverrini with mebendazole. | journal=Southeast Asian J Trop Med Public Health | year= 1981 | volume= 12 | issue= 4 | pages= 595-7 | pmid=7344109 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7344109  }} </ref>
-:*Note: Urgent biliary decompression might be required for patients with acute cholangitis.
-{{PBI|Dicrocoelium dendriticum}}
+::::::::* 3.2.5.2.1.2.2 '''For 34–37 week gestational age'''
-:*Preferred regimen: [[Praziquantel]] 25 mg/kg tid PO for 2 days<ref>{{Cite web | title =Dicrocoeliasis| url =http://www.cdc.gov/dpdx/dicrocoeliasis/tx.html }}</ref>
-::*Note: [[Praziquantel]] is not approved for treatment of children less than 4 years old.<ref>{{Cite web | title =Dicrocoeliasis| url =http://www.cdc.gov/dpdx/dicrocoeliasis/tx.html }}</ref>
-:*Alternative regimen (1): [[Myrrh]] (commiphora molmol) 12 mg/kg/day PO for 6 days.<ref name="pmid17418062">{{cite journal| author=Rana SS, Bhasin DK, Nanda M, Singh K| title=Parasitic infestations of the biliary tract. | journal=Curr Gastroenterol Rep | year= 2007 | volume= 9 | issue= 2 | pages= 156-64 | pmid=17418062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17418062  }} </ref>
-:*Alternative regimen (2): [[Triclabendazole]] 10 mg/kg PO single dose.<ref name="pmid17418062">{{cite journal| author=Rana SS, Bhasin DK, Nanda M, Singh K| title=Parasitic infestations of the biliary tract. | journal=Curr Gastroenterol Rep | year= 2007 | volume= 9 | issue= 2 | pages= 156-64 | pmid=17418062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17418062  }} </ref>
-{{PBI|Fasciola hepatica}}
+:::::::::* '''For < 1 week of age'''
-:*Preferred regimen: [[Triclabendazole]] 10 mg/kg PO one dose<ref>{{Cite web | title =Parasites - Fascioliasis| url = http://www.cdc.gov/parasites/fasciola/health_professionals/}}</ref>
-:*Note: Two-dose (double-dose) triclabendazole therapy can be given to patients who have severe or heavy Fasciola infections (many parasites) or who did not respond to single-dose therapy.
-:*Alternative regimen: [[Nitazoxanide]] PO 500mg bid for 7 days.<ref name="pmid12534412">{{cite journal| author=Favennec L, Jave Ortiz J, Gargala G, Lopez Chegne N, Ayoub A, Rossignol JF| title=Double-blind, randomized, placebo-controlled study of nitazoxanide in the treatment of fascioliasis in adults and children from northern Peru. | journal=Aliment Pharmacol Ther | year= 2003 | volume= 17 | issue= 2 | pages= 265-70 | pmid=12534412 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12534412  }} </ref>
-{{PBI|Paragonimus westermani}}
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 U/kg/day IV divided q8h for 2-3 weeks
-:*Preferred regimen (1): [[Praziquantel]] 25 mg/kg tid PO for 3 days<ref>{{Cite web | title =Parasites - Paragonimiasis| url =http://www.cdc.gov/parasites/paragonimus/health_professionals/index.html }}</ref>
-:*Preferred regimen (2): [[Triclabendazole]] PO 10 mg/kg qd or bid.
-:*Alternative regimen (1): [[Bithinol]] 30-50mg/kg on alternate days for 10-15 doses.
-:*Alternative regimen (2): [[Niclosamide]] 2mg/kg PO single dose.
-{{PBI|Schistosomiasis}}
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q8h for 2-3 weeks
-:*'''1. Schistosoma mansoni, S. haematobium, S. intercalatum'''
-::*Preferred regimen: [[Praziquantel]] 40 mg/kg per day PO in two divided doses for one day<ref>{{Cite web | title = Parasites - Schistosomiasis
-| url = http://www.wikidoc.org/index.php?title=Schistosomiasis_medical_therapy&action=edit&section=3}}</ref>
-:*'''<font color="#000000">2. </font>S. japonicum, S. mekongi'''
-::*Preferred regimen: [[Praziquantel]] 60 mg/kg per day PO in three divided doses for one day<ref>{{Cite web | title = Parasites - Schistosomiasis
-| url = http://www.wikidoc.org/index.php?title=Schistosomiasis_medical_therapy&action=edit&section=3}}</ref>
-====Parasites – Cestodes (Tapeworms)====
+:::::::::* '''For 1–4 week of age'''
-{{PBI|Echinococcus}}
+::::::::::* Alternative regimen (1): [[Penicillin G]] 400000 U/kg/day IV divided q6h for 2-3 weeks
+::::::::::* Alternative regimen (2): [[Ampicillin]] 200 mg/kg/day IV divided q6h for 2-3 weeks
-:* 1.1 '''Echinococcus granulosus (hydatid disease) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::::::::* 3.2.5.2.1.2.3 '''Term newborn infant'''
-::* Preferred regimen: Percutaneous aspiration-injection-reaspiration (PAIR) and [[Albendazole]].Before & after drainage:[[Albendazole]] ≥60 kg, 400 mg PO bid or <60 kg, 15 mg/kg per day divided bid, with meals. Then: Puncture (P) & needle aspirate (A) cyst content. Instill (I) hypertonic saline (15–30%) or absolute alcohol, wait 20–30 min, then re-aspirate (R) with final irrigation.
-::: Note: Continue [[Albendazole]] for 28 days Cure in 96% as comp to 90% patients with surgical resection
-:* 1.2 '''Echinococcus multilocularis (alveolar cyst disease) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+:::::::::* '''For < 1 week of age'''
-::* Preferred regimen: [[Albendazole]] ≥60 kg, 400 mg PO bid or <60 kg, 15 mg/kg per day divided bid, with meals.
-::: Note (1): [[Albendazole]] efficacy not clearly demonstrated, can try in dosages used for hydatid disease.
+::::::::::* Alternative regimen (1): [[Penicillin G]] 300000 U/kg/day IV divided q8h for 2-3 weeks
-::: Note (2): Wide surgical resection only reliable treatment; technique evolving.
-{{PBI|Neurocysticercosis}}
+::::::::::* Alternative regimen (2): [[Ampicillin]] 150 mg/kg/day IV divided q8h for 2-3 weeks
-:* '''Neurocysticercosis treatment''' (NCC)<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* 1. '''Larval form of Taenia solium'''
+:::::::::* '''For 1–4 week of age'''
-:::* Preferred regimen: Treat Taenia solium intestinal tapeworms, if present, with [[Praziquante]] l5-10 mg/kg PO for 1 dose for children & adults.
+::::::::::* Alternative regimen (1): [[Penicillin G]] 400000 U/kg/day IV divided q6h for 2-3 weeks
-::* 2. '''Parenchymal neurocysticercosis'''
-:::* Preferred regimen: Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days
+::::::::::* Alternative regimen (2):[[Ampicillin]] 200 mg/kg/day IV divided q6h for 2-3 weeks
-:::: Note : “Viable” cysts by CT/MRI Meta-analysis: treatment associated with cyst resolution, decreased seizures, and decreased seizure recurrence.
+::::::* 3.2.5.2.2 '''A protein synthesis inhibitor'''
-:::* Alternative regimen: ([[Praziquantel]] 100 mg/kg per day in 3 div. doses PO for 1 day, then 50 mg/kg/d in 3 doses and [[Dexamethasone]} {{and}}[[Dexamethasone]] 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.
+:::::::* 3.2.5.2.2.1 '''For 32–34 weeks gestational age'''
-:::: Note (1): [[Albendazole]] associated with 46% decrease in seizures.
+::::::::* '''For < 1 week of age'''
-:::: Note (2): [[Praziquantel]] less cysticidal activity.
+:::::::::* Preferred regimen (1): [[Clindamycin]] 10 mg/kg/day IV divided q12h for 2–3 wks
-:::: Note (3): Steroids decrease serum levels of [[Praziquantel].
+:::::::::* Preferred regimen (2): [[Linezolid]] 20 mg/kg/day IV divided q12h for 2–3 wks
-:::: Note (4): NIH reports [[Methotrexate]] at 20 mg/wk allows a reduction in steroid use.
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
-::* 3. '''Degenerating cysts'''
+::::::::* '''For 1–4 week of age'''
-:::* Preferred regimen: Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days
+:::::::::* Preferred regimen (1): [[Clindamycin]] 15 mg/kg/day IV divided q8h for 2–3 wks
-:::: Note (1): Treatment improves prognosis of associated seizures.
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
-:::: Note (2): For '''dead calcified cysts''', no treatment indicated
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
-::* 4. '''Subarachnoid neurocysticercosis'''
-:::* Preferred regimen: (Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days) {{and}} shunting for hydrocephalus.
+:::::::* 3.2.5.2.2.2 '''For 34–37 week gestational age'''
-:::: Note:  Without shunt, 50% died within 9 years.
+::::::::* '''For < 1 week of age'''
-::* 5. '''Intraventricular neurocysticercosis'''
+:::::::::* Preferred regimen (1): [[Clindamycin]]  15 mg/kg/day IV divided q8h for 2–3 wks
-:::* Preferred regimen: (Patients body weight of ≥60 kg,[[Albendazole]] 400mg bid with meals or Patients body weight of 60 kg, [[Albendazole]] 15 mg/kg per day in 2 divided doses (max. 800 mg/day) {{and}} [[Dexamethasone]] 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days) {{and}} perhaps neuroendoscopic removal if obstruction of CSF circulation.
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
-{{PBI|Sparganosis}}
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
-:* '''Sparganosis (Spirometra mansonoides) treatment''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred treatment: Surgical resection or ethanol injection of subcutaneous masses
+::::::::* '''For 1–4 week of age'''
-::: Note: Source for Spirometra mansonoides larval cysts is frogs or snakes
+:::::::::* Preferred regimen (1): [[Clindamycin]] 20 mg/kg/day IV divided q6h for 2–3 wks
-====Parasites – Ectoparasites====
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
-{{PBI|Body lice}}
+:::::::::* Preferred regimen (3): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
-:* '''Body lice'''
-::* '''Pediculus humanus, corporis treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+:::::::* 3.2.5.2.2.3 '''Term newborn infant'''
-:::* Preferred regimen (1): Success with [[Ivermectin]] in home shelter with 12 mg PO on days 0, 7, & 14
+::::::::* For 0–1 week of age :
-:::* Preferred regimen (2): Treat clothing with 1% [[Malathion]] powder {{or}} 0.5% [[Permethrin]] powder.
+:::::::::* Preferred regimen (1): [[Clindamycin]] 15 mg/kg/day  IV divided q8h for 2–3 wks
-:::: Note (1): No drugs for the patient.
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
-:::: Note (2): Organism lives in and deposits eggs in seams of clothing. Discard clothing; if not possible treat clothes with 1% [[Malathion]] powder {{or}} 0.5% [[Permethrin]] powder.
+:::::::::* Preferred regimen (3): [[Doxycycline]] 4.4 mg/kg/day IV divided q12h, (loading dose 4.4 mg/kg) for 2–3 wks
-{{PBI|Head lice}}
+:::::::::* Preferred regimen (4): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
-:* '''Head lice'''
-::* '''Pediculus humanus, capitis treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-:::* Preferred regimen: [[Permethrin]] 1% lotion apply to shampooed dried hair for 10 min.; repeat in 9-10 days {{or}} [[Malathion]] 0.5% lotion (Ovide) apply to dry hair for 8–12hrs, then shampoo. 2 doses 7-9 days apart.
+::::::::* For 1–4 week of age :
-:::* Alternative regimen: [[Ivermectin]] 200 μg/kg PO once; 3 doses at 7 day intervals reported effective. [[Malathion]] 0.5% lotion report that 1–2 20-minutes applications 98% effective.
+:::::::::* Preferred regimen (1): [[Clindamycin]] 20 mg/kg/day IV divided q6h for 2–3 wks
-::: Note (1):[[Malathion]] in alcohol is potentially flammable.
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day IV divided q8h for 2–3 wks
-::: Note (2): [[Permethrin]] success in 78%.
+:::::::::* Preferred regimen (3): [[Doxycycline]] 4.4 mg/kg/day IV divided q12h, (loading dose 4.4 mg/kg) for 2–3 wks
-::: Note (3): Extra combing of no benefit.
+:::::::::* Preferred regimen (4): [[Rifampin]] 10 mg/kg/day IV q24h for 2–3 wks
-::: Note (4): Resistance increasing.No advantage to 5% permethrin.
+:::::::::* Note: Duration of therapy for 2–3 wks, until clinical criteria for stability are met (see text). Will require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness
-{{PBI|Pubic lice}}
+:::::* 3.2.5.3 '''Oral follow-up combination therapy for severe anthrax'''
-:* '''Pubic lice'''
-::* '''Phthirus pubis treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::::::* 3.2.5.3.1 '''A bactericidal antimicrobial'''
-:::* Preferred regimen: Pubic hair with [[Permethrin]] 1% lotion {{or}} [[Malathion]] 0.5% lotion as for head lice
+:::::::* 3.2.5.3.1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-:::* Alternative regimen: For eyelids apply Petroleum jelly qid for 10 days {{or}} Yellow oxide of mercury 1% qid for 14 days.
+::::::::* 3.2.5.3.1.1.1 '''For 32–34 weeks gestational age'''
-{{PBI|Myiasis}}
+:::::::::* '''For < 1 week of age'''
-:*Preferred regimen: No medications approved by the FDA are available for treatment<ref>{{Cite web | title =Parasites - Myiasis | url =http://www.cdc.gov/parasites/myiasis/health_professionals/index.html }}</ref>
-:*Note: Fly larvae need to be surgically removed.
-::* '''Fly larvae treatment''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::::::::::* Preferred regimen: [[Ciprofloxacin]] 20 mg/kg/day PO bid
-::* Preferred treatment (1): Occlude punctum to prevent gas exchange with petrolatum, fingernail polish, makeup cream or bacon.
+::::::::::* '''For 1–4 week of age'''
-::* Preferred treatment (2): When larva migrates, manually remove.
+::::::::::* Preferred regimen: [[Ciprofloxacin]] 20 mg/kg/day PO bid
-:::: Note (1): Myiasis is due to larvae of flies
+::::::::* 3.2.5.3.1.1.2 '''For 34–37 week gestational age'''
-:::: Note (2): Usually cutaneous/subcutaneous nodule with central punctum.
+:::::::::*  '''For < 1 week of age'''
-{{PBI|Scabies}}
+::::::::::* Preferred regimen: [[Ciprofloxacin]] 20 mg/kg/day PO bid
-:* '''Scabies'''
-::* '''Sarcoptes scabiei treatment''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+:::::::::* '''For 1–4 week of age'''
-:::* 1. '''Immunocompetent patisent'''
+::::::::::* Preferred regimen: [[Ciprofloxacin]] 20 mg/kg/day PO bid
-::::* Preferred regimen: (Primary) [[Permethrin]] 5% cream (ELIMITE).
+::::::::* 3.2.5.3.1.1.3 '''Term newborn infant'''
-::::: Note (1): Apply entire skin from chin down to and including toes with [[Permethrin]] 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.
+:::::::::* '''For < 1 week of age'''
-::::: Note (2): Safe for children >2 months old.
+::::::::::* Preferred regimen: [[Ciprofloxacin]] 30 mg/kg/day PO bid
-::::* Alternative regimen: [[Ivermectin]] 200 μg/kg PO once. As above, second dose if persistent symptoms.
+:::::::::* '''For 1–4 week of age'''
-::::: Note (1): Trim fingernails.
+::::::::::* Preferred regimen: [[Ciprofloxacin]] 30 mg/kg/day PO bid {{or}}
-::::: Note (2): Reapply to hands after hand washing.
+:::::::* 3.2.5.3.1.2 '''Alternatives for penicillin-susceptible strains'''
-::::: Note (3): Pruritus may persist times 2 weeks after mites gone.
+::::::::* 3.2.5.3.1.2.1 '''For 32–34 weeks gestational age'''
-::::* Alternative regimen (2): Less effective is [[Crotamiton]] 10% cream, apply for 24 hours, rinse off, then reapply for 24 hours.
+:::::::::* '''For < 1 week of age'''
-:::* 2. '''AIDS patients (CD4 <150 per mm3), debilitated or developmentally disabled patients '''
+::::::::::* Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day PO bid
-:::: * preferred regimen (for Norwegian scabies) : [[Permethrin]] 5% cream-2 or more applications a week apart may be needed. After each [[Permethrin]] dose (days 2-7) apply 6% [[Sulfur]] in petrolatum.
+::::::::::* Alternative regimen (2): Penicillin VK  50 mg/kg/day PO bid
-::::: Note: Apply entire skin from chin down to and including toes with [[Permethrin]] 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.
+:::::::::* '''For 1–4 week of age'''
-::::* Alternative regimen: [[Ivermectin]] 200 mcg/kg PO once is reported effective; may need 2 or more doses separated by 14 days.
+::::::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO bid
-::::: Note: Norwegian scabies in AIDS patients is extensive, crusted. Can mimic psoriasis and not pruritic but highly contagious—isolate.
+::::::::::* Alternative  regimen (2): Penicillin VK 75 mg/kg/day PO bid
-====Viruses====
+::::::::* 3.2.5.3.1.2.2 '''For 34–37 week gestational age'''
-{{PBI|Adenovirus}}
+:::::::::* '''For < 1 week of age'''
-:* Adenovirus<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* 1. '''In severe cases of pneumonia or post hematopoietic stem cell transplantation'''
-:::* Preferred regimen (1): [[Cidofovir]] 5 mg/kg/week IV for 2 weeks, then q 2 weeks {{and}} [[Probenecid]] 1.25 g/M<sup>2</sup> PO given 3 hours before [[Cidofovir]] and 3 & 9 hours after each infusion
-:::* Preferred regimen (2): [[Cidofovir]] 1 mg/kg IV 3 times per week
+::::::::::* Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day PO bid
-::* 2. '''For hemorrhagic cystitis'''
+::::::::::* Alternative regimen (2): Penicillin VK 50 mg/kg/day PO bid
-:::* Preferred regimen: [[Cidofovir]] (5 mg/kg in 100 mL saline instilled into bladder) intravesical.
-:::: Note (1): Adenovirus is the cause of respiratory tract infections including fatal pneumonia in children and young adults and 60% mortality in transplant patients.
+::::::::* '''For 1–4 week of age'''
-:::: Note (2): Adenovirus  is frequent cause of cystitis in transplant patients.
+:::::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO bid
-:::: Note (3): Adenovirus 14 associated with severe pneumonia in otherwise healthy young adults .Findings include fever, decreases liver enzymes, leukopenia, thrombocytopenia, diarrhea, pneumonia, or hemorrhagic cystitis.
+:::::::::* Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid
-:::: note (4):  [[Cidofovir]] is successful in 3/8 immunosuppressed children and 8 of 10 children with post  Hematopoietic stem cell transplantation. Decrease in virus load predicted response to [[Cidofovir]].
+::::::::* 3.2.5.3.1.2.3 '''Term newborn infant'''
-::* 3. '''Pink eye (viral conjunctivitis)'''
+:::::::::* '''For < 1 week of age'''
-::: Note (1): Usually unilateral Adenovirus (types 3 & 7 in children, 8, 11 & 19 in adults)
+::::::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid
-::: Note (2): No treatment.
+::::::::::* Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid
-::: Note (3): If symptomatic, cold artificial tears may help.
+:::::::::* '''For 1–4 week of age'''
-::: Note (4): Highly contagious.
+::::::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid
+::::::::::* Alternative regimen (2): Penicillin VK 75 mg/kg/day PO tid or qid
-::: Note (5): Onset of ocular pain and photophobia in an adult suggests associated keratitis—rare.
+::::::* 3.2.5.3.2 '''A protein synthesis inhibitor'''
-::* 4.'''Bronchitis'''
+:::::::* 3.2.5.3.2.1 '''For 32–34 weeks gestational age'''
-::: '''Infants/children (≤ age 5)'''
+::::::::* '''For < 1 week of age'''
+:::::::::* Preferred regimen (1): [[Clindamycin]] 10 mg/kg/day PO bid
-:::< Age 2: Adenovirus;
+:::::::::* Preferred regimen (2): [[Linezolid]] 20 mg/kg/day PO bid
-:::: Note:Antibiotics indicated only with associated sinusitis or heavy growth on throat culture for S. pneumo., Group A strep, H. influenzae or no improvement in 1 week. Otherwise treatment is symptomatic.
+::::::::* '''For 1–4 week of age'''
+:::::::::* Preferred regimen (1): [[Clindamycin]] 15 mg/kg/day PO bid
-{{PBI|SARS}}
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day PO bid
-:* '''Severe acute respiratory distress syndrome- coronavirus'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Supportive therapy
-:::* [[Ribavirin]]—ineffective.
-:::* Interferon alfa with or without steroids—small case series.
-:::* Pegylated IFN-α effective in monkeys.
-:::* Low dose [[steroids]] alone successful.
-:::* High dose [[steroids]] increases serious fungal infections.
-:::* Inhaled [[Nitric oxide]] improved oxygenation and improved chest x-ray.
-:::: Note (1): Therapy remains predominantly supportive care.Therapy tried or under evaluation
-:::: Note (2):Transmission by close contact: effective infection control practices (mask [changed frequently], eye protection, gown, gloves) key to stopping transmission.
-:::: Note (3):Other coronaviruses  implicated as cause of croup, asthma exacerbations and other RTIs in children.May be associated with Kawasaki disease.
-----
+:::::::* 3.2.5.3.2.2 '''For 34–37 week gestational age'''
-{{PBI|Cytomegalovirus}}
+::::::::* '''For < 1 week of age'''
-:* '''Cytomegalovirus treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* 1.'''Retinitis'''
+:::::::::* Preferred regimen (1): [[Clindamycin]] 15 mg/kg/day PO tid
-:::* 1.1 '''In HIV-infected adults'''
-::::* Preferred regimen (1): [[Ganciclovir]] IV
-::::* Preferred regimen (2): [[Valganciclovir]] PO
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day PO tid
-::::* Preferred regimen (3): [[Foscarnet]] IV, [[Cidofovir]] IV {{and}} [[Ganciclovir]] intraocular implant coupled with [[Valganciclovir]].
+::::::::* '''For 1–4 week of age'''
-:::* 1.2 '''In HIV-infected infants and children '''
-::::* Initial treatment (induction therapy): [[Ganciclovir]] IV  for acquired CMV disease, including CMV retinitis and other end-organ disseminated CMV disease (e.g., colitis, esophagitis, CNS disease).
-:::: Note (1): Oral [[Valganciclovir]], a prodrug of [[Ganciclovir]], is one of the first-line treatments for HIV infected adults with CMV retinitis and is an option in older children who weigh enough to receive the adult dose and tablet formulation of [[Valganciclovir]]. The drug is well absorbed from the GI tract and rapidly metabolized to [[Ganciclovir]] in the intestine and liver.
-:::: Note (2): [[Valganciclovir]] oral solution has not been studied in pediatric patients for treatment of CMV retinitis, but consideration can be given to its use for transitioning from [[Ganciclovir]] IV to [[Valganciclovir]] oral to complete treatment and or for secondary prophylaxis once improvement in retinitis is noted.
-:::* 1.3 '''An alternative drug for treating CMV disease or for use in [[Ganciclovir]]-resistant CMV infections in HIV infected children''' : [[Foscarnet]].
-:::: Note (1): [[Foscarnet]] used as suppressive therapy has been associated with increased length of survival relative to [[Ganciclovir]] in HIV-infected adults. Doses should be modified in patients with renal insufficiency.
-:::: Note (2): [[Cidofovir]] is effective in treating CMV retinitis in adults who are intolerant of other therapies.
-:::: Note (3): Combination therapy with [[Ganciclovir]] and [[Foscarnet]] delays progression of retinitis in certain patients in whom monotherapy fails and can be used as initial therapy in children with sight-threatening disease.
-:::: Note (4): Combination therapy also has been used for adults with retinitis that has relapsed on single-agent therapy.
-::* 2. '''In Transplant patients'''
+:::::::::* Preferred regimen (1): [[Clindamycin]] 20 mg/kg/day PO qid
-:::* Preferred regimen: [[Valganciclovir]]
-:::: Note (1): Use of [[Valganciclovir]] to prevent infections in CMV seronegative recipients who receive organs from a seropositive donor and in seropositive receivers has been highly effective.
-:::: Note (2): Others suggest preemptive treatment when pt develops CMV antigenemia or positive PCR post-transplant.
-::* 3. '''Colitis, Esophagitis'''
+:::::::::* Preferred regimen (2): [[Linezolid]] 30 mg/kg/day PO tid
-:::* '''Preferred regimen (1)''': [[Valganciclovir]] 900 mg PO q24h.
-:::* '''Preferred regimen (2)''': [[Valganciclovir]] 900 mg PO q12h for 14–21 days, then 900 mg PO q24h for maintenance therapy
-:::* Alternative regimen: [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days ,[[Ganciclovir]] as with retinitis except induction period extended for 3–6 wks (No agreement on use of maintenance; may not be necessary except after relapse. Responses less predictable than for retinitis.), then [[Valganciclovir]] 900 mg PO q24h {{or}} [[Foscarnet]] 60 mg/kg IV q8h or 90 mg/kg IV q12h for 14–21 days, then 90–120 mg/kg IV q24h {{or}} [[Cidofovir]] 5 mg/kg IV for 2wks, then 5 mg/kg every other wk; each dose should be administered with IV saline hydration {{and}} oral probenecid {{or}} repeated intravitreal injections with [[Fomivirsen]] (for relapses only, not as initial therapy)
-:::: Note (1): Diagnosis by biopsy of ulcer base or edge  with demonstration of CMV inclusions and other pathogen.
-:::: Note (2): Switch to oral [[Valganciclovir]] when PO tolerated & when symptoms not severe enough to interfere with absorption.
-:::: Note (3): Antiretroviral therapy is essential in long term suppression.
-::* 4. '''Pneumonia'''
+:::::::* 3.2.5.3.2.3 '''Term newborn infant'''
-:::* Preferred regimen: : [[Valganciclovir]] 900 mg PO q12h for 14–21 days, then 900 mg PO q24h for maintenance therapy
-:::* Alternative regimen for retinitis: [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days, then [[Valganciclovir]] 900 mg PO q24h {{or}} [[Foscarnet]] 60 mg/kg IV q8h or 90 mg/kg IV q12h for 14–21 days, then 90–120 mg/kg IV q24h {{or}} [[Cidofovir]] 5 mg/kg IV for 2wks, then 5 mg/kg every other wk; each dose should be administered with IV saline hydration {{and}} oral probenecid.
-:::: Note (1): CMV pneumonia seen predominantly in transplants (esp. bone marrow), rare in HIV.
-:::: Note (2): Treat only when histological evidence resent in IDS patients and other pathogens not identified.
-:::: Note (3): High rate of CMV reactivation in immunocompetent ICU patients; prolonged hospitalizations and increased mortality.
-:::: Note (4): In bone marrow transplant patients, combination therapy with CMV immune globulin. In bone marrow transplant patients, serial measure of pp65 antigen was useful in establishing early diagnosis of CMV interstitial pneumonia with good results if [[Ganciclovir]] was initiated within 6 days of antigen positivity.
-::* 5. '''Encephalitis, Ventriculitis'''
+::::::::* '''For < 1 week of age'''
-::: Note: Treatment not defined, but should be considered the same as retinitis. Disease may develop while taking [[Ganciclovir]] as suppressive therapy.
-::* 6. '''Lumbosacral polyradiculopathy'''
+:::::::::* Preferred regimen (1): [[Clindamycin]] 15 mg/kg/day PO tid
-:::* Preferred regimen: [[Ganciclovir]], as with retinitis. [[Foscarnet]] 40 mg/kg IV q12h another option.Switch to [[Valganciclovir]] when possible.
-:::: Note (1): Diagnosis by CMV DNA in CSF.
-:::: Note (2): Suppression continued until CD4 remains >100/mm3 for 6 months.
-:::: Note (3): About 50% will respond; survival increases (5.4wks to 14.6wks).
-::* 7. '''Mononeuritis multiplex'''
+:::::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (loading dose 4.4 mg/kg)
-::: Note (1):  Due to vasculitis and may not be responsive to antiviral therapy
+:::::::::* Preferred regimen (3): [[Linezolid]] 30 mg/kg/day PO tid
-::: Note (2): Marked decrease in HIV associated CMV infections & death with Highly Active Antiretroviral Therapy. Initial treatment should optimize HAART.
+::::::::* '''For 1–4 week of age'''
-::: Note (3): Primary prophylaxis not generally recommended. Preemptive therapy in patients with increased in  CMV DNA titers in plasma and CD4 <100/mm3. Recommended by some is  [[Valganciclovir]] 900 mg PO q24h.
+:::::::::* Preferred regimen (1): [[Clindamycin]] 20 mg/kg/day PO qid
-::: Note (4): Risk for developing CMV disease correlates with quantity of CMV DNA in plasma is each log 10. increase associated with 3.1-fold increase in disease.
+:::::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (loading dose 4.4 mg/kg)
+:::::::::* Preferred regimen (3): [[Linezolid]] 30 mg/kg/day PO tid
-::* 8. '''Specific considerations'''
+:::::::::* Note: Duration of therapy to complete a treatment course of 10–14 days or greater. May require prophylaxis to complete an antimicrobial course of upto 60 days from onset of illness.
-::: Note (1): Currently, no therapies are available for the treatment of maternal or fetal CMV infection.
-::: Note (2): Antiviral medications such as [[Ganciclovir]], [[Valganciclovir]] and [[Foscarnet]] are approved by the U.S. Food and Drug Administration (FDA) only for treatment of patients with acquired immunodeficiency syndrome (AIDS) or organ transplants.
-:* '''Prevention'''
+:::::* 3.2.5.4 '''Treatment of cutaneous anthrax without systemic involvement'''
-::* 1. '''Prevention of opportunistic infections in human stem cell transplantation (HSCT) by CMV''' (Recipient with CMV positive or Donor with CMV  positive /Recipient with negative CMV)
-:::* '''Preemptive therapy''': Monitor ≥1  wk (days 10-100) CMV viremia by PCR or CMV-antigenemia and start treatment if positive. Traditional approach was to use [[Ganciclovir]] 5 mg/kg IV q12h for 7-14 days, then 5 mg/kg IV q24h 5 days/wk to the longer of: d 100 or ≥3 wks.
-:::: Note (1): More recently, [[Valganciclovir]] used more often in those who can take oral medications. Continue therapy until viral load negative (preferably twice).
-:::: Note (2): One study found [[Valganciclovir]] 900 mg po bid comparable to [[Ganciclovir]] 5 mg/kg iv bid in preemptive regimen
-:::: Note (3): [[Valganciclovir]] 900 mg po bid for 2 wks, then 900 mg PO q24h for ≥7 days after negative viral assay, was effective
-:::: Note (4): Preemptive regimen of [[Valganciclovir]] 900 mg po bid×2 wks, then 450 mg po bid, was effective {{or}}
-:::* '''Alternatively Prophylaxis approach''' (for high-risk pts or when CMV detection tests not rapidly available): From engraftment to day 100, ganciclovir 5 mg/kg IV q12h for 7 days, then 5 mg/kg IV q24h 5 to 6 days per week.
-::* 2. '''Prevention of opportunistic infections in Solid organ transplant (SOT) by CMV''' (Recipient with CMV positive or Donor with CMV  positive /Recipient with negative CMV)
+::::::* 3.2.5.4.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-:::* 2.1 '''Kidney, Kidney/Pancreas, Heart'''
-::::* Preferred regimen: [[Valganciclovir]] 900 mg PO q24h; start by day 10 and continue to at least day 100.
-:::* 2.2 '''Liver'''
-::::* Preferred regimen: [[Ganciclovir]] 5 mg/kg IV qd or [[Ganciclovir]] 1 gm PO tid; start by day 10 and continue to at least day 100. Or, with caution, [[Valganciclovir]].
-:::* 2.3 '''Lung'''
-::::* Preferred regimen: [[Ganciclovir]] 5 mg/kg iv q12h for 5-7 days, then [[Valganciclovir]] 900 mg po q24h for 6 mos (or at least 3 months).
-::::: Note (1): With antiviral prophylaxis, onset of CMV is appearing later; optimal duration of prophylaxis under study.
-::::: Note (2): [[Valganciclovir]] does not have FDA indication for CMV prevention in liver or lung transplantation, but commonly used.
-::::: Note (3): In selected cases, some institutions add CMV immune globulin to antiviral drug in high risk cases. Regimen for lung, heart, liver, pancreas: 150 mg/kg within 72h of transplant and at 2, 4, 6 & 8 weeks post-transplant; then 100 mg/kg at weeks 12 & 16.
-::* 3. '''Post treatment suppression for retinitis '''(prophylactic) if CD4 count <100/mm3
+:::::::* 3.2.5.4.1.1 '''For 32–34 weeks gestational age'''
-:::* Preferred regimen: [[Valganciclovir]] 900 mg PO q24h.
-:::: Note (1): Discontinue if CD4 >100/mm3 for 6 months on ART.
-:::: Note (2): Patients who discontinue suppression therapy should undergo regular eye examination for early detection of relapses.
-{{PBI|Enterovirus D68}}
+::::::::* '''For < 1 week of age'''
-:* '''Enterovirus treatment'''
-::* '''Aseptic Meningitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-:::* Preferred regimen: Immunoglobulins IV typical dose is 2 g/kg IV infused over 24hrs.
-:::* Alternative regimen: [[Pleconaril]]
-:::: Note (1): Pleocytosis of 100s of cells, CSF glucose normal, negative culture for bacteria
-:::: Note (2): Enterovirus is the most common cause of aseptic meningitis.
-:::: Note (3): Rapid CSF PCR test is accurate; reduces costs and hospital stay for infants.
-:::: Note (4): No treatment currently recommended; however,  still under investigation.
-:::: Note (5): Hot tender parotid swelling and vesicular,ulcerative pharyingitis are also caused by Enterovirus.
-{{PBI|Ebola virus}}
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day PO bid
-:* Ebola virus treatment<ref>{{cite web|title=Ebola virus treatment|url=http://www.cdc.gov/vhf/ebola/treatment/index.html}}</ref>
-::* Supportive therapy
-::: Providing intravenous fluids (IV) and balancing electrolytes (body salts).
-::: Maintaining oxygen status and blood pressure
-::: Treating other infections if they occur.
-:::: Note (1):  No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Ebola.
-:::: Note (2):  Recovery from Ebola depends on good supportive care and the patient’s immune response.
-:::: Note (3): People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola.
-:::: Note (4): Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.
+:::::::::* Preferred regimen (2): [[Clindamycin]] 10 mg/kg/day PO bid
-{{PBI|Marburg virus}}
+::::::::* '''For 1–4 week of age'''
-{{PBI|Hantavirus}}
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day PO bid
-:* Hanta virus treatment<ref>{{citeweb|title=Hanta virus|url=http://www.cdc.gov/hantavirus/technical/hps/treatment.html}}</ref>
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day PO tid
-::* Supportive therapy
-:::* ICU management should include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed.
-:::* Fluids should be administered carefully due to the potential for capillary leakage.
-:::* Supplemental oxygen should be administered if patients become hypoxic.
-:::* Equipment and materials for intubation and mechanical ventilation should be readily available since onset of respiratory failure may be precipitous.
-:::: Note (1): There is no specific treatment or cure for hantavirus infection.
-:::: Note (2):if the individual is experiencing fever and fatigue and has a history of potential rural rodent exposure, together with shortness of breath, would be strongly suggestive of Hantavirus pulmonary syndrome.
-:::: Note (3): Treatment of patients with Hantavirus pulmonary syndrome remains supportive in nature.
-:::: Note (4): If there is a high degree of suspicion of Hantavirus pulmonary syndrome, patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care.
-:::: Note (5): Patients should receive appropriate, broad-spectrum antibiotic therapy while awaiting confirmation of a diagnosis of Hantavirus pulmonary syndrome. Care during the initial stages of the disease should include antipyretics and analgesia as needed.
+:::::::* 3.2.5.4.1.2 '''For 34–37 week gestational age'''
-{{PBI|Dengue virus}}
+::::::::* '''For < 1 week of age'''
-:* [[Dengue virus]] <ref>{{cite book | last = LastName | first = FirstName | title = Dengue guidelines for diagnosis, treatment, prevention, and control | publisher = TDR World Health Organization | location = Geneva | year = 2009 | isbn = 9789241547871 }}</ref>
-::* 1. '''Patients who may be sent home'''
-:::* These are patients who are able to tolerate adequate volumes of oral fluids and pass urine at least once every six hours, and do not have any of the warning signs, particularly when fever subsides
-:::* Patients who are sent home should be monitored daily by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, signs of plasma leakage and bleeding, haematocrit, and white blood cell and platelet counts
-::* 2. '''Ambulatory patients  with stable haematocrit can be sent home '''
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day PO bid
-:::* Encourage oral intake of oral rehydration solution (ORS), fruit juice and other fluids containing electrolytes and sugar to replace losses from fever and vomiting
-:::* Give [[Paracetamol]] for high fever if the patient is uncomfortable. The interval of paracetamol dosing should not be less than six hours. Tepid sponge if the patient still has high fever
-:::* Should be brought to hospital immediately if any of the following occur: no clinical improvement, deterioration around the time of defervescence, severe abdominal pain, persistent vomiting, cold and clammy extremities, lethargy or irritability/restlessness, bleeding (e.g. black stools or coffee-ground vomiting), not passing urine for more than 4–6 hours
-::* 3. '''Patients who should be referred for in-hospital management'''
+:::::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day PO tid
-:::* Patients may need to be admitted to a secondary health care centre for close observation, particularly as they approach the critical phase. These include patients with warning signs (Abdominal pain or tenderness, Persistent vomiting, Clinical fluid accumulation, Mucosal bleed, Lethargy, restlessness, Liver enlargment >2cm, Laboratory:increase in HCT concurrent with rapid decrease in platelet count), those with co-existing conditions that may make dengue or its management more complicated (such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, chronic haemolytic diseases), and those with certain social circumstances (such as living alone, or living far from a health facility without reliable means of transport)
-::::* 3.1 '''With warning signs'''
+::::::::* '''For 1–4 week of age'''
-:::::* Obtain a reference haematocrit before fluid therapy. Give only isotonic solutions such as 0.9% saline, Ringer’s lactate, or Hartmann’s solution. Start with 5–7 ml/ kg/hour for 1–2 hours, then reduce to 3–5 ml/kg/hr for 2–4 hours, and then reduce to 2–3 ml/kg/hr or less according to the clinical response
-:::::* Reassess the clinical status and repeat the haematocrit. If the haematocrit remains the same or rises only minimally, continue with the same rate (2–3 ml/kg/hr) for another 2–4 hours. If the vital signs are worsening and haematocrit is rising rapidly, increase the rate to 5–10 ml/kg/hour for 1–2 hours. Reassess the clinical status, repeat the haematocrit and review fluid infusion rates accordingly
-:::::* Give the minimum intravenous fluid volume required to maintain good perfusion and urine output of about 0.5 ml/kg/hr. Intravenous fluids are usually needed for only 24–48 hours. Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase. This is indicated by urine output and/or oral fluid intake that is/are adequate, or haematocrit decreasing below the baseline value in a stable patient
-:::::* Patients with warning signs should be monitored by health care providers until the period of risk is over. A detailed fluid balance should be maintained. Parameters that should be monitored include vital signs and peripheral perfusion (1–4 hourly until the patient is out of the critical phase), urine output (4–6 hourly), haematocrit (before and after fluid replacement, then 6–12 hourly), blood glucose, and other organ functions (such as renal profile, liver profile, coagulation profile, as indicated)
-::::* 3.2 '''Without warning signs'''
-:::::* Encourage oral fluids. If not tolerated, start intravenous fluid therapy of 0.9% saline or Ringer’s lactate with or without dextrose at maintenance rate. For obese and overweight patients, use the ideal body weight for calculation of fluid infusion. Patients may be able to take oral fluids after a few hours of intravenous fluid therapy. Thus, it is necessary to revise the fluid infusion frequently. Give the minimum volume required to maintain good perfusion and urine output. Intravenous fluids are usually needed only for 24–48 hours
-:::::* Patients should be monitored by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, haematocrit, and white blood cell and platelet counts. Other laboratory tests (such as liver and renal functions tests) can be done, depending on the clinical picture and the facilities of the hospital or health centre
-::* 4. '''Severe dengue'''
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day PO bid
-:::* Severe dengue: Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress; severe haemorrhages; severe organ impairment (hepatic damage, renal impairment, cardiomyopathy, encephalopathy or encephalitis)
-:::* 4.1 '''Treatment of shock'''
+:::::::::* Preferred regimen (2): [[Clindamycin]] 20 mg/kg/day PO qid
-::::* 4.1.1 '''Compensated shock'''
-:::::* Start intravenous fluid resuscitation with isotonic crystalloid solutions at 5–10 ml/kg/hour over one hour. Then reassess the patient’s condition (vital signs, capillary refill time, haematocrit, urine output). The next steps depend on the situation
+:::::::* 3.2.5.4.1.3 '''Term newborn infant'''
-:::::* If the patient’s condition improves, intravenous fluids should be gradually reduced to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, then to 2–3 ml/kg/hr, and then further depending on haemodynamic status, which can be maintained for up to 24–48 hours
-:::::* If vital signs are still unstable (i.e. shock persists), check the haematocrit after the first bolus. If the haematocrit increases or is still high (>50%), repeat a second bolus of crystalloid solution at 10–20 ml/kg/hr for one hour. After this second bolus, if there is improvement, reduce the rate to 7–10 ml/ kg/hr for 1–2 hours, and then continue to reduce as above. If haematocrit decreases compared to the initial reference haematocrit (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible
-:::::* Further boluses of crystalloid or colloidal solutions may need to be given during the next 24–48 hours
-::::* 4.1.2 '''Hypotensive shock'''
+::::::::* '''For < 1 week of age'''
-:::::* Initiate intravenous fluid resuscitation with crystalloid or colloid solution (if available) at 20 ml/kg as a bolus given over 15 minutes to bring the patient out of shock as quickly as possible
-:::::* If the patient’s condition improves, give a crystalloid/colloid infusion of 10 ml/kg/hr for one hour. Then continue with crystalloid infusion and gradually reduce to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, and then to 2–3 ml/kg/hr or less, which can be maintained for up to 24–48 hours
-:::::* If vital signs are still unstable (i.e. shock persists), review the haematocrit obtained before the first bolus. If the haematocrit was low (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross- match and transfuse blood as soon as possible (see treatment for haemorrhagic complications)
-:::::* If the haematocrit was high compared to the baseline value (if not available, use population baseline), change intravenous fluids to colloid solutions at 10–20 ml/kg as a second bolus over 30 minutes to one hour. After the second bolus, reassess the patient. If the condition improves, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above. If the condition is still unstable, repeat the haematocrit after the second bolus
-:::::* If the haematocrit decreases compared to the previous value (<40% in children and adult females, less than 45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible (see treatment for haemorrhagic complications). If the haematocrit increases compared to the previous value or remains very high ( more than 50%), continue colloid solutions at 10–20 ml/kg as a third bolus over one hour. After this dose, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above when the patient’s condition improves
-:::::* Further boluses of fluids may need to be given during the next 24 hours. The rate and volume of each bolus infusion should be titrated to the clinical response. Patients with severe dengue should be admitted to the high-dependency or intensive care area
-:::* 4.2 '''Treatment of haemorrhagic complications'''
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day PO bid
-::::* Blood transfusion required
-:::::* Give 5–10ml/kg of fresh-packed red cells or 10–20 ml/kg of fresh whole blood at an appropriate rate and observe the clinical response. It is important that fresh whole blood or fresh red cells are given. Oxygen delivery at tissue level is optimal with high levels of 2,3 di-phosphoglycerate (2,3 DPG). Stored blood loses 2,3 DPG, low levels of which impede the oxygen-releasing capacity of haemoglobin, resulting in functional tissue hypoxia. A good clinical response includes improving haemodynamic status and acid-base balance
-:::::* Consider repeating the blood transfusion if there is further blood loss or no appropriate rise in haematocrit after blood transfusion. There is little evidence to support the practice of transfusing platelet concentrates and/or fresh-frozen plasma for severe bleeding. It is being practised when massive bleeding can not be managed with just fresh whole blood/fresh-packed cells, but it may exacerbate the fluid overload
-:::::* Great care should be taken when inserting a naso-gastric tube which may cause severe haemorrhage and may block the airway. A lubricated oro-gastric tube may minimize the trauma during insertion. Insertion of central venous catheters should be done with ultra-sound guidance or by a very experienced person
-::* 5. '''Treatment of complications and other areas of treatment'''
+:::::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)
-:::* 5.1 '''Fluid overload'''
-::::* Oxygen therapy should be given immediately
-::::* When the following signs are present, intravenous fluids should be discontinued or reduced to the minimum rate necessary to maintain euglycaemia
-:::::* signs of cessation of plasma leakage; stable blood pressure, pulse and peripheral perfusion; haematocrit decreases in the presence of a good pulse volume; afebrile for more than 24–48 days (without the use of antipyretics); resolving bowel/abdominal symptoms; improving urine output
-::::* The management of fluid overload varies according to the phase of the disease and the patient’s haemodynamic status. If the patient has stable haemodynamic status and is out of the critical phase (more than 24–48 hours of defervescence), stop intravenous fluids but continue close monitoring. If necessary, give oral or intravenous furosemide 0.1–0.5 mg/kg/dose once or twice daily, or a continuous infusion of furosemide 0.1 mg/kg/hour. Monitor serum potassium and correct the ensuing hypokalaemia
-::::* If the patient has stable haemodynamic status but is still within the critical phase, reduce the intravenous fluid accordingly. Avoid diuretics during the plasma leakage phase because they may lead to intravascular volume depletion
-::::* Patients who remain in shock with low or normal haematocrit levels but show signs of fluid overload may have occult haemorrhage. Further infusion of large volumes of intravenous fluids will lead only to a poor outcome. Careful fresh whole blood transfusion should be initiated as soon as possible. If the patient remains in shock and the haematocrit is elevated, repeated small boluses of a colloid solution may help
-:::* 5.2 '''Other complications of dengue'''
+:::::::::* Preferred regimen (3): [[Clindamycin]] 15 mg/kg/day PO tid
-::::* Both hyperglycaemia and hypoglycaemia may occur, even in the absence of diabetes mellitus and/or hypoglycaemic agents. Electrolyte and acid-base imbalances are also common observations in severe dengue and are probably related to gastrointestinal losses through vomiting and diarrhoea or to the use of hypotonic solutions for resuscitation and correction of dehydration. Hyponatraemia, hypokalaemia, hyperkalaemia, serum calcium imbalances and metabolic acidosis (sodium bicarbonate for metabolic acidosis is not recommended for pH ≥ 7.15) can occur. One should also be alert for co-infections and nosocomial infections.
-:::* 5.3 '''Supportive care and adjuvant therapy'''
-::::* renal replacement therapy, with a preference to continuous veno-venous haemodialysis (CWH), since peritoneal dialysis has a risk of bleeding;
-::::* vasopressor and inotropic therapies as temporary measures to prevent life- threatening hypotension in dengue shock and during induction for intubation, while correction of intravascular volume is being vigorously carried out;
-::::* further treatment of organ impairment, such as severe hepatic involvement or encephalopathy or encephalitis;
-::::* further treatment of cardiac abnormalities, such as conduction abnormalities, may occur (the latter usually not requiring interventions)
-{{PBI|West Nile virus}}
+::::::::* '''For 1–4 week of age'''
-{{PBI|Yellow Fever}}
-:* Yellow fever<ref>{{cite web | title = District guidelines for yellow fever surveillance | url = http://www.who.int/csr/resources/publications/yellowfev/whoepigen9809.pdf?ua=1 }}</ref><ref> name="pmid3547569">{{cite journal| author=Monath TP| title=Yellow fever: a medically neglected disease. Report on a seminar. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 1 | pages= 165-75 |pmid=3547569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3547569  }} </ref>
-::* Preferred regimen: No specific treatment is available for yellow fever. In the toxic phase, supportive treatment includes therapies for treating dehydration and fever. Ribavirin has failed in several studies in the monkey model.
-:::* Note: An international seminar held by WHO in 1984 recommended maintenance of nutrition, prevention of hypoglycemia, maintenance of the blood pressure with fluids and vasoactive drugs, prevention of bleeding with fresh-frozen plasma, dialysis if renal failure, correction of metabolic acidosis, administration of cimetidine IV to avoid gastric bleeding and oxygen if needed.
-{{PBI|Chikungunya virus}}
+:::::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day PO bid
-::'''Chikungunya Fever''' <ref name="pmid25806915">{{cite journal| author=Weaver SC, Lecuit M| title=Chikungunya virus and the global spread of a mosquito-borne disease. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 13 | pages= 1231-9 | pmid=25806915 | doi=10.1056/NEJMra1406035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25806915  }} </ref>
-::*Preferred regimen: no specific therapeutics agents are available and there are no licensed vaccines to prevent Chikungunya Fever.
-:::* Note: Anti inflammatory drugs can be used to control joint swelling and arthritis.
-{{PBI|Hepatitis A virus}}
+:::::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day PO bid (Loading dose 4.4 mg/kg)
-:*Preferred regimen: No therapy recommended. If within 2 wks of exposure, IVIG 0.02 mL per kg IM times 1 protective.
-{{PBI|Hepatitis B virus}}
+:::::::::* Preferred regimen (3): [[Clindamycin]] 20 mg/kg/day PO qid
-*'''Acute Hepatitis B'''
+::::::* 3.2.5.4.2 '''Alternatives for penicillin-susceptible strains'''
-*Chronic Hepatitis B
+:::::::* 3.2.5.4.2.1 '''For 32–34 weeks gestational age'''
-:*'''1. Patients with HBeAg-positive chronic hepatitis B''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-::*'''1.1. HBV DNA >20,000, ALT <2 times upper limit normal (ULN)''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
-:::*Observe; consider treatment when ALT becomes elevated.
+::::::::* '''For < 1 week of age'''
-:::*Consider biopsy in persons 40 years, ALT persistently high normal >2 times upper limit normal (ULN), or with family history of HCC.
-:::*Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.
-::*'''1.2. HBV DNA >20,000, ALT >2 times upper limit normal (ULN)''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+:::::::::* Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day PO bid
+:::::::::* Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid
-:::*'''Preferred regimen(1)''': Pegylated IFN-alpha 180 mcg weekly SC for 48 weeks
+::::::::* '''For 1–4 week of age'''
-:::*'''Preferred regimen(2)''': [[Tenofovir]](TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
-::::*If creatinine clearance 30–49 give 300 mg q48 hrs
-::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
-::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
-::::*If creatinine clearance <10 without dialysis there is no recommendation
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
+:::::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid
-:::*'''Preferred regimen(3)''': [[Entecavir]](ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid
-::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
+:::::::* 3.2.5.4.2.2 '''For 34–37 week gestational age'''
-::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
+::::::::* '''For < 1 week of age'''
-::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
+:::::::::* Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day PO bid
+:::::::::* Alternative regimen (2): Penicillin Vk 50 mg/kg/day PO bid
-::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
+::::::::* '''For 1–4 week of age'''
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
+:::::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO bid
-:::*'''Alternative regimen(1)''': [[Interferon alpha]](IFNα) 5 MU daily or 10 MU thrice weekly SC for 16 weeks
+:::::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO bid
-:::*'''Alternative regimen(2)''': [[Lamivudine]](LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
+:::::::* 3.2.5.4.2.3 '''Term newborn infant'''
-::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
-::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
-::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
-::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
-::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
-:::*'''Alternative regimen(3)''': [[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::::::* '''For < 1 week of age'''
-::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-::::*If creatinine clearance 30–49 give 10 mg PO every other day
-::::*If creatinine clearance 10–19 10 mg PO every third day
-::::*If hemodialysis patients give 10 mg PO every week following dialysis
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
-:::*'''Alternative regimen(4)''': [[Telbivudine]](LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day PO tid
-::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
+:::::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid
-::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
-::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
-::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
-::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
+::::::::* '''For 1–4 week of age'''
+:::::::::* Alternative regimen (1): [[Amoxicillin]]  75 mg/kg/day PO tid
-:::*Notes:
+:::::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day PO tid or qid
-::::*Observe for 3-6 months and treat if no spontaneous HBeAg loss.
+:::::::::* Note : Duration of therapy for naturally acquired infection is 7–10 days and for a biological weapon–related event,may require additional prophylaxis for inhaled spores to complete an antimicrobial course of up to 60 days from onset of illness.
-::::*Consider liver biopsy prior to treatment if compensated.
-::::*Immediate treatment if icteric or clinical decompensation.
-::::*[[Interferon alpha]](IFNα)/ pegylated interferon-alpha(peg-IFNα), [[Lamivudine]](LAM), [[Adefovir]](ADV), [[Entecavir]](ETV), tenofovir disoproxil fumarate(TDF) or [[telbivudine]](LdT) may be used as initial therapy.
-::::*Adefovir(ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
-::::*Lamivudine(LAM) and Telbivudine(LdT) not preferred due to high rate of drug resistance.
-::::*End-point of treatment – Seroconversion from HBeAg to anti-HBe.
-::::*[[Interferon alpha]](IFNα)  non-responders / contraindications to IFNα change to [[Tenofovir]](TDF)/[[Entecavir]](ETV).
-::*'''1.3. Children with elevated ALT greater than 2 times normal''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+:* '''Bacillus anthracis, postexposure prophylaxis'''
-:::*Preferred regimen(1): [[Interferon alpha]](IFNα) 6 MU/m2  SC thrice weekly with a maximum of 10 MU
-:::*Preferred regimen(2): [[Lamivudine]](LAM) 3 mg/kg/d PO with a maximum of 100 mg/d.
-:*'''2. Patients with HBeAg-negative chronic hepatitis B''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+::* 1. '''For adults'''<ref name="pmid24447897">{{cite journal| author=Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT et al.| title=Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults. | journal=Emerg Infect Dis | year= 2014 | volume= 20 | issue= 2 | pages=  | pmid=24447897 | doi=10.3201/eid2002.130687 | pmc=PMC3901462 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24447897  }} </ref>
-::*'''2.1. HBV DNA >20,000 IU/mL and elevated ALT >2 times normal'''
-:::*'''Preferred regimen(1)''': Pegylated IFN-alpha 180 mcg weekly SC for 1 year
-:::*'''Preferred regimen(2)''': [[Tenofovir]](TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
-::::*If creatinine clearance 30–49 give 300 mg q48 hrs
-::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
-::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
-::::*If creatinine clearance <10 without dialysis there is no recommendation
-::::*Note: duration of treatment is more than 1 year
-:::*'''Preferred regimen(3)''': [[Entecavir]](ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::* 1.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
+::::* Preferred regimen (1): [[Ciprofloxacin]] 500 mg IV q12h
-::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine
+::::* Preferred regimen (2): [[Doxycycline]] 100 mg IV q12h
-::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
-::::*Note: duration of treatment is more than 1 year
+::::* Preferred regimen (3): [[Levofloxacin]] 750 mg IV q24h
-:::*'''Alternative regimen(1)''': [[Interferon alpha]](IFNα) 5 MU daily or 10 MU thrice weekly SC for 1 year
+::::* Preferred regimen (4): [[Moxifloxacin]] 400 mg IV q24h
-:::*'''Alternative regimen(2)''': [[Lamivudine]](LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
+::::* Preferred regimen (5): [[Clindamycin]] 600 mg IV q8h
-::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
-::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
-::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
-::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
-::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
-::::*Note: duration of treatment is more than 1 year
-:::*'''Alternative regimen(3)''': [[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::* 1.2 '''Alternatives for penicillin-susceptible strain'''
-::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-::::*If creatinine clearance 30–49 give 10 mg PO every other day
-::::*If creatinine clearance 10–19 10 mg PO every third day
-::::*If hemodialysis patients give 10 mg PO every week following dialysis
-::::*Note: duration of treatment is more than 1 year
-:::*'''Alternative regimen(4)''': [[Telbivudine]](LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::* Preferred regimen (1): [[Amoxicillin]] 1 g IV q8h
-::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
-::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
-::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
-::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
-::::*Note: duration of treatment is more than 1 year
-:::*Notes:
+::::* Preferred regimen (2): Penicillin VK 500 mg IV q6h
-::::*[[Interferon alpha]](IFNα)/ pegylated interferon-alpha(peg-IFNα), [[Lamivudine]](LAM), [[Adefovir]](ADV), [[Entecavir]](ETV), tenofovir disoproxil fumarate(TDF) or [[telbivudine]](LdT) may be used as initial therapy.
-::::*Adefovir(ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
-::::*[[Lamivudine]](LAM) and [[Telbivudine]](LdT) not preferred due to high rate of drug resistance.
-::::*End-point of treatment – not defined
-::::*[[Interferon alpha]](IFNα)  non-responders / contraindications to IFNα change to [[Tenofovir]](TDF)/[[Entecavir]](ETV).
+::* 2. '''For children = 1 month'''<ref name="pmid24777226">{{cite journal| author=Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D et al.| title=Pediatric anthrax clinical management. | journal=Pediatrics | year= 2014 | volume= 133 | issue= 5 | pages= e1411-36 | pmid=24777226 | doi=10.1542/peds.2014-0563 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24777226  }} </ref>
-:*'''3. HBV DNA >2,000 IU/mL and elevated ALT >1-2 times normal''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+:::* 2.1 '''For penicillin-resistant strains or prior to susceptibility testing'''
-::*Consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.
-:*'''4. HBV DNA <2,000 IU/mL and ALT < upper limit normal (ULN)''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day, PO, bid (not to exceed 500 mg/dose)
-::*Observe, treat if HBV DNA or ALT becomes higher.
+::::* Preferred regimen (2):
-:*'''5. +/- HBeAg and detectable HBV DNA with Cirrhosis''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+:::::* If patients body weight < 45 kg: [[Doxycycline]] 4.4 mg/kg/day, PO, bid (not to exceed 100 mg/dose)
-::*'''5.1. Compensated Cirrhosis and HBV DNA >2,000'''
+:::::* If patients body weight > 45 kg: [[Doxycycline]] 100 mg/dose, PO, bid
-:::*'''Preferred regimen(1)''': [[Lamivudine]](LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
-::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
-::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
-::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
-::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
-::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
-:::*'''Preferred regimen(2)''': [[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::* Preferred regimen (3): [[Clindamycin]] 30 mg/kg/day, PO, tid (not to exceed 900 mg/dose)
-::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-::::*If creatinine clearance 30–49 give 10 mg PO every other day
-::::*If creatinine clearance 10–19 give 10 mg PO every third day
-::::*If hemodialysis patients give 10 mg PO every week following dialysis
-:::*'''Preferred regimen(3)''': [[Entecavir]](ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::* Preferred regimen (4):
-::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
+:::::* If patients body weight < 50 kg: [[Levofloxacin]] 16 mg/kg/day, PO, bid (not to exceed 250 mg/dose)
-::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
+:::::* If patients body weight > 50 kg: [[Levofloxacin]] 500 mg, PO, qd
-::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
+:::* 2.2 '''For penicillin-susceptible strains'''
-:::*'''Preferred regimen(4)''': [[Telbivudine]](LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::* Preferred regimen (1): [[Amoxicillin]] 75 mg/kg/day, PO, tid (not to exceed 1 g/dose)
-::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
-::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
-::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
-::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
-:::*'''Preferred regimen(5)''': [[Tenofovir]](TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::* Preferred regimen (2): [[Penicillin VK]] 50-75 mg/kg/day, PO, id or tid
-::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
-::::*If creatinine clearance 30–49 give 300 mg q48 hrs
-::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
-::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
-::::*If creatinine clearance <10 without dialysis there is no recommendation
-:::*Notes:
+::::* Note: '''Duration of Therapy is 60 days after exposure'''
-::::*LAM and LdT not preferred due to high rate of drug resistance.
-::::*ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.
-::::*These patients should receive long-term treatment. However, treatment may be stopped in HBeAg-positive patients if they have confirmed HBeAg seroconversion and have completed at least 6 months of consolidation therapy and in HBeAg-negative patients if they have confirmed HBsAg clearance.
+::* 3. '''For children < 1 month'''
-::*'''5.2. Compensated Cirrhosis and HBV DNA <2,000'''
+:::* 3.1 '''For all strains, regardless of penicillin susceptibility or if susceptibility is unknown'''
-:::*Consider treatment if ALT elevated.
-::*'''5.3. Decompensated Cirrhosis'''
+::::* 3.1.1 '''For 32–34 weeks gestational age'''
-:::*'''Preferred regimen(1)''': [[Tenofovir]](TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
-::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
-::::*If creatinine clearance 30–49 give 300 mg q48 hrs
-::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
-::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
-::::*If creatinine clearance <10 without dialysis there is no recommendation
-:::*'''Preferred regimen(2)''': [[Entecavir]](ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::* 3.1.1.1 '''For < 1 week of Age'''
-::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day, PO, bid
-::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
-::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
+::::::* Preferred regimen (2): [[Clindamycin]] 10 mg/kg/day, PO, bid
-::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
+:::::* 3.1.1.2 '''For 1–4 week of age '''
-:::*'''Preferred regimen(3)''': [[Lamivudine]](LAM) {{and}} [[Adefovir]](ADV)
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day, PO,bid
-::::*[[Lamivudine]](LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day, PO, tid
-:::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
-:::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
+::::* 3.1.2 '''For 34–37 week gestational age'''
-:::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
-:::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
-:::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
-:::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
-::::*[[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::* 3.1.2.1 '''For < 1 week of age'''
-:::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-:::::*If creatinine clearance 30–49 give 10 mg PO every other day
-:::::*If creatinine clearance 10–19 give 10 mg PO every third day
-:::::*If hemodialysis patients give 10 mg PO every week following dialysis
-:::*'''Preferred regimen(4)''': [[Telbivudine]](LdT) {{and}} [[Adefovir]](ADV)
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day, PO, bid
-::::*[[Telbivudine]](LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::::* Preferred regimen (2): [[Clindamycin]] 15 mg/kg/day, PO, tid
-:::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
-:::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
-:::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
-:::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
-::::*[[Adefovir]](ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::* 3.1.2.2 '''For 1–4 week of age'''
-:::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
-:::::*If creatinine clearance 30–49 give 10 mg PO every other day
-:::::*If creatinine clearance 10–19 give 10 mg PO every third day
-:::::*If hemodialysis patients give 10 mg PO every week following dialysis
-:::*Notes:
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 20 mg/kg/day, PO, bid
-::::*Coordinate treatment with transplant center.
+::::::* Preferred regimen (2): [[Clindamycin]] 20 mg/kg/day, PO, id
-::::*Refer for liver transplant.
-::::*Life-long treatment is recommended.
+::::* 3.1.3 '''Term newborn infant'''
-:* '''6. +/- HBeAg and undetectable HBV DNA  with Cirrhosis''' <ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+:::::* 3.1.3.1 '''For < 1 week of age '''
-::*Compensated Cirrhosis: Observe
-::*Uncompensated Cirrhosis: Refer for liver transplant
-{{PBI|Hepatitis C virus}}
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day, PO, bid
-Chronic Hepatitis C
-*'''1. Treatment regimens for chronic hepatitis C virus genotype 1''' <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''1.1. Treatment regimens for genotype 1a''':
-::*'''Preferred regimen(1)''': Daily fixed-dose combination of Ledipasvir 90 mg {{and}} [[Sofosbuvir]] 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 1a infection
-::*'''Preferred regimen(2)''': Daily fixed-dose combination of Paritaprevir 150 mg {{and}} [[Ritonavir]] 100 mg {{and}} Ombitasvir 25 mg plus twice-daily dosed Dasabuvir 250 mg {{and}} weight-based [[Ribavirin]](RBV) ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) {{or}} 24 weeks (cirrhosis) is recommended for treatment-naive patients with HCV genotype 1a infection.
-::*'''Preferred regimen(3)''': Daily [[Sofosbuvir]] 400 mg plus [[Simeprevir]] 150 mg {{withorwithout}} weight-based [[Ribavirin]](RBV) ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis) is recommended for treatment-naive patients with HCV genotype 1a infection.
-:*'''1.2. Treatment regimens for genotype 1b''':
+::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day, PO, bid (Loading dose 4.4 mg/kg)
-::*'''Preferred regimen(1)''': Daily fixed-dose combination of [[Ledipasvir]] 90 mg {{and}} [[Sofosbuvir]] 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 1b infection.
-::*'''Preferred regimen(2)''': Daily fixed-dose combination of Paritaprevir 150 mg {{and}} [[Ritonavir]] 100 mg {{and}} Ombitasvir 25 mg plus twice-daily dosed Dasabuvir 250 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 1b infection. The addition of weight-based RBV (1000 mg [<75kg] to 1200 mg [>75 kg]) is recommended in patients with cirrhosis.
-::*'''Preferred regimen(3)''': Daily [[Sofosbuvir]] 400 mg plus [[Simeprevir]] 150 mg for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis) is recommended for treatment-naive patients with HCV genotype 1b infection.
-*'''2. Treatment regimens for chronic hepatitis C virus genotype 2'''  <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+::::::* Preferred regimen (3): [[Clindamycin]] 15 mg/kg/day, PO, tid
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''Preferred regimen''': Daily [[sofosbuvir]] 400 mg {{and}} weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks is recommended for treatment-naive patients with HCV genotype 2 infection. Extending treatment to 16 weeks is recommended in patients with cirrhosis.
-*'''3. Treatment regimens for chronic hepatitis C virus genotype 3'''  <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+:::::* 3.1.3.2 '''For 1–4 week of Age'''
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''Preferred regimen''': Daily sofosbuvir (400 mg) and weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks is recommended for treatment-naive patients with HCV genotype 3 infection.
-:*'''Alternative regimen''': Daily sofosbuvir 400 mg and weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) plus weekly PEG-IFN for 12 weeks is an acceptable regimen for IFN-eligible, treatment-naive patients with HCV genotype 3 infection.
-*'''4. Treatment regimens for chronic hepatitis C virus genotype 4'''
+::::::* Preferred regimen (1): [[Ciprofloxacin]] 30 mg/kg/day, PO, bid
-:*'''Preferred regimen(1)''': Daily fixed-dose combination of Ledipasvir 90 mg {{and}} [[Sofosbuvir]] 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 4 infection.
-:*'''Preferred regimen(2)''': Daily fixed-dose combination of Paritaprevir 150 mg {{and}} [[Ritonavir]] 100 mg {{and}} Ombitasvir 25 mg {{and}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks is recommended for treatment-naive patients with HCV genotype 4 infection.
-:*'''Preferred regimen(3)''': Daily [[Sofosbuvir]] 400 mg {{and}} weight-based [[Ribavirin]]RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks is recommended for treatment-naive patients with HCV genotype 4 infection.
-:*'''Alternative regimen(1)''': Daily [[Sofosbuvir]] 400 mg {{and}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) plus weekly PEG-IFN for 12 weeks is an acceptable regimen for treatment-naive patients with HCV genotype 4 infection.
-:*'''Alternative regimen(2)''': Daily [[Sofosbuvir]] 400 mg plus [[Simeprevir]] 150 mg {{withorwithout}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks is an acceptable regimen for treatment-naive patients with HCV genotype 4 infection.
-*'''5. Treatment regimens for chronic hepatitis C virus genotype 5'''  <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+::::::* Preferred regimen (2): [[Doxycycline]] 4.4 mg/kg/day, PO, bid (Loading dose 4.4 mg/kg)
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''Preferred regimen''': Daily [[Sofosbuvir]] 400 mg {{and}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) plus weekly PEG-IFN for 12 weeks is recommended for treatment-naive patients with HCV genotype 5 infection.
-:*'''Alternative regimen''': Weekly PEG-IFN plus weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 48 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 5 infection.
-*'''6. Treatment regimens for chronic hepatitis C virus genotype 6'''  <ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+::::::* Preferred regimen (3): [[Clindamycin]] 20 mg/kg/day, PO, qid
-| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
-:*'''Preferred regimen''': Daily fixed-dose combination of [[Ledipasvir]] 90 mg {{and}} [[Sofosbuvir]] 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 6 infection.
-:*'''Alternative regimen''': Daily [[Sofosbuvir]] 400 mg {{and}} weight-based [[Ribavirin]](RBV) (1000 mg [<75 kg] to 1200 mg [>75 kg]) plus weekly PEG-IFN for 12 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 6 infection.
-{{PBI|Hepatitis E virus}}
+:::* 3.2 '''Alternatives for penicillin-susceptible strains'''
-* Hepatitis E treatment<ref>{{citeweb|title=Hepatitis E virus|url=http://www.who.int/mediacentre/factsheets/fs280/en/}}</ref>
-:* Supportive therapy
-::* Hepatitis E is usually self-limiting, hospitalization is generally not required.
-::* Hospitalization is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant women.
-::: Note (1): There is no available treatment capable of altering the course of acute hepatitis.
-::: Note (2): Prevention is the most effective approach against the disease.
-:* '''Prevention'''
+::::* 3.2.1 '''For 32–34 weeks gestational age'''
-::* ''' The risk of infection and transmission can be reduced by'''
-:::* (1) Maintaining quality standards for public water supplies;
-:::* (2) Establishing proper disposal systems to eliminate sanitary waste.
-::* '''On an individual level, infection risk can be reduced by'''
-:::* (1) Maintaining hygienic practices such as hand washing with safe water, particularly before handling food;
-:::* (2) Avoiding drinking water and/or ice of unknown purity;
-:::* (3) Adhering to WHO safe food practices-determining the mode of transmission; identifying the population specifically exposed to increased risk of infection; eliminating a common source of infection; improving sanitary and hygienic practices to eliminate faecal contamination of food and water raising awareness, promoting partnerships and mobilizing resources;formulating evidence-based policy and data for action;preventing transmission; and executing screening, care and treatment.
-{{PBI|Epstein-Barr virus}}
+:::::* 3.2.1.1 '''For < 1 week of age'''
-:* [[Epstein-Barr Virus]] (EBV) <ref name=CDC>{{cite web | title = Epstein-Barr Virus (EBV) center for disease control and prevention| url =http://www.cdc.gov/epstein-barr/about-ebv.html }}</ref>
-::* There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection.
-::* There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including
-:::* drinking fluids to stay hydrated
-:::* getting plenty of rest
-:::* taking over-the-counter medications for pain and fever
-{{PBI|Human herpesvirus 6}}
+::::::* Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day, PO, bid
-:* '''Human herpesvirus 6 treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
-::* Preferred regimen: [[Ganciclovir]] decreased viral copies in response to treatment and [[Foscarnet]] therapy improved thrombotic microangiopathy.
+::::::* Alternative regimen (2): Penicillin Vk  50 mg/kg/day, PO, bid
-::: Note (1): Human herpesvirus 6 (HHV-6) infects lymphocytes. It is typically acquired in early infancy and causes exanthem subitum (roseola infantum) and other febrile diseases of childhood.
+:::::* 3.2.1.2 '''For 1–4 week of age'''
-::: Note (2): Fever & rash documented in transplant patients .
-::: Note (3): Reactivation in hematopoietic stem cell transplant patients associated with delayed monocytes & platelet engraftment.
-::: Note (4): Recognized in assocation with meningoencephalitis in immunocompetent adults.
-::: Note (5): Diagnosis made by positive PCR in CSF.
-{{PBI|Roseola|Human herpesvirus 7}}
+::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day, PO, tid
-:* '''Human herpesvirus 7 (roseola virus) treatment'''
-::* Supportive therapy
-:::* Most patients with infection with HHV-7 will be asymptomatic. It is unknown whether treatment in asymptomatic patients will lead to a reduction in subsequent infection.<ref name="pmid15504215">{{cite journal| author=| title=Other herpesviruses: HHV-6, HHV-7, HHV-8, HSV-1 and -2, VZV. | journal=Am J Transplant | year= 2004 | volume= 4 Suppl 10 | issue=  | pages= 66-71 | pmid=15504215 | doi=10.1111/j.1600-6135.2004.00697.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15504215  }} </ref>
-:::* Immunocompetent hosts with uncomplicated skin manifestations associated with HHV-7, particularly roseola infantum and pityriasis rosea, need only symptomatic management.<ref name="pmid22819486">{{cite journal| author=Wolz MM, Sciallis GF, Pittelkow MR| title=Human herpesviruses 6, 7, and 8 from a dermatologic perspective. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 10 | pages= 1004-14 | pmid=22819486 | doi=10.1016/j.mayocp.2012.04.010 | pmc=PMC3538396 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22819486  }} </ref>
-:::* For HIV-positive patients, antiretroviral therapy may be advisable.<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* There are no defined circumstances that warrant specific antiviral therapy for HHV-7.<ref name="pmid10578120">{{cite journal| author=Black JB, Pellett PE| title=Human herpesvirus 7. | journal=Rev Med Virol | year= 1999 | volume= 9 | issue= 4 | pages= 245-62 | pmid=10578120 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10578120  }} </ref>
-:::* The most active antiviral compounds against HHV-7 are [[Cidofovir]] and [[Foscarnet]].<ref name="pmid11747000">{{cite journal| author=De Clercq E, Naesens L, De Bolle L, Schols D, Zhang Y, Neyts J| title=Antiviral agents active against human herpesviruses HHV-6, HHV-7 and HHV-8. | journal=Rev Med Virol | year= 2001 | volume= 11 | issue= 6 | pages= 381-95 | pmid=11747000 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11747000  }} </ref>
-::::* Note (1) Ubiquitous virus (>90% of the population is infected by age 3 yrs).
-::::* Note (2) Infects CD4 lymphocytes via CD4 receptor; transmitted via saliva.
-----
+::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day, PO, tid
-{{PBI|Human herpesvirus 8 (KSHV)}}
+::::* 3.2.2 '''For 34–37 week gestational age'''
-:* 1. '''Mild to moderate Kaposi sarcoma'''<ref>{{ cite web | title = Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultOITablesOnly.pdf }}</ref>
-::* Preferred regimen: initiate or optimize ART
-:* 2. '''Advanced Kaposi sarcoma (ACTG Stage T1, including disseminated cutaneous or visceral Kaposi sarcoma)'''
+:::::* 3.2.2.1 '''For < 1 week of age'''
-::* Preferred regimen: chemotherapy (per oncology consult) {{and}} ART
-:* 3. '''Primary effusion lymphoma'''
+::::::* Alternative regimen (1): [[Amoxicillin]] 50 mg/kg/day, PO, bid
-::* Preferred regimen: chemotherapy (per oncology consult) {{and}} ART
-::* Note: [[Valganciclovir]] PO or [[Ganciclovir]] IV can be used as adjunctive therapy.
-:* 4. '''Multicentric Castleman's disease'''
+::::::* Alternative regimen (2): Penicillin Vk 50 mg/kg/day, PO, bid
-::* Preferred regimen (1): [[Valganciclovir]] 900 mg PO bid for 3 weeks
-::* Preferred regimen (2): [[Ganciclovir]] 5 mg/kg IV q12h for 3 weeks
-::* Preferred regimen (3): [[Valganciclovir]] 900 mg PO BID {{and}} [[Zidovudine]] 600 mg PO q6h for 7–21 days
-::* Alternative regimen: [[Rituximab]] 375 mg/m2 given weekly for 4–8 weeks (may be an alternative to or used adjunctively with antiviral therapy)
-----
+:::::* 3.2.2.2 '''For 1–4 week of age'''
-{{PBI|Herpes simplex virus}}
+::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day, PO, tid
-::* 1.'''First Clinical Episode of Genital Herpes'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
-::::* Preferred Regimens: [[Acyclovir]] 400 mg PO tid for 7–10 days {{or}} [[Acyclovir]] 200 mg PO five times a day for 7–10 days{{or}} [[Valacyclovir]] 1 g PO bid for 7–10 days{{or}}[[ Famciclovir]] 250 mg PO tid  for 7–10 days
-::::* Note:Treatment can be extended if healing is incomplete after 10 days of therapy.
-::* 2.'''Established HSV-2 Infection '''
+::::::* Alternative regimen (2): Penicillin Vk  75 mg/kg/day, PO, tid
-::::* 2.1 '''Suppressive Therapy for Recurrent Genital Herpes'''
-::::* Preferred Regimen: [[Acyclovir]] 400 mg PO bid {{or}} [[Valacyclovir]] 500 mg PO qd {{or}} [[Valacyclovir]] 1 g PO qd {{or}} [[Famciclovir]] 250 mg PO bid
-::::* Note(1):daily therapy with  [[Acyclovir]] for as long as 6 years and with [[Valacyclovir]] or [[Famciclovir]] for 1 year
-::::* Note(2):[[Valacyclovir]] 500 mg qd might be less effective than other [[Valacyclovir]] or [[Acyclovir]] dosing regimens in persons who have very frequent recurrences (i.e., ≥10 episodes per year).
-::::* 2.2 '''Episodic Therapy for Recurrent Genital Herpes'''
-::::* Preferred Regimen: [[Acyclovir]] 400 mg PO tid for 5 days {{or}} Acyclovir 800 mg PO bid for 5 days {{or}}  [[Acyclovir]] 800 mg  PO tid for 2 days{{or}} [[Valacyclovir]] 500 mg  PO bid for 3 days{{or}} [[Valacyclovir]] 1 g PO qd for 5 days {{or}} [[Famciclovir]] 125 mg  PO bid  for 5 days{{or}}[[ Famciclovir]] 1 gram  PO bid  for 1 day {{or}} [[Famciclovir]] 500 mg once, followed by 250 mg  PO bid   for 2 days
-::* 3. '''Severe Disease''' (disseminated infection, pneumonitis, or hepatitis) or CNS complications (e.g., meningoencephalitis).
+::::* 3.2.3 '''Term newborn infant'''
-::::* Preferred Regimens: [[ Acyclovir]] 5–10 mg/kg IV q8h  for 2–7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy. HSV encephalitis requires 21 days of intravenous therapy. Impaired renal function warrants an adjustment in acyclovir dosage.
-::* 4. '''Special Considerations'''
+:::::* 3.2.3.1 '''For < 1 week of age'''
-::* 4.1'''HIV Infection'''
-::::* 4.1.1 '''Daily Suppressive Therapy in Persons with HIV'''
-::::* Preferred Regimens: [[Acyclovir]] 400–800 mg PO bid /tid  {{or}}[[Valacyclovir]] 500 mg  PO bid {{or}}[[Famciclovir]] 500 mg PO bid
-::::* 4.1.2 '''Episodic Infection in Persons with HIV'''
-::::* Preferred Regimens: [[Acyclovir]] 400 mg  PO tid  for 5–10 days {{or}} [[Valacyclovir]] 1 g PO bid for 5–10 days {{or}} [[Famciclovir]] 500 mg  PO bid for 5–10 days
-::::* Note:For severe HSV disease, initiating therapy with [[Acyclovir]] 5–10 mg/kg IV every 8 hours might be necessary.
-::* 4.2.'''Genital Herpes in Pregnancy'''
+::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day, PO, tid
-::::* suppressive therapy of pregnant women with recurrent genital herpes *
-::::* Preferred Regimens: [[Acyclovir]] 400–800 mg PO bid /tid  {{or}}[[Valacyclovir]] 500 mg  PO bid
-::::* Note:Treatment recommended starting at 36 weeks of gestation.
-::* 4.3'''Neonatal Herpes '''
+::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day, PO, tid
-::::* known or suspected neonatal herpes: [[Acyclovir]] 20 mg/kg IV q 8 h
-::::* Note(1):treatment for 14 days if disease is limited to the skin and mucous membranes, or
-::::* Note(2):treatment for 21 days for disseminated disease and that involving the central nervous system.
-::* 4.4''' Acyclovir-resistant genital herpes'''
+:::::* 3.2.3.2 '''For 1–4 week of age'''
-::::* Preferred Regimens:[[Foscarnet ]]40–80 mg/kg IV q8 h until clinical resolution is attained
-::::* Alternative Regimens: [[Cidofovir]]  5 mg/kg  IV once weekly might also be effective.
-::::* Alternative Regimens:Imiquimod topical preparations should be applied to the lesions qd for 5 consecutive days.
-::* 4.5'''Management of Sex Partners'''
+::::::* Alternative regimen (1): [[Amoxicillin]] 75 mg/kg/day, PO, tid
-::::* Preferred Regimens: [[Acyclovir]] 400 mg PO tid for 7–10 days {{or}} [[Acyclovir]] 200 mg PO five times a day for 7–10 days{{or}} [[Valacyclovir]] 1 g PO bid for 7–10 days{{or}} [[Famciclovir]] 250 mg PO tid  for 7–10 days
-::::* Note:The sex partners of persons who have genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated
-::* 4.6 '''Allergy, Intolerance, and Adverse Reactions'''
+::::::* Alternative regimen (2): Penicillin Vk 75 mg/kg/day, PO, id or tid
-::::* Allergic and other adverse reactions to oral acyclovir, valacyclovir, and famciclovir are rare. Desensitization to acyclovir has been described.
-{{PBI|Varicella-zoster virus}}
+::::::* Note: Duration of therapy is  60 days from exposure
-{{PBI|Human papillomavirus}}
-::* 1.'''Preferred regimen for External Anogenital Warts''' (i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)
-::::* 1.1 '''Patient-Applied:''':[[Imiquimod]] 3.75% or 5% cream {{or}}[[Podofilox]] 0.5% solution or gel {{or}} [[Sinecatechins]] 15% ointment
-::::* 1.2 '''Provider-Administered''':Cryotherapy with liquid nitrogen or cryoprobe  {{or}} Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser,or electrosurgery {{or}} [[Trichloroacetic acid]] (TCA) or Bichloroacetic acid (BCA) 80%-90% solution
-::::* Note(1):Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.
-::::* Note(2):Might weaken condoms and vaginal diaphragms.
-::* 2.'''Alternative Regimens for External Genital Warts'''
+----
-::::* 2.1 '''Urethral Meatus Warts'''
-::::* Regimens :Cryotherapy with liquid nitrogen {{or}}  Surgical removal
-::::* 2.2'''Vaginal Warts'''
-::::* Regimens:Cryotherapy with liquid nitrogen. {{or}} Surgical removal  {{or}}  TCA or BCA 80%–90% solution
-::::* Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation
-::::* 2.3 '''Cervical Warts'''
-::::* Regimen: Cryotherapy with liquid nitrogen {{or}} Surgical removal {{or}}  TCA or BCA 80%–90% solution
-::::* Note: Management of cervical warts should include consultation with a specialist.For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated.
-::::* 2.4 '''Intra-anal Warts'''
-::::* Regimens :Cryotherapy with liquid nitrogen {{or}} Surgical removal{{or}} TCA or BCA 80%–90% solution
-::::* Note:Management of intra-anal warts should include consultation with a specialist.
-:* '''3. Specific considerations'''
+{{PBI|Bacillus cereus}}
-::* '''3.1. Follow-up'''
+:* 1. '''Food poisoning'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:::* Most anogenital warts respond within 3 months of therapy. Factors that might affect response to therapy include immunosuppression and treatment compliance. In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment. A new treatment modality should be selected when no substantial improvement is observed after a complete course of treatment or in the event of severe side effects; treatment response and therapy-associated side effects should be evaluated throughout the course of therapy.
+::* Preferred regimen: Food poisoning is usually self-limited and requires no antibiotic therapy.
+:* 2. '''Bacteremia'''
+::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
+::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
+::* Note (1): Bacillus cereus is commonly resistant to beta-lactams.
+::* Note (2): Pseudobacteremia is transient and usually results from contaminated blood cultures, gloves, or syringes.
+:* 3. '''Meningitis or brain abscess'''
+::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
+::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
+::* Note: Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.
+:* 4. '''Endophthalmitis'''
+::* Preferred regimen: [[Clindamycin]] 450 μg intravitreal {{and}} [[Gentamicin]] 400 μg intravitreal {{or}} [[Dexamethasone]] intravitreal {{and}} [[Vancomycin]] 15 mg/kg IV q12h
+::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
+::* Note: Ophthalmological consultation, culture ocular fluids, early vitrectomy, and intravitreal antibiotics are necessary.
+:* 5. '''Endocarditis'''
+::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
+::* Note: Most blood cultures in intravenous drug users are contaminates or represent transient bacteremia.
+:* 6. ''' Soft tissue infection'''
+::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
+::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
+:* 7. '''Pneumonia'''
+::* Preferred regimen: [[Vancomycin]] 15 mg/kg IV q12h
+::* Alternative regimen: [[Clindamycin]] 600 mg IV q8h
-::* '''3.2 Management of sex partners'''
+----
-:::* Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can be passed on to partners. Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.
-::* '''3.3 Pregnancy'''
+{{PBI|Bacillus subtilis}}
-:::* Podofilox (podophyllotoxin), podophyllin, and sinecatechins should not be used during pregnancy. Imiquimod appears to pose low risk but should be avoided until more data are available.
+:* Bacillus subtilis infection treatment<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref><ref>{{Cite journal| issn = 0305-7453| volume = 49| issue = 6| pages = 1040–1042| last1 = Andrews| first1 = J. M.| last2 = Wise| first2 = R.| title = Susceptibility testing of Bacillus species| journal = The Journal of Antimicrobial Chemotherapy| date = 2002-06| pmid = 12039902}}</ref>
-:::* Cesarean delivery is indicated for women with anogenital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
+::* 1. Food poisoning
-:::* Pregnant women with anogenital warts should be counseled concerning the low risk for warts on the larynx of their infants or children (recurrent respiratory papillomatosis).
+:::* Preferred regimen: supportive treatment
+::* 2. Other infections
+:::* Preferred regimen: [[Vancomycin]] {{or}} [[Clindamycin]]
+:::* Alternative regimen: [[Ciprofloxacin]] {{or}} [[Imipenem]]
+:::* Note: Distinguish clinically significant infection from contamination before administering antibiotics.
-::* '''3.4 HIV infection'''
+----
-:::* Data do not support altered approaches to treatment for persons with HIV infection.
-:::* Squamous cell carcinomas arising in or resembling anogenital warts might occur more frequently among immunosuppressed persons, therefore requiring biopsy for confirmation of diagnosis for suspicious cases
-::* '''3.5 High-grade squamous intraepithelial lesions'''
-:::* Biopsy of an atypical wart might reveal HSIL or cancer of the anogenital tract. In this instance, referral to a specialist for treatment is recommended.
-{{PBI|Influenza A}}
-{{PBI|Influenza B}}
-{{PBI|Avian influenza}}
-::*1.Preferred regimen:[[Oseltamivir]] 75 mg PO qd for a minimum 10 days <ref name=":1">Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015</ref><ref>{{Cite web| title= avian influenza| url=http://www.cdc.gov/flu/avianflu/avian-in-humans.htm}} </ref>
-:::*Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently
-::*2 Patients with Avian Influenza who have diarrhea and  malabsorption
-:::*Preferred regimen:[[Zanamivir]]10 mg inhaled bid for minimum 5 days {{or}} [[Peramivir]]600 mg IV as a single dose for1 day
-:::*Note(1)Preliminary evidence demonstrates that [[neuraminidase inhibitor]] can reduce the duration of [[viral replication]] and improve survival among patients with [[avian influenza]]. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.
-:::*Note(2)The use of [[corticosteroids]] is not recommended.
-:::*Note(3): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
-:::*Note(4):The use of [[amantadine]] is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.<ref>WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/ Accessed on April 22, 2015
-</ref>
-:::*Note(5):Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.
-{{PBI|Swine influenza}}
+{{PBI|Clostridium botulinum}}
-* [[Swine influenza]] <ref>{{Cite book| publisher = World Health Organization| title = WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and Other Influenza Viruses| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-07-14| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138515/| pmid = 23741777}}</ref>
+:* '''Botulism'''
-:*1. '''Condition1: Patients who have severe or progressive clinical illness'''
+::* 1.'''Foodborne botulism'''<ref>{{cite web | title = CDC Drug Service  | url = http://www.cdc.gov/laboratory/drugservice/formulary.html#tbat }}</ref>
-::* Preferred regimen: [[Oseltamivir]] 150 mg PO BID, treatment duration depends on clinical response
+:::*  1.1 '''Adult'''
-::* NOTE(1): Where the clinical course remains severe or progressive, despite 5 or more days of antiviral treatment, monitoring of virus replication and shedding, and antiviral drug susceptibility testing is desirable
+::::* Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min
+:::* 1.2 '''Children'''
+::::* 1.2.1 '''Children < 1 year'''
+:::::* Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01  mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01  mL/kg/min ; maximum infusion rate: 0.03  mL/kg/min (10% of adult dose regardless of body weight)
+::::* 1.2.1 '''Children  1-17 years'''
+:::::* Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01  mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01  mL/kg/min ; maximum infusion rate: 0.03  mL/kg/min (20 – 100% of adult dose)
+:::::* Note:Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas.  A patient with severe botulism may require a ventilator as well as intensive medical and nursing care for several months.
+::* 2. '''Infant botulism'''<ref>{{Cite web | title =BabyBIG | url =http://www.fda.gov/BiologicsBloodVaccines/BloodBloodProducts/ApprovedProducts/LicensedProductsBLAs/FractionatedPlasmaProducts/ucm089339.htm }}</ref>
+:::* Preferred regimen:  BabyBIG, Botulism Immune Globulin Intravenous (Human) (BIG-IV) is  for the treatment of patients below one year of age.The recommended total dosage  is 1mL/kg (50mg/kg), given as a single IV infusion as soon as the clinical diagnosis of infant botulism is made
+:::* Note: infant with botulism must receive supportive care during their recovery. This includes ensuring proper nutrition,keeping the airway clear,watching for respiratory failure and if it develops,ventilator  may be needed.
+::* 3. '''Wound botulism'''
+:::*  3.1 '''Adult'''
+::::* Preferred regimen (adult): Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min
+:::* 3.2 '''Children'''
+::::* 3.2.1 '''Children < 1 year'''
+:::::* Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01  mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01  mL/kg/min ; maximum infusion rate: 0.03  mL/kg/min (10% of adult dose regardless of body weight)
+::::* 3.2.2 '''Children  1-17 years'''
+:::::* Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01  mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01  mL/kg/min ; maximum infusion rate: 0.03  mL/kg/min (20 – 100% of adult dose)
+:::::* Note (1): Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas.  A patient with severe botulism may require a ventilator as well as intensive medical and nursing care for several months.
+:::::* Note (2): For wound botulism, antibiotics are used in addition to appropriate debridement.
+:::::* Note (3): Antibiotic therapy is recommended for wound botulism after antitoxin has been administered.  [[Penicillin G]] 3 MU IV q4h in adults is frequently used. [[Metronidazole]] 500 mg IV q8h may be used as an alternative for penicillin-allergic patients.
-::* NOTE(2): Antiviral treatment should be maintained without a break until virus infection is resolved or there is satisfactory clinical improvement
-::* NOTE(3): Patients who have severe or progressive clinical illness, but who are unable to take oral medication may be treated with oseltamivir administered by nasogastric or orogastric tube
+{{PBI|Clostridium perfringens}}
+:* Clostridium perfringens <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*'''Gas gangrene'''
+:::* Preferred regimen: [[Penicillin G]] 3-4 million units IV q4h {{and}} ([[Clindamycin]] 900 mg IV q8h {{or}} [[Tetracycline]] 500 mg IV q6h)<ref name="pmid5109333">{{cite journal| author=Altemeier WA, Fullen WD| title=Prevention and treatment of gas gangrene. | journal=JAMA | year= 1971 | volume= 217 | issue= 6 | pages= 806-13 | pmid=5109333 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5109333  }} </ref>
+{{PBI|Clostridium tetani}}
+:*1. '''General measures''' <ref name=World Health Organization>{{cite web | title = Current recommendations for treatment of tetanus during humanitarian emergencies| url =http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/ }}</ref>
+::*Preferred regimen: Patients should be placed in a quiet shaded area and protected from tactile and auditory stimulation as much as possible; All wounds should be cleaned and debrided as indicated
+:*2. '''Immunotherapy'''
+::*Preferred regimen: Human TIG 500 units IV/IM as soon as possible {{and}} Age-appropriate TT-containing vaccine, 0.5 cc IM at a separate site
+::*Note: patients without a history of primary TT vaccination should receive a second dose 1–2 months after the first dose and a third dose 6–12 months later
+:*3. '''Antibiotic treatment'''<ref>http://www.who.int/diseasecontrol_emergencies/who_hse_gar_dce_2010_en.pdf</ref>
+::*Preferred regimen: [[Metronidazole]] 500 mg IV/PO q6h {{or}} [[Penicillin G]] 100,000–200,000 IU/kg/day IV, administered in 2–4 divided doses
+::*Alternative regimen: [[Tetracyclines]] {{or}} [[Macrolides]] {{or}} [[Clindamycin]] {{or}} [[Cephalosporins]] {{or}} [[Chloramphenicol]]
+:*4. '''Muscle spasm control'''
+::*Preferred regimen: [[Diazepam]] 5 mg IV {{or}} [[Lorazepam]] 2 mg IV titrating to achieve spasm control without excessive sedation and hypoventilation
+::*Alternative regimen (1): [[Magnesium]] sulphate 5 g (or 75mg/kg) IV loading dose, then 2–3 g per hour until spasm control is achieved {{withorwithout}} [[Benzodiazepines]]
+::*Note: Monitor patellar reflex as areflexia (absence of patellar reflex) occurs at the upper end of the therapeutic range (4mmol/L). If areflexia develops, dose should be decreased
+::*Alternative regimen (2): [[Baclofen]] {{or}} [[Dantrolene]] 1–2 mg/kg IV/PO q4h
+::*Alternative regimen (3): [[Barbiturates]] 100–150 mg q1-4h by any route
+::*Alternative regimen (4): [[Chlorpromazine]] 50–150 mg IM q4–8h
+::*Pediatric regimen: [[Lorazepam]] 0.1–0.2 mg/kg IV q2–6h, titrating upward as needed; [[Barbiturates]] 6–10 mg/kg in children by any route; [[Chlorpromazine]] 4–12 mg IM every q4–8h
+::*Note: As for [[Benzodiazepines]], large amounts may be required (up to 600 mg/day); oral preparations could be used but must be accompanied by careful monitoring to avoid respiratory depression or arrest
+:* 5. '''Autonomic dysfunction control'''
+::*Preferred regimen: [[Magnesium]] sulphate {{or}} [[Morphine]] {{or}} [[Esmolol]]
+:* 6. '''Airway/respiratory control'''
+::*Note: Drugs used to control spasm and provide sedation can result in respiratory depression. If spasm, including laryngeal spasm, is impeding or threatening adequate ventilation, mechanical ventilation is recommended when possible. Early tracheostomy is preferred as endotracheal tubes can provoke spasm and exacerbate airway compromise.
+{{PBI|Clostridium difficile}}
+:*1. '''Pseudomembranous colitis - mild to moderate'''<ref name="pmid25626036">{{cite journal| author=Bagdasarian N, Rao K, Malani PN| title=Diagnosis and treatment of Clostridium difficile in adults: a systematic review. | journal=JAMA | year= 2015 | volume= 313 | issue= 4 | pages= 398-408 | pmid=25626036 | doi=10.1001/jama.2014.17103 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25626036  }} </ref>
+::*Preferred regimen:[[Metronidazole]] 500 mg PO tid for 10-14 days
+::*Alternative regimen: [[Vancomycin]] 125 mg PO qid for 10-14 days
+::*Note: If significant risk of recurrence: [[Vancomycin]] 125 mg PO qid for 10-14 days {{or}} [[Fidaxomicin]] 200 mg PO bid for 10 days
+:*2. '''Pseudomembranous colitis - severe'''<ref name="pmid25626036">{{cite journal| author=Bagdasarian N, Rao K, Malani PN| title=Diagnosis and treatment of Clostridium difficile in adults: a systematic review. | journal=JAMA | year= 2015 | volume= 313 | issue= 4 | pages= 398-408 | pmid=25626036 | doi=10.1001/jama.2014.17103 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25626036  }} </ref>
+::*Preferred regimen: [[Vancomycin]] 125 mg PO qid for 10-14 days
+::*Note: If significant risk of recurrence: [[Vancomycin]] 125 mg PO qid for 10-14 days {{or}} [[Fidaxomicin]] 200 mg PO bid for 10 days
+:*3. '''Pseudomembranous colitis - severe, complicated'''<ref name="pmid25626036">{{cite journal| author=Bagdasarian N, Rao K, Malani PN| title=Diagnosis and treatment of Clostridium difficile in adults: a systematic review. | journal=JAMA | year= 2015 | volume= 313 | issue= 4 | pages= 398-408 | pmid=25626036 | doi=10.1001/jama.2014.17103 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25626036  }} </ref>
+::*Preferred regimen: [[Vancomycin]] 125-500 mg PO qid for 10-14 days {{and}} [[Vancomycin]] 500 mg diluted in 500 ml of saline as enema per rectum q6h {{and}} [[Metronidazole]] 500 mg IV q8h
+::*Note: Consider urgent surgical consult
+:*4. '''Recurrent pseudomembranous colitis'''<ref name="pmid25626036">{{cite journal| author=Bagdasarian N, Rao K, Malani PN| title=Diagnosis and treatment of Clostridium difficile in adults: a systematic review. | journal=JAMA | year= 2015 | volume= 313 | issue= 4 | pages= 398-408 | pmid=25626036 | doi=10.1001/jama.2014.17103 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25626036  }} </ref>
+::*First recurrence treatment
+:::*Preferred regimen: same as first episode or [Fidaxomicin]] 200 mg PO bid for 10 days
+::*Second or more recurrence treatment
+:::*Preferred regimen: [[Vancomycin]] 125 mg PO qid for 14 days {{then}} [[Vancomycin]] 125 mg PO tid for 7 days {{then}} [[Vancomycin]] 125 mg PO bid for 7 days {{then}} [[Vancomycin]] 125 mg PO qd for 7 days {{then}} [[Vancomycin]] 125 mg PO q48h for 7 days {{then}} [[Vancomycin]] 125 mg PO q72h for 7 days {{or}} [[Fidaxomicin]] 200 mg PO bid for 10 days
+:::*Note: Consider expert consult for fecal microbiota transplantation
+==Corynebacterium==
+{{PBI|Corynebacterium diphtheriae}}
+:* Diphtheria treatment <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> <ref>{{cite web | title = Diphtheria CDC| url =http://www.cdc.gov/vaccines/pubs/pinkbook/dip.html }}</ref>
+::* 1. '''Antitoxin '''
+:::* 1.1 '''Pharyngeal disease <48 hrs'''
+::::* Preferred regimen: 20,000-40,000 U IV/IM
+:::* 1.2 '''Nasopharyngeal'''
+::::* Preferred regimen: 40-60,000 U IV/IM
+:::* 1.3 '''Extensive disease, or > 72 hrs'''
+::::* Preferred regimen: 80-120,000 U IV/IM
+:::* Note: IV administration for severe disease
+::* 2. '''Antibiotics '''
+:::* Preferred regimen: [[Erythromycin]] 40 mg/kg/day (Maximum, 2 gm/day) PO/IV for 14 days
+:::* Alternative regimen: [[Procaine penicillin G]] 600,000 U/day IM qd for 14 days
+:::* Note: Procaine penicillin G  300,000 U/day for those weighing 10 kg or less
+::* 3. '''Preventive antibiotic use'''
+:::* Note: For close contacts, especially household contacts, a diphtheria booster, appropriate for age, should be given
+:::* Preferred regimen: [[Benzathine penicillin G ]]
+::::* younger than 6 years old: 600,000 U IM
+::::* 6 years old and older: 1,200,000 U IM
+:::* Alternative regimen: [[Erythromycin]]
+::::* Adult: 1 g/day PO 7-10 days
-:* 2. '''Condition2: In situations where oseltamivir is not available, or not possible to use, patients who have severe or progressive clinical illness'''
+::::* Pediatric: 40 mg/kg/day PO 7-10 days
-::* Preferred regimen: [[Zanamivir]] inhaled
+:::* Note (1): If surveillance of contacts cannot be maintained, they should receive benzathine penicillin G
-::* NOTE: Intravenous [[Zanamivir]] should be considered where available and is recommended for those with serious or progressive illness. If not available, intravenous [[Peramivir]] may be considered
+:::* Note (2): Maintain close surveillance and begin antitoxin at the first signs of illness
-:* 3. '''Condition3: Severely immunosuppressed patients'''
+{{PBI|Corynebacterium jeikeium}}
-::* Preferred regimen: Antiviral chemoprophylaxis by using [[Oseltamivir]] {{or}} [[Zanamivir]]
+:* Corynebacterium jeikeium<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-{{PBI|Measles}}
+::* Preferred regimen : [[Vancomycin]] 1 gm IV q12h
-{{PBI|Middle East respiratory syndrome}}
+::* Alternative regimen : [[Penicillin G]] {{and}} Anti pseudomonal aminoglycosides like [[Tobramycin]], [[Gentamicin]], [[Amikacin]]
+{{PBI|Corynebacterium urealyticum}}
+:* '''Corynebacterium urealyticum'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* 1. '''Post renal transplant obstructive uropathy'''
+:::* Preferred regimen (1): [[Vancomycin]] 1 gm IV q12h
+:::* Preferred regimen (2): [[Teicoplanin]] 6 mg/kg/day IV q24h
+----
+{{PBI|Coxiella burnetii}}
+:* '''Q fever'''<ref>{{cite web | title =q fever | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm   }}</ref>
+::* 1. '''Acute Q fever'''
+:::* 1.1 '''Adults'''
+::::* Preferred Regimen: [[Doxycycline]] 100 mg PO bid for 14 days
+:::* 1.2 '''Children'''
+::::* 1.2.1 '''Children with age  ≥8 years'''
+:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 14 days (maximum 100 mg per dose)
+::::* 1.2.2  '''Children with age <8 years with high risk criteria'''
+:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg PO bid for 14 days (maximum: 100 mg per dose)
+::::* 1.2.3  '''Children with age <8 years with mild or uncomplicated illness'''
+:::::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg  PO bid for 5 days (maximum 100 mg per dose).
+::::* 1.2.3  '''Children with age < 8 years with mild or uncomplicated illness,who remains febrile past 5 days of treatment'''
+:::::* Preferred regimen: [[Trimethoprim/Sulfamethoxazole]] 4-20 mg/kg  PO bid for 14 days (maximum: 800 mg per dose)
+:::* 1.3 '''Pregnant women'''
+::::* Preferred regimen: [[Trimethoprim/Sulfamethoxazole]] 160 mg/800 mg  PO bid a day throughout pregnancy
+::* 2. '''Chronic Q fever'''
+:::* 2.1 '''Endocarditis or vascular infection'''
+::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid  for ≥18 months
+::::* Note: childern and pregnant women- consultation  Recommended
+:::* 2.2 '''Noncardiac organ disease'''
+::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid
+::::* Note: childern and pregnant women- consultation  Recommended
+:::* 2.3 '''Postpartum with serologic profile for chronic Q fever'''
+::::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[Hydroxychloroquine]] 200 mg PO tid for 12 months
+::::* Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
+::::* Note (2): Post-Q fever fatigue syndrome- no current recommendation.
+----
+{{PBI|Ehrlichia}}
+:* 1. '''[[Ehrlichiosis|Human Monocytic Ehrlichiosis]] or [[Human Granulocytic Anaplasmosis]] (adult)''' <ref name=CDC centers for the disease control and prevention>{{cite web | title =Ehrlichiosis CDC centers for the disease control and prevention| url= http://www.cdc.gov/ehrlichiosis/symptoms/index.html#treatment }}</ref> <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen: [[Doxycycline]] 100 mg PO/IV q12h for 7-14 days
+::* Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
+::* Alternative regimen (1): [[Chloramphenicol]] 500mg PO qid
+::* Alternative regimen (2): [[Rifampin]] 600 mg PO/IV qd for 7-10 days
+:* 2. '''[[Ehrlichiosis|Human Monocytic Ehrlichiosis]] or [[Human Granulocytic Anaplasmosis]] (pediatric)'''
+::* 2.1 '''≥ 8 years old'''
+:::* Preferred regimen: [[Doxycycline]] 2 mg/kg IV/PO q12h (Maximum, 200 mg/day) for 10 days
+::* 2.2 '''< 8 years old without Lyme disease'''
+:::* Preferred regimen: [[Doxycycline]] 2 mg/kg IV/PO q12h (Maximum, 200 mg/day) for 4-5 days (or 3 days after resolution of fever)
+::* 2.3 '''co-infected with Lyme disease'''
+:::* Preferred regimen: [[Doxycycline]] (see above) {{then}} [[Amoxicillin]] 50 mg/kg/day tid (Maximum, 500 mg/dose) {{or}} [[Cefuroxime]] 30 mg/kg/day bid (Maximum, 500 mg/dose) for 14 days
+{{PBI|Erysipelothrix rhusiopathiae}}
+:* Erysipelothrix rhusiopathiae <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Erysipeloid of Rosenbach (localized cutaneous infection)'''
+:::* Preferred regimen (1): [[Penicillin G benzathine]] 1.2 MU IV single dose
+:::* Preferred regimen (2): [[Penicillin VK]] 250 mg PO qid for 5-7 days
+:::* Preferred regimen (3): [[Procaine penicillin]] 0.6-1.2 MU IM qd for 5-7 days
+:::* Alternative regimen (1): [[Erythromycin]] 250 mg PO qid for 5-7 days
+:::* Alternative regimen (2): [[Doxycycline]] 100 mg PO bid for 5-7 days
+::* 2. '''Diffuse cutaneous infection'''
+:::* Preferred regimen: See localized infection
+::* 3. '''Bacteremia or endocarditis'''
+:::* Preferred regimen: [[Penicillin G benzathine]] 2-4 MU IV q4h for 4-6 weeks
+:::* Alternative regimen (1): [[Ceftriaxone]] 2 g IV q24h for 4-6 weeks
+:::* Alternative regimen (2): [[Imipenem]] 500 mg IV q6h for 4-6 weeks
+:::* Alternative regimen (3): [[Ciprofloxacin]] 400 mg IV q12h for 4-6 weeks
+:::* Alternative regimen (4): [[Daptomycin]] 6 mg/kg IV q24h for 4-6 weeks
+:::* Note: Recommended duration of therapy for endocarditis is 4 to 6 weeks, although shorter courses consisting of 2 weeks of intravenous therapy followed by 2 to 4 weeks of oral therapy have been successful
+{{PBI|Listeria monocytogenes}}
+:* 1. '''Meningitis''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for more than 3 weeks
+::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) IV q6h for more than 3 weeks
+:* 2. '''Bacteremia'''
+::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for 2 weeks
+::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 2 weeks
+:* 3. '''Brain abscess or rhomboencephalitis'''
+::* Preferred regimen: [[Ampicillin]] 2g IV q4-6h {{withorwithout}} [[Gentamicin]] 1.7 mg/kg IV q8h for 4-6 weeks
+::* Alternative regimen: [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 4-6 weeks
+:* 4. '''Gastroenteritis'''
+::* Preferred regimen (1): [[Amoxicillin]] 2g IV q4-6h
+::* Preferred regimen (2): [[TMP-SMX]] 3-5 mg/kg (trimethoprim) q6h IV for 7 days
+{{PBI|Lactobacillus}}
+:* 1. '''Endovascular Infection''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regiemn (1): [[Penicillin G]] 20 MU/day for 6 weeks
+::* Preferred regiemn (2): [[Gentamicin]] 1.3 mg/kg IV q8h (trough <1.5 mg/L) {{and}} [[Polychlorinated naphthalene]]
+:* 2. '''Odontogenic Infection'''
+::* Preferred regiemn: [[Clindamycin]] 450 mg PO qid
+:* 3. '''Intrabdominal Abscess'''
+::* Preferred regiemn: [[Clindamycin]] 450 mg PO qid
+{{PBI|Leuconostoc}}
+:* Leuconostoc <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen (1): [[Penicillin G]]
+::* Preferred regimen (2): [[Ampicillin]]
+::* Alternative regimen (1): [[Clindamycin]]
+::* Alternative regimen (2): [[Erythromycin]]
+::* Alternative regimen (3): [[Minocycline]]
+{{PBI|Nocardia}}
+:* 1. '''Sulfonamide-based therapies''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1.1 '''Pulmonary'''
+:::* Preferred regimen: [[TMP-SMX]] 10 mg/kg/day (TMP) IV q6-12h for 3-6 weeks {{then}} 2 DS PO bid for at least 5 months
+::* 1.2 '''Pulmonary alternatives'''
+:::* Preferred regimen: [[Sulfisoxazole]] {{or}} [[Sulfadiazine]] {{or}} Trisulfapyrimidine 3-6 g/day PO bid-qid {{or}} [[TMP-SMX]] 2 DS bid up to 2 DS tid
+::* 1.3 '''CNS (AIDS, severe or disseminated disease)'''
+:::* Preferred regimen: [[TMP-SMX]] 15 mg/kg/day (TMP) IV for 3-6 weeks {{then}} 3 DS PO bid for 6-12 months
+::* 1.4 '''CNS alternatives'''
+:::* Preferred regimen: [[Imipenem]] 1000 mg IV q8h {{or}} [[Ceftriaxone]] 2 g IV q12h {{or}} [[Cefotaxime]] 2-3 g IV q6h {{and}} [[Amikacin]]
+::* 1.5 '''Severe disease, compromised host, multiple sites'''
+:::* Preferred regimen: [[TMP-SMX]] 15 mg/kg/day (TMP) IV {{and}} [[Amikacin]] 7.5 mg/kg q12h {{or}} [[Sulfonamide]] 6-12 mg/day PO
+::* 1.6 '''Sporotrichoid (cutaneous)'''
+:::* Preferred regimen: [[TMP-SMX]] 1 DS bid for 4-6 months
+::* Note (1): Immunocompetent medicine use for 6 months; Immunosuppressed medicine for 12 months
+::* Note (2): Treat based on host, site of disease and in vitro activity; Sulfonamide usually preferred, must treat for 6-12 months; Preferred drugs for resistant strains are [[Amikacin]] and/or [[Imipenem]]
+::* Note (3): Seriously ill usually treated with IV [[Imipenem]] or [[Sulfonamide]] or [[Cefotaxime]] all potentially combined with [[Amikacin]]; less seriously ill treated with oral agents— especially [[TMP-SMX]] or [[Minocycline]]
+:* 2. '''Sulfonamide alternatives'''
+::* 2.1 '''Severe'''
+:::* Preferred regimen (1): (For AIDS) ([[Imipenem]] 1000 mg IV q8h {{or}} [[Meropenem]] 2 g q8h {{and}} [[Amikacin]] 7.5 mg/kg q12h IV
+:::* Preferred regimen (2): [[Cefotaxime]] 2-3 g q6-8h {{or}} [[Ceftriaxone]] 2 g/day IV {{withorwithout}} [[Amikacin]]
+::* 2.2 '''Mild'''
+:::* Preferred regimen: [[Minocycline]] 100 mg bid for at least 6 months (initial treatment of local disease or maintenance)
+:::* Alternative regimen: [[Amoxicillin clavulanate]] 875/125 mg bid {{or}} [[Doxycycline]] {{or}} [[Erythromycin]] {{or}} [[Clarithromycin]] {{or}} [[Linezolid]] {{or}} [[Fluoroquinolone]] {{or}} combinations for at least 6 months
+{{PBI|Propionibacterium acnes}}
+:* Propiobacterium acnes <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Systemic infection'''
+:::* Preferred regimen: [[Penicillin G]] 2 MU IV q4h for 2-4 weeks
+:::* Alternative regimen (1): [[Clindamycin]] 600 mg IV q8h for 2-4 weeks
+:::* Alternative regimen (2): [[Vancomycin]] 15 mg/kg IV q12h for 2-4 weeks
+::* 2. '''Shoulder prosthesis infection'''
+:::* Preferred regimen: [[Amoxicillin]] {{and}} [[Rifampin]] for 3-6 months
+::* 3. '''Acne vulgaris'''
+:::* Topical antibiotics: [[Erythromycin]] {{or}} [[Clindamycin]]
+:::* Systemic antibiotics: [[Minocycline]] {{or}} [[Doxycycline]] {{or}} [[Trimethoprim-Sulfamethoxazole]]
+{{PBI|Rhodococcus equi}}
+:* Rhodococcus equi <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* First line:
+:::* Preferred regimen: [[Vancomycin]] 1 g IV q12h (15 mg/kg q12 for >70 kg) {{or}} [[Imipenem]] 500 mg IV q6h {{and}} [[Rifampin]] 600 mg PO qd {{or}} [[Ciprofloxacin]] 750 mg PO bid {{or}} [[Erythromycin]] 500 mg PO qid for at least 4 weeks or until infiltrate disappears
+:::* Note: Should be administrated at least 8 weeks in immunocompromised patients
+::* Oral/maintenance therapy (after infiltrate clears):
+:::* Preferred regimen (1): [[Ciprofloxacin]] 750 mg PO bid
+:::* Preferred regimen (2): [[Erythromycin]] 500 mg PO qid
+::* Alternative regimen: [[Azithromycin]] {{or}} [[TMP-SMX]] {{or}} [[Chloramphenicol]] {{or}} [[Clindamycin]]
+::* Note: Avoid Penicillins/Cephalosporins due to development of resistance; Linezolid effective in vitro, but no clinical reports of use
+{{PBI|Rickettsia prowazekii}}
+{{PBI|Rickettsia rickettsii}}
+:* 1. '''Adult''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref> <ref>{{cite web | title = Rocky Mountain Spotted Fever (RMSF) CDC| url =http://www.cdc.gov/rmsf/symptoms/index.html#treatment }}</ref>
+::* Preferred regimen: [[Doxycycline]] 100 mg q12h
+::* Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement. Standard duration of treatment is 7-14 days
+::* Alternative regimen: [[Chloramphenicol]] 500 mg PO qid for 7 days or stop 3 days after defervescence
+:* 2. '''Pediatric (under 45 kg (100 lbs))'''
+::* Preferred regimen: [[Doxycycline]] 2.2 mg/kg bid
+::* Note: The recommended dose and duration of medication needed to treat RMSF has not been shown to cause staining of permanent teeth, even when five courses are given before the age of eight. Healthcare providers should use doxycycline as the first-line treatment for suspected Rocky Mountain spotted fever in patients of all ages
+{{PBI|Rickettsia typhi}}
+====Bacteria – Gram-Negative Cocci and Coccobacilli====
+{{PBI|Aggregatibacter aphrophilus}}
+:* 1. '''Endocarditis'''<ref>{{Cite web | title = Infective Endocarditis: | url = http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Endocarditis%20Management.pdf }}</ref>
+::* 1.1 '''Adults'''
+:::* Preferred regimen (1): [[Ceftriaxone]] 2 g/day TV/IM q24h for 4 weeks
+:::* Preferred regimen (2): [[Ampicillin-sulbactam]] 12 g/day TV q6h for 4 weeks
+:::* Preferred regimen (3): [[Ciprofloxacin]] 1000 mg PO q24h {{or}} 800 mg/day IV q12h for 4 weeks
+::* 1.2 '''Pediatrics'''
+:::* Preferred regimen (1): [[Ceftriaxone]] 100 mg/kg/day TV/IM q24h for 4 weeks
+:::* Preferred regimen (2): [[Ampicillin-sulbactam]] 300 mg/kg/day TV q6h/q4h for 4 weeks
+:::* Preferred regimen (3): [[Ciprofloxacin]] 20-30 mg/kg/day IV/PO bid for 4 weeks
+:::* Note (1): Floroquinolone therapy recommended for patients unable to tolerate Cephalosporin and ampicillin thearpy
+:::* Note (2): For patients < 18 years, Flourouinolones are generally not recommended
+:::* Note (3): For patients with endocarditis involving the prosthetic cardiac valve or other prosthetic cardiac material should be treated for 6 weeks
+:* 2. '''Abscess''' <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* Note: The small number of patients reported and the variety of antibiotics used, do not permit identification of the optimal therapeutic regimen for this organism.
+==Bordetella pertusis==
+{{PBI|Bordetella pertussis}}
+:* Bordetella pertussis<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis 2005 CDC Guidelines
+ | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref>
+::* 1. '''Whooping cough'''
+:::* 1.1. '''Adults'''
+::::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose on day 1 {{then}} 250 mg PO qd on 2-5 days
+::::* Preferred regimen (2): [[Erythromycin]] 2 g/day PO qid for 14 days
+::::* Preferred regimen (3): [[Clarithromycin]] 1 g PO bid for 7 days.
+::::* Alternative regimen (intolerant of macrolides): [[Trimethoprim]] 320 mg/day {{and}} [[Sulfamethoxazole]] 1600 mg/day PO bid for 14 days
+:::* 1.2. '''Infants <6 months of age'''
+::::* 1.2.1. '''Infants <1 month'''
+:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
+:::::* Preferred regimen (2) (if azithromycin unavailable): [[Erythromycin]] 40-50 mg/kg/day PO q6h for 14 days
+:::::* Note: TMP-SMX contraindicated for infants aged < 2 months
+::::* 1.2.2. '''Infants of 1-5 months of age'''
+:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
+:::::* Preferred regimen (2): [[Erythromycin]] 40-50 mg/kg/day PO qid for 14 days
+:::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days
+:::::* Alternative regimen: For infants aged ≥ 2 months [[TMP]] 8 mg/kg q24h {{and}} [[Sulfamethoxazole|SMX]] 40 mg/kg/day PO bid for 14 days
+:::* 1.3. '''Infants ≥6 months of age-children'''
+:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg single dose {{then}} 5 mg/kg (500 mg Maximum) qd for 2-5 days
+:::::* Preferred regimen (2): [[Erythromycin]] 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days
+:::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO (1 g daily Maximum) bid for 7 days
+:::::* Preferred regimen (4): [[TMP]] 8 mg/kg/day {{and}} [[Sulfamethoxazole|SMX]] 40 mg/kg/day bid for 14 days
+::* 2. '''Post exposure prophylaxis'''<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Post exposure Prophylaxis of Pertussis 2005 CDC Guidelines
+ | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref>
+:::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
+:::* Note (1):  Post exposure prophylaxis to an asymptomatic contacts within 21 days of onset of cough in the index patient can potentially prevent symptomatic infection
+:::* Note (2): Close contacts include persons who have direct contact with respiratory, oral or nasal secretions from a symptomatic patient (eg: cough, sneeze, sharing food, eating utensils, mouth to mouth resuscitation, or performing a medical examination of the mouth, nose, throat.
+:::* Note (3): Some close contacts are at high risk for acquiring severe disease following exposure to pertussis. These contacts include infants aged < 1 year , persons with some immunodeficiency conditions, or other underlying medical conditions such as chronic lung disease, respiratory insufficiency and cystic fibrosis.
+==Brucella==
+{{PBI|Brucella}}
+:* '''Brucellosis '''<ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>,<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* 1.'''Uncomplicated brucellosis in adults and children ≥8yrs of age'''
+:::* Preferred regimen: [[Doxycycline]] 100 mg  PO bid for 6 weeks {{and}} [[Streptomycin]] 1 g/day IM  for  2-3 weeks
+:::* Alternative regimen (1): [[Doxycycline]] 100 mg/day PO for six weeks {{and}} [[Gentamicin]] 5mg/kg IM  for 7-days
+:::* Alternative regimen (2): [[Gentamicin]] 5mg/kg/day IV/ IM  for 7-10 days  {{and}} [[Rifampicin]] 600–900 mg/day PO for six weeks
+::* 2. '''Complications of brucellosis'''
+:::* 2.1 '''Spondylitis'''
+::::* Preferred regimen:[[ Doxycycline]] for 3 months  {{and}} [[Streptomycin]] for 2 to 3 weeks.
+:::* 2.2 '''Neurobrucellosis'''
+::::* Preferred regimen: [[Ceftriaxone]] 2 mg IV q12h for 1 month {{and}} [[Doxycycline]] 100 mg PO bid for 4-5 month {{and}} [[Rifampicin]] 600–900 mg/day PO for  4-5 month
+:::* 2.3 '''Brucella endocarditis'''
+::::* Preferred regimen: [[Doxycycline]] {{and}} an [[Aminoglycoside]] for at least 8 weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
+::::* Note: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes
+::* 3. '''Pregnancy'''
+:::* Preferred regimen: [[Rifampin]] 900 mg PO qd  for 6 weeks
+:::* Note: Adding [[Trimethoprim-sulfamethoxazole]] can be considered, but this option should probably be avoided preceding the 13th week and after the 36th week of gestation because of concern about teratogenicity and kernicterus.
+::* 4.'''For children < 8 yrs of age'''
+:::* Preferred regimen (1): [[TMP/SMZ]] 8/40 mg/ kg/day PO bid  for 6 weeks {{and}} [[Streptomycin]] 30 mg/kg/day IM q24h  for 3 weeks
+:::* Preferred regimen (2): [[Gentamicin]] 5 mg/kg/day IM/ IV q24h for 7-10 days
+:::* Alternative regimen (1): [[TMP/SMZ]] {{and}} [[Rifampicin]] 15 mg/kg/day PO for 6 weeks
+:::* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
+{{PBI|Eikenella corrodens}}
+:* 1. '''Human bite/soft tissue infections''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1.1 '''Severe'''
+:::* Preferred regimen: [[Ampicillin sulbactam]] 1.5-3 g IV q6h
+:::* Alternative regimen (1): [[Doxycycline]] 100 mg IV bid
+:::* Alternative regimen (2): [[Moxifloxacin]] 400 mg IV q24h
+:::* Alternative regimen (3): [[Levofloxacin]] 500 mg IV q24h
+::* 1.2 '''Mild'''
+:::* Preferred regimen: [[Amoxicillin clavulanate]] 250-500 mg tid or 875/125 mg PO bid
+:::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid
+:::* Alternative regimen (2): [[Moxifloxacin]] 400 mg PO qd
+:::* Alternative regimen (3): [[Levofloxacin]] 500 mg PO qd
+:* 2. '''Head and neck infections '''
+::* 2.1 '''Severe'''
+:::* Preferred regimen: [[Ampicillin sulbactam]] 1.5-3 g IV q6h
+:::* Alternative regimen (1): [[Doxycycline]] 100 mg IV bid
+:::* Alternative regimen (2): [[Moxifloxacin]] 400 mg IV q24h
+:::* Alternative regimen (3): [[Levofloxacin]] 500 mg IV q24h
+::* 2.2 '''Mild'''
+:::* Preferred regimen: [[Amoxicillin clavulanate]] 250-500 mg tid or 875/125 mg PO bid
+:::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid
+:::* Alternative regimen (2): [[Moxifloxacin]] 400 mg PO qd
+:::* Alternative regimen (3): [[Levofloxacin]] 500 mg PO qd
+:* 3. '''Endocarditis'''
+::* Preferred regimen (1): [[Ceftriaxone]] 1 g IV q12h
+::* Preferred regimen (1): [[Cefotaxime]] 1-2 g IV q8h
+::* Preferred regimen (1): [[Cefepime]] 1-2g IV q8h
+----
+==Haemophilus ducreyi==
+{{PBI|Haemophilus ducreyi}}
+:* 1. '''Chancroid'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* Preferred Regimen (1): [[Azithromycin]] 1 g PO in a single dose
+::* Preferred Regimen (2): [[Ceftriaxone]] 250 mg IM in a single dose
+::* Preferred Regimen (3): [[Ciprofloxacin]] 500 mg PO bid for 3 days
+::* Preferred Regimen (4): [[Erythromycin]] base 500 mg PO tid for 7 days
+::* Note: Patients should be tested for HIV infection at the time chancroid is diagnosed. If the initial test results were negative, a serologic test for syphilis and HIV infection should be performed 3 months after the diagnosis of chancroid.
+::* 1.1 '''Follow-up'''
+:::* Patients should be re-examined 3–7 days after initiation of therapy. If treatment is successful, ulcers usually improve symptomatically within 3 days and objectively within 7 days after therapy. If no clinical improvement is evident, the clinician must consider whether 1) the diagnosis is correct, 2) the patient is coinfected with another STD, 3) the patient is infected with HIV, 4) the treatment was not used as instructed, or 5) the H. ducreyi strain causing the infection is resistant to the prescribed antimicrobial.
+:::* Clinical resolution of fluctuant lymphadenopathy is slower than that of ulcers and might require needle aspiration or incision and drainage, despite otherwise successful therapy. Although needle aspiration of buboes is a simpler procedure, incision and drainage might be preferred because of reduced need for subsequent drainage procedures.
+::* 1.2 '''Management of sex partners'''
+:::* Regardless of whether symptoms of the disease are present, sex partners of patients who have chancroid should be examined and treated if they had sexual contact with the patient during the 10 days preceding the patient’s onset of symptoms.
+::* 1.3 '''Pregnancy'''
+:::* [[Ciprofloxacin]] presents a low risk to the fetus during pregnancy, with a potential for toxicity during breastfeeding. Alternative drugs should be used during pregnancy and lactation
+::* 1.4 '''HIV Infection'''
+:::* Persons with HIV infection who have chancroid should be monitored closely because they are more likely to experience treatment failure and to have ulcers that heal slowly. Persons with HIV infection might require repeated or longer courses of therapy, and treatment failures can occur with any regimen.
+----
+==Haemophilus influenzae==
+{{PBI|Haemophilus influenzae}}
+:* Haemophilus influenzae<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Non- life threatening infections'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* 1.1 '''Adults'''
+::::* Preferred regimen (1): [[Amoxicillin-clavulanate]] 500 mg PO tid or 875 mg PO bid
+::::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid
+::::* Preferred regimen (3): [[TMP-SMX]] DS PO bid
+::::* Preferred regimen (4): [[Cefuroxime]] 250-500 mg PO bid
+::::* Preferred regimen (5): [[Moxifloxacin]] 400 mg PO qd
+::::* Preferred regimen (6): [[Levofloxacin]] 500 mg PO qd
+::::* Preferred regimen (7): [[Azithromycin]] 500 mg PO single dose then 250 mg for 4 days
+::::* Preferred regimen (8): [[Clarithromycin]] 500 mg PO bid or XL 500 mg PO q24h
+::::* Note: Treatment duration of otitis media is 10-14 days, acute exacerbation of chronic bronchitis is 5 days (quinolone - 14 days), sinusitis is 10-14 days.
+::* 2. '''Meningitis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* [[Dexamethasone]] 0.15 mg/kg 15-20 mins before first dose of antibiotic and then q6h for 4 days
+::::* 2.1 '''Adults'''
+:::::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q12h (4 g maximum)
+:::::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q4-6h (12 g maximum)
+:::::* Preferred regimen (3): [[Ampicillin]] 2 g IV q4h if sensitive
+:::::* Alternative regimen: [[Ciprofloxacin]] 400 mg IV q8h {{or}} other [[Fluoroquinolones]]
+::::* 2.2 '''Pediatric'''
+:::::* 2.2.1 '''Neonates < 7 days'''
+::::::* 2.2.1.1 Weight < 2 kg
+:::::::* Preferred regimen: [[Cefotaxime]] 50 mg/kg IV q12h for 10-14 days
+::::::* 2.2.1.2 Weight > 2 kg
+:::::::* Preferred regimen (1): [[Cefotaxime]] 50 mg/kg IV q8h
+:::::::* Preferred regimen (2): [[Ceftriaxone]] 50 mg/kg IV q24h for 10-14 days
+:::::* 2.2.2 '''Neonates >7 days'''
+::::::* 2.2.2.1 Weight > 2 kg
+:::::::* Preferred regimen (1): [[Cefotaxime]] 50 mg/kg IV q6-8h
+:::::::* Preferred regimen (2): [[Ceftriaxone]] 75 mg/kg IV q24h for 10-14 days
+:::::* 2.2.3 '''Children'''
+::::::* Preferred regimen (1): [[Cefotaxime]] 200 mg/kg/day IV q6h
+::::::* Preferred regimen (2): [[Ceftriaxone]] 100 mg/kg IV q12-24h for 10-14 days
+::::* 2.3 '''Post-meningitis exposure prophylaxis'''<ref name="pmid6819447">{{cite journal| author=Centers for Disease Control (CDC)| title=Prevention of secondary cases of Haemophilus influenzae type b disease. | journal=MMWR Morb Mortal Wkly Rep | year= 1982 | volume= 31 | issue= 50 | pages= 672-4, 679-80 | pmid=6819447 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6819447  }} </ref>
+:::::* Preferred regimen (1): [[Rifampin]] 600 mg PO qd for 4 days
+::* 3. '''Severe infections'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* 3.1 '''Adults'''
+::::* Preferred regimen (1): [[Ceftriaxone]] 1-2 g IV q24 or q12h
+::::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q6h
+::::* Alternative regimen (1): [[Ciprofloxacin]] 400 mg IV q8h or other [[Fluoroquinolones]]
+::::* Alternative regimen (2): [[Ampicillin]] 2 g IV q6h if sensitive
+----
+==Neisseria gonorrhoeae==
+{{PBI|Neisseria gonorrhoeae}}
+:* '''Neisseria gonorrhoeae treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* 1. '''Gonococcal infections in adolescents and adults'''
+:::* 1.1 '''Uncomplicated gonococcal infections of the cervix, urethra, and rectum'''
+::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
+::::* Alternative regimen: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose (if ceftriaxone is not available)
+:::* 1.2 '''Uncomplicated gonococcal infections of the pharynx'''
+::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
+:::::* 1.2.1 '''Management of sex partners'''
+::::::* Expedited partner therapy: [[Cefixime]] 400 mg PO in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
+::::::* Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or gonorrhea diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
+::::::* Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
+::::::* Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present.
+:::::* 1.2.2  '''Allergy, intolerance, and adverse reactions'''
+::::::* Preferred regimen (1): [[Gemifloxacin]] 320 mg PO in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
+::::::* Preferred regimen (2): [[Gentamicin]] 240 mg IM in a single dose {{and}} [[Azithromycin]] 2 g PO in a single dose
+::::::* Note: Use of ceftriaxone or cefixime is contraindicated in persons with a history of an IgE-mediated penicillin allergy (e.g., anaphylaxis, Stevens Johnson syndrome, and toxic epidermal necrolysis).
+:::::* 1.2.3 '''Pregnancy'''
+::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
+:::::* 1.2.4 '''Suspected cephalosporin treatment failure'''
+::::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
+::::::* Alternative regimen (1): [[Gemifloxacin]] 320 mg PO  single dose  {{and}} [[Azithromycin]] 2 g PO  single dose (when isolates have elevated cephalosporin MICs)
+::::::* Alternative regimen (2): [[Gentamicin]] 240 mg IM  single dose {{and}} [[Azithromycin]] 2 g PO single dose (when isolates have elevated cephalosporin MICs)
+::::::* Alternative regimen (3): [[Ceftriaxone]] 250 mg IM as a single dose {{and}} [[Azithromycin]] 2 g PO as a single dose (failure after treatment with cefixime and azithromycin)
+::::::* Note: Treatment failure should be considered in: (1) persons whose symptoms do not resolve within 3–5 days after appropriate treatment and report no sexual contact during the post-treatment follow-up period; (2) persons with a positive test-of-cure (i.e., positive culture ≥ 72 hours or positive NAAT ≥ 7 days after receiving recommended treatment) when no sexual contact is reported during the post-treatment follow-up period; (3) persons who have a positive culture on test-of-cure (if obtained) if there is evidence of decreased susceptibility to cephalosporins on antimicrobial susceptibility testing, regardless of whether sexual contact is reported during the post-treatment follow-up period.
+:::* 1.3 '''Gonococcal conjunctivitis'''
+::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1 g PO in a single dose
+::::: Note: Consider one-time lavage of the infected eye with saline solution.
+:::::* 1.3.1 '''Management of sex partners'''
+::::::* Patients should be instructed to refer their sex partners for evaluation and treatment.
+:::* 1.4 '''Disseminated gonococcal infection'''
+:::::* 1.4.1 '''Arthritis and arthritis-dermatitis syndrome '''
+::::::* Preferred regimen: [[Ceftriaxone]] 1 g IM/IV q24h for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
+::::::* Alternative regimen (1): [[Cefotaxime]] 1 g IV q8h for 7 days
+::::::* Alternative regimen (2): [[Ceftizoxime]] 1 g IV q8h  for 7 days {{and}} [[Azithromycin]] 1 g PO in a single dose
+:::::* 1.4.2 '''Gonococcal meningitis and endocarditis'''
+::::::* Preferred regimen: [[Ceftriaxone]] 1-2 g IV  q 12-24 h  for 10-14 days {{and}} [[Azithromycin]] 1 g PO in a single dose
+::* 2. '''Gonococcal infections among neonates'''
+:::* 2.1 '''Ophthalmia neonatorum caused by N. gonorrhoeae'''
+::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
+:::::* 2.1.1 '''Management of mothers and their sex partners'''
+::::::* Mothers of infants with ophthalmia neonatorum caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
+:::* 2.2 '''Disseminated gonococcal infection and gonococcal scalp abscesses in neonates'''
+::::* Preferred regimen (1): [[Ceftriaxone]] 25-50 mg/kg/day IM/IV q24h for 7 days
+::::* Preferred regimen (2): [[Cefotaxime]] 25 mg/kg IM/IV  q12h for 7 days.
+::::* Note (1): The duration of treatment is 10-14 days if meningitis is documented.
+::::* Note (2): Ceftriaxone should be administered cautiously to hyperbilirubinemic infants, especially those born prematurely.
+:::::* 2.2.1 '''Management of mothers and their sex partners'''
+::::::* Mothers of infants who have DGI or scalp abscesses caused by N. gonorrhoeae should be evaluated, tested, and presumptively treated for gonorrhea, along with their sex partner(s).
+:::* 2.3 '''Neonates born to mothers who have gonococcal infection'''
+::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
+:::::* 2.3.1 '''Management of mothers and their sex partners'''
+::::::* Mothers who have gonorrhea and their sex partners should be evaluated, tested, and presumptively treated for gonorrhea.
+::* 3. '''Gonococcal infections among infants and children'''
+:::* 3.1 '''Infants and children who weigh ≤ 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis'''
+::::* Preferred regimen: [[Ceftriaxone]] 25-50 mg/kg IM/IV in a single dose, not to exceed 125 mg
+:::* 3.2 '''Children who weigh > 45 kg and who have uncomplicated gonococcal vulvovaginitis, cervicitis, urethritis, pharyngitis, or proctitis'''
+::::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose {{and}} [[Azithromycin]] 1g PO in a single dose
+::::* Alternative regimen: [[Cefixime]] 400 mg PO  single dose {{and}} [[Azithromycin]] 1 g PO single dose.(If ceftriaxone is not available)
+:::* 3.3 '''Children who weigh ≤ 45 kg and who have bacteremia or arthritis'''
+::::* Preferred regimen: [[Ceftriaxone]] 50 mg/kg (maximum dose: 1 g) IM/IV q24h for 7 days
+:::* 3.4 '''Children who weigh > 45 kg and who have bacteremia or arthritis'''
+::::* Preferred regimen: [[Ceftriaxone]] 1 g IM/IV q24h for 7 days
+==Neisseria meningitidis==
+{{PBI|Neisseria meningitidis}}
+:* 1. '''Meningococcal meningitis or meningococcemia, treatment'''<ref name="pmid15494903">{{cite journal| author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al.| title=Practice guidelines for the management of bacterial meningitis. | journal=Clin Infect Dis | year= 2004 | volume= 39 | issue= 9 | pages= 1267-84 | pmid=15494903 | doi=10.1086/425368 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15494903  }} </ref><ref name="pmid23141618">{{cite journal| author=van de Beek D, Brouwer MC, Thwaites GE, Tunkel AR| title=Advances in treatment of bacterial meningitis. | journal=Lancet | year= 2012 | volume= 380 | issue= 9854 | pages= 1693-702 | pmid=23141618 | doi=10.1016/S0140-6736(12)61186-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23141618  }} </ref>
+::* 1.1 '''Adults'''
+:::* 1.1.1 '''Penicillin MIC < 0.1 mcg/mL'''
+::::* Preferred regimen (1): [[Penicillin G]] 4 MU IV q4h for 7 days
+::::* Preferred regimen (2): [[Ampicillin]] 2 g IV q4h for 7 days
+::::* Alternative regimen (1): [[Ceftriaxone]] 4 g/day IV q12-24h for 7 days
+::::* Alternative regimen (2): [[Cefotaxime]] 8-12 g/day IV q4-6h for 7 days
+::::* Alternative regimen (3): [[Chloramphenicol]] 4-6 g/day IV q6h for 7 days
+:::* 1.1.2 '''Penicillin MIC 0.1-1.0 mcg/mL'''
+::::* Preferred regimen (1): [[Ceftriaxone]] 4 g/day IV q12-24h for 7 days
+::::* Preferred regimen (2): [[Cefotaxime]] 8-12 g/day IV q4-6h for 7 days
+::::* Alternative regimen (1): [[Cefepime]] 2 g IV q8h for 7 days
+::::* Alternative regimen (2): [[Chloramphenicol]] 4-6 g/day IV q6h for 7 days
+::::* Alternative regimen (3): [[Moxifloxacin]] 400 mg IV q24h for 7 days
+::::* Alternative regimen (4): [[Meropenem]] 2 g IV q8h for 7 days
+::* 1.2 '''Neonates (birth-7 days old)'''
+:::* 1.2.1 '''Penicillin MIC < 0.1 mcg/mL'''
+::::* Preferred regimen (1): [[Penicillin G]] 0.15 MU/kg/day IV q8-12h for 7 days
+::::* Preferred regimen (2): [[Ampicillin]] 150 mg/kg/day IV q8h for 7 days
+::::* Alternative regimen (1): [[Cefotaxime]] 100-150 mg/kg/day IV q8-12h for 7 days
+::::* Alternative regimen (2): [[Chloramphenicol]] 25 mg/kg/day IV q24h for 7 days
+:::* 1.2.2 '''Penicillin MIC 0.1-1.0 mcg/mL'''
+::::* Preferred regimen: [[Cefotaxime]] 100-150 mg/kg/day IV q8-12h for 7 days
+::::* Alternative regimen: [[Chloramphenicol]] 25 mg/kg/day IV q24h for 7 days
+::* 1.3 '''Neonates (8-28 days old)'''
+:::* 1.3.1 '''Penicillin MIC < 0.1 mcg/mL'''
+::::* Preferred regimen (1): [[Penicillin G]] 0.2 MU/kg/day IV q6-8h for 7 days
+::::* Preferred regimen (2): [[Ampicillin]] 200 mg/kg/day IV q6-8h for 7 days
+::::* Alternative regimen (1): [[Cefotaxime]] 150-200 mg/kg/day IV q6-8h  for 7 days
+::::* Alternative regimen (2): [[Chloramphenicol]] 50 mg/kg/day IV q12-24h for 7 days
+:::* 1.3.2 '''Penicillin MIC 0.1-1.0 mcg/mL'''
+::::* Preferred regimen : [[Cefotaxime]] 150-200 mg/kg/day IV q6-8h  for 7 days
+::::* Alternative regimen : [[Chloramphenicol]] 50 mg/kg/day IV q12-24h for 7 days
+::* 1.4 '''Infants and children'''
+:::* 1.4.1 '''Penicillin MIC < 0.1 mcg/mL'''
+::::* Preferred regimen (1): [[Penicillin G]] 0.3 MU/kg/day IV q4-6h for 7 days
+::::* Preferred regimen (2): [[Ampicillin]] 300 mg/kg/day IV q6h for 7 days
+::::* Alternative regimen (1): [[Ceftriaxone]] 80-100 mg/kg/day IV q12-24h for 7 days
+::::* Alternative regimen (2): [[Cefotaxime]] 225-300 mg/kg/day IV q6-8h for 7 days
+::::* Alternative regimen (3): [[Chloramphenicol]] 75-100 mg/kg/day IV q6h for 7 days
+:::* 1.4.2 '''Penicillin MIC 0.1-1.0 mcg/mL'''
+::::* Preferred regimen (1): [[Ceftriaxone]] 80-100 mg/kg/day IV q12-24h for 7 days
+::::* Preferred regimen (2): [[Cefotaxime]] 225-300 mg/kg/day IV q6-8h for 7 days
+::::* Alternative regimen (1): [[Cefepime]] 150 mg/kg/day IV q8h for 7 days
+::::* Alternative regimen (2): [[Chloramphenicol]] 75-100 mg/kg/day q6h for 7 days
+::::* Alternative regimen (3): [[Meropenem]] 120 mg/kg/day IV q8h for 7 days
+::* Note (1): Dexamethasone has not been shown to be beneficial in meningococcal meningitis and should be discontinued once this diagnosis is established.<ref name="pmid12432041">{{cite journal| author=de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators| title=Dexamethasone in adults with bacterial meningitis. | journal=N Engl J Med | year= 2002 | volume= 347 | issue= 20 | pages= 1549-56 | pmid=12432041 | doi=10.1056/NEJMoa021334 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12432041  }}  [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12725615 Review in: ACP J Club. 2003 May-Jun;138(3):60] </ref><ref name="pmid20824838">{{cite journal| author=Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D| title=Corticosteroids for acute bacterial meningitis. | journal=Cochrane Database Syst Rev | year= 2010 | volume=  | issue= 9 | pages= CD004405 | pmid=20824838 | doi=10.1002/14651858.CD004405.pub3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20824838  }} </ref>
+::* Note (2): Clinical data are limited on the use of fluoroquinolones for therapy for meningococcal meningitis but may be considered in patients not responding to standard therapy or when disease is caused by resistant organisms.
+:* 2. '''Meningococcal meningitis, prophylaxis for household and close contacts'''<ref name="pmid15917737">{{cite journal| author=Bilukha OO, Rosenstein N, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC)| title=Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP). | journal=MMWR Recomm Rep | year= 2005 | volume= 54 | issue= RR-7 | pages= 1-21 | pmid=15917737 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15917737  }} </ref>
+::* 2.1 '''Adults'''
+:::* Preferred regimen (1): [[Rifampin]] 600 mg PO bid for 2 days
+:::* Preferred regimen (2): [[Ciprofloxacin]] 500 mg PO single dose
+:::* Preferred regimen (3): [[Ceftriaxone]] 250 mg IM single dose
+::* 2.2 '''Children < 15 years'''
+:::* Preferred regimen: [[Ceftriaxone]] 12 mg IM single dose
+::* 2.3 '''Children ≥ 1 month'''
+:::* Preferred regimen: [[Rifampin]]  10 mg /kg  PO bid for 2 days
+::* 2.4 '''Children < 1 month'''
+:::* Preferred regimen: [[Rifampin]] 5 mg/kg PO bid for 2 days
+----
+{{PBI|Moraxella catarrhalis}}
+:* ''Moraxella catarrhalis'' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen(1): [[TMP-SMX]] 1DS PO bid
+::* Preferred regimen(2): [[Erythromycin]] 500 mg PO qid
+::* Preferred regimen(3): [[Clarithromycin]] 500 mg PO bid or XL 1 g PO qd
+::* Preferred regimen(4): [[Azithromycin]] 500 mg PO single dose {{then}} 250 mg PO qd
+::* Preferred regimen(5): [[Doxycycline]] 100 mg PO/IV bid/q12h
+::* Preferred regimen(6): [[Cefprozil]] 200-500 mg PO bid
+::* Preferred regimen(7): [[Cefpodoxime]] 200-400 mg PO bid
+::* Preferred regimen(8): [[Cefuroxime]] 250-500 mg PO bid
+::* Preferred regimen(9): [[Cefdinir]] 300 mg PO bid
+::* Preferred regimen(10): [[Moxifloxacin]] 400 mg IV/PO qd
+::* Preferred regimen(11): [[Levofloxacin]] 500 mg IV/PO qd
+::* Preferred regimen(12): [[Amoxicillin clavulanate]] 875/125 mg PO bid or XL 2000/125 PO bid
+{{PBI|Pasteurella multocida}}
+:* ''Pasteurella multocida'' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Amoxicillin clavulanate]] 500 mg PO tid or 875 mg PO bid with food
+::* Note: Its also a preferred empirical coverage of animal bite wounds
+::* Preferred regimen (2): [[Ampicillin sulbactam]] 3 g IV q6h
+::* Preferred regimen (3): [[Ciprofloxacin]] 500 mg PO bid or 400 mg IV q12h
+::* Preferred regimen (4): [[Levofloxacin]] 500 mg PO qd or IV q24h
+::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid
+::* Alternative regimen (2): [[TMP-SMX]] DS PO bid (for beta-lactam allergic patients )
+::* Alternative regimen (3): [[Penicillin]] 500 mg PO qid or 4 MU IV q4h (use only if isolate known to be susceptible)
+====Bacteria – Spirochetes====
+{{PBI|Borrelia burgdorferi}}
+:* Lyme disease <ref>{{cite journal |vauthors=Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, Krause PJ, Bakken JS, Strle F, Stanek G, Bockenstedt L, Fish D, Dumler JS, Nadelman RB |title=The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America |journal=Clin. Infect. Dis. |volume=43 |issue=9 |pages=1089–134 |year=2006 |pmid=17029130 |doi=10.1086/508667 |url=}}</ref>
+::* 1. '''Early Lyme Disease'''
+:::* 1.1 '''Erythema migrans'''
+::::* 1.1.1 '''Adult'''
+:::::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 10-21 days
+:::::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid for 14-21 days
+:::::* Preferred regimen (3): [[Cefuroxime axetil]] 500 mg bid for 14-21 days
+:::::* Alternatie regimen (1): [[Azithromycin]] 500 mg PO qd for 7–10 days
+:::::* Alternatie regimen (2): [[Clarithromycin]] 500 mg PO bid for 14–21 days (if the patient is not pregnant)
+:::::* Alternatie regimen (3): [[Erythromycin]] 500 mg PO qid for 14–21 days
+::::* 1.1.2 '''Pediatric'''
+:::::* 1.1.2.1 '''children <8 years of age'''
+::::::* Preferred regimen (1): [[Amoxicillin]] 50 mg/kg/day PO q8h (Maximum of 500 mg per dose)
+::::::* Preferred regimen (2): [[Cefuroxime axetil]] 30 mg/kg/day PO q12h（Maximum, 500 mg per dose)
+::::* 1.1.2.2 '''children ≥8 years of age'''
+::::::* Preferred regimen (1): [[Doxycycline]] 4 mg/kg/day PO q12h（Maximum, 100 mg per dose）
+::::::* Preferred regimen (2): [[Azithromycin]] 10 mg/kg PO qd (Maximum, 500 mg qd)
+::::::* Preferred regimen (3): [[Clarithromycin]] 7.5 mg/kg PO bid (Maximum, 500 mg per dose)
+::::::* Preferred regimen (4): [[Erythromycin]] 12.5 mg/kg PO qid (Maximum, 500 mg per dose)
+:::* 1.2 '''When erythema migrans cannot be reliably distinguished from community-acquired bacterial cellulitis'''
+::::* Preferred regimen: [[Amoxicillin-Clavulanate]] 500 mg PO tid
+::::* Pediatric regimen: [[Amoxicillin-Clavulanate]] 50 mg/kg/day q8h (Maximum, 500 mg per dose)
+:::* 1.3 '''Lyme meningitis and other manifestations of early neurologic Lyme disease'''
+::::* 1.3.1 '''Adult'''
+:::::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 10–28 days
+:::::* Alternative regimen (1): [[Cefotaxime]] 2 g IV q8h
+:::::* Alternative regimen (2): [[Penicillin G]] 18–24 MU q4h (for patients with normal renal function)
+:::::* Alternative regimen (3): [[Doxycycline]] 200–400 mg/day PO bid for 10–28 days
+::::* 1.3.2 '''Pediatric'''
+:::::* Preferred regimen (1): [[Ceftriaxone]] 50–75 mg/kg IV single dose (Maximum, 2 g)
+:::::* Preferred regimen (2): [[Cefotaxime]] 150–200 mg/kg/day IV q6-8h (Maximum, 6 g per day)
+:::::* Alternative regimen (1): [[Penicillin G]] 200,000–400,000 units/kg/day IV  q4h (for normal renal function) (maximum, 18–24 MU per day)
+:::::* Alternative regimen (2): [[Doxycycline]] 4–8 mg/kg/day PO bid (maximum, 100–200 mg per dose) (≥8 years old)
+:::* 1.4 '''Lyme carditis'''
+::::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 10–28 days
+::::* Note: patients with advanced heart block, a temporary pacemaker may be required; expert consultation with a cardiologist is recommended; Use of the pacemaker may be discontinued when the advanced heart block has resolved; An oral antibiotic treatment regimen should be used for completion of therapy and for outpatients, as is used for patients with erythema migrans without carditis (see above)
+:::* 1.5 '''Borrelial lymphocytoma'''
+::::* Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)
+::* 2. '''Late Lyme Disease'''
+:::* 2.1 '''Lyme arthritis'''
+::::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid
+::::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid
+::::* Alternative regimen: [[Cefuroxime axetil]] 500 mg PO bid for 28 days
+::::* Pediatric regimen: [[Amoxicillin]] 50 mg/kg/day tid (Maximum, 500 mg per dose); [[Cefuroxime axetil]] 30 mg/kg/day bid (Maximum,500 mg per dose); (≥8 years of age) [[Doxycycline]] 4 mg/kg/day bid (Maximum, 100 mg per dose)
+::::* Note: For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4 weeks course of [[Ceftriaxone]] IV
+:::* 2.2 '''patients with arthritis and objective evidence of neurologic disease'''
+::::* Preferred regimen: [[Ceftriaxone]] IV for 2–4 weeks
+::::* Alternative regimen (1): [[Cefotaxime]] IV
+::::* Alternative regimen (1): [[Penicillin G]] IV
+::::* Pediatric regime: [[Ceftriaxone]]; [[Cefotaxime]]; [[Penicillin G]] IV
+:::* 2.3 '''Late neurologic Lyme disease'''
+::::* Preferred regimen: [[Ceftriaxone]] IV for 2 to 4 weeks
+::::* Alternative regimen (1): [[Cefotaxime]] IV
+::::* Alternative regimen (2): [[Penicillin G]] IV
+::::* Pediatric regimen: [[Ceftriaxone]]; [[Cefotaxime]]; [[Penicillin G]]
+:::* 2.4 '''Acrodermatitis chronica atrophicans'''
+::::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 21 days
+::::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO tid for 21 days
+::::* Preferred regimen (3): [[Cefuroxime axetil]] 500 mg PO bid for 21 days
+::* 3. '''Post–Lyme Disease Syndromes'''
+::::* Preferred regimen: Further antibiotic therapy for Lyme disease should not be given unless there are objective findings of active disease (including physical findings, abnormalities on cerebrospinal or synovial fluid analysis, or changes on formal neuropsychologic testing)
+{{PBI|Borrelia recurrentis}}
+:* 1. '''Tick-Borne Relapsing Fever''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 5-10 days
+::* Alternative regimen: [[Erythromycin]] 500 mg PO qid for 5-10 days
+::* Note: If meningitis/encephalitis present, use [[Ceftriaxone]] 2 g IV q12h for 14 days
+:* 2. '''Louse-Borne Relapsing Fever'''
+::* Preferred regimen: [[Tetracycline]] 500 mg PO single dose
+::* Alternative regimen: [[Erythromycin]] 500 mg PO single dose
+{{PBI|Leptospira}}
+:* 1. '''Severe''' <ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref> <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen: [[Penicillin]] 1.5 MU IV q6h for 5-7 days
+:* 2. '''Less severe'''
+::* Preferred regimen (1): [[Amoxycillin]]
+::* Preferred regimen (2): [[Ampicillin]]
+::* Preferred regimen (3): [[Doxycycline]] 100 mg IV/PO q12h/bid for 5-7 days
+::* Preferred regimen (4): [[Erythromycin]]
+::* Preferred regimen (5): [[Ceftriaxone]] 1 g IV q24h for 5-7 days
+::* Preferred regimen (6): [[Cefotaxime]]
+::* Preferred regimen (7): [[Quinolone]] PO
+{{PBI|Treponema pallidum}}
+:* 1. '''Syphilis Among non-HIV-Infected Persons''' <ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=[[MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports / Centers for Disease Control]] |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6403a1.htm |issn=}}</ref>
+::* 1.1 '''Primary and Secondary Syphilis'''
+:::* Preferred regimen: [[Benzathine penicillin G]] 2.4 MU IM single dose
+:::* Pediatric regimen: [[Benzathine penicillin G]] 50,000 U/kg (Maximum, 2.4 MU) IM single dose
+::* 1.2 '''Latent Syphilis'''
+:::* 1.2.1 '''Early Latent Syphilis'''
+::::* Preferred regimen: [[Benzathine penicillin G]] 2.4 MU IM in a single dose
+::::* Pediatric regimen: [[Benzathine penicillin G]] 50,000 U/kg (Maximum, 2.4 MU) IM single dose
+:::* 1.2.2 '''Late Latent Syphilis or Latent Syphilis of Unknown Duration'''
+::::* Preferred regimen: [[Benzathine penicillin G]] 7.2 MU total, administered as 3 doses of 2.4 MU IM each at 1 week intervals
+::::* Pediatric regimen: [[Benzathine penicillin G]] 50,000 U/kg IM (Maximum, 2.4 MU), administered as 3 doses at 1 week intervals (total 150,000 U/kg up to the adult total dose of 7.2 MU)
+::* 1.3 '''Tertiary Syphilis'''
+:::* Preferred regimen: [[Benzathine penicillin G]] 7.2 MU total, administered as 3 doses of 2.4 MU IM each at 1 week intervals
+::* 1.4 '''Neurosyphilis and ocular syphilis'''
+:::* Preferred regimen: [[Aqueous crystalline penicillin G]] 18-24 MU per day, administered as 3-4 MU IV q4h or continuous infusion, for 10-14 days
+:::* Alternative regimen: [[Procaine penicillin]] 2.4 MU IM q24h {{and}} [[Probenecid]] 500 mg PO qid for 10-14 days
+:* 2. '''Syphilis Among HIV-Infected Persons'''
+::* 2.1 '''Primary and Secondary Syphilis Among HIV-Infected Persons'''
+:::* Preferred regimen: [[Benzathine penicillin G]] 2.4 MU IM single dose
+::* 2.2 '''Latent Syphilis Among HIV-Infected Persons'''
+:::* 2.2.1 '''early latent'''
+::::* Preferred regimen: [[Benzathine penicillin G]] 2.4 MU IM single dose
+:::* 2.2.2 '''late latent'''
+::::* Preferred regimen: [[Benzathine penicillin G]] 2.4 MU once a week for 3 weeks
+::* 2.3 '''Neurosyphilis Among HIV-Infected Persons'''
+:::* Preferred regimen: [[Aqueous crystalline penicillin G]] 18-24 MU per day, administered as 3-4 MU IV q4h or continuous infusion, for 10-14 days
+:::* Alternative regimen: [[Procaine penicillin]] 2.4 MU IM q24h {{and}} [[Probenecid]] 500 mg PO qid  for 10-14 days
+:* 3. '''Syphilis During Pregnancy'''
+::* Pregnant women should be treated with the [[penicillin]] regimen appropriate for their stage of infection
+:* 4. '''Congenital Syphilis in neonates'''
+::* 4.1 '''condition1''': Infants with proven or highly probable disease and (1) an abnormal physical examination that is consistent with congenital syphilis;（2）a serum quantitative nontreponemal serologic titer that is fourfold higher than the mother's titer; or（3）a positive darkfield test of body fluid(s).
+:::* Preferred regimen (1): [[Aqueous crystalline penicillin G]] 100,000-150,000 U/kg/day, administered as 50,000 U/kg/dose IV q12h during the first 7 days of life and q8h thereafter for a total of 10 days
+:::* Preferred regimen (2): [[Procaine penicillin G]] 50,000 U/kg/dose IM q24h for 10 days
+:::* Note: If more than 1 day of therapy is missed, the entire course should be restarted. Data are insufficient regarding the use of other antimicrobial agents (e.g., ampicillin). When possible, a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis. The use of agents other than penicillin requires close serologic follow-up to assess adequacy of therapy. In all other situations, the maternal history of infection with T. pallidum and treatment for syphilis must be considered when evaluating and treating the infant.
+::* 4.2 '''condition2''': Infants who have a normal physical examination and a serum quantitive nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1) mother was not treated, inadequately treated, or has no documentation of having received treatment; (2) mother was treated with erythromycin or another nonpenicillin regimen; or (3) mother received treatment <4 weeks before delivery.
+:::* Preferred regimen (1): [[Aqueous crystalline penicillin G]] 100,000-150,000 U/kg/day, administered as 50,000 U/kg/dose IV q12h during the first 7 days of life and q8h thereafter for a total of 10 days
+:::* Preferred regimen (2): [[Procaine penicillin G]] 50,000 U/kg/dose IM q24h for 10 days
+:::* Preferred regimen (3): [[Benzathine penicillin G]] 50,000 U/kg/dose IM single dose
+:::* Note: If the mother has untreated early syphilis at delivery, 10 days of parenteral therapy can be considered
+::* 4.3 '''condition3''': Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1) mother was treated during pregnancy, treatment was appropriate for the stage of infection, and treatment was administered >4 weeks before delivery and (2) mother has no evidence of reinfection or relapse.
+:::* Preferred regimen: [[Benzathine penicillin G]] 50,000 U/kg/dose IM single dose
+::* 4.4 '''condition4''': Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1) mother's treatment was adequate before pregnancy; and (2) mother's nontreponemal serologic titer remained low and stable before and during pregnancy and at delivery (VDRL <1:2; RPR <1:4).
+:::* No treatment is required
+:::* [[Benzathine penicillin G]] 50,000 U/kg IM single dose might be considered, particularly if follow-up is uncertain.
+:* 5. '''Congenital Syphilis in infants and children'''
+:::* Preferred regimen: [[Aqueous crystalline penicillin G]] 50,000 U/kg q4–6h for 10 days
+====Bacteria – Gram-Negative Bacilli====
+{{PBI|Achromobacter xylosoxidans}}
+:* Achromobacter xylosoxidans treatment<ref name="pmid17283625">{{cite journal| author=Neuwirth C, Freby C, Ogier-Desserrey A, Perez-Martin S, Houzel A, Péchinot A et al.| title=VEB-1 in Achromobacter xylosoxidans from cystic fibrosis patient, France. | journal=Emerg Infect Dis | year= 2006 | volume= 12 | issue= 11 | pages= 1737-9 | pmid=17283625 | doi=10.3201/eid1211.060143 | pmc=PMC3372329 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17283625  }} </ref>,<ref name="pmid15664479">{{cite journal| author=Sader HS, Jones RN| title=Antimicrobial susceptibility of uncommonly isolated non-enteric Gram-negative bacilli. | journal=Int J Antimicrob Agents | year= 2005 | volume= 25 | issue= 2 | pages= 95-109 | pmid=15664479 | doi=10.1016/j.ijantimicag.2004.10.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15664479  }} </ref>,<ref name="pmid19889520">{{cite journal| author=Almuzara M, Limansky A, Ballerini V, Galanternik L, Famiglietti A, Vay C| title=In vitro susceptibility of Achromobacter spp. isolates: comparison of disk diffusion, Etest and agar dilution methods. | journal=Int J Antimicrob Agents | year= 2010 | volume= 35 | issue= 1 | pages= 68-71 | pmid=19889520 | doi=10.1016/j.ijantimicag.2009.08.015 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19889520  }} </ref>,<ref name="pmid23727271">{{cite journal| author=Wang M, Ridderberg W, Hansen CR, Høiby N, Jensen-Fangel S, Olesen HV et al.| title=Early treatment with inhaled antibiotics postpones next occurrence of Achromobacter in cystic fibrosis. | journal=J Cyst Fibros | year= 2013 | volume= 12 | issue= 6 | pages= 638-43 | pmid=23727271 | doi=10.1016/j.jcf.2013.04.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23727271  }} </ref>,<ref name="pmid22404460">{{cite journal| author=Atalay S, Ece G, Samlioğlu P, Kose S, Maras G, Gonullu M| title=Clinical and microbiological evaluation of eight patients with isolated Achromobacter xylosoxidans. | journal=Scand J Infect Dis | year= 2012 | volume= 44 | issue= 10 | pages= 798-801 | pmid=22404460 | doi=10.3109/00365548.2012.664780 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22404460  }} </ref>,<ref name="pmid23449384">{{cite journal| author=Ciofu O, Hansen CR, Høiby N| title=Respiratory bacterial infections in cystic fibrosis. | journal=Curr Opin Pulm Med | year= 2013 | volume= 19 | issue= 3 | pages= 251-8 | pmid=23449384 | doi=10.1097/MCP.0b013e32835f1afc | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23449384  }} </ref>
+::* Preferred regimen: most active agents are [[Piperacillin-Tazobactam]], [[Meropenem]] {{and}} [[Trimethoprim]]–[[Sulfamethoxazole]] whereas [[Ceftazidime]] is more active than [[Cefepime]]
+::* Alternative regimen: [[Colistin]] inhaled, could also be considered
+::* Note : Achromobacter (formerly Alcaligenes) xylosoxidans is a newly emerging microorganism isolated with increased frequency from the lungs of patients with cystic fibrosis. Combination therapy has been recommended for the treatment of Achromobacter xylosoxidans pulmonary exacerbations in cystic fibrosis
+==Acinetobacter baumannii==
+{{PBI|Acinetobacter baumannii}}
+:* Acinetobacter baumannii<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Imipenem]] 0.5-1 g IV q6h
+::* Preferred regimen (2): [[Ampicillin/sulbactam]] 3 g IV q4h
+::* Preferred regimen (3): [[Cefepime]] 1-2 g IV q8h
+::* Preferred regimen (4): [[Colistin]] 2.5 mg/kg IV q12h
+::* Preferred regimen (5): [[Tigecycline]] 100 mg IV single dose {{then}} 50 mg IV q12h
+::* Preferred regimen (6): [[Amikacin]] 7.5 mg/kg IV q12h or 15 mg/kg IV q24h
+::* Preferred regimen (7) (pan-resistant isolates): [[Colistin]] 5 mg/kg/day IV q12h {{withorwithout}} [[Imipenem]]
+::* Preferred regimen (8) (pan-resistant isolates): [[Ampicillin-sulbactam]] 3 g IV q4h
+::* Alternative regimen (1): [[Ceftriaxone]] 1-2 g IV qd
+::* Alternative regimen (2): [[Cefotaxime]] 2-3 g IV q6-8h
+::* Alternative regimen (3): [[Ciprofloxacin]] 400 mg IV q8-12h or 750 mg PO bid
+::* Alternative regimen (4): [[TMP-SMX]] 15-20 mg (TMP)/kg/day IV q6-8h or 2 DS PO bid
+==Aeromonas hydrophila==
+{{PBI|Aeromonas hydrophila}}
+:* Aeromonas hydrophila <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::*1. '''Diarrhea'''
+:::* Preferred regimen (if not self-limiting, or if severe): [[Ciprofloxacin]] 500 mg PO bid.
+:::* Alternate regimen: [[TMP-SMX]] 1 DS PO bid
+:::* Note: High resistance to sulfa agents described in Taiwan and Spain
+::*2. '''Skin and soft tissue infection'''
+:::*2.1 '''Mild infection'''
+::::* Preferred regimen (1): [[Ciprofloxacin]] 500 mg PO bid
+::::* Preferred regimen (2): [[Levofloxacin]] 500 mg qd
+:::*2.2 '''Severe infection or sepsis'''
+::::* Preferred regimen (1): [[Ciprofloxacin]] 400 mg IV q8h
+::::* Preferred regimen (2): [[Levofloxacin]] 750 mg IV q24h
+::::*Note (1): For suspicion of water-based injury,empiric coverage for Vibrio doxycycline 100 mg bid, although flouroquinolones may also cover and vancomycin 15 mg/kg IV q12h with or without clindamycin or linezolid for inhibition of gram-positive toxin production
+::::* Note (2): Alternatives to fluoroquinolones for Aeromonas coverage include carbapenems (ertapenem, doripenem, imipenem or meropenem), ceftriaxone, cefepime and aztreonam
+::*3. '''Prevention'''
+:::*Preferred regimen: Frequent recommendations include using a [[Cephalosporin]] (e.g.,cefuroxime,ceftriaxone or cefixime) {{or}} a [[Fluoroquinolone]] (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches
+:::*Note (1): Duration of antibiotic use is 3-5 days, some recommend continuing until wound or eschar resolves
+:::*Note (2): Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones
+==Bartonella==
+{{PBI|Bartonella}}
+:* Bartonella<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Bartonella quintana'''
+:::* 1.1 '''Acute or chronic infections without endocarditis'''<ref name="pmid12821469">{{cite journal| author=Foucault C, Raoult D, Brouqui P| title=Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia. | journal=Antimicrob Agents Chemother | year= 2003 | volume= 47 | issue= 7 | pages= 2204-7 | pmid=12821469 | doi= | pmc=PMC161867 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12821469  }} </ref>
+::::* Preferred regimen: [[Doxycycline]] 200 mg PO qd or 100 mg bid for 4 weeks {{and}} [[Gentamicin]] 3 mg/kg IV qd for the first 2 weeks
+:::* 1.2 '''Endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
+::::* Preferred regimen: [[Gentamicin]] 3 mg/kg/day IV q8h for 14 days {{and}} [[Ceftriaxone]] 2 g IV q24h for 6 weeks {{withorwithout}} [[Doxycycline]] 100 mg PO bid for 6 weeks
+::* 2. '''Bartonella elizabethae'''
+:::* 2.1 '''Endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
+::::* Preferred regimen: [[Gentamicin]] 3 mg/kg/day IV q8h for 14 days {{and}}  [[Ceftriaxone]] 2 g IV q24h for 6 weeks {{withorwithout}} [[Doxycycline]] 100 mg PO bid for 6 weeks
+::* 3. '''Bartonella bacilliformis'''
+:::* 3.1 '''Oroya fever'''
+::::* Preferred regimen: [[Ciprofloxacin]] 500 mg PO bid for 14 days
+::::* Note: If severe disease, add [[Ceftriaxone]] 1 g IV qd for 14 days
+:::* 3.2 '''Verruga peruana'''<ref>Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.</ref>
+::::* Preferred regimen: [[Azithromycin]] 500 mg PO qd for 7 days
+::::* Alternative regimen (1): [[Rifampin]] 600 mg PO qd for 14-21 days
+::::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg bid for 7-10 days
+::* 4. '''Bartonella henselae'''<ref name="pmid15155180">{{cite journal| author=Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D| title=Recommendations for treatment of human infections caused by Bartonella species. | journal=Antimicrob Agents Chemother | year= 2004 | volume= 48 | issue= 6 | pages= 1921-33 | pmid=15155180 | doi=10.1128/AAC.48.6.1921-1933.2004 | pmc=PMC415619 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15155180  }} </ref>
+:::* 4.1 '''Cat scratch disease'''
+::::* No treatment recommended for typical cat scratch disease, consider treatment if there is an extensive lymphadenopathy
+::::* 4.1.1 '''If extensive lymphadenopathy'''
+:::::* Preferred regimen (1) (pediatrics): [[Azithromycin]] 500 mg PO on day 1 {{then}} 250 mg PO qd on days 2 to 5
+:::::* Preferred regimen (2) (adults): [[Azithromycin]] 1 g PO at day 1 {{then}} 500 mg PO for 4 days
+:::* 4.2 '''Endocarditis'''
+::::* Preferred regimen: [[Gentamicin]] 3 mg/kg/day IV q8h for 14 days {{and}}  [[Ceftriaxone]] 2 g/day IV for 6weeks {{withorwithout}} [[Doxycycline]] 100 mg PO bid for 6 weeks
+:::* 4.3 '''Retinitis'''
+::::* Preferred regimen: [[Doxycycline]] 100 mg bid {{and}}  [[Rifampin]] 300 mg bid PO for 4-6 weeks
+:::* 4.4 '''Bacillary angiomatosis'''<ref name="pmid9494835">{{cite journal| author=Spach DH, Koehler JE| title=Bartonella-associated infections. | journal=Infect Dis Clin North Am | year= 1998 | volume= 12 | issue= 1 | pages= 137-55 | pmid=9494835 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9494835  }} </ref>
+::::* Preferred regimen (1): [[Erythromycin]] 500 mg PO qid for 2 months at least
+::::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 2 months at least
+:::* 4.5 '''Bacillary Pelliosis'''<ref name="pmid9494835">{{cite journal| author=Spach DH, Koehler JE| title=Bartonella-associated infections. | journal=Infect Dis Clin North Am | year= 1998 | volume= 12 | issue= 1 | pages= 137-55 | pmid=9494835 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9494835  }} </ref>
+::::* Preferred regimen (1): [[Erythromycin]] 500 mg PO qid  for 4 months at least
+::::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 4 months at least
+----
+==Bordetella pertussis==
+{{PBI|Bordetella pertussis}}
+:*Bordetella pertussis<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis 2005 CDC Guidelines
+ | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref>
+::* 1. '''Whooping cough'''
+:::* 1.1 '''Adults'''
+::::* Preferred regimen (1): [[Azithromycin]] 500 mg PO single dose on day 1 {{then}} 250 mg PO qd on 2-5 days
+::::* Preferred regimen (2): [[Erythromycin]] 2 g/day PO qid for 14 days
+::::* Preferred regimen (3): [[Clarithromycin]] 1 g PO bid for 7 days.
+::::* Alternative regimen (intolerant of macrolides): [[Trimethoprim]] 320 mg/day {{and}} [[Sulfamethoxazole]] 1600 mg/day PO bid for 14 days
+:::* 1.2 '''Infants <6 months of age'''
+::::* 1.2.1 '''Infants <1 month'''
+:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
+:::::* Preferred regimen (2) (if azithromycin unavailable): [[Erythromycin]] 40-50 mg/kg/day PO q6h for 14 days
+:::::* Note: TMP-SMX contraindicated for infants aged < 2 months
+::::* 1.2.2 '''Infants of 1-5 months of age'''
+:::::* Preferred regimen (1): [[Azithromycin]] 10 mg/kg PO qd for 5 days
+:::::* Preferred regimen (2): [[Erythromycin]] 40-50 mg/kg/day PO qid for 14 days
+:::::* Preferred regimen (3): [[Clarithromycin]] 15 mg/kg PO bid for 7 days
+:::::* Alternative regimen: For infants aged ≥ 2 months [[TMP]] 8 mg/kg q24h {{and}} [[Sulfamethoxazole|SMX]] 40 mg/kg/day PO bid for 14 days
+:::* 1.3 '''Infants ≥6 months of age-children'''
+:::::* Preferred regimen(1): [[Azithromycin]] 10 mg/kg single dose {{then}} 5 mg/kg (500 mg Maximum) qd for 2-5 days
+:::::* Preferred regimen(2): [[Erythromycin]] 40-50 mg/kg PO (2 g daily Maximum) qid for 14 days
+:::::* Preferred regimen(3): [[Clarithromycin]] 15 mg/kg PO (1 g daily Maximum) bid for 7 days
+:::::* Preferred regimen(4): [[TMP]] 8 mg/kg/day {{and}} [[Sulfamethoxazole|SMX]] 40 mg/kg/day bid for 14 days
+::* 2. '''Post exposure prophylaxis'''<ref>{{Cite web | title = Recommended Antimicrobial Agents for the Treatment and Post exposure Prophylaxis of Pertussis 2005 CDC Guidelines
+ | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5414a1.htm#tab4}}</ref>
+:::* Preferred regimen: The antibiotic regimens for post exposure prophylaxis are similar to the regimens used for the treatment of pertussis
+:::* Note (1):  Post exposure prophylaxis to an asymptomatic contacts within 21 days of onset of cough in the index patient can potentially prevent symptomatic infection
+:::* Note (2): Close contacts include persons who have direct contact with respiratory, oral or nasal secretions from a symptomatic patient (eg: cough, sneeze, sharing food, eating utensils, mouth to mouth resuscitation, or performing a medical examination of the mouth, nose, throat.
+:::* Note (3): Some close contacts are at high risk for acquiring severe disease following exposure to pertussis. These contacts include infants aged < 1 year , persons with some immunodeficiency conditions, or other underlying medical conditions such as chronic lung disease, respiratory insufficiency and cystic fibrosis.
+----
+==Burkholderia cepacia==
+{{PBI|Burkholderia cepacia}}
+:* Burkholderia cepacia complex<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Ceftazidime]] 2 g IV q8h
+::* Preferred regimen (2): [[Imipenem]] 1 g IV q6h
+::* Preferred regimen (3): [[Meropenem]] 1-2 g IV q8h
+::* Preferred regimen (4): [[Minocycline]] 100 mg IV/PO bid
+==Burkholderia pseudomallei==
+{{PBI|Burkholderia pseudomallei}}
+:* Burkholderia pseudomallei
+::* 1. '''Melioidosis'''<ref name="pmid22970946">{{vcite2 journal |vauthors=Wiersinga WJ, Currie BJ, Peacock SJ |title=Melioidosis |journal=N. Engl. J. Med. |volume=367 |issue=11 |pages=1035–44 |year=2012 |pmid=22970946 |doi=10.1056/NEJMra1204699 |url= |issn=}}</ref>
+:::* 1.1 '''Intial intensive therapy''' (Minimum of 10-14 days)
+::::* Preferred regimen (1): [[Ceftazidime]] 50 mg/kg upto 2 g q6h
+::::* Preferred regimen (2): [[Meropenem]] 25 mg/kg upto 1 g q8h
+::::* Preferred regimen (3): [[Imipenem]] 25 mg/kg upto 1 g q6h
+::::* Note: Any one of the three may be combined with [[TMP-SMX]] 6/30 mg/kg upto 320/1600 mg/kg q12h (recommended for neurologic, bone, joint, cutaneous and prostatic melioidosis)
+:::* 1.2 '''Eradication therapy''' (Minimum of 3 months)
+::::* Preferred regimen: [[TMP-SMX]] 6/30 mg/kg upto 320/1600 mg/kg q12h
+----
+==Campylobacter fetus==
+{{PBI|Campylobacter fetus}}
+:* Campylobacter fetus<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* 1. '''Gastroenteritis'''
+:::* Preferred regimen: [[Gentamicin]] 5 mg/kg IV q24h
+:::* Alternative regimen (1): [[Ampicillin]] 100 mg/kg IV  q6h
+:::* Alternative regimen (2): [[Imipenem]] 500 mg IV q6h
+{{PBI|Campylobacter jejuni}}
+:* Campylobacter jejuni
+::* 1. '''Gastroenteritis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Most patients donot require antibiotics and symptoms last < 1 week
+:::* 1.1 '''Indications for the treatment'''
+::::* Highfevers
+::::* Bloodystools
+::::* Prolonged illness > 1 week
+::::* Pregnancy
+::::* HIV and other immunosuppressed states
+:::* 1.2 '''Treatment regimen''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::::* Preferred regimen (1):[[Erythromycin|Erythromycin stearate]] 500 mg PO bid for 5 days
+::::* Preferred regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 3–5 days
+::::* Alternative regimen (1): [[TMP-SMX]] DS PO bid for 3–5 days
+::::* Note (1): Campylobacter resistance to TMP-SMX common in tropics
+::::* Note (2): Extraintestinal infections should be treated for longer duration (e.g.,2-4 weeks)
+----
+==Capnocytophaga canimorsus==
+{{PBI|Capnocytophaga canimorsus}}
+:* Capnocytophaga canimorsus<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Severe cellulitis/sepsis or endocarditis'''
+:::* Preferred regimen (1) (Beta-lactam/beta-lactamase inhibitor): [[Ampicillin]]/[[sulbactam]] 3 g IV q6h
+:::* Preferred regimen (2) (Non-beta-lactamase producing): [[Penicillin G]] 2-4 MU IV q24h
+:::* Alternative regimen (1): [[Ceftriaxone]] 1-2 g IV q24h
+:::* Alternative regimen (2): [[Meropenem]] 1 g IV q8h
+:::* Alternative regimen (3) (complicated infections or immunocompromise): [[Clindamycin]] 600 mg IV q8h may be combined with above agents
+:::* Note (1): Resistance to aztreonam described, and variable susceptibility reported to TMP-SMX and aminoglycosides
+:::* Note (2): For endocarditis, alternatives to penicillins not well established, treated for duration of 6 weeks
+:::* Note (3): For non-endocarditis infections, duration not well established, but most authorities recommend at least 14-21 days of therapy
+::* 2. '''Mild cellulitis/dog or cat bites'''
+:::* Preferred regimen (1): [[Amoxicillin/clavulanate]] 500 mg PO q8h or 875 mg PO bid
+:::* Preferred regimen (2): [[Amoxicillin]] 500 mg PO q8h
+:::* Alternative regimen (1): [[Clindamycin]] 300 mg PO q6h
+:::* Alternative regimen (2): [[Doxycycline]] 100 mg PO bid
+:::* Alternative regimen (3): [[Clarithromycin]] 500 mg PO bid
+:::* Alternative regimen (4): [[Moxifloxacin]] 400 mg PO qd
+::* 3. '''Meningitis or brain abscess'''
+:::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q12h {{and}} [[Ampicillin]] 2 g IV q4h
+:::* Preferred regimen (2) (if beta-lactamase producing or polymicrobial brain abscess): [[Imipenem]]/[[Cilastin]] 1000 mg q6-8h {{and}} [[Clindamycin]] 600 mg IV q8h
+::* 4. '''Prevention'''
+:::* Although no firm data supports this recommendation, many clinicians do give prophylaxis for dog and cat bites in asplenic patients with [[Amoxicillin/clavulanate]] for 7-10 days.
+----
+==Citrobacter freundii==
+{{PBI|Citrobacter freundii}}
+:* Citrobacter freundii<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Meropenem]] 1-2 g IV q8h
+::* Preferred regimen (2): [[Imipenem]] 1 g IV q6h
+::* Preferred regimen (3): [[Doripenem]] 500 mg IV q8h
+::* Preferred regimen (4): [[Cefepime]] 1-2 g IV q8h
+::* Preferred regimen (5): [[Ciprofloxacin]] 400 mg IV q12h or 500 mg PO bid for UTI
+::* Preferred regimen (6): [[Gentamicin]] 5 mg/kg IV q24h
+::* Alternate regimen (1): [[Piperacillin-tazobactam]] 3.375 mg IV q6h
+::* Alternate regimen (2): [[Aztreonam]] 1-2 g IV q6h
+::* Alternate regimen (3): [[TMP-SMX]] 5 mg/kg q6h IV or DS PO bid for UTI
+::* Note: Usually carbenicillin sensitive, cephalothin resistant
+==Citrobacter koseri==
+{{PBI|Citrobacter koseri}}
+:* Citrobacter koseri<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Ceftriaxone]] 1-2 g IV q12-24h
+::* Preferred regimen (2): [[Cefotaxime]] 1-2 g IV q6h
+::* Preferred regimen (3): [[Cefepime]] 1-2 IV q8h
+::* Alternate regimen (1): [[Ciprofloxacin]] 400 mg IV q12h or 500 mg PO q12h for UTI
+::* Alternate regimen (2): [[Imipenem]] 1 g IV q6h
+::* Alternate regimen (3): [[Doripenem]] 500 mg IV q8h
+::* Alternate regimen (4): [[Meropenem]] 1-2 g IV q8h
+::* Alternate regimen (5): [[Aztreonam]] 1-2 g IV q6h
+::* Alternate regimen (6): [[TMP-SMX]] 5 mg/kg IV q6h  or DS PO bid for UTI
+::* Note: Usually Ampicillin resistant, but may be sensitive to first generation cephalosporins
+----
+{{PBI|Elizabethkingia meningoseptica}}
+:* 1. '''Bacteremia'''<ref>{{Cite journal| doi = 10.1007/s10096-011-1223-0| issn = 1435-4373| volume = 30| issue = 10| pages = 1271–1278| last1 = Hsu| first1 = M.-S.| last2 = Liao| first2 = C.-H.| last3 = Huang| first3 = Y.-T.| last4 = Liu| first4 = C.-Y.| last5 = Yang| first5 = C.-J.| last6 = Kao| first6 = K.-L.| last7 = Hsueh| first7 = P.-R.| title = Clinical features, antimicrobial susceptibilities, and outcomes of Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteremia at a medical center in Taiwan, 1999-2006| journal = European Journal of Clinical Microbiology & Infectious Diseases: Official Publication of the European Society of Clinical Microbiology| date = 2011-10| pmid = 21461847}}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen (1): [[Levofloxacin]] 750 mg IV/PO q24h
+::* Preferred regimen (2): [[TMP-SMX]] 8–10 mg/kg/day IV divided q6–8h
+::* Alternative regimen (1): [[Ciprofloxacin]] 400 mg IV q12h
+::* Alternative regimen (2): [[TMP-SMX]] 8–10 mg/kg/day IV divided q6–8h
+----
+==Enterobacter==
+{{PBI|Enterobacter}}
+:* '''Enterobacter species including <i>E. aerogenes</i> and <i>E. cloacae</i>'''<ref>{{Cite journal| issn = 0893-8512| volume = 10| issue = 2| pages = 220–241| last1 = Sanders| first1 = W. E.| last2 = Sanders| first2 = C. C.| title = Enterobacter spp.: pathogens poised to flourish at the turn of the century| journal = Clinical Microbiology Reviews| date = 1997-04| pmid = 9105752| pmc = PMC172917}}</ref><ref>{{Cite journal| doi = 10.1128/CMR.00036-08| issn = 1098-6618| volume = 22| issue = 1| pages = 161–182| last = Jacoby| first = George A.| title = AmpC beta-lactamases| journal = Clinical Microbiology Reviews| date = 2009-01| pmid = 19136439| pmc = PMC2620637}}</ref><ref>{{Cite journal| doi = 10.1128/CMR.18.4.657-686.2005| issn = 0893-8512| volume = 18| issue = 4| pages = 657–686| last1 = Paterson| first1 = David L.| last2 = Bonomo| first2 = Robert A.| title = Extended-spectrum beta-lactamases: a clinical update| journal = Clinical Microbiology Reviews| date = 2005-10| pmid = 16223952| pmc = PMC1265908}}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* 1. '''Empiric antimicrobial therapy pending <i>in vitro</i> susceptibility'''
+:::* 1.1 '''Non–life-threatening infections or MDR-GNB prevalence &lt; 20%'''
+::::* Preferred regimen: [[Piperacillin-Tazobactam]] 3.375 g IV q6h {{withorwithout}} [[Aminoglycosides]]
+::::* Alternative regimen: [[Ciprofloxacin]] 400 mg IV q8–12h
+:::* 1.2 '''Life-threatening infections or MDR-GNB prevalence &gt; 20%'''
+::::* Preferred regimen: [[Meropenem]] 0.5–1 g IV q8h
+::::* Alternative regimen (1): [[Colistin]] {{and}} [[Meropenem]] 0.5–1 g IV q8h
+::::* Alternative regimen (2): [[Colistin]] {{and}} [[Imipenem]] 500 mg IV q6h
+::::* Alternative regimen (3): [[Colistin]] {{and}} [[Doripenem]] 500 mg IV q8h
+::::* Alternative regimen (4): [[Colistin]] {{and}} [[Ertapenem]] 1 g IV q24h
+::::* Alternative regimen (5): [[Colistin]] {{and}} [[Fosfomycin]] 6 g IV q6h
+::* 2. '''<i>In vitro</i> susceptibility available'''
+:::* 2.1 '''Susceptible to all tested agents'''
+::::* Preferred regimen: [[Piperacillin-Tazobactam]] 3.375 g IV q6h
+::::* Alternative regimen (1): [[Ciprofloxacin]] 400 mg IV q8–12h
+::::* Alternative regimen (2): [[Cefepime]] 2 g IV q8h (if MIC ≤ 1 μg/mL)
+:::* 2.2 '''Extended spectrum beta-lactamase (ESBL)-producing Enterobacter spp.'''
+::::* Preferred regimen: [[Meropenem]] 0.5–1 g IV q8h
+::::* Alternative regimen (1): [[Imipenem]] 500 mg IV q6h
+::::* Alternative regimen (2): [[Doripenem]] 500 mg IV q8h
+::::* Alternative regimen (3): [[Ertapenem]] 1 g IV q24h
+::::* Alternative regimen (4): [[Cefepime]] 2 g IV q8h (if MIC ≤ 1 μg/mL)
+:::* 2.3 '''Resistant to all tested agents'''
+::::* Preferred regimen: [[Colistin]] {{and}} [[Meropenem]] 0.5–1 g IV q8h
+::::* Alternative regimen (1): [[Colistin]] {{and}} [[Imipenem]] 500 mg IV q6h
+::::* Alternative regimen (2): [[Colistin]] {{and}} [[Doripenem]] 500 mg IV q8h
+::::* Alternative regimen (3): [[Colistin]] {{and}} [[Ertapenem]] 1 g IV q24h
+::::* Alternative regimen (4): [[Colistin]] {{and}} [[Minocycline]] 100 mg IV q12h
+----
+==Escherichia coli==
+{{PBI|Escherichia coli}}
+:* Escherichia coli<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Meningitits'''
+:::* Preferred regimen (1): [[Ceftriaxone]] 4 g IV q12–24h
+:::* Preferred regimen (2): [[Cefotaxime]] 8–12 g/day IV q4–6h
+:::* Alternative regimen (1): [[Aztreonam]] 6–8 g/day IV q6–8h
+:::* Alternative regimen (2): [[Gatifloxacin]] 400 mg/day IV q24h
+:::* Alternative regimen (3): [[Moxifloxacin]] 400 mg/day IV q24h
+:::* Alternative regimen (4): [[Meropenem]] 6 g/day IV q8h
+:::* Alternative regimen (5): [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day IV q6–12h
+:::* Alternative regimen (6): [[Ampicillin]] 12 g/day IV q4h
+::* 2. '''Uncomplicated urinary tract infection'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred agents (IDSA/AUA Guidelines): [[TMP-SMX]] DS PO bid for 3 days
+:::* Alternative regimen (1): [[Ciprofloxacin]] 250 mg PO bid
+:::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg XR qd for 3 days
+:::* Alternative regimen (3): [[Levofloxacin]] 250 mg PO qd for 3 days.
+:::* Alternative regimen (4): [[Nitrofurantoin]] 100 mg PO q6h
+:::* Alternative regimen (5): [[Nitrofurantoin]] macrocrystals 100 mg PO bid for 7 days
+:::* Alternative regimen (6): [[Fosfomycin]] 3 g sachet PO single dose
+:::* Note: For older patients, those with comorbidities (e.g., diabetes mellitus) use 7-10 days course.
+::* 3. '''Pyelonephritis'''
+:::* 3.1 '''Acute uncomplicated pyelonephritis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::::* Preferred regimen (1): [[Ciprofloxacin]] 500 mg bid PO for 5-7 days
+::::* Preferred regimen (2): [[Ciprofloxacin]]-[[Erythromycin]] 1000 mg q24h
+::::* Preferred regimen (3): [[Levofloxacin]] 750 mg q24h
+::::* Preferred regimen (4): [[Ofloxacin]] 400 mg bid
+::::* Preferred regimen (5): [[Moxifloxacin]] 400 mg q24h
+::::* Alternative regimen (1): [[Amoxicillin-Clavulanic acid]] 875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid
+::::* Alternative regimen (2): [[Cephalosporins|Oral Cephalosporins]]
+::::* Alternative regimen (3): [[TMP-SMX]] 2 mg/kg IV q6h PO for 14 days
+:::* 3.2 '''Acute pyelonephritis (Hospitalized)'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::::* Preferred regimen (1): [[Ciprofloxacin]] 400 mg IV q12h
+::::* Preferred regimen (2): [[Ampicillin]] and [[Gentamicin]]
+::::* Preferred regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q4-6h for 14 days
+::::* Alternative regimen (1): [[Ticarcillin-Clavulanate]] 3.1 g IV q6h
+::::* Alternative regimen (2): [[Ampicillin]]-[[Sulbactam]] 3 g IV q6h
+::::* Alternative regimen (3): [[Piperacillin-Tazobactam]] 3.375 g IV q4-6h
+::::* Alternative regimen (4): [[Ertapenem]] 1 g IV q24h
+::::* Alternative regimen (5): [[Doripenem]] 500 mg q8h for 14 days
+::* 4. '''Traveler’s diarrhea'''<ref>{{Cite web | title = The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America   | url = http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Travel%20Medicine.pdf }} </ref>
+:::* 4.1 '''Prophylaxis'''
+::::* Preferred regimen (1): [[Bismuth subsalicylate]]  two chewable tablets  qid
+::::* Preferred regimen (2): [[Norfloxacin]] 400 mg PO qd
+::::* Preferred regimen (3): [[Ciprofloxacin]] 500 mg PO qd
+::::* Preferred regimen (4): [[Rifaximin]] 200 mg  PO qd or bid
+:::* 4.2 '''Symptomatic treatment'''
+::::* Preferred regimen (1): [[Bismuth subsalicylate]] 1 oz PO every 30 min for 8 doses
+::::* Preferred regimen (2): [[Loperamide]] 4 mg PO then 2 mg after each loose stool not to exceed 16 mg daily
+:::* 4.3 '''Antibiotic treatment'''
+::::* Preferred regimen (1): [[Fluoroquinolones]], [[Norfloxacin]] 400 mg PO bid
+::::* Preferred regimen (2): [[Ciprofloxacin]] 500 mg PO bid
+::::* Preferred regimen (3): [[Ofloxacin]] 200 mg PO bid
+::::* Preferred regimen (4): [[Levofloxacin]] 500 mg PO qd
+::::* Preferred regimen (5): [[Azithromycin]] 1000 mg PO single dose
+::::* Preferred regimen (6): [[Rifaximin]] 200 mg PO tid
+::*5. '''Malacoplakia'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen (1): [[Bethanechol chloride]] {{and}} [[Ciprofloxacin]] 400 mg IV q12h
+:::* Preferred regimen (2): [[Bethanechol chloride]] {{and}} [[TMP-SMX]] 2 mg/kg (TMP component IV q6h)
+::*6. '''Bacteremia/pneumonia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen (1): [[Ceftriaxone]] 1-2 g IV q24h
+:::* Preferred regimen (2): [[Ciprofloxacin]] 400 mg IV q12h or 500 mg PO q12h
+:::* Preferred regimen (3): [[Levofloxacin]] 500 mg PO/IV q24h
+:::* Preferred regimen (4): [[Moxifloxacin]] 400 mg IV/PO q24h
+:::* Preferred regimen (5): [[Ampicillin]] 2 g IV q6h (if sensitive)
+:::* Preferred regimen (6): [[TMP-SMX]] 5-10 mg/kg/day for q6-8h IV (if sensitive)
+:::* Alternative regimen (1): [[Imipenem]], [[Meropenem]], [[Ertapenem]], [[Doripenem]]; [[Ceftazidime]], [[Cefepime]]; [[Cefazolin]] or [[Cefuroxime]] (if sensitive); [[Aztreonam]]; [[Ticarcillin]], [[Piperacillin]]; [[Piperacillin-Tazobactam]]
+:::* Alternative regimen (2): [[Ampicillin-sulbactam]] 3 g IV q6h {{and}} ([[Gentamicin]] 1.5 mg/kg IV q8h or 5-7 mg/kg/day IV {{or}} [[Tobramycin]] 5 mg/kg/day IV)
+:::* Note (1): A 7- to 14-day course of antibiotic therapy is usually recommended.
+:::* Note (2): The choice of antimicrobial agents should be based on susceptibility results.
+:::* Note (3): Monotherapy with aminoglycosides is generally not recommended for bacteremia or pneumonia.
+----
+==Francisella tularensis==
+{{PBI|Francisella tularensis}}
+:* Francisella tularensis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Tularemia'''
+:::* Preferred regimen (1): [[Streptomycin]] 1 g IM bid
+:::* Preferred regimen (2): [[Gentamicin]] 5 mg/kg IV q24h for 10 days
+:::* Preferred regimen (3) (pregnancy): [[Gentamicin]] 5 mg/kg IV q24h for 10 days
+:::* Alternative regimen (1): [[Doxycycline]] 100 mg IV  bid
+:::* Alternative regimen (2): [[Chloramphenicol]] 1 g IV q6h
+:::* Alternative regimen (3): [[Ciprofloxacin]] 400 mg IV bid until stable {{then}} PO for 14-21 days (total)
+----
+==Helicobacter pylori==
+{{PBI|Helicobacter pylori}}
+:* 1. '''Peptic ulcer disease'''<ref name="pmid22491499">{{vcite2 journal |vauthors=Malfertheiner P, Megraud F, O'Morain CA, et al. |title=Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report |journal=Gut |volume=61 |issue=5 |pages=646–64 |year=2012 |pmid=22491499 |doi=10.1136/gutjnl-2012-302084 |url= |issn=}}</ref>
+::* In patients aged 55 years or younger with no alarm features, two management options may be considered:
+::* 1.1 '''Indications for eradication therapy'''
+:::* In moderate to high prevalence of H. pylori infection (≥ 10%): Test-and-treat strategy using a validated noninvasive test (urea breathing test or stool antigen test)
+:::* In low prevalence situations: Treatment indicated after the empiric trial of acid suppression with a proton pump inhibitor for 4–8 weeks
+::* 1.2 '''Proton pump inhibitors (PPI)'''
+:::* Preferred regimen (1): [[Lansoprazole]] 30 mg q12h
+:::* Preferred regimen (2): [[Omeprazole]] 20 mg q12h
+:::* Preferred regimen (3): [[Esomeprazole]] 40 mg q24h
+:::* Preferred regimen (4): [[Rabeprazole]] 20 mg q12h
+::* 1.3 '''Regimens for Initial Treatment'''
+:::* 1.3.1 '''Triple therapy'''
+::::* Preferred regimen (1): [[Proton pump inhibitor]] standard dose bid {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Clarithromycin]] 500 mg bid  for 7-14 days
+::::* Preferred regimen (2): [[Proton pump inhibitor]] standard dose bid {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Metronidazole]] 500 mg bid for 7-14 days
+::::* Preferred regimen (3) (Levofloxacin triple therapy): [[Proton pump inhibitor]] standard dose bid {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Levofloxacin]] 500 mg bid for 10 days
+::::* Preferred regimen (4) (Rifabutin triple therapy): [[Proton pump inhibitor]] standard dose bid {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Rifabutin]] 150-300 mg/day for 10 days
+:::* 1.3.2 '''Quadruple therapy'''
+::::* Preferred regimen (1): [[Proton pump inhibitor]] standard dose bid {{and}} [[Metronidazole]] 250 mg q6h {{and}} [[Tetracycline]] 500 mg q6h {{and}} [[Bismuth]] (dose depends on preparation) for 10-14 days
+::::* Preferred regimen (2) non-bismuth quadruple therapy (concomitant therapy): Proton pump inhibitor (standard dose twice daily) for 7–14 days {{and}} [[Clarithromycin]] 500 mg bid for 7–14 days {{and}} [[Amoxicillin]] 1 g bid for 10 days {{and}} [[Metronidazole]] 250 mg qid for 7–14 days
+:::* 1.3.3 '''Sequential therapy'''
+::::* Preferred regimen: [[Proton pump inhibitor]] standard dose bid {{and}} [[Amoxicillin]] 1 g bid for 1-5 days followed by [[Proton pump inhibitor]] standard dose bid {{and}} [[Clarithromycin]] 500 mg bid {{and}} [[Tinidazole]] 500 mg bid for 6-10 days
+:::* Note: Alternative triple therapies appropriate for patients with an allergy to Amoxicillin include (Proton pump inhibitor and Clarithromycin and Metronidazole) or (Proton pump inhibitor and Tetracycline and Metronidazole)
+::* 1.5 '''Clarithromycin resistance'''
+:::* 1.5.1 Clarithromycin resistance ≥ 20%
+::::* Preferred regimen (1) (bismuth quadruple therapy): [[Proton pump inhibitor]] standard dose bid {{and}} [[Metronidazole]] 250 mg q6h {{and}} [[Tetracycline]] 500 mg q6h {{and}} [[Bismuth]] (dose depends on preparation) for 10-14 days
+::::* Preferred regimen (2) (sequential therapy): [[Proton pump inhibitor]] standard dose bid {{and}} [[Amoxicillin]] 1 g bid for 1-5 days followed by [[Proton pump inhibitor]] standard dose bid {{and}} [[Clarithromycin]] 500 mg bid {{and}} [[Tinidazole]] 500 mg bid for 6-10 days
+::::* Preferred regimen (3) non-bismuth quadruple therapy (concomitant therapy): Proton pump inhibitor (standard dose twice daily) for 7–14 days {{and}} [[Clarithromycin]] 500 mg bid for 7–14 days {{and}} [[Amoxicillin]] 1 g bid for 10 days {{and}} [[Metronidazole]] 250 mg qid for 7–14 days
+::::* Alternative regimen: [[Proton pump inhibitor]] standard dose bid {{and}} [[Amoxicillin]] 1 g bid {{and}} [[Levofloxacin]] 500 mg bid for 10 days
+:::* 1.5.2 Clarithromycin resistance < 20%
+::::* Preferred regimen (1): [[Proton pump inhibitor]] standard dose bid for 7-14 days {{and}} [[Clarithromycin]] 500 mg bid for 7–14 days {{and}} [[Amoxicillin]]  1 g bid for 7–14 days {{or}} [[Metronidazole]] 250 mg qid for 7–14 days
+::::* Preferred regimen (2): [[Proton pump inhibitor]] standard dose bid {{and}} [[Metronidazole]] 250 mg q6h {{and}} [[Tetracycline]] 500 mg q6h {{and}} [[Bismuth]] (dose depends on preparation) for 10-14 days
+::::* Alternative regimen (1):[[Proton pump inhibitor]] standard dose bid {{and}} [[Metronidazole]] 250 mg q6h {{and}} [[Tetracycline]] 500 mg q6h {{and}} [[Bismuth]] (dose depends on preparation) for 10-14 days
+::::* Alternative regimen (2): [[Proton pump inhibitor]] standard dose bid for 10 days {{and}} [[Levofloxacin]] 500 mg bid for 10 days {{and}} [[Amoxicillin]] 1 g bid for 10 days
+----
+==Klebsiella granulomatis==
+{{PBI|Klebsiella granulomatis}}
+:* Klebsiella granulomatis (formly known as Calymmatobacterium granulomatis)
+::*1. '''Granuloma inguinale (donovanosis)'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+:::* Preferred regimen: [[Azithromycin]] 1 g PO once a week or 500 mg qd for 3 weeks {{then}} until all lesions have completely healed
+:::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid for 3 weeks {{then}} until all lesions have completely healed
+:::* Alternative regimen (2): [[Ciprofloxacin]] 750 mg PO bid for at least 3 weeks {{then}} until all lesions have completely healed
+:::* Alternative regimen (3): [[Erythromycin]] base 500 mg PO qid for at least 3 weeks {{then}} until all lesions have completely healed
+:::* Alternative regimen (4): [[Trimethoprim-sulfamethoxazole]] DS (160 mg/800 mg) tablet PO bid for at least 3 weeks {{then}} until all lesions have completely healed
+==Klebsiella pneumoniae==
+{{PBI|Klebsiella pneumoniae}}
+:* '''Klebsiella pneumoniae'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Severe, nosocomial infections'''
+:::* 1.1 '''Non-ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections'''
+::::* Preferred regimen (1): [[Cefepime]] 2 g IV q8h
+::::* Preferred regimen (2): [[Ceftazidime]] 2 g IV q8h
+::::* Preferred regimen (3): [[Imipenem]] 500 mg IV q6h
+::::* Preferred regimen (4): [[Meropenem]] 1 g IV q8h
+::::* Preferred regimen (5): [[Piperacillin-tazobactam]] 4.5 g IV q6h {{and}} [[Aminoglycoside]]
+::::* Alternative regimen (1): [[Ceftriaxone]] 1 g IV q24h {{and}} [[Metronidazole]] 500 mg IV q6h or 1 g IV q12h
+::::* Alternative regimen (2): [[Moxifloxacin]] 400 mg IV/PO q24h
+:::* 1.2 '''ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections'''
+::::* Preferred regimen (1): [[Imipenem]] 500 mg IV q6h
+::::* Preferred regimen (2): [[Meropenem]] 1 g IV q8h
+::::* Preferred regimen (3): [[Ertapenem]] 1 g IV q24h
+::::* Preferred regimen (4): [[Doripenem]] 500 mg IV q8h
+::::* Note: In ESBLs, inconsistent activity is seen with aminoglycosides, fluoroquinolones, and piperacillin-tazobactam. Avoid cephalosporins.
+==Klebsiella rhinoscleromatis==
+{{PBI|Klebsiella rhinoscleromatis}}
+:* 1. '''Rhinoscleroma'''<ref>{{Cite journal| doi = 10.1007/s00405-013-2649-z| issn = 1434-4726| volume = 271| issue = 7| pages = 1851–1856| last1 = Mukara| first1 = B. K.| last2 = Munyarugamba| first2 = P.| last3 = Dazert| first3 = S.| last4 = Löhler| first4 = J.| title = Rhinoscleroma: a case series report and review of the literature| journal = European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery| date = 2014-07| pmid = 23904142}}</ref><ref>{{Cite journal| doi = 10.1086/592966| issn = 1537-6591| volume = 47| issue = 11| pages = 1396–1402| last1 = de Pontual| first1 = Loïc| last2 = Ovetchkine| first2 = Philippe| last3 = Rodriguez| first3 = Diana| last4 = Grant| first4 = Audrey| last5 = Puel| first5 = Anne| last6 = Bustamante| first6 = Jacinta| last7 = Plancoulaine| first7 = Sabine| last8 = Yona| first8 = Laurent| last9 = Lienhart| first9 = Pierre-Yves| last10 = Dehesdin| first10 = Danièle| last11 = Huerre| first11 = Michel| last12 = Tournebize| first12 = Régis| last13 = Sansonetti| first13 = Philippe| last14 = Abel| first14 = Laurent| last15 = Casanova| first15 = Jean Laurent| title = Rhinoscleroma: a French national retrospective study of epidemiological and clinical features| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2008-12-01| pmid = 18947330}}</ref><ref>{{Cite journal| doi = 10.3109/00016489.2010.539264| issn = 1651-2251| volume = 131| issue = 4| pages = 440–446| last1 = Gaafar| first1 = Hazem A.| last2 = Gaafar| first2 = Alaa H.| last3 = Nour| first3 = Yasser A.| title = Rhinoscleroma: an updated experience through the last 10 years| journal = Acta Oto-Laryngologica| date = 2011-04| pmid = 21198342}}</ref>
+::* Preferred regimen (1): [[Ciprofloxacin]] 500–750 mg PO bid for 2–3 months
+::* Preferred regimen (2): [[Levofloxacin]] 750 mg PO qd for 2–3 months
+::* Preferred regimen (3): [[Trimethoprim-Sulfamethoxazole]] 1 DS tab PO bid for 3 months {{and}} [[Rifampicin]] 300 mg PO bid for 3 months
+::* Alternative regimen: [[Tetracycline]] {{or}} [[Streptomycin]] {{or}} [[Doxycycline]]  {{or}} [[Ceftriaxone]] {{or}} [[Ofloxacin]]
+::* Note (1): The optimal duration of antimicrobial therapy remains unclear. A 6-week to 6-month course of antibiotics until histology exams and cultures are negative may be required.
+::* Note (2): Use of topical antiseptics such as Acriflavinium and Rifampin ointment has been reported with resolution of symptoms.<ref>{{Cite journal| doi = 10.1007/s00405-013-2649-z| issn = 1434-4726| volume = 271| issue = 7| pages = 1851–1856| last1 = Mukara| first1 = B. K.| last2 = Munyarugamba| first2 = P.| last3 = Dazert| first3 = S.| last4 = Löhler| first4 = J.| title = Rhinoscleroma: a case series report and review of the literature| journal = European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery| date = 2014-07| pmid = 23904142}}</ref>
+----
+==Legionella pneumophila==
+{{PBI|Legionella pneumophila}}
+:* 1.'''Atypical pneumonia (Legionnaires' disease )'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* 1.1  '''Mild pneumonia inpatient or outpatient, non immunocompromised'''
+:::* Preferred regimen (1): [[Azithromycin]] 500 mg PO qd for 3-5 days
+:::* Preferred regimen (2): [[Levofloxacin]] 500 mg PO qd for 7-10 days
+:::* Preferred regimen (3): [[Ciprofloxacin]] 500 mg PO bid for 7-10 days
+:::* Preferred regimen (4): [[Moxifloxacin]] 400 mg PO qd for 7-10 days
+:::* Preferred regimen (5): [[Clarithromycin]] 500 mg PO bid for 10-14 days
+:::* Alternative regimen (1): [[Doxycycline]] 200 mg PO loading dose, then 100 mg PO bid for 10-14 days
+:::* Alternative regimen (2): [[Erythromycin]] 500 mg PO qid for 10-14 days
+:::* Note: Patients with mild disease may be treated entirely with oral therapy.
+::* 1.2 '''Moderate to severe pneumonia or immunocompromised'''
+:::* Preferred regimen (1): [[Azithromycin]] 500 mg PO/IV  q24h for 5-7 days
+:::* Preferred regimen (2): [[Levofloxacin]] 500 mg PO/IV q24h for 7-10 days {{or}} 750 mg PO/IV q24h for 5-7 days
+:::* Alternative regimen (1): [[Ciprofloxacin]] 750 mg PO bid for 14 days
+:::* Alternative regimen (2): [[Moxifloxacin]] 400 mg PO qd for 14 days
+:::* Alternative regimen (3): [[Erythromycin]] 750-1000 mg IV q6h for 3-7 days, then 500 mg PO qid for a total course of 21 days
+:::* Alternative regimen (4): [[Clarithromycin]] 500 mg IV q12h for 3-7 days, and then 500 mg PO bid  for a total course of 21 days
+:::* Note: Severely ill patients parenteral therapy is advised until improvement is seen and oral absorption is sufficient.
+:*  2 '''Pontiac fever'''
+::*  Pontiac fever is febrile, self-limited form of Legionella infection which requires only symptomatic therapy, such as analgesics for headache. Antibiotics are not indicated.
+==Moraxella catarrhalis==
+{{PBI|Moraxella catarrhalis}}
+:* Moraxella catarrhalis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[TMP-SMX]] 1DS PO bid
+::* Preferred regimen (2): [[Erythromycin]] 500 mg PO q6h
+::* Preferred regimen (3): [[Clarithromycin]] 500 mg bid or XL 1 g PO qd
+::* Preferred regimen (4): [[Azithromycin]] 500 mg single dose {{then}} 250 mg PO qd
+::* Preferred regimen (5): [[Doxycycline]] 100 mg PO/IV bid
+::* Preferred regimen (6): Parenteral cephalosporins such as [[Cefuroxime]] {{or}} [[Cefotaxime]] {{or}} [[Ceftriaxone]]
+::* Preferred regimen (7): [[Cefprozil]] 200-500 mg PO bid
+::* Preferred regimen (8): [[Cefpodoxime]] 200-400 mg PO bid
+::* Preferred regimen (9): [[Cefuroxime]] 250-500 mg PO bid
+::* Preferred regimen (10): [[Cefdinir]] 300 mg bid
+::* Preferred regimen (11): [[Moxifloxacin]] 400 mg IV/PO qd
+::* Preferred regimen (12): [[Levofloxacin]] 500 mg IV/PO qd
+::* Preferred regimen (13): [[Amoxicillin-Clavulanate]] 875/125 mg PO bid or XL 2000/125 PO bid
+==Morganella morganii==
+{{PBI|Morganella morganii}}
+:* Morganella morganii<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Imipenem]] 500 mg IV q6h
+::* Preferred regimen (2): [[Meropenem]] 1.0 g IV q8h (adjust dose if necessary for renal function).
+::* Note (1): [[Carbapenems]] are considered first line therapy due to inducible cephalosporinases, and presence of extended-spectrum beta-lactamases in some isolates
+::* Note (2): Duration of treatment for UTI (generally complicated) is 7 days and duration of treatment for bacteremia is 14 days
+::* Note (3): [[Tigecycline]] is not reliably effective
+::* Alternative Regimen (1): [[Cefepime]] 2.0 g IV q8-12h
+::* Alternative Regimen (2): [[Ciprofloxacin]] 500 mg PO/400 mg IV q12h
+::* Alternative Regimen (3): [[Piperacillin]] 3 g IV q6h
+::* Alternative Regimen (4): [[Ticarcillin]] 3 g IV q4h
+::* Alternative Regimen (5): [[Gentamicin]]
+::* Alternative Regimen (6): [[Tobramycin]] 1 mg/kg IV q24h
+::* Alternative Regimen (7): [[Amikacin]] 3 mg/kg IV q24h
+::* Note: Aminoglycosides can be used alone for treatment of UTI
+==Plesiomonas shigelloides==
+{{PBI|Plesiomonas shigelloides}}
+:* Plesiomonas shigelloides<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Immunocompetent hosts or severe Infection'''
+:::* Preferred regimen: [[Ciprofloxacin]] 500 mg PO bid or 400 mg IV q12h
+:::* Alternative regimen (1): [[Ofloxacin]] 300 mg PO bid
+:::* Alternative regimen (2): [[Norfloxacin]] 400 mg PO bid
+:::* Alternative regimen (3): [[TMP-SMX]] DS PO bid for 3 days
+:::* Alternative regimen (4): [[Ceftriaxone]] 1-2 g IV qd in severe cases
+::* 2. '''Immunocompromised hosts'''
+:::* Preferred regimen: [[Ciprofloxacin]] 500 mg PO bid for 3 days
+:::* Alternative regimen (1): [[Ofloxacin]] 300 mg PO bid
+:::* Alternative regimen (2): [[Norfloxacin]] 400 mg PO bid
+:::* Alternative regimen (3): [[TMP-SMX]] DS PO bid for 3 days if susceptible
+==Proteus mirabilis==
+{{PBI|Proteus mirabilis}}
+:* Proteus mirabilis<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Ampicillin]] 500 mg PO q6h or 2 g IV q6h
+::* Preferred regimen (2): [[Cefuroxime]] 250 mg PO bid or 750 mg IV q8h
+::* Preferred regimen (3): [[Ciprofloxacin]] 250-500 mg PO bid or 400 mg IV q12h
+::* Preferred regimen (4): [[Levofloxacin]] 500 mg PO OD or 500 mg IV q24h
+::* Note: Duration of treatment for uncomplicated UTI 3 days, pyelonephritis 7-14 days, complicated UTI 10-21 days and bacteremia is 7-14 days
+==Indole positive Proteus species==
+:* '''Indole positive Proteus species'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Ceftriaxone]] 1 g IV q24h
+::* Preferred regimen (2): [[Imipenem]] 500 mg IV q6h
+::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q12h or 250-500 mg PO bid
+::* Preferred regimen (4): [[Levofloxacin]] 500 mg IV/PO q24h
+==Providencia==
+{{PBI|Providencia}}
+:* Providencia<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Complicated uti/bacteremia/acute prostatitis'''
+:::* Preferred regimen (1): [[Ciprofloxacin]] 500-750 mg PO q12h or 400 mg IV q8-12h
+:::* Preferred regimen (2): [[Levofloxacin]] 500 mg IV/PO q24h
+:::* Preferred regimen (3): [[Piperacillin]]-[[Tazobactam]] 3.375 mg IV q6h
+:::* Preferred regimen (4): [[Ceftriaxone]] 1-2 g IV q24h (donot use if ESBL suspected or critically ill)
+:::* Preferred regimen (5): [[Meropenem]] 1 g IV q8h (consider if critically ill or ESBL suspected)
+:::* Preferred regimen (6): [[Amikacin]] 7.5 mg/kg IV q12h
+:::* Preferred regimen (7): [[Gentamicin]]
+:::* Preferred regimen (8): [[Tobramycin]] acceptable if susceptible but many species are resistant
+:::* Note (1): Duration of treatment for (UTI) is 7 days common or 3-5 days after defervescence or control/elimination of complicating factors (e.g.,removal of foreign material catheter).
+:::* Note (2): Duration of treatment for (bacteremia) is 10-14 days or 3-5 days after defervescence or control/elimination of complicating factors
+:::* Note (3): Duration for acute prostatitis (2 weeks), shorter than chronic prostatitis (4-6 weeks)
+:::* Alternative regimen: [[TMP-SMX]] DS PO q12h for 10-14 days or [[TMP]] 5-10 mg/kg/day IV q6h
+==Pseudomonas aeruginosa==
+{{PBI|Pseudomonas aeruginosa}}
+:*Pseudomonas aeruginosa<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Cefepime]] 2 g IV q8h
+::* Preferred regimen (2): [[Ceftazidime]] 2 g IV q8h
+::* Preferred regimen (3): [[Piperacillin]] 3-4 g IV q4h in (no benefit for pseudomonas from beta-lactamase inhibitor)
+::* Preferred regimen (4): [[Ticarcillin]] 3-4 g IV q4h (no benefit for pseudomonas from beta-lactamase inhibitor)
+::* Preferred regimen (5): [[Imipenem]] 500 mg—1 g IV q6h
+::* Preferred regimen (6): [[Meropenem]] 1 g IV q8h
+::* Preferred regimen (7): [[Doripenem]] 500 mg IV q8h
+::* Preferred regimen (8): [[Ciprofloxacin]] 400 mg IV q8h or 750 mg PO q12h (for less serious infections)
+::* Preferred regimen (9): [[Aztreonam]] 2 g IV q6-8h
+::* Preferred regimen (10): [[Colistin]] 2.5 mg/kg IV q12h
+::* Preferred regimen (11): [[Polymyxin B]] 0.75-1.25 mg/kg IV q12h
+::* Preferred regimen (12): [[Gentamicin]]
+::* Preferred regimen (13): [[Tobramycin]] 1.7-2.0 mg/Kg IV q8h or 5-7 mg/kg IV
+::* Preferred regimen (14): [[Amikacin]] 2.5 mg/kg IV q12h
+::* Note: Amikacin > Tobramycin > Gentamicin with respect to P.aeruginosa susceptibility percentages at most institutions.
+==Salmonella==
+{{PBI|Salmonella}}
+:* 1. '''Salmonellosis in immunocompetent hosts'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1.1 '''Gastroenteritis'''
+:::* Antimicrobial therapy is usually not recommended for uncomplicated diarrheal illness.
+:::* 1.1.1 '''Indications for antimicrobial therapy'''
+::::* severedisease,
+::::* Age > 50 yrs
+::::* Prosthesis
+::::* Presence of valvular heart disease
+::::* Severe atherosclerosis
+::::* Cancer
+::::* Uremia
+::::* Immunosuppression
+:::* 1.1.2 Treatment regimens
+::::* Preferred regimen (1): [[TMP-SMX]] DS PO bid for 5-7 days
+::::* Preferred regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 5-7 days
+::::* Preferred regimen (3): [[Ceftriaxone]] 2 g IV q24h for 5-7 days
+::* 1.2 '''Typhoid fever'''<ref>{{Cite web | title = TYPHOID FEVER | url = http://www.nejm.org/doi/pdf/10.1056/NEJMra020201}}</ref>
+:::* 1.2.1 '''Uncomplicated typhoid'''
+::::* Preferred regimen (1) (fully susceptible): [[Fluoroquinolone]] (e.g., [[Ofloxacin]] 15 mg/kg PO qd for 5–7 days)
+::::* Preferred regimen (2) (multi drug-resistant): [[Fluoroquinolone]] ([[Ofloxacin]] 15 mg/kg PO qd for 5–7 days)
+::::* Preferred regimen (3) (quinolone-resistant): [[Azithromycin]] 8–10 mg/kg  PO qd for 7 days
+::::* Preferred regimen (4) (quinolone-resistant): [[Fluoroquinolone]] 20 mg/kg PO qd for 10-14 days
+::::* Alternative regimen (1) (fully susceptible): [[Chloramphenicol]] 50–75 mg/kg PO qd for 14-21 days
+::::* Alternative regimen (2) (fully susceptible): [[Amoxicillin]] 75–100 mg/kg PO qd for 14 days
+::::* Alternative regimen (3) (fully susceptible): [[Trimethoprim–Sulfamethoxazole]], 8 mg/kg ([[trimethoprim]])– 40 mg/kg ([[sulfamethoxazole]]) PO qd for 14 days
+::::* Alternative regimen (4) (multi drug-resistant): [[Azithromycin]] 8–10 mg/kg PO for 7 days
+::::* Alternative regimen (5) (multi drug-resistant): Third-generation cephalosporin, e.g., [[Cefixime]] 20 mg/kg PO qd for 7-14 days
+::::* Alternative regimen (6) (quinolone-resistant): Third-generation cephalosporin, e.g., [[Cefixime]] 20 mg/kg PO qd for 7-14 days
+:::* 1.2.2 '''Severe typhoid'''
+::::* Preferred regimen (1) (fully susceptible): [[Fluoroquinolone]] (e.g., [[Ofloxacin]] 15 mg/kg IV qd for 10-14 days)
+::::* Preferred regimen (2) (multi drug-resistant): [[Fluoroquinolone]] ([[Ofloxacin]] 15 mg/kg IV qd for 10-14 days)
+::::* Preferred regimen (3) (quinolone-resistant): [[Ceftriaxone]] 60 mg/kg IV qd for 10-14 days
+::::* Preferred regimen (4) (quinolone-resistant): [[Cefotaxime]] 80 mg/kg IV qd for 10-14 days
+::::* Alternative regimen (1) (fully susceptible): [[Chloramphenicol]] 100 mg/kg PO qd for 14-21 days
+::::* Alternative regimen (2) (fully susceptible): [[Ampicillin]] 100 mg/kg PO qd for 14-21 days
+::::* Alternative regimen (3) (fully susceptible): [[Trimethoprim–Sulfamethoxazole]], 8 mg/kg ([[trimethoprim]])– 40 mg/kg ([[sulfamethoxazole]]) IV qd for 10-14 days
+::::* Alternative regimen (4) (multi drug-resistant): [[Ceftriaxone]] 60 mg/kg IV qd for 10-14 days
+::::* Alternative regimen (5) (multi drug-resistant): [[Cefotaxime]] 80 mg/kg IV qd for 10-14 days
+::::* Alternative regimen (6) (quinolone-resistant): [[Fluoroquinolone]] 20 mg/kg IV qd for 10-14 days
+::* 1.3 '''Non-typhoid (serious infection)'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen (1): [[Cephalosporin|3rd generation cephalosporin]] ([[Ceftriaxone]]/[[Cefotaxime]])
+:::* Preferred regimen (2): [[Fluoroquinolone]] ([[Ciprofloxacin]], [[Levofloxacin]])
+::* 1.4 '''Bacteremia'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h
+:::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q6-8h for 7-14 days
+:::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q12h for 7-14 days
+::* 1.5 '''Vascular prosthesis infection'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen (1): [[Ceftriaxone]]
+:::* Preferred regimen (2): [[Cefotaxime]]
+:::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q12h for 6 weeks
+::* 1.6 '''Osteomyelitis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h
+:::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q6-8h
+:::* Preferred regimen (3): [[Ciprofloxacin]] 750 mg PO bid for ≥ 4 weeks
+::* 1.7 '''Arthritis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h
+:::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q6-8h for 6 weeks
+::* 1.8 '''Endocarditis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h
+:::* Preferred regimen (2): [[Cefotaxime]] 2 g IV q6-8h for 6 weeks
+::* 1.9 '''UTI'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::*Preferred regimen (1): [[Ceftriaxone]]
+:::*Preferred regimen (2): [[Cefotaxime]]
+:::*Preferred regimen (3): [[Ciprofloxacin]] IV for 1-2 weeks {{then}} ([[Ciprofloxacin|oral Ciprofloxacin]] {{or}} [[TMP-SMX]] for 6 weeks)
+::* 1.10 '''Carrier state'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen (1): [[Ciprofloxacin]] 500 mg PO bid for 4-6 weeks
+:::* Preferred regimen (2): [[TMP-SMX]] 1DS bid PO for 6 weeks
+:::* Preferred regimen (3): [[Amoxicillin]] 500 mg PO for 6 weeks
+::* 2. '''Salmonellosis in immunocompromised hosts'''
+:::* 2.1 '''HIV and salmonellosis'''<ref>{{Cite web | title = Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultOITablesOnly.pdf}}</ref>
+::::* 2.1.1 Gastroenteritis
+:::::* Preferred regimen: [[Ciprofloxacin]] 500-750 mg PO bid or 400 mg IV q12h, if susceptible
+:::::* Alternative regimen (1): [[Levofloxacin]] 750 mg PO/IV q24h
+:::::* Alternative regimen (2): [[Moxifloxacin]] 400 mg PO/IV q24h
+:::::* Alternative regimen (3): [[TMP]] 160 mg {{and}} [[sulfamethoxazole|SMX]] 800 mg PO/IV q12h
+:::::* Alternative regimen (4): [[Ceftriaxone]] 1 g IV q24h
+:::::* Alternative regimen (5): [[Cefotaxime]] 1 g IV q8h
+:::::* Duration of treatment for gastroenteritis without bacteremia
+::::::* If CD4 count ≥ 200 cells/μL: Duration of treatment is 7–14 days
+::::::* If CD4 count < 200 cells/μL: Duration of treatment is 2–6 weeks
+:::::* Duration of treatment for gastroenteritis with bacteremia
+::::::* If CD4 count ≥ 200/μL: Duration of treatment is 14 days; longer duration if bacteremia persists or if the infection is complicated (e.g., if metastatic foci of infection are present)
+::::::* If CD4 count < 200 cells/μL: Duration of treatment is 2–6 weeks
+:::::* Note: Secondary prophylaxis should be considered for
+::::::* Patients with recurrent Salmonella gastroenteritis with or without bacteremia
+::::::* Patients with CD4 < 200 cells/μL with severe diarrhea
+==Serratia marcescens==
+{{PBI|Serratia marcescens}}
+:* Serratia marcescens<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Bacteremia, pneumonia or serious infections'''
+:::* Preferred regimen (1): [[Cefepime]] 1-2 g IV q8h
+:::* Preferred regimen (2): [[Imipenem]] 0.5-1.0 g IV q6h
+:::* Preferred regimen (3): [[Ciprofloxacin]] 400 mg IV q8h
+:::* Alternative regimen (1): [[Aztreonam]]
+:::* Alternative regimen (2): [[Gentamicin]]
+:::* Alternative regimen (3): [[Amikacin]]
+:::* Alternative regimen (4): [[Piperacillin-tazobactam]] also often effective
+:::* Note: Duration depends on clinical response, usually 7-14 days
+::* 2. '''Endocarditis'''
+:::* Note: Choice dictated by sensitivities, 4 to 6 week duration of parenteral therapy.
+::* 3. '''Osteomyelitis'''
+:::* Note (1): Choice dictated by sensitivity profile, treat for 6-12 weeks depending upon response.
+:::* Note (2): Use IV treatment until stable/clinically improved (10-14 days Minimum) then may convert to oral therapy if appropriate.
+::* 4. '''UTI'''
+:::* Preferred regimen (1): [[Ciprofloxacin]] 250 mg PO bid or 400 mg IV q12h
+:::* Preferred regimen (2): [[Levofloxacin]] 250 mg PO qd or 500mg IV q24h
+:::* Note: Fluoroquinolones often sensitive but in seriously ill patient consider empiric coverage with two drugs (e.g.,beta-lactam and aminoglycoside or fluoroquinolones and carbapenem) until susceptibilities known.
+==Shigella==
+{{PBI|Shigella}}
+:* 1. '''Shigellosis''' <ref>{{Cite web | title = Guidelines for the control of shigellosis, including epidemics due to Shigella dysenteriae type 1
+ | url = http://apps.who.int/iris/bitstream/10665/43252/1/924159330X.pdf?ua=1&ua=1}}</ref>
+::* 1.1 '''Adults'''
+:::* Preferred regimen (1): [[Ciprofloxacin]] 500 mg PO bid for 3 days
+:::* Alternative regimen (1): [[Pivmecillinam]] 100 mg PO qid for 5 days
+:::* Alternative regimen (2): [[Azithromycin]] 1-1.5 g PO qd for 1 to 5 days
+::* 1.2 '''Pediatrics'''
+:::* Preferred regimen (1): [[Ciprofloxacin]] 15 mg/kg PO bid for 3 days
+:::* Alternative regimen (1): [[Pivmecillinam]] 20 mg/kg PO qid for 5 days
+:::* Alternative regimen (2): [[Ceftriaxone]] 50-100 mg/kg IM qd for 2 to 5 days
+:::* Alternative regimen (3): [[Azithromycin]] 6-20 mg/kg PO qd for 1 to 5 days
+==Stenotrophomonas maltophilia==
+{{PBI|Stenotrophomonas maltophilia}}
+:*Stenotrophomonas maltophilia<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred treatment: [[TMP-SMX]] 15-20 mg/kg/day (TMP component) IV/PO q8h
+::* Alternative treatment (1): [[Ceftazidime]] 2 g IV q8h
+::* Alternative treatment (2): [[Ticarcillin-clavulanate]] 3.1 g IV q4h
+::* Alternative treatment (3): [[Tigecycline]] 100 mg IV single dose {{then}} 50 mg IV q12h
+::* Alternative treatment (4): [[Ciprofloxacin]] 500-750 mg PO /400 mg IV q12h
+::* Alternative treatment (5): [[Moxifloxacin]] 400 mg PO/IV
+::* Alternative treatment (6): [[Levofloxacin]] 750 mg PO/IV .
+::* Alternative treatment (7) (Multiply-resistantance): [[Colistin]] 2.5 mg/kg q12h IV
+::* Note: Treatment duration uncertain, but usually ≥ 14 days
+{{PBI|Vibrio cholerae}}
+:* 1. '''WHO''' <ref>{{cite web | title = WHO. Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness.| url =http://www.who.int/cholera/publications/final%20outbreak%20booklet%20260105-OMS.pdf }}</ref> <ref>{{cite web | title = Prevention and control of cholera outbreaks: WHO policy and recommendations| url =http://www.who.int/cholera/prevention_control/recommendations/en/index4.html}}</ref>
+:::* Note: Antibiotic treatment for cholera patients with severe dehydration only
+:::* Adults
+::::* Preferred regimen: [[Doxycycline]] 300 mg po single dose
+::::* Alternative regimen: [[Tetracycline]] 12.5 mg/kg PO qid for 3 days
+:::* Pediatric
+::::* Under 12 years old
+:::::* Preferred regimen: [[Erythromycin]] 12.5 mg/kg PO qid for 3 days
+::::* Over 12 years old
+:::::* Preferred regimen: [[Doxycycline]] 300 mg po single dose
+:::::* Alternative regimen: [[Tetracycline]] 12.5 mg/kg PO qid for 3 days
+:* 2. '''Pan American Health Organization''' <ref>{{cite web | title = PAHO. Recommendations for clinical management of cholera| url =file:///Users/censhanshan/Desktop/cholera_clin_management_ENG_rev_JUN%201.pdf }}</ref>
+:::* Note: Antibiotic treatment for cholera patients with moderate or severe dehydration
+:::* 2.1 '''Adult'''
+::::* Preferred regimen: [[Doxycycline]] 300 mg po single dose
+::::* Alternative regimen (1): [[Ciprofloxacin]] 1 g PO single dose
+::::* Alternative regimen (2): [[Azithromycin]] 1 g PO single dose
+:::* 2.2 '''Pediatric'''
+::::* 2.2.1 '''Children over 3 year, who can swallow tablets'''
+:::::* Preferred regimen (1): [[Erythromycin]] 12.5 mg/kg/ PO qid for 3 days
+:::::* Preferred regimen (2): [[Azithromycin]] 20 mg/kg PO in a single dose
+:::::* Alternative regimen (1): [[Ciprofloxacin]] suspension or tablets 20 mg/kg PO single dose
+:::::* Alternative regimen (2): [[Doxycycline]] suspension or tablets 2-4 mg/kg PO single dose
+:::::* Note: Although doxycycline has been associated with a low risk of yellowing of the teeth in children, its benefits outweigh its risks
+::::* 2.2.2 '''Children under 3 year, or infants who cannot swallow tablets'''
+:::::* Preferred regimen (1): [[Erythromycin]] suspension 12.5 mg/kg/ PO qid for 3 days
+:::::* Preferred regimen (2): [[Azithromycin]] suspension 20 mg/kg PO single dose
+:::::* Alternative regimen (1): [[Ciprofloxacin]] suspension 20 mg/kg PO single dose
+:::::* Alternative regimen (2): [[Doxycycline]] syrup 2-4 mg/kg PO single dose
+:::* 2.3 '''Pregnancy'''
+::::* Preferred regimen (!): [[Erythromycin]] 500 mg/ PO qid for 3 days
+::::* Preferred regimen (2): [[Azithromycin]] 1 g PO single dose
+{{PBI|Vibrio parahaemolyticus}}
+:* [[Vibrio parahaemolyticus]] <ref>{{cite web | title = Vibrio parahaemolyticus CDC| url =http://www.cdc.gov/vibrio/vibriop.html }}</ref>
+::* 1. '''Mild to Moderate '''
+:::* Treatment is not necessary in most cases of V. parahaemolyticus infection
+:::* There is no evidence that antibiotic treatment decreases the severity or the length of the illness
+:::* Patients should drink plenty of liquids to replace fluids lost through diarrhea
+::* 2. '''Severe or prolonged illnesses'''
+:::* Preferred regimen: [[Tetracycline]] {{or}} [[Ciprofloxacin]]
+{{PBI|Vibrio vulnificus}}
+:* [[Vibrio vulnificus]] <ref>{{cite web | title = Vibrio vulnificus CDC| url =http://www.cdc.gov/vibrio/vibriov.html }}</ref>
+::* Note: If V. vulnificus is suspected, treatment should be initiated immediately because antibiotics improve survival
+::* Preferred regimen: [[Doxycycline]] 100 mg PO/IV bid for 7-14 days {{and}} [[Ceftazidime]] 1-2 g IV/IM q8h
+::* Note: A single agent regimen with a fluoroquinolone such as [[Levofloxacin]], [[Ciprofloxacin]] or [[Gatifloxacin]], has been reported to be at least as effective in an animal model as combination drug regimens with [[Doxycycline]] and a [[Cephalosporin]]
+::* Pediatric regimen: [[Doxycycline]] {{and}} [[Fluoroquinolones]]; [[trimethoprim-sulfamethoxazole]] {{and}} an [[Aminoglycoside]]
+----
+====Bacteria – Atypical Organisms====
+==Chlamydophila pneumoniae==
+{{PBI|Chlamydophila pneumoniae}}
+:* 1. '''Atypical pneumonia''' <ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* 1.1 ''' Adult'''
+:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 14-21 days
+:::* Preferred regimen (2): [[Tetracycline]] 250  mg PO qid for 14-21 days
+:::* Preferred regimen (3): [[Azithromycin]] 500 mg PO as a single dose, followed by 250 mg PO qd for 4 days
+:::* Preferred regimen (4): [[Clarithromycin]] 500 mg  PO bid for 10 days
+:::* Preferred regimen (5): [[Levofloxacin]] 500 mg IV {{or}} PO qd for 7 to 14 days
+:::* Preferred regimen (6): [[Moxifloxacin]] 400 mg PO qd for 10 days.
+::* 1.2 '''Pediatric'''
+:::* Preferred regimen (1): [[ Erythromycin]] suspension PO 50 mg/kg/day for 10 to 14 days
+:::* Preferred regimen (2): [[ Clarithromycin]] suspension PO 15 mg/kg/day for 10 days
+:::* Preferred regimen (3): [[Azithromycin ]]suspension PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days
+:* 2. '''Upper respiratory tract infection'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 2.1 '''Bronchitis'''
+:::* Antibiotic therapy for C. pneumoniae is not required.
+::* 2.2 '''Pharyngitis'''
+:::* Antibiotic therapy for C. pneumoniae is not required.
+::* 2.3 '''Sinusitis'''
+:::* Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.
+----
+==Chlamydia trachomatis==
+{{PBI| Chlamydia trachomatis}}
+:* 1 '''Chlaymydial infections '''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* 1.1 '''Chlamydial Infections in Adolescents and Adults'''
+:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days
+:::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
+:::* Alternative regimen (1): [[ Erythromycin]] base 500 mg PO qid for 7 days
+:::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO qid for 7 days
+:::* Alternative regimen (3): [[Levofloxacin]] 500 mg PO qd for 7 days
+:::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
+:::* Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.
+::* 1.2 '''Chlamydial Infections in patients with HIV Infection'''
+:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days
+:::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
+:::* Preferred regimen (3): [[Azithromycin]] 1 g PO in a single dose
+:::* Alternative regimen (1): [[ Erythromycin]] base 500 mg PO qid for 7 days
+:::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO  qid for 7 days
+:::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
+:::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
+::* 1.3 '''Pregancy'''
+:::* Preferred regimen: [[Azithromycin]] 1 g PO in a single dose
+:::* Alternative regimen (1): [[ Amoxicillin]]  500 mg PO tid for 7 days
+:::* Alternative regimen (2): [[ Erythromycin]] base 500 mg PO qid for 7 days
+:::* Alternative regimen (3): [[Erythromycin]] base 250 mg PO  qid for 14 days
+:::* Alternative regimen (4): [[ Erythromycin]] ethylsuccinate 800 mg PO qid for 7 days
+:::* Alternative regimen (5): [[Erythromycin]] ethylsuccinate 400 mg PO qid for 14 days
+:::* Note:[[ Doxycycline]], [[Ofloxacin]], and [[Levofloxacin]] are contraindicated in pregnant women
+::* 1.4 '''Management of sex partners'''
+:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 7 days
+:::* Preferred regimen (2): [[Azithromycin]] 1 g PO in a single dose
+:::* Alternative regimen (1): [[ Erythromycin]] base 500 mg PO qid for 7 days
+:::* Alternative regimen (2): [[Erythromycin]] ethylsuccinate 800 mg PO qid for 7 days
+:::* Alternative regimen (3): [[Levofloxacin]] 500 mg  PO qd for 7 days
+:::* Alternative regimen (4): [[Ofloxacin]] 300 mg PO bid for 7 days.
+:::* Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia  diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
+:::* Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
+:::* Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present
+:* 2. '''Chlamydial infection among neonates'''
+::* 2.1 '''Ophthalmia Neonatorum'''caused by ''C. trachomatis''
+:::* Preferred regimen: [[ Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day  PO qid for 14 days
+:::* Alternative regimen: [[Azithromycin ]]suspension 20 mg/kg /day PO qd for 3 days
+:::* Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.
+::* 2.2 '''Infant Pneumonia'''
+:::* Preferred regimen: [[ Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day  PO qid for 14 days
+:::* Alternative regimen: [[Azithromycin ]]suspension 20 mg/kg /day PO qd for 3 days
+:* 3.'''Chlamydial infection among infants and childern'''
+::* 3.1 '''Infants and childern who weigh < 45 kg'''
+:::* Preferred regimen: [[Erythromycin]]  base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days
+::* 3.2 '''Infants and childern who weigh ≥45 kg but who are aged <8 years'''
+:::* Preferred regimen: [[Azithromycin]] 1 g PO in a single dose
+::* 3.3 '''Infants and childern aged  ≥8 years'''
+:::* Preferred regimen (1): [[Azithromycin]] 1 g PO in a single dose
+:::* Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 7 days
+:* 4. '''Lymphogranuloma venereum (LGV) '''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 21 days
+::* Alternative regimen: [[ Erythromycin]] base 500 mg PO qid for 21 days
+::* Note (1): [[Azithromycin]] 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
+::* Note (2): Pregnant and lactating women should be treated with [[Erythromycin]]. [[Azithromycin]] might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. [[Doxycycline]] is contraindicated in pregnant women.
+::* Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
+::* Note (4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( [[Azithromycin]] 1 g PO single dose {{or}} [[Doxycycline]] 100 mg PO bid for 7 days).
+----
+==Chlamydophila psittaci==
+{{PBI|Chlamydophila psittaci}}
+:* 1. ''' Psittacosis ''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* 1.1 '''Adult'''
+:::* Preferred regimen (1): [[Doxycycline]] 100 mg PO bid for 10-21 days
+:::* Preferred regimen (2): [[Tetracycline]] 500  mg PO qid for 10-21 days
+:::* Alternative regimen: [[Minocycline]]
+::* 1.2 '''Pediatric'''
+:::* 1.2.1 '''Mild infection, Infants >3 months'''
+::::* Preferred regimen: [[Azithromycin ]] 10 mg/kg PO qd on day 1 {{then}} 5 mg/kg PO q24h  for 4 days; (Maximum, 500 mg for 1st dose, 250 mg for subsequent doses)
+:::* 1.2.2 '''Moderate-severe infection, Infants  >3 months'''
+::::* Preferred regimen: [[Azithromycin ]] 10 mg/kg IV q24h for 2 days {{then}} 5 mg/kg PO qd for 3 days; (Maximum, 500 mg/dose IV; 250 mg/dose PO)
+::* 1.3 '''Pregnant Patients'''
+:::* Preferred regimen: [[Azithromycin ]] 500 mg PO on day 1 {{then}} by 250 mg qd on days 2-5  {{or}}  500 mg  IV as a single dose for at least 2 days, followed by 500 mg  PO qd  for 7- 10 days
+==Coxiella burnetii==
+{{PBI|Coxiella burnetii}}
+:* 1. '''Acute Q fever''' <ref>{{cite web | title =q fever | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6203a1.htm   }}</ref>
+::* 1.1 '''Adults'''
+:::* Preferred Regimen: [[Doxycycline]] 100 mg PO bid for 14 days
+::* 1.2 '''Pediatric'''
+:::* 1.2.1 '''≥ 8 years old'''
+::::* Preferred regimen:[[Doxycycline]] 2.2 mg/kg PO bid for 14 days (Maximum, 100 mg per dose)
+:::* 1.2.2 '''< 8 years old with high risk criteria'''
+::::* Preferred regimen:[[Doxycycline]] 2.2 mg/kg PO bid for 14 days (Maximum, 100 mg per dose)
+:::* 1.2.3 '''< 8 years old with mild or uncomplicated illness'''
+::::* Preferred regimen:[[Doxycycline]] 2.2 mg/kg PO bid for 5 days (Maximum, 100 mg per dose)
+::::* Alternative regimen: (If patient remains febrile past 5 days of treatment) [[Trimethoprim/Sulfamethoxazole]] 4-20 mg/kg PO bid for 14 days (Maximum, 800 mg per dose)
+::* 1.3 '''Pregnant women'''
+:::* Preferred regimen: [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg PO bid
+:::* Note: Should be given throughout pregnancy
+:* 2. '''Chronic Q fever'''
+::* 2.1 '''Endocarditis or vascular infection'''
+:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[hydroxychloroquine]] 200 mg PO tid for ≥18 months
+:::* Note: Childern and pregnant women consultation recommended
+::* 2.2 '''Non-cardiac organ disease'''
+:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[hydroxychloroquine]] 200 mg PO tid
+:::* Note: childern and pregnant women consultation recommended
+::* 2.3 '''Postpartumwith serologic profile for chronic Q fever'''
+:::* Preferred regimen: [[Doxycycline]] 100 mg PO bid {{and}} [[hydroxychloroquine]] 200 mg PO tid for 12 months
+:::* Note (1): Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024); Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
+:::* Note (2): Post-Q fever fatigue syndrome- no current recommendation
+----
+==Mycoplasma pneumoniae==
+{{PBI|Mycoplasma pneumoniae}}
+:* 1. '''Atypical pneumonia'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* Preferred regimen (1): [[Azithromycin]] 500 mg PO qd on day 1 and 250 mg PO qd on days 2 to 5
+::* Preferred regimen (2): [[Clarithromycin]] 500 mg PO qd for 14 days
+::* Preferred regimen (3): [[Moxifloxacin]] 400 mg PO qd for 14 days
+::* Preferred regimen (4): [[Levofloxacin]] 750 mg PO qd for 14 days
+::* Alternative regimen : [[Doxycycline]] 100 mg PO bid for 14 days
+==Mycoplasma genitalium==
+{{PBI|Mycoplasma genitalium}}
+:* 1. '''Urethritis and cervicitis'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* Preferred regimen (macrolide-susceptible strains) (1): [[Azithromycin]] 1 g PO as a single dose
+::* Preferred regimen (macrolide-susceptible strains) (2): [[Azithromycin]] 500 mg PO as a dose followed by 250 mg PO qd for 4 days
+::* Preferred regimen (for patients with previous treatment failures): [[Moxifloxacin]] 400 mg PO qd for 7–14 days
+:* 2. '''Pelvic inflammatory disease (PID)'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* Preferred regimen: [[Moxifloxacin]] 400 mg PO qd for 14 days
+:* 3. '''Specific considerations'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* 3.1 '''Management of sex partners'''
+::* Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.
+::* 3.2 '''HIV infection'''
+::* Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.
+----
+====Bacteria – Miscellaneous====
+{{PBI|Gardnerella vaginalis}}
+:* 1.'''Bacterial Vaginosis'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* Gardnerella vaginalis is one of the anaerobic bacteria causing Bacterial Vaginosis,which is a polymicrobial clinical syndrome
+:::* Preferred regimen (1): [[Metronidazole]] 500 mg PO bid for 7 days
+:::* Preferred regimen (2): [[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
+:::* Preferred regimen (3): [[Clindamycin]] cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
+:::* Alternative regimen (1): [[Tinidazole]] 2 g PO qd for 2 days
+:::* Alternative regimen (2): [[Tinidazole]] 1 g  PO qd for 5 days
+:::* Alternative regimen (3): [[Clindamycin]] 300 mg  PO bid for 7 days
+:::* Alternative regimen (4): [[Clindamycin]] ovules 100 mg intravaginally once at bedtime for 3 days
+:::* Note: [[Clindamycin]] ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended.
+::* 2. '''Management of Sex Partners'''
+:::* Routine treatment of sex partners is not recommended.
+::* 3. '''Special Considerations'''
+:::* 3.1 '''Allergy, Intolerance, or Adverse Reactions'''
+:::* Intravaginal [[Clindamycin]] cream is preferred in case of allergy or intolerance to [[Metronidazole]] or [[Tinidazole]]. Intravaginal [[Metronidazole]] gel can be considered for women who are not allergic to [[Metronidazole]] but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.
+::* 3.2  '''Pregnancy'''
+:::* Preferred regimen (1): [[Metronidazole]] 500 mg PO bid for 7 days
+:::* Preferred regimen (2): [[Metronidazole]] gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
+:::* Note: [[Tinidazole]] should be avoided during pregnancy
+::*3.3 '''HIV Infection'''
+:::* Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection.
+{{PBI|Eikenella corrodens}}
+{{PBI|Bordetella pertussis}}
+{{PBI|Bartonella}}
+{{PBI|Stenotrophomonas maltophilia}}
+{{PBI|Acinetobacter baumannii}}
+----
+{{PBI|Yersinia enterocolitica}}
+:* '''Yersinia enterocolitica infection (yersiniosis)'''
+::* 1. '''Enterocolitis and mesenteric adenitis'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:::* Preferred regimen: Enterocolitis and adenitis usually self-limited.  No antibiotic therapy is required unless clinically indicated.
+::* 2. '''Septicemia'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen (1): [[Doxycycline]] 100 mg IV q12h {{and}} [[Tobramycin]] 5 mg/kg IV q24h
+:::* Preferred regimen (2): [[Doxycycline]] 100 mg IV q12h {{and}} [[Gentamicin]] 5 mg/kg IV q24h
+:::* Alternative regimen (1): [[Ciprofloxacin]] 500 mg IV q12h
+:::* Alternative regimen (2): [[TMP-SMX]] TMP 8 mg/kg/day and SMX 40 mg/kg/day IV q12h
+::* 3. '''Peritonitis'''<ref>{{Cite journal| issn = 1058-4838| volume = 25| issue = 6| pages = 1468–1469| last1 = Reed| first1 = R. P.| last2 = Robins-Browne| first2 = R. M.| last3 = Williams| first3 = M. L.| title = Yersinia enterocolitica peritonitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 1997-12| pmid = 9431397}}</ref>
+:::* Preferred regimen: [[Fluoroquinolones]]
+----
+{{PBI|Yersinia pestis}}
+----
+{{PBI|Yersinia pseudotuberculosis}}
+----
+====Bacteria – Anaerobic Gram-Negative Bacilli====
+{{PBI|Bacteroides fragilis}}
+:* [[Bacteroides fragilis]] <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Monotherapy '''
+:::* Preferred regimen (1): [[Imipenem]]
+:::* Preferred regimen (2): [[Ertapenem]]
+:::* Preferred regimen (3): [[Meropenem]]
+:::* Preferred regimen (4): [[Doripenem]] 0.5-1.0 g IV q6h
+:::* Preferred regimen (5): [[Piperacillin-tazobactam]] 3.375 g IV q6h
+:::* Preferred regimen (6): [[Ampicillin-sulbactam]] 1-2 g IV q6h
+:::* Preferred regimen (7): [[Tigecycline]] 100 mg IV {{then}} 50 mg IV q12h
+::* 2. '''Combination therapy'''
+:::* Preferred regimen: [[Metronidazole]] 0.75-1.0 g IV q12h {{and}} [[Cefotaxime]] 1.5-2 g IV q6h {{or}} [[Aztreonam]] 1-2 g IV q8h {{or}} [[Ceftriaxone]] 1 g IV q12h
+{{PBI|Fusobacterium necrophorum}}
+====Fungi====
+{{PBI|Aspergillosis}}<ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+* '''1. Invasive pulmonary aspergillosis'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+* '''2. Invasive sinus aspergillosis'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+* '''3. Tracheobronchial aspergillosis'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+* '''4. Chronic necrotizing pulmonary aspergillosis'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+* '''5. Aspergillosis of the CNS'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+:*Note: There are drug interactions with anticonvulsant therapy.
+* '''6. Aspergillus infections of the heart (endocarditis, pericarditis, and myocarditis)'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+:*Note: endocardial lesions generally require surgical treatment. Aspergillus pericarditis usually requires pericardiectomy.
+* '''7. Aspergillus osteomyelitis and septic arthritis'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+:*Note: Surgical resection of devitalized bone and cartilage is important for curative intent.
+* '''8. Aspergillus infections of the eye (endophthalmitis and keratitis)'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+:*Note: Topical therapy is indicated for keratitis, ophthalmologic intervention and management is recommended for all forms of ocular infection. Systemic therapy may be beneficial when treating aspergillus endophthalmitis.
+* '''9. Cutaneous aspergillosis'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+:*Note: Surgical resection is indicated when feasible.
+* '''10. Aspergillus peritonitis'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+* '''11. Prophylaxis against invasive aspergillosis'''
+:*Preferred regimen: [[Posaconazole]] PO 200 mg tid
+:*Alternative regimen: (1) [[Itraconazole]] 200 mg IV bid for 2 days then 200 mg IV qd {{or}} [[Itraconazole]] PO 200mg bid
+:*Alternative regimen: (2) [[Micafungin]] 50 mg/day PO qd
+* '''12. Aspergilloma'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen: [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+* '''13. Chronic cavitary pulmonary aspergillosis'''
+:*Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h single dose, {{then}} 4 mg/kg IV q12h or PO 200 mg q12h
+:*Alternative regimen (1): Liposomal [[Amphotericin B]] (L-AMB) 3–5 mg/kg/day IV qd
+:*Alternative regimen (2): [[Amphotericin B]] lipid complex (ABLC) 5 mg/ kg/day IV qd
+:*Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose {{then}} 50 mg/day IV qd
+:*Alternative regimen (4): [[Posaconazole]] 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
+:*Alternative regimen (5): [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (6): [[Micafungin]] 100–150 mg/day PO qd<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref><ref name="pmid18177225">{{cite journal| author=Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA et al.| title=Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 3 | pages= 327-60 | pmid=18177225 | doi=10.1086/525258 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18177225  }} </ref>
+:*Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
+:*Note: long-term therapy might be needed.
+*'''14. Allergic bronchopulmonary Itraconazole aspergillosis'''
+:*Preferred regimen: [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Alternative regimen (1): [[Voriconazole]] PO 200 mg bid
+:*Alternative regimen (2): [[Posaconazole]] PO 400 mg bid
+:*Note: Corticosteroids are a cornerstone of the therapy.
+*'''15. Allergic aspergillus sinusitis'''
+:*Preferred regimen: None or [[Itraconazole]] dosage depends upon formulation - 600 mg/day PO for 3 days, {{then}} 400 mg/day PO {{or}} 200 mg q12h IV for 2 days, {{then}} 200 mg IV qd
+:*Note: Few data available for other agents.
+*'''16. Relative indications for surgical treatment of invasive aspergillosis'''
+:*Pulmonary lesion in proximity to great vessels or pericardium;
+:*Pericardial infection;
+:*Invasion of chest wall from contiguous pulmonary lesion;
+:*Aspergillus empyema;
+:*Persistent hemoptysis from a single cavitary lesion;
+:*Infection of skin and soft tissues;
+:*Infected vascular catheters and prosthetic devices;
+:*Endocarditis;
+:*Osteomyelitis;
+:*Sinusitis;
+:*Cerebral lesions.
+{{PBI|Blastomycosis}}
+*[[Blastomycosis]]<ref name="pmid18462107">{{cite journal| author=Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG et al.| title=Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2008 | volume= 46 | issue= 12 | pages= 1801-12 | pmid=18462107 | doi=10.1086/588300 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18462107  }} </ref>
+:* '''1. Mild to moderate pulmonary blastomycosis'''
+::* Preferred regimen: [[Itraconazole]] 200 mg PO qd or bid for 6–12 months
+::* Note: Oral [[Itraconazole]], 200 mg tid PO for 3 days and {{then}} 200 mg PO qd or bid for 6–12 months
+:* '''2. Moderately severe to severe pulmonary blastomycosis'''
+::* Preferred regimen (1): Lipid [[Amphotericin B]] 3–5 mg/kg IV qd for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
+::* Preferred regimen (2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg IV qd for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
+::* Note: Oral [[Itraconazole]], 200 mg tid PO for 3 days {{then}} 200 mg PO bid, for a total of 6–12 months
+:* '''3. Mild to moderate disseminated blastomycosis'''
+::* Preferred regimen: [[Itraconazole]] 200 mg PO qd or bid for 6–12 months
+::* Note (1): Treat osteoarticular disease for 12 months
+::* Note (2): Oral [[Itraconazole]], 200 mg PO tid for 3 days {{then}} 200 mg PO bid, for 6–12 months
+:* '''4. Moderately severe to severe disseminated blastomycosis'''
+::* Preferred regimen (1): Lipid [[Amphotericin B]] 3–5 mg/kg IV qd, for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
+::* Preferred regimen (2): [[Amphotericin B]] deoxycholate 0.7–1 mg/kg IV qd, for 1–2 weeks {{and}} [[Itraconazole]] 200 mg PO bid for 6–12 months
+::* Note: oral [[Itraconazole]], 200 mg PO tid for 3 days {{then}} 200 mg PO bid, for 6–12 months
+:* '''5. CNS disease'''
+::* Preferred regimen: Lipid [[Amphotericin B]] 5 mg/kg IV qd for 4–6 weeks {{and}} an oral azole for at least 1 year
+::* Note (1): Step-down therapy can be with [[Fluconazole]], 800 mg/day PO qd or bid {{or}} [[Itraconazole]], 200 mg bid or tid {{or}} voriconazole, 200–400 mg bid.
+::* Note (2): Longer treatment may be required for immunosuppressed patients.
+:* '''6. Immunosuppressed patients'''
+::* Preferred regimen (1): Lipid [[Amphotericin B]] 3–5 mg/kg IV qd, for 1–2 weeks, {{and}} [[Itraconazole]], 200 mg PO bid for 12 months
+::* Preferred regimen (2): [[Amphotericin B]] deoxycholate, 0.7–1 mg/kg IV qd, for 1–2 weeks, {{and}} [[Itraconazole]], 200 mg PO bid for 12 months
+::* Note (1): Oral [[Itraconazole]], 200 mg PO tid for 3 days {{then}} 200 mg PO bid, for 12 months
+::* Note (2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.
+:* '''7. Pregnant women'''
+::* Preferred regimen: Lipid [[Amphotericin B]] 3–5 mg/kg IV qd
+::* Note (1): Azoles should be avoided because of possible teratogenicity
+::* Note (2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg IV qd
+:* '''8. Children with mild to moderate disease'''
+::* Preferred regimen: [[Itraconazole]] 10 mg/kg PO qd for 6–12 months
+::* Note: Maximum dose 400 mg/day
+:* '''9. Children with moderately severe to severe disease'''
+::* Preferred regimen (1): Amphotericin B deoxycholate 0.7–1 mg/kg IV qd for 1–2 weeks {{and}} [[Itraconazole]] 10 mg/kg PO qd to a maximum of 400 mg/day for 6–12 months
+::* Preferred regimen (2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg IV qd for 1–2 weeks {{and}} [[Itraconazole]] 10 mg/kg PO qd to a maximum of 400 mg/day for 6–12 months
+::* Note: Children tolerate Amphotericin B deoxycholate better than adults do.
+{{PBI|Paracoccidioidomycosis}}
+:* Preferred regimen (1): <ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
+::* Adults: [[Itraconazole]] 200 mg/day PO
+::* Children: [[Itraconazole]] (<30/kg and >5 yr) 5-10 mg/kg/day PO
+::*Note: Treatment duration based on organ involvement:
+:::*Mild involvement: 6-9 months
+:::*Moderate involvement: 12-18 months
+:* Preferred regimen (2): <ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
+::* Adults [[Trimethoprim/sulfamethoxazole]] (TMP/SMX)  TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid
+::* Children [[Trimethoprim/sulfamethoxazole]] (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid
+::* Note (1): Treatment duration based on organ involvement:
+:::* Minor involvement: 12 months
+:::* Moderate involvement: 18-24 months
+::*Note (2): Preferred treatment in children due to larger experience.
+::*Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.
+:* Preferred regimen (3): [[Amphotericin B]] deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.<ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
+::*Note: Preferred in severe forms of the disease.<ref name="pmid16906260">{{cite journal| author=Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML| title=[Guidelines in paracoccidioidomycosis]. | journal=Rev Soc Bras Med Trop | year= 2006 | volume= 39 | issue= 3 | pages= 297-310 | pmid=16906260 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16906260  }} </ref>
+:* Alternative regimen (4): [[Ketoconazole]] 200-400 mg/day PO for 9-12 months<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:* Alternative regimen (5): [[Voriconazole]] initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* Note: Diminish the dose to 50% if weight is <40 kg.
+{{PBI|Candidiasis}}
+:*'''1. Candidemia'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*'''1.1. Nonneutropenic adults'''
+:::*Preferred regimen (1): [[Fluconazole]] 800 mg (12 mg/kg) loading dose, {{then}} 400 mg (6 mg/kg) qd
+:::*Preferred regimen (2): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg qd
+:::*Preferred regimen (3): [[Micafungin]] 100 mg qd
+:::*Preferred regimen (4): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg qd
+:::*Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg qd
+:::*Alternative regimen (2): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg qd
+:::*Alternative regimen (3): [[Voriconazole]] 400 mg (6 mg/kg) PO/IV bid for 2 doses, {{then}} 200 mg (3 mg/kg) bid
+:::*Note (1): Echinocandin includes Anidulafungin, Micafungin and Caspofungin.
+:::*Note (2): Choose an echinocandin for moderately severe to severe illness and for patients with recent azole exposure.
+:::*Note (3): Treat for 14 days after first negative blood culture result and resolution of signs and symptoms associated with candidemia.
+:::*Note (4): Ophthalmological examination recommended for all patients.
+::*'''1.2. Neutropenic patients'''
+:::*Preferred regimen (1): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg qd
+:::*Preferred regimen (2): [[Micafungin]] 100 mg qd
+:::*Preferred regimen (3): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg qd
+:::*Preferred regimen (4): Lipid formulation of [[Amphotericin B]] (LFAmB) 3–5 mg/kg qd
+:::*Alternative regimen (1): [[Fluconazole]] 800 mg (12 mg/kg) loading dose, {{then}} 400 mg (6 mg/kg) qd
+:::*Alternative regimen (2): [[Voriconazole]] 400 mg (6 mg/kg) bid for 2 doses, {{then}} 200 mg (3 mg/kg) bid
+:::*Note: [[Fluconazole]] is recommended for patients without recent azole exposure and who are not critically ill.
+:*'''2. Suspected candidiasis treated with empiric antifungal therapy'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*'''2.1. Nonneutropenic patients'''
+:::*Preferred regimen (1): [[Fluconazole]] 800 mg (12 mg/kg) loading dose, {{then}} 400 mg (6 mg/kg) daily
+:::*Preferred regimen (2): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily
+:::*Preferred regimen (3): [[Micafungin]] 100 mg daily
+:::*Preferred regimen (4): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily
+:::*Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily
+:::*Alternative regimen (2): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg daily
+:::*Note (1): Duration of therapy is uncertain, but should be discontinued if cultures and/or serodiagnostic tests have negative results.
+:::*Note (2): Echinocandin includes Anidulafungin, Micafungin and Caspofungin.
+:::*Note (3): Echinocandin is preferred for patients with recent azole exposure, patients with moderately severe to severe illness, or patients who are at high risk of infection due to C. glabrata or C. krusei.
+:::*Note (4): Empirical antifungal therapy should be considered in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever and should be based on clinical assessment of risk factors, serologic markers for invasive candidiasis, and/or culture data from nonsterile sites
+::*'''2.2. Neutropenic patients'''
+:::*Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily
+:::*Preferred regimen (2): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily
+:::*Preferred regimen (3): [[Voriconazole]] 400 mg (6 mg/kg) bid for 2 doses, {{then}} 200 mg (3 mg/kg) bid
+:::*Alternative regimen (1): [[Fluconazole]] 800 mg (12 mg/kg) loading dose, {{then}} 400 mg (6 mg/kg) daily
+:::*Alternative regimen (2): [[Itraconazole]] 200 mg (3 mg/ kg) bid
+:::*Note (1): In most neutropenic patients, it is appropriate to initiate empiric antifungal therapy after 4 days of persistent fever despite antibiotics.
+:::*Note (2): Do not use an azole in patients with prior azole prophylaxis.
+:*'''3. Urinary tract infection'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*'''3.1. Asymptomatic cystitis'''
+:::*Preferred regimen: Therapy not usually indicated, unless patients are at high risk (e.g., neonates and neutropenic adults) or undergoing urologic procedures.
+:::*Note (1): Elimination of predisposing factors recommended
+:::*Note (2): For high-risk patients, treat as for disseminated candidiasis
+:::*Note (3): For patients undergoing urologic procedures, fluconazole, 200–400 mg (3–6 mg/kg) daily or Amphotericin B deoxycholate (AmB-d) 0.3–0.6 mg/kg daily for several days before and after the procedure.
+::*'''3.2. Symptomatic cystitis'''
+:::*Preferred regimen: [[Fluconazole]] 200 mg (3 mg/kg) daily for 2 weeks
+:::*Alternative regimen (1): Amphotericin B deoxycholate(AmB-d) 0.3–0.6 mg/kg for 1–7 days
+:::*Alternative regimen (2): [[Flucytosine]] 25 mg/kg qid for 7–10 days
+:::*Note: [[Amphotericin B deoxycholate]] (AmB-d) bladder irrigation is recommended only for patients with refractory [[fluconazole]] -resistant organisms (e.g., Candida krusei and Candida glabrata).
+::*'''3.3 Pyelonephritis'''
+:::*Preferred regimen (1): [[Fluconazole]] 200–400 mg (3–6 mg/kg) daily for 2 weeks
+:::*Alternative regimen (1): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily {{withorwithout}} [[Flucytosine]] (5-FC) 25 mg/kg qid
+:::*Alternative regimen (2): [[Flucytosine]] (5-FC) 25 mg/kg qid for 2 weeks
+:::*Note: For patients with pyelonephritis and suspected disseminated candidiasis, treat as for candidemia.
+:*'''4. Urinary fungus balls'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*Preferred regimen (1): Surgical removal strongly recommended
+::*Preferred regimen (2): [[Fluconazole]] 200–400 mg (3–6 mg/kg) daily
+::*Preferred regimen (3): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily {{withorwithout}} [[Flucytosine]] (5-FC) 25 mg/kg qid
+::*Note (1): Local irrigation with Amphotericin B deoxycholate(AmB-d) may be a useful adjunct to systemic antifungal therapy.
+::*Note (2):  Treatment duration should be until symptoms have resolved and urine cultures no longer yield Candida species.
+:*'''5. Vulvovaginal candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*Preferred regimen (1): [[Butoconazole]] 2% cream 5 g intravaginally for 3 days
+::*Preferred regimen (2): [[Butoconazole]] 2% cream 5 g (butoconazole1-sustained release), single intravaginal application
+::*Preferred regimen (3): [[Clotrimazole]] 1% cream 5 g intravaginally for 7–14 days
+::*Preferred regimen (4): [[Clotrimazole]] 100-mg vaginal tablet for 7 days
+::*Preferred regimen (5): [[Clotrimazole]] 100-mg vaginal tablet, 2 tablets for 3 days
+::*Preferred regimen (6): [[Miconazole]] 2% cream 5 g intravaginally for 7 days
+::*Preferred regimen (7): [[Miconazole]] 100-mg vaginal suppository, 1 suppository for 7 days
+::*Preferred regimen (8): [[Miconazole]] 200-mg vaginal suppository, 1 suppository for 3 days
+::*Preferred regimen (9): [[Miconazole]] 1200-mg vaginal suppository, 1 suppository for 1 day
+::*Preferred regimen (10): [[Nystatin]] 100,000-unit vaginal tablet, 1 tablet for 14 days
+::*Preferred regimen (11): [[Tioconazole]] 6.5% ointment 5 g intravaginally in a single application
+::*Preferred regimen (12): [[Terconazole]] 0.4% cream 5 g intravaginally for 7 days
+::*Preferred regimen (13): [[Terconazole]] 0.4% cream 5 g intravaginally for 3 days
+::*Preferred regimen (14): [[Terconazole]] 80-mg vaginal suppository, 1 suppository for 3 days
+::*Preferred regimen (15): [[Fluconazole]] 150 mg single dose for uncomplicated vaginitis
+::*Note: For recurring Candida Vulvovaginal candidiasis (VVC), 10–14 days of induction therapy with a topical or oral azole, followed by fluconazole at a dosage of 150 mg once per week for 6 months, is recommended
+:*'''6. Chronic disseminated candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*Preferred regimen (1): [[Fluconazole]] 400 mg (6 mg/kg) daily for stable patients
+::*Preferred regimen (2): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily for severely ill patients
+::*Preferred regimen (3): Amphotericin B deoxycholate(AmB-d) 0.5–0.7 mg/kg daily for severely ill patients
+::*Alternative regimen (1): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily, followed by oral [[Fluconazole]] when clinically appropriate
+::*Alternative regimen (2): [[Micafungin]] 100 mg daily, followed by oral [[Fluconazole]] when clinically appropriate
+::*Alternative regimen (3): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily, followed by oral [[Fluconazole]] when clinically appropriate
+::*Note (1): Transition from Lipid formulation of amphotericin B(LFAmB) or Amphotericin B deoxycholate(AmB-d) to fluconazole is favored after several weeks in stable patients.
+::*Note (2): Duration of therapy is until lesions have resolved (usually months) and should continue through periods of immunosuppression (e.g., chemotherapy and transplantation).
+::*Note (3): Therapy should be continued for weeks to months, until calcification occurs or lesions resolve.
+:*'''7. Candida osteoarticular infection'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*'''7.1. Osteomyelitis'''
+:::*Preferred regimen (1): [[Fluconazole]] 400 mg (6 mg/kg) daily for 6–12 months
+:::*Preferred regimen (2): Lipid formulation of amphotericin B(LFAmB) 3–5 mg/kg daily for at least 2 weeks, then [[Fluconazole]] 400 mg daily for 6–12 months
+:::*Alternative regimen (1): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily for 6–12 months
+:::*Alternative regimen (2): [[Micafungin]] 100 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily for 6–12 months
+:::*Alternative regimen (3): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily for 6–12 months
+:::*Alternative regimen (4): Amphotericin B deoxycholate(AmB-d) 0.5–1.0 mg/kg daily followed by [[Fluconazole]] at a dosage of 400 mg daily for 6–12 months
+:::*Note (1): Duration of therapy usually is prolonged (6–12 months)
+:::*Note (2): Surgical debridement is frequently necessary
+::*'''7.2. Septic arthritis'''
+:::*Preferred regimen (1): [[Fluconazole]] 400 mg (6 mg/kg) for at least 6 weeks
+:::*Preferred regimen (2): Lipid formulation of amphotericin B (LFAmB) 3–5 mg/kg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily
+:::*Alternative regimen (1): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily
+:::*Alternative regimen (2): [[Micafungin]] 100 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily
+:::*Alternative regimen (3): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily for at least 2 weeks followed by [[Fluconazole]] at a dosage of 400 mg daily
+:::*Note (1): Duration of therapy usually is for at least 6 weeks, but few data are available.
+:::*Note (2): Surgical debridement is recommended for all cases.
+:::*Note (3): For infected prosthetic joints, removal is recommended for most cases.
+:*'''8. CNS candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily {{withorwithout}} [[Flucytosine]] at a dosage of 25 mg/kg qid for several weeks followed by [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
+::*Alternative regimen (1): [[Fluconazole]] 400–800 mg (6–12 mg/ kg) daily for patients unable to tolerate Lipid formulation of amphotericin B (LFAmB)
+::*Note (1): Treat until all signs and symptoms, CSF abnormalities, and radiologic abnormalities have resolved.
+::*Note (2): Removal of intraventricular devices is recommended.
+:*'''9. Candida endophthalmitis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*Preferred regimen (1): Amphotericin B deoxycholate(AmB-d) 0.7–1 mg/kg {{and}} [[Flucytosine]] 25 mg/ kg qid
+::*Preferred regimen (2): [[Fluconazole]] 400–800 mg daily (loading dose of 12 mg/kg then 6–12 mg/kg daily) is an acceptable alternative for less severe endophthalmitis
+::*Alternative regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily
+::*Alternative regimen (2): [[Voriconazole]] 6 mg/kg q12h for 2 doses, then 3–4 mg/kg q12h
+::*Alternative regimen (3): [[Caspofungin]] 70 mg loading dose, {{then}} 50 mg daily
+::*Alternative regimen (4): [[Micafungin]] 100 mg daily
+::*Alternative regimen (5): [[Anidulafungin]] 200 mg loading dose, {{then}} 100 mg daily
+::*Note (1): Alternative therapy is recommended for patients intolerant of or experiencing failure of Amphotericin B and Flucytosine therapy
+::*Note (2): Duration of therapy is at least 4–6 weeks as determined by repeated examinations to verify resolution.
+::*Note (3): Diagnostic vitreal aspiration should be done if etiology unknown.
+::*Note (4): Fluconazole at a dosage of 400–800 mg daily (loading dose of 12 mg/kg then 6–12 mg/kg daily) is an acceptable alternative for less severe endophthalmitis
+::*Note (5): Surgical intervention for patients with severe endophthalmitis or vitreitis
+:*'''10. Candida infection of the cardiovascular system'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*'''10.1. Endocarditis'''
+:::*Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily {{withorwithout}} [[Flucytosine]] at a dosage of 25 mg/kg qid
+:::*Preferred regimen (2): Amphotericin B deoxycholate AmB-d 0.6–1 mg/kg daily {{withorwithout}} [[Flucytosine]] 25 mg/kg qid
+:::*Preferred regimen (3): [[Caspofungin]] 50–150 mg daily
+:::*Preferred regimen (4): [[Micafungin]]  100–150 mg daily
+:::*Preferred regimen (5): [[Anidulafungin]]  100–200 mg daily
+:::*Alternative regimen (1): Step-down therapy to [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily for susceptible organism in stable patient with negative blood culture results
+:::*Note (1): Valve replacement is strongly recommended.
+:::*Note (2): For those who are unable to undergo surgical removal of the valve, chronic suppression with fluconazole 400–800 mg (6–12 mg/kg) daily is recommended.
+:::*Note (3): Lifelong suppressive therapy for prosthetic valve endocarditis if valve cannot be replaced is recommended.
+::*'''10.2. Pericarditis or myocarditis'''
+:::*Preferred regimen (1): Lipid formulation of amphotericin B (LFAmB) at a dosage of 3–5 mg/kg daily
+:::*Preferred regimen (2): [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
+:::*Preferred regimen (3): [[Caspofungin]] 50–150 mg daily
+:::*Preferred regimen (4): [[Micafungin]] 100–150 mg daily
+:::*Preferred regimen (5): [[Anidulafungin]] 100–200 mg daily
+:::*Alternative regimen (1): After stable, step-down therapy to [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
+:::*Note(1): Therapy is often for several months, but few data are available
+:::*Note(2): A pericardial window or pericardiectomy is recommended.
+::*'''10.3. Suppurative thrombophlebitis'''
+:::*Preferred regimen (1): Lipid formulation of amphotericin B (LFAmB) at a dosage of 3–5 mg/kg daily
+:::*Preferred regimen (2): [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
+:::*Preferred regimen (3): [[Caspofungin]] 50–150 mg daily
+:::*Preferred regimen (4): [[Micafungin]] 100–150 mg daily
+:::*Preferred regimen (5): [[Anidulafungin]] 100–200 mg daily
+:::*Alternative regimen (1): After stable, step-down therapy to [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily
+:::*Note(1): Surgical incision and drainage or resection of the vein is recommended if feasible.
+:::*Note(2): Treat for at least 2 weeks after candidemia has cleared.
+::*'''10.4. Infected pacemaker, ICD, or VAD'''
+:::*Preferred regimen (1): Lipid formulation of amphotericin B(LFAmB) at a dosage of 3–5 mg/kg daily {{withorwithout}} [[Flucytosine]] at a dosage of 25 mg/kg qid
+:::*Preferred regimen (2): Amphotericin B deoxycholate (AmB-d) 0.6–1 mg/kg daily {{withorwithout}} [[Flucytosine]] 25 mg/kg qid
+:::*Preferred regimen (3): [[Caspofungin]] 50–150 mg daily
+:::*Preferred regimen (4): [[Micafungin]]  100–150 mg daily
+:::*Preferred regimen (5): [[Anidulafungin]]  100–200 mg daily
+:::*Alternative regimen (1): Step-down therapy to [[Fluconazole]] 400–800 mg (6–12 mg/kg) daily for susceptible organism in stable patient with negative blood culture results
+:::*Note(1): Removal of pacemakers and ICDs strongly recommended.
+:::*Note(2): Treat for 4–6 weeks after the device removed.
+:::*Note(3): For VAD that cannot be removed, chronic suppressive therapy with fluconazole is recommended.
+:*'''11. Neonatal candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*Preferred regimen (1): Amphotericin B deoxycholate (AmB-d) 1 mg/kg daily for 3 weeks
+::*Preferred regimen (2): [[Fluconazole]] 12 mg/kg daily for 3 weeks
+::*Alternative regimen (1): Lipid formulation of amphotericin B (LFAmB) 3–5 mg/kg daily for 3 weeks
+::*Note (1): A lumbar puncture and dilated retinal examination should be performed on all neonates with suspected invasive candidiasis.
+::*Note (2): Intravascular catheter removal is strongly recommended.
+::*Note (3): Duration of therapy is at least 3 weeks.
+::*Note (4): Lipid formulation of amphotericin B (LFAmB) used only if there is no renal involvement.
+::*Note (5): Echinocandins should be used with caution when other agents cannot be used.
+:*'''12. Candida isolated from respiratory secretions'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::*Preferred regimen (1): Therapy not recommended
+::*Note (1): Candida lower respiratory tract infection is rare and requires histopathologic evidence to confirm a diagnosis.
+:*'''13. Nongenital mucocutaneous candidiasis'''<ref name="pmid19191635">{{cite journal| author=Pappas PG, Kauffman CA, Andes D, Benjamin DK, Calandra TF, Edwards JE et al.| title=Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 5 | pages= 503-35 | pmid=19191635 | doi=10.1086/596757 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19191635  }} </ref>
+::* '''13.1. Oropharyngeal'''
+:::*Preferred regimen (1): [[Clotrimazole]] troches 10 mg 5 times daily
+:::*Preferred regimen (2): [[Nystatin]] suspension at a concentration of 100,000 U/mL and a dosage of 4–6 mL qid {{or}} 1–2 [[Nystatin]] pastilles (200,000 U each) administered qid for 7–14 days
+:::*Preferred regimen (3): [[Fluconazole]] 100–200 mg PO (3 mg/kg) daily for 7–14 days
+:::*Alternative regimen (1): [[Itraconazole]] solution 200 mg daily
+:::*Alternative regimen (2): [[Posaconazole]] suspension at a dosage of 400 mg twice daily for 3 days, {{then}} 400 mg daily for up to 28 days
+:::*Alternative regimen (3): [[Voriconazole]] 200 mg bid
+:::*Alternative regimen (4): Amphotericin B deoxycholate (AmB-d) 1-mL oral suspension administered at a dosage of 100 mg/mL qid
+:::*Alternative regimen (5): [[Caspofungin]] 70 mg IV loading dose, {{then}} 50 mg daily
+:::*Alternative regimen (6): [[Micafungin]] 100 mg IV daily
+:::*Alternative regimen (7): [[Anidulafungin]] 200 mg IV loading dose, {{then}} 100 mg daily
+:::*Alternative regimen (8): Amphotericin B deoxycholate (AmB-d) 0.3 mg/kg daily
+:::*Note(1): [[Fluconazole]] is recommended for moderate-to-severe disease, and topical therapy with clotrimazole or nystatin is recommended for mild disease.
+:::*Note(2): Treat uncomplicated disease for 7–14 days.
+:::*Note(3): For refractory disease, itraconazole, voriconazole, posaconazole, or AmB suspension is recommended.
+::*'''13.2. Esophageal'''
+:::*Preferred regimen (1): Fluconazole 200–400 mg  (3–6 mg/kg) PO daily
+:::*Preferred regimen (2): [[Caspofungin]] 70 mg IV loading dose, {{then}} 50 mg daily
+:::*Preferred regimen (3): [[Micafungin]] 100 mg IV daily
+:::*Preferred regimen (4): [[Anidulafungin]] 200 mg IV loading dose, {{then}} 100 mg daily
+:::*Preferred regimen (4): AmB-d 0.3–0.7 mg/kg daily
+:::*Alternative regimen (1): [[Itraconazole]] oral solution 200 mg daily
+:::*Alternative regimen (2): [[Posaconazole]] 400 mg bid
+:::*Alternative regimen (3): [[Voriconazole]] 200 mg bid
+:::*Note(1): Oral fluconazole is preferred.
+:::*Note(2): For patients unable to tolerate an oral agent,[[Fluconazole]] IV, an echinocandin, or AmB-d is appropriate.
+:::*Note(3): Treat for 14–21 days.
+:::*Note(4): For patients with refractory disease, the alternative therapy as listed or AmB-d or an echinocandin is recommended.
+{{PBI|Chromoblastomycosis}}<ref name="pmid25395928">{{cite journal| author=Krzyściak PM, Pindycka-Piaszczyńska M, Piaszczyński M| title=Chromoblastomycosis. | journal=Postepy Dermatol Alergol | year= 2014 | volume= 31 | issue= 5 | pages= 310-21 | pmid=25395928 | doi=10.5114/pdia.2014.40949 | pmc=PMC4221348 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25395928  }} </ref>
+:*Preferred regimen: [[Itraconazole]] 200-400 mg PO q24h {{or}} 400 mg pulse therapy once daily for 1 week monthly for 6-12 months
+:*Note: Pulse therapy reduces cost but it is questionable if it produces resistance to the drug.
+:*Alternative regimen (1): [[Terbinafine]] 500-1000 mg PO qd for 6-12 months
+:*Alternative regimen (2): [[Posaconazole]] 800 mg PO qd for 6-12 months
+:*Alternative regimen (3): [[5-fluorocytosine]] 100-150 mg/kg/day PO qd for 6-12 months
+:*Note: This disease has a low cure ratio and high relapse ratio. Physical treatment is needed to achieve better results:
+::*Cryosurgery with liquid nitrogen - most used physical therapy, it's used in localized lesions and it has a very good treatment response, probably achieved by immune mechanisms since fungi are eliminated from lesions as late as 1-2 weeks after the therapy.
+::*Thermotherapy - used in conjunction with systemic therapy, was developed by Japanese authors and consists in placing "pocket warmers" in the lesions for 24h/day for some months, as the fungi is sensible to heat.
+::*Laser vaporization - studied in Germany as an alternative therapy, reported to successfully treat relapsing lesions.
+{{PBI|Coccidioidomycosis}}
+:* 1. '''Primary pulmonary infection'''  <ref name="pmid16206093">{{cite journal| author=Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Johnson RH, Stevens DA et al.| title=Coccidioidomycosis. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 9 | pages= 1217-23 | pmid=16206093 | doi=10.1086/496991 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16206093  }} </ref>
+::* 1.1 '''Indications for antifungal therapy'''
+::::* Immunosupression (AIDS, therapy with high dose corticosteroids, receiptients of TNF-alpha, receiptients of an organ transplant)
+::::* Diabetes
+::::* Preexisting cardiomyopathy
+::::* Pregnancy (third trimester)
+::::* Filipino or African
+::::* Weight loss of > 10%
+::::* Intense night sweats persisting longer than 3 weeks
+::::* Infiltrates involving more than one-half of one lung or portions of both lungs
+::::* Prominent or persistent hilar adenopathy
+::::* Anticoccidiodial complement-fixing antibody concentrations in excess of 1:16
+::* 1.2 '''Patients with low risk of complications or dissemination'''
+::::* For many (if not most) patients, management may rely on periodic reassessment of symptoms and radiographic findings to assure resolution without antifungal treatment.
+::* 1.3 '''Patients with high risk of complications or dissemination'''
+:::* 1.3.1 '''Mild to moderate pneumonia'''
+::::* Preferred regimen (1): [[Itraconazole]] solution 200 mg PO bid or IV q12h
+::::* Preferred regimen (2): [[Fluconazole]] 400 mg PO q24h for 3–12 months
+:::* 1.3.2 '''Locally severe or disseminated pneumonia'''
+::::* Preferred regimen: ([[Amphotericin B]] 0.6–1 mg/kg PO qd every 7 days {{then}} 0.8 mg/kg PO every other day {{or}} [[Liposomal Amphotericin B]] 3-5 mg/kg IV q24 hrs {{or}} [[Amphotericin B lipid complex]] 5 mg/kg IV q24 hrs until clinical improvement) followed by [[Itraconazole]] {{or}} [[Fluconazole]] for at least 1 year.
+::::* Note (1): Some use combination of Amphotericin B and Fluconazole for progressive severe disease; controlled series lacking.
+::::* Note (2): Consultation with specialist recommendation, surgery may be required.
+:* 2. '''Meningitis'''
+::* 2.1 '''Adult'''
+::::* Preferred regimen: [[Fluconazole]] 400–1,000 mg PO q24h indefinitely.
+::::* Alternative regimen: [[Amphotericin B]] 3-5 mg/kg IV q24 hrs {{plus}} 0.1–0.3 mg qd intrathecal (intraventricular) via reservoir device {{or}} [[Itraconazole]] 400–800 mg q24h {{or}} [[Voriconazole]]
+::::* Note: Some use combination of [[Amphotericin B]] and [[Fluconazole]] for progressive severe disease; controlled series lacking.
+::* 2.2 '''Child'''
+::::* Preferred regimen: [[Fluconazole]] PO (Pediatric dose not established, 6 mg per kg q24h used)
+::::* Alternative regimen: [[Amphotericin B]] 3-5 mg/kg IV q24 hrs {{plus}} 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device {{or}} itra 400–800 mg q24h {{or}} [[Voriconazole]]
+:* 3. '''Special considerations for HIV/AIDS patients'''<ref>{{ cite web | title = Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultOITablesOnly.pdf }}</ref>
+::* 3.1 '''Clinically mild infections (e.g., focal pneumonia)'''
+:::* Preferred regimen: [[Fluconazole]] 400 mg PO daily {{or}} [[Itraconazole]] 200 mg PO bid
+:::* Alternative regimen (unresponsive to Fluconazole or Itraconazole): [[Posaconazole]] 200 mg PO bid {{or}} [[Voriconazole]] 200 mg PO bid
+:::* Note: Itraconazole, posaconazole, and voriconazole may have significant interactions with certain antiretro viral agents. These interactions are complex and can be bi-directional
+::* 3.2 '''Severe, non-meningeal infection (diffuse pulmonary infection or severely ill patients with extrathoracic, disseminated disease)'''
+:::*Preferred regimen: [[Amphotericin B]] deoxycholate 0.7–1.0 mg/kg IV q12hrs {{or}} Lipid formulation [[Amphotericin B]] 4–6 mg/kg IV q24hrs. Duration of therapy: continue until clinical improvement, then switch to an azole.
+:::*Alternative regimen: Some specialists will add a triazole ([[Fluconazole]] or [[Itraconazole]], with [[Itraconazole]] (preferred for bone disease) 400 mg per day to [[Amphotericin B]] therapy and continue triazole once [[Amphotericin B]] is stopped
+:::* Note (1): Therapeutic drug monitoring and dosage adjustment may be necessary to ensure triazole antifungal and antiretroviral efficacy and reduce concentration-related toxicities.
+:::* Note (2): Therapy should be continued indefinitely in patients with diffuse pulmonary or disseminated diseases because relapse can occur in 25%–33% of HIV-negative patients. It can also occur in HIV-infected patients with CD4 counts >250 cells/μL
+::* 3.3 '''Meningeal Infections'''
+:::* Preferred regimen: [[Fluconazole]] 400–800 mg IV or PO daily
+:::* Alternative regimen: [[Itraconazole]] 200 mg PO tid for 3 days {{then}} 200 mg PO bid {{or}} [[Posaconazole]] 200 mg PO bid {{or}} [[Voriconazole]] 200–400 mg PO bid {{or}} Intrathecal [[Amphotericin B]] deoxycholate when triazole antifungals are ineffective.
+:::* Note (1): Intrathecal amphotericin B should only be given in consultation with a specialist and administered by an individual with experience with the technique.
+:::* Note (2): Some patients with meningitis may develop hydrocephalus and require CSF shunting
+:::* Note (3): Therapy should be lifelong in patients with meningeal infections because relapse occurs in 80% of HIV-infected patients after discontinuation of triazole therapy
+::* 3.4 '''Chronic Suppressive Therapy'''
+:::* Preferred regimen (1): [[Fluconazole]] 400 mg PO qd
+:::* Preferred regimen (2): [[Itraconazole]] 200 mg PO bid
+:::* Alternative regimen (1): [[Posaconazole]] 200 mg PO bid
+:::* Alternative regimen (2): [[Voriconazole]] 200 mg PO bid
+{{PBI|Cryptococcosis}}
+{{PBI|Cryptococcus}}
+:* 1. '''Cryptococcus neoformans'''
+::* 1.1 '''Cryptococcus neoformans meningitis in HIV infected patients'''<ref name="pmid20047480">{{cite journal| author=Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ et al.| title=Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. | journal=Clin Infect Dis | year= 2010 | volume= 50 | issue= 3 | pages= 291-322 | pmid=20047480 | doi=10.1086/649858 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20047480  }} </ref>
+:::*Preferred regimen for induction and consolidation: ([[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction) {{or}} [[Liposomal AmB]] 3-4mg/kg IV qd {{or}} [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV qd) {{plus}} [[Flucytosine]] 100mg/kg/day PO or IV qid for at least 2 weeks followed by [[Fluconazole]] 400mg (6mg/kg) PO qd for at least 8 weeks.
+:::*Alternative regimen for induction and consolidation (1): [[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg IV qd {{or}} [[Liposomal AmB]] 3-4 mg/kg IV qd {{or}} AmB lipid complex 5mg/kg IV qd for 4-6 weeks
+:::*Alternative regimen for induction and consolidation (2): [[Amphotericin B]] deoxycholate 0.7 mg/kg IV qd {{plus}} [[Fluconazole]] 800mg PO qd for 2 weeks, followed by [[Fluconazole]] 800mg PO qd for at least 8 weeks
+:::*Alternative regimen for induction and consolidation (3): [[Fluconazole]] (>800 mg PO qd, 1200mg PO qd is favored) {{plus}} [[Flucytosine]] (100mg/kg/day PO qid) for 6 weeks
+:::*Alternative regimen for induction and consolidation (4): [[Fluconazole]] PO 800-2000mg qd for 10-12 weeks
+:::*Preferred regimen for maintenance and prophylactic therapy: Initiate HAART 2-10 weeks after commencing initial antifungal therapy {{and}} [[Fluconazole]] 200mg PO qd
+:::*Alternative regimen for maintenance and prophylactic therapy: [[Itraconazole]] 200mg PO bid - monitor drug-level {{or}} [[Amphotericin B]] deoxycholate (1 mg/kg) per week IV (should be used in azole-intolerant patients).
+:::* Note (1): Consider discontinuing supressive therapy if CD4 count is higher than 100 cells/uL {{and}} undetectable {{or}} very low HIV RNA level for more than 3 months. Consider reinstitution of maintenance therapy if CD4 count <100 cels/uL.
+:::* Note (2): Do not use [[acetazolamide]] {{or}} [[mannitol]] {{or}} [[corticosteroids]] to treat increased intracranial pressure, instead it should be used lombar puncture in the absence of focal neurologic signs or impaired mentation (which, if present, patient must be submitted to CT or MRI scan first).
+::'''1.2. Cerebral cryptococcomas'''
+:::*Preferred regimen for induction and consolidation: ([[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction) {{or}} [[Liposomal AmB]] 3-4mg/kg IV qd {{or}} [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV qd) {{plus}} [[Flucytosine]] 100mg/kg/day PO or IV qid for at least 2 weeks followed by [[Fluconazole]] 400mg (6mg/kg) PO qd for at least 8 weeks
+:::*Note: Consider surgery if lesions are larger than 3cm, accessible lesions with mass effect or lesions that are enlarging and not explained by IRIS.
+::'''1.3. Cryptococcus neoformans meningitis in HIV negative patients'''
+:::*Preferred regimen: [[Amphotericin B deoxycholate]] 0.7-1.0 mg/kg IV qd {{plus}} [[Flucytosine]] 100mg/kg/day PO or IV qid for at least 4 weeks (which may be extended to 6 weeks if there is any neurological complication) followed by [[Fluconazole]] 400mg PO qd for 8 weeks. If there's toxicity to AmBd, consider changing to LFAmB in the second 2 weeks.
+:::*Note (1): After induction and consolidation therapy, start [[Fluconazole]] 200mg (3mg/kg) PO qd for 6-12 months.
+:::*Note (2): If [[Flucytosine]] is not given, consider lengthening the induction therapy for at least 2 weeks.
+::'''1.4. Cryptococcus neoformans pulmonary disease - immunosupressed'''
+:::*Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:
+::::*Preferred regimen: [[Fluconazole]] 400mg PO qd for 6-12 months
+:::*Severe pneumonia or disseminated disease or CNS infection:
+::::*Preferred regimen: treat like CNS cryptococcosis.
+:::*Note (1): In HIV- infected patients, treatment should be stopped after 1 year if CD4 count is >100 and a cryptococcal antigen titer is <1:512 and not increasing.
+:::*Note (2): Consider [[corticosteroid]] if [[ARDS]] is present in a context which it might be attributed to [[IRIS]].
+::'''1.5 Cryptococcus neoformans pulmonary disease - non-immunosupressed'''
+:::*Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:
+::::*Preferred regimen: [[Fluconazole]] 400mg PO qd for 6-12 months
+::::*Alternative regimen: if [[Fluconazole]] is unavailable or contraindicated, [[Itraconazole]] 200mg PO bid, [[Voriconazole]] 200 mg PO bid, and [[Posaconazole]] 400mg PO bid
+:::*If there's severe pneumonia, disseminated disease or CNS infection:
+::::*Preferred regimen: treat like CNS cryptococcosis for 6-12 months.
+::'''1.6 Cryptococcus neoformans non-lung, non-CNS infection'''
+:::*Cryptococcemia or disseminated cryptococcic disease  (involvement of at least 2 noncontiguous sites or cryptococcal antigen titer >1:512):
+::::*Preferred regimen: treat like CNS infection.
+:::*If infection occurs at a single site and no immunosupressive risk factors
+::::*Preferred regimen: [[Fluconazole]] 400mg PO qd for 6-12 months
+::'''1.7. Cryptococcosis in Children'''
+::::*Preferred regimen for induction and consolidation: [[Amphotericin B]] deoxycholate 1.0 mg/kg qd IV {{plus}} [[Flucytosine]] 100mg/kg PO or IV qid for 2 weeks followed by [[Fluconazole]] 10-12mg/kg PO qd for 8 weeks
+::::*Alternative regimen: patients with renal dysfunction: change [[Amphotericin B]] deoxycholate by [[Liposomal AmB]] 5mg/kg IV qd or [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV qd
+::::*Preferred regimen for maintenance: Fluconazole 6mg/kg PO qd. Discontinuation of maintenance therapy is poorly studied and should be individualized.
+:::*Cryptococcal pneumonia:
+::::*Preferred regimen Fluconazole 6-12mg/kg PO qd for 6-12 months
+::'''1.8. Cryptococcosis in Pregnant Women'''
+:::*Preferred regimen for induction and consolidation: [[Amphotericin B]] deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction - [[Liposomal AmB]] 3-4mg/kg IV qd {{or}} [[Amphotericin B]] lipid complex (ABLC) 5mg/kg IV qd. Consider using [[Flucytosine]] in relationship to benefit risk basis, since it is a Category C drug for pregnancy. Start [[Fluconazole]] after delivery. Avoid use during first trimester and consider use in the last 2 trimesters with the need for continuous antifungal therapy during pregnancy.
+:::*Note: If pulmonary cryptococcosis: perform close follow-up and administer fluconazole after delivery.
+:'''2. Cryptococcus gatti'''
+::*Disseminated cryptococcosis or CNS disease:
+:::*Preferred regimen: treatment is the same as C. neoformans.
+::*Pulmonary disease: single and small cryptococcoma:
+:::*Preferred regimen: [[Fluconazole]] 400mg per day PO for 6-18months
+::*Pulmonary disease: Very large or multiple cryptococcomas:
+:::*Preferred regimen: administer [[Flucytosine]] {{and}} [[AmB deocycholate]] for 4-6 weeks, followed by fluconazole for 6-18 months.
+:::*Note: Surgery should be considered if there is compression of vital structures {{or}} failure to reduce the size of the cryptococcoma after 4 weeks of therapy
+----
+{{PBI|Tinea cruris}}
+:*'''Tinea Cruris'''<ref>{{cite book | last = Ferri| first = Fred F. | title = Ferri's Clinical Advisor 2016: 5 Books in 1, 1e (Ferri's Medical Solutions)
+ | publisher = Elsevier/Saunders | location =  | year = 2015 | isbn =  978-0323280471  }}</ref>
+::*'''1. Topical cream/ointment'''
+:::* Preferred regimen (1): [[Butenafine]] cream applied qd for 14 days
+:::* Preferred regimen (2): [[Terbinafine]] cream applied bid for 14 days
+::* '''2. Oral antifungal'''
+:::* Preferred regimen: [[Fluconazole]] 200 mg qd for 10 days {{and}} [[Terbinafine]] 250 mg qd for 30 days
+:::*Note: Oral antifungal therapy is generally reserved for cases unresponsive to topical agents or can be used along with topical agents in severe cases.
+----
+{{PBI|Tinea corporis}}
+*Tinea corporis<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:*Small, well-defined lesions
+::*Preferred regimen: Topical cream/ointment like [[Terbinafine]] {{or}} [[Miconazole]] {{or}} [[Econazole]] {{or}} [[Clotrimazole]]
+:*Larger lesionss
+::*Preferred regimen:  [[Terbinafine]] 250 mg/day PO for 2 weeks {{or}} [[Itraconazole]] 200 mg/day PO for 1 wk {{or}} [[Fluconazole]] 250 mg PO weekly for 2-4 weeks
+----
+{{PBI|Tinea pedis}}
+*'''1. Tinea pedis'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:* '''1.1 Athlete's foot'''
+::* '''1.1.1 Interdigital'''
+:::*Preferred regimen: Topical cream/ointment [[Terbinafine]] {{or}} [[Miconazole]] {{or}} [[Econazole]] {{or}} [[Clotrimazole]]
+::*'''1.1.2 Dry type'''
+:::*Preferred regimen (1): [[Terbinafine]] 250 mg/day PO for 2-4 weeks
+:::*Preferred regimen (2): [[Itraconazole]] 400 mg/day PO for 1 week per month (repeated if necessary)
+:::*Preferred regimen (3): [[Fluconazole]] 200 mg PO  weekly for 4-8 weeks
+----
+{{PBI|Tinea capitis}}
+*Tinea capitis<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:*Preferred regimen (1): [[Griseofulvin]] 10-20 mg/kg/day for minimum 6 weeks
+:*Preferred regimen (2): [[Itraconazole]] 4-6 mg/kg pulsed dose weekly
+:*Preferred regimen (3): [[Terbinafine]] if <20 kg: 62.5 mg/day, if 20-40 kg: 125 mg/day, if >40 kg: 250 mg/day
+----
+{{PBI|Tinea barbae}}
+:*'''Tinea Barbae'''
+::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 4 weeks.
+::*Alternative regimen: [[Itraconazole]] PO 200mg/day for 2 weeks.
+----
+{{PBI|Tinea incognito}}
+:*'''Tinea Incognito'''
+::*Preferred regimen: Stop topical [[steroids]] and treat with topical 1% [[terbinafine]] cream for 6 weeks.
+----
+{{PBI|Tinea manuum}}
+:*'''Tinea Manuum'''
+::*Preferred regimen: topical or systemic [[terbinafine]] PO 250 mg/day por 2-4 weeks.
+----
+{{PBI|Tinea versicolor}}
+:*Tinea versicolor<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::*Preferred regimen: [[Ketoconazole]] 400 mg PO single dose {{or}} 200 mg q24h for 7 days {{or}} 2% cream once q24h for 2 weeks
+::*Alternative regimen: [[Fluconazole]] 400 mg PO single dose {{or}} [[Itraconazole]] 400 mg PO q24h for 3–7 days
+----
+{{PBI|Majocchi's granuloma}}
+:*'''Majocchi's Granuloma'''
+::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 2-4 weeks.
+::*Alternative regimen: [[Itraconazole]] 200mg PO bid for 1 week, per month for 2 months.
+----
+{{PBI|Onychomycosis}}
+:*'''Onychomycosis'''<ref name="pmid19439745">{{cite journal| author=de Berker D| title=Clinical practice. Fungal nail disease. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 20 | pages= 2108-16 | pmid=19439745 | doi=10.1056/NEJMcp0804878 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19439745  }} </ref>
+:::*10.1 Fingernails
+::::*Preferred regimen: [[Terbinafine]] PO 250mg/day for 6 weeks {{or}} [[Itraconazole]] PO 200mg twice a day for a week a month for 2 months (European guidelines).
+:::*10.2 Toenails
+::::*Preferred regimen: Toenails [[Terbinafine]] PO 250mg/day for 12 weeks {{or}} [[Itraconazole]] PO 200mg/day for 12 weeks (U.S. guidelines) {{or}} [[Itraconazole]] PO 200mg twice a day for a week a month for 3 months (European guidelines).
+:::*Note (1): There is no evidence that combining systemic and topic treatments has any benefit to the patient.
+----
+{{PBI|Histoplasmosis}}
+:* 1. '''Adult treatment:''' <ref name="pmid17806045">{{cite journal| author=Wheat LJ, Freifeld AG, Kleiman MB, Baddley JW, McKinsey DS, Loyd JE et al.| title=Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2007 | volume= 45 | issue= 7 | pages= 807-25 | pmid=17806045 | doi=10.1086/521259 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17806045  }} </ref>
+::* 1.1 '''Pulmonary'''
+:::* 1.1.1 '''Acute pulmonary histoplasmosis'''
+::::* 1.1.1.1 '''Moderate severe or severe'''
+:::::* Preferred regimen (1): Lipid formulation of [[Amphotericin B]] (3.0–5.0 mg/kg IV q12h for 1–2 weeks) {{then}} [[Itraconazole]] (200 mg tid for 3 days {{then}} 200 mg bid for a total of 12 weeks).
+:::::* Preferred regimen (2): [[Methylprednisolone]] (0.5–1.0 mg/kg IV q24h) during the first 1–2 weeks of antifungal therapy is recommended for patients who develop respiratory complications, including hypoxemia or significant respiratory distress
+:::::* Alternative regimen: The deoxycholate formulation of [[Amphotericin B]] (0.7–1.0 mg/kg q24h IV) is an alternative to a lipid formulation in patients who are at a low risk for nephrotoxicity.
+:::::* Note (1): In severe cases, cases accompanied by respiratory insufficiency, or hypoxemia, anecdotal reports suggest that corticosteroid therapy may hasten recovery
+:::::* Note (2): The pulmonary infiltrates should be resolved on the chest radiograph before antifungal therapy is stopped.
+::::* 1.1.1.2 '''Mild to moderate:'''
+:::::* Treatment is usually unnecessary
+:::::* Preferred regimen for patients who continue to have symptoms for >1 month: [[Itraconazole]] (200 mg tid for 3 days {{then} 200 mg qd {{or}} bid for 6–12 weeks)
+:::::* Note (1): Antifungal treatment is unnecessary in patients with mild symptoms caused by acute pulmonary histoplasmosis
+:::* 1.1.2 '''Chronic cavitary pulmonary histoplasmosis:'''
+::::* Preferred regimen: [[Itraconazole]] (200 mg tid for 3 days and {{then}} qd or bid for at least 1 year) is recommended
+::::* Note (1): Blood levels of itraconazole should be obtained after the patient has been receiving this agent for at least 2 weeks to ensure adequate drug exposure
+::::* Note (2): Patients with underlying emphysema often develop progressive pulmonary disease, which is characterized by cavities with surrounding inflammation after infection with hysotplasma capsulatum
+:::* 1.1.3 '''Broncholithiasis'''
+::::* Antifungal treatment is not recommended
+::::* Note: Bronchoscopic or surgical removal of the broncholith is recommended
+:::* 1.1.4 '''Pulmonary nodules (Histoplasmomas)'''
+::::* Antifungal treatment is not recommended**
+::::* Note: There is no evidence that antifungal agents have any effect on histoplasmomas or that histoplasmomas contain viable organisms.
+::* 1.2 '''Mediastinitis'''
+:::* 1.2.1 '''Mediastinal lymphadenitis'''
+::::* 1.2.1.1 '''Asymptomatic cases'''
+:::::* Treatment is usually unnecessary
+::::* 1.2.1.2 '''Patients who have symptoms that warrant treatment with corticosteroids and in those who continue to have symptoms for > 1 month'''
+:::::* [[Itraconazole]] (200 mg 3 tid for 3 days and {{then}} 200 mg qd or bid for 6–12 weeks)
+::::* 1.2.1.2 '''Severe cases with obstruction or compression of contiguous structures'''
+:::::* Preferred regimen: [[Prednisone]] (0.5–1.0 mg/kg qd [maximum 80 mg qd] in tapering doses over 1–2 weeks)
+:::::* Note (1): Antifungal treatment is unnecessary in most patients with symptoms due to mediastinal lymphadenitis
+:::::* Note (2): Itraconazole is recommended for 6–12 weeks to reduce the risk of progressive disseminated disease caused by corticosteroid-induced immunosuppression in patients who are given corticosteroids and in patients whose symptoms last longer than 1 month.
+:::* 1.2.2 '''Mediastinal granuloma'''
+::::* 1.2.2.1 '''Asymptomatic cases'''
+:::::* Treatment is usually unnecessary
+::::* 1.2.2.2 '''Symptomatic cases'''
+:::::* Preferred regimen: [[Itraconazole]] (200 mg 3 times qd for 3 days and {{then}} qd or bid for 6–12 weeks)
+:::::* Note (1): [[Itraconazole]] is appropriate for symptomatic cases but there are no controlled trials to prove its efficacy.
+:::::* Note (2): There is no evidence that mediastinal granuloma evolves into mediastinal fibrosis. Thus treatment with either surgery or itraconazole should not be used to prevent the development of mediastinal fibrosis
+:::* 1.2.3 '''Mediastinal fibrosis'''
+::::* Antifungal treatment is not recommended**
+:::* 1.2.3.1 '''If clinical findings cannot differentiate mediastinal fibrosis from mediastinal granuloma'''
+::::* Preferred regimen: [[Itraconazole]] (200 mg qd or bid for 12 weeks)
+::::* Note: The placement of intravascular stents is recommended for selected patients with pulmonary vessel obstruction
+::::* Note (2): Mediastinal fibrosis is characterized by invasive fibrosis that encases mediastinal or hilar nodes and that is defined by occlusion of central vessels and airways
+::* 1.3 '''Pericarditis:'''
+:::* 1.3.1 '''Mild cases'''
+::::* Preferred regimen: Nonsteroidal anti-inflammatory therapy
+:::* 1.3.2 '''Patients with evidence of hemodynamic compromise or unremitting symptoms after several days of therapy with nonsteroidal anti-inflammatory therapy'''
+::::* [[Prednisone]] (0.5–1.0 mg/kg qd [maximum, 80 mg qd] in tapering doses over 1–2 weeks)
+:::* 1.3.3 '''If corticosteroids are administered'''
+::::* Preferred regimen: [[Itraconazole]] (200 mg tid for 3 days and {{then}} qd or bid for 6–12 weeks)
+::::* Note (1): Pericardial fluid removal is indicated for patients with hemodynamic compromise.
+::::* Note (2): Pericarditis occurs as a complication of inflammation in adjacent mediastinal lymph nodes in patients with acute pulmonary histoplasmosis.
+::* 1.4 '''Central nervous system histoplasmosis'''
+:::* Preferred regimen: Liposomal [[Amphotericin B]] (5.0 mg/kg qd for a total of 175 mg/kg given over 4–6 weeks) followed by [[Itraconazole]] (200 mg 2 or 3 times qd) for at least 1 year and until resolution of cerebro spinal fluid abnormalities including Histoplasma antigen levels.
+:::* Note: Blood levels of Itraconazole should be obtained to ensure adequate drug exposure
+::* 1.5 '''Rheumatologic syndromes'''
+:::* 1.5.1 '''Mild cases'''
+::::* Preferred regimen: Nonsteroidal anti-inflammatory therapy
+:::* 1.5.2 '''Severe cases'''
+::::* Preferred regimen: [[Prednisone]] (0.5–1.0 mg/kg qd [maximum, 80 mg qd] in tapering doses over 1–2 weeks)
+:::* 1.5.3 '''Corticosteroids administration'''
+::::* [[Itraconazole]] (200 mg 3 times tid for 3 days and {{then}} qd or bid for 6–12 weeks)
+::::* Note (1): If corticosteroids are used, concurrent itraconazole treatment is recommended to reduce the risk of progressive infection
+::::* Note (2): Bone or joint involvement is very rare in progressive disseminated histoplasmosis but it should not be overlooked.
+::* 1.6 '''Progressive disseminated histoplasmosis'''
+:::* 1.6.1 '''Moderately severe to severe disease'''
+::::* Preferred regimen: Liposomal [[Amphotericin B]] (3.0 mg/kg qd) is recommended for 1–2 weeks followed by oral [[Itraconazole]] (200 mg 3 times qd for 3 days and {{then}} 200 mg bid for a total of at least 12 months)
+::::* Note (1): Substitution of another lipid formulation at a dosage of 5.0 mg/kg qd may be preferred in some patients because of cost or tolerability
+::::* Note (2): The deoxycholate formulation of Amphotericin B (0.7–1.0 mg/kg qd) is an alternative to a lipid formulation in patients who are at a low risk for nephrotoxicity
+:::* 1.6.2 '''Immunosupressed patients'''
+::::* Lifelong suppressive therapy with [[Itraconazole]] (200 mg qd)
+:::* 1.6.3 '''Mild to moderate disease'''
+::::* [[Itraconazole]] (200 mg tid for 3 days and then bid qid for at least 12 months)
+::::* Note (1): Lifelong suppressive therapy with itraconazole (200 mg daily) may be required in immunosuppressed patients if immunosuppression cannot be reversed and in patients who relapse despite receipt of appropriate therapy
+::::* Note (2): Blood levels of itraconazole should be obtained to ensure adequate drug exposure
+::::* Note (3): Antigen levels should be measured during therapy and for 12 months after therapy is ended to monitor for relapse. Persistent low-level antigenuria may not be a reason to prolong treatment in patients who have completed appropriate therapy and have no evidence of active infection.
+::::* Note (4): Progressive disseminated histoplasmosis is fatal without therapy and treatment with either Amphotericin B or Itraconazole is highly effective. Among patients with AIDS and moderately severe to severe disseminated histoplasmosis, the rate of response was higher (88% vs. 64%) and the mortality rate was lower (2% vs. 13%) among recipients of liposomal amphotericin B (3 mg/kg qd for 1–2 weeks) than among recipients of the deoxycholate formulation.
+::* 1.7 '''Prophylaxis recommended for immunosuppressed patients'''
+:::* Preferred regimen: [[Itraconazole]] (200 mg qd) in patients with HIV infection with CD4 cell counts <150 cells/mm3 in specific areas of endemicity where the incidence of histoplasmosis is >10 cases per 100 patient-years
+:::* Note: Prophylaxis with Itraconazole (200 mg qd) may be appropriate in specific circumstances in other immunosuppressed patients
+::* 1.8 '''Performance Measures'''
+:::* Preferred regimen: [[Itraconazole]] is the preferred azole for initial therapy for patients with mild-to-moderate histoplasmosis and as step-down therapy after receipt of [[Amphotericin B]]
+:::* Note: When other azole agents are used, the medical record should document the specific reasons that Itraconazole was not used and why other azoles were used.
+:::* 14.1 '''Severe or moderately severe histoplasmosis'''
+:::* Preferred regimen: [[Amphotericin B]]
+:::* Note: When Amphotericin B is used the patient's electrolyte level renal function and blood cell count should be monitored several times per week and documented in the medical record.
+:::* Note (2): Itraconazole drug levels should be measured during the first month in patients with disseminated or chronic pulmonary histoplasmosis and these levels should be documented in the medical record as well as the physician's response to levels that are too low.
+:::* Note (3): Itraconazole should not be given to patients receiving contraindicated medications (i.e., pimozide, quinidine, dofetilide, lovastatin, simvastatin, midazolam, and triazolam). Reasons for deviation from this practice should be documented in the medical record.
+::* 2. '''Pregnancy treatment'''
+::::* Preferred regimen: Lipid formulation [[Amphotericin B]] (3.0–5.0 mg/kg qd for 4–6 weeks) is recommended
+::::* Prefered regimen low risk for nephrotoxicity: The deoxycholate formulation of [[Amphotericin B]] (0.7–1.0 mg/kg qd) is an alternative to a lipid formulation
+::::* Note (1): If the newborn shows evidence for infection, treatment is recommended with [[Amphotericin B]] deoxycholate (1.0 mg/kg daily for 4 weeks)
+::::* Note (2): Unique issues in pregnancy include the risk of teratogenic complications of azole therapy and of transplacental transmission of Histoplasma capsulatum to the fetus
+::* 3. '''Children treatment'''
+::::* 3.1 '''Acute pulmonary histoplasmosis'''
+::::* Treatment indications and regimens are similar to those for adults, except that [[Amphotericin B]] deoxycholate (1.0 mg/kg daily) is usually well tolerated and the lipid preparations are not preferred
+::::* Note: [[Itraconazole]] dosage: 5.0–10.0 mg/kg daily in 2 divided doses (not to exceed 400 mg daily), generally using the solution formulation
+::::* '''Progressive disseminated histoplasmosis'''
+::::* Prefered regimen: [[Amphotericin B]] deoxycholate (1.0 mg/kg qd for 4–6 weeks)
+::::* Alternative regimen: [[Amphotericin B]] deoxycholate (1.0 mg/kg qd for 2–4 weeks) followed by itraconazole (5.0–10.0 mg/kg qd in 2 divided doses) to complete 3 months of therapy.
+::::* '''Immunosuppressed patients if immunosuppression cannot be reversed and patients in relapse despite appropiate therapy'''
+::::: Preferred regimen: Lifelong suppressive therapy with [[Itraconazole]] (5.0 mg/kg qd up to 200 mg qd)
+::::* Note (1): Longer therapy may be needed for patients with severe disease, immunosuppression, or primary immunodeficiency syndromes
+::::* Note (2): Blood levels of itraconazole should be obtained to ensure adequate drug exposure
+::::* Note (3): Antigen levels should be monitored during therapy and for 12 months after therapy is ended to monitor for relapse. Persistent low-level antigenuria may not be a reason to prolong treatment in patients who have completed appropriate therapy and have no evidence of active infection.
+----
+{{PBI|Mucormycosis}}
+* '''Mucormycosis'''<ref name="pmid19435437">{{cite journal| author=Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J, Ibrahim AS| title=Recent advances in the management of mucormycosis: from bench to bedside. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 12 | pages= 1743-51 | pmid=19435437 | doi=10.1086/599105 | pmc=PMC2809216 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19435437  }} </ref>
+:* Treatment include surgical debridement of involved tissues, antifungal therapy, use of growth factors to accelerate recovery from neutropenia, provision of granulocyte transfusions with sustained circulating neutrophils until the patient recovers from neutropenia, and discontinuation or reduction in the dose of glucocorticoids, correction of metabolic acidosis and hyperglycemia.
+:* Preferred regimen (1): [[Amphotericin B]] Deoxycholate 1.0-1.5 mg/kg/day IV q24h
+:* Preferred regimen (2): Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h
+:* Preferred regimen (3): [[Amphotericin B]] lipid complex 5-7.5 mg/kg/day IV q24h
+:* Alternative regimen (1):[[Caspofungin]] 70 mg IV load dose, 50 mg/day for >2 weeks {{plus}} Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h
+::*Pediatric dose: [[Caspofungin]] 50 mg/m² IV q24h {{plus}}  Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h
+:* Alternative regimen (2): [[Micafungin]] {{or}} [[Anidulafungin]] 100 mg/day for 2 weeks {{plus}} Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h
+::*Pediatric dose: [[Micafungin]] 4 mg/kg/day; [[Micafungin]] 10mg/kg/day for low-birth weight infants; [[Anidulafungin]] 1.5 mg/kg/day
+:* Alternative regimen (3): [[Deferasirox]] 20 mg/kg PO qd for 2–4 weeks {{plus}} Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h
+:* Alternative regimen (4): [[Posaconazole]] 800 mg/day PO qid or bid
+:* Alternative regimen (5): Initial: [[Isavuconazole]] 200 mg PO/IV q8h for 6 doses; maintenance: 200 mg PO/IV qd
+:* Note (1): start maintenance dose 12 to 24 hours after the last loading dose.
+:* Note (2): For salvage therapy: ([[Posaconazole]] 800 mg/day PO qid or bid {{withorwithout}} Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h) {{or}} ([[Deferasirox]] 20 mg/kg PO qd for 2–4 weeks {{plus}} Lipid [[Amphotericin B]] 5-10 mg/kg/day IV q24h) {{or}} Granulocyte transfusions (for persistently neutropenic patients) ∼10ˆ9 cells/kg {{or}} Recombinant cytokines G-CSF 5 μg/kg/day, GM-CSF 100–250 μg/m², or IFN-g at 50 μg/m² for those with body surface area ≥ 0.5 m² and 1.5 μg/kg for those with body surface area <0.5 m²
+{{PBI|Penicilliosis}}
+:* '''Penicilliosis treatment'''
+::*1. '''Mild disease'''
+:::* Preferred regimen: [[Itraconazole]] 200 mg PO bid for 8 to 12 weeks without amphotericin B induction therapy<ref name="pmid1339213">{{cite journal| author=Supparatpinyo K, Chiewchanvit S, Hirunsri P, Baosoung V, Uthammachai C, Chaimongkol B et al.| title=An efficacy study of itraconazole in the treatment of Penicillium marneffei infection. | journal=J Med Assoc Thai | year= 1992 | volume= 75 | issue= 12 | pages= 688-91 | pmid=1339213 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1339213  }} </ref>
+:::* Alternative regimen: [[Voriconazole]] 400 mg PO bid on day 1 {{then}} 200 mg PO bid for 12 weeks<ref name="pmid17690411">{{cite journal| author=Supparatpinyo K, Schlamm HT| title=Voriconazole as therapy for systemic Penicillium marneffei infections in AIDS patients. | journal=Am J Trop Med Hyg | year= 2007 | volume= 77 | issue= 2 | pages= 350-3 | pmid=17690411 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17690411  }} </ref>
+::*2. '''Moderate-severe disease'''
+:::* Preferred regimen: Liposomal [[Amphotericin B]] 3-5 mg/kg/day IV qd {{or}} [[Amphotericin B]] lipid complex 5 mg/kg/day IV qd for 2 weeks {{then}} [[Itraconazole]] 200 mg PO bid for 10 weeks<ref name="pmid9831676">{{cite journal| author=Sirisanthana T, Supparatpinyo K| title=Epidemiology and management of penicilliosis in human immunodeficiency virus-infected patients. | journal=Int J Infect Dis | year= 1998 | volume= 3 | issue= 1 | pages= 48-53 | pmid=9831676 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9831676  }} </ref>
+:::* Alternative regimen:  [[Voriconazole]] 6 mg/kg IV q12h on day 1 {{then}} 4 mg/kg q12h for at least 3 days {{then}} [[Voriconazole]] 200 mg PO bid for a total of 12 weeks<ref name="pmid17690411">{{cite journal| author=Supparatpinyo K, Schlamm HT| title=Voriconazole as therapy for systemic Penicillium marneffei infections in AIDS patients. | journal=Am J Trop Med Hyg | year= 2007 | volume= 77 | issue= 2 | pages= 350-3 | pmid=17690411 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17690411  }} </ref>
+::*3. '''Maintenance therapy'''<ref name="pmid9845708">{{cite journal| author=Supparatpinyo K, Perriens J, Nelson KE, Sirisanthana T| title=A controlled trial of itraconazole to prevent relapse of Penicillium marneffei infection in patients infected with the human immunodeficiency virus. | journal=N Engl J Med | year= 1998 | volume= 339 | issue= 24 | pages= 1739-43 | pmid=9845708 | doi=10.1056/NEJM199812103392403 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9845708  }} </ref>
+:::* Preferred regimen [[Itraconazole]] 200 mg PO qd
+:::* Alternative regimen: [[Voriconazole]] 200 mg PO bid
+::* Note: [[Voriconazole]] and [[Itraconazole]] use require serum levels to be monitored to ensure adequate absorption.
+{{PBI|Sporotrichosis}}
+<ref name="KauffmanBustamante2007">{{cite journal|last1=Kauffman|first1=C. A.|last2=Bustamante|first2=B.|last3=Chapman|first3=S. W.|last4=Pappas|first4=P. G.|title=Clinical Practice Guidelines for the Management of Sporotrichosis: 2007 Update by the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=45|issue=10|year=2007|pages=1255–1265|issn=1058-4838|doi=10.1086/522765}}</ref>
+:* '''Lymphocutaneous/cutaneous'''
+::* Preferred regimen: [[Itraconazole]] 200mg PO qd
+::* Alternative regimen: [[Itraconazole]] 200 mg PO bid {{or}} [[Terbinafine]] 500 mg PO bid {{or}} Saturated solution potassium iodide with increasing doses {{or}} [[Fluconazole]] 400–800 mg PO qd {{or}} local hyperthermia
+::* Note (1): Treat for 2–4 weeks after lesions resolved
+::* Note (2): SSKI initiated at a dosage of 5 drops (using a standard eyedropper) q8h, increasing as tolerated to 40–50 drops q8h
+:* '''Osteoarticular'''
+::* Preferred regimen: [[Itraconazole]] 200mg PO bid for 12 months
+::* Alternative regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day IV {{or}} [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day IV
+::* Note (1): Switch to [[Itraconazole]] after favorable response if AmB used
+::* Note (2): Treat for a total of at least 12 months
+:* '''Pulmonary'''
+::* Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day IV for severe or life-threatening pulmonary sporotrichosis, then [[Itraconazole]] 200 mg PO bid
+::* Preferred regimen(2): [[Itraconazole]] 200 mg PO bid for 12 months for less severe disease
+::* Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/d IV {{then}} [[Itraconazole]] 200 mg PO bid {{or}} surgical removal
+::* Note (1): Treat severe disease with an AmB formulation followed by [[Itraconazole]]
+::* Note (2): Treat less severe disease with [[Itraconazole]]
+::* Note (3): Treat for a total of at least 12 monthsSurgery combined with amphotericin B therapy is rec- ommended for localized pulmonary disease
+:* '''Meningitis'''
+::* Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg daily for 4–6 weeks, then [[Itraconazole]] 200 mg PO bid
+::* Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/d, then [[Itraconazole]] 200 mg PO bid
+::* Note  (1): Length of therapy with AmB not established, but therapy for at least 4–6 weeks is recommended.
+::* Note (2): Treat for a total of at least 12 months.
+::* Note (3): May require long-term suppression with [[Itraconazole]].
+:* '''Disseminated'''
+::* Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
+::* Alternative regimen: [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day, then [[Itraconazole]] 200 mg PO bid
+::* Note(1): Therapy with AmB should be continued until the patient shows objective evidence of improvement.
+::* Note(2): Treat for a total of at least 12 months.
+::* Note(3): May require long-term suppression with [[Itraconazole]].
+:* '''Pregnant women'''
+::* Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg/day IV {{or}} [[Amphotericin B]] deoxycholate 0.7–1 mg/kg/day IV for severe sporotrichosis
+::* Preferred regimen(2): Local hyperthermia for cutaneous disease.
+::* Note (1): It is preferable to wait until after delivery to treat non–life-threatening forms of sporotrichosis.
+::* Note (2): Azoles should be avoided.
+:* '''Children'''
+::* Preferred regimen:
+:::* Mild disease: [[Itraconazole]] 6–10 mg/kg/day PO (400 mg/day maximum)
+:::* Severe disease: [[Amphotericin B]] deoxycholate 0.7 mg/kg/day IV followed by [[Itraconazole]] 6–10 mg/kg PO up to a maximum of 400 mg PO daily, as step-down therapy
+::* Alternative regimen: Saturated solution potassium iodide with increasing doses for mild disease initiated at a dosage of 1 drop (using a standard eyedropper) q8h and increased as tolerated up to a maximum of 1 drop/kg or 40–50 drops q8h, whichever is lowest
+{{PBI|Pneumocystis jiroveci}}
+:*'''1. Preventing First Episode of PCP (Primary Prophylaxis)'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
+}}</ref>
+::*Preferred regimen: [[TMP-SMX]] 1 Double-Strength(DS) PO daily {{or}} [[TMP-SMX]] 1 Single-Strength(SS) PO daily
+::*Alternative regimen (1): [[TMP-SMX]] 1 Double-Strength(DS) tid weekly {{or}} [[Dapsone]] 100 mg PO daily or 50 mg PO bid
+::*Alternative regimen (2): [[Dapsone]] 50 mg PO {{and}} ([[Pyrimethamine]] 50 mg PO {{and}} [[Leucovorin]] 25 mg) PO weekly
+::*Alternative regimen (3): [[Dapsone]] 200 mg PO {{and}} [[Pyrimethamine]] 75 mg PO {{and}} [[Leucovorin]] 25 mg PO weekly
+::*Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
+::*Alternative regimen (5): [[Atovaquone]] 1500 mg PO qd with food
+::*Alternative regimen (6): [[Atovaquone]] 1500 mg PO {{and}} [[Pyrimethamine]] 25 mg PO {{and}} [[Leucovorin]] 10 mg PO daily with food
+:*'''2. Treatment of Pneumocystis Pneumonia'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
+}}</ref>
+::*'''2.1. Moderate to Severe PCP'''
+:::*Preferred regimen: [[TMP-SMX]] (TMP 15–20 mg and SMX 75–100 mg)/kg/day IV given q6h or q8h
+:::*Note: May switch to PO after clinical improvement
+:::*Alternative regimen (1): [[Pentamidine]] 4 mg/kg IV once daily infused over at least 60 minutes
+:::*Note: May reduce the dose to 3 mg/kg IV once daily because of toxicities.
+:::*Alternative regimen (2): [[Primaquine]] 30 mg (base) PO once daily {{and}} ([[Clindamycin]] [IV 600 mg q6h or 900 mg q8h] or [PO 450 mg q6h or 600 mg q8h])
+::*Note (1): Duration of PCP treatment is 21 days
+::*Note (2): Adjunctive corticosteroid may be indicated in some moderate to severe cases.Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy) (AI):
+::*Note (3): Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy)
+:::*Days 1–5 40 mg PO BID
+:::*Days 6–10 40 mg PO daily
+:::*Days 11–21 20 mg PO daily
+::*'''2.2. Mild to Moderate PCP'''
+:::*Preferred regimen: [[TMP-SMX]] (TMP 15–20 mg/kg/day and SMX 75–100 mg/kg/day), given PO in 3 divided doses {{or}} [[TMP-SMX]] Double-Strength(DS) - 2 tablets tid
+:::*Alternative regimen (1): [[Dapsone]] 100 mg PO daily {{and}} [[TMP]] 15 mg/kg/day PO (3 divided doses)
+:::*Alternative regimen (2): [[Primaquine]] 30 mg (base) PO daily {{and}} [[Clindamycin]] PO (450 mg q6h or 600 mg q8h)
+:::*Alternative regimen (3): [[Atovaquone]] 750 mg PO BID with food
+::*Note: Duration of PCP treatment is 21 days
+:*'''3. Preventing Subsequent Episode of PCP (Secondary Prophylaxis)'''<ref>{{Cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url =https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/321/pcp
+}}</ref>
+::*Preferred regimen: [[TMP-SMX]] 1 Double-Strength(DS) PO daily {{or}} [[TMP-SMX]] 1 Single-Strength(SS) PO daily
+::*Alternative regimen (1): [[TMP-SMX]] 1 Double-Strength(DS) tid weekly {{or}} [[Dapsone]] 100 mg PO daily or 50 mg PO BID
+::*Alternative regimen (2): [[Dapsone]] 50 mg PO daily {{and}} ([[Pyrimethamine]] 50 mg + [[Leucovorin]] 25 mg) PO weekly
+::*Alternative regimen (3): [[Dapsone]] 200 mg {{and}} [[Pyrimethamine]] 75 mg {{and}} [[Leucovorin]] 25 mg PO weekly
+::*Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
+::*Alternative regimen (5): [[Atovaquone]] 1500 mg PO daily with food
+::*Alternative regimen (6): [[Atovaquone]] 1500 mg {{and}} [[Pyrimethamine]] 25 mg {{and}} [[Leucovorin]] 10 mg PO daily with food
+====Mycobacteria====
+{{PBI|Mycobacterium tuberculosis}}
+:* 1. '''Standard Regimens for new patients''' <ref>{{cite book | title = Treatment of tuberculosis guidelines | publisher = World Health Organization | location = Geneva | year = 2010 | isbn = 9789241547833 }}</ref>
+::* 1.1 '''Adult'''
+:::* 1.1.1 '''Initial phase'''
+::::* Preferred regimen: [[Isoniazid]] 300 mg PO (5 mg/kg/day) qd for 8 weeks {{and}} [[Rifampicin]] 600 mg PO (10 mg/kg/day) qd for 8 weeks {{and}} [[Pyrazinamide]] 2 g PO (25 mg/kg/day) qd for 8 weeks {{and}} [[Ethambutol]] 1.6 g PO (15 mg/kg/day) qd for 8 weeks
+::::* Alternative regimen (1): [[Isoniazid]] 300 mg/day PO for 2 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO for 2 weeks (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2 g/day PO for 2 weeks (25 mg/kg/day) {{and}} [[Ethambutol]] 1.6 g PO for 2 weeks (15 mg/kg/day), followed by [[Isoniazid]] 300 mg/day PO twice weekly for 6 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO twice weekly for 6 weeks (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2 g/day PO twice weekly for 6 weeks {{and}} [[Ethambutol]] 1.6 g PO for 2 weeks (15 mg/kg/day)
+::::* Alternative regimen (2): [[Isoniazid]] 300 mg/day PO thrice weekly for 8 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO thrice weekly for 8 weeks (10 mg/kg/day) {{and}} [[Pyrazinamide]] 2g/day PO thrice weekly for 8 week (25 mg/kg/day) {{and}} [[Ethambutol]] 1.6 g PO thrice weekly for 8 weeks (15 mg/kg/day)
+:::* 1.1.2 '''Continuation phase'''
+::::* Preferred regimen (1): [[Isoniazid]] 300 mg PO (5 mg/kg/day) qd {{and}} [[Rifampicin]] 600 mg PO (10 mg/kg/day) qd for 18 weeks
+::::* Preferred regimen (2): [[Isoniazid]] 300 mg PO twice weekly (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO twice weekly (10 mg/kg/day) for 18 weeks
+::::* Alternative regimen (1): [[Isoniazid]] 300 mg/day PO biweekly for 18 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO biweekly for 18 weeks (10 mg/kg/day)
+::::* Alternative regimen (2): [[Isoniazid]] 300 mg/day PO thrice weekly for 18 weeks (5 mg/kg/day) {{and}} [[Rifampicin]] 600 mg/day PO thrice weekly for 18 weeks (10 mg/kg/day)
+::* 1.2 '''Pediatric'''
+:::* 1.2.1 '''Initial phase'''
+::::* Preferred regimen: [[Isoniazid]] 10 mg/kg PO (Maximum, 300 mg/day) {{and}} [[Rifampicin]] 15 mg/kg PO (Maximum, 600 mg/day) {{and}} [[Pyrazinamide]] 35 mg/kg PO (Maximum, 2 g/day) {{and}} [[Ethambutol]] 20 mg/kg PO (Maximum, 1.6 g/day), each for 8 weeks
+:::* 1.2.2 '''Continuation phase'''
+::::* Preferred regimen: [[Isoniazid]] 10 mg/kg PO (Maximum, 300 mg/day) {{and}} [[Rifampicin]] 15 mg/kg PO (Maximum, 600 mg/day), each drug daily for 18 weeks
+:* 2. '''MDR Tuberculosis''' <ref name=WHO>{{cite web | title = The use of delamanid in the treatment of multidrug-resistant tuberculosis| url =http://apps.who.int/iris/bitstream/10665/137334/1/WHO_HTM_TB_2014.23_eng.pdf?ua=1 }}</ref>
+::* 2.1 '''Adult'''
+:::* Preferred regimen: 4 agents combination
+::::* Agent 1: [[Pyrazinamide]] 20–30 mg/kg {{or}} [[Ethambutol]] 15–25 mg/kg {{or}} [[Rifabutin]] 5 mg/kg
+::::* Agent 2: [[Capreomycin]] 15 mg/kg {{or}} [[Kanamycin]] 15 mg/kg {{or}} [[Amikacin]] 7.5-10 mg/kg {{or}} [[Streptomycin]] 12–18 mg/kg
+::::* Agent 3: [[Levofloxacin]] 500-1000 mg {{or}} [[Moxifloxacin]] 400 mg {{or}} [[Ofloxacin]] 400 mg
+::::* Agent 4: [[Ethionamide]] 15-20 mg/kg {{or}} [[Protionamide]] 15-20 mg/kg {{or}} [[Cycloserine]] 10-15 mg/kg {{or}} [[Terizidone]] 10-20 mg/kg {{or}} Para-[[aminosalicylic acid]] 8-12 g/day IV q8-12h
+::* 2.2 '''Pediatric'''
+:::* Preferred regimen: 4 agents combination
+::::* Agent 1: [[Pyrazinamide]] 20-30 mg/kg (Maximum: 600 mg) {{or}} [[Ethambutol]] 15-20 mg/kg {{or}} [[Rifabutin]] 5 mg/kg
+::::* Agent 2: [[Capreomycin]] 15-30 mg/kg (Maximum: 1000 mg) {{or}} [[Kanamycin]] 15-30 mg/kg (Maximum: 1000 mg) {{or}} [[Amikacin]] 15-22.5 mg/kg (Maximum: 1000 mg) {{or}} [[Streptomycin]] 12-18 mg/kg {{and}}
+::::* Agent 3: [[Levofloxacin]] 7.5-10 mg/kg {{or}} [[Moxifloxacin]] 7.5-10 mg/kg {{or}} [[Ofloxacin]] 15-20 mg/kg/day q12h (Maximum: 800 mg)
+::::* Agent 4: [[Ethionamide]] 15-20 mg/kg/day q12h (Maximum: 1000 mg) {{or}} [[Protionamide]] 15-20 mg/kg/day q12h (Maximum: 1000 mg) {{or}} [[Cycloserine]] 10-20 mg/kg (Maximum: 1000 mg) {{or}} [[Terizidone]] 10-20 mg/kg (Maximum: 1000 mg) {{or}} Para-aminosalicylic acid 150 mg/kg/day q8-12h(Maximum: 12,000 mg)
+:* 3. '''XDR Tuberculosis''' <ref>{{cite web | title = WHO| url =http://www.who.int/tb/challenges/mdr/programmatic_guidelines_for_mdrtb/en/}}</ref>
+::* 3.1 '''Adult'''
+:::* Preferred regimen: 3 agents combination
+::::* Agent 1: [[Pyrazinamide]] 20–30 mg/kg {{or}} [[Ethambutol]] 15–25 mg/kg {{or}} [[Rifabutin]] 5 mg/kg
+::::* Agent 2: [[Ethionamide]] 15-20 mg/kg {{or}} [[Protionamide]] 15-20 mg/kg {{or}} [[Cycloserine]] 10-15 mg/kg {{or}} [[Terizidone]] 10-20 kg/mg {{or}} Para-[[aminosalicylic acid]] 8-12 g/day q8-12h
+::::* Agent 3: [[Clofazimine]] 50 mg/d AND 300 mg once a month {{or}} [[Amoxicillin]]/clavulanate 500 mg/125 mg q12h {{or}} [[Linezolid]] 300-600 mg {{or}} [[Imipenem]] 500mg q6h {{or}} [[Clarithromycin]] 500-1000 mg q12h {{or}} [[Thioacetazone]] 2.5 mg/kg {{or}} [[Isoniazid]] (high-dose) 16–20 mg/kg
+::* 3.2 '''Pediatric'''
+:::* Preferred regimen: 3 agents combination
+::::* Agent 1: [[Pyrazinamide]] 20-30 mg/kg (Maximum: 600 mg) {{or}} [[Ethambutol]] 15 mg/kg {{or}} [[Rifabutin]] 5 mg/kg
+::::* Agent 2: [[Ethionamide]] 15-20 mg/kg (Maximum: 1000 mg) {{or}} [[Protionamide]] 15-20 mg/kg (Maximum: 1000 mg) {{or}} [[Cycloserine]] 10-20 mg/kg (Maximum: 1000 mg) {{or}} [[Terizidone]] 10-20 mg/kg (Maximum: 1000 mg) {{or}} Para-[[aminosalicylic acid]] 150 mg/kg/day q8-12h
+::::* Agent 3: [[Clofazimine]] 50 mg/d AND 300 mg once a month {{or}} [[Amoxicillin]]/clavulanate {{or}} [[Linezolid]] 300-600 mg {{or}} [[Imipenem]] 500mg q6h {{or}} [[Clarithromycin]] 500-1000 mg q12h {{or}} [[Thioacetazone]] 2.5 mg/kg {{or}} [[Isoniazid]] (high-dose) 16–20 mg/kg
+{{PBI|Mycobacterium abscessus}}
+*1.'''Limited, localized extrapulmonary disease ''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:* Preferred regimen: [[Clarithromycin]] 500 mg PO bid {{withorwithout}} [[Amikacin]] 10-15 mg/kg/day IV or 25 mg/kg three times weekly for 4 months
+:* Alternative regimen (1): [[Amikacin]] {{and}} [[Cefoxitin]] 12 g/day PO for two weeks
+:* Note: until clinical improvement in severe cases
+:* Alternative regimen (2): [[Amikacin]] {{and}} [[Imipenem]] 500 mg IV q6-8h for two weeks
+:* Note(1): Until clinical improvement in severe cases
+:* Note(2): Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed
+*2.'''Pulmonary or serious extrapulmonary disease'''
+:* Preferred regimen: [[Clarithromycin]] 500 mg PO bid {{and}} [[Amikacin]] 15 mg/kg/day IV {{and}} [[Cefoxitin]] 2g IV q4h {{or}} [[Imipenem]] 1g IV q6h for at least 2-4 months
+:* Note: If limited by adverse effects {{then}} [[Clarithromycin]] 500 mg PO bid or 1000 mg XR qd {{or}} [[Azithromycin]] 250 mg PO qd
+:* Alternative regimen(1): [[Tigecycline]] 100 mg IV loading dose {{then}} 50 mg IV q12h
+:* Note: could be substituted as one of the injectables
+:* Alternative regimen(2): [[Linezolid]] 600 mg PO bid or 600 mg PO qd {{and}} [[Clarithromycin]]
+:* Note: Could replace parental tx if not tolerated or feasible
+{{PBI|Mycobacterium bovis}}
+:* [[Mycobacterium bovis]] <ref name="pmid12836625">{{cite journal| author=American Thoracic Society. CDC. Infectious Diseases Society of America| title=Treatment of tuberculosis. | journal=MMWR Recomm Rep | year= 2003 | volume= 52 | issue= RR-11 | pages= 1-77 | pmid=12836625 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12836625  }} </ref>
+::* Note: Is intrinsically resistant to [[Pyrazinamide]] (PZA). The treatment of M. bovis is extrapolated from experience with the treatment of PZA-resistant ''M. tuberculosis''
+::* 1. '''Pulmonary and most extrapulmonary disease'''
+:::* Preferred regimen: [[Isoniazid]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]] for 2 months, followed by [[Isoniazid]] {{and}} [[Rifampin]] for 7 months
+::* 2. '''Meningitis '''
+:::* Preferred regimen: [[Isoniazid]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]] for 2 months, followed by [[Isoniazid]] {{and}} [[Rifampin]] for 10 months
+{{PBI|Mycobacterium avium-intracellulare}}
+:* 1. '''Treatment of MAC pulmonary disease''' <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = Daviday E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richarday J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, anday prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory anday Critical Care Medicine| date = 2007-02-15| pmiday = 17277290}}</ref>
+::* 1.1 '''Patients with nodular/bronchiectatic disease'''
+:::* Preferreday regimen: [[Clarithromycin]] 1,000 mg three times weekly {{or}} [[Azithromycin]] 500–600 mg three times weekly {{and}} [[Ethambutol]] 25 mg/kg three times weekly {{and}} [[Rifampin]] 600 mg three times weekly
+:::* Note: Patients should be treated until culture negative on therapy for 1 year
+::* 1.2 '''Patients with fibrocavitary or severe nodular/bronchiectatic disease'''
+:::* Preferreday regimen: [[Clarithromycin]] 500–1,000 mg/day {{or}} [[Azithromycin]] 250–300 mg/day {{or}} [[Rifampin]] 600 mg/day {{or}} [[Rifabutin]] 150–300 mg/day {{and}} [[Ethambutol]] 15 mg/kg/day
+:::* Note(1): [[Amikacin]] {{or}} [[Streptomycin]] threetimes-weekly can be used early in therapy
+:::* Note(2): Patients should be treated until culture negative on therapy for 1 year
+:* 2. '''Disseminateday MAC disease'''
+::* Preferreday regimen: [[Clarithromycin]] 1,000 mg/day {{or}} [[Azithromycin]] 250 mg/day {{and}} [[Ethambutol]] 15 mg/kg/day {{withorwithout}} [[Rifabutin]] 150–350 mg/day
+{{PBI|Mycobacterium celatum}}
+:* [[Mycobacterium celatum]] <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen: [[Clarithromycin]] {{and}} [[Ethambutol]] {{and}} [[Ciprofloxacin]] {{withorwithout}} [[Rifabutin]]
+{{PBI|Mycobacterium chelonae}}
+:* [[Mycobacterium chelonae]] <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+:* 1. '''Localized infections'''
+::* Preferred regimen: [[Clarithromycin]] 500 mg PO bid
+::* Alternative regimen: [[Azithromycin]]
+:* 2. '''Disseminated or extensive disease'''
+::* 2.1 '''monotherapy '''
+:::* Preferred regimen: [[Clarithromycin]] 500 mg PO bid for 6 months
+::* 2.2 '''multidrug therapy '''
+:::* preferred regimen: [[Clarithromycin]] 500 mg PO bid {{and}} [[Tobramycin]] 5 mg/kg IV q24h {{or}} [[Imipenem]] 0.5-1 g IV q6h {{or}} [[Linezolid]] 600 mg IV/PO q12h/bid for 4-8 weeks
+:::* Alternative regimen: [[Moxifloxacin]] 400 mg PO qd {{and}} [[Linezolid]] 600 mg PO bid
+:::* Note(1): During initial treatment, multidrug therapy may prevent development of acquired resistance
+:::* Note(2): Total treatment duration is 6 months
+:* 3. '''Keratitis (LASIK-related)'''
+::* Preferred regimen: [[Clarithromycin]] 500 mg PO bid {{and}} [[Tobramycin]] 0.3% 2 gtts q4h {{and}} [[Gatifloxacin]] 0.3% 1 gtt q4h {{or}} [[Moxifloxacin]] 0.5% 1 gtt q4h
+{{PBI|Mycobacterium foruitum}}
+:* [[Mycobacterium foruitum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* 1. '''In vitro isolates '''
+:::* Susceptible agents: [[Amikacin]] (100%), [[Ciprofloxacin]] and [[Ofloxacin]] (100%), [[Sulfonamides]] (100%), [[Cefoxitin]] (50%), [[Imipenem]] (100%), [[Clarithromycin]] (80%), and [[Doxycycline]] (50%)
+::* 2. '''Disease'''
+:::* 2.1 '''M. fortuitum lung disease'''
+::::* At least two agents with in vitro activity against the clinical isolate should be given for at least 12 months of negative sputum cultures
+:::* 2.2 '''Serious skin, bone, and soft tissue M fortuitum disease'''
+::::* At least two agents with in vitro activity against the clinical isolate should be given for a minimum of 4 months; For bone infections, 6 months of therapy is recommended
+{{PBI|Mycobacterium haemophilum}}
+:* [[Mycobacterium haemophilum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* 1. '''In vitro'''
+:::* Susceptible: [[Amikacin]], [[Clarithromycin]], [[Ciprofloxacin]], [[Rifampin]], and [[Rifabutin]]
+:::* Less susceptible: [[Doxycycline]] and [[Sulfonamides]]
+::* 2. '''Infection'''
+:::* 2.1 '''Disseminated disease'''
+::::* Preferred regimen: [[Clarithromycin]] {{and}} [[Rifampin]] {{and}} [[Rifabutin]] {{and}} [[Ciprofloxacin]]
+{{PBI|Mycobacterium genavense}}
+:* [[Mycobacterium genavense]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* Susceptibility: [[Amikacin]], [[Rifamycin]], [[Fluoroquinolones]], [[Streptomycin]], and [[Macrolides]]
+::* Note(1): [[Ethambutol]] has limited activity
+::* Note(2): Optimal therapy is not determined, but multidrug therapies including [[Clarithromycin]] appear to be more effective than those without [[Clarithromycin]]
+{{PBI|Mycobacterium gordonae}}
+:* [[Mycobacterium gordonae]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* Preferred regimen: [[Ethambutol]] {{or}} [[Rifabutin]] {{or}} [[Clarithromycin]] {{or}} [[Linezolid]] {{or}} [[Fluoroquinolones]]
+{{PBI|Mycobacterium kansasii}}
+:* [[Mycobacterium kansasii]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* 1. '''pulmonary disease'''
+:::* Preferred regimen: [[Rifampin]] 10 mg/kg/day (Maximum, 600 mg) PO {{and}} [[Ethambutol]] 15 mg/kg/ day PO {{and}} [[Isoniazid]] 5 mg/kg/day (Maximum 300 mg) PO {{and}} [[Pyridoxine]] 50 mg/day PO
+:::* Note: Treatment duration for M. kansasii lung disease should include 12 months of negative sputum cultures
+::* 2. '''Rifampin-resistant M. kansasii disease'''
+:::* Preferred regimen: [[Clarithromycin]] {{or}} [[Azithromycin]] {{or}} [[Moxifloxacin]] {{or}} [[Ethambutol]] {{or}} [[Sulfamethoxazole]] {{or}} [[Streptomycin]]
+:::* Note(1): Use three-drug regimen
+:::* Note(2): Patients undergoing therapy for M. kansasii lung disease should have close clinical monitoring with frequent sputum examinations for mycobacterial culture throughout therapy
+::* 3. '''Disseminated M. kansasii disease'''
+:::* Note: The treatment regimen for disseminated disease should be the same as for pulmonary disease
+{{PBI|Mycobacterium marinum}}
+:* [[Mycobacterium marinum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* 1. '''In vitro M. marinum isolates'''
+:::* Susceptible: [[Rifampin]], [[Rifabutin]], [[Ethambutol]], [[Clarithromycin]], [[Sulfonamides]], and [[Trimethoprim sulfamethoxazole]]
+:::* Intermediately susceptible: [[Streptomycin]], [[Doxycycline]], and [[Minocycline]]
+:::* Resistant: [[Isoniazid]] and [[Pyrazinamide]]
+:::* Note: Two active agents for 1 to 2 months after resolution of symptoms, typically 3 to 4 months in total
+::* 2. '''Infection'''
+:::* 2.1 '''skin and soft tissue infections'''
+::::* Preferred regimen (1): [[Clarithromycin]] {{and}} [[Ethambutol]]
+::::* Preferred regimen (2): [[Ethambutol]] {{and}} [[Rifampin]]
+::::* Note: [[Azithromycin]] can replace [[Clarithromycin]]
+:::* 2.2 '''osteomyelitis or deep structure infection'''
+::::* Preferred regimen: [[Clarithromycin]] {{and}} [[Ethambutol]] {{and}} [[Rifampin]]
+{{PBI|Mycobacterium scrofulaceum}}
+:* [[Mycobacterium scrofulaceum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* Susceptibility data are lacking and standard treatment regimens for M. scrofulaceum are controversial, emphasizing the need to perform susceptibility testing on confirmed disease-producing isolates of M. scrofulaceum
+{{PBI|Mycobacterium simiae}}
+:* [[Mycobacterium simiae]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* Preferred regimen: [[Clarithromycin]] {{and}} [[Moxifloxacin]] {{and}} [[Trimethoprim/sulfamethoxazole]]
+{{PBI|Mycobacterium ulcerans}}
+:* [[Mycobacterium ulcerans]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+:* 1. '''Preulcerative lesions'''
+::* Excision and primary closure, [[Rifampin]] monotherapy, or heat therapy
+:* 2. '''Established ulcers'''
+::* Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice
+:* 3. '''Control complications of the ulcer'''
+::* Preferred regimen: [[Clarithromycin]] {{and}} [[Rifampin]]
+{{PBI|Mycobacterium xenopi}}
+:* [[Mycobacterium xenopi]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+:* 1. '''The cornerstone of therapy for M. xenopi'''
+::* Preferred regimen: [[Clarithromycin]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]]
+::* Note: Therapy should be continued until the patient has maintained negative sputum cultures while on therapy for 12 months
+:* 2. '''Pulmonary disease'''
+::* Preferred regimen: [[INH]] {{and}} [[Rifabutin]] {{or}} [[Rifampin]] {{and}} [[Ethambutol]] {{and}} [[Clarithromycin]] {{withorwithout}} [[Streptomycin]]
+::* Note: A quinolone, preferably [[Moxifloxacin]], could be substituted for one of the antituberculous drugs
+:* 3. '''Extrapulmonary disease'''
+::* Note: Therapy for extrapulmonary disease would include the same agents as for pulmonary disease
+{{PBI|Mycobacterium leprae}}
+:* [[Mycobacterium leprae]] <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
+::* 1. '''Multibacillary Leprosy (Skin smear positive) '''
+:::* 1.1 '''Adult'''
+::::* Preferred regimen: [[Dapsone]] 100 mg/day PO {{and}} [[Rifampin]] 600 mg PO 4 times per week {{and}} [[Clofazimine]] 50 mg PO qd for 12-24 months
+::::* Note: [[Clofazimine]] should be supplemented by loading dose 300 mg PO monthly
+:::* 1.2 '''Pediatric'''
+::::* 1.2.1 '''< 35 kg'''
+:::::* Preferred regimen: [[Dapsone]] 1-2 mg/kg/day PO {{and}} [[Rifampin]] 450 mg PO for 12-24 months
+::::* 1.2.2 '''< 20 kg'''
+:::::* Preferred regimen: [[Dapsone]] 1-2 mg/kg/day PO {{and}} [[Rifampin]] 300 mg PO for 12-24 months
+::::* 1.2.3 '''< 12 kg'''
+:::::* Preferred regimen: [[Dapsone]] 1-2 mg/kg/day PO {{and}} [[Rifampin]] 150 mg PO for 12-24 months
+::* 2. '''Paucibacillary Leprosy (Skin Smear negative)'''
+:::* Preferred regimen: [[Rifampin]] 600 mg PO once a month for 6 months {{and}} [[Dapsone]] 100 mg PO qd for 6 months
+::* 3. '''Erythema Nodosum Leprosum (ENL)'''
+:::* 3.1 '''Mild'''
+::::* Preferred regimen: Rest affect limb, analgesics, follow-up twice a week, check for iridocyclitis; [[Chloroquine]] {{or}} [[Aspirin]] may be useful
+:::* 3.2 '''Severe (numerous nodules + fever, ulcerating/pustular ENL, visceral involvement, nodules + neuritis, recurrent ENL)'''
+::::* Preferred regimen: [[Prednisolone]] 30-40 mg/day PO for 1-2 weeks {{then}} taper over 12 weeks
+::::* Alternative regimen (1): (If unresponsive to corticosteroids or if risk of corticosteroids prevent administration) [[Clofazimine]] 100 mg PO tid for maximum of 12 weeks {{then}} taper the dose to 100 mg PO bid for 12 weeks {{then}} 100 mg qd for 12-24 weeks
+::::* Alternative regimen (2): (if not contraindicated) [[Thalidomide]] 200-400 mg/day PO {{then}} 50-100 mg/day after 1-2 weeks
+::* 4. '''Reversal Reaction'''
+:::* Preferred regimen: [[Prednisolone]] start with 40 mg/day PO {{then}} taper by 10 mg twice a week for 12 weeks
+{{PBI|Mycobacterium smegmatis}}
+:* [[Mycobacterium smegmatis]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* 1. '''Mild disease'''
+:::* Preferred regimen: [[Doxycycline]] PO {{and}} [[ Trimethoprim sulfamethoxazole]] PO
+::* 2. '''Severe disease'''
+:::* Preferred regimen: [[Amikacin]] IV {{or}} [[Imipenem]] IV
+{{PBI|Mycobacterium immunogenum}}
+:* [[Mycobacterium immunogenum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* In vitro
+:::* Susceptible: [[Amikacin]] and [[Clarithromycin]]
+:::* Resistant: [[Ciprofloxacin]], [[Doxycycline]], [[Cefoxitin]], [[Tobramycin]], and [[Sulfamethoxazole]]
+:::* Note: The optimal therapy for this organism is unknown; however, successful therapy is likely difficult due to the extensive antibiotic resistance of the organism
+{{PBI|Mycobacterium malmoense }}
+:* [[Mycobacterium malmoense]]<ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* 1. '''In vitro '''
+:::* Susceptible: [[Ethambutol]], [[Ethionamide]], [[Kanamycin]], and [[Cycloserine]]
+:::* Resistant: [[INH]], [[Streptomycin]], [[Rifampin]], and [[Capreomycin]]
+::* 2. '''Pulmonary M. malmoense infection'''
+:::* Preferred regimen: [[INH]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]] {{withorwithout}} [[Quinolones]] {{and}} [[Macrolides]]
+{{PBI|Mycobacterium mucogenicum}}
+:* [[Mycobacterium mucogenicum]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* In vitro susceptible agents: [[Aminoglycosides]], [[Cefoxitin]], [[Clarithromycin]], [[Minocycline]], [[Doxycycline]], [[Quinolones]], [[Trimethoprim/sulfamethoxazole]], and [[Imipenem]]
+{{PBI|Mycobacterium szulgai}}
+:* [[Mycobacterium szulgai]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref><ref>{{Cite journal| issn = 0903-1936| volume = 11| issue = 4| pages = 975–977| last1 = Tortoli| first1 = E.| last2 = Besozzi| first2 = G.| last3 = Lacchini| first3 = C.| last4 = Penati| first4 = V.| last5 = Simonetti| first5 = M. T.| last6 = Emler| first6 = S.| title = Pulmonary infection due to Mycobacterium szulgai, case report and review of the literature| journal = The European Respiratory Journal| date = 1998-04| pmid = 9623706}}</ref>
+::* '''1. in vitro susceptibility'''
+:::* M. szulgai is susceptible in vitro to most antituberculous drugs including [[Quinolones]] and newer [[Macrolides]]
+::* '''2. Infection'''
+:::* '''2.1 Pulmonary infection'''
+::::* Three- or four-drug regimen based on susceptibility that includes 12 months of negative sputum cultures while on therapy
+:::* '''2.2 Extrapulmonary infection'''
+::::* Combination anti-tuberculous medications based on in vitro susceptibilities for 4-6 months
+{{PBI|Mycobacterium terrae}}
+:* [[Mycobacterium terrae]] <ref>{{Cite journal| doi = 10.1164/rccm.200604-571ST| issn = 1073-449X| volume = 175| issue = 4| pages = 367–416| last1 = Griffith| first1 = David E.| last2 = Aksamit| first2 = Timothy| last3 = Brown-Elliott| first3 = Barbara A.| last4 = Catanzaro| first4 = Antonino| last5 = Daley| first5 = Charles| last6 = Gordin| first6 = Fred| last7 = Holland| first7 = Steven M.| last8 = Horsburgh| first8 = Robert| last9 = Huitt| first9 = Gwen| last10 = Iademarco| first10 = Michael F.| last11 = Iseman| first11 = Michael| last12 = Olivier| first12 = Kenneth| last13 = Ruoss| first13 = Stephen| last14 = von Reyn| first14 = C. Fordham| last15 = Wallace| first15 = Richard J.| last16 = Winthrop| first16 = Kevin| last17 = ATS Mycobacterial Diseases Subcommittee| last18 = American Thoracic Society| last19 = Infectious Disease Society of America| title = An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases| journal = American Journal of Respiratory and Critical Care Medicine| date = 2007-02-15| pmid = 17277290}}</ref>
+::* 1. '''In vitro susceptibility'''
+:::* All six of the isolates from a single center and 90% or more of an additional 22 isolates of M. terrae complex were susceptible to [[Ciprofloxacin]] and [[Sulfonamides]]. Recently, 11 isolates of M. terrae complex were also shown to be susceptible to [[Linezolid]]
+::* 2. '''Antimicrobial therapy'''
+:::* Based on in vitro susceptibility results
+----
+====Parasites – Intestinal Protozoa====
+:* Balantidium coli treatment<ref name="pmid18854484">{{cite journal| author=Schuster FL, Ramirez-Avila L| title=Current world status of Balantidium coli. | journal=Clin Microbiol Rev | year= 2008 | volume= 21 | issue= 4 | pages= 626-38 | pmid=18854484 | doi=10.1128/CMR.00021-08 | pmc=PMC2570149 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18854484  }} </ref>
+::* Adult dosage:
+:::* Preferred regimen: [[Metronidazole]] 750 mg PO tid for 5 days, [[Tetracycline]] 500 mg PO qid for 10 days
+:::* Alternative regimen: [[Iodoquinol]] 650 mg PO tid for a 20-days
+::* Pediatric dosage:
+:::* Preferred regimen: [[Metronidazole]] 35-50 mg/kg/day PO in three doses (maximum dosage: 2 g) for 5 days, [[Tetracycline]] 40 mg/kg/dose PO in four doses for 10 days.
+:::* Alternative regimen: [[Iodoquinol]] 40 mg/kg/dose PO in three doses for 20 days {{and}} [[Doxycycline]].
+:::* Note: [[Nitazoxanide]], a broad-spectrum antiparasitic and antihelminthic drug, may be another treatment for balantidiosis.
+{{PBI|Blastocystis hominis}}
+:* Blastocystis<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* Preferred regimen (1): [[Metronidazole]] 750 mg PO tid or 1.5 g qd for 10 days
+::* Preferred regimen (2): [[Trimethoprim-sulfamethoxazole]] 1 DS PO bid or 2 DS PO qd for 7 days
+::* Preferred regimen (3): [[Iodoquinol]] 650 mg PO tid for 20 days
+::* Preferred regimen (4): [[Nitazoxanide]] 500 mg PO bid for 3 days
+::* Preferred regimen (5): [[Paromomycin]] 25-35 mg/kg/day PO tid for 7 days
+::* Note (1): Treatment of asymptomatic infections is unnecessary
+::* Note (2): One double strength tablet contains 160 mg trimethoprim/800 mg sulfamethoxazole
+----
+{{PBI|Cryptosporidium parvum}}
+::* '''1. Immunocompetent'''<ref name="pmid11398117">{{cite journal| author=Rossignol JF, Ayoub A, Ayers MS| title=Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide. | journal=J Infect Dis | year= 2001 | volume= 184 | issue= 1 | pages= 103-6 | pmid=11398117 | doi=10.1086/321008 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11398117  }} </ref>
+:::* Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: [[Nitazoxanide]] 500 mg PO bid for 3 days.
+::* '''2. HIV'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen: [[Nitazoxanide]] 500 mg PO bid for 3 days
+::* '''3. HIV and Immunodeficiency'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen: Effective antiretroviral therapy
+:::* Note: Nitazoxanide is not licensed for immunodeficient patients
+----
+{{PBI|Cryptosporidium hominis}}
+::* '''1. Immunocompetent'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: [[Nitazoxanide]] 500 mg PO bid for 3 days.<ref name="pmid15640710">{{cite journal| author=Smith HV, Corcoran GD| title=New drugs and treatment for cryptosporidiosis. | journal=Curr Opin Infect Dis | year= 2004 | volume= 17 | issue= 6 | pages= 557-64 | pmid=15640710 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15640710  }} </ref>
+::* '''2. HIV'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen: [[Nitazoxanide]] 500 mg PO bid for 3 days
+::* '''3. HIV and Immunodeficiency'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen: Effective antiretroviral therapy
+:::* Note: Nitazoxanide is not licensed for immunodeficient patients
+----
+{{PBI|Cyclospora cayetanensis}}
+*Cyclospora cayetanensis<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:*Preferred regimen: [[Trimethoprim-sulfamethoxazole]] one double-strength tablet PO bid for 7-10 days
+:*Alternative regimen(1): [[Ciprofloxacin]] 500 mg PO bid for 7 days
+:*Alternative regimen(2): [[Nitazoxanide]] 500 mg PO bid for 7 days
+:*Note(1): One double-strength tablet (160 mg TMP/800 mg SMX) .
+:*Note(2): Treatment is continued for 7 days in immunocompetent hosts and for 7 to 10 days in patients with HIV infection.
+----
+{{PBI|Dientamoeba fragilis}}
+:*'''Dientamoebiasis'''<ref>{{citeweb|title=CDC Dientamoeba fragilis|url=http://www.cdc.gov/parasites/dientamoeba/health_professionals/index.html}}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref><ref>{{Cite journal| doi = 10.1016/j.ijpddr.2012.08.002| issn = 2211-3207| volume = 2| pages = 204–215| last1 = Nagata| first1 = Noriyuki| last2 = Marriott| first2 = Deborah| last3 = Harkness| first3 = John| last4 = Ellis| first4 = John T.| last5 = Stark| first5 = Damien| title = Current treatment options for Dientamoeba fragilis infections| journal = International Journal for Parasitology. Drugs and Drug Resistance| date = 2012-12| pmid = 24533282| pmc = PMC3862407}}</ref>
+::* Preferred regimen: [[Iodoquinol]] 650 mg PO tid for 20 days
+::* Alternative regimen (1): [[Paromomycin]] 25–35 mg/kg/day PO in three divided doses for 7 days
+::* Alternative regimen (2): [[Metronidazole]] 500–750 mg PO tid for 10 days
+::* Alternative regimen (3): [[Tetracycline]] 500 mg PO qid for 10 days
+:::* 1.1 '''Treatment in pregnancy'''
+::::* The use of [[Iodoquinol]] in pregnancy is limited, and risk to the embryo-fetus is unknown, should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
+::::* Oral dose of [[Paromomycin]] generally is poorly absorbed from the gastrointestinal tract, with minimal, if any, systemic availability.
+::::* [[Metronidazole]] is in pregnancy category B. Data on the use of this drug in pregnant women are conflicting. The available evidence suggests use during pregnancy has a low risk of congenital anomalies. May be used during pregnancy in those patients who will clearly benefit from the drug, although its use in the first trimester is generally not advised.
+:::* 1.2 '''Treatment during lactation'''
+::::* [[Iodoquinol]] should be used with caution in breastfeeding women.
+::::* Oral dose of [[Paromomycin]] is unlikely to be excreted in breast milk, and the drug generally is poorly absorbed from the gastrointestinal tract.
+::::* [[Metronidazole]] should be used during lactation only if the potential benefit of therapy to the mother justifies the potential risk to the infant.
+:::* 1.3 '''Treatment in pediatric patients'''
+::::* [[Iodoquinol]] 30–40 mg/kg/day (maximum 2 g) PO in 3 doses for 􏰄20 days. The safety of iodoquinol in children has not been established.
+::::* [[Paromomycin]] 25–35 mg/kg/day PO in 3 doses􏰄 for 7 days. The safety of oral dose in children has not been formally evaluated. However, the safety profiles likely are comparable in children and adults.
+::::* [[Metronidazole]] 35–50 mg/kg/day PO in 3 doses for􏰄 10 days. The safety in children has not been established, is listed as an antiamebic and antigiardiasis medicine on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
+::::* [[Tetracycline]] 40 mg/kg/day (maximum 2 g) PO in 4 doses for􏰄 10 days
+----
+{{PBI|Entamoeba histolytica}}
+:* '''1. Amebic Liver Abscess'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* Preferred regimen: ([[Metronidazole]] 750 mg PO tid for 10 days {{or}} [[Tinidazole]] 2 g PO qd for 5 days) {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days)
+::*Alternative regimen (1): [[Nitazoxanide]] 500 mg bid for 10 days {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days)
+::* Alternative regimen (2): [[Tinidazole]] 2 g PO qd for 5 days {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days)
+::* Alternative regimen (2): [[Tinidazole]] 2 g PO qd for 5 days
+:* '''2. Amebic Colitis'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* Preferred regimen: [[Metronidazole]] 500-750 mg PO tid for 7-10 days. Pediatric dose: 35-50 mg/kg per day tid {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days)
+::* Alternative regimen: [[Tinidazole]] 2 g PO qd for 5 days {{and}} ([[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days {{or}} [[Diloxanide furoate]] 500 mg PO tid for 10 days)
+:* '''3. Asymptomatic Intestinal Colonization'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* Preferred regimen: [[Paromomycin]] 30 mg/kg/day PO tid for 5-10 days
+::* Alternative regimen (1): [[Diloxanide furoate]] 500 mg PO tid for 10 days
+::* Alternative regimen (2): [[Diiodohydroxyquin]] 650 mg PO tid for 20 days for adults and 30 to 40 mg/kg per day tid for 20 days for children
+----
+{{PBI|Giardia lamblia}}
+:* 1. '''Giardiasis'''<ref>{{cite web | title = CDC Parasites - Giardia | url = http://www.cdc.gov/parasites/giardia/treatment.html }}</ref><ref name="pmid11148005">{{cite journal| author=Gardner TB, Hill DR| title=Treatment of giardiasis. | journal=Clin Microbiol Rev | year= 2001 | volume= 14 | issue= 1 | pages= 114-28 | pmid=11148005 | doi=10.1128/CMR.14.1.114-128.2001 | pmc=PMC88965 | url=http://www.ncbi.nlm.nih.gov/entrez/11148005  }} </ref>
+::* 1.1 '''Adult'''
+:::* Preferred regimen (1): [[Metronidazole]] 250 mg tid 5–7 days
+:::* Preferred regimen (2): [[Tinidazole]] 2 g single dose
+:::* Preferred regimen (3): [[Nitazoxanide]] 500 mg PO bid (with food)
+:::* Alternative regimen (1): [[Paromomycin]] 500 mg tid 3 5–10 days
+:::* Alternative regimen (2): [[Quinacrine]] 100 mg tid 3 5–7 days
+:::* Alternative regimen (3): [[Furazolidone]] 100 mg qid 3 7–10 days
+::* 1.2 '''Pediatric'''
+:::* Preferred regimen (1): [[Metronidazole]] 5 mg/kg tid 3 5–7 days
+:::* Preferred regimen (2): [[Tinidazole]] 50 mg/kg single dose (max, 2 g)
+:::* Preferred regimen (3): [[Nitazoxanide]] 100 mg PO bid for age 1-3 years or 200 mg PO bid for age 4-11 years (with food)
+:::* Alternative regimen (1): [[Paromomycin]] 30 mg/kg/day in 3 doses 3 5–10 days
+:::* Alternative regimen (2): [[Quinacrine]] 2 mg/kg tid 3 7 days
+:::* Alternative regimen (3): [[Furazolidone]] 2 mg/kg qid 3 10 days
+----
+{{PBI|Cystoisospora belli}}
+:* 1. '''Cystoisospora belli treatment'''<ref>{{cite web | title = CDC - Cystoisosporiasis | url = http://www.cdc.gov/parasites/cystoisospora/health_professionals/index.html }}</ref>
+::* 1.1 '''Immunocompetent hosts'''
+:::* In the immunocompetent hosts, symptoms of Cystoisospora infection are usually self-limited.
+:::* Antimicrobial therapy to immunocompetent patients may be considered if symptoms do not start to resolve spontaneously after 5 to 7 days (depending upon severity)
+:::* Prefered regimen: [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO bid for 7-10 days
+:::* Alternative regimen (1) (for patients who are allergic to or intolerant of TMP-SMX): [[Pyrimethamine]] 50-75 mg/day PO qd or divided in 2 equal doses {{and}} [[Leucovorin]] 10–25 mg PO qd
+:::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 7 days (second-line alternative)
+::::* 1.1.1 '''In pregnancy'''
+:::::* TMP-SMX should be avoided near-term because of the potential for hyperbilirubinemia and kernicterus in the newborn.
+:::::* Ciprofloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
+::::* 1.1.2 '''During lactation'''
+:::::* TMP-SMX generally should be avoided by women when nursing infants who are premature, jaundiced, ill, or stressed, or who have glucose-6-phosphate dehydrogenase deficiency.
+:::::* The American Academy of Pediatrics classifies Ciprofloxacin as usually compatible with breastfeeding, whereas the World Health Organization recommends avoiding Ciprofloxacin while breastfeeding and CDC recommends Ciprofloxacin should be used during lactation only if the potential benefit justifies the potential risk to the fetus.
+::::* 1.1.3 '''In pediatric patients'''
+:::::* The use of TMP-SMX in children less than 2 months of age generally is not recommended.
+:::::* Available evidence is conflicting regarding the potential for growth defects and arthropathies in exposed children. Use of Ciprofloxacin in children requires assessment of potential risks and benefits.
+::* 1.2 '''Immunocompromised hosts'''
+:::* Preferred regimen (1): [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO/IV qid for 10 days
+:::* Preferred regimen (2): [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO/IV bid for 7-10 days
+:::* Note (1): One approach is to start with TMP-SMX (160 mg/800 mg) bid regimen first, and increase daily dose and/or duration (up to 3–4 weeks) if symptoms worsen or persist.
+:::* Note (2): IV therapy is recommended for patients with potential or documented malabsorption.
+:::* Alternative regimen (1): [[Pyrimethamine]] 50–75 mg PO qd {{and}} [[Leucovorin]] 10–25 mg PO qd
+:::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg PO bid for 7 days
+:* 2. '''Cystoisospora belli prophylaxis'''<ref>{{cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf }}</ref>
+::* 2.1 '''Primary prophylaxis'''
+:::* Insufficient evidence is available to support a general recommendation for primary prophylaxis for Cystoisosporiasis per se, especially for U.S. travelers in isoporiasis-endemic areas.
+::* 2.2 '''Secondary prophylaxis (preventing recurrence in patients with CD4 count < 200 cells/mm<sup>3</sup>)'''
+:::* Prefered regimen: [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO 3 times weekly
+:::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]] 160 mg/800 mg PO qd
+:::* Alternative regimen (2): [[Trimethoprim-sulfamethoxazole]] 320 mg/1600 mg PO 3 times weekly
+:::* Alternative regimen (3): [[Pyrimethamine]] 25 mg PO qd {{and}} [[Leucovorin]] 5–10 mg PO qd
+:::* Alternative regimen (4): [[Ciprofloxacin]] 500 mg PO 3 times weekly (second-line alternative)
+:::* Note (1): Criteria for discontinuation of chronic maintenance therapy: sustained increase in CD4 count > 200 cells/mm<sup>3</sup> for > 6 months in response to ART and without evidence of active Cystoisospora belli infection
+:::* Note (2): Because of concerns about possible teratogenicity associated with first-trimester drug exposure, clinicians may withhold secondary prophylaxis during the first trimester and treat only symptomatic infection.
+----
+{{PBI|Microsporidiosis}}
+:* '''1. Ocular'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen: [[Albendazole]] 400 mg PO bid for 3 weeks {{and}} [[Fumagillin]] eye drops.
+:* '''2. Intestinal (diarrhea)'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen:
+:::* Adult: [[Albendazole]] 400 mg PO bid for 3 weeks  for E. intestinalis.
+:::* Pediatric: [[Albendazole]] 15 mg/kg per day divided into 2 daily doses for 7 days  for E. intestinalis.
+::* Note: [[Fumagillin]] 20 mg PO tid is the only reported effective treatment for E. bieneusi.
+:* '''3. Disseminated'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::*Preferred regimen: [[Albendazole]] 400 mg po bid for 3 weeks.
+====Parasites – Extraintestinal Protozoa====
+==Acanthamoeba==
+{{PBI|Acanthamoeba}}
+:* 1. '''Granulomatous amoebic encephalitis, meningitis, and disseminated Acanthamoeba disease'''<ref>{{Cite journal| doi = 10.1111/j.1574-695X.2007.00232.x| issn = 0928-8244| volume = 50| issue = 1| pages = 1–26| last1 = Visvesvara| first1 = Govinda S.| last2 = Moura| first2 = Hercules| last3 = Schuster| first3 = Frederick L.| title = Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea| journal = FEMS immunology and medical microbiology| date = 2007-06| pmid = 17428307}}</ref><ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* Preferred regimen (1): [[Pentamidine]] {{and}} [[Itraconazole]] {{and}} [[Sulfadiazine]] {{and}} [[Flucytosine]]
+::* Preferred regimen (2): [[Sulfadiazine]] {{and}} [[Fluconazole]] {{and}} [[Pyrimethamine]]
+::* Preferred regimen (3): [[Sulfadiazine]] {{and}} [[Flucytosine]] {{and}} [[TMP-SMX]]
+::* Preferred regimen (4): [[TMP-SMX]] {{and}} [[Rifampin]] {{and}} [[Ketoconazole]]
+::* Preferred regimen (5): [[Miltefosine]] {{and}} [[Amikacin]]
+::* Preferred regimen (6): [[Miltefosine]] {{and}} [[Voriconazole]]
+::* Preferred regimen (7): [[Pentamidine]] {{and}} [[Itraconazole]] {{and}} [[Flucytosine]] {{and}} [[Levofloxacin]] {{and}} [[Amphotericin B]] {{and}} [[Rifampin]]
+::* Preferred regimen (8): [[Pentamidine]] {{and}} [[Fluconazole]] {{and}} [[Miltefosine]]
+::* Note: The mainstay of successful treatment includes early diagnosis and combination therapy with pentamidine, azole, sulfonamide, miltefosine, and possibly flucytosine.
+:* 2. '''Cutaneous acanthamoebiasis'''<ref>{{Cite journal| issn = 0893-8512| volume = 16| issue = 2| pages = 273–307| last1 = Marciano-Cabral| first1 = Francine| last2 = Cabral| first2 = Guy| title = Acanthamoeba spp. as agents of disease in humans| journal = Clinical Microbiology Reviews| date = 2003-04| pmid = 12692099| pmc = PMC153146}}</ref><ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref><ref>{{Cite journal| doi = 10.1111/j.1574-695X.2007.00232.x| issn = 0928-8244| volume = 50| issue = 1| pages = 1–26| last1 = Visvesvara| first1 = Govinda S.| last2 = Moura| first2 = Hercules| last3 = Schuster| first3 = Frederick L.| title = Pathogenic and opportunistic free-living amoebae: Acanthamoeba spp., Balamuthia mandrillaris, Naegleria fowleri, and Sappinia diploidea| journal = FEMS immunology and medical microbiology| date = 2007-06| pmid = 17428307}}</ref>
+::* Preferred regimen: [[Pentamidine]] {{and}} [[Sulfadiazine]] {{and}} [[Flucytosine]] {{and}} ([[Itraconazole]] {{or}} [[Fluconazole]]) {{and}} [[Chlorhexidine]] topical {{and}} [[Ketoconazole]] topical
+:* 3. '''Acanthamoeba keratitis'''<ref>{{cite web | title = Acanthamoeba Keratitis Fact Sheet (CDC) | url = http://www.cdc.gov/parasites/acanthamoeba/health_professionals/acanthamoeba_keratitis_hcp.html }}</ref>
+::* Preferred regimen: ([[Polyhexamethylene biguanide]] topical {{or}} [[Chlorhexidine]] topical) {{withorwithout}} ([[Propamidine]] topical {{or}} [[Hexamidine]] topical)
+::* Note (1): Azole antifungal drugs (Ketoconazole, Itraconazole, Voriconazole) may be considered as oral or topical adjuncts.
+::* Note (2): The duration of therapy for Acanthamoeba keratitis may last six months to a year.
+::* Note (3): Pain control can be helped by topical cyclopegic solutions and oral nonsteroidal medications.
+::* Note (4): The use of corticosteroids to control inflammation is controversial.
+::* Note (5): Penetrating keratoplasty may help restore visual acuity.
+==Balamuthia mandrillaris==
+{{PBI|Balamuthia mandrillaris}}
+:* 1. '''Granulomatous Amebic Encephalitis'''<ref>{{cite web | title = Balamuthia mandrillaris - Granulomatous Amebic Encephalitis (CDC) | url = http://www.cdc.gov/parasites/balamuthia/treatment.html }}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen (1): [[Pentamidine]] {{and}} [[Flucytosine]] {{and}} [[Fluconazole]] {{and}} [[Sulfadiazine]] {{and}} ([[Azithromycin]] {{or}} [[Clarithromycin]])
+::* Preferred regimen (2): [[Pentamidine]] {{and}} [[Albendazole]] {{and}} ([[Itraconazole]] {{or}} [[Fluconazole]]) {{and}} [[Miltefosine]]
+==Naegleria fowleri==
+{{PBI|Naegleria fowleri}}
+:* '''Primary amoebic meningoencephalitis'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref><ref>{{Citeweb|title=PAM | url=http://www.cdc.gov/parasites/naegleria/index.html }}</ref>
+::* Preferred regimen: [[Amphotericin B]] 1.5 mg/kg/day bid for 3 days; then 1 mg/kg/day for 6 days {{and}} 1.5 mg/day intrathecal for 2 days; then 1 mg/day intrathecal qd for 8 days.
+::* Note: Investigational drug called miltefosine  also available for treatment.
+----
+==Babesia microti==
+{{PBI|Babesia microti}}
+:* '''Babesiosis'''
+::* 1. '''Mild/moderate disease'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen: [[Atovaquone]] 750 mg PO bid {{and}} [[Azithromycin]] 600 mg PO qd for 7-10 days
+::* 2. '''Severe disease:'''
+:::* Preferred regimen: [[Clindamycin]] 600 mg PO tid {{and}} [[Quinine]] 650 mg PO tid for 7–10 days
+:::* Preferred regimen: [[Clindamycin]] 1.2 g IV q12h
+:::* Note (1): For overwhelming infection in asplenic patients and immunocompromised patients, treat for 6 or more weeks.
+:::* Note (2): Consider transfusion if 􀂕10% parasitemia.
+==Leishmania==
+{{PBI|Leishmania}}
+:* '''Leishmaniasis'''
+::* 1. '''Cutaneous Leishmaniasis'''<ref>{{Citeweb|title=leishmaniasis | url=http://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html#tx}}</ref>
+:::* Different Leishmania species cause Old World versus New World (American) cutaneous leishmaniasis. In the Old World (the Eastern Hemisphere), the etiologic agents include Leishmania tropica, L. major, and L. aethiopica, as well as L. infantum and L. donovani. The main species in the New World (the Western Hemisphere) are either in the L. mexicana species complex (L. mexicana, L. amazonensis, and L. venezuelensis) or the subgenus Viannia (L. [V.] braziliensis, L. [V.] guyanensis, L. [V.] panamensis, and L. [V.] peruviana). The Viannia subgenus is also referred to as the L. (V.) braziliensis species complex.
+::::* 1.1 '''Systemic Therapy (Parenteral)'''
+:::::* Preferred Regimen (1): [[Sodium stibogluconate]] 20 mg/kg IV/IM q24h for 10-20 days
+:::::* Preferred Regimen (2): [[Meglumine antimoniate]] 20 mg/kg IV/IM  q24h for 10-20 days
+:::::* Alternative Regimen (1): [[Liposomal amphotericin B]] 3 mg/kg/day IV infusion for 6-10 days
+:::::* Alternative Regimen (2): [[Pentamidine]] 2-3 mg/kg/day IV/IM for 4-7 days
+:::::* Note: Data supporting the use of amphotericin B for treatment of cutaneous and mucosal leishmaniasis are anecdotal; standard dosage regimens have not been established. In the United States, pentamidine isethionate is uncommonly used for treatment of cutaneous leishmaniasis. Its limitations include the potential for irreversible toxicity and variable effectiveness.
+::::* 1.2 '''Systemic Therapy (Oral)'''
+:::::*  1.2.1 '''Adults and adolescents at least 12 years of age, who weigh from 33-44 kg'''
+::::::* Preferred Regimen:[[Miltefosine]] 50 mg PO q12h for 28 days
+:::::* 1.2.2 '''Adults and adolescents at least 12 years of age, who weigh  >45 kg '''
+::::::* Preferred Regimen:[[Miltefosine]] 50 mg PO q8h for 28 days
+::::::* Alternative Regimen (1): [[Ketoconazole]] 600 mg qd for 28 days {{or}} qd for 6 weeks
+::::::* Alternative Regimen (2): [[Fluconazole]] 200 mg qd for 6 weeks
+::::::* Note:The FDA-approved indications are limited to infection caused by three particular species, all three of which are New World species in the Viannia subgenus—namely, Leishmania (V.) braziliensis, L. (V.) panamensis, and L. (V.) guyanensis.  The "azoles" showed modest activity against some Leishmania species in some cases, but are not FDA approved
+::::* 1.3 '''Local Therapy'''
+:::::* List of possible local therapies
+:::::* Cryotherapy (with [[liquid nitrogen]] {{or}} Thermotherapy (use of localized current field radiofrequency heat) {{or}} Intralesional administration of [[SbV]] {{or}} Topical application of [[Paromomycin]] (such as an ointment containing 15% [[Paromomycin]]/12% methylbenzethonium chloride in soft white paraffin)
+::* 2. '''Visceral Leishmaniasis'''
+:::* Visceral leishmaniasis usually is caused by the species L. donovani and L. infantum (L. chagasi generally is considered synonymous with L. infantum)
+::::* 2.1 '''Systemic Therapy (Parenteral)'''
+:::::* Preferred Regimen (1): [[Liposomal amphotericin B]] 3 mg/kg/day IV for 5 days, then once on day 14 and once on day 21  (Total dose: 21 mg/kg)
+:::::* Preferred Regimen (2): [[Sodium stibogluconate]] 20 mg/kg IV/IM q24h for 28 days
+:::::* Preferred Regimen (3): [[Meglumine antimoniate]] 20 mg/kg IV/IM q24h for 28 days
+:::::* Alternative Regimen: [[Amphotericin B]] deoxycholate 0.5-1 mg/kg IV  q24h (Total dose: 15-20 mg/kg)
+:::::* Note: In immunosuppressed patients, dose is 4 mg/kg/day for 5 days, then once on day 10,  17, 24, 31, and 38  (Total dose: 40 mg/kg)
+::::* 2.2 '''Systemic Therapy (Oral)'''
+:::::* 2.2.1 '''Adults and adolescents at least 12 years of age, who weigh from 33-44 kg'''
+::::::* Preferred Regimen: [[Miltefosine]] 50 mg PO q12h for 28 days
+:::::* 2.2.2 '''Adults and adolescents at least 12 years of age, who weigh >45 kg'''
+::::::* Preferred Regimen: [[Miltefosine]] 50 mg PO q8h for 28 days
+==Plasmodium==
+{{PBI|Plasmodium}}
+:* 1. '''Plasmodium falciparum'''<ref>{{cite web | title = Guidelines for the treatment of malaria. Third edition April 2015 | url = http://apps.who.int/iris/bitstream/10665/162441/1/9789241549127_eng.pdf?ua=1&ua=1 }}</ref>
+::* 1.1 '''Treatment of uncomplicated P. falciparum malaria'''
+:::* 1.1.1 '''Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)'''
+::::* Preferred regimen (1):  [[Artemether]] 5–24 mg/kg/day PO bid {{and}} [[Lumefantrine]] 29–144 mg/kg/day PO bid for 3 days.
+:::::* Note: The first two doses should, ideally, be given 8 h apart.
+:::::* Dosage regimen based on Body weight (kg)
+:::::* Body weight (kg)-5 to < 15-     [[Artemether]] 20 mg PO bid {{and}} [[Lumefantrine]] 120 mg PO bid  for 3 days
+:::::* Body weight (kg)-15 to < 25-    [[Artemether]] 40 mg PO bid {{and}} [[Lumefantrine]] 240 mg PO bid  for 3 days
+:::::* Body weight (kg)-25 to < 35-    [[Artemether]] 60 mg PO bid {{and}} [[Lumefantrine]] 360 mg PO bid  for 3 days
+:::::* Body weight (kg)   ≥ 35-       [[Artemether]] 80 mg PO bid {{and}} [[Lumefantrine]] 480 mg PO bid  for 3 days
+::::* Preferred regimen (2): [[Artesunate]] 2–10 mg/kg/day PO qd {{and}} [[Amodiaquine]] 7.5–15 mg/kg/day PO qd for 3 days
+:::::* Note: A total therapeutic dose range of 6–30 mg/kg/day artesunate and 22.5–45 mg/kg/day per dose amodiaquine is recommended.
+:::::* Dosage regimen based on Body weight (kg)
+:::::* Body weight (kg)-4.5 to < 9-   [[Artesunate]] 25 mg PO qd {{and}} [[Amodiaquine]] 67.5 mg PO qd  for 3 days
+:::::* Body weight (kg)-9 to < 18 -   [[Artesunate]] 50 mg PO qd {{and}} [[Amodiaquine]] 135 mg PO qd for 3 days
+:::::* Body weight (kg)-18 to < 36-   [[Artesunate]] 100 mg PO qd {{and}} [[Amodiaquine]] 270 mg PO qd for 3 days
+:::::* Body weight (kg)   ≥ 36 -         [[Artesunate]] 200 mg PO qd {{and}} [[Amodiaquine]] 540 mg PO qd for 3 days
+::::* Preferred regimen (3): [[Artesunate]] 2–10 mg/kg/day PO qd {{and}} [[Mefloquine]] 2–10 mg/kg/day PO qd for 3 days
+:::::* Dosage regimen based on Body weight (kg)
+:::::* Body weight (kg)-5 to < 9-      [[Artesunate]] 25 mg PO qd {{and}} [[Mefloquine]] 55 mg PO qd  for 3 days
+:::::* Body weight (kg)-9to < 18-      [[Artesunate]] 50 mg PO qd {{and}} [[Mefloquine]] 110 mg PO qd for 3 days
+:::::* Body weight (kg)-18 to < 36-   [[Artesunate]] 100 mg PO qd {{and}} [[Mefloquine]] 220 mg PO qd for 3 days
+:::::* Body weight (kg)- ≥ 36  -      [[Artesunate]] 200 mg PO qd {{and}} [[Mefloquine]] 440 mg PO qd for 3 days
+::::* Preferred regimen (4): [[Artesunate]] 2–10 mg/kg/day PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]]  1.25 (25–70 / 1.25–3.5) mg/kg/day  PO given as a single dose on day 1
+:::::* Dosage regimen based on Body weight (kg)
+:::::* Body weight (kg)-5 to < 10-      [[Artesunate]] 25 mg PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] 250/12 mg PO given as a single dose on day 1
+:::::* Body weight (kg)-10 to < 25-    [[Artesunate]] 50 mg PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] 500/25 mg PO given as a single dose on day 1
+:::::* Body weight (kg)-25 to < 50-      [[Artesunate]] 100 mg PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] 1000/50 mg PO given as a single dose on day 1
+:::::* Body weight (kg)-    ≥50-         [[Artesunate]] 200 mg PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] 1500/75 mg PO given as a single dose on day 1
+::::*  Preferred regimen (5): [[Dihydroartemisinin]] 2–10 mg/kg/day PO qd {{and}} [[Piperaquine]]16–27 mg/kg/day PO qd for 3 days
+:::::* Dosage regimen based on Body weight (kg)
+:::::* Body weight (kg)-5 to < 8-     [[Dihydroartemisinin]] 20 mg PO qd {{and}}  [[Piperaquine]] 160 mg PO qd for 3 days
+:::::* Body weight (kg)-8 to < 11-      [[Dihydroartemisinin]] 30 mg PO qd {{and}}  [[Piperaquine]] 240 mg PO qd for 3 days
+:::::* Body weight (kg)-11 to < 17 -      [[Dihydroartemisinin]] 40 mg PO qd {{and}}  [[Piperaquine]] 320 mg PO qd for 3 days
+:::::* Body weight (kg)-17 to < 25-      [[Dihydroartemisinin]] 60 mg PO qd {{and}}  [[Piperaquine]] 480 mg PO qd for 3 days
+:::::* Body weight (kg)-25 to < 36-       [[Dihydroartemisinin]] 80 mg PO qd {{and}}  [[Piperaquine]] 640 mg PO qd for 3 days
+:::::* Body weight (kg)-36 to < 60-      [[Dihydroartemisinin]] 120 mg PO qd {{and}}  [[Piperaquine]] 960 mg PO qd for 3 days
+:::::*  Body weight (kg)-60 < 80 -       [[Dihydroartemisinin]] 160 mg PO qd {{and}}  [[Piperaquine]] 1280 mg PO qd for 3 days
+:::::* Body weight (kg)- >80-      Dose of [[Dihydroartemisinin]] 200 mg PO qd {{and}}  [[Piperaquine]] 1600 mg PO qd for 3 days
+:::* 1.1.2 '''Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in  patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) '''
+:::::* Preferred regimen: Single dose of 0.25 mg/kg [[Primaquine]] with ACT
+::* 1.2 '''Recurrent Falciparum Malaria'''
+:::* 1.2.1 '''Failure within 28 days '''
+::::* Note:The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens (with artesunate or quinine both of which should be co-administered with + tetracycline, or doxycycline or clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.
+:::* 1.2.2 '''Failure after 28 days'''
+::::* Note: all presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used.
+::* 1.3 '''Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in  patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) '''
+:::* Note: Single dose of 0.25 mg/kg bw [[Primaquine]] with ACT
+::* 1.4 '''Treating uncomplicated P. falciparum malaria in special risk groups'''
+:::* 1.4.1 '''Pregnancy '''
+::::* First trimester of pregnancy : [[Quinine]] {{and}} [[Clindamycin]] 10mg/kg/day PO bid for 7 days
+::::* Second and third trimesters : [[Mefloquine]] is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
+::::* Note (1): Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
+::::* Note (2): Primaquine and tetracyclines should not be used in pregnancy.
+:::* 1.4.2 '''Infants less than 5kg body weight''' :  with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
+:::* 1.4.3 '''Patients co-infected with HIV''': should avoid [[Artesunate]] + SP if they are also receiving [[Co-trimoxazole]], and avoid [[Artesunate]] {{and}} [[Amodiaquine]] if they are also receiving efavirenz or zidovudine.
+:::* 1.4.4 '''Large and Obese adults''': For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
+:::* 1.4.5 '''Patients co-infected with TB''': Rifamycins, in particular rifampicin, are potent CYP3A4 inducers with weak antimalarial activity. Concomitant administration of rifampicin during quinine treatment of adults with malaria was associated with a significant decrease in exposure to quinine and a five-fold higher recrudescence rate
+:::* 1.4.6 '''Non-immune travellers''' : Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
+:::* 1.4.7 '''Uncomplicated hyperparasitaemia''': People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT.
+:* 2. '''Treatment of uncomplicated malaria caused by P. vivax, P. ovale, P. malariae or P. knowlesi'''
+::* 2.1  '''Blood Stage infection'''
+:::* 2.1.1.  '''Uncomplicated malaria caused by P. vivax'''
+::::* 2.1.1.1 '''In areas with chloroquine-sensitive P. vivax'''
+:::::* Preferred regimen: [[Chloroquine]] total dose of 25 mg/kg PO. [[Chloroquine]] is given at an initial dose of 10 mg/kg, followed by 10 mg/kg on the second day and 5 mg/kg on the third day.
+::::* 2.1.1.2 '''In areas with chloroquine-resistant P. vivax'''
+:::::* Note: ACTs containing [[Piperaquine]], [[Mefloquine]] {{or}} [[Lumefantrine]] are the recommended treatment, although [[Artesunate]] + [[Amodiaquine]] may also be effective in some areas. In the systematic review of ACTs for treating P. vivax malaria, [[Dihydroartemisinin]] + [[Piperaquine]] provided a longer prophylactic effect than ACTs with shorter half-lives ([[Artemether]] + [[Lumefantrine]], [[Artesunate]] + [[Amodiaquine]]), with significantly fewer recurrent parasitaemias during 9 weeks of follow-up.
+:::* 2.1.2 '''Uncomplicated malaria caused by P. ovale, P. malariae or P. knowlesi malaria'''
+::::* Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to chloroquine. In only one study, conducted in Indonesia, was resistance to chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or [[Chloroquine]], as for vivax malaria.
+:::* 2.1.3 '''Mixed malaria infections '''
+::::* Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.
+::* 2.2 '''Liver stages (hypnozoites) of P. vivax and P. ovale'''
+:::* Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.]
+::* 2.2.1 '''Primaquine for preventive relapse'''
+:::* Preferred regimen: [[Primaquine]] 0.25–0.5 mg/kg/day PO qd for 14 days
+::* 2.2.2 '''Primaquine and glucose-6-phosphate dehydrogenase deficiency'''
+:::* Preferred regimen: [[Primaquine]] 0.75 mg base/kg/day PO once a week for 8 weeks.
+:::* Note: The decision to give or withhold [[Primaquine]] should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.
+::* 2.2.3 '''Prevention of relapse in pregnant or lacating women and infants'''
+:::* Note: Primaquine is contraindicated in pregnant women, infants < 6 months of age and in lactating women (unless the infant is known not to be G6PD deficient).
+:* 3. '''Treatment of severe malaria'''
+::* 3.1 Treatment of severe falciparum infection with Artesunate
+:::* 3.1.1 Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women):-
+::::* Preferred regimen: [[Artesunate]] IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT (add single dose [[Primaquine]] in areas of low transmission).
+:::* 3.1.2 Young children weighing < 20 kg
+::::* Preferred regimen:[[Artesunate]] 3 mg/kg per dose IV/IM q24h
+::::* Alternatives regimen: use [[Artemether]] in preference to quinine for treating children and adults with severe malaria
+::* 3.2.'''Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)'''
+:::* 3.2.1 '''Adults and children '''
+::::* Preferred regimen: [[Artesunate]] IM q24h
+::::* Alternative regimen: [[Artemether]] IM {{or}} [[Quinine]] IM
+:::* 3.2.2  '''Children < 6 years'''
+::::* Preferred regimen: Where intramuscular injections of artesunate are not available, treat with a single rectal dose (10 mg/kg) of [[Artesunate]], and refer immediately to an appropriate facility for further care.
+::::* Note: Do not use rectal artesunate in older children and adults.
+::* 3.3 '''Pregancy'''
+:::* Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed.
+::* 3.4 '''Treatment of severe P. Vivax infection'''
+:::* Note: parenteral artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). A full course of radical treatment with primaquine should be given after recovery.
+::* 3.5 '''Additional aspects of management in severe malaria'''
+:::* '''Fluid therapy''':  It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit.
+:::* '''Blood Transfusion ''':In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended.
+:::* '''Exchange blood transfusion''': Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.
+==Toxoplasma gondii==
+{{PBI|Toxoplasma gondii}}
+:* Toxoplasma gondii (treatment)
+::* 1. '''Lymphadenopathic toxoplasmosis'''<ref>{{ cite web | title = Parasites - Toxoplasmosis (Toxoplasma infection) |  url = http://www.cdc.gov/parasites/toxoplasmosis/health_professionals/ }}</ref>
+:::* Preferred regimen: Treatment of immunocompetent adults with lymphadenopathic toxoplasmosis is rarely indicated; this form of the disease is usually self-limited.
+::* 2. '''Ocular disease'''<ref>{{ cite web | title = Parasites - Toxoplasmosis (Toxoplasma infection) |  url = http://www.cdc.gov/parasites/toxoplasmosis/health_professionals/ }}</ref>
+:::* 2.1 '''Adults'''
+::::* Preferred regimen: [[Pyrimethamine]] 100 mg PO for 1 day as a loading dose, then 25 to 50 mg/day {{and}} [[Sulfadiazine]] 1 g PO qid {{and}} folinic acid ([[Leucovorin]] 5-25 mg PO with each dose of [[Pyrimethamine]]
+:::* 2.2 '''Pediatric'''
+::::* Preferred regimen: [[Pyrimethamine]] 2 mg/kg PO first day then 1 mg/kg each day {{and}} [[Sulfadiazine]] 50 mg/kg PO bid {{and}} folinic acid ([[Leucovorin]] 7.5 mg/day PO ) for 4 to 6 weeks followed by reevaluation of the patient's condition
+::::* Alternative regimen: The fixed combination of [[Trimethoprim]] with [[Sulfamethoxazole]]  has been used as an alternative.
+::::* Note: If the patient has a hypersensitivity reaction to sulfa drugs, [[Pyrimethamine]] {{and}}  [[Clindamycin]] can be used instead.
+::* 3. '''Maternal and fetal infection'''<ref>{{ cite web | title = Parasites - Toxoplasmosis (Toxoplasma infection) |  url = http://www.cdc.gov/parasites/toxoplasmosis/health_professionals/ }}</ref>
+:::* 3.1 '''First and early second trimesters'''
+::::* Preferred regimen: [[Spiramycin]] is recommended
+:::* 3.2 '''Late second and third trimesters'''
+::::* Preferred regimen: [[Pyrimethamine]]/[[ Sulfadiazine]] {{and}} [[Leucovorin]] for women with acute T. gondii infection diagnosed at a reference laboratory during gestation.
+:::* 3.3 '''Infant'''
+::::* Note: If the infant is likely to be infected, then treatment with drugs such as [[Pyrimethamine]], [[Atovaquone]], [[Sulfadiazine]], [[Leucovorin]]  is typical. Congenitally infected newborns are generally treated with [[pyrimethamine]], a sulfonamide, and [[leucovorin]] for 1 year.
+::* 4. '''Toxoplasma gondii Encephalitis in AIDS'''<ref>{{ cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents  | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultOITablesOnly.pdf }}</ref>
+:::* 4.1 '''Treatment for acute infection'''
+::::* 4.1.1 '''Patients with weight <60 kg'''
+::::* Preferred regimen: [[Pyrimethamine]] 200 mg PO 1 time, followed by [[Pyrimethamine]] 50 mg PO qd {{and}} [[Atovaquone]] {{and}} [[Sulfadiazine]] 1000 mg PO q6h {{and}} [[Leucovorin]] 10–25 mg PO qd,
+::::* 4.1.2  '''Patients with weight ≥60 kg'''
+:::::* Preferred regimen: [[Pyrimethamine]] 200 mg PO 1 time, followed by [[Pyrimethamine]] 75 mg PO qd {{and}} [[Sulfadiazine]] 1500 mg PO q6h {{and}} [[Leucovorin]] 10–25 mg PO qd and [[Leucovorin]] dose can be increased to 50 mg qd or bid
+:::::* Alternative regimen (1): [[Pyrimethamine]] {{and}} [[Leucovorin]] {{and}} [[Clindamycin]] 600 mg IV/ PO q6h
+:::::* Alternative regimen (2): [[TMP-SMX]] (TMP 5 mg/kg and SMX 25 mg/kg ) IV/PO bid
+:::::* Alternative regimen (3): [[Atovaquone]] 1500 mg PO bid {{and}} [[Pyrimethamine]] {{and}} [[Leucovorin]]
+:::::* Alternative regimen (4): [[Atovaquone]]1500 mg PO bid {{and}} [[sulfadiazine]] 1000–1500 mg PO q6h (weight-based dosing, as in preferred therapy)
+:::::* Alternative regimen (5): [[Atovaquone]] 1500 mg PO bid
+:::::* Alternative regimen (6): [[Pyrimethamine]] {{and}} [[Leucovorin]] {{and}} [[Azithromycin]] 900–1200 mg PO qd
+:::::* Note: Treatment for at least 6 weeks; longer duration if clinical or radiologic disease is extensive or response is incomplete at 6 weeks.
+:::* 4.2  '''Chronic maintenance therapy'''
+::::* Preferred regimen:  [[Pyrimethamine]] 25–50 mg PO qd {{and}} [[sulfadiazine]] 2000–4000 mg PO qd (in 2–4 divided doses) {{and}} [[Leucovorin]] 10–25 mg PO qd
+::::* Alternative regimen (1): [[Clindamycin]] 600 mg PO q8h {{and}} ([[Pyrimethamine]] 25–50 mg {{and}} [[Leucovorin]] 10–25 mg) PO qd
+::::* Alternative regimen (2): [[TMP-SMX]] DS 1 tablet bid
+::::* Alternative regimen (3): [[Atovaquone]] 750–1500 mg PO bid {{and}} ([[Pyrimethamine]] 25 mg {{and}} [[Leucovorin]] 10 mg) PO qd
+::::* Alternative regimen (4): [[Atovaquone]] 750–1500 mg PO bid
+::::* Alternative regimen (5): [[Sulfadiazine]] 2000–4000 mg PO bid/qid
+::::* Alternative regimen (6): [[Atovaquone]] 750–1500 mg PO bid [[Pyrimethamine]] and [[Leucovorin]] doses are the same as for preferred therapy
+::::* Note: Adjunctive corticosteroids (e.g., [[Dexamethasone]]) should only be administered when clinically indicated to treat mass effect associated with focal lesions or associated edema; discontinue as soon as clinically feasible. Anticonvulsants should be administered to patients with a history of seizures and continued through acute treatment, but should not be used as seizure prophylaxis . If [[Clindamycin]] is used in place of [[Sulfadiazine]], additional therapy must be added to prevent PCP.
+:* '''Toxoplasma gondii (prophylaxis)'''
+::* 1. '''Prophylaxis to prevent first episode of encephalitis in AIDS'''<ref>{{ cite web | title = Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents  | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultOITablesOnly.pdf }}</ref>
+:::* 1.1 '''Indications'''
+::::* Toxoplasma IgG-positive patients with CD4 count <100 cells/µL
+::::* Seronegative patients receiving PCP prophylaxis not active against toxoplasmosis should have toxoplasma serology retested if CD4 count decline to <100 cells/µL. Prophylaxis should be initiated if seroconversion occurred.
+:::* 1.2 '''Prophylactic therapy'''
+::::* Preferred regimen: [[TMP-SMX]] 1 DS PO daily
+::::* Alternative regimen (1): [[TMP-SMX]] 1 DS PO three times weekly
+::::* Alternative regimen (2): [[TMP-SMX]] 1 SS PO qd
+::::* Alternative regimen (3): [[Dapsone]] 50 mg PO qd {{and}} ([[Pyrimethamine]] 50 mg PO {{and}} [[Leucovorin]] 25 mg) PO weekly
+::::* Alternative regimen (4): [[Dapsone]] 200 mg PO {{and}} [[Pyrimethamine]] 75 mg PO {{and}} [[Leucovorin]] 25 mg PO weekly
+::::* Alternative regimen (5): [[Atovaquone]] 1500 mg PO qd
+::::* Alternative regimen (6): [[Atovaquone]] 1500 mg  PO {{and}} [[Pyrimethamine]] 25 mg PO {{and}} [[Leucovorin]] 10 mg PO qd
+==Trichomonas vaginalis==
+{{PBI|Trichomonas vaginalis}}
+:* 1. '''T. vaginalis infection in adults''' <ref>{{cite web | title =trichomoniasis | url =  http://www.cdc.gov/std/tg2015/trichomoniasis.htm  }}</ref>
+::* Preferred regimen (1): [[Metronidazole]] 2 g PO in a single dose
+::* Preferred regimen (2): [[Tinidazole]] 2 g PO in a single dose
+::* Alternative regimen: [[Metronidazole]] 500  mg PO bid for 7 days
+:* 2. '''T. vaginalis infection in pregnant and lactating Women'''
+::* 2.1 '''Pregnant women'''
+:::* Preferred regimen: [[Metronidazole]] 2 g PO in a single dose.
+::* 2.2 '''Post-partum and Breastfeeding'''
+:::* Preferred regimen (1): [[Metronidazole]] 2 g PO in a single dose.
+:::* Preferred regimen (2): [[Tinidazole]] 2 g PO in a single dose
+:::* Note (1): Do not breastfeed for 12-24 hrs following [[Metronidazole]] and 72 hrs following  [[Tinidazole]]
+:::* Note (2): Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment. Pregnant women should be advised of the risk and benefits to treatment as infection (definitely) and treatment (possibly)
+:::* Note (3): Pregnant women with HIV who are treated for T. vaginalis infection should be retested 3 months after treatment.
+:* 3. '''T. vaginalis infection in patients with HIV'''
+::* Preferred regimen: [[Metronidazole]] 500  mg PO bid for 7 days
+:* 4. '''Persistent or recurrent trichomoniasis'''
+::* 4.1 '''Treatment failure'''
+:::* Preferred regimen: [[Metronidazole]] 500  mg PO bid for 7 days
+::* 4.2 '''Treatment failure again'''
+:::* Preferred regimen (1): [[Metronidazole]] 2 g PO for 7 days
+:::* Preferred regimen (2): [[Tinidazole]] 2 g PO for 7 days
+::* 4.3 '''Nitroimidazole-resistant cases'''
+:::* Preferred regimen: [[Tinidazole]] 2-3 g PO for 14 days
+==African trypanosomiasis==
+{{PBI|African trypanosomiasis}}
+:* ''' Sleeping sickness'''<ref>{{cite web|title=African Trypanosomiasis| url=  http://www.cdc.gov/parasites/sleepingsickness/health_professionals/index.html}}</ref>
+::* 1. '''East african trypanosomiasis'''
+:::* 1.1 '''T. b. rhodesiense, hemolymphatic stage'''
+::::* 1.1.1 '''Adult '''
+:::::* Preferred regimen: [[Suramin]] 1 gm IV on days 1,3,5,14, and 21
+::::* 1.1.2 '''Pediatric'''
+:::::* Preferred regimen: [[Suramin]] 20 mg/kg IV on days 1, 3, 5, 14, and 21
+:::* 1.2 '''T. b. rhodesiense, CNS involvement'''
+::::* 1.2.1 '''Adult'''
+:::::* Preferred regimen: [[Melarsoprol]] 2-3.6 mg/kg/day IV for 3 days. After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days.
+::::* 1.2.2 '''Pediatric'''
+:::::* Preferred regimen: [[Melarsoprol]] 2-3.6 mg/kg/day IV for 3 days. After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days
+::* 2. '''West african trypanosomiasis'''
+:::* 2.1 '''T. b. gambiense, hemolymphatic stage'''
+::::* 2.1.1 '''Adult'''
+:::::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM/ IV for 7-10 days
+::::* 2.1.2 '''Pediatric'''
+:::::* Preferred regimen: [[Pentamidine]] 4 mg/kg/day IM/IV for 7-10 days
+:::::* Note (1): Pentamidine should be used during pregnancy and lacation  only if the potential benefit justifies the potential risk
+:::::* Note (2): IM/IV Pentamidine have a similar safety profile in children age 4 months and older as in adults. Pentamidine is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (Trypanosoma brucei gambiense) on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
+:::* 2.2  '''T. b. gambiense, CNS involvement'''
+::::* 2.2.1 '''Adult'''
+:::::* Preferred regimen: [[Eflornithine]] 400 mg/kg/day  IV qid for 14 days
+::::* 2.2.2 '''Pediatric'''
+:::::* Preferred regimen: [[Eflornithine]] 400 mg/kg/day IV  qid for 14 days
+:::::* Note (1): [[Eflornithine]] should be used during pregnancy and lactation, only if the potential benefit justifies the potential risk
+:::::* Note (2): The safety of [[Eflornithine]] in children has not been established. Eflornithine is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. [[Eflornithine]] is listed for the treatment of 1st stage African trypanosomiasis inTrypanosoma brucei gambiense infection on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
+==American trypanosomiasis==
+{{PBI|American trypanosomiasis}}
+:* '''Chagas disease'''<ref>{{Cite web | title =  Parasites - American Trypanosomiasis (also known as Chagas Disease) | url = http://www.cdc.gov/parasites/chagas/health_professionals/tx.html }}</ref>
+::* 1. Preferred regimen(1):
+:::* Patients of age < 12 years- [[Benznidazole]]  5-7.5 mg/kg/ day PO  bid for 60 days
+:::* Patients of age 12 years or older- [[Benznidazole]]  5-7 mg/kg/day PO bid for 60 days
+::* 2. Preferred regimen(2):
+:::* Patients of age ≤ 10 years- [[Nifurtimox]] 15-20 mg/kg/day PO tid/ qid for 90 days
+:::* Patients of age 11-16 years- [[Nifurtimox]] 12.5-15 mg/kg/day PO tid/ qid for 90 days
+:::* Patients of age 17 years or older-  [[Nifurtimox]]  8-10 mg/kg/day PO tid/ qid for 90 days
+::* Note: In the United States, [[Nifurtimox]] and [[Benznidazole]] are not FDA approved and are available only from CDC under investigational protocols.
+====Parasites – Intestinal Nematodes (Roundworms)====
+{{PBI|Gnathostoma spinigerum}}
+:*'''Eosinophilic Meningitis'''
+:**Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.<ref name="pmid19123863">{{cite journal| author=Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J et al.| title=Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 3 | pages= 322-7 | pmid=19123863 | doi=10.1086/595852 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19123863  }} </ref>
+:*'''Cutaneous disease:'''
+::*Preferred regimen: [[Albendazole]] 400 mg bid for 21 days {{or}} [[Ivermectin]] 200 mcg/kg qd for 2 days<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
+::*Alternative regimen: [[Albendazole]] 400 mg qd for 21 days {{or}} [[Ivermectin]] 200 mcg/kg qd single dose<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
+{{PBI|Ancylostoma braziliense}}
+:* '''Cutaneous larva migrans treatment'''<ref>{{Cite web | title = Parasites - Zoonotic Hookworm | url = http://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html}}</ref>
+::* 1.1 '''In adults'''
+:::* Preferred regimen: [[Albendazole]] 400 mg PO qd for 3-7 days
+:::* Alternative regimen: [[Ivermectin]] 200 mcg/kg PO qd for 1-2 days
+::* 1.2 '''In children'''
+:::* Preferred regimen: [[Albendazole]] > 2 years then 400 mg PO qd for 3 days
+:::* Alternative regimen: [[Ivermectin]] > 15 kg give 200 mcg/kg single dose
+:::* Note: [[Albendazole]] is contraindicated in children younger than 2 years age
+{{PBI|Angiostrongylus cantonensis}}
+:*Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60 mg qd for 2 weeks) and analgesics.<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*Note: [[Albendazole]] and [[Mebendazole]] are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.<ref name="pmid19706911">{{cite journal| author=Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y| title=Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis. | journal=Am J Trop Med Hyg | year= 2009 | volume= 81 | issue= 3 | pages= 443-5 | pmid=19706911 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19706911  }} </ref>
+{{PBI|Ascaris lumbricoides}}
+::* Preferred regimen: [[Albendazole]] 400 mg PO qd {{or}} [[Mebendazole]] 500 mg PO qd or 100 mg bid for 3 days<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
+:::*Note: [[Albendazole]] dose for children of 1-2 years is 200 mg instead of 400 mg.
+::* Alternative regimen (1): [[Ivermectin]] 150 to 200 µg/kg PO single dose<ref>{{Cite web | title = Parasites - Ascariasis| url = http://www.cdc.gov/parasites/ascariasis/health_professionals/}}</ref>
+::* Alternative regimen (2): [[Nitazoxanide]] 500 mg bid for 3 days <ref name="pmid9580117">{{cite journal| author=Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A| title=Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico. | journal=Trans R Soc Trop Med Hyg | year= 1997 | volume= 91 | issue= 6 | pages= 701-3 | pmid=9580117 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9580117  }} </ref>
+::* Alternative regimen (3): [[Levamisole]] 120 mg PO single dose
+::*Note: Pediatric dose: 2.5 mg/kg <ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
+::* Alternative regimen (4): [[Pyrantel]] Pamoate 11 mg/kg single dose PO - maximum 1.0 g<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
+::* Alternative regimen (5): [[Piperazine citrate]] 75 mg/kg qd for 2 days - maximum 3.5 g<ref name="pmid8863040">{{cite journal| author=Khuroo MS| title=Ascariasis. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 553-77 | pmid=8863040 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863040  }} </ref>
+{{PBI|Capillaria philippinensis}}
+::* '''1. Intestinal capillariasis'''<ref>{{Cite journal| issn = 0893-8512| volume = 5| issue = 2| pages = 120–129| last = Cross| first = J. H.| title = Intestinal capillariasis| journal = Clinical Microbiology Reviews| date = 1992-04| pmid = 1576584| pmc = PMC358231}}</ref><ref>{{Cite journal| doi = 10.4269/ajtmh.2012.11-0321| issn = 1476-1645| volume = 86| issue = 1| pages = 126–133| last1 = Attia| first1 = Rasha A. H.| last2 = Tolba| first2 = Mohammed E. M.| last3 = Yones| first3 = Doaa A.| last4 = Bakir| first4 = Hanaa Y.| last5 = Eldeek| first5 = Hanan E. M.| last6 = Kamel| first6 = Shereef| title = Capillaria philippinensis in Upper Egypt: has it become endemic?| journal = The American Journal of Tropical Medicine and Hygiene| date = 2012-01| pmid = 22232463| pmc = PMC3247121}}</ref><ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:::* Preferred regimen: [[Albendazole]] 400 mg/day PO for 10-30 days
+:::* Alternative regimen: [[Mebendazole]] 200 mg PO bid for 20-30 days
+{{PBI|Enterobius vermicularis}}
+*'''1. Enterobius vermicularis'''<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+:* Preferred regimen (1): [[Albendazole]] 400 mg PO single dose
+:* Preferred regimen (2): [[Mebendazole]] 100 mg PO single dose
+:* Preferred regimen (3): [[Ivermectin]] 200 µg/kg PO single dose
+:* Preferred regimen (4): [[Pyrantel pamoate]] 11 mg/kg up to 1.0 g PO single dose
+:*Note: A second dose is given 2 weeks later because of the frequency of reinfection and autoinfection.
+{{PBI|Necator americanus}}
+::* Preferred regimen: [[Albendazole]] 400 mg PO single dose<ref name="pmid18430913">{{cite journal| author=Keiser J, Utzinger J| title=Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. | journal=JAMA | year= 2008 | volume= 299 | issue= 16 | pages= 1937-48 | pmid=18430913 | doi=10.1001/jama.299.16.1937 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18430913  }} </ref>
+::* Alternative regimen (1): [[Mebendazole]] 100 mg PO bid or 500 mg daily for 3 days
+::* Alternative regimen (2): [[Pyrantel pamoate]] 11 mg/kg PO qd (maximum 1 g/day) for 3 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+{{PBI|Ancylostoma duodenale}}
+::* Preferred regimen: [[Albendazole]] 400 mg PO single dose<ref name="pmid18430913">{{cite journal| author=Keiser J, Utzinger J| title=Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis. | journal=JAMA | year= 2008 | volume= 299 | issue= 16 | pages= 1937-48 | pmid=18430913 | doi=10.1001/jama.299.16.1937 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18430913  }} </ref>
+::* Alternative regimen (1): [[Mebendazole]] 100 mg PO bid or 500 mg daily for 3 days
+::* Alternative regimen (2): [[Pyrantel pamoate]] 11 mg/kg PO qd (maximum 1 g/day) for 3 days<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+{{PBI|Strongyloides stercoralis}}
+::* Preferred regimen: [[Ivermectin]] 200 mcg/kg/day PO qd for 2 days or two doses 2 weeks apart from each other<ref>{{Cite web | title = WGO Practice Guideline Management of Strongyloidiasis| url = http://www.worldgastroenterology.org/assets/downloads/en/pdf/guidelines/15_management_strongyloidiasis_en.pdf}}</ref>
+::* Alternative regimen: [[Albendazole]] 400 mg PO bid for 3-7 days<ref name="pmid8483992">{{cite journal| author=Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR| title=Albendazole is effective treatment for chronic strongyloidiasis. | journal=Q J Med | year= 1993 | volume= 86 | issue= 3 | pages= 191-5 | pmid=8483992 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8483992  }} </ref>
+{{PBI|Trichuris trichiura}}
+::* Preferred regimen: [[Albendazole]] 400 mg PO qd for 3 days
+::* Alternatie regimen (1): [[Mebendazole]] 100 mg PO bid for 3 days
+::* Alternative regimen (2): [[Ivermectin]] 200 mcg/kg/day PO qd for 3 days<ref>{{Cite web | title = Parasites - Trichuriasis| url = http://www.cdc.gov/parasites/whipworm/health_professionals/index.html#tx}}</ref>
+====Parasites – Extraintestinal Nematodes (Roundworms)====
+{{PBI|Ancylostoma braziliense}}
+::* Preferred regimen<ref>{{Cite web | title = Parasites - Zoonotic Hookworm | url = http://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html}}</ref>
+:::* Adult: [[Albendazole]] 400mg PO qd for 3-7 days.
+:::* Pediatric: [[Albendazole]] > 2 years 400mg PO qd for 3 days
+:::* Note: This drug is contraindicated in children younger than 2 years.
+::* Alternative regimen<ref>{{Cite web | title = Parasites - Zoonotic Hookworm | url = http://www.cdc.gov/parasites/zoonotichookworm/health_professionals/index.html}}</ref>
+:::* Adult: [[Ivermectin]] 200 mcg/kg PO qd for one or two days.
+:::* Pediatric: [[Ivermectin]] >15 kg give 200mcg/kg single dose.
+{{PBI|Angiostrongylus cantonensis}}
+:*Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60mg qd for 2 weeks) and analgesics<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+:*Note: [[Albendazole]] and [[Mebendazole]] are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.<ref name="pmid19706911">{{cite journal| author=Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y| title=Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis. | journal=Am J Trop Med Hyg | year= 2009 | volume= 81 | issue= 3 | pages= 443-5 | pmid=19706911 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19706911  }} </ref>
+----
+{{PBI|Filariasis}}
+:* '''Filariasis'''<ref>{{cite web | title = Drugs for Parasitic Infections (Treatment Guidelines from The Medical Letter) | url = http://secure.medicalletter.org/para }}</ref><ref name="pmid20739055">{{cite journal| author=Taylor MJ, Hoerauf A, Bockarie M| title=Lymphatic filariasis and onchocerciasis. | journal=Lancet | year= 2010 | volume= 376 | issue= 9747 | pages= 1175-85 | pmid=20739055 | doi=10.1016/S0140-6736(10)60586-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20739055  }} </ref><ref name="pmid22632644">{{cite journal| author=Knopp S, Steinmann P, Hatz C, Keiser J, Utzinger J| title=Nematode infections: filariases. | journal=Infect Dis Clin North Am | year= 2012 | volume= 26 | issue= 2 | pages= 359-81 | pmid=22632644 | doi=10.1016/j.idc.2012.02.005 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22632644  }}</ref>
+::* 1. '''Lymphatic filariasis caused by Wuchereria bancrofti, Brugia malayi, Brugia timori'''
+:::* Preferred regimen: [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12 days (single dose if patient will continue to live in endemic area or is younger than 9 years old)
+::* 2. '''Loa loa filariasis'''<ref>{{cite web | title = Parasites - Loiasis (CDC) | url = http://www.cdc.gov/parasites/loiasis/health_professionals/index.html }}</ref>
+:::* 2.1 '''Symptomatic loiasis with < 8,000 microfilariae/mL'''
+::::* Preferred regimen: [[Diethylcarbamazine]] 8–10 mg/kd/day PO tid for 21 days
+:::* 2.2 '''Symptomatic loiasis, with < 8,000 microfilariae/mL and failed 2 rounds DEC'''
+::::* Preferred regimen: [[Albendazole]] 200 mg PO bid for 21 days
+:::* 2.3 '''Symptomatic loiasis, with ≥ 8,000 microfilariae/ml to suppress microfilaremia prior to treatment with DEC'''
+::::* Preferred regimen: [[Albendazole]] 200 mg PO bid for 21 days
+:::* 2.4 '''Symptomatic loiasis, with ≥ 8,000 microfilariae/mL'''
+::::* Preferred regimen: Apheresis followed by [[Diethylcarbamazine]]
+::::* Note: Apheresis should be performed at an institution with experience in using this therapeutic modality for loiasis.
+::* 3. '''River blindness (onchocerciasis) caused by Onchocerca volvulus'''
+:::* Preferred regimen: [[Ivermectin]] 150 μg/kg PO single dose, repeated every 6-12 mos until asymptomatic
+:::* Alternative regimen: [[Doxycycline]] 100 mg PO qd for 6 weeks, alone or followed by [[Ivermectin]] 150 μg/kg PO single dose
+:::* Note: Do <u>NOT</u> administer Diethylcarbamazine where onchocerciasis is endemic due to increased risk for severe local inflammation in patients with ocular microfilariae.
+::* 4. '''Mansonella ozzardi'''
+:::* Preferred regimen: [[Ivermectin]] 200 μg/kg PO single dose
+:::* Note: Endosymbiotic Wolbachia are essential to filarial growth, development, embryogenesis and survival and represent an additional target for therapy.  [[Doxycycline]] 100–200 mg PO qd for 6–8 weeks results in loss of Wolbachia and decrease in both micro- and macrofilariae.
+::* 5. '''Mansonella perstans'''
+:::* Preferred regimen: [[Doxycycline]] 100–200 mg PO qd for 6–8 weeks
+::* 6. '''Mansonella streptocerca'''
+:::* Preferred regimen (1): [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12 days
+:::* Preferred regimen (2): [[Ivermectin]] 150 μg/kg PO single dose
+::* 7. '''Tropical pulmonary eosinophilia caused by Wuchereria bancrofti'''
+:::* Preferred regimen: [[Diethylcarbamazine]] 6 mg/kd/day PO tid for 12–21 days
+----
+{{PBI|Gnathostoma spinigerum}}
+:*'''1. Eosinophilic Meningitis'''
+:**Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.<ref name="pmid19123863">{{cite journal| author=Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J et al.| title=Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 3 | pages= 322-7 | pmid=19123863 | doi=10.1086/595852 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19123863  }} </ref>
+:*'''2. Cutaneous disease:'''
+::*Preferred regimen (1): [[Albendazole]] 400 mg bid for 21 days<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
+::*Preferred regimen (2): [[Ivermectin]] 200 mcg/kg once daily for 2 days<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
+::*Alternative regimen (1): [[Albendazole]] 400 mg daily for 21 days<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
+::*Alternative regimen (2): [[Ivermectin]] 200 mcg/kg once daily for 1 day<ref>{{Cite web | title =Gnathostomiasis| url =http://www.cdc.gov/dpdx/gnathostomiasis/tx.html }}</ref>
+{{PBI|Toxocariasis}}
+:*'''1.1 Visceral toxocariasis'''
+::*Preferred regimen: [[Albendazole]] 400 mg PO bid for five days (both adult and pediatric dosage)<ref>{{Cite web | title = Parasites - Toxocariasis| url = http://www.cdc.gov/parasites/toxocariasis/health_professionals/index.html}}</ref>
+::*Alternative regimen: [[Mebendazole]] 100-200 mg PO bid for five days (both adult and pediatric dosage)<ref>{{Cite web | title = Parasites - Toxocariasis| url = http://www.cdc.gov/parasites/toxocariasis/health_professionals/index.html}}</ref>
+::*Note: Treatment is indicated for moderate-severe cases. Patients with mild symptoms of toxocariasis may not require anthelminthic therapy as symptoms are limited.<ref name="pmid622118">{{cite journal| author=Schantz PM, Glickman LT| title=Toxocaral visceral larva migrans. | journal=N Engl J Med | year= 1978 | volume= 298 | issue= 8 | pages= 436-9 | pmid=622118 | doi=10.1056/NEJM197802232980806 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=622118  }} </ref>
+:*'''1.2 Ocular toxocariasis'''
+::*Preferred regimen: [[Prednisone]] 0.5-1mg/kg/day PO q24h {{and}} [[Albendazole]] 400mg PO bid for 2 to 4 weeks (pediatric dose: 400mg PO qd)<ref name="pmid11436948">{{cite journal| author=Barisani-Asenbauer T, Maca SM, Hauff W, Kaminski SL, Domanovits H, Theyer I et al.| title=Treatment of ocular toxocariasis with albendazole. | journal=J Ocul Pharmacol Ther | year= 2001 | volume= 17 | issue= 3 | pages= 287-94 | pmid=11436948 | doi=10.1089/108076801750295317 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11436948  }} </ref>
+::*Note: Surgical therapy might be neeeded.
+{{PBI|Trichinella spiralis}}
+:* Trichinella spiralis<ref name="pmid19136437">{{cite journal| author=Gottstein B, Pozio E, Nöckler K| title=Epidemiology, diagnosis, treatment, and control of trichinellosis. | journal=Clin Microbiol Rev | year= 2009 | volume= 22 | issue= 1 | pages= 127-45, Table of Contents | pmid=19136437 | doi=10.1128/CMR.00026-08 | pmc=PMC2620635 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19136437  }} </ref>
+::* Preferred regimen (1): [[Albendazole]] 400 mg PO bid for 8-14 days
+::* Preferred regimen (2): [[Mebendazole]] 200-400 mg PO tid for 3 days {{then}} 400-500 mg PO tid for 10 days
+::* Note (1): Both treatment schemes are suitable for adult and pediatric dosages
+::* Note (1): Albendazole and Mebendazole are contraindicated during pregnancy and not recommended in children aged 2 years.
+::* Alternative regimen (1): (severe symptoms) [[Prednisone]] 30 mg/day-60 mg/day for 10-15 days
+::* Alternative regimen (2): [[Pyrantel]] 10-20 mg/kg single dose for 2-3 days
+====Parasites – Trematodes (Flukes)====
+{{PBI|Clonorchis sinensis}}
+:*Preferred regimen: [[Praziquantel]] 75mg/kg/day PO tid for 2 days<ref>{{Cite web | title =Clonorchis | url = http://www.cdc.gov/parasites/clonorchis/health_professionals/index.html}}</ref>
+:*Alternative regimen (1): [[Albendazole]] 10mg/kg/day PO qd for 7 days<ref>{{Cite web | title =Clonorchis | url = http://www.cdc.gov/parasites/clonorchis/health_professionals/index.html}}</ref>
+:*Alternative regimen (2): [[Tribendimidine]] 400mg PO single dose<ref name="pmid23223597">{{cite journal| author=Qian MB, Yap P, Yang YC, Liang H, Jiang ZH, Li W et al.| title=Efficacy and safety of tribendimidine against Clonorchis sinensis. | journal=Clin Infect Dis | year= 2013 | volume= 56 | issue= 7 | pages= e76-82 | pmid=23223597 | doi=10.1093/cid/cis1011 | pmc=PMC3588115 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23223597  }} </ref>
+:* This regimen is still under investigation, but it appears to be as effective as [[Praziquantel]].
+:*Note: Urgent biliary decompression might be required for patients with acute cholangitis.
+{{PBI|Dicrocoelium dendriticum}}
+:*Preferred regimen: [[Praziquantel]] 25 mg/kg PO tid for 2 days<ref>{{Cite web | title =Dicrocoeliasis| url =http://www.cdc.gov/dpdx/dicrocoeliasis/tx.html }}</ref>
+:*Note: [[Praziquantel]] is not approved for treatment of children less than 4 years old.<ref>{{Cite web | title =Dicrocoeliasis| url =http://www.cdc.gov/dpdx/dicrocoeliasis/tx.html }}</ref>
+:*Alternative regimen (1): [[Myrrh]] (commiphora molmol) 12 mg/kg/day PO for 6 days<ref name="pmid17418062">{{cite journal| author=Rana SS, Bhasin DK, Nanda M, Singh K| title=Parasitic infestations of the biliary tract. | journal=Curr Gastroenterol Rep | year= 2007 | volume= 9 | issue= 2 | pages= 156-64 | pmid=17418062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17418062  }} </ref>
+:*Alternative regimen (2): [[Triclabendazole]] 10 mg/kg PO single dose<ref name="pmid17418062">{{cite journal| author=Rana SS, Bhasin DK, Nanda M, Singh K| title=Parasitic infestations of the biliary tract. | journal=Curr Gastroenterol Rep | year= 2007 | volume= 9 | issue= 2 | pages= 156-64 | pmid=17418062 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17418062  }} </ref>
+{{PBI|Fasciola hepatica}}
+:*Preferred regimen: [[Triclabendazole]] 10 mg/kg PO one dose<ref>{{Cite web | title =Parasites - Fascioliasis| url = http://www.cdc.gov/parasites/fasciola/health_professionals/}}</ref>
+:*Note: Two-dose (double-dose) triclabendazole therapy can be given to patients who have severe or heavy Fasciola infections (many parasites) or who did not respond to single-dose therapy.
+:*Alternative regimen: [[Nitazoxanide]] 500mg PO bid for 7 days
+{{PBI|Paragonimus westermani}}
+:*Preferred regimen (1): [[Praziquantel]] 25 mg/kg PO tid for 3 days<ref>{{Cite web | title =Parasites - Paragonimiasis| url =http://www.cdc.gov/parasites/paragonimus/health_professionals/index.html }}</ref>
+:*Preferred regimen (2): [[Triclabendazole]] 10 mg/kg PO qd or bid
+:*Alternative regimen (1): [[Bithinol]] 30-50mg/kg PO on alternate days for 10-15 doses
+:*Alternative regimen (2): [[Niclosamide]] 2mg/kg PO single dose
+{{PBI|Schistosomiasis}}
+:*'''1. Schistosoma mansoni, S. haematobium, S. intercalatum'''<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
+::*Preferred regimen: [[Praziquantel]] 40 mg/kg per day PO in qd or bid for one day
+::*Alternative regimen (1): [[Oxamniquine]] 20 mg/kg PO single dose<ref>National Center for Biotechnology Information. PubChem Compound Database; CID=4612, https://pubchem.ncbi.nlm.nih.gov/compound/4612 (accessed July 16, 2015).</ref><ref>BINA, J. C.  and  PRATA, A.. Tratamento da esquistossomose com oxamniquine (xarope) em crianças. Rev. Soc. Bras. Med. Trop.[online]. 1975, vol.9, n.4 [cited  2015-07-16], pp. 175-178 . Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86821975000400002&lng=en&nrm=iso>. ISSN 0037-8682.  http://dx.doi.org/10.1590/S0037-86821975000400002.</ref>
+::*Alternative regimen (2): [[Artemisinin]] no dose is established yet<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
+::*Alternative regimen (3): [[Mefloquine]] 250 mg PO single dose
+::*Note: There is no benefit in associating the alternative therapies to Praziquantel.
+::*Note: Praziquantel is not effective against larval/egg stages of the disease.<ref name="pmid24445340">{{cite journal| author=Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G| title=Invasive fungal infections in the ICU: how to approach, how to treat. | journal=Molecules | year= 2014 | volume= 19 | issue= 1 | pages= 1085-119 | pmid=24445340 | doi=10.3390/molecules19011085 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24445340  }} </ref>
+:*'''2. S. japonicum, S. mekongi'''<ref name="pmid24698483">{{cite journal| author=Colley DG, Bustinduy AL, Secor WE, King CH| title=Human schistosomiasis. | journal=Lancet | year= 2014 | volume= 383 | issue= 9936 | pages= 2253-64 | pmid=24698483 | doi=10.1016/S0140-6736(13)61949-2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24698483  }} </ref>
+::*Preferred regimen: [[Praziquantel]] 60 mg/kg per day PO bid for one day
+::*Alternative regimen (1): [[Artemisinin]] no dose is established yet
+::*Alternative regimen (2): [[Mefloquine]] 250 mg PO single dose
+::*Note: There is no benefit in associating the alternative therapies to Praziquantel.
+:*'''3. Katayama Fever'''
+::*Preferred regimen: Prednisone 20-40 mg/day PO for 5 days, {{then}} Praziquantel<ref name="pmid20222897">{{cite journal| author=Jauréguiberry S, Paris L, Caumes E| title=Acute schistosomiasis, a diagnostic and therapeutic challenge. | journal=Clin Microbiol Infect | year= 2010 | volume= 16 | issue= 3 | pages= 225-31 | pmid=20222897 | doi=10.1111/j.1469-0691.2009.03131.x | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20222897  }} </ref>
+::*Note: Praziquantel should be used after 4-6 weeks of exposure, because it cannot kill the larvae stages of the Schistosoma. Praziquantel should be used after acute schistosomiasis syndrome symptoms have resolved always together with corticosteroids, only when ova are detected in stool or urine samples.<ref name="pmid19292640">{{cite journal| author=Jauréguiberry S, Paris L, Caumes E| title=Difficulties in the diagnosis and treatment of acute schistosomiasis. | journal=Clin Infect Dis | year= 2009 | volume= 48 | issue= 8 | pages= 1163-4; author reply 1164-5 | pmid=19292640 | doi=10.1086/597497 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19292640  }} </ref>
+:*'''4. Neuroschistosomiasis'''
+::*Preferred regimen: prednisone 1-2 mg/kg
+::*Note: Praziquantel should only be introduced after a few days of the initiation of corticosteroid therapy, due to the risk of increasing the inflammatory response.
+====Parasites – Cestodes (Tapeworms)====
+{{PBI|Echinococcus}}
+* Echinococcus treatment<ref name="pmid8863045">{{cite journal| author=Ammann RW, Eckert J| title=Cestodes. Echinococcus. | journal=Gastroenterol Clin North Am | year= 1996 | volume= 25 | issue= 3 | pages= 655-89 | pmid=8863045 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8863045  }} </ref>
+:* 1.1 '''Echinococcus granulosus (hydatid disease) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::* Preferred regimen: [[Albendazole]] ≥ 60 kg 400 mg PO bid or < 60 kg 10-15 mg/kg/day PO bid with meals for 3-6 months
+::*Alternative regimen: [[Mebendazole]] 40-50mg/kg/day PO tid for 3-6 months
+::*Note: Percutaneous aspiration-injection-reaspiration (PAIR). Puncture & needle aspirate cyst content. Instill hypertonic saline (15–30%) or absolute alcohol, wait 20–30 min, then re-aspirate with final irrigation. Administer [[Albendazole]] at least 4 hours before PAIR.
+::*Note: If surgery is needed, make sure to administer [[Albendazole]] for at least a week before the surgery, and to keep the medication for at least 4 weeks after the procedure.
+:* 1.2 '''Echinococcus multilocularis (alveolar cyst disease) treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::* Preferred regimen: [[Albendazole]] ≥ 60 kg 400 mg PO bid or < 60 kg 15 mg/kg/day PO bid with meals for at least 2 years. Long-term follow up needed to evaluate progression of the lesions.
+::: Note: Wide surgical resection only reliable treatment; technique evolving.
+==Neurocysticercosis==
+{{PBI|Neurocysticercosis}}
+:* '''Neurocysticercosis treatment'''
+::* 1. '''Parenchymal neurocysticercosis'''
+:::* 1.1 '''Single lesions'''<ref name="pmid12364377">{{cite journal| author=García HH, Evans CA, Nash TE, Takayanagui OM, White AC, Botero D et al.| title=Current consensus guidelines for treatment of neurocysticercosis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 747-56 | pmid=12364377 | doi= | pmc=PMC126865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364377  }} </ref>
+::::* Preferred regimen:  [[Albendazole]] 15 mg/kg/day PO bid for 3-8 days {{and}} [[Prednisone]] 1 mg/kg/day PO qid for 8-10 days followed by a taper
+:::* 1.2  '''Multiple cysts'''
+::::* Preferred regimen: [[Albendazole]] 15 mg/kg/day PO bid for 8-15 days and high-dose steroids
+::::* Preferred regimen: [[Praziquantel]] 50 mg/kg/day PO tid {{and}} [[Albendazole]] 15 mg/kg/day PO bid
+:::* 1.3 '''Cysticercal encephalitis''' <ref name="pmid12364377">{{cite journal| author=García HH, Evans CA, Nash TE, Takayanagui OM, White AC, Botero D et al.| title=Current consensus guidelines for treatment of neurocysticercosis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 747-56 | pmid=12364377 | doi= | pmc=PMC126865 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364377  }} </ref>
+::::* Cysticercal encephalitis (diffuse cerebral edema associated with multiple inflamed cysticerci) is a contraindication for antiparasitic therapy, since enhanced parasite killing can exacerbate host inflammatory response and lead to diffuse cerebral edema and potential transtentorial herniation. Most cases of cysticercal encephalitis improve with corticosteroid therapy
+:::* 1.4 '''Calcified cysts '''
+::::* Radiographic evidence of parenchymal calcifications is a significant risk factor for recurrent seizure activity; these lesions are present in about 10 percent of individuals in regions where neurocysticercosis is endemic. Seizures in these patients should be treated with antiepileptic therapy.
+::* 2. '''Extraparenchymal NCC'''
+:::* 2.1 '''Subarachnoid cysts'''
+::::* Preferred regimen: [[Albendazole]]  15 mg/kg/day PO bid  for  28 days {{and}} ([[Prednisone]] up to 60 mg/day PO {{or}} [[Dexamethasone]] (up to 24 mg/day)) along with the antiparasitic therapy. The dose can often be tapered after a few weeks. However, in cases for which more prolonged steroid therapy is required, methotrexate can be used as a steroid-sparing agent
+:::*  2.2 '''Giant cysts'''
+::::* Giant cysticerci are usually accompanied by cerebral edema and mass effect, which should be managed with high-dose corticosteroids (with or without mannitol).
+:::* 2.3 ''' Intraventricular cysts'''
+::::* Emergent management with CSF diversion via a ventriculostomy or placement of a ventriculo-peritoneal shunt
+::::* Treatment of residual hydrocephalus may be managed with endoscopic foraminotomy and endoscopic third ventriculostomy; this approach may also allow debulking of cisternal cysticerci
+:::* 2.4 ''' Ocular cysticercosis'''
+::::* Surgical excision is warranted in the setting of intraocular cysts
+::::* Cysticercal involvement of the extraocular muscles should be managed with albendazole and corticosteroids.
+:::* 2.5 '''Spinal cysticercosis'''
+::::* Medical therapy with corticosteroids and antiparasitic drugs
+{{PBI|Sparganosis}}
+:* '''Sparganosis (Spirometra mansonoides) treatment''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::* Preferred treatment: Surgical resection or ethanol injection of subcutaneous masses
+::*Note: [[Praziquantel]] 75 mg/kg/day PO qd for 3 days is controversial. It's been innefective in some cases, but has had some results in patients when surgical therapy wasn't an option.<ref name="pmid21359068">{{cite journal| author=Lee JH, Kim GH, Kim SM, Lee SY, Lee WY, Bae JW et al.| title=A case of sparganosis that presented as a recurrent pericardial effusion. | journal=Korean Circ J | year= 2011 | volume= 41 | issue= 1 | pages= 38-42 | pmid=21359068 | doi=10.4070/kcj.2011.41.1.38 | pmc=PMC3040402 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21359068  }} </ref>
+====Parasites – Ectoparasites====
+{{PBI|Body lice}}
+:* '''Pediculus humanus, corporis treatment'''<ref>{{Cite web | title = body lice | url =http://www.cdc.gov/parasites/lice/body/treatment.html }} </ref>
+::*  A body lice infestation is treated by improving the personal hygiene of the infested person, including assuring a regular (at least weekly) change of clean clothes.
+::*  Clothing, bedding, and towels used by the infested person should be laundered using hot water (at least 130°F) and machine dried using the hot cycle.
+::*  Sometimes the infested person also is treated with a pediculicide [[Ivermectin]] Lotion; however, a pediculicide  [[Ivermectin]] generally is not necessary if hygiene is maintained and items are laundered appropriately at least once a week. A pediculicide [[Ivermectin]] should be applied exactly as directed on the bottle or by your physician.
+{{PBI|Head lice}}
+:* '''Pediculus humanus, capitis treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Preferred regimen (1): [[Permethrin]] 1% lotion apply to shampooed dried hair for 10 min.; repeat in 9-10 days
+::* Preferred regimen (2):  [[Malathion]] 0.5% lotion (Ovide) apply to dry hair for 8–12hrs, then shampoo (2 doses 7-9 days apart)
+::* Alternative regimen: [[Ivermectin]] 200 μg/kg PO once; 3 doses at 7 day intervals reported effective.
+{{PBI|Pubic lice}}
+:* '''Phthirus pubis treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* Preferred regimen (1): [[Permethrin]] 1% cream rinse applied to affected areas and washed off after 10 minutes
+::* Preferred regimen (2): Pyrethrins with piperonyl butoxide applied to the affected area and washed off after 10 minutes
+::* Alternative regimen (1): [[Malathion]] 0.5% lotion applied to affected areas and washed off after 8–12 hours
+::* Alternative regimen (2): [[Ivermectin]] 250 ug/kg  PO, repeated in 2 weeks
+{{PBI|Myiasis}}
+:*Preferred regimen: No medications approved by the FDA are available for treatment<ref>{{Cite web | title =Parasites - Myiasis | url =http://www.cdc.gov/parasites/myiasis/health_professionals/index.html }}</ref>
+:*Note: Fly larvae need to be surgically removed.
+::* '''Fly larvae treatment''' <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::* Preferred treatment (1): Occlude punctum to prevent gas exchange with petrolatum, fingernail polish, makeup cream or bacon.
+::* Preferred treatment (2): When larva migrates, manually remove.
+::*Note (1): Myiasis is due to larvae of flies.
+::*Note (2): Usually cutaneous/subcutaneous nodule with central punctum.
+{{PBI|Scabies}}
+:* '''Sarcoptes scabiei treatment'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* 1. '''Adult'''
+:::* Preferred regimen (1): [[Permethrin]] 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
+:::* Preferred regimen (2): [[Ivermectin]]  200 ug/kg PO qd and repeated in 2 weeks
+:::* Alternative regimen: [[Lindane]] (1%) 1 oz of lotion or 30 g of cream applied in a thin layer to all areas of the body from the neck down and thoroughly washed off after 8 hours
+::*  2. '''Infants and young children'''
+:::* Preferred regimen: [[Permethrin]] 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
+:::* Note: Infants and young children aged< 10 years should not be treated with lindane.
+::*  3. '''Crusted Scabies'''
+:::* Crusted scabies (i.e., Norwegian scabies) is an aggressive infestation that usually occurs in immunodeficient, debilitated, or malnourished persons, including persons receiving systemic or potent topical glucocorticoids, organ transplant recipients, persons with HIV infection or human T-lymphotrophic virus-1-infection, and persons with hematologic malignancies.
+::::* Preferred regimen:   (Topical scabicide  5% topical [[Benzyl benzoate]] 5% {{or}}  topical [[Permethrin]]  5% cream (full-body application to be repeated daily for 7 days then twice weekly until discharge or cure) {{and}} treatment with [[Ivermectin]] 200 ug/kg  PO on days 1,2,8,9, and 15. Additional [[Ivermectin]] treatment on days 22 and 29 might be required for severe cases
+::*  4.'''Pregnant or Lactating Women'''
+:::* Preferred regimen: [[Permethrin]] 5% cream applied to all areas of the body from the neck down and washed off after 8–14 hours
+====Viruses====
+{{PBI|Adenovirus}}
+:* '''Adenovirus'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::* 1. '''In severe cases of pneumonia or post hematopoietic stem cell transplantation'''
+:::* Preferred regimen (1): [[Cidofovir]] 5 mg/kg/week IV for 2 weeks, then every 2 weeks {{and}} [[Probenecid]] 1.25 g/M<sup>2</sup> PO given 3 hours before [[Cidofovir]] and 3 & 9 hours after each infusion
+:::* Preferred regimen (2): [[Cidofovir]] 1 mg/kg IV 3 times per week
+:::*Note: [[Ganciclovir]], [[Foscarnet]] and [[Ribavirin]] are not recommended for use on adenovirus infection.<ref name="pmid24982316">{{cite journal| author=Lion T| title=Adenovirus infections in immunocompetent and immunocompromised patients. | journal=Clin Microbiol Rev | year= 2014 | volume= 27 | issue= 3 | pages= 441-62 | pmid=24982316 | doi=10.1128/CMR.00116-13 | pmc=PMC4135893 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24982316  }} </ref>
+::* 2. '''For hemorrhagic cystitis'''
+:::* Preferred regimen: [[Cidofovir]] (5 mg/kg in 100 mL saline instilled into bladder) intravesical<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::* 3. '''Pink eye (viral conjunctivitis)'''
+:::*Preferred regimen: No specific treatment available. If symptomatic, cold artificial tears may help.
+::* 4.'''Bronchitis'''
+:::*Preferred regimen: No specific therapy recommended, treatment is symptomatic.
+{{PBI|SARS}}
+* '''Severe acute respiratory distress syndrome- coronavirus infection treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref><ref name="pmid16968120">{{cite journal| author=Stockman LJ, Bellamy R, Garner P| title=SARS: systematic review of treatment effects. | journal=PLoS Med | year= 2006 | volume= 3 | issue= 9 | pages= e343 | pmid=16968120 | doi=10.1371/journal.pmed.0030343 | pmc=PMC1564166 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16968120  }} </ref><ref name="pmid15766649">{{cite journal| author=Groneberg DA, Poutanen SM, Low DE, Lode H, Welte T, Zabel P| title=Treatment and vaccines for severe acute respiratory syndrome. | journal=Lancet Infect Dis | year= 2005 | volume= 5 | issue= 3 | pages= 147-55 | pmid=15766649 | doi=10.1016/S1473-3099(05)01307-1 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15766649  }} </ref>
+:*Preferred regimen: supportive therapy
+:*Note: New therapies were studied for SARS during the last outbreaks which concluded:
+::* [[Ribavirin]] ineffective and probably harmful due to haemolytic anaemia
+::* [[Lopinavir]] {{and}} [[Ritonavir]] is still controversial and need further investigation
+::* Interferon has no benefit and its studies are inconclusive
+::* [[Corticosteroids]] increases risk of fungal infections, some studies showed a higher incidence of psychosis, diabetes, avascular necrosis and osteoporosis
+::* Inhaled [[Nitric oxide]] potent mediator of airway inflammation, its has improved oxygenation in some studies
+{{PBI|Cytomegalovirus}}
+:* '''Cytomegalovirus treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::*1. '''Immunocompetent patients'''
+:::*1.1 '''Mononucleosis syndrome'''
+::::*Preferred regimen: supportive therapy
+:::*1.2 '''CMV in pregnancy'''
+::::*Preferred regimen: Hyperimmune 200 IU/kg of maternal weight as single-dose during pregnancy
+::*2. '''Immunocompromised patients'''
+:::*2.1 '''Retinitis'''
+::::*Preferred regimen (1): [[Ganciclovir]] intraocular implant {{plus}} [[Valganciclovir]] 900 mg PO bid for 14-21 days {{then}} [[Valganciclovir]] 900mg PO qq for maintenance therapy - for immediate sight-threatening lesions
+::::*Preferred regimen (2): [[Valganciclovir]] 900 mg PO bid for 14-21 days {{then}} [[Valganciclovir]] 900 mg PO qq for maintenance therapy - for peripheral lesions
+::::*Alternative regimen (1): [[Foscarnet]] 60 mg/kg IV q8h {{or}} [[Foscarnet]] 90 mg/kg IV q12h for 14-21 days {{then}} [[Foscarnet]] 90-120 mg/kg IV q24h
+::::*Alternative regimen (2): [[Cidofovir]] 5 mg/kg IV for 2 weeks {{then}} [[Cidofovir]] 5 mg/kg IV every other week - each dose should be admnistered with IV saline hydration and probenecid
+::::*Alternative regimen (3): [[Ganciclovir]] 5 mg/kg IV q12h for 14-21 days {{then}} [[Valganciclovir]] 900 mg PO bid
+::::*Alternative regimen (4): [[Fomivirsen]] intravitreal injection - for relapses
+::::*Note: keep a maintenance dose of [[Valganciclovir]] 900 mg PO qd until CD4 >100/mm³
+:::* 2.2 '''Transplant patients'''
+::::*Preferred regimen: [[Valganciclovir]] 900 mg PO bid {{or}} [[Ganciclovir]] 5 mg/kg IV q12h for at least 2-3 weeek
+::::*Note: Use [[Valganciclovir]] 900 mg PO qd for 1-3 months if high dose of immunosuppression.
+:::* 2.3 '''Colitis, esophagitis, gastritis'''
+::::*Preferred regimen: [[Ganciclovir]] 5 mg/kg/dose IV q12h for 3-6 weeks weeks for induction. There is no agreement on the use of maintenance.
+::::*Alternative regimen: [[Cidofovir]] 5 mg/kg IV for 2 weeks, then 5 mg/kg every other week; each dose should be administered with IV saline hydration and oral probenecid 2 g PO 3h before each dose and further 1 g doses after 2h and 8h.
+::::*Note: Switch to oral [[Valganciclovir]] when PO tolerated & when symptoms not severe enough to interfere with absorption.
+:::* 2.4 '''Pneumonia'''
+::::*Preferred regimen: [[Valganciclovir]] 900 mg PO bid for 14–21 days, then 900 mg PO qd for maintenance therapy
+::::*Alternative regimen for retinitis: [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days, then [[Valganciclovir]] 900 mg PO qd
+::::*Note: In bone marrow transplant patients, combine therapy with CMV immune globulin.
+:::* 2.5 '''Encephalitis, ventriculitis'''
+::::*Note: Treatment not defined, but should be considered the same as retinitis. Disease may develop while taking [[Ganciclovir]] as suppressive therapy.
+:::* 2.6 '''Lumbosacral polyradiculopathy'''
+::::*Preferred regimen: [[Ganciclovir]], as with retinitis
+::::*Alternative regimen: [[Foscarnet]] 40 mg/kg IV q12h another option
+::::*Alternative regimen: [[Cidofovir]] 5 mg/kg IV for 2 weeks, then 5 mg/kg every other week; each dose should be administered with IV saline hydration and oral probenecid 2 g PO 3h before each dose and further 1 g doses after 2h and 8h.
+::::*Note (1): Switch to [[Valganciclovir]] when possible.
+::::*Note (2): Suppression continued until CD4 remains >100/mm³ for 6 months.
+:::*2.7 '''Peri/postnatal severe CMV infection in very low birth weight infants'''
+::::*Preferred regimen: [[Ganciclovir]] 6 mg/kg/dose IV q12h for 3 weeks<ref name="pmid25243446">{{cite journal| author=Josephson CD, Caliendo AM, Easley KA, Knezevic A, Shenvi N, Hinkes MT et al.| title=Blood transfusion and breast milk transmission of cytomegalovirus in very low-birth-weight infants: a prospective cohort study. | journal=JAMA Pediatr | year= 2014 | volume= 168 | issue= 11 | pages= 1054-62 | pmid=25243446 | doi=10.1001/jamapediatrics.2014.1360 | pmc=PMC4392178 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25243446  }} </ref>
+{{PBI|Enterovirus D68}}
+:* '''Enterovirus treatment'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+:::*Preferred regimen: supportive therapy
+:::*Note: A new drug [[Pleconaril]] designed to affect Rhinovirus is being suggested to be effective against Enterovirus D68 but further investigation is required<ref name="pmid25554786">{{cite journal| author=Liu Y, Sheng J, Fokine A, Meng G, Shin WH, Long F et al.| title=Structure and inhibition of EV-D68, a virus that causes respiratory illness in children. | journal=Science | year= 2015 | volume= 347 | issue= 6217 | pages= 71-4 | pmid=25554786 | doi=10.1126/science.1261962 | pmc=PMC4307789 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25554786  }} </ref>
+{{PBI|Ebola virus}}
+:*'''Ebola virus treatment'''<ref>{{cite web|title=Ebola virus treatment|url=http://www.cdc.gov/vhf/ebola/treatment/index.html}}</ref><ref name="pmid21084112">{{cite journal| author=Feldmann H, Geisbert TW| title=Ebola haemorrhagic fever. | journal=Lancet | year= 2011 | volume= 377 | issue= 9768 | pages= 849-62 | pmid=21084112 | doi=10.1016/S0140-6736(10)60667-8 | pmc=PMC3406178 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21084112  }} </ref>
+::*Preferred regimen: supportive therapy. There is no specific antiviral drug available for Ebola thus far. For information of investigational therapies including Favipiravir, Brincidofovir, ZMapp, TKM-Ebola, AVI-6002, and BCX4430, see [[Ebola future or investigational therapies|here]].
+:::*Isolate patient
+:::*Provide intravenous fluids (IV) (patients need large volumes in some cases) and maintain electrolytes at normal levels
+:::*Maintain oxygen saturation and blood pressure
+:::*Administer blood products if coagulopathy or bleeding, antiemetics if vomiting , antipyretics if fever, analgesics, anti-motility if severe diarrhea, total parenteral nutrition if patient has poor oral intake and dialysis if there's renal failure
+:::*Treat other infections if they occur. Provide adequate Gram-negative coverage and gram-positive if the patient has any catheter or hospital-acquired pneumonia.
+:::*If there's respiratory failure, invasive mechanical ventilation may be the best option to offer respiratory support
+::*Note (1): Recovery from Ebola depends on good supportive care and the patient’s immune response.
+::*Note (2): While there is no proven treatment available for Ebola virus disease, human convalescent whole blood has been used as an empirical treatment with promising results in a small group of EVD cases.<ref>[http://apps.who.int/iris/bitstream/10665/135591/1/WHO_HIS_SDS_2014.8_eng.pdf interim]</ref><ref name="pmid9988160">{{cite journal| author=Mupapa K, Massamba M, Kibadi K, Kuvula K, Bwaka A, Kipasa M et al.| title=Treatment of Ebola hemorrhagic fever with blood transfusions from convalescent patients. International Scientific and Technical Committee. | journal=J Infect Dis | year= 1999 | volume= 179 Suppl 1 | issue=  | pages= S18-23 | pmid=9988160 | doi=10.1086/514298 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9988160  }} </ref>
+::*Note (3): People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola.
+::*Note (4): Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.
+{{PBI|Marburg virus}}
+:*Marburg virus treatment
+::*Preferred regimen: supportive therapy including maintenance of blood volume and electrolyte balance, as well as analgesics and standard nursing care<ref>http://www.cfsph.iastate.edu/Factsheets/pdfs/viral_hemorrhagic_fever_filovirus.pdf</ref><ref>http://www.cdc.gov/vhf/marburg/treatment/index.html</ref>
+{{PBI|Hantavirus}}
+:*'''Hantavirus cardiopulmonary syndrome treatment'''<ref>{{citeweb|title=Hanta virus|url=http://www.cdc.gov/hantavirus/technical/hps/treatment.html}}</ref>
+::*Preferred regimen: Supportive therapy, there is no specific treatment for hantavirus cardiopulmonary syndrome
+::*Note (1): ICU management should include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed
+::*Note (2): Fluids should be administered carefully due to the potential for capillary leakage
+::*Note (3): Supplemental oxygen should be administered if patients become hypoxic
+::*Note (4): Equipment and materials for intubation and mechanical ventilation should be readily available since onset of respiratory failure may be precipitous
+::*Note (5): Extracorporeal membrane oxygenation was used with survival rates of 50% in some studies in patients with cardiac index output <2.5L/min/m²<ref name="pmid9468181">{{cite journal| author=Crowley MR, Katz RW, Kessler R, Simpson SQ, Levy H, Hallin GW et al.| title=Successful treatment of adults with severe Hantavirus pulmonary syndrome with extracorporeal membrane oxygenation. | journal=Crit Care Med | year= 1998 | volume= 26 | issue= 2 | pages= 409-14 | pmid=9468181 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9468181  }} </ref>
+{{PBI|Dengue virus}}
+:* [[Dengue virus]] <ref>{{cite book | last = LastName | first = FirstName | title = Dengue guidelines for diagnosis, treatment, prevention, and control | publisher = TDR World Health Organization | location = Geneva | year = 2009 | isbn = 9789241547871 }}</ref>
+::* 1. '''Patients who may be sent home'''
+:::* These are patients who are able to tolerate adequate volumes of oral fluids and pass urine at least once every six hours, and do not have any of the warning signs, particularly when fever subsides
+:::* Patients who are sent home should be monitored daily by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, signs of plasma leakage and bleeding, haematocrit, and white blood cell and platelet counts
+::* 2. '''Ambulatory patients  with stable haematocrit can be sent home '''
+:::* Encourage oral intake of oral rehydration solution (ORS), fruit juice and other fluids containing electrolytes and sugar to replace losses from fever and vomiting
+:::* Give [[Paracetamol]] for high fever if the patient is uncomfortable. The interval of paracetamol dosing should not be less than six hours. Tepid sponge if the patient still has high fever
+:::* Should be brought to hospital immediately if any of the following occur: no clinical improvement, deterioration around the time of defervescence, severe abdominal pain, persistent vomiting, cold and clammy extremities, lethargy or irritability/restlessness, bleeding (e.g. black stools or coffee-ground vomiting), not passing urine for more than 4–6 hours
+::* 3. '''Patients who should be referred for in-hospital management'''
+:::* Patients may need to be admitted to a secondary health care centre for close observation, particularly as they approach the critical phase. These include patients with warning signs (Abdominal pain or tenderness, Persistent vomiting, Clinical fluid accumulation, Mucosal bleed, Lethargy, restlessness, Liver enlargment >2cm, Laboratory:increase in HCT concurrent with rapid decrease in platelet count), those with co-existing conditions that may make dengue or its management more complicated (such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, chronic haemolytic diseases), and those with certain social circumstances (such as living alone, or living far from a health facility without reliable means of transport)
+::::* 3.1 '''With warning signs'''
+:::::* Obtain a reference haematocrit before fluid therapy. Give only isotonic solutions such as 0.9% saline, Ringer’s lactate, or Hartmann’s solution. Start with 5–7 ml/ kg/hour for 1–2 hours, then reduce to 3–5 ml/kg/hr for 2–4 hours, and then reduce to 2–3 ml/kg/hr or less according to the clinical response
+:::::* Reassess the clinical status and repeat the haematocrit. If the haematocrit remains the same or rises only minimally, continue with the same rate (2–3 ml/kg/hr) for another 2–4 hours. If the vital signs are worsening and haematocrit is rising rapidly, increase the rate to 5–10 ml/kg/hour for 1–2 hours. Reassess the clinical status, repeat the haematocrit and review fluid infusion rates accordingly
+:::::* Give the minimum intravenous fluid volume required to maintain good perfusion and urine output of about 0.5 ml/kg/hr. Intravenous fluids are usually needed for only 24–48 hours. Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase. This is indicated by urine output and/or oral fluid intake that is/are adequate, or haematocrit decreasing below the baseline value in a stable patient
+:::::* Patients with warning signs should be monitored by health care providers until the period of risk is over. A detailed fluid balance should be maintained. Parameters that should be monitored include vital signs and peripheral perfusion (1–4 hourly until the patient is out of the critical phase), urine output (4–6 hourly), haematocrit (before and after fluid replacement, then 6–12 hourly), blood glucose, and other organ functions (such as renal profile, liver profile, coagulation profile, as indicated)
+::::* 3.2 '''Without warning signs'''
+:::::* Encourage oral fluids. If not tolerated, start intravenous fluid therapy of 0.9% saline or Ringer’s lactate with or without dextrose at maintenance rate. For obese and overweight patients, use the ideal body weight for calculation of fluid infusion. Patients may be able to take oral fluids after a few hours of intravenous fluid therapy. Thus, it is necessary to revise the fluid infusion frequently. Give the minimum volume required to maintain good perfusion and urine output. Intravenous fluids are usually needed only for 24–48 hours
+:::::* Patients should be monitored by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, haematocrit, and white blood cell and platelet counts. Other laboratory tests (such as liver and renal functions tests) can be done, depending on the clinical picture and the facilities of the hospital or health centre
+::* 4. '''Severe dengue'''
+:::* Severe dengue: Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress; severe haemorrhages; severe organ impairment (hepatic damage, renal impairment, cardiomyopathy, encephalopathy or encephalitis)
+:::* 4.1 '''Treatment of shock'''
+::::* 4.1.1 '''Compensated shock'''
+:::::* Start intravenous fluid resuscitation with isotonic crystalloid solutions at 5–10 ml/kg/hour over one hour. Then reassess the patient’s condition (vital signs, capillary refill time, haematocrit, urine output). The next steps depend on the situation
+:::::* If the patient’s condition improves, intravenous fluids should be gradually reduced to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, then to 2–3 ml/kg/hr, and then further depending on haemodynamic status, which can be maintained for up to 24–48 hours
+:::::* If vital signs are still unstable (i.e. shock persists), check the haematocrit after the first bolus. If the haematocrit increases or is still high (>50%), repeat a second bolus of crystalloid solution at 10–20 ml/kg/hr for one hour. After this second bolus, if there is improvement, reduce the rate to 7–10 ml/ kg/hr for 1–2 hours, and then continue to reduce as above. If haematocrit decreases compared to the initial reference haematocrit (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible
+:::::* Further boluses of crystalloid or colloidal solutions may need to be given during the next 24–48 hours
+::::* 4.1.2 '''Hypotensive shock'''
+:::::* Initiate intravenous fluid resuscitation with crystalloid or colloid solution (if available) at 20 ml/kg as a bolus given over 15 minutes to bring the patient out of shock as quickly as possible
+:::::* If the patient’s condition improves, give a crystalloid/colloid infusion of 10 ml/kg/hr for one hour. Then continue with crystalloid infusion and gradually reduce to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, and then to 2–3 ml/kg/hr or less, which can be maintained for up to 24–48 hours
+:::::* If vital signs are still unstable (i.e. shock persists), review the haematocrit obtained before the first bolus. If the haematocrit was low (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross- match and transfuse blood as soon as possible (see treatment for haemorrhagic complications)
+:::::* If the haematocrit was high compared to the baseline value (if not available, use population baseline), change intravenous fluids to colloid solutions at 10–20 ml/kg as a second bolus over 30 minutes to one hour. After the second bolus, reassess the patient. If the condition improves, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above. If the condition is still unstable, repeat the haematocrit after the second bolus
+:::::* If the haematocrit decreases compared to the previous value (<40% in children and adult females, less than 45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible (see treatment for haemorrhagic complications). If the haematocrit increases compared to the previous value or remains very high ( more than 50%), continue colloid solutions at 10–20 ml/kg as a third bolus over one hour. After this dose, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above when the patient’s condition improves
+:::::* Further boluses of fluids may need to be given during the next 24 hours. The rate and volume of each bolus infusion should be titrated to the clinical response. Patients with severe dengue should be admitted to the high-dependency or intensive care area
+:::* 4.2 '''Treatment of haemorrhagic complications'''
+::::* Blood transfusion required
+:::::* Give 5–10ml/kg of fresh-packed red cells or 10–20 ml/kg of fresh whole blood at an appropriate rate and observe the clinical response. It is important that fresh whole blood or fresh red cells are given. Oxygen delivery at tissue level is optimal with high levels of 2,3 di-phosphoglycerate (2,3 DPG). Stored blood loses 2,3 DPG, low levels of which impede the oxygen-releasing capacity of haemoglobin, resulting in functional tissue hypoxia. A good clinical response includes improving haemodynamic status and acid-base balance
+:::::* Consider repeating the blood transfusion if there is further blood loss or no appropriate rise in haematocrit after blood transfusion. There is little evidence to support the practice of transfusing platelet concentrates and/or fresh-frozen plasma for severe bleeding. It is being practised when massive bleeding can not be managed with just fresh whole blood/fresh-packed cells, but it may exacerbate the fluid overload
+:::::* Great care should be taken when inserting a naso-gastric tube which may cause severe haemorrhage and may block the airway. A lubricated oro-gastric tube may minimize the trauma during insertion. Insertion of central venous catheters should be done with ultra-sound guidance or by a very experienced person
+::* 5. '''Treatment of complications and other areas of treatment'''
+:::* 5.1 '''Fluid overload'''
+::::* Oxygen therapy should be given immediately
+::::* When the following signs are present, intravenous fluids should be discontinued or reduced to the minimum rate necessary to maintain euglycaemia
+:::::* signs of cessation of plasma leakage; stable blood pressure, pulse and peripheral perfusion; haematocrit decreases in the presence of a good pulse volume; afebrile for more than 24–48 days (without the use of antipyretics); resolving bowel/abdominal symptoms; improving urine output
+::::* The management of fluid overload varies according to the phase of the disease and the patient’s haemodynamic status. If the patient has stable haemodynamic status and is out of the critical phase (more than 24–48 hours of defervescence), stop intravenous fluids but continue close monitoring. If necessary, give oral or intravenous furosemide 0.1–0.5 mg/kg/dose once or twice daily, or a continuous infusion of furosemide 0.1 mg/kg/hour. Monitor serum potassium and correct the ensuing hypokalaemia
+::::* If the patient has stable haemodynamic status but is still within the critical phase, reduce the intravenous fluid accordingly. Avoid diuretics during the plasma leakage phase because they may lead to intravascular volume depletion
+::::* Patients who remain in shock with low or normal haematocrit levels but show signs of fluid overload may have occult haemorrhage. Further infusion of large volumes of intravenous fluids will lead only to a poor outcome. Careful fresh whole blood transfusion should be initiated as soon as possible. If the patient remains in shock and the haematocrit is elevated, repeated small boluses of a colloid solution may help
+:::* 5.2 '''Other complications of dengue'''
+::::* Both hyperglycaemia and hypoglycaemia may occur, even in the absence of diabetes mellitus and/or hypoglycaemic agents. Electrolyte and acid-base imbalances are also common observations in severe dengue and are probably related to gastrointestinal losses through vomiting and diarrhoea or to the use of hypotonic solutions for resuscitation and correction of dehydration. Hyponatraemia, hypokalaemia, hyperkalaemia, serum calcium imbalances and metabolic acidosis (sodium bicarbonate for metabolic acidosis is not recommended for pH ≥ 7.15) can occur. One should also be alert for co-infections and nosocomial infections.
+:::* 5.3 '''Supportive care and adjuvant therapy'''
+::::* renal replacement therapy, with a preference to continuous veno-venous haemodialysis (CWH), since peritoneal dialysis has a risk of bleeding;
+::::* vasopressor and inotropic therapies as temporary measures to prevent life- threatening hypotension in dengue shock and during induction for intubation, while correction of intravascular volume is being vigorously carried out;
+::::* further treatment of organ impairment, such as severe hepatic involvement or encephalopathy or encephalitis;
+::::* further treatment of cardiac abnormalities, such as conduction abnormalities, may occur (the latter usually not requiring interventions)
+{{PBI|West Nile virus}}
+:* '''West nile virus<ref name=CDC West nile virus>{{cite web | title = CDC West nile virus | url =http://www.cdc.gov/westnile/symptoms/index.html }}</ref>'''
+::* 1.1. '''Prevention'''
+:::* No WNV vaccines are licensed for use in humans. In the absence of a vaccine, prevention of WNV disease depends on community-level mosquito control programs to reduce vector densities, personal protective measures to decrease exposure to infected mosquitoes, and screening of blood and organ donors.
+:::* Personal protective measures include use of mosquito repellents, wearing long-sleeved shirts and long pants, and limiting outdoor exposure from dusk to dawn. Using air conditioning, installing window and door screens, and reducing peridomestic mosquito breeding sites, can further decrease the risk for WNV exposure.
+:::* Blood and some organ donations in the United States are screened for WNV infection; health care professionals should remain vigilant for the possible transmission of WNV through blood transfusion or organ transplantation. Any suspected WNV infections temporally associated with blood transfusion or organ transplantation should be reported promptly to the appropriate state health department.
+::* 1.2. '''Treatment'''
+:::* There is no specific treatment for WNV disease; clinical management is supportive. Patients with severe meningeal symptoms often require pain control for headaches and antiemetic therapy and rehydration for associated nausea and vomiting. Patients with encephalitis require close monitoring for the development of elevated intracranial pressure and seizures. Patients with encephalitis or poliomyelitis should be monitored for inability to protect their airway. Acute neuromuscular respiratory failure may develop rapidly and prolonged ventilatory support may be required.
+{{PBI|Yellow Fever}}
+:* Yellow fever<ref>{{cite web | title = District guidelines for yellow fever surveillance | url = http://www.who.int/csr/resources/publications/yellowfev/whoepigen9809.pdf?ua=1 }}</ref><ref> name="pmid3547569">{{cite journal| author=Monath TP| title=Yellow fever: a medically neglected disease. Report on a seminar. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 1 | pages= 165-75 |pmid=3547569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3547569  }} </ref>
+::* Preferred regimen: No specific treatment is available for yellow fever. In the toxic phase, supportive treatment includes therapies for treating dehydration and fever. Ribavirin has failed in several studies in the monkey model.
+:::* Note: An international seminar held by WHO in 1984 recommended maintenance of nutrition, prevention of hypoglycemia, maintenance of the blood pressure with fluids and vasoactive drugs, prevention of bleeding with fresh-frozen plasma, dialysis if renal failure, correction of metabolic acidosis, administration of cimetidine IV to avoid gastric bleeding and oxygen if needed.
+{{PBI|Chikungunya virus}}
+::'''Chikungunya Fever''' <ref name="pmid25806915">{{cite journal| author=Weaver SC, Lecuit M| title=Chikungunya virus and the global spread of a mosquito-borne disease. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 13 | pages= 1231-9 | pmid=25806915 | doi=10.1056/NEJMra1406035 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25806915  }} </ref>
+::*Preferred regimen: no specific therapeutics agents are available and there are no licensed vaccines to prevent Chikungunya Fever.
+:::* Note: Anti inflammatory drugs can be used to control joint swelling and arthritis.
+{{PBI|Hepatitis A virus}}
+:*Preferred regimen: No therapy recommended. If within 2 wks of exposure, IVIG 0.02 mL per kg IM times 1 protective.
+{{PBI|Hepatitis B virus}}
+*'''Acute Hepatitis B'''
+*'''Chronic Hepatitis B'''
+:*'''1. Patients with HBeAg-positive chronic hepatitis B'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+::*'''1.1. HBV DNA >20,000, ALT <2 times upper limit normal (ULN)'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+:::*Observe; consider treatment when ALT becomes elevated.
+:::*Consider biopsy in persons 40 years, ALT persistently high normal >2 times upper limit normal (ULN), or with family history of HCC.
+:::*Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.
+::*'''1.2. HBV DNA >20,000, ALT >2 times upper limit normal (ULN)'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+:::*Preferred regimen (1): Pegylated IFN-alpha 180 mcg weekly SC for 48 weeks
+:::*Preferred regimen (2): [[Tenofovir]] (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
+::::*If creatinine clearance 30–49 give 300 mg q48 hrs
+::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
+::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
+::::*If creatinine clearance <10 without dialysis there is no recommendation
+::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
+:::*Preferred regimen (3): [[Entecavir]] (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
+::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
+::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
+::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
+::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
+:::*Alternative regimen (1): [[Interferon alpha]] (IFNα) 5 MU daily or 10 MU thrice weekly SC for 16 weeks
+:::*Alternative regimen (2): [[Lamivudine]] (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
+::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
+::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
+::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
+::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
+::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
+::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
+:::*Alternative regimen (3): [[Adefovir]] (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
+::::*If creatinine clearance 30–49 give 10 mg PO every other day
+::::*If creatinine clearance 10–19 10 mg PO every third day
+::::*If hemodialysis patients give 10 mg PO every week following dialysis
+::::*Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
+:::*Alternative regimen (4): [[Telbivudine]] (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
+::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
+::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
+::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
+:::*Note (1): duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
+:::*Note (2): Observe for 3-6 months and treat if no spontaneous HBeAg loss.
+:::*Note (3): Consider liver biopsy prior to treatment if compensated.
+:::*Note (4): Immediate treatment if icteric or clinical decompensation.
+:::*Note (5): [[Interferon alpha]] (IFNα)/ pegylated interferon-alpha (peg-IFNα), [[Lamivudine]] (LAM), [[Adefovir]] (ADV), [[Entecavir]] (ETV), tenofovir disoproxil fumarate (TDF) or [[telbivudine]] (LdT) may be used as initial therapy.
+:::*Note (6): Adefovir (ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
+:::*Note (7): Lamivudine (LAM) and Telbivudine (LdT) not preferred due to high rate of drug resistance.
+:::*Note (8): End-point of treatment – Seroconversion from HBeAg to anti-HBe.
+:::*Note (9): [[Interferon alpha]] (IFNα)  non-responders / contraindications to IFNα change to [[Tenofovir]] (TDF)/[[Entecavir]] (ETV).
+::*'''1.3. Children with elevated ALT greater than 2 times normal'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+:::*Preferred regimen(1): [[Interferon alpha]] (IFNα) 6 MU/m2  SC thrice weekly with a maximum of 10 MU
+:::*Preferred regimen(2): [[Lamivudine]] (LAM) 3 mg/kg/d PO with a maximum of 100 mg/d.
+:*'''2. Patients with HBeAg-negative chronic hepatitis B'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+::*'''2.1. HBV DNA >2,000 IU/mL and elevated ALT >2 times normal'''
+:::*Preferred regimen (1): Pegylated IFN-alpha 180 mcg weekly SC for 1 year
+:::*Preferred regimen (2): [[Tenofovir]] (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
+::::*If creatinine clearance 30–49 give 300 mg q48 hrs
+::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
+::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
+::::*If creatinine clearance <10 without dialysis there is no recommendation
+::::*Note: duration of treatment is more than 1 year
+:::*Preferred regimen (3): [[Entecavir]] (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine
+::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine
+::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine
+::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
+::::*Note: duration of treatment is more than 1 year
+:::*Alternative regimen (1): [[Interferon alpha]] (IFNα) 5 MU daily or 10 MU thrice weekly SC for 1 year
+:::*Alternative regimen (2): [[Lamivudine]] (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
+::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
+::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
+::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
+::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
+::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
+::::*Note: duration of treatment is more than 1 year
+:::*Alternative regimen (3): [[Adefovir]] (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
+::::*If creatinine clearance 30–49 give 10 mg PO every other day
+::::*If creatinine clearance 10–19 10 mg PO every third day
+::::*If hemodialysis patients give 10 mg PO every week following dialysis
+::::*Note: duration of treatment is more than 1 year
+:::*Alternative regimen (4): [[Telbivudine]] (LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
+::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
+::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
+::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
+:::*Note (1): duration of treatment is more than 1 year
+:::*Note (2): [[Interferon alpha]] (IFNα)/ pegylated interferon-alpha (peg-IFNα), [[Lamivudine]] (LAM), [[Adefovir]] (ADV), [[Entecavir]] (ETV), tenofovir disoproxil fumarate (TDF) or [[telbivudine]] (LdT) may be used as initial therapy.
+:::*Note (3): Adefovir (ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
+:::*Note (4): [[Lamivudine]] (LAM) and [[Telbivudine]] (LdT) not preferred due to high rate of drug resistance.
+:::*Note (5): End-point of treatment – not defined
+:::*Note (6): [[Interferon alpha]] (IFNα)  non-responders / contraindications to IFNα change to [[Tenofovir]] (TDF)/[[Entecavir]] (ETV).
+:*'''3. HBV DNA >2,000 IU/mL and elevated ALT 1->2 times normal'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+::*Consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.
+:*'''4. HBV DNA <2,000 IU/mL and ALT < upper limit normal (ULN)'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+::*Observe, treat if HBV DNA or ALT becomes higher.
+:*'''5. +/- HBeAg and detectable HBV DNA with Cirrhosis'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+::*'''5.1. Compensated Cirrhosis and HBV DNA >2,000'''
+:::*Preferred regimen (1): [[Entecavir]] (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
+::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
+::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
+::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
+:::*Preferred regimen (2): [[Tenofovir]] (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
+::::*If creatinine clearance 30–49 give 300 mg q48 hrs
+::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
+::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
+::::*If creatinine clearance <10 without dialysis there is no recommendation
+:::*Alternative regimen (1): [[Lamivudine]] (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
+::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
+::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
+::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
+::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
+::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
+:::*Alternative regimen (2): [[Adefovir]] (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
+::::*If creatinine clearance 30–49 give 10 mg PO every other day
+::::*If creatinine clearance 10–19 give 10 mg PO every third day
+::::*If hemodialysis patients give 10 mg PO every week following dialysis
+:::*Alternative regimen (3): [[Telbivudine]] (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
+::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
+::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
+::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
+:::*Note (1): LAM and LdT not preferred due to high rate of drug resistance.
+:::*Note (2): ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.
+:::*Note (3): These patients should receive long-term treatment. However, treatment may be stopped in HBeAg-positive patients if they have confirmed HBeAg seroconversion and have completed at least 6 months of consolidation therapy and in HBeAg-negative patients if they have confirmed HBsAg clearance.
+::*'''5.2. Compensated Cirrhosis and HBV DNA <2,000'''
+:::*Consider treatment if ALT elevated.
+::*'''5.3. Decompensated Cirrhosis'''
+:::*Preferred regimen (1): [[Tenofovir]] (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
+::::*If creatinine clearance 30–49 give 300 mg q48 hrs
+::::*If creatinine clearance 10–29 give 300 mg q72-96 hrs
+::::*If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
+::::*If creatinine clearance <10 without dialysis there is no recommendation
+:::*Preferred regimen (2): [[Entecavir]] (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+::::*If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior [[Lamivudine]] treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
+::::*If creatinine clearance 30–49 give 0.25 mg PO qd {{or}} 0.5 mg PO q48 hr for patients with no prior [[Lamivudine]] treatment, and 0.5 mg PO qd {{or}} 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
+::::*If creatinine clearance 10–29 give 0.15 mg PO qd {{or}} 0.5 mg PO q 72 hr for patients with no prior [[Lamivudine]] treatment, and 0.3 mg PO qd {{or}} 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
+::::*If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd {{or}} 0.5 mg PO q7 days for patients with no prior [[Lamivudine]] treatment, and 0.1 mg PO qd {{or}} 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
+:::*Preferred regimen (3): [[Lamivudine]] (LAM) {{and}} [[Adefovir]] (ADV)
+::::*[[Lamivudine]] (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::*If creatinine clearance >50 or normal renal function give 100 mg PO qd
+:::::*If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
+:::::*If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
+:::::*If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
+:::::*If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
+:::::*The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
+::::*[[Adefovir]] (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
+:::::*If creatinine clearance 30–49 give 10 mg PO every other day
+:::::*If creatinine clearance 10–19 give 10 mg PO every third day
+:::::*If hemodialysis patients give 10 mg PO every week following dialysis
+:::*Preferred regimen (4): [[Telbivudine]] (LdT) {{and}} [[Adefovir]] (ADV)
+::::*[[Telbivudine]] (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::*If creatinine clearance >50 or normal renal function give 600 mg PO once daily
+:::::*If creatinine clearance 30–49 600 give mg PO once every 48 hours
+:::::*If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
+:::::*If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis
+::::*[[Adefovir]] (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:
+:::::*If creatinine clearance >50 or normal renal function give 10 mg PO daily
+:::::*If creatinine clearance 30–49 give 10 mg PO every other day
+:::::*If creatinine clearance 10–19 give 10 mg PO every third day
+:::::*If hemodialysis patients give 10 mg PO every week following dialysis
+:::*Note: coordinate treatment with transplant center and refer for liver transplant.
+:::*Life-long treatment is recommended.
+:* '''6. +/- HBeAg and undetectable HBV DNA  with Cirrhosis'''<ref name="pmid19714720">{{cite journal| author=Lok AS, McMahon BJ| title=Chronic hepatitis B: update 2009. | journal=Hepatology | year= 2009 | volume= 50 | issue= 3 | pages= 661-2 | pmid=19714720 | doi=10.1002/hep.23190 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19714720  }} </ref>
+::*Compensated Cirrhosis: Observe
+::*Uncompensated Cirrhosis: Refer for liver transplant
+{{PBI|Hepatitis C virus}}
+'''Chronic Hepatitis C'''
+*'''1. Treatment regimens for chronic hepatitis C virus genotype 1'''<ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
+:*'''1.1. Treatment regimens for genotype 1a''':
+::*Preferred regimen (1): [[Ledipasvir]] 90 mg PO qd {{and}} [[Sofosbuvir]] 400 mg PO qd for 12 weeks
+::*Preferred regimen (2): [[Paritaprevir]] 150 mg PO qd {{and}} [[Ritonavir]] 100 mg PO qd {{and}} [[Ombitasvir]] 25 mg PO qd {{and}} Dasabuvir 250 mg PO bid {{and}} weight-based [[Ribavirin]] PO qd ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) {{or}} 24 weeks (cirrhosis)
+::*Preferred regimen (3): [[Sofosbuvir]] 400 mg PO qd {{and}} [[Simeprevir]] 150 mg PO qd {{withorwithout}} weight-based [[Ribavirin]] PO qd ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
+::*Note: these regimens are recommended for treatment-naive patients with HCV genotype 1a infection.
+:*'''1.2. Treatment regimens for genotype 1b''':
+::*Preferred regimen (1): [[Ledipasvir]] 90 mg PO qd {{and}} [[Sofosbuvir]] 400 mg PO qd for 12 weeks
+::*Preferred regimen (2): [[Paritaprevir]] PO 150 mg qd {{and}} [[Ritonavir]] 100 mg PO qd {{and}} Ombitasvir 25 mg PO qd {{and}} Dasabuvir 250 mg PO bid for 12 weeks. The addition of weight-based [[Ribavirin]] PO qd (1000 mg [<75kg] to 1200 mg [>75 kg]) is recommended in patients with cirrhosis
+::*Preferred regimen (3): [[Sofosbuvir]] 400 mg PO qd {{and}} [[Simeprevir]] 150 mg PO qd for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
+::*Note: these regimens are recommended for treatment-naive patients with HCV genotype 1b infection.
+*'''2. Treatment regimens for chronic hepatitis C virus genotype 2'''<ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
+:*Preferred regimen: [[Sofosbuvir]] 400 mg PO qd {{and}} weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
+:*Note (1): This regimen are recommended for treatment-naive patients with HCV genotype 2 infection.
+:*Note (2): Extending treatment to 16 weeks is recommended in patients with cirrhosis.
+*'''3. Treatment regimens for chronic hepatitis C virus genotype 3'''<ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
+:*Preferred regimen: [[Sofosbuvir]] 400 mg PO qd and weight-based [[Ribavirin]] PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) PO qd for 24 weeks
+:*Alternative regimen: [[Sofosbuvir]] 400 mg and weight-based [[Ribavirin]] PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) PO qd {{and}} weekly [[PEG-IFN]] for 12 weeks is an acceptable regimen for IFN-eligible, treatment-naive patients with HCV genotype 3 infection.
+:*Note: These regimens are recommended for treatment-naive patients with HCV genotype 3 infection.
+*'''4. Treatment regimens for chronic hepatitis C virus genotype 4'''
+:*Preferred regimen (1): [[Ledipasvir 90 mg]] PO qd {{and}} [[Sofosbuvir]] 400 mg PO qd for 12 weeks
+:*Preferred regimen (2): [[Paritaprevir 150 mg]] PO qd {{and}} [[Ritonavir]] 100 mg PO qd {{and}} Ombitasvir 25 mg PO qd {{and}} weight-based [[Ribavirin]] PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
+:*Preferred regimen (3): [[Sofosbuvir]] 400 mg PO qd {{and}} weight-based [[Ribavirin]] PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks
+:*Alternative regimen (1): [[Sofosbuvir]] 400 mg PO qd {{and}} weight-based [[Ribavirin]] PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) {{and}} weekly PEG-IFN for 12 weeks
+:*Alternative regimen (2): [[Sofosbuvir]] 400 mg PO qd {{and}} [[Simeprevir]] 150 mg PO qd {{withorwithout}} weight-based [[Ribavirin]] PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
+:*Note: These regimens are accpetable for treatment-naive patients with HCV genotype 3 infection.
+*'''5. Treatment regimens for chronic hepatitis C virus genotype 5'''<ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
+:*Preferred regimen: [[Sofosbuvir]] 400 mg PO qd {{and}} weight-based [[Ribavirin]] PO qd(1000 mg [<75 kg] to 1200 mg [>75 kg]) {{and}} weekly [[PEG-IFN]] for 12 weeks is recommended for treatment-naive patients with HCV genotype 5 infection.
+:*Alternative regimen: Weekly [[PEG-IFN]] {{and}} weight-based [[Ribavirin]] PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 48 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 5 infection.
+*'''6. Treatment regimens for chronic hepatitis C virus genotype 6'''<ref> {{Cite web | title = INITIAL TREATMENT OF HCV INFECTION
+| url = http://www.hcvguidelines.org/full-report/initial-treatment-hcv-infection}}</ref>
+:*Preferred regimen: [[Ledipasvir]] 90 mg PO qd {{and}} [[Sofosbuvir]] PO qd 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 6 infection.
+:*Alternative regimen: [[Sofosbuvir]] 400 mg PO qd {{and}} weight-based [[Ribavirin]] PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) {{and}} weekly PEG-IFN for 12 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 6 infection.
+{{PBI|Hepatitis D virus}}
+*Preferred regimen: [[Interferon alpha]](IFNα) 5 MU daily {{or}} 9 MU three times a week for 6–12 months <ref name="pmid23286865">{{cite journal| author=Rizzetto M| title=Current management of delta hepatitis. | journal=Liver Int | year= 2013 | volume= 33 Suppl 1 | issue=  | pages= 195-7 | pmid=23286865 | doi=10.1111/liv.12058 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23286865  }} </ref>
+{{PBI|Hepatitis E virus}}
+* '''Hepatitis E treatment'''<ref>{{citeweb|title=Hepatitis E virus|url=http://www.who.int/mediacentre/factsheets/fs280/en/}}</ref>
+:*Preferred regimen: supportive therapy. There is no specific treatment available.
+::*Note (1): Hepatitis E is usually self-limiting, hospitalization is generally not required.
+::*Note (2): Hospitalization is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant women.
+{{PBI|Epstein-Barr virus}}
+:* [[Epstein-Barr Virus]] (EBV) <ref name=CDC>{{cite web | title = Epstein-Barr Virus (EBV) center for disease control and prevention| url =http://www.cdc.gov/epstein-barr/about-ebv.html }}</ref>
+::* There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection.
+::* There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including
+:::* drinking fluids to stay hydrated
+:::* getting plenty of rest
+:::* taking over-the-counter medications for pain and fever
+{{PBI|Human herpesvirus 6}}
+:* '''Human herpesvirus 6 treatment'''<ref name="pmid25582535">{{cite journal| author=Tong LX, Worswick SD| title=Viral infections in acute graft-versus-host disease: a review of diagnostic and therapeutic approaches. | journal=J Am Acad Dermatol | year= 2015 | volume= 72 | issue= 4 | pages= 696-702 | pmid=25582535 | doi=10.1016/j.jaad.2014.12.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25582535  }} </ref><ref name="pmid15653828">{{cite journal| author=De Bolle L, Naesens L, De Clercq E| title=Update on human herpesvirus 6 biology, clinical features, and therapy. | journal=Clin Microbiol Rev | year= 2005 | volume= 18 | issue= 1 | pages= 217-45 | pmid=15653828 | doi=10.1128/CMR.18.1.217-245.2005 | pmc=PMC544175 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653828  }} </ref>
+::* Preferred regimen: supportive therapy
+::* Note: If patient is immunocompromised, there are no antiviral regimens stablished as there are no clinical trials to validate their use on these cases. Consider administering [[Ganciclovir]], [[Acyclovir]], [[Foscarnet]] {{or}} [[Cidofovir]].<ref name="pmid22819486">{{cite journal| author=Wolz MM, Sciallis GF, Pittelkow MR| title=Human herpesviruses 6, 7, and 8 from a dermatologic perspective. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 10 | pages= 1004-14 | pmid=22819486 | doi=10.1016/j.mayocp.2012.04.010 | pmc=PMC3538396 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22819486  }} </ref><ref name="pmid15653828">{{cite journal| author=De Bolle L, Naesens L, De Clercq E| title=Update on human herpesvirus 6 biology, clinical features, and therapy. | journal=Clin Microbiol Rev | year= 2005 | volume= 18 | issue= 1 | pages= 217-45 | pmid=15653828 | doi=10.1128/CMR.18.1.217-245.2005 | pmc=PMC544175 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15653828  }} </ref>
+{{PBI|Roseola|Human herpesvirus 7}}
+:* '''Human herpesvirus 7 (roseola virus) treatment'''
+::* Preferred regimen: Supportive therapy
+::* Note (1): Immunocompetent hosts with uncomplicated skin manifestations associated with HHV-7, particularly roseola infantum and pityriasis rosea, need only symptomatic management<ref name="pmid22819486">{{cite journal| author=Wolz MM, Sciallis GF, Pittelkow MR| title=Human herpesviruses 6, 7, and 8 from a dermatologic perspective. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 10 | pages= 1004-14 | pmid=22819486 | doi=10.1016/j.mayocp.2012.04.010 | pmc=PMC3538396 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22819486  }}</ref>
+::* Note (2): For HIV-positive patients, antiretroviral therapy may be advisable<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::* Note (3): The most active antiviral compounds against HHV-7 are [[Cidofovir]] and [[Foscarnet]]<ref name="pmid11747000">{{cite journal| author=De Clercq E, Naesens L, De Bolle L, Schols D, Zhang Y, Neyts J|title=Antiviral agents active against human herpesviruses HHV-6, HHV-7 and HHV-8. | journal=Rev Med Virol | year= 2001 | volume= 11 | issue= 6 | pages= 381-95 | pmid=11747000 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11747000  }} </ref><ref name="pmid22819486">{{cite journal| author=Wolz MM, Sciallis GF, Pittelkow MR| title=Human herpesviruses 6, 7, and 8 from a dermatologic perspective. | journal=Mayo Clin Proc | year= 2012 | volume= 87 | issue= 10 | pages= 1004-14 | pmid=22819486 | doi=10.1016/j.mayocp.2012.04.010 | pmc=PMC3538396 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22819486  }} </ref>
+----
+{{PBI|Human herpesvirus 8 (KSHV)}}
+:* 1. '''Mild to moderate Kaposi sarcoma'''<ref>{{ cite web | title = Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents | url = https://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultOITablesOnly.pdf }}</ref>
+::* Preferred regimen: initiate or optimize ART
+:* 2. '''Advanced Kaposi sarcoma (ACTG Stage T1, including disseminated cutaneous or visceral Kaposi sarcoma)'''
+::* Preferred regimen: chemotherapy (per oncology consult) {{and}} ART
+:* 3. '''Primary effusion lymphoma'''
+::* Preferred regimen: chemotherapy (per oncology consult) {{and}} ART
+::* Note: [[Valganciclovir]] PO or [[Ganciclovir]] IV can be used as adjunctive therapy.
+:* 4. '''Multicentric Castleman's disease'''
+::* Preferred regimen (1): [[Valganciclovir]] 900 mg PO bid for 3 weeks
+::* Preferred regimen (2): [[Ganciclovir]] 5 mg/kg IV q12h for 3 weeks
+::* Preferred regimen (3): [[Valganciclovir]] 900 mg PO BID {{and}} [[Zidovudine]] 600 mg PO q6h for 7–21 days
+::* Alternative regimen: [[Rituximab]] 375 mg/m2 given weekly for 4–8 weeks (may be an alternative to or used adjunctively with antiviral therapy)
+{{PBI|Herpes simplex virus}}
+:* '''Genital Herpes'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* 1.'''First Clinical Episode of Genital Herpes'''
+:::* Preferred Regimen (1): [[Acyclovir]] 400 mg PO tid for 7–10 days
+:::* Preferred Regimen (2): [[Acyclovir]] 200 mg PO five times a day for 7–10 days
+:::* Preferred Regimen (3): [[Valacyclovir]] 1 g PO bid for 7–10 days
+:::* Preferred Regimen (4): [[Famciclovir]] 250 mg PO tid  for 7–10 days
+:::* Note:Treatment can be extended if healing is incomplete after 10 days of therapy.
+::* 2.'''Established HSV-2 Infection '''
+:::* 2.1 '''Suppressive Therapy for Recurrent Genital Herpes'''
+::::* Preferred Regimen (1): [[Acyclovir]] 400 mg PO bid
+::::* Preferred Regimen (2): [[Valacyclovir]] 500 mg PO qd
+::::* Preferred Regimen (3): [[Valacyclovir]] 1 g PO qd
+::::* Preferred Regimen (4): [[Famciclovir]] 250 mg PO bid
+::::* Note(1):Daily therapy with [[Acyclovir]] for as long as 6 years and with [[Valacyclovir]]  {{or}} [[Famciclovir]] for 1 year
+::::* Note(2):[[Valacyclovir]] 500 mg qd might be less effective than other [[Valacyclovir]] {{or}} [[Acyclovir]] dosing regimens in persons who have very frequent recurrences (i.e., ≥10 episodes per year).
+:::* 2.2 '''Episodic Therapy for Recurrent Genital Herpes'''
+::::* Preferred Regimen (1): [[Acyclovir]] 400 mg PO tid for 5 days
+::::* Preferred Regimen (2): [[Acyclovir]] 800 mg PO bid for 5 days
+::::* Preferred Regimen (3): [[Acyclovir]] 800 mg  PO tid for 2 days
+::::* Preferred Regimen (4): [[Valacyclovir]] 500 mg PO bid for 3 days
+::::* Preferred Regimen (5): [[Valacyclovir]] 1 g PO qd for 5 days
+::::* Preferred Regimen (6): [[Famciclovir]] 125 mg  PO bid  for 5 days
+::::* Preferred Regimen (7): [[ Famciclovir]] 1 g PO bid  for 1 day
+::::* Preferred Regimen (8): [[Famciclovir]] 500 mg once, followed by 250 mg  PO bid  for 2 days
+::* 3. '''Severe Disease''' (disseminated infection, pneumonitis, or hepatitis) or CNS complications (e.g., meningoencephalitis).
+:::* Preferred Regimen: [[ Acyclovir]] 5–10 mg/kg IV q8h  for 2–7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy. HSV encephalitis requires 21 days of intravenous therapy. Impaired renal function warrants an adjustment in acyclovir dosage.
+::* 4. '''Special Considerations'''
+:::* 4.1 '''HIV Infection'''
+::::* 4.1.1 '''Daily Suppressive Therapy in Persons with HIV'''
+:::::* Preferred Regimen (1): [[Acyclovir]] 400–800 mg PO bid /tid
+:::::* Preferred Regimen (2): [[Valacyclovir]] 500 mg  PO bid
+:::::* Preferred Regimen (3): [[Famciclovir]] 500 mg PO bid
+::::* 4.1.2 '''Episodic Infection in Persons with HIV'''
+:::::* Preferred Regimen (1): [[Acyclovir]] 400 mg  PO tid  for 5–10 days
+:::::* Preferred Regimen (2): [[Valacyclovir]] 1 g PO bid for 5–10 days
+:::::* Preferred Regimen (3): [[Famciclovir]] 500 mg  PO bid for 5–10 days
+:::::* Note: For severe HSV disease, initiating therapy with [[Acyclovir]] 5–10 mg/kg IV q8 h might be necessary.
+:::* 4.2 '''Genital Herpes in Pregnancy'''
+::::* Suppressive therapy of pregnant women with recurrent genital herpes
+::::* Preferred Regimen (1): [[Acyclovir]] 400–800 mg PO bid /tid
+::::* Preferred Regimen (2): [[Valacyclovir]] 500 mg  PO bid
+::::* Note:Treatment recommended starting at 36 weeks of gestation.
+:::* 4.3 '''Neonatal Herpes '''
+::::* Known or suspected neonatal herpes
+::::* Preferred Regimen: [[Acyclovir]] 20 mg/kg IV q 8 h
+::::* Note (1): Treatment for 14 days if disease is limited to the skin and mucous membranes, or
+::::* Note (2): Treatment for 21 days for disseminated disease and that involving the central nervous system.
+:::* 4.4 '''Acyclovir-resistant genital herpes'''
+::::* Preferred Regimens: [[Foscarnet ]] 40–80 mg/kg IV q8 h until clinical resolution is attained
+::::* Alternative Regimen (1): [[Cidofovir]] 5 mg/kg  IV once weekly might also be effective.
+::::* Alternative Regimen (2): Imiquimod topical preparations should be applied to the lesions qd for 5 consecutive days.
+:::* 4.5 '''Management of Sex Partners'''
+::::* Preferred Regimen (1): [[Acyclovir]] 400 mg PO tid for 7–10 days
+::::* Preferred Regimen (2): [[Acyclovir]] 200 mg PO five times a day for 7–10 days
+::::* Preferred Regimen (3): [[Valacyclovir]] 1 g PO bid for 7–10 days
+::::* Preferred Regimen (4): [[Famciclovir]] 250 mg PO tid  for 7–10 days
+::::* Note:The sex partners of persons who have genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated
+:::* 4.6 '''Allergy, Intolerance, and Adverse Reactions'''
+::::* Allergic and other adverse reactions to oral [[Acyclovir]], [[Valacyclovir]], and [[Famciclovir]] are rare. Desensitization to acyclovir has been described.
+----
+==vzv==
+{{PBI|Varicella-zoster virus}}
+::* 1. '''Varicella zoster treatment'''<ref name="pmid23863052">{{cite journal| author=Cohen JI| title=Clinical practice: Herpes zoster. | journal=N Engl J Med | year= 2013 | volume= 369 | issue= 3 | pages= 255-63 | pmid=23863052 | doi=10.1056/NEJMcp1302674 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23863052  }} </ref>
+:::* 1.1 '''Non Immunocompromised person'''
+::::* Preferred regimen (1): [[Acyclovir]] 500 mg PO five times a dayfor 7-10 days
+::::* Preferred regimen (2): [[Famciclovir]] 500 mg PO tid  for 7 days
+::::* Preferred regimen (3): [[Valacyclovir]] 1 g PO tid for 7 days
+::::* Preferred regimen (4): Brivudin 125 mg PO qd for 7 days
+:::* 1.2 '''Immunocompromised person requiring hospitalization or persons with sever neurologic complications'''
+::::* Preferred regimen (1): [[Acyclovir]] 10 mg/ kg IV q8h for 7-10 days
+::::* Preferred regimen (2): [[Foscarnet]] 40 mg/ kg IV q8h until lesions are healed
+::::* Note: Brivudin is not available in USA and has not been approved by FDA. [[Foscarnet]] is not approve by FDA
+::* 2. '''Treatment of VZV complications'''<ref name="pmid17143845">{{cite journal| author=Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M et al.| title=Recommendations for the management of herpes zoster. | journal=Clin Infect Dis | year= 2007 | volume= 44 Suppl 1 | issue=  | pages= S1-26 | pmid=17143845 | doi=10.1086/510206 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17143845  }} </ref>
+:::* 2.1 '''VZV ophthalmicus'''
+::::* Treatment includes the following
+:::::* (1) [[Famciclovir]] {{or}} [[Valacyclovir]] for 7–10 days, preferably started within 72 h of rash onset (with [[Acyclovir]] IV given as needed for retinitis), to resolve acute disease and inhibit late inflammatory recurrences, {{and}} [[Prednisone]] 20 mg PO tid for 4 days or bid for 6 days, and then qd for 4 day
+:::::* (2) Bacitracin-Polymyxin ophthalmic ointment administered bid ,to protect the ocular surface;
+:::::* (3) Topical  [[Prednisolone]] 0.125%–1% 2–6 times daily prescribed and managed only by an ophthalmologist for corneal immune disease, episcleritis, scleritis, or iritis;
+:::::* (4) [[Homatropine]] 5% bid as needed for iritis
+:::::* (5) Latanaprost qd and/or Timolol maleate ophthalmic gel forming solution every morning)ocular pressure–lowering drugs given as needed for glaucoma
+:::::* Note (1): Systemic steroids are indicated in the presence of moderate to severe pain or rash, particularly if there is significant edema, which may cause orbital apex syndrome through pressure on the nerves entering the orbit.
+:::::* Note (2): pain medications and cool to tepid wet compresses (if tolerated) and no topical antivirals, because they are ineffective
+:::* 2.2 '''VZV retinitis'''
+::::* Preferred regimen: [[Acyclovir]] IV  10–15 mg/kg q8h for 10–14 days followed by [[Valacyclovir]] PO 1 g tid  daily for 4–6 weeks
+::* 3 '''Recommendations for treating varicella zoster virus (VZV) Infections in HIV-Infected adults and adolescents'''<ref>{{Cite web | title =VZV |https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/341/vzv }} </ref>
+:::* 3.1 '''Primary Varicella Infection (Chickenpox)'''
+::::* 3.1.1 '''Uncomplicated Cases'''
+:::::* Preferred regimen (1):[[Valacyclovir]] 1 g PO tid for 5–7 days
+:::::* Preferred regimen (2): [[Famciclovir]] 500 mg PO tid  for 5–7 days
+:::::* Alternative regimen: [[Acyclovir]] 800 mg PO 5 times daily for 5–7 days
+::::* 3.1.2 '''Severe or Complicated Cases'''
+:::::* Preferred regimen: [[Acyclovir]] 10–15 mg/kg IV q8h for 7–10 days
+:::::* Note: May switch to oral [[Famciclovir]], [[Valacyclovir]], or [[Acyclovir]] after defervescence if no evidence of visceral involvement is evident
+:::* 3.2 '''Herpes Zoster (Shingles)'''
+::::* 3.2.1 '''Acute Localized Dermatomal'''
+:::::* Preferred regimen (1): [[Valacyclovir]] 1000 mg PO tid for 7–10 days
+:::::* Preferred regimen (2): [[Famciclovir]] 500 mg PO tid for 7–10 days
+:::::* Alternative Therapy: [[Acyclovir]] 800 mg PO 5 times daily for 7–10 days
+:::::* Note: Longer duration should be considered if lesions resolve slowly
+::::* 3.2.2 '''Extensive Cutaneous Lesion or Visceral Involvement'''
+:::::* Preferred regimen: [[Acyclovir]] 10–15 mg/kg IV q8h until clinical improvement is evident, then switch to ([[Valacyclovir]] 1 g PO tid, [[Famciclovir]] 500 mg PO tid, or [[Acyclovir]] 800 mg PO 5 times daily)—to complete a 10–14 day course, when formation of new lesions has ceased  and signs and symptoms of visceral VZV infection are improving
+:::* 3.3 '''PORN (Progressive outer retinal necrosis)'''
+::::* Preferred regimen: [[Ganciclovir]] 5 mg/kg and/or [[Foscarnet]] 90 mg/kg IV q12h {{and}} [[Ganciclovir]] 2 mg/0.05mL and/or foscarnet 1.2 mg/0.05mL intravitreal twice weekly.
+::::* Note: Duration of therapy is not well defined and should be determined based on clinical, virologic, and immunologic response in consultation with experienced ophthalmologist and optimize ART regimen.
+::::* Note: [[Ganciclovir]] ocular implants are no longer commercially available
+:::* 3.4 '''ARN (Acute retinal necrosis)'''
+::::* Preferred regimen: [[Acyclovir]] 10-15 mg/kg IV q8h for 10–14 days, followed by [[Valacyclovir]] 1 g PO tid for 6 weeks {{and}} [[Ganciclovir]] 2 mg/0.05mL intravitreal qd/bid twice weekly
+::::* Note: Duration of therapy is not well defined and should be determined based on clinical, virologic, and immunologic response in consultation with experienced ophthalmologist
+::* 4 '''Prevention  of  varicella zoster virus (VZV) Infections in HIV-Infected Adults and Adolescents'''
+:::* 4.1 '''Pre-Exposure Prevention of VZV Primary Infection'''
+::::* '''Indications'''
+:::::* Adult and adolescent patients with CD4 count ≥200 cells/mm3 without documentation of vaccination, health-care provider diagnosis or verification of a history of varicella or herpes zoster, laboratory confirmation of disease, or persons who are seronegative for VZV. Routine VZV serologic testing in HIV-infected adults and adolescents is not recommended.
+:::::* '''Vaccination'''
+:::::* Primary varicella vaccination (Varivax™), 2 doses (0.5 mL SQ) administered 3 months apart
+:::::* If vaccination results in disease because of vaccine virus, treatment with acyclovir is recommended.
+:::::* VZV-susceptible household contacts of susceptible HIV-infected persons should be vaccinated to prevent potential transmission of VZV to their HIV-infected contacts.
+:::::* If post-exposure VariZIG has been administered, wait at least 5 months before varicella vaccination.
+:::::* If post-exposure acyclovir has been administered, wait at least 3 days before varicella vaccine.
+:::* 4.2 '''Post-Exposure Prophylaxis'''
+::::* '''Indication'''
+:::::* Close contact with a person who has active varicella or herpes zoster, and
+:::::* Is susceptible to VZV (i.e., has no history of vaccination or of either condition, or is known to be VZV seronegative)
+::::* Preferred regimen: VariZIG 125 IU /10 kg (maximum of 625 IU) IM, administered as soon as possible and within 10 days after exposure to a person with active varicella or herpes zoster
+::::* Alternative regimen (Begin 7–10 Days After Exposure): [[Acyclovir]] 800 mg PO 5 times/day for 5–7 days {{or}} [[Valacyclovir]] 1 g PO tid for 5–7 days
+::::* If post-exposure VariZIG has been administered, wait at least 5 months before varicella vaccination.
+::::* Note: Patients receiving monthly high dose IVIG (i.e., >400 mg/kg) are likely to be protected against VZV and probably do not require VariZIG if the last dose of IVIG was administered <3 weeks before VZV exposure.
+::::* Note: Neither these pre-emptive interventions nor post-exposure varicella vaccination have been studied in HIV-infected adults and adolescents.
+::::* If acyclovir or valacyclovir is used, varicella vaccines should not be given until at least 72 hours after the last dose of the antiviral drug.
+==hpv==
+{{PBI|Human papillomavirus}}
+:* ''' Anogenital Warts'''<ref>{{Cite journal| issn = 1545-8601| volume = 64| issue = RR-03| pages = 1–137| last1 = Workowski| first1 = Kimberly A.| last2 = Bolan| first2 = Gail A.| title = Sexually transmitted diseases treatment guidelines, 2015| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2015-06-05| pmid = 26042815}}</ref>
+::* 1.'''Preferred regimen for External Anogenital Warts'''(i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)
+:::* 1.1 '''Patient-Applied''': [[Imiquimod]] 3.75% or 5% cream {{or}} [[Podofilox]] 0.5% solution or gel {{or}} [[Sinecatechins]] 15% ointment
+:::* 1.2 '''Provider-Administered''': Cryotherapy with liquid nitrogen or cryoprobe  {{or}} Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser,or electrosurgery {{or}} [[Trichloroacetic acid]] (TCA) {{or}} Bichloroacetic acid (BCA) 80%-90% solution
+:::* Note (1): Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.
+:::* Note (2): Might weaken condoms and vaginal diaphragms.
+::* 2.'''Alternative Regimens for External Genital Warts'''
+:::* 2.1 '''Urethral Meatus Warts'''
+::::* Preferred regimen: Cryotherapy with liquid nitrogen {{or}} Surgical removal
+:::* 2.2 '''Vaginal Warts'''
+::::* Preferred regimen: Cryotherapy with liquid nitrogen {{or}} Surgical removal  {{or}}  (TCA {{or}} BCA 80%–90% solution)
+::::* Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation
+:::* 2.3 '''Cervical Warts'''
+::::* Preferred regimen: Cryotherapy with liquid nitrogen {{or}} Surgical removal {{or}} (TCA {{or}} BCA 80%–90% solution)
+::::* Note: Management of cervical warts should include consultation with a specialist.For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated.
+:::* 2.4 '''Intra-anal Warts'''
+::::* Preferred regimen: Cryotherapy with liquid nitrogen {{or}} Surgical removal {{or}} (TCA {{or}} BCA 80%–90% solution)
+::::* Note: Management of intra-anal warts should include consultation with a specialist.
+::* 3. '''Specific considerations'''
+:::* 3.1 '''Follow-up'''
+::::* Most anogenital warts respond within 3 months of therapy. Factors that might affect response to therapy include immunosuppression and treatment compliance. In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment. A new treatment modality should be selected when no substantial improvement is observed after a complete course of treatment or in the event of severe side effects; treatment response and therapy-associated side effects should be evaluated throughout the course of therapy.
+:::* 3.2 '''Management of sex partners'''
+::::* Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can be passed on to partners. Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.
+:::* 3.3 '''Pregnancy'''
+::::* [[Podofilox]] (podophyllotoxin), [[Podophyllin]], and [[Sinecatechins]] should not be used during pregnancy. Imiquimod appears to pose low risk but should be avoided until more data are available.
+::::* Cesarean delivery is indicated for women with anogenital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
+::::* Pregnant women with anogenital warts should be counseled concerning the low risk for warts on the larynx of their infants or children (recurrent respiratory papillomatosis).
+:::* 3.4 '''HIV infection'''
+::::* Data do not support altered approaches to treatment for persons with HIV infection.
+::::* Squamous cell carcinomas arising in or resembling anogenital warts might occur more frequently among immunosuppressed persons, therefore requiring biopsy for confirmation of diagnosis for suspicious cases
+:::* 3.5 '''High-grade squamous intraepithelial lesions'''
+::::* Biopsy of an atypical wart might reveal HSIL or cancer of the anogenital tract. In this instance, referral to a specialist for treatment is recommended.
+----
+==influenza A& B==
+{{PBI|Influenza A & B}}
+:* '''Antiviral Medications Recommended for Treatment of Influenza'''
+::* 1. '''Adults'''
+:::* Preferred regimen (1): [[Oseltamivir]] (Tamiflu®) 75 mg PO bid for 5 days
+:::* Preferred regimen (2): [[Zanamivir]] (Relenza®) 10 mg (two 5-mg inhalations) bid for 5 days
+:::* Preferred regimen (3): [[Peramivir]] (Rapivab®) 600 mg IV for 15-30 minutes (single dose)
+:::* Note: FDA approved and recommended Peramivir (Rapivab®) for use in adults ≥18 yrs
+::* 2. '''Children'''
+:::* 2.1 '''Children < 1 yr'''
+::::* Preferred regimen: [[Oseltamivir]] (Tamiflu®) 3 mg/kg/dose PO bid for 5 days
+:::* 2.2 '''Children > 1 yr'''
+::::* 2.2.1 '''Children ≤ 15 kg'''
+:::::* Preferred regimen: [[Oseltamivir]] (Tamiflu®) 30 mg PO bid for 5 days
+::::* 2.2.2 '''Children > 15 to 23 kg'''
+:::::* Preferred regimen: [[Oseltamivir]] (Tamiflu®) 45 mg PO bid for 5 days
+::::* 2.2.3 '''Children > 23 to 40 kg'''
+:::::* Preferred regimen: [[Oseltamivir]] (Tamiflu®) 60 mg PO bid for 5 days
+::::* 2.2.4 '''Children > 40 kg'''
+:::::* Preferred regimen (1): [[Oseltamivir]] (Tamiflu®) 75 mg PO bid for 5 days
+:::::* Preferred regimen (2): [[Zanamivir]] (Relenza®) 10 mg (two 5-mg inhalations)  bid  for 5 days, may be considered for children > 7 yrs old
+::* 3. '''Adult Patients with Renal Impairment or End Stage Renal Disease (ESRD) on Dialysis'''
+:::* 3.1 '''[[Oseltamivir]] '''
+::::* Creatinine clearance 61 to 90 mL/min-75 mg PO bid for 5 days
+::::* Creatinine clearance 31 to 60 mL/min-30 mg PO bid for 5 days
+::::* Creatinine clearance 10 to 30 mL/min-30 mg PO qd  for 5 days
+::::* ESRD Patients on Hemodialysis
+::::* Creatinine clearance ≤10 mL/min-30 mg after every hemodialysis cycle. Treatment duration not to exceed 5 days
+::::* ESRD Patients on Continuous Ambulatory Peritoneal Dialysis-A single 30 mg dose administered immediately after a dialysis exchange
+:::* 3.2 '''[[Peramivir]]'''
+::::* Creatinine clearance >50 mL/min-600mg IV single dose
+::::* Creatinine clearance 30 to 49 mL/min-200mg IV single dose
+::::* Creatinine clearance 10 to 29 mL/min-100mg IV single dose
+::::* ESRD Patients on Hemodialysis-Dose administered after dialysis at a dose adjusted based on creatinine clearance
+::::* Note: No dose adjustment is recommended for inhaled zanamivir for a 5-day course of treatment for patients with renal impairment.
+::* 4. '''Antiviral Medications Recommended for Chemoprophylaxis of Influenza'''
+:::* 4.1. '''Adults'''
+::::* Preferred regimen (1): [[Oseltamivir]] (Tamiflu®) 75 mg PO qd for 7days
+::::* Preferred regimen (2): [[Zanamivir]] (Relenza®) 10 mg (two 5-mg inhalations) qd for 7 days
+:::* 4.2. '''Children'''
+::::* 4.2.1 '''Children < 1 yr'''
+:::::* Preferred regimen: [[Oseltamivir]] (Tamiflu®) 3 mg/kg/dose PO qd for 7 days
+::::* 4.2.2 '''Children > 1 yr'''
+:::::* 4.2.2.1 '''Children ≤ 15 kg'''
+::::::* Preferred regimen: [[Oseltamivir]] (Tamiflu®) 30 mg PO qd for 7 days
+:::::* 4.2.2.2 '''Children > 15 to 23 kg'''
+::::::* Preferred regimen: [[Oseltamivir]] (Tamiflu®) 45 mg PO qd for 7 days
+:::::* 4.2.2.3 '''Children > 23 to 40 kg'''
+::::::* Preferred regimen: [[Oseltamivir]] (Tamiflu®) 60 mg PO qd for 7 days
+:::::* 4.2.2.4 '''Children > 40 kg'''
+::::::* Preferred regimen (1): [[Oseltamivir]] (Tamiflu®) 75 mg PO qd for 7 days
+::::::* Preferred regimen (2):  [[Zanamivir]] (Relenza®) 10 mg (two 5-mg inhalations) qd  for 7 days, may be considered for children > 7 yrs older
+::::::* Note: If child is < 3 months old, use of [[Oseltamivir]] for chemoprophylaxis is not recommended unless situation is judged critical due to limited data in this age group.
+==Avian influenza==
+{{PBI|Avian influenza}}
+::*1. Preferred regimen:[[Oseltamivir]] 75 mg PO qd for a minimum 10 days <ref name=":1">Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015</ref><ref>{{Cite web| title= avian influenza| url=http://www.cdc.gov/flu/avianflu/avian-in-humans.htm}} </ref>
+:::*Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently
+::*2. Patients with Avian Influenza who have diarrhea and  malabsorption
+:::* Preferred regimen (1): [[Zanamivir]] 10 mg inhaled bid for minimum 5 days
+:::* Preferred regimen (2): [[Peramivir]] 600 mg IV as a single dose for 1 day
+:::* Note(1): Preliminary evidence demonstrates that [[Neuraminidase inhibitor]] can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.
+:::* Note(2): The use of [[Corticosteroids]] is not recommended.
+:::* Note(3): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
+:::* Note(4): The use of [[Amantadine]] is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.<ref>WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/ Accessed on April 22, 2015
+</ref>
+:::* Note(5): Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.
+----
+{{PBI|Swine influenza}}
+:* [[Swine influenza]] <ref>{{Cite book| publisher = World Health Organization| title = WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and Other Influenza Viruses| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-07-14| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138515/| pmid = 23741777}}</ref>
+::* 1. '''Condition1: Patients who have severe or progressive clinical illness'''
+:::* Preferred regimen: [[Oseltamivir]] 150 mg PO bid
+:::* Note (1): Treatment duration depends on clinical response
+:::* Note (2): Where the clinical course remains severe or progressive, despite 5 or more days of antiviral treatment, monitoring of virus replication and shedding, and antiviral drug susceptibility testing is desirable
+:::* Note (3): Antiviral treatment should be maintained without a break until virus infection is resolved or there is satisfactory clinical improvement
+:::* Note (4): Patients who have severe or progressive clinical illness, but who are unable to take oral medication may be treated with oseltamivir administered by nasogastric or orogastric tube
+::* 2. '''Condition2: In situations where oseltamivir is not available, or not possible to use, patients who have severe or progressive clinical illness'''
+:::* Preferred regimen: [[Zanamivir]] inhaled
+:::* Note: [[Zanamivir]] IV should be considered where available and is recommended for those with serious or progressive illness. If not available, [[Peramivir]] IV may be considered
+::* 3. '''Condition3: Severely immunosuppressed patients'''
+:::* Preferred regimen: Antiviral chemoprophylaxis by using [[Oseltamivir]] {{or}} [[Zanamivir]]
+----
+{{PBI|Measles}}
+:* '''Measles<ref name=CDC Measles treatment>{{cite web | title = CDC Measles treatment | url =http://www.cdc.gov/measles/hcp/index.html }}</ref>'''
+::* 1.1. '''Prevention'''
+:::* 1.1.1. '''Vaccines'''
+::::* Note (1): Measles can be prevented with measles-containing vaccine, which is primarily administered as the combination measles-mumps-rubella (MMR) vaccine. The combination measles-mumps-rubella-varicella (MMRV) vaccine can be used for children aged 12 months through 12 years for protection against measles, mumps, rubella and varicella. Single-antigen measles vaccine is not available.
+::::* Note (2): Vaccination recommendations
+:::::* Children: CDC recommends routine childhood immunization for MMR vaccine starting with the first dose at 12 through 15 months of age, and the second dose at 4 through 6 years of age or at least 28 days following the first dose.
+:::::* Students at post-high school educational institutions: Students at post-high school educational institutions without evidence of measles immunity need two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose.
+:::::* Adults: People who are born during or after 1957 who do not have evidence of immunity against measles should get at least one dose of MMR vaccine.
+:::::* International travelers: People 6 months of age or older who will be traveling internationally should be protected against measles. Before travelling internationally,
+::::::* Infants 6 through 11 months of age should receive one dose of MMR vaccine
+::::::* Children 12 months of age or older should have documentation of two doses of MMR vaccine (the first dose of MMR vaccine should be administered at age 12 months or older; the second dose no earlier than 28 days after the first dose)
+::::::* Teenagers and adults born during or after 1957 without evidence of immunity against measles should have documentation of two doses of MMR vaccine, with the second dose administered no earlier than 28 days after the first dose
+:::* 1.1.2. '''Post-exposure Prophylaxis'''
+::::* 1.1.2.1. '''Indication'''
+:::::* People exposed to measles who cannot readily show that they have evidence of immunity against measles should be offered post-exposure prophylaxis (PEP) or be excluded from the setting (school, hospital, childcare). MMR vaccine, if administered within 72 hours of initial measles exposure, or immunoglobulin (IG), if administered within six days of exposure, may provide some protection or modify the clinical course of disease.
+::::* Note (1): If MMR vaccine is not administered within 72 hours of exposure as PEP, MMR vaccine should still be offered at any interval following exposure to the disease in order to offer protection from future exposures. People who receive MMR vaccine or IG as PEP should be monitored for signs and symptoms consistent with measles for at least one incubation period.
+::::* Note (2): If many measles cases are occurring among infants younger than 12 months of age, measles vaccination of infants as young as 6 months of age may be used as an outbreak control measure. Note that children vaccinated before their first birthday should be revaccinated when they are 12 through 15 months old and again when they are 4 through 6 years of age.
+::::* Note (3): People who are at risk for severe illness and complications from measles, such as infants younger than 12 months of age, pregnant women without evidence of measles immunity, and people with severely compromised immune systems, should receive IG. Intramuscular IG (IGIM) should be given to all infants younger than 12 months of age who have been exposed to measles.
+::::* Note (4):  For infants aged 6 through 11 months, MMR vaccine can be given in place of IG, if administered within 72 hours of exposure. Because pregnant women might be at higher risk for severe measles and complications, intravenous IG (IGIV) should be administered to pregnant women without evidence of measles immunity who have been exposed to measles. People with severely compromised immune systems who are exposed to measles should receive IGIV regardless of immunologic or vaccination status because they might not be protected by MMR vaccine.
+::::* Preferred regimen: The recommended dose of IGIM is 0.5 mL/kg of body weight (maximum dose = 15 mL) and the recommended dose of IGIV is 400 mg/kg.
+::::* Note (5): If a healthcare provider without evidence of immunity is exposed to measles, MMR vaccine should be given within 72 hours, or IG should be given within 6 days when available. Exclude healthcare personnel without evidence of immunity from duty from day 5 after first exposure to day 21 after last exposure, regardless of post-exposure vaccine.
+::* 1.2. '''Treatment'''
+:::* Note (1): There is no specific antiviral therapy for measles. Medical care is supportive and to help relieve symptoms and address complications such as bacterial infections.
+:::* Note (2): Severe measles cases among children, such as those who are hospitalized, should be treated with vitamin A. Vitamin A should be administered immediately on diagnosis and repeated the next day. The recommended age-specific daily doses are
+::::* 50,000 IU for infants younger than 6 months of age
+::::* 100,000 IU for infants 6–11 months of age
+::::* 200,000 IU for children 12 months of age and older
+{{PBI|Middle East respiratory syndrome}}
+:*'''Middle East Respiratory Syndrome treatment'''
+::* Preferred regimen: supportive care. There is no antiviral recommended for this infection at this moment, even though experimental therapies are at research (IFNs, [[Ribavirin]], [[Lopinavir]], [[Mycophenolic acid]], [[Cyclosporine]], [[Chloroquine]], [[Chlorpromazine]], [[Loperamide]], [[6-mercaptopurine]] and [[6-thioguanine]]). Supportive care include: administer oxygen to patients with severe acute pulmonary infection with signs of respiratory distress, hypoxaemia or shock; use conservative fluids management, avoid administering high-dose systemic glucocorticoids, use non-invasive ventilation, but, if its nor effective, do not delay endotracheal intubation; use lung-protective strategy for intubated patients, recognize sepsis as early as possible and treat it accordingly.<ref>http://apps.who.int/iris/bitstream/10665/178529/1/WHO_MERS_Clinical_15.1_eng.pdf?ua=1</ref>
+==Parainfluenza virus==
 {{PBI|Parainfluenza virus}}
 :*Parainfluenza virus<ref name="pmid23024295">{{cite journal| author=Hirsch HH, Martino R, Ward KN, Boeckh M, Einsele H, Ljungman P| title=Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus. | journal=Clin Infect Dis | year= 2013 | volume= 56 | issue= 2 | pages= 258-66 | pmid=23024295 | doi=10.1093/cid/cis844 | pmc=PMC3526251 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23024295  }} </ref>
+::* 1. '''Adults'''
+:::* Preferred regimen: [[Ribavirin]] PO/IV 10 mg/kg q8h
+::::* Day 1: Start with 600 mg loading dose,then 200 mg  q8h
+::::* Day 2: 400 mg q8h
+::::* Day 3: Increase the dose to a maximum of 10 mg/kg q8h
+:::* 1.1 '''In case of adverse events'''
+::::* Preferred regimen: Decrease dose or discontinue [[Ribavirin]]
+:::* 1.2 '''Creatinine clearance'''
+::::* 30–50 mL/min: [[Ribavirin]] PO/IV maximal 200 mg  q8h
+::::* 10–30 mL/ min: No recommendation can be given
+{{PBI|Parvovirus B19}}
+:* Parvovirus B19<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+::* 1. '''Erythema infectiosum'''
+:::* Supportive therapy: Symptomatic treatment only
+::* 2. '''Arthritis/arthalgia '''
+:::* Preferred regimen: Nonsteroidal anti-inflammatory drugs (NSAID)
+::* 3.'''Transient aplastic crisis'''
+:::* Supportive therapy: Transfusions and oxygen
+::* 4. '''Fetal hydrops'''
+:::* Supportive therapy: Intrauterine blood transfusion
+::* 5. '''Chronic infection with anemia'''
+:::* Preferred regimen: IVIG and transfusion
+::* 6.'''Chronic infection without anemia'''
+:::* Preferred regimen: IVIG
+:::: Note (1): Diagnostic tools are IgM and Igb antibody titers.Perhaps better is blood Parvovirus PCR.
+:::: Note (2): Dose of IVIG not standardized; suggest 400 mg/kg IV of commercial IVIG for 5 or 10 days or 1000 mg/kg IV for 3 days.
+:::: Note (3): Most dramatic anemias in pts with pre-existing hemolytic anemia.
+:::: Note (4): Bone marrow shown erythrocyte maturation arrest with giant pronormoblasts.
+{{PBI|BK virus}}
+:* '''Human polyomavirus (BK virus) treatment'''
+::* '''Maintenance regimen consisting of triple immunosuppression therapy''': [[Calcineurin]] inhibitor ([[Cyclosporine]] or [[Tacrolimus]]) {{and}} an antimetabolite ([[Azathioprine]], [[Mycophenolate mofetil]], or [[Mycophenolate sodium]]), {{and}} [[Prednisone]] is to discontinue completely the antimetabolite (usually [[Mycophenolate]]) and decrease the dose of the [[Calcineurin]] inhibitor.
+::* '''Alternative regimen (1)''': Decrease the [[Mycophenolate]] dose by 50 percent, followed by a 50 percent decrease in the [[Calcineurin]] inhibitor at three months if decoy cells persist. If using this approach, the target serum [[Tacrolimus]] trough level is 4 to 6, and the target serum [[Cyclosporine]] trough level is 60 to 100 ng/mL. [[Mycophenolate]] may be discontinued completely if viral activation persists. Maintenance immunosuppression then consists of [[Tacrolimus]] and low-dose [[Prednisone]].
+::* '''Alternative regimen (2)''': Reduce both the [[Calcineurin]] inhibitor and the [[Mycophenolate]], which allows both the targeting of two pathways and lower total immunosuppression.
+:::* Note (1): For those who are hypogammaglobulinemic, we administer intravenous immunoglobulins (IV IG) in replacement doses of 500 mg/kg. Quantitative immunoglobulins should be checked two to three months later to determine whether hypogammaglobulinemia has recurred. Intravenous immunoglobulins (IV IG) is also an option in certain settings, based upon polymerase chain reaction (PCR) and kidney biopsy results. IVIG may contain antibodies against BK and JC virus since these viruses are ubiquitous in the general population.
+:::* Note (2): The goals of decreased immunosuppressive therapy are to restrain viral replication without triggering rejection.
+:::* Note (3): Reduced immunosuppression (defined as lowering mean doses of [[Mycophenolate]] and [[Tacrolimus]]) resulted in the successful elimination of viremia (mean period of six months) and allograft survival.
+:::* Note (4): Alternative approaches to reducing immunosuppression have also been effective
+::::* 4.1 Changing from [[Tacrolimus]] to low-dose [[Cyclosporine]] not only reduces the effect of the [[Calcineurin]] inhibitor, but also reduces [[Mycophenolate]] concentrations.
+::::* 4.2 Replacing the [[Calcineurin]] inhibitor with [[Sirolimus]], with or without discontinuation of the antimetabolite, has the advantage of avoiding the long-term [[Calcineurin]] inhibitor-related nephrotoxic effects.
+::::* 4.3 Lowering the dose of [[Calcineurin]] inhibitors may slow the loss of renal function.
+:* '''Primary Regimens'''
+::* Decrease immunosuppression if possible. (Cornerstone of Treatment)
+::* Suggested antiviral therapy is based on anecdotal data. If progressive renal dysfunction:
+::* Fluoroquinolone {{and}} IVIG 500 mg/kg IV {{and}} Leflunomide 100 mg for daily for 3 days, then 10-20 mg PO daily
+::* If refractory to all of the above, add [[Cidofovir]] 5 mg/kg once per week for 2 weeks, then once every other week  if refractory to all of the above
+:* '''Ancillary Therapies in BK Virus Nephropathy'''
+::* [[Cidofovir]] 0.25-1.0 mg/kg IV biweekly for 8 wk without [[Probenecid]], prehydration recommended
+::* [[Leflunomide]] 100 mg loading dose for 3 days, 20-60 mg/day, goal [[Leflunomide]] trough 50-100 ng/mL (consider lower trough goals of 20-40 ng/mL given hemolysis risk)
+::* IV Ig 1-2 g/kg IV for 1-2 doses or 150 mg/kg  IV biweekly for 8 wk
+::* [[Fluoroquinolones]]-[[Ciproflaxacin]] 500 mg/day, duration dependent on virological response.
+{{PBI|JC virus}}
+:* '''Progressive Multifocal Leukoencephalopathy (PML) caused by JC Virus ( John Cunningham virus) infections'''<ref>{{citeweb|title=JCvirus|url=https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf}}</ref>
+::* There is no specific antiviral therapy for JC virus infection.
+::* The main treatment approach is to reverse the immunosuppression caused by HIV.
+::* Initiate anti retroviral therapy (ART) immediately in ART-naive patients .
+::* Optimize ART in patients who develop Progressive Multifocal Leukoencephalopathy in phase of HIV viremia on ART .
+::* [[Corticosteroids]] may be used for Progressive Multifocal Leukoencephalopathy- immune reconstitution inflammatory syndrome (IRIS) characterized by contrast enhancement, edema or mass effect, and with clinical deterioration
+{{PBI|Rabies}}
+:* Rabies treatment
+::* Preferred regimen: no specific therapetics agents are available once the disease is established.
+::* Note: There are vaccines and immunoglobulins available for postexposure prophylaxis
+:* Postexposure prophylaxis
+::* 1. '''For non immunized individuals'''
+ Wound cleansing, human rabies immunoglobulin - administer full dose infiltrated around any wound. Administer any remaining volume IM at other site anatomically distant from the wound. Administer vaccine 1.0 ml, IM at deltoid area one each on days 0, 3, 7 and 14.
+::* 2. '''For immunized individuals'''
+ Wound cleansing, do not administer human rabies immune globulin. Administer vaccine 1,0ml, IM at deltoid area one each on days 0 and 3.
+{{PBI|Respiratory Syncytial Virus}}
+* Respiratory syncytial virus treatment
+:* Supportive therapy
+::* Hydration and supplemental oxygen.
+::* Routine use of [[Ribavirin]] not recommended. [[Ribavirin]] therapy associated with small increases in O2 saturation.
+::* No consistent decrease in need for mechanical ventilation or ICU stays. High cost, aerosol administration and potential toxicity<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258  }} </ref>
+:::* Note (1): In adults, Respiratory syncytial virus accounted for 10.6% of hospitalizations for pneumonia, 11.4% for COPD, 7.2% for asthma & 5.4% for CHF in pts >65 yrs of age <ref name="pmid15858184">{{cite journal| author=Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE| title=Respiratory syncytial virus infection in elderly and high-risk adults. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 17 | pages= 1749-59 | pmid=15858184 | doi=10.1056/NEJMoa043951 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15858184  }} </ref>. Respiratory syncytial virus caused 11% of clinically important respiratory illnesses in military recruits<ref name="pmid16007526">{{cite journal| author=O'Shea MK, Ryan MA, Hawksworth AW, Alsip BJ, Gray GC| title=Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 3 | pages= 311-7 | pmid=16007526 | doi=10.1086/431591 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16007526  }} </ref>
+:::* Note (2): Respiratory Syncytial Virus major cause of morbidity in neonates/infants.
+:::* Note (3): Nucleic acid test now approved to detect 12 respiratory viruses (xTAG Respiratory Viral Panel, Luminex Molecular Diagnostics).
+:* '''Prevention of Respiratory syncytial virus'''
+::* 1. In children <24 months old with chronic lung disease of prematurity (formerly broncho-pulmonary dysplasia) requiring supplemental oxygen or
+::* 2. In premature infants (<32 wks gestation) and <6 months old at start of Respiratory syncytial virus season or
+::* 3. In children with selected congenital heart diseases.
+:::* Preferred regimen for prevention of Respiratory syncytial virus: [[Palivizumab]] (Synagis) 15 mg per kg IM q month Nov.-April<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258  }} </ref>
+:::: Note : Significant reduction in Respiratory syncytial virus hospitalization among children with congenital heart disease<ref name="pmid17727335">{{cite journal| author=Feltes TF, Sondheimer HM| title=Palivizumab and the prevention of respiratory syncytial virus illness in pediatric patients with congenital heart disease. | journal=Expert Opin Biol Ther | year= 2007 | volume= 7 | issue= 9 | pages= 1471-80 | pmid=17727335 | doi=10.1517/14712598.7.9.1471 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17727335  }} </ref>
+{{PBI|Rhinovirus}}
+* '''Rhinovirus treatment (commom cold)'''
+:* '''Supportive therapy'''
+::* 1. Symptomatic treatment-[[Ipratropium bromide]] intranasal (2 sprays tid) {{and}} [[Clemastine]] 1.34 mg 1–2 tab PO bid–tid (over the counter)
+::* 2. Symptomatic relief by [[Ipratropium]] nasal spray decreases rhinorrhea and sneezing vs placebo.<ref name="pmid9880472">{{cite journal| author=Gern JE, Busse WW| title=Association of rhinovirus infections with asthma. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 1 | pages= 9-18 | pmid=9880472 | doi= | pmc=PMC88904 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9880472}}</ref> {{and}} [[Clemastine]] (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.<ref name="pmid8729205">{{cite journal| author=Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB| title=Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 4 | pages= 656-62 | pmid=8729205 | doi= | pmc= url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205  }} </ref>{{or}} Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).<ref name="pmid12802751">{{cite journal| author=Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA et al.| title=Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials. | journal=Clin Infect Dis | year= 2003 | volume= 36 | issue= 12 | pages= 1523-32 | pmid=12802751 | doi=10.1086/375069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12802751  }} </ref>
+:::* Note (1): No antiviral treatment indicated . <ref name="pmid15693216">{{cite journal| author=Turner RB| title=New considerations in the treatment and prevention of rhinovirus infections. | journal=Pediatr Ann | year= 2005 | volume= 34 | issue= 1 | pages= 53-7 | pmid=15693216 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15693216  }} </ref>
+:::* Note (2): Found in half of children with community-acquired pneumonia; role in pathogenesis unclear (CID 39:681, 2004). <ref name="pmid12517470">{{cite journal| author=Heikkinen T, Järvinen A| title=The common cold. | journal=Lancet | year= 2003 | volume= 361 | issue= 9351 | pages= 51-9 | pmid=12517470 | doi=10.1016/S0140-6736(03)12162-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517470  }} </ref>
+:::* Note (3): High rate of rhinovirus identified in children with significant lower resp tract infections <ref name="pmid19258921">{{cite journal| author=Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T et al.| title=Rhinovirus associated with severe lower respiratory tract infections in children. | journal=Pediatr Infect Dis J | year= 2009 | volume= 28 | issue= 4 | pages= 337-9 | pmid=19258921 | doi=10.1097/INF.0b013e31818ffc1b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19258921  }} </ref>
+{{PBI|Rotavirus}}
+* Rotavirus treatment<ref>{{citeweb|title=Rotavirus|url=http://www.who.int/mediacentre/factsheets/fs330/en/}}</ref>, <ref>{{citeweb|title=Rotavirus|url=http://www.cdc.gov/rotavirus/about/treatment.html}}</ref>
+:* '''Treatment of diarrhoea caused by rotavirus '''
+::* Rehydration with oral rehydration salts (ORS) solution. oral rehydration salts (ORS) solution is a mixture of clean water, salt and sugar. It costs a few cents per treatment. oral rehydration salts (ORS) solution is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.
+::* Zinc supplements-with zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
+::* Rehydration with intravenous fluids in case of severe dehydration or shock.
+::* Nutrient-rich foods the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods  including breast milk during an episode, and by giving a nutritious diet  including exclusive breastfeeding for the first six months of life  to children when they are well.
+::* Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.
+::: Note (1): Rotavirus and Escherichia coli are the two most common etiological agents of diarrhoea in developing countries.
+::: Note (2): There is no antiviral drug to treat rotavirus infection. Antibiotic drugs will not help because antibiotics fight against bacteria not viruses.
+::: Note (3): Rotavirus infection can cause severe vomiting and diarrhea. This can lead to dehydration (loss of body fluids). During rotavirus infection, infants and young children, older adults, and people with other illnesses are most at risk becoming dehydrated.
+::: Note (4): Symptoms of dehydration include decrease in urination, dry mouth and throat, feeling dizzy when standing up. A dehydrated child may also cry with few or no tears and be unusually sleepy or fussy.
+:* Prevention
+::* Access to safe drinking-water
+::* Use of improved sanitation
+::* Hand washing with soap
+::* Exclusive breastfeeding for the first six months of life
+::* Good personal and food hygiene
+::* Health education about how infections spread; and Rotavirus vaccination.
+==Smallpox==
+{{PBI|Smallpox}}
+:* '''Smallpox''' <ref>{{Cite web | title = DIAGNOSIS AND MANAGEMENT OF SMALLPOX | url = http://www.nejm.org/doi/pdf/10.1056/NEJMra020025 }}</ref>
+::* Supportive care is the mainstay of therapy.
+::* Currently, there are no anti-viral drugs of proven efficacy.
+::* Recently, animal studies suggest that [[cidofovir]] and its cyclic analogues, given at the time of or immediately after exposure, have promise for the prevention of cowpox, vaccinia, and monkeypox.
+::* Patients need adequate hydration and nutrition, because substantial amounts of fluid and protein can be lost by febrile persons with dense, often weeping lesions.
+:::* 1. '''Secondary bacterial infection'''
+::::* Penicillinase-resistant antimicrobial agents should be used
+:::::* If smallpox lesions are secondarily infected,
+:::::* If bacterial infection endangers the eyes
+::::::* Daily eye rinsing is required in severe cases.
+::::::* Topical [[idoxuridine]] should be considered for the treatment of corneal lesions, although its efficacy is unproved for smallpox.
+:::::* If the eruption is very dense and widespread.
+==HIV/AIDS==
+{{PBI|HIV/AIDS}}
+]* 1. '''Antiretroviral regimen options for treatment-naive patients<ref name=AIDSinfoNIH>{{cite web | title = AIDSinfoNIH | url =https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/11/what-to-start }}</ref>'''
+:* 1.1. '''Integrase strand transfer inhibitor-based regimens'''
+::* Preferred regimen (1): [[Dolutegravir]] 50 mg PO qd {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg PO qd in patients who are HLA-B*5701-negative
+::* Preferred regimen (2): [[Dolutegravir]] 50 mg PO qd {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd
+::* Preferred regimen (3): [[Elvitegravir]] 150 mg-[[Cobicistat]] 150 mg-[[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd in patients with estimated CrCl ≥ 70 mL/min/1.73
+::* Preferred regimen (4): [[Raltegravir]] 400 mg PO bid {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd
+::* Alternative regimen (1): [[Efavirenz]] 600 mg PO qd {{or}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd
+::* Alternative regimen (2): [[Rilpivirine]] 25 mg PO qd {{and}} ([[Tenofovir]] 300 mg PO qd {{or}} [[Emtricitabine]] 200 mg PO qd) for patients with CD4 count >200 cells/microL
+::* Alternative regimen (3): [[Raltegravir]] 400 mg PO bid  {{and}} ([[Abacavir]] 600 mg PO qd {{or}} [[Lamivudine]] 300 mg PO qd) in patients who are HLA-B*5701-negative
+:* 1.2. '''Protease inhibitor-based regimen'''
+::* Preferred regimen: [[Darunavir]] 800 mg-[[Ritonavir]] 100 mg PO qd {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd
+::* Alternative regimen (1): [[Atazanavir]] 300 mg-[[Cobicistat]] 150 mg PO qd {{and}} [[Tenofovir]] disoproxil fumarate 300 mg-[[Emtricitabine]] 200 mg PO qd only for patients with pre-treatment estimated CrCl ≥70 mL/min
+::* Alternative regimen (2): [[Atazanavir]] 300 mg-[[Ritonavir]] 100 mg PO qd {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd
+::* Alternative regimen (3): ([[Darunavir]] 800 mg-[[Cobicistat]] 150 mg PO qd {{or}} [[Darunavir]] 800 mg-[[Ritonavir]] 100 mg PO qd) {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg PO qd only for patients who are HLA-B*5701 negative
+::* Alternative regimen (4): [[Darunavir]] 800 mg-[[Cobicistat]] 150 mg PO qd {{and}} [[Tenofovir]] disoproxil fumarate 300 mg-[[Emtricitabine]] 200 mg PO qd only for patients with pre-treatment estimated CrCl ≥70 mL/min
+::* Alternative regimen (5): [[Atazanavir]] 300 mg-[[Ritonavir]] 100 mg PO qd {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg PO qd in patients who are HLA-B*5701-negative and with pre-treatment HIV RNA <100,000 copies/mL
+::* Alternative regimen (6): [[Lopinavir]] 400 mg-[[Ritonavir]] 100 mg PO qd or bid {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg PO qd only for patients who are HLA-B*5701 negative
+::* Alternative regimen (7): [[Lopinavir]] 400 mg-[[Ritonavir]] 100 mg PO qd or bid {{and}} [[Tenofovir]] disoproxil fumarate 300 mg-[[Emtricitabine]] 200 mg PO qd
+:* 1.3. '''A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen'''
+::* Alternative regimen (1): [[Efavirenz]] 600 mg-[[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd
+::* Alternative regimen (2): [[Rilpivirine]] 25 mg-[[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd
+:* 1.4. '''Other regimen options'''
+::* 1.4.1. '''A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen'''
+:::* Preferred regimen (1):  [[Efavirenz]] 600 mg PO qd {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg PO qd only for patients who are HLA-B*5701 negative and with pre-treatment HIV RNA <100,000 copies/mL.
+::* 1.4.2. '''Other regimens when tenofovir or abacavir cannot be used'''
+:::* Preferred regimen (1): [[Darunavir]] 800 mg-[[Ritonavir]] 100 mg PO qd {{and}} [[Raltegravir]] 400 mg PO qd only for patients with pre-treatment HIV RNA <100,000 copies/mL and CD4 cell count >200 cells/mm3.
+:::* Preferred regimen (2): [[Lopinavir]] 400 mg-[[Ritonavir]] 100 mg PO bid {{and}} [[Lamivudine]] 300 mg PO bid
+:* 1.5. '''Pediatric doses<ref name=AIDSinfoNIH pediatric doses>{{cite web | title = AIDSinfoNIH pediatric doses | url =https://aidsinfo.nih.gov/contentfiles/lvguidelines/PediatricGuidelines.pdf }}</ref>'''
+::* [[Abacavir]] 300 mg PO bid
+::* [[Lamivudine]] 4 mg/kg/dose PO bid; maximum 150 mg PO bid
+::* [[Stavudine]] 1 mg/kg/dose PO bid
+::* [[Tenofovir]] 8 mg/kg/dose PO bid
+::* [[Zidovudine]] 180-240 mg/m<sup>2</sup>/dose PO bid or 160 mg/m<sup>2</sup>/dose PO tid (range 90 mg/m<sup>2</sup>/dose-180 mg/m<sup>2</sup>/dose)
+::* [[Lopinavir]] 400 mg PO bid
+::* [[Nelfinavir]] 50 mg/kg/dose PO bid
+::* [[Raltegravir]] 300 mg PO bid
+::* [[Didanosine]]
+:::* 20 to < 25 kg: 200 mg PO qd
+:::* 25 to < 60 kg: 250 mg PO qd
+:::* ≥60 kg: 400 mg PO qd
+::* [[Efavirenz]]
+:::* 10 to < 15 kg: 200 mg PO qd
+:::* 15 to <20 kg: 250 mg PO qd
+:::* 20 to < 25 kg: 300 mg PO qd
+:::* 25 to < 32.5 kg: 350 mg PO qd
+:::* 32.5 to <40 kg: 400 mg PO qd
+:::* ≥ 40 kg: 600 mg PO qd
+::* [[Nevirapine]] maximum 200 mg per dose
+:::* Between 1 day and 8 years: 200 mg/m<sup>2</sup>/dose PO qd for 14 days, then 200 mg/m<sup>2</sup>/dose PO bid
+:::* 8 years and above: 120-150 mg/m<sup>2</sup>/dose PO qd for 14 days, then 120-150 mg/m<sup>2</sup>/dose PO bid
+::* Note (1): Anti retroviral therapy for treatment naive patients is a life long therapy.
+::* Note (2): [[Tenofovir]] disoproxil fumarate should be avoided in patients with a creatinine clearance <50 mL/min.
+::* Note (3): [[Rilpivirine]] should be used in patients with a CD4 cell count >200 copies/mL and should not be used with proton pump inhibitors.
+::* Note (4): [[Efavirenz]] should not be used in pregnant women.
+* 2. '''Pre-exposure prophylaxis (PrEP)<ref name=CDC Pre-Exposure Prophylaxis>{{cite web | title = CDC Pre-Exposure Prophylaxis | url =http://www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf }}</ref>'''
+:* Preferred regimen: [[Tenofovir]] disoproxil fumarate 300 mg-[[Emtricitabine]] 200 mg PO qd for ≤90-days
+:* Note (1): People with high risk behavior such as men who have sex with men, intravenous drug abusers, HIV-positive sexual partner, recent bacterial STI, high number of sex partners, history of inconsistent or no condom use, commercial sex work, people in high-prevalence area or network are advised to take pre-exposure prophylaxis of drugs.
+:* Note (2): Follow-up visits at least every 3 months to provide the following: HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STI symptom assessment, pregnancy testing.
+:* Note (3): At 3 months and every 6 months thereafter, assess renal function.
+:* Note (4): Every 6 months, test for bacterial STIs.
+* 3. '''Post- exposure prophylaxis<ref name=WHO post exposure prophylaxis>{{cite web | title = WHO postexposureprophylaxis | url =http://www.who.int/hiv/topics/prophylaxis/en/ }}</ref>'''
+:* Preferred regimen: [[Raltegravir]] 400 mg PO bid {{and}} [[Tenofovir]] disoproxil fumarate 300 mg-[[Emtricitabine]] 200 mg PO qd
+:* Preferred basic regimen for low-risk exposures (Eg: mucus membrane):
+:** [[Zidovudine]] 100 mg PO qd {{and}} [[Lamivudine]] 300 mg PO qd
+:** [[Zidovudine]] 100 mg PO qd {{and}} [[Emtricitabine]] 200 mg PO qd
+:** [[Tenofovir]] 300 mg PO qd {{and}} [[Lamivudine]] 300 mg PO qd
+:** [[Tenofovir]] 300 mg PO qd {{and}} [[Emtricitabine]] 200 mg PO qd
+:* Preferred expanded regimen for high-risk exposure (Eg: percutaneous needle stick)
+:** [[Zidovudine]] 100 mg PO qd {{and}} [[Lamivudine]] 300 mg PO qd {{and}} [[Lopinavir]] 400 mg-[[Ritonavir]] 100 mg PO qd
+:** [[Zidovudine]] 100 mg PO qd {{and}} [[Emtricitabine]] 200 mg PO qd {{and}} [[Lopinavir]] 400 mg-[[Ritonavir]] 100 mg PO qd
+:** [[Tenofovir]] 300 mg PO qd {{and}} [[Lamivudine]] 300 mg PO qd {{and}} [[Lopinavir]] 400 mg-[[Ritonavir]] 100 mg PO qd
+:** [[Tenofovir]] 300 mg PO qd {{and}} [[Emtricitabine]] 200 mg PO qd{{and}} [[Lopinavir]] 400 mg-[[Ritonavir]] 100 mg PO qd
+:* Note: Ideally therapy should be started within hours of exposure and continued for 28 days.
+* 4. '''Perinatal antiretroviral regimen<ref name=AIDSinfoNIH Intrapartum car>{{cite web | title = AIDSinfoNIH intrapartum care | url =https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/180/intrapartum-antiretroviral-therapy-prophylaxis }}</ref>'''
+:* 4.1. '''Antepartum'''
+::* 4.1.1. '''Protease inhibitor-based regimen'''
+:::* Preferred regimen: ([[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg PO qd (fixed dose combination) {{or}} [[Tenofovir]] 300 mg-[[Lamivudine]] 300 mg PO qd {{or}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg PO qd {{or}} [[Zidovudine]] 100 mg-[[Lamivudine]] 300 mg PO qd) {{and}} ([[Atazanavir]] 300 mg-[[Ritonavir]] 100 mg PO qd {{or}} [[Lopinavir]] 400 mg-[[Ritonavir]] 100 mg PO qd)
+::* 4.1.2. '''A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen:'''
+:::* Preferred regimen (1): [[Efavirenz]] 600 mg-[[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg (fixed dose combination) PO qd
+:::* Preferred regimen (2): [[Efavirenz]] 600 mg-[[Tenofovir]] 300 mg-[[Lamivudine]] 300 mg PO qd
+:::* Alternative regimen: ([[Abacavir]] 600 mg-[[Lamivudine]] 300 mg PO qd {{or}} [[Zidovudine]] 100 mg-[[Lamivudine]] 300 mg PO qd) {{and}} [[Efavirenz]] 600 mg PO qd
+:* 4.2. '''Intrapartum'''
+::* Note (1): HIV RNA <1000 copies/mL and good adherance-Continue the regimen during delivery or cessarean section.
+::* Note (2): HIV RNA >1000 copies/mL near delivery, possible poor adherence, or unknown HIV RNA levels- Intravenous [[Zidovudine]] 2 mg/kg IV over 1 hr should be given three hours before cesarean section or delivery and then 1 mg/kg/hr IV continuous infusion until umbilical cord clamping.
+:* 4.3. '''Postpartum'''
+::* Note: Initiate anti retroviral therapy (ART) and continue after delivery and cessation of breastfeeding.
+* 5. '''Infant antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV<ref name=AIDSinfoNIH postpartum care>{{cite web | title = AIDSinfoNIH postpartumcare | url =https://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf }}</ref>'''
+:* 5.1 '''Prophylaxis for HIV-exposed infants of women who received antepartum antiretroviral prophylaxis'''
+::* Preferred regimen: [[Zidovudine]] (ZDV) 100 mg PO given at birth and continued till six weeks
+::* Note (1): Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
+::* Note (2): ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
+::* Note (3): ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
+::* Note (4): <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.
+:* 5.2. '''Prophylaxis for HIV-exposed infants of women who received no antepartum antiretroviral prophylaxis'''
+::: [[Nevirapine]]
+:::* Dose based on birth weight, initiated as soon after birth as possible.
+:::* Birth weight 1.5 to 2 kg: 8 mg/dose orally.
+:::* Birth weight >2 kg: 12 mg/dose orally.
+::: {{and}}
+::: [[Zidovudine]] (ZDV)
+:::* Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
+::::* ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
+::::* ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
+::::* <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.
+:::* Note (1): Three doses in the first week of life.
+:::* Note (2): First dose within 48 hours of birth (birth to 48 hrs).
+:::* Note (3): Second dose 48 hours after first.
+:::* Note (4): Third dose 96 hours after second.
-::*1.Adults
+:* 6. '''Treatment and prevention of opportunistic infections<ref name=AIDSinfoNIH opportunistic infectons>{{cite web | title = AIDSinfoNIH opportunistic infections | url =https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf }}</ref>'''
-:::*Preferred regimen : [[Ribavirin]] PO/IV 10 mg/kg q8h
+::* 6.1. '''Pneumocystis pneumonia (PCP)'''
-::::*Day 1: Start with 600 mg loading dose,then 200 mg  q8h
+:::* 6.1.1. '''Prevention'''
-::::*Day 2: 400 mg q8h
+::::* Indication
-::::*Day 3: Increase the dose to a maximum of 10 mg/kg q8h
+:::::* CD4 count <200 cells/mm3
-::*2.In case of adverse events: Decrease dose or Discontinue [[Ribavirin]]
+:::::* Oropharyngeal candidiasis
-::*3.Creatinine clearance
+:::::* CD4 <14%
-::::*30–50 mL/min : [[Ribavirin]] PO/IV  Maximal 200 mg q8h
+:::::* History of AIDS-defining illness
-::::*10–30 mL/ min : No recommendation can be given
+:::::* CD4 count >200 but <250 cells/mm3 if monitoring CD4 cell count every 3 months is not possible.
+::::* Preferred regimen: [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg PO qd or 80 mg/400 mg PO qd
+::::* Alternative regimen (1): [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg PO three times weekly
+::::* Alternative regimen (2): [[Dapsone]] 100 mg PO qd or 50 mg PO bid
+::::* Alternative regimen (3): [[Dapsone]] 50 mg PO qd {{and}} ([[Pyrimethamine]] 50 mg-[[Leucovorin]] 25 mg) PO weekly
+::::* Alternative regimen (4): [[Dapsone]] 200 mg PO qd {{and}} ([[Pyrimethamine]] 75 mg-[[Leucovorin]] 25 mg) PO weekly
+::::* Alternative regimen (5): Aerosolized [[Pentamidine]] 300 mg via [[Respigard]] nebulizer every month
+::::* Alternative regimen (6): [[Atovaquone]] 1500 mg PO qd
+::::* Alternative regimen (7): [[Atovaquone]] 1500 mg {{and}} ([[Pyrimethamine]] 25 mg {{and}} [[Leucovorin]] 10 mg) PO qd
+:::* 6.1.2. '''Treatment'''
+::::* 6.1.2.1. '''For Moderate-to-Severe PCP''''
+:::::* Preferred regimen:  [[Trimethoprim]] 15–20 mg {{and}} [[Sulfamethoxazole]] 75–100 mg/kg/day IV given q6h or q8h, may switch to PO after clinical improvement
+:::::* Alternative regimen (1): [[Pentamidine]] 4 mg/kg IV daily infused over ≥60 minutes
+:::::* Note: Reduce dose to 3 mg/kg IV daily if toxic.
+:::::* Alternative regimen (2): [[Primaquine]] 30 mg (base) PO qd {{and}} ([[Clindamycin]] 600 mg q6h IV {{or}} 900 mg IV q8h {{or}} [[Clindamycin]] 450 mg PO qid or 600 mg PO tid)
+::::* 6.1.2.2. '''For Mild-to-Moderate PCP'''
+:::::* Preferred regimen: [[Trimethoprim]] 15–20 mg {{and}} [[Sulfamethoxazole]] 75–100 mg/kg/day PO in TID {{or}} [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg 2 tablets PO tid
+:::::* Alternative regimen (1): [[Dapsone]] 100 mg PO qd {{and}} TMP 5 mg/kg PO tid
+:::::* Alternative regimen (2): [[Primaquine]] 30 mg (base) PO qd {{and}} ([[Clindamycin]] 450 mg PO qid or 600 mg PO tid {{or}} [[Atovaquone]] 750 mg PO bid with food)
+::::* 6.1.3. '''Secondary prophylaxis, after completion of PCP treatment'''
+:::::* Preferred regimen (1): [[Trimethoprim/Sulfamethoxazole]] 160 mg/800 mg  PO qd {{or}} [[Trimethoprim/Sulfamethoxazole]] 80 mg/400 mg PO qd
+:::::* Alternative regimen (1): [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg PO three times weekly
+:::::* Alternative regimen (2): [[Dapsone]] 100 mg PO qd
+:::::* Alternative regimen (3): [[Dapsone]] 50 mg PO qd {{and}} [[Pyrimethamine]] 50 mg PO {{and}} [[Leucovorin]] 25 mg PO weekly
+:::::* Alternative regimen (4): [[Dapsone]] 200 mg PO {{and}} [[Pyrimethamine]] 75 mg PO {{and}} [[Leucovorin]] 25 mg PO weekly
+:::::* Alternative regimen (5): [[Dapsone]] 100 mg PO qd
+:::::* Alternative regimen (6): [[Dapsone]] 50 mg PO qd {{and}} [[Pyrimethamine]] 50 mg PO {{and}} [[Leucovorin]] 25 mg PO weekly
+:::::* Alternative regimen (7): [[Dapsone]] 200 mg PO {{and}} [[Pyrimethamine]] 75 mg PO {{and}} [[Leucovorin]] 25 mg PO weekly
+:::::* Alternative regimen (8): Aerosolized [[Pentamidine]] 300 mg monthly via [[Respirgard]] nebulizer
+:::::* Alternative regimen (9): [[Atovaquone]] 1500 mg PO qd
+:::::* Alternative regimen (10): [[Atovaquone]] 1500 mg PO {{and}} [[Pyrimethamine]] 25 mg PO {{and}} [[Leucovorin]] 10 mg PO qd
+::::* 6.1.4. '''Adjunctive corticosteroids'''
+:::::* Indications- PaO2 <70 mmHg at room air {{or}} Alveolar-arterial O2 gradient >35 mmHg.
+:::::* Preferred regimen:
+::::::* Days 1–5: 40 mg PO bid
+::::::* Days 6–10: 40 mg PO qd
+::::::* Days 11–21: 20 mg PO qd
+:::::* Note (1): [[Trimethoprim/sulfamethoxazole]] should be permanently discontinued in patients with possible or definite stevens johnson syndrome or toxic epidermal necrosis.
+:::::* Note (2): Whenever possible, patients should be tested for G6PD before use of [[Dapsone]] or [[Primaquine]]. Alternative regimen should be used in patients found to have G6PD deficiency.
+::* 6.2. '''Toxoplasma gondii encephalitis'''
+:::* 6.2.1. '''Prevention'''
+::::* 6.2.1.1. '''Indication'''
+:::::* Toxoplasma IgG-positive patients with CD4 count <100 cells/µL.
+:::::* Seronegative patients receiving PCP prophylaxis not active against toxoplasmosis should have toxoplasma serology retested if CD4 count decline to <100 cellsµL.
+:::::* Prophylaxis should be initiated if seroconversion occurred.
+::::* Preferred regimen: [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg PO qd
+::::* Alternative regimen (1): [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg PO three times weekly
+::::* Alternative regimen (2): [[Trimethoprim/sulfamethoxazole]] 80 mg/400 mg PO qd
+::::* Alternative regimen (3): [[Dapsone]] 50 mg PO qd {{and}} [[Pyrimethamine]] 50 mg PO weekly {{and}} [[Leucovorin]] 25 mg PO weekly
+::::* Alternative regimen (4): [[Dapsone]] 200 mg PO weekly {{and}} [[Pyrimethamine]] 75 mg PO weekly {{and}} [[Leucovorin]] 25 mg PO weekly
+::::* Alternative regimen (5): [[Atovaquone]] 1500 mg PO qd
+::::* Alternative regimen (6): [[Atovaquone]] 1500 mg PO qd {{and}} [[Pyrimethamine]] 25 mg PO qd {{and}} [[Leucovorin]] 10 mg PO qd
+:::* 6.2.2. '''Treatment'''
+::::* 6.2.2.1. '''Treatment of acute infection'''
+:::::* Preferred regimen: [[Pyrimethamine]] 200 mg PO single dose, followed by weight-based therapy:
+::::::* If <60 kg, [[Pyrimethamine]] 50 mg PO qd {{and}} [[Sulfadiazine]] 1000 mg PO qid {{and}} [[Leucovorin]] 10–25 mg PO qd
+::::::* If ≥60 kg, [[Pyrimethamine]] 75 mg PO qd {{and}} [[Sulfadiazine]] 1500 mg PO qid {{and}} [[Leucovorin]] 10–25 mg PO qd
+::::::* Note: At least 6 weeks; longer duration if clinical or radiologic disease is extensive or response is incomplete at 6 weeks.
+:::::* Alternative regimen (1): [[Pyrimethamine]] 50 mg  PO qd{{and}} [[Leucovorin]] 10–25 mg PO qd {{and}} [[Clindamycin]] 600 mg IV or PO q6h
+:::::* Alternative regimen (2): [[Trimethoprim]] 5 mg/kg-[[Sulfamethoxazole]] 25 mg/kg  IV or PO bid
+:::::* Alternative regimen (3): [[Atovaquone]] 1500 mg PO bid with food {{and}} [[Pyrimethamine]] 50 mg PO qd {{and}} [[Leucovorin]] 10–25 mg PO qd
+:::::* Alternative regimen (4): [[Atovaquone]] 1500 mg PO bid with food {{and}} [[Sulfadiazine]] 1000–1500 mg PO qid (weight-based dosing, as in preferred therapy)
+:::::* Alternative regimen (5): [[Atovaquone]] 1500 mg PO bid with food
+:::::* Alternative regimen (6): [[Pyrimethamine]] 50 mg-[[Leucovorin]] 10–25 mg PO qd {{and}} [[Azithromycin]] 900–1200 mg PO qd
+::::* 6.2.2.2. '''Chronic maintenance therapy'''
+:::::* Preferred regimen: [[Pyrimethamine]] 25–50 mg PO qd {{and}} [[Sulfadiazine]] 2000–4000 mg PO qd (in 2–4 divided doses) {{and}} [[Leucovorin]] 10–25 mg PO qd
+:::::* Alternative regimen (1): [[Clindamycin]] 600 mg PO tid {{and}} [[Pyrimethamine]] 25–50 mg-[[Leucovorin]] 10–25 mg PO qd
+:::::* Alternative regimen (2): [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg bid
+:::::* Alternative regimen (3): [[Atovaquone]] 750–1500 mg PO bid {{and}} [[Pyrimethamine]] 25 mg-[[Leucovorin]] 10 mg PO qd
+:::::* Alternative regimen (4): [[Atovaquone]] 750–1500 mg PO bid {{and}} [[Sulfadiazine]] 2000–4000 mg PO qd in 2–4 divided doses
+:::::* Alternative regimen (5): [[Atovaquone]] 750–1500 mg PO bid with food
+::* 6.3. '''Mycobacterium tuberculosis infection'''
+:::* 6.3.1. '''Prevention'''
+::::* 6.3.1.1. '''Indication'''
+:::::* Positive screening test for latent tuberculosis infection, with no evidence of active tuberculosis, and no prior treatment for active tuberculosis or latent tuberculosis infection.
+:::::* Close contact with a person with infectious tuberculosis, with no evidence of active tuberculosis, regardless of screening test results.
+:::::* Preferred regimen: ([[Isoniazid]] 300 mg PO qd {{and}} [[Pyridoxine]] 25 mg PO qd for 9 months) {{or}} ([[Isoniazid]] 900 mg PO two times a week (by DOT) {{and}} [[Pyridoxine]] 25 mg PO qd for 9 months)
+:::::* Alternative regimen (1): [[Rifampin]] 600 mg PO qd for 4 months
+:::::* Alternative regimen (2): [[Rifabutin]] (dose adjusted based on concomitant ART) PO qd for 4 months
+:::* 6.3.2. '''Treatment'''
+:::::* Preferred regimen
+::::::* Initiation phase: [[Isoniazid]] 300 mg PO qd {{and}} ([[Rifampin]] 600 mg PO qd {{or}} [[Rifabutin]] 300 mg PO qd) {{and}} [[Pyrazinamide ]] (upto 2000 mg) PO qd {{and}} [[Ethambutol]] (upto 1600 mg) PO qd for initial phase for 2 months.
+:::::* Continuation phase: [[Isoniazid]] 300 mg PO qd {{and}} ([[Rifampin]] 600 mg PO qd {{or}} [[Rifabutin]] 300 mg PO qd) (5–7 times/week) or three times a week.
+:::::* Duration of therapy:
+::::::* Pulmonary tuberculosis: 6 months
+::::::* Pulmonary tuberculosis and culture positive after 2 months of tuberculosis treatment: 9 months
+::::::* Extra-pulmonary tuberculosis w/CNS infection: 9–12 months
+::::::* Extra-pulmonary tuberculosis with bone or joint involvement: 6 to 9 months
+::::::* Extra-pulmonary tuberculosis in other sites: 6 months
+::::::* Total duration of therapy should be based on number of doses received, not on calendar time
+::::* 6.3.1.3. '''Treatment for drug-resistant tuberculosis'''
+:::::* Resistant to [[Isoniazid]]:
+::::::* Preferred regimen (1): ([[Rifampin]] 600 mg PO qd {{or}} [[Rifabutin]] 300mg PO qd) {{and}} [[Ethambutol]] (upto 1600 mg) PO qd {{and}} [[Pyrazinamide]] (upto 2000 mg) PO qd {{and}} ([[Moxifloxacin]] 400 mg PO or IV qd {{or}} [[Levofloxacin]] 500-1000 mg PO or IV qd) for 2 months; followed by [[Rifampin]] 600 mg PO qd for 7 months.
+::::::* Preferred regimen (2): [[Rifabutin]] 300mg PO qd {{and}} [[Ethambutol]] (upto 1600 mg) PO qd {{and}} ([[Moxifloxacin]] 400 mg PO or IV qd{{or}} [[Levofloxacin]] 500-1000 mg PO or IV qd) for 7 months
-{{PBI|Parvovirus B19}}
+::* 6.4. '''Disseminated mycobacterium avium complex (MAC) disease'''
-:* Parvovirus B19<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy 2014 | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2014 | isbn = 978-1930808782 }}</ref>
+:::* 6.4.1. '''Prevention'''
-::* 1. '''Erythema infectiosum'''
+::::* 6.4.1.1. '''Indication-CD4 count <50 cells/µL—after ruling out active disseminated MAC disease based on clinical assessment'''
-:::* Supportive therapy: Symptomatic treatment only
+:::::* Preferred regimen (1): [[Azithromycin]] 1200 mg PO once weekly
-::* 2. '''Arthritis/arthalgia '''
+:::::* Preferred regimen (2): [[Clarithromycin]] 500 mg PO bid
-:::* Preferred regimen: Nonsteroidal anti-inflammatory drugs (NSAID)
+:::::* Preferred regimen (3): [[Azithromycin]] 600 mg PO twice weekly.
-::* 3.'''Transient aplastic crisis'''
+:::* 6.4.2. '''Treatment'''
-:::* Supportive therapy: Transfusions and oxygen
+::::* Preferred regimen:  [[Clarithromycin]] 500 mg PO bid {{and}} [[Ethambutol]] 15 mg/kg PO qd {{or}} [[Azithromycin]] 500–600 mg PO qd for at least 12 months of therapy
-::* 4. '''Fetal hydrops'''
+::::* Note (1): Treatment can be discontinued if no signs and symptoms of MAC disease and sustained (>6 months) CD4 count >100 cells/µL in response to anti retroviral therapy.
-:::* Supportive therapy: Intrauterine blood transfusion
+::::* Note (2): Addition of a third or fourth drug should be considered for patients with advanced immunosuppression (CD4 counts <50 cells/µL), high mycobacterial loads (>2 log CFU/mL of blood), or in the absence of effective anti retroviral therapy which include [[Amikacin]] 10–15 mg/kg IV qd, [[Streptomycin]] 1 g IV or IM qd, [[Moxifloxacin]] 400 mg PO qd, [[Levofloxacin]] 500 mg PO qd.
-::* 5. '''Chronic infection with anemia'''
-:::* Preferred regimen: IVIG and transfusion
-::* 6.'''Chronic infection without anemia'''
-:::* Preferred regimen: IVIG
-:::: Note (1): Diagnostic tools are IgM and Igb antibody titers.Perhaps better is blood Parvovirus PCR.
-:::: Note (2): Dose of IVIG not standardized; suggest 400 mg/kg IV of commercial IVIG for 5 or 10 days or 1000 mg/kg IV for 3 days.
-:::: Note (3): Most dramatic anemias in pts with pre-existing hemolytic anemia.
-:::: Note (4): Bone marrow shown erythrocyte maturation arrest with giant pronormoblasts.
-{{PBI|BK virus}}
+::* 6.5. '''Streptococcus pneumoniae infection'''
-:* '''Human polyomavirus (BK virus) treatment'''
+:::* 6.5.1. '''Prevention'''
-::* '''Maintenance regimen consisting of triple immunosuppression therapy''': [[Calcineurin]] inhibitor ([[Cyclosporine]] or [[Tacrolimus]]) {{and}} an antimetabolite ([[Azathioprine]], [[Mycophenolate mofetil]], or [[Mycophenolate sodium]]), {{and}} [[Prednisone]] is to discontinue completely the antimetabolite (usually [[Mycophenolate]]) and decrease the dose of the [[Calcineurin]] inhibitor.
+::::* 6.5.1.1. '''Indication'''
-::* '''Alternative regimen (1)''': Decrease the [[Mycophenolate]] dose by 50 percent, followed by a 50 percent decrease in the [[Calcineurin]] inhibitor at three months if decoy cells persist. If using this approach, the target serum [[Tacrolimus]] trough level is 4 to 6, and the target serum [[Cyclosporine]] trough level is 60 to 100 ng/mL. [[Mycophenolate]] may be discontinued completely if viral activation persists. Maintenance immunosuppression then consists of [[Tacrolimus]] and low-dose [[Prednisone]].
+:::::* 6.5.1.1.1. '''For individuals who have not received any pneumococcal vaccine, regardless of CD4 count'''
-::* '''Alternative regimen (2)''': Reduce both the [[Calcineurin]] inhibitor and the [[Mycophenolate]], which allows both the targeting of two pathways and lower total immunosuppression.
+::::::* Preferred regimen: PCV13 0.5ml IM single dose
-:::* Note (1): For those who are hypogammaglobulinemic, we administer intravenous immunoglobulins (IV IG) in replacement doses of 500 mg/kg. Quantitative immunoglobulins should be checked two to three months later to determine whether hypogammaglobulinemia has recurred. Intravenous immunoglobulins (IV IG) is also an option in certain settings, based upon polymerase chain reaction (PCR) and kidney biopsy results. IVIG may contain antibodies against BK and JC virus since these viruses are ubiquitous in the general population.
+::::::* Alternative regimen: PPV23 0.5 mL IM or SQ single dose
-:::* Note (2): The goals of decreased immunosuppressive therapy are to restrain viral replication without triggering rejection.
+::::::* Note (1): If CD4 count ≥200 cells/µL, administer PPV23 0.5 mL IM or SQ at least 8 weeks after the PCV13 vaccine.
-:::* Note (3): Reduced immunosuppression (defined as lowering mean doses of [[Mycophenolate]] and [[Tacrolimus]]) resulted in the successful elimination of viremia (mean period of six months) and allograft survival.
+::::::* Note (2): If CD4 count <200 cells/µL, PPV23 can be offered at least 8 weeks after receiving PCV13 or can wait until CD4 count increased to ≥200 cells/µL.
-:::* Note (4): Alternative approaches to reducing immunosuppression have also been effective
+::::* 6.5.1.1.2. '''For individuals who have previously received PPV23'''
-::::* 4.1 Changing from [[Tacrolimus]] to low-dose [[Cyclosporine]] not only reduces the effect of the [[Calcineurin]] inhibitor, but also reduces [[Mycophenolate]] concentrations.
+:::::* Note: One dose of PCV13 should be given atleast 1 year after the last receipt of PPV23
-::::* 4.2 Replacing the [[Calcineurin]] inhibitor with [[Sirolimus]], with or without discontinuation of the antimetabolite, has the advantage of avoiding the long-term [[Calcineurin]] inhibitor-related nephrotoxic effects.
+::::* 6.5.1.1.3. '''Re-vaccination'''
-::::* 4.3 Lowering the dose of [[Calcineurin]] inhibitors may slow the loss of renal function.
+:::::* If age 19–64 years and ≥5 years since the first PPV23 dose  PPV23 0.5 mL IM or SQ
+:::::*  If age ≥65 years, and if ≥5 years since the previous PPV23 dose PPV23 0.5 mL IM or SQ
+:::::* If age ≥65 years, and if ≥5 years since the previous PPV23 dose PPV23 0.5 mL IM or SQ
-:* '''Primary Regimens'''
+::* 6.6. '''Influenza A and B virus infection'''
-::* Decrease immunosuppression if possible. (Cornerstone of Treatment)
-::* Suggested antiviral therapy is based on anecdotal data. If progressive renal dysfunction:
-::* Fluoroquinolone {{and}} IVIG 500 mg/kg IV {{and}} Leflunomide 100 mg for daily for 3 days, then 10-20 mg PO daily
-::* If refractory to all of the above, add [[Cidofovir]] 5 mg/kg once per week for 2 weeks, then once every other week  if refractory to all of the above
-:* '''Ancillary Therapies in BK Virus Nephropathy'''
+:::* 6.6.1. '''Prevention'''
-::* [[Cidofovir]] 0.25-1.0 mg/kg IV biweekly for 8 wk without [[Probenecid]], prehydration recommended
+::::* 6.6.1.1. '''Indication'''
-::* [[Leflunomide]] 100 mg loading dose for 3 days, 20-60 mg/day, goal [[Leflunomide]] trough 50-100 ng/mL (consider lower trough goals of 20-40 ng/mL given hemolysis risk)
+:::::* All HIV-infected patients
-::* IV Ig 1-2 g/kg IV for 1-2 doses or 150 mg/kg  IV biweekly for 8 wk
+:::::* Note (1): Inactivated influenza vaccine annually (per recommendation for the season).
-::* [[Fluoroquinolones]]-[[Ciproflaxacin]] 500 mg/day, duration dependent on virological response.
+:::::* Note (2): Live-attenuated influenza vaccine is contraindicated in HIV-infected patients.
-{{PBI|JC virus}}
+::* 6.7. '''Syphilis'''
-:* '''Progressive Multifocal Leukoencephalopathy (PML) caused by JC Virus ( John Cunningham virus) infections'''<ref>{{citeweb|title=JCvirus|url=https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf}}</ref>
+:::* 6.7.1. '''Prevention'''
+::::* 6.7.1.1. '''Indication'''
+:::::* For individuals exposed to a sex partner with a diagnosis of primary, secondary, or early latent syphilis within past 90 days.
+:::::* For individuals exposed to a sex partner >90 days before syphilis diagnosis in the partner, if serologic test results are not available immediately and the opportunity for follow-up is uncertain.
+:::::* Preferred regimen: [[Benzathine penicillin]] G 2.4 million units IM single dose
+:::::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid for 14 days
+:::::* Alternative regimen (2): [[Ceftriaxone]] 1 g IM or IV q24h for 8– 10 days
+:::::* Alternative regimen (3): [[Azithromycin]] 2 g PO single dose
+:::::* Note: [[Azithromycin]] is not recommended for MSM or pregnant women.
+:::* 6.7.2. '''Treatment'''
+::::* 6.7.2.1. '''Early stage (primary, secondary, and early-latent syphilis)'''
+:::::* Preferred regimen:  [[Benzathine penicillin]] G 2.4 million units IM single dose
+:::::* Alternative regimen (1): [[Doxycycline]] 100 mg PO bid for 14 days
+:::::* Alternative regimen (2): [[Ceftriaxone]] 1 g IM or IV q24h for 10–14 days
+:::::* Alternative regimen (3): [[Azithromycin]] 2 g PO single dose
+::::* 6.7.2.2. '''Late-stage (tertiary–cardiovascular or gummatous disease)'''
+:::::* Preferred regimen: [[Benzathine penicillin]] G 2.4 million units IM weekly for 3 doses
+:::::* Alternative regimen: [[Doxycycline]] 100 mg PO bid for 28 days
+::::* 6.7.2.3. '''Neurosyphilis (including otic or ocular disease)'''
+:::::* Preferred regimen: Aqueous crystalline [[Penicillin]] G 18– 24 million units per day (administered as 3–4 million units IV q4h or by continuous IV infusion) for 10–14 days with or without [[Benzathine penicillin G]] 2.4 million units IM weekly for 3 doses after completion of IV therapy
+:::::* Alternative regimen: [[Procaine penicillin]] 2.4 million units IM q24h {{and}} [[Probenecid]] 500 mg PO qid for 10–14 days  with or without [[Benzathine penicillin]] G 2.4 million units IM weekly for 3 doses after completion
+:::::* Note (1): The Jarisch-Herxheimer reaction is an acute febrile reaction accompanied by headache and myalgia that can occur within the first 24 hours after therapy for syphilis.
+:::::* Note (2): This reaction occurs most frequently in patients with early syphilis, high nontreponemal titers and prior penicillin treatment.
-::* There is no specific antiviral therapy for JC virus infection.
+::* 6.8. '''Histoplasma capsulatum infection'''
+:::* 6.8.1. '''Prevention'''
+::::* 6.8.1.1. '''Indication'''
+:::::* CD4 count ≤150 cells/µL and at high risk because of occupational exposure or live in a community with a hyperendemic rate of histoplasmosis (>10 cases/100 patient-years).
+:::::* Preferred regimen: [[Itraconazole]] 200 mg PO qd
+:::* 6.8.2. '''Treatment'''
+::::* 6.8.2.1. '''Moderately severe to severe disseminated disease'''
+:::::* Induction therapy (for at least 2 weeks or until clinically improved)
+::::::* Preferred regimen: Liposomal [[Amphotericin B]] 3 mg/kg IV q24h
+:::::* Maintenance therapy:
+::::::* Preferred regimen: [[Itraconazole]] 200 mg PO tid for 3 days, then 200 mg PO bid
+::::* 6.8.2.2. '''Less severe disseminated disease'''
+:::::* Induction therapy:
+::::::* Preferred regimen: Liposomal [[Amphotericin B]] 3 mg/kg IV q24h
+::::::* Alternative regimen: [[Amphotericin B]] lipid complex 3 mg/kg IV q24h {{or}} [[Amphotericin B]] cholesteryl sulfate complete 3 mg/kg IV q24h
+::::::* Note: Induction therapy should be for at least 2 weeks or until clinically improved.
+:::::* Maintenance therapy:
+::::::* Preferred regimen: [[Itraconazole]] 200 mg PO tid for 3 days and then [[Itraconazole]] 200 mg PO bid for 12 months
+::::::* Alternative regimen (1): [[Voriconazole]] 400 mg PO bid for 1 day, then 200 mg bid
+::::::* Alternative regimen (2): [[Posaconazole]] 400 mg PO bid
+::::::* Alternative regimen (3): [[Fluconazole]] 800 mg PO qd
+::::* 6.8.2.3. '''Meningitis'''
+:::::* Induction therapy:
+::::::* Preferred regimen: Liposomal [[amphotericin B]] 5 mg/kg/day for 4–6 weeks
+:::::* Maintenance therapy:
+::::::* Preferred regimen: [[Itraconazole]] 200 mg PO bid to tid for ≥1 year
+:::::* Note: Treatment continued until resolution of abnormal CSF findings.
+:::::* Long-Term Suppression Therapy
+::::::* Preferred regimen: [[Itraconazole]] 200 mg PO qd
+::::::* Alternative regimen: [[Fluconazole]] 400 mg PO qd
+::::::* Note: Therapeutic drug monitoring and dosage adjustment may be necessary to ensure [[Triazole]] antifungal and ARV efficacy and reduce concentration-related toxicities.
-::* The main treatment approach is to reverse the immunosuppression caused by HIV.
+::* 6.9. '''Coccidioidomycosis'''
+:::* 6.9.1. '''Prevention'''
+:::* 6.9.1.1. '''Indication'''
+::::* A new positive IgM or IgG serologic test in patients who live in a disease-endemic area and with CD4 count <250 cells/µL.
+::::* Preferred regimen: [[Fluconazole]] 400 mg PO qd
+:::* 6.9.2. '''Treatment'''
+::::* 6.9.2.1. '''Clinically mild infections (e.g., focal pneumonia)'''
+:::::* Preferred regimen: [[Fluconazole]] 400 mg PO qd {{or}} [[Itraconazole]] 200 mg PO bid
+:::::* Alternative regimen: [[Posaconazole]] 200 mg PO bid {{or}} [[Voriconazole]] 200 mg PO bid
+::::* 6.9.2.2. '''Severe, non-meningeal infection (diffuse pulmonary infection or severely ill patients with extrathoracic, disseminated disease)'''
+:::::* Preferred regimen: [[Amphotericin B]] deoxycholate 0.7–1.0 mg/kg IV qd {{or}} Lipid formulation [[Amphotericin B]] 4–6 mg/kg IV qd
+:::::* Alternative regimen: [[Fluconazole]] or [[Itraconazole]], with [[Itraconazole]] preferred for bone disease 400 mg per day to [[Amphotericin B]] therapy and continue triazole once [[Amphotericin B]] is stopped.
+::::* 6.9.2.3. '''Meningeal infections'''
+:::::* Preferred regimen: [[Fluconazole]] 400–800 mg IV or PO qd
+:::::* Alternative regimen: [[Itraconazole]] 200 mg PO tid for 3 days, then 200 mg PO bid {{or}} [[Posaconazole]] 200 mg PO bid {{or}} [[Voriconazole]] 200–400 mg PO bid
+::::* 6.9.2.4. '''Chronic suppressive therapy'''
+:::::* Preferred regimen: [[Fluconazole]] 400 mg PO qd {{or}} [[Itraconazole]] 200 mg PO bid
+:::::* Alternative regimen:  [[Posaconazole]] 200 mg PO bid {{or}} [[Voriconazole]] 200 mg PO bid
+:::::* Note (1): Therapy should be continued indefinitely in patients with diffuse pulmonary or disseminated diseases because relapse can occur in 25%–33% of HIV-negative patients. It can also occur in HIV-infected patients with CD4 counts >250 cells/µL.
+:::::* Note (2): Therapy should be lifelong in patients with meningeal infections because relapse occurs in 80% of HIV-infected patients after discontinuation of triazole therapy.
-::* Initiate anti retroviral therapy (ART) immediately in ART-naive patients .
+::* 6.10. '''Herpes simplex virus (HSV) Disease'''
+:::* 6.10.1. '''Orolabial lesions (For 5–10 Days)'''
+::::* Preferred regimen (1): [[Valacyclovir]] 1 g PO bid
+::::* Preferred regimen (2): [[Famciclovir]] 500 mg PO bid
+::::* Preferred regimen (3): [[Acyclovir]] 400 mg PO tid
+:::* 6.10.2. '''Initial or recurrent genital HSV (For 5–14 Days)'''
+::::* Preferred regimen (1): [[Valacyclovir]] 1 g PO bid
+::::* Preferred regimen (2): [[Famciclovir]] 500 mg PO bid
+::::* Preferred regimen (3): [[Acyclovir]] 400 mg PO tid
+:::* 6.10.3. '''Severe mucocutaneous HSV'''
+::::* Preferred regimen:  Initial therapy [[Acyclovir]] 5 mg/kg IV q8h.
+::::* Note:  After lesions begin to regress, change to PO therapy as above. Continue until lesions are completely healed.
+:::* 6.10.4. '''Chronic suppressive therapy'''
+::::* Preferred regimen (1): [[Valacyclovir]] 500 mg PO bid
+::::* Preferred regimen (2): [[Famciclovir]] 500 mg PO bid
+::::* Preferred regimen (3): [[Acyclovir]] 400 mg PO bid
+:::* 6.10.4. '''For acyclovir-resistant HSV'''
+::::* Preferred therapy: [[Foscarnet]] 80–120 mg/kg/day IV q12h-q8h
+::::* Alternative regimen: [[Cidofovir]] IV {{or}} Topical [[Trifluridine]] {{or}} Topical [[Imiquimod]] for 21-28 days
+::::* Note: Continue indefinitely regardless of CD4 cell count.
-::* Optimize ART in patients who develop Progressive Multifocal Leukoencephalopathy in phase of HIV viremia on ART .
+::* 6.11. '''Varicella-zoster virus (VZV) infection'''
+:::* 6.11.1. '''Varicella-zoster virus (VZV) infection'''
+::::* 6.11.1.2 '''Prevention'''
+:::::* 6.11.1.1. '''Pre-exposure prevention'''
+::::::* Indication: Patients with CD4 counts ≥200 cells/µL who have not been vaccinated, have no history of varicella or herpes zoster, or who are seronegative for VZV.
+::::::* Preferred regimen: Primary varicella vaccination, 2 doses (0.5 mL SQ each) administered 3 months apart
+::::::* Alternative regimen: VZV-susceptible household contacts of susceptible HIV-infected persons should be vaccinated to prevent potential transmission of VZV to their HIV-infected contacts
+::::::* Note (1):  Routine VZV serologic testing in HIV-infected adults and adolescents is not recommended.
+::::::* Note (2): If vaccination results in disease because of vaccine virus, treatment with [[Acyclovir]] is recommended.
+:::::* 6.11.1.2. '''Post-exposure prevention'''
+::::::* Indication: Close contact with a person with chickenpox or herpes zoster; and is susceptible (i.e., no history of vaccination or of either condition, or known to be VZV seronegative).
+::::::* Preferred regimen: Varicella-zoster immune globulin (VariZIG™) 125 international units per 10 kg (maximum 625 international units) IM, administered as soon as possible and within 10 days after exposure.
+::::::* Alternative regimen (1): [[Acyclovir]] 800 mg PO qd for 5– 7 days
+::::::* Alternative regimen (2): [[Valacyclovir]] 1 g PO tid for 5–7 days
+::::::* Note (1):  Individuals receiving monthly high-dose IVIG (>400 mg/kg) are likely to be protected if the last dose of IVIG was administered <3 weeks before exposure.
+::::::* Note (2): If antiviral therapy is used, varicella vaccines should not be given until at least 72 hours after the last dose of the antiviral drug.
+::::* 6.11.1.2. '''Treatment'''
+:::::* 6.11.1.2.1 '''Primary varicella infection (chickenpox)'''
+::::::* 6.11.1.2.1. '''Uncomplicated cases (For 5–7 Days)'''
+:::::::* Preferred regimen (1):  [[Valacyclovir]] 1 g PO tid
+:::::::* Preferred regimen (2): [[Famciclovir]] 500 mg PO tid
+::::::* 6.11.1.2.1. '''Severe or complicated Cases'''
+:::::::* Preferred regimen: [[Acyclovir]] 10–15 mg/kg IV q8h for 7–10 days.
+:::::::* Alternative regimen: [[Acyclovir]] 800 mg PO 5 times/day for 5-7 days.
+:::::* 6.11.1.2.2. '''Herpes zoster (Shingles)'''
+::::::* 6.11.1.2.2.1. '''Acute localized dermatomal'''
+:::::::* Preferred regimen (1): [[Valacyclovir]] 1 g PO tid for 7–10 days; consider longer duration if lesions are slow to resolve
+:::::::* Preferred regimen (2): [[Famciclovir]] 500 mg tid for 7–10 days; consider longer duration if lesions are slow to resolve
+::::::* 6.11.1.2.2.2. '''Extensive cutaneous lesion or visceral involvement'''
+:::::::* Preferred regimen: [[Acyclovir]] 10–15 mg/kg IV q8h until clinical improvement is evident.
+:::::::* Note: Treatment may switch to PO therapy ([[Valacyclovir]], [[Famciclovir]], or [[Acyclovir]]) after clinical improvement (i.e., when no new vesicle formation or improvement of signs and symptoms of visceral VZV), to complete a 10–14 day course.
+:::::::* Alternative regimen: [[Acyclovir]] 800 mg PO 5 times/day for 7–10 days; consider longer duration if lesions are slow to resolve.
+::::::* 6.11.1.2.2.3. '''Progressive outer retinal necrosis (PORN)'''
+:::::::* Preferred regimen: ([[Ganciclovir]] 5 mg/kg with or without [[Foscarnet]] 90 mg/kg) IV q12h {{and}} ([[Ganciclovir]] 2 mg/0.05mL with or without [[Foscarnet]] 1.2 mg/0.05 ml) intravitreal injection biweekly.
+::::::* 6.11.1.2.2.4. '''Acute retinal necrosis (ARN)'''
+:::::::* Preferred regimen: [[Acyclovir]] 10-15 mg/kg IV q8h {{and}} ([[Ganciclovir]] 2 mg/0.05mL intravitreal injection 1-2 doses biweekly for 10-14 days, followed by [[Valacyclovir]] 1g PO tid for 6 weeks
-::* [[Corticosteroids]] may be used for Progressive Multifocal Leukoencephalopathy- immune reconstitution inflammatory syndrome (IRIS) characterized by contrast enhancement, edema or mass effect, and with clinical deterioration
+::* 6.12. '''Cytomegalovirus (CMV) Disease'''
-{{PBI|Rabies}}
+:::* 6.12.1. '''Treatment'''
-::*Preferred regimen: no specific therapeutics agents are available once the disease is established.
+::::* 6.12.1.1. '''CMV retinitis'''
-:::* Note: There are vaccines and immune globulins available for postexposure prophylaxis:
+:::::* Induction therapy
-::::* Postexposure Prophylaxis for non immunized individuals: Wound cleansing, human rabies immune globulin - administer full dose infiltrated around any wound. Administer any remaining volume IM at other site anatomically distant from the wound. Administer vaccine 1,0ml, IM at deltoid area one each on days 0, 3, 7 and 14.
+::::::* Preferred regimen (1): [[Ganciclovir]] 2mg {{or}} [[Foscarnet]]  2.4mg intravitreal injections for 1-4 doses over a period of 7-10 days to achieve high intraocular concentration faster
-::::* Postexposure Prophylaxis for immunized individuals: Wound cleansing, do not administer human rabies immune globulin. Administer vaccine 1,0ml, IM at deltoid area one each on days 0 and 3.
+::::::* Preferred regimen (2): [[Valganciclovir]] 900 mg PO bid for 14–21 days
+::::::* Alternative regimen (1): [[Ganciclovir]] 5 mg/kg IV q12h for 14–21 days
+::::::* Alternative regimen (2): [[Foscarnet]] 90 mg/kg IV q12h or 60 mg/kg q8h for 14–21 days
+::::::* Alternative regimen (3): [[Cidofovir]] 5 mg/kg/week IV for 2 weeks
+::::::* Note: Saline hydration before and after therapy should be given and [[Probenecid]], 2 g PO 3 hours before dose, followed by 1 g PO 2 hours and 8 hours after the dose (total of 4 g) is recommended.
+:::::* Chronic maintenance (secondary prophylaxis):
+::::::*  Preferred regimen: [[Valganciclovir]] 900 mg PO qd
+::::::* Alternative regimen (1): [[Ganciclovir]] 5 mg/kg IV 5–7 times weekly
+::::::* Alternative regimen (2): [[Foscarnet]] 90–120 mg/kg IV once daily
+::::::* Alternative regimen (3): [[Cidofovir]] 5 mg/kg/week IV for 2 weeks; saline hydration before and after therapy {{and}} [[Probenecid]], 2 g PO 3 hours before dose, followed by 1 g PO 2 hours and 8 hours after the dose (total of 4 g)
+::::* 6.12.1.2. '''CMV esophagitis or colitis'''
+:::::* 6.12.1.2.1. '''Severe condition'''
+::::::* Preferred regimen: [[Ganciclovir]] 5 mg/kg IV q12h; may switch to [[Valganciclovir]] 900 mg PO bid once the patient can tolerate oral therapy for 21-42 days or till the symptoms are resolved
+::::::* Alternative regimen: [[Foscarnet]] 90 mg/kg IV q12h or 60 mg/kg q8h for 21-42 days
+::::::* Note: For patients with treatment-limiting toxicities to [[Ganciclovir]] or with [[Ganciclovir]] resistance, above regimen is recommended.
+:::::* 6.12.1.2.2. '''Mild disease and able to tolerate oral therapy'''
+::::::* Preferred regimen: [[Valganciclovir]] 900 mg PO bid 21-42 days
+::::* 6.12.1.3. '''CMV neurological disease'''
+:::::* Preferred regimen: [[Ganciclovir]] 5 mg/kg IV q12h {{and}} ([[Foscarnet]] 90 mg/kg IV q12h or 60 mg/kg IV q8h) to stabilize disease
-{{PBI|Respiratory Syncytial Virus}}
+::* 6.13. '''HHV-8 Diseases (kaposi sarcoma [KS], primary effusion lymphoma [PEL], multicentric castleman’s disease [MCD])'''
-* Respiratory syncytial virus treatment
+:::* 6.13.1. '''Treatment'''
-:* Supportive therapy
+::::* Mild to moderate KS (ACTG Stage T0)
-::* Hydration and supplemental oxygen.
+:::::* Note:  Initiate or optimize anti retroviral therapy.
-::* Routine use of [[Ribavirin]] not recommended. [[Ribavirin]] therapy associated with small increases in O2 saturation.
+::::* Advanced KS [ACTG Stage T1, Including Disseminated Cutaneous (AI) Or Visceral KS]
-::* No consistent decrease in need for mechanical ventilation or ICU stays. High cost, aerosol administration and potential toxicity<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258  }} </ref>
+:::::* Note: Chemotherapy (per oncology consult) {{and}} anti retroviral therapy.
+::::* Primary effusion lymphoma
+:::::* Preferred regimen (1): [[Valganciclovir]] 900 mg PO bid for 3 weeks
+:::::* Preferred regimen (2): [[Ganciclovir]] 5 mg/kg IV q12h for 3 weeks
+:::::* Preferred regimen (3): [[Valganciclovir]] 900 mg PO bid {{and}} [[Zidovudine]] 600 mg PO qid for 7– 21 days
+:::::* Alternative regimen: [[Rituximab]] (375 mg/m<sup>2</sup> given weekly for 4–8 weeks) may be an alternative to or used adjunctively with antiviral therapy
+:::::* Note: [[Valganciclovir]] PO {{or}} [[Ganciclovir]] IV can be used as adjunctive therapy
-::: Note (1) In adults, Respiratory syncytial virus accounted for 10.6% of hospitalizations for pneumonia, 11.4% for COPD, 7.2% for asthma & 5.4% for CHF in pts >65 yrs of age <ref name="pmid15858184">{{cite journal| author=Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE| title=Respiratory syncytial virus infection in elderly and high-risk adults. | journal=N Engl J Med | year= 2005 | volume= 352 | issue= 17 | pages= 1749-59 | pmid=15858184 | doi=10.1056/NEJMoa043951 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15858184  }} </ref>. Respiratory syncytial virus caused 11% of clinically important respiratory illnesses in military recruits<ref name="pmid16007526">{{cite journal| author=O'Shea MK, Ryan MA, Hawksworth AW, Alsip BJ, Gray GC| title=Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment. | journal=Clin Infect Dis | year= 2005 | volume= 41 | issue= 3 | pages= 311-7 | pmid=16007526 | doi=10.1086/431591 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16007526  }} </ref>
+::* 6.14. '''Human papillomavirus (HPV) infection'''
+:::* 6.14.1. '''Prevention'''
+::::* For females aged 13–26 years
+:::::* Preferred regimen (1): HPV quadrivalent vaccine 0.5 mL IM at months 0, 1–2, and 6 {{or}} HPV bivalent vaccine 0.5 mL IM at months 0, 1–2, and 6
+::::* Males aged 13–26 years
+:::::* Preferred regimen (1): HPV quadrivalent vaccine 0.5 mL IM at months 0, 1–2, and 6
+:::* 6.14.2. '''Treatment'''
+::::* 6.14.2.1. '''Patient-applied therapy for uncomplicated external warts that can be easily identified by patients'''
+:::::* Preferred regimen (1):  [[Podophyllotoxin]] (e.g., podofilox 0.5% solution or 0.5% gel)
+:::::* Note: Apply to all lesions bid for 3 consecutive days, followed by 4 days of no therapy, repeat weekly for up to 4 cycles, until lesions are no longer visible)
+:::::* Preferred regimen (2):  [[Imiquimod]] 5% cream
+:::::* Note: Apply to lesion at bedtime and remove in the morning on 3 nonconsecutive nights weekly for up to 16 weeks, until lesions are no longer visible. Each treatment should be washed with soap and water 6–10 hours after application.
+:::::* Preferred regimen (3): [[Sinecatechins]] 15% ointment
+:::::* Note: Apply to affected areas tid for up to 16 weeks, until warts are completely cleared and not visible
+::::* 6.14.2.2. '''Provider-applied therapy for complex or multicentric lesions, or lesions inaccessible to patient'''
+:::::* Note (1): Cryotherapy (liquid nitrogen or cryoprobe): Apply until each lesion is thoroughly frozen. Repeat every 1–2 weeks for up to 4 weeks, until lesions are no longer visible. Some providers allow the lesion to thaw, then freeze a second time in each session.
+:::::* Note (2): [[Trichloroacetic acid]] or [[bichloroacetic acid]] cauterization: 80%–90% aqueous solution, apply to wart only, allow to dry until a white frost develops. Repeat weekly for up to 6 weeks, until lesions are no longer visible.
+:::::* Note (3): Surgical excision or laser surgery to external or anal warts.
+:::::* Note (4): [[Podophyllin]] resin 10%–25% in tincture of benzoin: Apply to all lesions (up to 10 cm2 ), then wash off a few hours later, repeat weekly for up to 6 weeks until lesions are no longer visible.
-::: Note (2) Respiratory Syncytial Virus major cause of morbidity in neonates/infants.
+::* 6.15. '''Hepatitis A virus (HAV) infection'''
-::: Note (3) Nucleic acid test now approved to detect 12 respiratory viruses (xTAG Respiratory Viral Panel, Luminex Molecular Diagnostics).
+:::* 6.15.1. '''Prevention'''
-:* '''Prevention of Respiratory syncytial virus'''
+::::* Indication: HAV-susceptible patients with chronic liver disease, or who are injection-drug users or homosexuals
+::::* Preferred regimen: Hepatitis A vaccine 1 mL IM  2 doses at 0 and 6–12 months.
+::::* Alternative regimen: Combined HAV and HBV vaccine 1 mL IM as a 3-dose (0, 1, and 6 months) or 4-dose series (days 0, 7, 21 to 30, and 12 months).
+::::* Note (1): For patients susceptible to both HAV and hepatitis B virus (HBV) infection, alternative regimen is recommended.
+::::* Note (2): IgG antibody response should be assessed 1 month after vaccination; nonresponders should be revaccinated when CD4 count >200 cells/µL.
-::* 1. In children <24 months old with chronic lung disease of prematurity (formerly broncho-pulmonary dysplasia) requiring supplemental oxygen or
+::* 6.16. '''Hepatitis B virus (HBV) infection'''
-::* 2. In premature infants (<32 wks gestation) and <6 months old at start of Respiratory syncytial virus season or
+:::* 6.16.1. '''Prevention'''
-::* 3. In children with selected congenital heart diseases.
+::::* 6.16.1.1. '''Indication'''
-:::* Preferred regimen for prevention of Respiratory syncytial virus: [[Palivizumab]] (Synagis) 15 mg per kg IM q month Nov.-April<ref name="pmid19736258">{{cite journal| author=Committee on Infectious Diseases| title=From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. | journal=Pediatrics | year= 2009 | volume= 124 | issue= 6 | pages= 1694-701 | pmid=19736258 | doi=10.1542/peds.2009-2345 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19736258  }} </ref>
+:::::*  Patients without chronic HBV or without immunity to HBV (i.e., anti-HBs <10 international units/mL).
+:::::*  Patients with isolated anti-HBc and negative HBV DNA.
+:::::* Early vaccination is recommended before CD4 count falls below 350 cells/µL.
+:::::*  However, in patients with low CD4 cell counts, vaccination should not be deferred until CD4 count reaches >350 cells/µL, because some patients with CD4 counts <200 cells/µL do respond to vaccination.
+:::::* Preferred regimen (1): HBV vaccine IM (Engerix-B 20 µg/mL or Recombivax HB 10 µg/mL), 0, 1, and 6 months
+:::::* Preferred regimen (2): HBV vaccine IM (Engerix-B 40 µg/mL or Recombivax HB 20 µg/mL) 0, 1, 2 and 6 months
+:::::* Preferred regimen (3): Combined HAV and HBV vaccine, 1 mL IM as a 3-dose (0, 1, and 6 months) or 4-dose series (days 0, 7, 21 to 30, and 12 months)
+:::::* Alternative regimen: Some experts recommend vaccinating with 40-µg doses of either HBV vaccine
+:::::* Note:  Anti-HBs should be obtained 1 month after completion of the vaccine series. Patients with anti-HBs <10 international units/mL at 1 month are considered nonresponders.
+:::::* Vaccine Non-Responders:
+::::::* Preferred regimen (1): HBV vaccine IM (Engerix-B 40 µg/mL or Recombivax HB 20 µg/mL), 0, 1, 2 and 6 months.
+::::::* Note (1): Vaccination non-responders have anti-HBs <10 international units/mL 1 month after vaccination series.
+::::::* Note (2): For patients with low CD4 counts at time of first vaccine series, some experts might delay revaccination until after a sustained increase in CD4 count with anti retroviral therapy.
+:::* 6.16.2. '''Treatment'''
+::::* Preferred regimen: [[Tenofovir]] 300 mg PO qd{{and}} [[Emtricitabine]] 200 mg PO qd {{or}} [[Lamivudine]] 300 mg PO qd {{and}} additional drug(s) for HIV
+::::* Note: Anti retroviral therapy regimen should include 2 drugs that are active against both HBV and HIV.
+::::* Alternative regimen: [[Peginterferon]] alfa-2a 180 μg SQ once weekly for 48 weeks {{or}} [[Peginterferon]] alfa 2b 1.5 μg/kg SQ once weekly for 48 weeks.
+::::* Note: For HBV treatment is indicated for patients with elevated ALT and HBV DNA >2,000 IU/mL significant liver fibrosis, advanced liver disease or cirrhosis, above regimen is indicated.
-:::: Note : Significant reduction in Respiratory syncytial virus hospitalization among children with congenital heart disease<ref name="pmid17727335">{{cite journal| author=Feltes TF, Sondheimer HM| title=Palivizumab and the prevention of respiratory syncytial virus illness in pediatric patients with congenital heart disease. | journal=Expert Opin Biol Ther | year= 2007 | volume= 7 | issue= 9 | pages= 1471-80 | pmid=17727335 | doi=10.1517/14712598.7.9.1471 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17727335  }} </ref>
+::* 6.17. '''Penicilliosis marneffei'''
+:::* 6.17.1. '''Prevention'''
+::::* 6.17.1.1. '''Indication'''
+:::::* Patients with CD4 cell counts <100 cells/µL who live or stay for a long period in rural areas in northern Thailand, Vietnam, or Southern China.
+:::::* Preferred regimen: [[Itraconazole]] 200 mg PO qd
+:::::* Alternative regimen: [[Fluconazole]] 400 mg PO once weekly
+:::* 6.17.2. '''Treatment'''
+::::* 6.17.2.1. '''For acute infection in severely ill patients'''
+:::::* Preferred regimen: [[Liposomal amphotericin]] B 3–5 mg/kg/day IV for 2 weeks, followed by [[Itraconazole]] 200 mg PO bid for 10 weeks, followed by chronic maintenance therapy
+:::::* Alternative regimen: [[Voriconazole]] 6 mg/kg IV q12h for 1 day, then 4 mg/kg IV q12h for at least 3 days, followed by 200 mg PO bid for a maximum of 12 weeks, followed by maintenance therapy
+::::* 6.17.2.2. '''For mild disease'''
+:::::* Preferred regimen: [[Itraconazole]] 200 mg PO bid for 8 weeks; followed by chronic maintenance therapy
+:::::* Alternative regimen: [[Voriconazole]] 400 mg PO bid for 1 day, then 200 mg bid for a maximum of 12 weeks, followed by chronic maintenance therapy
+::::* 6.17.2.3. '''Chronic Maintenance Therapy (Secondary Prophylaxis)'''
+:::::* Preferred regimen: [[Itraconazole]] 200 mg PO qd
+:::::* Note (1): Anti retroviral therapy should be initiated simultaneously with treatment for penicilliosis to improve treatment outcome.
+:::::* Note (2): [[Itraconazole]] and [[Voriconazole]] may have significant interactions with certain ARV agents. These interactions are complex and can be bi-directional.
+:::::* Note (3): Therapeutic drug monitoring and dosage adjustment may be necessary to ensure triazole antifungal and ARV efficacy and reduce concentration-related toxicities.
-{{PBI|Rhinovirus}}
+::* 6.18. '''Isosporiasis'''
-*'''Rhinovirus treatment (commom cold)'''
+:::* 6.18.1. '''Treatment'''
-:* '''Supportive therapy'''
+::::* For Acute Infection:
+:::::* Preferred regimen (1): [[Trimethoprim/Sulfamethoxazole]] 160 mg/800 mg PO (or IV) qid for 10 days
+:::::* Preferred regimen (2): [[Trimethoprim/Sulfamethoxazole]] 160 mg/800 mg PO (or IV) bid for 7–10 days
+:::::* Alternative regimen (1): [[Pyrimethamine]] 50–75 mg PO daily {{and}} [[Leucovorin]] 10–25 mg PO qd
+:::::* Alternative regimen (2):  [[Ciprofloxacin]] 500 mg PO bid for 7 days as a second line alternative
+::::* Chronic Maintenance Therapy (Secondary Prophylaxis):
+:::::* Preferred regimen (1): In patients with CD4 count <200/µL, [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg PO three times a week
+:::::* Alternative regimen (1): [[Trimethoprim/sulfamethoxazole]] 160 mg/800 mg PO qd or (320 mg/1600 mg) three times a week
+:::::* Alternative regimen (2): [[Pyrimethamine]] 25 mg PO qd {{and}} [[Leucovorin]] 5–10 mg PO qd
+:::::* Alternative regimen (3): [[Ciprofloxacin]] 500 mg three times a week as a second-line alternative
+:::::* Note (1): Fluid and electrolyte management in patients with dehydration.
+:::::* Note (2): Immune reconstitution with anti retroviral therapy may result in fewer relapses.
+:::::* Note (3): IV therapy may be used for patients with potential or documented mal-absorption.
-::* Symptomatic treatment-[[Ipratropium bromide]] intranasal (2 sprays tid) {{and}} [[Clemastine]] 1.34 mg 1–2 tab PO bid–tid (over the counter)
+::* 6.19. '''Chagas disease (American trypanosomiasis)'''
-::* Symptomatic relief by [[Ipratropium]] nasal spray decreases rhinorrhea and sneezing vs placebo.<ref name="pmid9880472">{{cite journal| author=Gern JE, Busse WW| title=Association of rhinovirus infections with asthma. | journal=Clin Microbiol Rev | year= 1999 | volume= 12 | issue= 1 | pages= 9-18 | pmid=9880472 | doi= | pmc=PMC88904 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9880472}}</ref> {{and}} Clemastine (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.<ref name="pmid8729205">{{cite journal| author=Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB| title=Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds. | journal=Clin Infect Dis | year= 1996 | volume= 22 | issue= 4 | pages= 656-62 | pmid=8729205 | doi= | pmc= url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205  }} </ref>{{or}} Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).<ref name="pmid12802751">{{cite journal| author=Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA et al.| title=Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials. | journal=Clin Infect Dis | year= 2003 | volume= 36 | issue= 12 | pages= 1523-32 | pmid=12802751 | doi=10.1086/375069 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12802751  }} </ref>
+:::* 6.19.1. '''Treatment'''
-:::* Note (1)No antiviral rx indicated . <ref name="pmid15693216">{{cite journal| author=Turner RB| title=New considerations in the treatment and prevention of rhinovirus infections. | journal=Pediatr Ann | year= 2005 | volume= 34 | issue= 1 | pages= 53-7 | pmid=15693216 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15693216  }} </ref>
+::::* For acute, earlychronic, and reactivated Disease:
+:::::* Preferred regimen: [[Benznidazole]] 5–8 mg/kg/day PO in 2 divided doses for 30–60 days
+:::::* Alternative regimen: [[Nifurtimox]] 8–10 mg/kg/day PO for 90–120 days.
-:::* Note (2) Found in 1/2 of children with community-acquired pneumonia; role in pathogenesis unclear (CID 39:681, 2004). <ref name="pmid12517470">{{cite journal| author=Heikkinen T, Järvinen A| title=The common cold. | journal=Lancet | year= 2003 | volume= 361 | issue= 9351 | pages= 51-9 | pmid=12517470 | doi=10.1016/S0140-6736(03)12162-9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12517470  }} </ref>
+::* 6.20. '''Leishmaniasis, visceral'''
-:::* Note (3) High rate of rhinovirus identified in children with significant lower resp tract infections <ref name="pmid19258921">{{cite journal| author=Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T et al.| title=Rhinovirus associated with severe lower respiratory tract infections in children. | journal=Pediatr Infect Dis J | year= 2009 | volume= 28 | issue= 4 | pages= 337-9 | pmid=19258921 | doi=10.1097/INF.0b013e31818ffc1b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19258921  }} </ref>
+:::* 6.20.1. '''Leishmaniasis, visceral'''
+::::* 6.20.1.1. '''Treatment'''
+:::::* For initial infection:
+::::::* Preferred regimen (1): Liposomal [[amphotericin B]] 2–4 mg/kg IV qd
+::::::* Preferred regimen (2): Liposomal [[amphotericin B]] interrupted schedule (e.g., 4 mg/kg on days 1–5, 10, 17, 24, 31, 38)
+::::::* Alternative regimen (1): [[Amphotericin B]] deoxycholate 0.5–1.0 mg/kg IV q24h for total dose of 1.5–2.0 g
+::::::* Alternative regimen (2): Sodium stibogluconate (pentavalent antimony) 20 mg/kg IV or IM q24h for 28 days
+::::::* Alternative regimen (3): [[Miltefosine]] 100 mg PO qd for 4 weeks
+:::::* Chronic maintenance therapy (secondary prophylaxis); Especially in Patients with CD4 Count <200 cells/µL:
+::::::* Preferred regimen (1): Liposomal [[amphotericin B]] 4 mg/kg every 2–4 weeks
+::::::* Preferred regimen (2): [[Amphotericin B]] lipid complex 3 mg/kg every 21 days
+::::::* Alternative regimen: [[Sodium stibogluconate]] 20 mg/kg IV or IM every 4 weeks
+:::* 6.20.2. '''Leishmaniasis, cutaneous'''
+::::::* Preferred regimen (1): Liposomal [[amphotericin B]] 2–4 mg/kg IV daily for 10 days
+::::::* Preferred regimen (2): Liposomal [[amphotericin B]] interrupted schedule (e.g., 4 mg/kg on days 1–5, 10, 17, 24, 31, 38) to achieve total dose of 20–60 mg/kg
+::::::* Preferred regimen (3): [[Sodium stibogluconate]] 20 mg/kg IV or IM daily for 3–4 weeks
-{{PBI|Rotavirus}}
+::* 6.21. '''Aspergillosis, invasive'''
-* Rotavirus treatment<ref>{{citeweb|title=Rotavirus|url=http://www.who.int/mediacentre/factsheets/fs330/en/}}</ref>, <ref>{{citeweb|title=Rotavirus|url=http://www.cdc.gov/rotavirus/about/treatment.html}}</ref>
+:::* 6.21.1. '''Treatment'''
+::::* Preferred regimen: [[Voriconazole]] 6 mg/kg IV q12h for 1 day, then 4 mg/kg IV q12h, followed by [[Voriconazole]] 200 mg PO q12h after clinical improvement until CD4 cell count >200 cells/µL and the infection appears to be resolved.
+::::* Alternative regimen (1): Lipid formulation of [[Amphotericin B]] 5 mg/kg IV q24h
+::::* Alternative regimen (2): [[Amphotericin B]] deoxycholate 1mg/kg IV q24h
+::::* Alternative regimen (3): [[Caspofungin]] 70 mg IV single dose, then 50 mg IV q24h
+::::* Alternative regimen (4): [[Micafungin]] 100–150 mg IV q24h
+::::* Alternative regimen (5): [[Anidulafungin]] 200 mg IV single dose, then 100 mg IV q24h
+::::* Alternative regimen (6): [[Posaconazole]] 200 mg PO qid, then, after condition improved, 400 mg PO bid
-:* '''Treatment of diarrhoea caused by rotavirus '''
+::* 6.22. '''Malaria'''
+:::* 6.22.1. '''Prevetion<ref name=CDC Malaria prophylaxis>{{cite web | title = CDC Malaria prophylaxis | url =http://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/malaria#4660 }}</ref>'''
+::::* 6.22.1.1. '''Prophylaxis in all areas'''
+:::::* Preferred regimen (1): [[Atovaquone]] 250 mg  and [[Proguanil hydrochloride]] 100 mg PO qd
+:::::* Pediatric doses: Pediatric tablets contain 62.5 mg atovaquone and 25 mg proguanil hydrochloride
+::::::* 5–8 kg: 1/2 pediatric tablet daily
+::::::* >8–10 kg: 3/4 pediatric tablet daily
+::::::* >10–20 kg: 1 pediatric tablet daily
+::::::* >20–30 kg: 2 pediatric tablets daily
+::::::* >30–40 kg: 3 pediatric tablets daily
+:::::* Note (1): Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Contraindicated in people with severe renal impairment (creatinine clearance <30 mL/min).
+:::::* Note (2):  Atovaquone-proguanil should be taken with food or a milky drink. Not recommended for prophylaxis for children weighing <5 kg, pregnant women, and women breastfeeding infants weighing <5 kg. Partial tablet doses may need to be prepared by a pharmacist and dispensed in individual capsules.
+:::::* Preferred regimen (2): [[Doxycycline]] 100 mg PO qd
+:::::* Pediatric dose: ≥8 years of age: 2.2 mg/kg up to adult dose of 100 mg/day
+:::::* Note: Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 4 weeks after leaving such areas. Contraindicated in children <8 years of age and pregnant women.
+::::* 6.22.1.2. '''Prophylaxis only in areas with chloroquine-sensitive malaria'''
+:::::* Preferred regimen: [[Chloroquine phosphate]] 300 mg base (500 mg salt) PO once a week
+:::::* Note: Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. May exacerbate psoriasis.
+:::::* Alternative regimen: [[Hydroxychloroquine sulfate]] 400 mg salt PO once a week
+:::::* Note: Begin 1–2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas.
+:::::* Pediatric doses: [[Chloroquine phosphate]] 5 mg/kg base (8.3 mg/kg salt) orally, once/week, up to maximum adult dose of 300 mg base; [[Hydroxychloroquine sulfate]] 5 mg/kg base (6.5 mg/kg salt) orally, once/week, up to a maximum adult dose of 310 mg base
+::::* 6.22.1.3. '''Prophylaxis in areas with mefloquine-sensitive malaria'''
+:::::* Preferred regimen: [[Mefloquine]] 250 mg PO once a week
+:::::* Note (1): Begin ≥2 weeks before travel to malarious areas. Take weekly on the same day of the week while in the malarious area and for 4 weeks after leaving such areas. Contraindicated in people allergic to mefloquine or related compounds (quinine, quinidine) and in people with active depression, a recent history of depression, generalized anxiety disorder, psychosis, schizophrenia, other major psychiatric disorders, or seizures.
+:::::* Note (2): Use with caution in persons with psychiatric disturbances or a previous history of depression. Not recommended for persons with cardiac conduction abnormalities.
+:::::* Pediatric dose: [[Mefloquine]] ≤9 kg: 4.6 mg/kg base (5 mg/kg salt) orally, once/week
+::::::* >9–19 kg: 1/4 tablet once/week
+::::::* >19–30 kg: 1/2 tablet once/week
+::::::* >30–45 kg: 3/4 tablet once/week
+::::::* >30–45 kg: 3/4 tablet once/week
+::::* 6.22.1.4. '''Prophylaxis for short-duration travel to areas with principally Plasmodium vivax'''
+:::::* Preferred regimen: [[Primaquine]] 52.6 mg PO qd
+:::::* Note: Begin 1–2 days before travel to malarious areas. Take daily at the same time each day while in the malarious area and for 7 days after leaving such areas. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and lactation, unless the infant being breastfed has a documented normal G6PD level.
+:::::* Pediatric dose: [[Primaquine]] 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose orally, daily
+::::* 6.22.1.5. '''Terminal prophylaxis to decrease the risk for relapses of Plasmodium vivax and Plasmodium ovale'''
+:::::* Preferred regimen: [[Primaquine]] 52.6 mg PO qd  for 14 days after departure from the malarious area
+:::::* Note: Indicated for people who have had prolonged exposure to P. vivax, P. ovale, or both. Contraindicated in people with G6PD deficiency. Also contraindicated during pregnancy and lactation, unless the infant being breastfed has a documented normal G6PD level.
+:::::* Pediatric dose: [[Primaquine]] 0.5 mg/kg base (0.8 mg/kg salt) up to adult dose orally, daily for 14 days after departure from the malarious area
+:::* 6.22.2. '''Treatment'''
+::::* Note (1): Patients coinfected with HIV  should avoid [[Artesunate]] {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] if they are also receiving [[Co-trimoxazole]], and avoid [[Artesunate]] {{and}} [[Amodiaquine ]] if they are also receiving [[Efavirenz]] {{or}} [[Zidovudine]].
+::::* Note (2):   Because Plasmodium falciparum malaria can progress within hours from mild symptoms or low-grade fever to severe disease or death, all HIV-infected patients with confirmed or suspected P.  falciparum infection should be hospitalized for evaluation, initiation of treatment, and observation.
+::::* 6.22.2.1. '''Plasmodium falciparum'''<ref>{{cite web | title = Guidelines for the treatment of malaria. Third edition April 2015 | url = http://apps.who.int/iris/bitstream/10665/162441/1/9789241549127_eng.pdf?ua=1&ua=1 }}</ref>
+:::::* 6.22.2.1.1. '''Treatment of uncomplicated Plasmodium falciparum malaria'''
+::::::* 6.22.2.1.1.1. '''Treat children and adults with uncomplicated Plasmodium falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)'''
+:::::::* Preferred regimen (1): [[Artemether]] 5–24 mg/kg/day PO bid {{and}} [[Lumefantrine]] 29–144 mg/kg/day PO bid for 3 days
+:::::::* Note: The first two doses should, ideally, be given 8 hours apart.
+:::::::* Dosage regimen based on Body weight (kg)
+::::::::* Body weight (kg)-5 to < 15- [[Artemether]] 20 mg PO bid {{and}} [[Lumefantrine]] 120 mg PO bid  for 3 days
+::::::::* Body weight (kg)-15 to < 25- [[Artemether]] 40 mg PO bid {{and}} [[Lumefantrine]] 240 mg PO bid  for 3 days
+::::::::* Body weight (kg)-25 to < 35- [[Artemether]] 60 mg PO bid {{and}} [[Lumefantrine]] 360 mg PO bid  for 3 days
+::::::::* Body weight (kg)   ≥ 35- [[Artemether]] 80 mg PO bid {{and}} [[Lumefantrine]] 480 mg PO bid  for 3 days
+:::::::* Preferred regimen (2): [[Artesunate]] 2–10 mg/kg/day PO qd {{and}} [[Amodiaquine]] 7.5–15 mg/kg/day PO qd for 3 days
+:::::::* Note: A total therapeutic dose range of 6–30 mg/kg/day [[Artesunate]] and 22.5–45 mg/kg/day per dose [[Amodiaquine]] is recommended.
+:::::::* Dosage regimen based on body weight (kg)
+::::::::* Body weight (kg)-4.5 to < 9- [[Artesunate]] 25 mg PO qd {{and}} [[Amodiaquine]] 67.5 mg PO qd  for 3 days
+::::::::* Body weight (kg)-9 to < 18 - [[Artesunate]] 50 mg PO qd {{and}} [[Amodiaquine]] 135 mg PO qd for 3 days
+::::::::* Body weight (kg)-18 to < 36- [[Artesunate]] 100 mg PO qd {{and}} [[Amodiaquine]] 270 mg PO qd for 3 days
+::::::::* Body weight (kg)   ≥ 36 - [[Artesunate]] 200 mg PO qd {{and}} [[Amodiaquine]] 540 mg PO qd for 3 days
+:::::::* Preferred regimen (3): [[Artesunate]] 2–10 mg/kg/day PO qd {{and}} [[Mefloquine]] 2–10 mg/kg/day PO qd for 3 days
+:::::::* Dosage regimen based on body weight (kg)
+::::::::* Body weight (kg)-5 to < 9- [[Artesunate]] 25 mg PO qd {{and}} [[Mefloquine]] 55 mg PO qd  for 3 days
+::::::::* Body weight (kg)-9to < 18- [[Artesunate]] 50 mg PO qd {{and}} [[Mefloquine]] 110 mg PO qd for 3 days
+::::::::* Body weight (kg)-18 to < 36- [[Artesunate]] 100 mg PO qd {{and}} [[Mefloquine]] 220 mg PO qd for 3 days
+::::::::* Body weight (kg)- ≥ 36  - [[Artesunate]] 200 mg PO qd {{and}} [[Mefloquine]] 440 mg PO qd for 3 days
+:::::::* Preferred regimen (4): [[Artesunate]] 2–10 mg/kg/day PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]]  1.25 (25–70 / 1.25–3.5) mg/kg/day  PO given as a single dose on day 1
+:::::::* Dosage regimen based on body weight (kg)
+::::::::* Body weight (kg)- 5 to < 10- [[Artesunate]] 25 mg PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] 250/12 mg PO given as a single dose on day 1
+::::::::* Body weight (kg)- 10 to < 25- [[Artesunate]] 50 mg PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] 500/25 mg PO given as a single dose on day 1
+::::::::* Body weight (kg)- 25 to < 50- [[Artesunate]] 100 mg PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] 1000/50 mg PO given as a single dose on day 1
+::::::::* Body weight (kg)- ≥50- [[Artesunate]] 200 mg PO qd for 3 days {{and}} [[Sulfadoxine]]-[[Pyrimethamine]] 1500/75 mg PO given as a single dose on day 1
+:::::::*  Preferred regimen (5): [[Dihydroartemisinin]] 2–10 mg/kg/day PO qd {{and}} [[Piperaquine]]16–27 mg/kg/day PO qd for 3 days
+:::::::* Dosage regimen based on Body weight (kg)
+::::::::* Body weight (kg)-5 to < 8: [[Dihydroartemisinin]] 20 mg PO qd {{and}} [[Piperaquine]] 160 mg PO qd for 3 days
+::::::::* Body weight (kg)-8 to < 11: [[Dihydroartemisinin]] 30 mg PO qd {{and}} [[Piperaquine]] 240 mg PO qd for 3 days
+::::::::* Body weight (kg)-11 to < 17: [[Dihydroartemisinin]] 40 mg PO qd {{and}} [[Piperaquine]] 320 mg PO qd for 3 days
+::::::::* Body weight (kg)-17 to < 25: [[Dihydroartemisinin]] 60 mg PO qd {{and}}  [[Piperaquine]] 480 mg PO qd for 3 days
+::::::::* Body weight (kg)-25 to < 36: [[Dihydroartemisinin]] 80 mg PO qd {{and}}  [[Piperaquine]] 640 mg PO qd for 3 days
+::::::::* Body weight (kg)-36 to < 60: [[Dihydroartemisinin]] 120 mg PO qd {{and}}  [[Piperaquine]] 960 mg PO qd for 3 days
+::::::::*  Body weight (kg)-60 < 80: [[Dihydroartemisinin]] 160 mg PO qd {{and}}  [[Piperaquine]] 1280 mg PO qd for 3 days
+::::::::* Body weight (kg)- >80: Dose of [[Dihydroartemisinin]] 200 mg PO qd {{and}}  [[Piperaquine]] 1600 mg PO qd for 3 days
+::::::* 6.22.2.1.1.2 '''Reducing the transmissibility of treated Plasmodium falciparum infections In low-transmission areas in  patients with Plasmodium falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) '''
+:::::::* Preferred regimen: [[Primaquine]] 0.25 mg/kg PO single dose with ACT
+:::::* 6.22.2.1.2. '''Recurrent falciparum malaria'''
+::::::* 6.22.2.1.2.1. '''Failure within 28 days '''
+:::::::* Note: The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens with [[Artesunate]] or [[Quinine]] both of which should be co-administered with [[Tetracycline]], or [[Doxycycline]] or [[Clindamycin]]) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.
+::::::* 6.22.2.1.2.2. '''Failure after 28 days'''
+:::::::* Note: All presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of [[Mefloquine]] within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used.
+:::::* 6.22.2.1.3. '''Reducing the transmissibility of treated Plasmodium falciparum infections in low-transmission areas in  patients with Plasmodium falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months) '''
+::::::* Note: Single dose of 0.25 mg/kg biweekly [[Primaquine]] with ACT
+:::::* 6.22.2.1.4. '''Treating uncomplicated Plasmodium falciparum malaria in special risk groups'''
+::::::* 6.22.2.1.4.1. '''Pregnancy '''
+:::::::* First trimester of pregnancy : [[Quinine]] {{and}} [[Clindamycin]] 10 mg/kg/day PO bid for 7 days
+:::::::* Second and third trimesters : [[Mefloquine]] is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
+:::::::* Note (1): [[Quinine]] is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
+:::::::* Note (2): [[Primaquine]] and [[Tetracyclines]] should not be used in pregnancy.
+::::::* 6.22.2.1.4.2. '''Infants less than 5kg body weight'''
+:::::::* Note: They should be treated with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
+::::::* 6.22.2.1.4.4. '''Large and obese adults'''
+:::::::* Note: For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
+::::::* 6.22.2.1.4.5. '''Non-immune travellers'''
+:::::::* Note: Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
+::::::* 6.22.2.1.4.6. '''Uncomplicated hyperparasitaemia'''
+:::::::* Note: People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT.
+::::* 6.22.2.2. '''Treatment of uncomplicated malaria caused by Plasmodium vivax, Plasmodium ovale, Plasmodium malariae or Plasmodium knowlesi'''
+:::::* 6.22.2.2.1.  '''Blood Stage infection'''
+::::::* 6.22.2.2.1.1.  '''Uncomplicated malaria caused by Plasmodium vivax'''
+:::::::* 6.22.2.2.1.1.1. '''In areas with chloroquine-sensitive Plasmodium vivax'''
+::::::::* Preferred regimen: [[Chloroquine]] total dose of 25 mg/kg PO. [[Chloroquine]] is given at an initial dose of 10 mg/kg, followed by 10 mg/kg on the second day and 5 mg/kg on the third day PO
+:::::::* 6.22.2.2.1.1.2. '''In areas with chloroquine-resistant Plasmodium vivax'''
+::::::::* Note: ACTs containing [[Piperaquine]], [[Mefloquine]] {{or}} [[Lumefantrine]] are the recommended treatment, although [[Artesunate]] {{and}} [[Amodiaquine]] may also be effective in some areas. In the systematic review of ACTs for treating P. vivax malaria, [[Dihydroartemisinin]] {{and}} [[Piperaquine]] provided a longer prophylactic effect than ACTs with shorter half-lives ([[Artemether]] {{and}}[[Lumefantrine]]) {{or}} ([[Artesunate]] {{and}} [[Amodiaquine]]), with significantly fewer recurrent parasitaemias during 9 weeks of follow-up.
+::::::* 6.22.2.2.1.2. '''Uncomplicated malaria caused by Plasmodium ovale, Plasmodium malariae or Plasmodium knowlesi malaria'''
+:::::::* Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to [[Chloroquine]]. In only one study, conducted in Indonesia, was resistance to [[Chloroquine]] reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or [[Chloroquine]], as for vivax malaria.
+::::::* 6.22.2.2.1.3. '''Mixed malaria infections '''
+:::::::* Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.
+:::::* 6.22.2.2.2. '''Liver stages (hypnozoites) of Plasmodium vivax and Plasmodium ovale'''
+::::::* Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of [[Primaquine]] in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.
+:::::* 6.22.2.2.2.1. '''Primaquine for preventive relapse'''
+::::::* Preferred regimen: [[Primaquine]] 0.25–0.5 mg/kg/day PO qd for 14 days
+:::::* 6.22.2.2.2.2. '''Primaquine and glucose-6-phosphate dehydrogenase deficiency'''
+::::::* Preferred regimen: [[Primaquine]] 0.75 mg base/kg/day PO once a week for 8 weeks
+::::::* Note: The decision to give or withhold [[Primaquine]] should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.
+:::::* 6.22.2.2.2.3. '''Prevention of relapse in pregnant or lacating women and infants'''
+::::::* Note: [[Primaquine]] is contraindicated in pregnant women, infants < 6 months of age and in lactating women (unless the infant is known not to be G6PD deficient)
+::::* 6.22.2.3. '''Treatment of severe malaria'''
+:::::* 6.22.2.3.1. '''Treatment of severe falciparum infection with Artesunate'''
+::::::* 6.22.2.3.1.1. '''Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women)'''
+:::::::* Preferred regimen: [[Artesunate]] IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT (add single dose [[Primaquine]] in areas of low transmission).
+::::::* 6.22.2.3.1.2. '''Young children weighing < 20 kg'''
+:::::::* Preferred regimen:[[Artesunate]] 3 mg/kg per dose IV/IM q24h
+:::::::* Alternative regimen: use [[Artemether]] in preference to quinine for treating children and adults with severe malaria
+:::::* 6.22.2.3.2.'''Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)'''
+::::::* 6.22.2.3.2.1. '''Adults and children'''
+:::::::* Preferred regimen: [[Artesunate]] IM q24h
+:::::::* Alternative regimen: [[Artemether]] IM {{or}} [[Quinine]] IM
+::::::* 6.22.2.3.2.2.  '''Children < 6 years'''
+:::::::* Preferred regimen: Where intramuscular injections of artesunate are not available, treat with a single rectal dose (10 mg/kg) of [[Artesunate]], and refer immediately to an appropriate facility for further care.
+:::::::* Note: Do not use rectal artesunate in older children and adults.
+:::::* 6.22.2.3.3. '''Pregancy'''
+::::::* Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed.
+:::::* 6.22.2.3.4. '''Treatment of severe Plasmodium Vivax infection'''
+::::::* Note: Parenteral [[Artesunate]], treatment can be completed with a full treatment course of oral ACT or [[Chloroquine]] (in countries where [[Chloroquine]] is the treatment of choice). A full course of radical treatment with [[Primaquine]] should be given after recovery.
+:::::* 6.22.2.3.5. '''Additional aspects of management in severe malaria'''
+::::::* Fluid therapy:  It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit.
+::::::* Blood Transfusion: In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended.
+::::::* Exchange blood transfusion: Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.
-::* Rehydration with oral rehydration salts (ORS) solution. oral rehydration salts (ORS) solution is a mixture of clean water, salt and sugar. It costs a few cents per treatment. oral rehydration salts (ORS) solution is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.
+::* 6.23. '''Cryptococcosis'''
+:::* 6.23.1. '''Treatment'''
+::::* 6.23.1.1. '''Cryptococcal meningitis'''
+:::::* 6.23.1.1.1. '''Induction therapy'''
+::::::* Preferred regimen: Liposomal [[amphotericin B]] 3–4 mg/kg IV q24h {{and}} [[Flucytosine]] 25 mg/kg PO qid for at least 2 weeks, followed by consolidation therapy
+::::::* Alternative regimen (1):  [[Amphotericin B]] deoxycholate 0.7 mg/kg IV q24h {{and}} [[Flucytosine]] 25 mg/kg PO qid
+::::::* Alternative regimen (2): [[Amphotericin B]] lipid complex 5 mg/kg IV q24h {{and}} [[Flucytosine]] 25 mg/kg PO qid
+::::::* Alternative regimen (3): Liposomal [[Amphotericin B]] 3-4 mg/kg IV q24h {{and}} [[Fluconazole]] 800 mg PO or IV q24h
+::::::* Alternative regimen (4): [[Amphotericin B]] deoxycholate 0.7 mg/kg IV q24h {{and}} [[Fluconazole]] 800 mg PO or IV q24h
+::::::* Alternative regimen (5): [[Fluconazole]] 400–800 mg PO or IV qd {{and}} [[Flucytosine]] 25 mg/kg PO qid
+::::::* Alternative regimen (6): [[Fluconazole]] 1200 mg PO or IV qd
+:::::* 6.23.1.1.2. '''Consolidation therapy'''
+::::::* Preferred regimen: [[Fluconazole]] 400 mg PO (or IV) qd for atleast 8 weeks
+::::::* Note: Preferred therapy followed by maintenance therapy.
+::::::*  Maintenance therapy:  Fluconazole 200 mg PO qd for at least 12 months
+::::::* Alternative regimen:  [[Itraconazole]] 200 mg PO bid for 8 weeks
+::::* 6.23.1.2. '''Non-CNS cryptococcosis with mild-to-moderate symptoms and focal pulmonary infiltrates'''
+:::::* Preferred regimen: [[Fluconazole]], 400 mg PO qd for 12 months
+:::::* Note: Patients receiving [[Flucytosine]] should have either blood levels monitored (peak level 2 hours after dose should be 30–80 mcg/mL) or close monitoring of blood counts for development of cytopenia. Dosage should be adjusted in patients with renal insufficiency.
-::* Zinc supplements-with zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
+::* 6.24. '''Mucocutaneous candidiasis'''
-::* Rehydration with intravenous fluids in case of severe dehydration or shock.
+:::* 6.24.1. '''Treatment'''
-::* Nutrient-rich foods the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods  including breast milk during an episode, and by giving a nutritious diet  including exclusive breastfeeding for the first six months of life  to children when they are well.
+::::* 6.24.1.1. '''For oropharyngeal candidiasis'''
-::* Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.
+:::::* Oral Therapy
+::::::* Preferred regimen: [[Fluconazole]] 100 mg PO qd for 7-14 days.
+::::::* Alternative regimen:  [[Itraconazole]] oral solution 200 mg PO qd for 7-14 days {{or}} [[Posaconazole]] oral suspension 400 mg PO bid for 1 day, then 400 mg qd 7-14 days
+:::::* Topical therapy
+::::::* Preferred regimen: [[Clotrimazole]] troches, 10 mg PO 5 times daily {{or}} [[Miconazole]] mucoadhesive buccal 50-mg tablet
+::::::* Note: Apply to mucosal surface over the canine fossa once daily (do not swallow, chew, or crush).
+::::::* Alternative regimen: [[Nystatin]] suspension 4–6 mL qid or 1–2 flavored pastilles 4– 5 times daily
+::::* 6.24.1.2. '''For esophageal candidiasis'''
+::::::* Preferred regimen: [[Fluconazole]] 100 mg (up to 400 mg) PO or IV qd for 14-21 days {{or}}  [[Itraconazole]] oral solution 200 mg PO qd for 14-21 days
+::::::* Alternative regimen (1): [[Voriconazole]] 200 mg PO or IV bid for 14-21 days
+::::::* Alternative regimen (2): [[Anidulafungin]] 100 mg IV single dose, then 50 mg IV qd for 14-21 days
+::::::* Alternative regimen (3): [[Caspofungin]] 50 mg IV qd for 14-21 days
+::::::* Alternative regimen (4): [[Micafungin]] 150 mg IV qd for 14-21 days
+::::::* Alternative regimen (5): [[Amphotericin B]] deoxycholate 0.6 mg/kg IV qd for 14-21 days
+::::::* Alternative regimen (6): Lipid formulation of amphotericin B 3–4 mg/kg IV qd for 14-21 days
+::::* 6.24.1.3. '''For uncomplicated vulvo-vaginal candidiasis'''
+:::::* Preferred regimen:  Oral [[Fluconazole]] 150 mg for 1 dose {{or}} Topical azoles ([[Clotrimazole]], [[Butoconazole]], [[Miconazole]], [[Tioconazole]], or [[Terconazole]]) for 3– 7 days
+:::::* Alternative regimen:  [[Itraconazole]] oral solution 200 mg PO qd for 3–7 days
+::::* 6.24.1.4. '''For severe or recurrent vulvovaginal candidiasis'''
+:::::* Preferred regimen: [[Fluconazole]] 100–200 mg PO qd for ≥7 days {{or}} Topical antifungal ≥7 days
-::: Note (1): Rotavirus and Escherichia coli are the two most common etiological agents of diarrhoea in developing countries.
+::* 6.25. '''Bartonellosis'''
+:::* 6.25.1. '''Treatment'''
+::::* 6.25.1.1. '''For bacillary angiomatosis, peliosis hepatis, bacteremia, and osteomyelitis'''
+:::::* Preferred regimen (1): [[Doxycycline]] 100 mg PO or IV q12h for 3 months
+:::::* Preferred regimen (2): [[Erythromycin]] 500 mg PO or IV q6h for 3 months
+:::::* Alternative regimen (1):  [[Azithromycin]] 500 mg PO qd
+:::::* Alternative regimen (2):} [[Clarithromycin]] 500 mg PO bid
+::::* 6.25.1.2. '''Confirmed bartonella endocarditis'''
+:::::* Preferred regimen: [[Doxycycline]] 100 mg IV q12h {{and}} [[Gentamicin]] 1 mg/kg IV q8h) for 2 weeks, then continue with [[Doxycycline]] 100 mg IV or PO q12h
+:::::* Altered regimen: [[Doxycycline]] 100 mg IV {{and}} [[Rifabutin]] 300 mg PO or IV q12h for 2 weeks, then continue with [[Doxycycline]] 100 mg IV or PI q12h
+::::* 6.25.1.3. '''CNS infections'''
+:::::* Preferred regimen: ([[Doxycycline]] 100 mg with or without [[Rifabutin]] 300 mg PO or IV q12h
+::::* 6.25.1.4. '''Other severe infections'''
+:::::* Preferred regimen (1): [[Doxycycline]] 100 mg PO or IV with or without [[Rifabutin]] 300 mg PO or IV) q12h for 3 months
+:::::* Preferred regimen (2): [[Erythromycin]] 500 mg PO or IV q6h) with or without [[Rifabutin]]) 300 mg PO or IV q12h for 3 months.
+::::* Note: If relapse occurs after initial (>3 month) course of therapy, longterm suppression with [[Doxycycline]] or a macrolide is recommended as long as CD4 count <200 cells/µL.
-::: Note (2): There is no antiviral drug to treat rotavirus infection. Antibiotic drugs will not help because antibiotics fight against bacteria not viruses.
+::* 6.26. '''Campylobacteriosis'''
+:::* 6.26.1. '''Treatment'''
+::::* 6.26.1.1. '''For mild-to-moderate disease (If Susceptible)'''
+:::::* Preferred regimen: [[Ciprofloxacin]] 500–750 mg PO or 400 mg IV q12h {{or}} [[ Azithromycin]] 500 mg PO qd
+:::::* Alternative regimen: [[Levofloxacin]] 750 mg PO or IV q24h {{or}}  [[Moxifloxacin]] 400 mg (PO or IV) q24h
+::::* 6.26.1.2. '''For campylobacter bacteremia'''
+:::::* Preferred regimen: [[Ciprofloxacin]] 500–750 mg PO or 400 mg IV q12h {{and}} an aminoglycoside.
+:::::* Duration of Therapy:
+::::::* Gastroenteritis: 7–10 days (5 days with [[Azithromycin]])
+::::::* Bacteremia: ≥14 days
+::::::* Recurrent bacteremia: 2–6 weeks.
-::: Note (3): Rotavirus infection can cause severe vomiting and diarrhea. This can lead to dehydration (loss of body fluids). During rotavirus infection, infants and young children, older adults, and people with other illnesses are most at risk becoming dehydrated.
+::* 6.27. '''Shigellosis'''
+:::* 6.27.1. '''Treatment'''
+::::* Preferred regimen: [[Ciprofloxacin]] 500–750 mg PO or 400 mg IV q12h
+::::* Duration of Therapy:
+:::::* Gastroenteritis: 7–10 days
+:::::* Bacteremia: ≥14 days
+:::::* Recurrent Infections: 2–6 weeks
+::::* Alternative regimen (1): [[Levofloxacin]] 750 mg PO or IV q24h for 5 days
+::::* Alternative regimen (2): [[Moxifloxacin]] 400 mg PO or IV q24h for 5 days
+::::* Alternative regimen (3): [[Trimethoprim/Sulfamethoxazole]] 160 mg/800 mg PO or IV q12h for 5 days
+::::* Alternative regimen (4): [[Azithromycin]] 500 mg PO qd for 5 days
+::::* Note: Antimotility agents should be avoided.
-::: Note (4): Symptoms of dehydration include decrease in urination, dry mouth and throat, feeling dizzy when standing up. A dehydrated child may also cry with few or no tears and be unusually sleepy or fussy.
+::* 6.28. '''Salmonellosis'''
-:* Prevention
+:::* 6.28.1. '''Treatment'''
-::* Access to safe drinking-water
+::::* Preferred regimen: [[Ciprofloxacin]] 500–750 mg PO or 400 mg IV q12h
-::* Use of improved sanitation
+::::* Alternative regimen (1): Levofloxacin 750 mg PO or IV q24h
-::* Hand washing with soap
+::::* Alternative regimen (2): [[Moxifloxacin]] 400 mg PO or IV q24h
+::::* Alternative regimen (3): [[Trimethoprim/Sulfamethoxazole]] 160 mg/800 mg PO or IV q12h
+::::* Alternative regimen (4): [[Cefotaxime]] 1 g IV q8h
+::::* Alternative regimen (5): [[Ceftriaxone]] 1 g IV q24h
+::::* Duration of therapy:
+:::::* For gastroenteritis without bacteremia:
+::::::* If CD4 count ≥200 cells/µL: 7–14 days.
+::::::* If CD4 count <200 cells/µL: 2–6 weeks.
+:::::* For gastroenteritis with bacteremia:
+::::::*  If CD4 count ≥200/µL: 14 days; longer duration if bacteremia persists or if the infection is complicated (e.g., if metastatic foci of infection are present)
+::::::*  If CD4 count <200 cells/µL: 2–6 weeks
+::::* Note (1): The role of long-term secondary prophylaxis in patients with recurrent Salmonella bacteremia is not well established. Must weigh benefit against risks of long-term antibiotic exposure.
+::::* Note (2): Secondary Prophylaxis Should Be Considered For:
+:::::* Patients with recurrent Salmonella gastroenteritis +/- bacteremia.
+:::::* Patients with CD4 <200 cells/µL with severe diarrhea.
-::* Exclusive breastfeeding for the first six months of life
+::* 6.29. '''Bacterial enteric infections'''
+:::* 6.29.1. '''Empiric therapy'''
+::::* Preferred regimen: [[Ciprofloxacin]] 500–750 mg PO or 400 mg IV q12h
+::::* Alternative regimen:  [[Ceftriaxone]] 1 g IV q24h {{or}}  [[Cefotaxime]] 1 g IV q8h
+::::* Note: Antimotility agents should be avoided if there is concern about inflammatory diarrhea, including Clostridium-difficile-associated diarrhea.
-::* Good personal and food hygiene
+::* 6.30.'''Bacterial respiratory diseases'''
-::* Health education about how infections spread; and Rotavirus vaccination.
+:::* 6.30.1. '''Treatment'''
+::::* 6.30.1.1. '''Empiric outpatient therapy'''
+:::::* Preferred regimen: [[Amoxicillin]] 500 mg PO  {{and}} ([[Azithromycin]] 500 mg PO {{or}} [[Clarithromycin]] 500 mg PO) qd for 7-10 days
+:::::* Alternative regimen: [[Amoxicillin]] 500 mg PO {{and}} [[Doxycycline]] 100mg PO qd
+:::::* Note: Therapy should be adjusted based on the results of diagnostic workup.
+::::* 6.30.1.2. '''For penicillin-allergic patients'''
+:::::* Preferred regimen: [[Ceftriaxone]] 1 g IV q24h {{and}} ([[Azithromycin]] 500 mg PO {{or}} [[Clarithromycin]] 500 mg PO) qd for 7-10 days
+:::::* Alternative regimen: [[Aztreonam]] 1 g IV q24h {{and}} [[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h
+::::* 6.30.1.3. '''Empiric therapy for non-ICU hospitalized patients'''
+:::::* Preferred regimen: [[Ceftriaxone]] 1 g IV q24h {{and}} ([[Azithromycin]] 500 mg PO {{or}} [[Clarithromycin]] 500 mg PO) qd
+::::* 6.30.1.3. '''Empiric therapy for patients at risk of pseudomonas pneumonia'''
+:::::* Preferred regimen: : [[Piperacillin-Tazobactam]] 2 g-0.25 g IV q24h {{and}} ([[Ciprofloxacin]] 400 mg IV q8–12h {{or}} [[Levofloxacin]] 750 mg IV) q24h
+::::* 6.30.1.4. '''Empiric therapy for patients at risk for methicillin-resistant staphylococcus aureus pneumonia'''
+:::::* Preferred regimen: [[Amoxicillin]] 500 mg PO {{and}} ([[Azithromycin]] 500 mg PO {{or}} [[Clarithromycin]] 500 mg) PO {{and}} [[Linezolid]] 600 mg (IV or PO).
+:::::* Note (1): Empiric therapy with a macrolide alone is not routinely recommended, because of increasing pneumococcal resistance.
+:::::* Note (2): Chemoprophylaxis can be considered for patients with frequent recurrences of serious bacterial pneumonia.
-{{PBI|Smallpox}}
+::* 6.31. '''Cryptosporidiosis'''
-:*Smallpox <ref>{{Cite web | title = DIAGNOSIS AND MANAGEMENT OF SMALLPOX | url = http://www.nejm.org/doi/pdf/10.1056/NEJMra020025 }}</ref>
+:::* 6.31.1. '''Treatment'''
-::*Supportive care is the mainstay of therapy.
+::::* Note (1): Initiate or optimize ART for immune restoration to CD4 count >100 cells/µL. Aggressive oral or IV rehydration and replacement of electrolyte loss and symptomatic treatment of diarrhea with anti-motility agents.
-::*Currently, there are no anti-viral drugs of proven efficacy.
+::::* Preferred regimen (1): [[Nitazoxanide]] 500–1000 mg PO bid for 14 days
-::*Recently, animal studies suggest that [[cidofovir]] and its cyclic analogues, given at the time of or immediately after exposure, have promise for the prevention of cowpox, vaccinia, and monkeypox.
+::::* Preferred regimen (2): [[Paromomycin]] 500 mg PO qid for 14–21 days
-::*Patients need adequate hydration and nutrition, because substantial amounts of fluid and protein can be lost by febrile persons with dense, often weeping lesions.
+::::* Note (2): With optimized anti retroviral therapy, symptomatic treatment and rehydration and electrolyte replacement is recommended. Tincture of opium may be more effective than [[Loperamide]] in management of diarrhea.
-:::*Secondary baceterial infection
-::*Penicillinase-resistant antimicrobial agents should be used if smallpox lesions are secondarily infected, if bacterial infection endangers the eyes, or if the eruption is very dense and widespread.
-::*Daily eye rinsing is required in severe cases. Topical [[idoxuridine]] (Dendrid, Herplex, or Stoxil) should be considered for the treatment of corneal lesions, although its efficacy is unproved for smallpox.
-{{PBI|HIV/AIDS}}
+::* 6.32. '''Microsporidiosis'''
-* * [[HIV]]/[[AIDS]]
+:::* 6.32.1. '''Treatment'''
-* [[HIV]]/[[AIDS]]
+::::* 6.32.1.1. '''For GI infections caused by enterocytozoon bienuesi'''
-* 1.'''Antiretroviral Regimen Options for Treatment-Naive Patients<ref name=AIDSinfoNIH>{{cite web | title = AIDSinfoNIH | url =https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/11/what-to-start }}</ref>'''
+:::::* Note: Initiate or optimize anti retroviral therapy as immune restoration to CD4 count >100 cells/µL {{and}} manage severe dehydration, malnutrition, and wasting by fluid support.
-:* 1.1 '''A Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) Based Regimen:'''
+:::::* Preferred therapy (1): [[Fumagillin]] 60 mg/day  PO bid
-::* Preferred regimen: [[Efavirenz]] 600 mg once-daily {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily.
+:::::* Preferred therapy (2): [[TNP-470]] PO bid
-:* 1.2 '''Integrase Strand Transfer Inhibitor-Based Regimens'''
+:::::* Preferred therapy (3): [[Nitazoxanide]] 1000 mg PO bid
-::* Preferred regimen:
+::::* 6.32.1.2. '''For intestinal and disseminated (not ocular) infections caused by microsporidia other than E. bienuesi and vittaforma corneae'''
-:::* [[Dolutegravir]] 50 mg once-daily {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg once-daily in patients who are HLA-B*5701-negative.
+:::::* Preferred regimen: [[Albendazole]] 400 mg PO bid, continue until CD4 count >200 cells/µL for >6 months after initiation of anti retroviral therapy
-:::* [[Dolutegravir]] 50 mg once-daily {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily.
+:::::* Alternative regimen: [[Itraconazole]] 400 mg PO qd {{and}} [[Albendazole]] 400 mg PO bid
-:::* [[Elvitegravir]] 150 mg {{or}} [[Cobicistat]] 150 mg {{or}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily in patients with estimated CrCl ≥ 70 mL/min/1.73.
+::::* 6.32.1.3. '''For ocular infection'''
-:::* [[Raltegravir]] 400 mg twice-daily {{and}} [[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily.
+:::::* Preferred regimen: Topical [[fumagillin]] bicylohexylammonium (Fumidil B) eye drops: 3 mg/mL in saline ([[fumagillin]] 70 µg/mL)—2 drops q2h for 4 days, then 2 drops qid {{and}} [[Albendazole]] 400 mg PO bid, for management of systemic infection
-::* Alternative Regimen
+:::::* Note: Therapy should be continued until resolution of ocular symptoms and CD4 count increase to >200 cells/µL for >6 months in response to anti retroviral therapy.
-:::* [[Efavirenz]] 600 mg once-daily/[[Tenofovir]] 300 mg-[[Emtricitabine]] 200 mg once-daily.
-:::* [[Rilpivirine]] 25 mg once-daily plus [[Tenofovir]] 300 mg/[[Emtricitabine]] 200 mg once-daily (for patients with CD4 count >200 cells/microL.
-:::* [[Raltegravir]] 400 mg twice-daily  {{and}} [[Abacavir]] 600 mg/[[Lamivudine]] 300 mg once-daily in patients who are HLA-B*5701-negative.
-:* 1.3 '''Protease Inhibitor-Based Regimen'''
-::* Preferred regimen: [[Darunavir]] 800mg-[[Ritonavir]] 100 mg once-daily {{and}} [[Tenofovir]] 300 mg/[[Emtricitabine]] 200 mg once-daily.
-::* Alternative Regimen(1)
-:::* [[Atazanavir]] 300 mg/[[Cobicistat]] 150 mg {{and}} [[Tenofovir]] disoproxil fumarate 300 mg/[[Emtricitabine]] 200 mg once-daily—only for patients with pre-treatment estimated CrCl ≥70 mL/min.
-::* Alternative Regimen(2)
-:::* [[Atazanavir]] 300 mg-[[Ritonavir]] 100 mg once-daily plus [[Tenofovir]] 300 mg/[[Emtricitabine]] 200 mg once-daily.
-::* Alternative Regimen(3)
-:::* [[Darunavir]] 800mg /[[Cobicistat]] 150 mg {{or}} [[Darunavir]] 800mg/[[Ritonavir]] 100mg {{and}} [[Abacavir]] 600 mg/[[Lamivudine]] 300mg —only for patients who are HLA-B*5701 negative.
-::* Alternative Regimen(4)
-:::* [[Darunavir]] 800mg/[[Cobicistat]] 150 mg {{and}} [[Tenofovir]] disoproxil fumarate 300mg/[[Emtricitabine]] 200 mg  —only for patients with pre-treatment estimated CrCl ≥70 mL/min.
-::* Alternate Regimen(5)
-:::* [[Atazanavir]] 300 mg-[[Ritonavir]] 100 mg once-daily {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300 mg once-daily in patients who are HLA-B*5701-negative and with pre-treatment HIV RNA <100,000 copies/mL.
-::* Alternate Regimen(6)
-:::* [[Lopinavir]] 400mg/[[Ritonavir]] 100mg (once or twice daily) {{and}} [[Abacavir]] 600 mg-[[Lamivudine]] 300mg—only for patients who are HLA-B*5701 negative.
-::* Alternate Regimen(7)
-:::* [[Lopinavir]] 400mg/[[Ritonavir]] 100mg (once or twice daily) {{and}} [[Tenofovir]] disoproxil fumarate 300mg/[[Emtricitabine]] 200 mg.
-:* 1.4 Other Regimen Options
-::* 1.4.1 '''NNRTI-Based Regimen'''
-:::* Preferred regimen: [[Efavirenz]] 600mg {{and}} [[Abacavir]] 600 mg/[[Lamivudine]]—only for patients who are HLA-B*5701 negative and with pre-treatment HIV RNA <100,000 copies/mL.
-::* 1.4.2 '''Other Regimens When Tenofovir or Abacavir  Cannot be Used'''
-:::* [[Darunavir]]-[[Ritonavir]] 100 {{and}} [[Raltegravir]]—only for patients with pre-treatment HIV RNA <100,000 copies/mL and CD4 cell count >200 cells/mm3.
-:::* [[Lopinavir]] 400mg/[[Ritonavir]] 100mg (twice daily) {{and}} [[Lamivudine]] 300mg BID.
-:::: Pediatric dose: [[Abacavir]] 300 mg po BID, [[Didanosine]] 20 to < 25 kg: 200 mg po once daily 25 to < 60 kg: 250 mg po once daily ≥60 kg: 400 mg po once daily; [[Lamivudine]] 4 mg/kg/dose po BID; maximum 150 mg po BID; [[Stavudine]] 1 mg/kg/dose po q12h, [[Tenofovir]] Recommended oral dose is 8 mg/kg; [[Zidovudine]] 180 - 240 mg/m2/dose po q12h or 160 mg/m2/dose po q8h (range 90-180); [[Efavirenz]] 10 to < 15 kg: 200 mg, 15 to <20 kg: 250 mg, 20 to < 25 kg: 300 mg, 25 to < 32.5 kg: 350 mg, 32.5 to <40 kg: 400 mg, ≥ 40 kg: 600 mg; [[Nevirapine]] maximum 200 mg per dose; [[Lopinavir]] 400mg; [[Nelfinavir]] 50 mg/kg/dose po BID; [[Raltegravir]] 300mg
-* 2. '''Pre-Exposure Prophylaxis(PrEP)<ref name=CDC Pre-Exposure Prophylaxis>{{cite web | title = CDC Pre-Exposure Prophylaxis | url =http://www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf }}</ref>'''
-:* Preferred regimen- Daily, continuing, oral doses of [[Tenofovir]] disoproxil fumarate 300mg-[[Emtricitabine]] 200 mg, ≤90-day supply.
-:: Note(1): People with high risk behaviour such as men who have sex with men, intravenous drug abusers, HIV-positive sexual partner, recent bacterial STI, high number of sex partners,  history of inconsistent or no condom use, commercial sex work, people in high-prevalence area or network are advised to take pre-exposure prophylaxis of drugs.
-:: Note(2): Follow-up visits at least every 3 months to provide the following: HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STI symptom assessment, pregnancy testing.
-:: Note(3): At 3 months and every 6 months thereafter, assess renal function.
-:: Note(4): Every 6 months, test for bacterial STIs.
-* 3. '''Post- Exposure Prophylaxis<ref name=WHO post exposure prophylaxis>{{cite web | title = WHO postexposureprophylaxis | url =http://www.who.int/hiv/topics/prophylaxis/en/ }}</ref>'''
-:* Preferred HIV PEP regimen- Raltegravir 400 mg BID + [[Tenofovir]] disoproxil fumarate 300mg/[[Emtricitabine]] 200 mg 1 QD.
-:* Preferred '''Basic regimen''' for low-risk exposures (Eg: mucus membrane):
-:** [[Zidovudine]] 100mg {{and}} [[Lamivudine]] 300mg.
-:** [[Zidovudine]] 100mg {{and}} [[Emtricitabine]] 200 mg.
-:** [[Tenofovir]] 300mg {{and}} [[Lamivudine]] 300mg.
-:** [[Tenofovir]] 300mg {{and}} [[Emtricitabine]] 200 mg.
-:* Preferred '''Expanded regimen''' for high-risk exposure (Eg: percutaneous needle stick).
-:** [[Zidovudine]] 100mg {{and}} [[Lamivudine]] 300mg {{and}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-:** [[Zidovudine]] 100mg {{and}} [[Emtricitabine]] 200 mg {{and}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-:** [[Tenofovir]] 300mg {{and}} [[Lamivudine]] 300mg {{and}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-:** [[Tenofovir]] 300mg {{and}} [[Emtricitabine]] 200 mg {{and}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-:* Note: Ideally therapy should be started within hours of exposure and continued for 28 days.
-* 4. '''Perinatal Antiretroviral Regimen<ref name=AIDSinfoNIH Intrapartum car>{{cite web | title = AIDSinfoNIH intrapartum care | url =https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/180/intrapartum-antiretroviral-therapy-prophylaxis }}</ref>'''
-:*4.1 '''Antepartum'''
-::*4.1.1 '''Protease Inhibitor-Based Regimen'''
-:::* Preferred regimen: [[Tenofovir]] 300mg-[[Emtricitabine]] 200mg (fixed dose combination) {{or}} [[Tenofovir]] 300mg-[[Lamivudine]] 300mg {{or}} [[Abacavir]] 600mg-[[Lamivudine]] 300mg {{or}} [[Zidovudine]] 100mg-[[Lamivudine]] 300mg {{and}} [[Atazanavir]]300 mg-[[Ritonavir]] 100mg {{or}} [[Lopinavir]] 400mg-[[Ritonavir]] 100mg.
-::*4.1.2 '''A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen:'''
-:::* Preferred regimen-[[Efavirenz]] 600mg-[[Tenofovir]] 300mg-[[Emtricitabine]] 200mg (fixed dose combination) or [[Efavirenz]] 600mg-[[Tenofovir]] 300 mg-[[Lamivudine]] 300mg.
-:::* Alternate regimen-[[Abacavir]] 600mg-[[Lamivudine]] 300mg {{or}} [[Zidovudine]] 100mg-[[Lamivudine]] 300mg {{and}} [[Efavirenz]] 600mg.
-:*4.2 '''Intrapartum'''
-::* HIV RNA <1000 copies/mL and good afherance-Continue the regimen during delivery or cessarean section.
-::* HIV RNA >1000 copies/mL near delivery, possible poor adherence, or unknown HIV RNA levels- Intravenous [[Zidovudine]] 2 mg/kg IV over 1 hr should be given three hours before cesarean section or delivery and then 1 mg/kg/hr IV continuous infusion until umbilical cord clamping.
-:*4.3 '''Postpartum'''
-::Initiate ART and continue after delivery and cessation of breastfeeding
-* 5.'''Infant Antiretroviral Prophylaxis for Prevention of Mother-To-Child Transmission of HIV<ref name=AIDSinfoNIH postpartum care>{{cite web | title = AIDSinfoNIH postpartumcare | url =https://aidsinfo.nih.gov/contentfiles/lvguidelines/PerinatalGL.pdf }}</ref>'''
-:*5.1 Preferred regimen: [[Zidovudine]] (ZDV) 100mg given at birth and continued till six weeks.
-::: Note(1): Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
-::: Note(2): ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
-::: Note(3): ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
-:::* <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.
-:*5.2 Prophylaxis for HIV-exposed infants of women who received no antepartum antiretroviral prophylaxis
-::* [[Nevirapine]]
-:::* Dose based on birth weight, initiated as soon after birth as possible.
-:::* Birth weight 1.5 to 2 kg: 8 mg/dose orally.
-:::* Birth weight >2 kg: 12 mg/dose orally.
-::: {{and}}
-::: [[Zidovudine]] (ZDV)
-:::* Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
-:::* ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
-:::* ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
-:::* <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.
-:::Note(1): Three doses in the first week of life
-:::Note(2): First dose within 48 hours of birth (birth to 48 hrs)
-:::Note(3): Second dose 48 hours after first
-:::Note(4): Third dose 96 hours after second
-----
+::* 6.33. '''Progressive Multifocal Leukoencephalopathy (PML)'''
+:::* Note (1): There is no specific antiviral therapy for JC virus infection. The main treatment approach is to reverse the immunosuppression caused by HIV.
+:::* Note (2): Initiate anti retroviral therapy immediately in anti retroviral therapy naive patients.
+:::* Note (3): Optimize anti retroviral therapy in patients who develop PML in phase of HIV viremia on anti retroviral therapy.
+:::* Note (4): [[Corticosteroids]] may be used for PML-IRIS characterized by contrast enhancement, edema or mass effect, and with clinical deterioration.
 ==References==
 {{reflist}}