Sandbox sss: Difference between revisions

Jump to navigation Jump to search
mNo edit summary
 
(35 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
{{Meningitis}}
{{Meningitis}}
{{CMG}}
<div class="mw-collapsible mw-collapsed">


====Streptococcus pneumoniae====
====Streptococcus pneumoniae====
<div class="mw-collapsible-content">


{|
{|
Line 13: Line 19:
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g)'''''<BR>''OR''<BR>▸ '''''[[Ampicillin]] 150–200 mg/kg IV q3-4h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g)'''''<BR>''OR''<BR>▸ '''''[[Ampicillin]] 150–200 mg/kg IV q3-4h'''''
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
Line 21: Line 26:
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Penicillin]] MIC ≥0.12 μg/mL}}
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Penicillin]] MIC ≥0.12 μg/mL}}''
|-
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Cefotaxime]] or [[Ceftriaxone]] MIC† <1.0 μg/mL}}
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Cefotaxime]] or [[Ceftriaxone]] MIC† <1.0 μg/mL}}
Line 41: Line 46:
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''AND''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''AND''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' <BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis  also IM in 1% lidocaine)'''''<sup>‡<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' <BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis  also IM in 1% lidocaine)'''''<sup>‡</sup>
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
Line 49: Line 54:
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''AND''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''AND''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg po IV q24h '''''<sup>ɸ<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg po IV q24h '''''<sup>ɸ</sup>
|-
|-
|}
|}
|}
|}
</div></div>
<div class="mw-collapsible mw-collapsed">


====Neisseria meningitidis====
====Neisseria meningitidis====


<div class="mw-collapsible-content">


{|
{|
Line 71: Line 81:
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis  also IM in 1% lidocaine)'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR><BR><BR>
 
▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis  also IM in 1% lidocaine)'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR><BR><BR>
|-
|-
|}
|}
Line 88: Line 96:
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ<sup><BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup><BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h'''''
 
|-
|-
|}
|}
|}
|}


====Listeria Monocytogenes and Streptococcus agalactiae====
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
====Listeria Monocytogenes and Streptococcus agalactiae====
 
<div class="mw-collapsible-content">


{|
{|
Line 104: Line 117:
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)'''''<sup>£<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)'''''<sup>£</sup>
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
Line 117: Line 130:
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)'''''<sup>£<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)'''''<sup>£</sup>
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
Line 127: Line 140:
|}
|}
|}
|}
</div></div>
<div class="mw-collapsible mw-collapsed">


====Haemophilus influenzae====
====Haemophilus influenzae====
<div class="mw-collapsible-content">


{|
{|
Line 142: Line 161:
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis  also IM in 1% lidocaine)'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Aztreonam]] 1 g IV q8h–2 g IV q6h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis  also IM in 1% lidocaine)'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Aztreonam]] 1 g IV q8h–2 g IV q6h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup>
|-
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|β-lactamase negative, ampicillin resistant}}
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|β-lactamase negative, ampicillin resistant}}
Line 152: Line 171:
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolone]]'''''<sup>Δ<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup>
|}
|}
| valign=top |
| valign=top |
Line 164: Line 183:
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup>
|-
|-
|}
|}
|}
|}
</div></div>
<div class="mw-collapsible mw-collapsed">


====Staphylococcus aureus====
====Staphylococcus aureus====
<div class="mw-collapsible-content">


{|
{|
|-
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus aureus}}
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus aureus <BR> Meticillin sensitive}}''
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Meticillin sensitive}}
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
Line 189: Line 213:
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus aureus}}
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus aureus <BR> Meticillin resistant}}<sup>₦</sup>
|-
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Meticillin resistant}}<sup>₦<sup>
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
Line 204: Line 226:
|}
|}


====Staphylococcus epidermidis and Acinetobacter baumannii<sup>Ω<sup>====
</div></div>
 
<div class="mw-collapsible mw-collapsed">
 
====Staphylococcus epidermidis and Acinetobacter baumannii<sup>Ω</sup>====
 
<div class="mw-collapsible-content">


{|
{|
|-
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus epidermidis}}<sup>₦<sup>
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus epidermidis}}<sup>₦</sup>
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
Line 220: Line 249:
|-
|-
|}
|}
{|
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
Line 231: Line 259:
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] <BR>in US:2.5-5 mg/kg/day q6-12h( 6.7-13.3 mg/kg/day of colistimethate sodium (CMS),max 800 mg/day); <BR>Elsewhere: ≤60 kg, 50,000-75,000 IU/kg/day IV q8h (=4-6 mg/kg per day of CMS). >60 kg, 1-2 mill IU IV q8h (= 80-160 mg IV tid).''''' <BR>''OR''<BR>▸ '''''[[Polymyxin B]] 15,000–25,000 units/kg/day q12h<sup>ǂ<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] <BR>in US:2.5-5 mg/kg/day q6-12h( 6.7-13.3 mg/kg/day of colistimethate sodium (CMS),max 800 mg/day); <BR>Elsewhere: ≤60 kg, 50,000-75,000 IU/kg/day IV q8h (=4-6 mg/kg per day of CMS). >60 kg, 1-2 mill IU IV q8h (= 80-160 mg IV tid).''''' <BR>''OR''<BR>▸ '''''[[Polymyxin B]] 15,000–25,000 units/kg/day q12h<sup>ǂ</sup>
|-
|-
|}
|}
|}
|}
</div></div>
<div class="mw-collapsible mw-collapsed">


====Enterobacteriaceae and Pseudomonas aeruginosa====
====Enterobacteriaceae and Pseudomonas aeruginosa====
<div class="mw-collapsible-content">


{|
{|
|-
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em; height: 25em;" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Enterobacteriaceae}}<sup>Ω<sup>
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Enterobacteriaceae}}<sup>Ω</sup>
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis  also IM in 1% lidocaine)'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis  also IM in 1% lidocaine)'''''
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h'''''<BR>''OR''<BR>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h''''' <BR> ''OR'' <BR> ▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup><BR> ''OR'' <BR> ▸ '''''[[Trimethoprim-sulfamethoxazole]] 5–20 mg/kg/day q6-12h''''' <BR> ''OR'' <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> ''OR'' <BR>▸ '''''[[Ampicillin]] 150–200 mg/kg/day IV'''''
▸ '''''[[Fluoroquinolone]]'''''<sup>Δ<sup><BR>''OR''<BR>▸ '''''[[Trimethoprim-sulfamethoxazole]] 5–20 mg/kg/day q6-12h'''''<BR>''OR''<BR>
▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Ampicillin]] 150–200 mg/kg/day IV'''''
|-
|-
|}
|}
{|
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em; height: 25em;" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pseudomonas aeruginosa}}
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pseudomonas aeruginosa}}''
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime ]] 1–2 g IV/IM q8–12h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<sup>£<sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime ]] 1–2 g IV/IM q8–12h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<sup>£</sup>
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Ciprofloxacin]] 500-750 mg po bid'''''<sup>£<sup><BR><BR><BR>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h'''''<BR>''OR''<BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR>''OR''<BR> ▸ '''''[[Ciprofloxacin]] 500-750 mg po bid'''''<sup>£</sup><BR><BR><BR><BR><BR>
|-
|-
|}
|}
|}
|}
<BR><SMALL><sup>†</sup> MIC = minimum inhibitory concentration.‡Addition of rifampicin can be considered if the organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC of the pneumococcal isolate is >4.0 μg/mL organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC.
<sup>Φ</sup> No clinical data exist for use of this agent in patients with pneumococcal meningitis; recommendation is based on cerebrospinal fluid penetration and in-vitro activity against S. pneumoniae.
<sup>£</sup> Addition of an aminoglycoside should be considered; might need intraventricular or intrathecal administration in Gram-negative meningitis.
<sup>ǁ</sup> Addition of rifampicin should be considered.
<sup>Ω</sup> Choice of a specific agent should be based on in-vitro susceptibility testing.
<sup>††</sup> Might also need to be administered by the intraventricular or intrathecal routes.
<sup>ǂ</sup> Might also need to be administered by the intraventricular or intrathecal routes.


<sup>₦</sup> Addition of rifampicin should be considered.


<sup>Δ</sup> The fluoroquinolones gatifloxacin and moxifloxacin pene trate the CSF effectively and have greater in-vitro activity against Gram-positive bacteria than do their earlier counterparts (eg, ciprofloxacin). Findings from experi mental meningitis models suggested their efficacy in S. pneumoniae meningitis, including that caused by penicillin-resistant and cephalosporin-resistant strains. Although one controlled trial suggested the fluoroquinolone trovafl -oxacin mesilate to be as eff  ective as ceftriaxone, with or without the addition of vancomycin, for paediatric bacterial meningitis, no clinical trials describe the use of gatifloxacin or moxifloxacin to treat bacterial meningitis in human beings. Trovafloxacin and gatifloxacin have been asso ciated with serious hepatic toxicity and dysglycaemia, respectively, and were with drawn from many markets. The IDSA guidelines recommend moxifloxacin as an alternative to third-generation cephalosporins plus vancomycin for meningitis caused by S. pneumoniae strains resistant to penicillin and third-generation cephalosporins, although some experts recom mend that this agent should not be used alone but rather should be combined with another drug (either vancomycin or a third-generation cephalosporin), because of the absence of clinical data supporting its use.
</SMALL>


†MIC=minimum inhibitory concentration.‡Addition of rifampicin can be considered if the organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC of the pneumococcal isolate is >4·0 μg/mLorganism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC.ΦNo clinical data exist for use of this agent in patients with pneumococcal
</div></div>
meningitis; recommendation is based on cerebrospinal fl uid penetration and in-vitro activity against S pneumoniae.£Addition of an aminoglycoside should be considered; might need intraventricular or intrathecal administration in Gram-negative meningitis. ||Addition of rifampicin should be considered.Ω Choice of a specifi c agent should be based on in-vitro susceptibility testing. ††Might also need to be administered by the intraventricular or intrathecal routes. ǂ Might also need to be administered by the intraventricular or intrathecal routes. ₦ Addition of rifampicin should be considered.Δ The fluoroquinolones gatifl  oxacin and moxifl  oxacin pene trate the CSF eff  ectively and have greater in-vitro activity against Gram-positive bacteria than do their earlier counterparts (eg, ciprofl oxacin). Findings from experi mental meningitis models suggested their effi  cacy in  S pneumoniae meningitis,
including that caused by penicillin-resistant and cephalosporin-resistant strains. Although one controlled trial suggested the fluoroquinolone trovafl -oxacin mesilate to be as eff  ective as ceftriaxone, with or without the addition of vancomycin, for paediatric bacterial meningitis, no clinical trials describe the use of gatifl oxacin or moxifl  oxacin to treat bacterial meningitis in human beings. Trovafl  oxacin and gatifl oxacin have been asso ciated with serious hepatic toxicity and dysglycaemia, respectively, and were with drawn from many markets.51 The IDSA guidelines recom mend moxifl  oxacin as an alternative to third-generation cephalosporins plus vancomycin for menin-gitis caused by S pneumoniae strains resistant to penicillin and third-generation cephalosporins, although some experts recom mend that this agent should not be used alone but rather should be combined with another drug (either
vancomycin or a third-generation cephalo sporin), because of the absence of clinical data supporting its use.

Latest revision as of 02:50, 27 January 2014

Meningitis Main Page

Patient Information

Overview

Causes

Classification

Viral Meningitis
Bacterial Meningitis
Fungal Meningitis

Differential Diagnosis

Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Streptococcus pneumoniae

Penicillin MIC ≤0.06 μg/mL
Preferred Regimen
Penicillin G Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g)
OR
Ampicillin 150–200 mg/kg IV q3-4h
Alternative Regimen
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR
Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
OR
Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day
Penicillin MIC ≥0.12 μg/mL
Cefotaxime or Ceftriaxone MIC† <1.0 μg/mL
Preferred Regimen
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR
Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
Cefepime 1–2 g IV q12h
OR
Meropenem 2 g IV q8h
Cefotaxime or Ceftriaxone MIC† >1.0 μg/mL
Preferred Regimen
Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
AND
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR
Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
AND
Moxifloxacin 400 mg po IV q24h ɸ

Neisseria meningitidis

Neisseria meningitidis
Penicillin MIC <0.1 μg/mL
Preferred Regimen
Penicillin G Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g)
OR
Ampicillin 0.25–0.5 g po q6h.150–200 mg/kg/day IV
Alternative Regimen
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR
Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
OR
Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day


Neisseria meningitidis
Penicillin MIC ≥0.1 μg/mL
Preferred Regimen
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR
Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
Cefepime 1–2 g IV q12h
OR
Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day
OR
FluoroquinoloneΔ
OR
Meropenem 2 g IV q8h

Listeria Monocytogenes and Streptococcus agalactiae

Listeria Monocytogenes
Preferred Regimen
Ampicillin 0.25–0.5 g po q6h.150–200 mg/kg/day IV
OR
Penicillin G Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)£
Alternative Regimen
Trimethoprim-sulfamethoxazole 5–20 mg/kg/day q6-12h
Streptococcus agalactiae
Preferred Regimen
Ampicillin 0.25–0.5 g po q6h.150–200 mg/kg/day IV
OR
Penicillin G Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)£
Alternative Regimen
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR

Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
OR
Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )

Haemophilus influenzae

Haemophilus influenzae
β-lactamase negative
Preferred Regimen
Ampicillin 0.25–0.5 g po q6h.150–200 mg/kg/day IV
Alternative Regimen
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR
Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
OR
Cefepime 1–2 g IV q12h
OR
Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day
OR
Aztreonam 1 g IV q8h–2 g IV q6h
OR
FluoroquinoloneΔ
β-lactamase negative, ampicillin resistant
Preferred Regimen
Meropenem 2 g IV q8h
Alternative Regimen
FluoroquinoloneΔ
Haemophilus influenzae
β-lactamase positive
Preferred Regimen
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR
Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
Cefepime 1–2 g IV q12h
OR
Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day
OR
Aztreonam 1 g q8h–2 g IV q6h
OR
FluoroquinoloneΔ

Staphylococcus aureus

Staphylococcus aureus
Meticillin sensitive
Preferred Regimen
Nafcillin 1–2 g IV/IM q4h
OR
Oxacillin 1–2 g IV/IM q4h
Alternative Regimen
Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
OR
linezolid 600 mg IV/PO q12h
OR
Daptomycin 6 mg/kg IV q24h
Staphylococcus aureus
Meticillin resistant
Preferred Regimen
Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
Alternative Regimen
Trimethoprim-sulfamethoxazole 5–20 mg/kg/day q6-12h
OR
linezolid 600 mg IV/PO q12h
OR
Daptomycin 6 mg/kg IV q24h


Staphylococcus epidermidis and Acinetobacter baumanniiΩ

Staphylococcus epidermidis
Preferred Regimen
Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
Alternative Regimen
Linezolid 600 mg IV/PO q12h




Acinetobacter baumannii
Preferred Regimen
Meropenem 2 g IV q8h
Alternative Regimen
Colistin
in US:2.5-5 mg/kg/day q6-12h( 6.7-13.3 mg/kg/day of colistimethate sodium (CMS),max 800 mg/day);
Elsewhere: ≤60 kg, 50,000-75,000 IU/kg/day IV q8h (=4-6 mg/kg per day of CMS). >60 kg, 1-2 mill IU IV q8h (= 80-160 mg IV tid).

OR
Polymyxin B 15,000–25,000 units/kg/day q12hǂ

Enterobacteriaceae and Pseudomonas aeruginosa

EnterobacteriaceaeΩ
Preferred Regimen
Cefotaxime 1 g q8–12h to 2 g IV q4h
OR
Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
Aztreonam 1 g q8h–2 g IV q6h
OR
FluoroquinoloneΔ
OR
Trimethoprim-sulfamethoxazole 5–20 mg/kg/day q6-12h
OR
Meropenem 2 g IV q8h
OR
Ampicillin 150–200 mg/kg/day IV
Pseudomonas aeruginosa
Preferred Regimen
Ceftazidime 1–2 g IV/IM q8–12h
OR
Cefepime 1–2 g IV q12h£
Alternative Regimen
Aztreonam 1 g q8h–2 g IV q6h
OR
Meropenem 2 g IV q8h
OR
Ciprofloxacin 500-750 mg po bid£





MIC = minimum inhibitory concentration.‡Addition of rifampicin can be considered if the organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC of the pneumococcal isolate is >4.0 μg/mL organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC.

Φ No clinical data exist for use of this agent in patients with pneumococcal meningitis; recommendation is based on cerebrospinal fluid penetration and in-vitro activity against S. pneumoniae.

£ Addition of an aminoglycoside should be considered; might need intraventricular or intrathecal administration in Gram-negative meningitis.

ǁ Addition of rifampicin should be considered.

Ω Choice of a specific agent should be based on in-vitro susceptibility testing.

†† Might also need to be administered by the intraventricular or intrathecal routes.

ǂ Might also need to be administered by the intraventricular or intrathecal routes.

Addition of rifampicin should be considered.

Δ The fluoroquinolones gatifloxacin and moxifloxacin pene trate the CSF effectively and have greater in-vitro activity against Gram-positive bacteria than do their earlier counterparts (eg, ciprofloxacin). Findings from experi mental meningitis models suggested their efficacy in S. pneumoniae meningitis, including that caused by penicillin-resistant and cephalosporin-resistant strains. Although one controlled trial suggested the fluoroquinolone trovafl -oxacin mesilate to be as eff ective as ceftriaxone, with or without the addition of vancomycin, for paediatric bacterial meningitis, no clinical trials describe the use of gatifloxacin or moxifloxacin to treat bacterial meningitis in human beings. Trovafloxacin and gatifloxacin have been asso ciated with serious hepatic toxicity and dysglycaemia, respectively, and were with drawn from many markets. The IDSA guidelines recommend moxifloxacin as an alternative to third-generation cephalosporins plus vancomycin for meningitis caused by S. pneumoniae strains resistant to penicillin and third-generation cephalosporins, although some experts recom mend that this agent should not be used alone but rather should be combined with another drug (either vancomycin or a third-generation cephalosporin), because of the absence of clinical data supporting its use.