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Revision as of 02:43, 2 May 2015

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

Overview

Acute non-gonococcal septic arthritis is a medical emergency requiring prompt drainage followed by empiric antimicrobial therapy according to patient's history, clinical presentation, and synovial fluid analysis. Vancomycin is recommended as empirical therapy for patients with Gram-positive cocci on a synovial fluid Gram stain or as a component of regimen for those with a negative Gram stain if methicillin-resistant Staphylococcus aureus (MRSA) is prevalent. If Gram-negative bacilli are observed, an anti-pseudomonal cephalosporin (e.g., ceftazidime, cefepime) should be administered. Carbapenems should be considered in conditions such as colonization or infection by extended-spectrum β-lactamase–producing pathogens. Antibiotic regimen may be deescalated as culture results and susceptibility tests permit. The optimal duration of therapy for septic arthritis remains uncertain. A minimum 3- to 4-week course is suggested for septic arthritis caused by S. aureus or Gram-negative bacteria. The use of corticosteroids or intraarticular antibiotics is not advisable.

Medical Therapy

Empiric treatment should be commenced as soon as possible after culture samples have been obtained. The choice of empiric antibiotics should be determined on the basis of:

Gram stain results of synovial fluid analysis
Local prevalence of organisms and resistance patterns
Predisposing factors including intravenous drug use, hospitalization, or colonization of infectious pathogens, and risk for methicillin-resistant Staphylococcus aureus (MRSA)

If the patient fails to respond to initial treatment, consider:

Misidentification of causative pathogen
Infection with atypical pathogen
Concurrent osteomyelitis
Occult nidus of infection

Specific Considerations

Tailoring antibiotic coverage to clinical scenario

Organisms commonly isolated in specific setting:

Neonate

Staphylococcus aureus

Infant < 2 years

Haemophilus influenzae, Staphylococcus aureus

Infant > 2 years

Staphylococcus aureus

Young adults (sexually active)

Neisseria gonorrhoeae

Elderly adults

Staphylococcus aureus, streptococci, Gram-negative bacilli

Post-aspiration or injection

Staphylococcus aureus

Trauma

Gram-negative bacilli, anaerobes, Staphylococcus aureus

Prosthesis

Staphylococcus epidermidis (early infection)

Gram-positive cocci, anaerobes (late infection)

Injecting drug use

Atypical gram-negative bacilli including Pseudomonas

Rheumatoid arthritis

Staphylococcus aureus

Systemic lupus erythematosus

Salmonella

Sickle cell anemia

Salmonella

Hemophilia

Staphylococcus aureus, streptococci, Gram-negative bacilli

Immunosuppression

Staphylococcus aureus, Mycobacterium, fungi

Methicillin-resistant Staphylococcus aureus (MRSA)

Risk factors for septic arthritis caused by methicillin-resistant Staphylococcus aureus (MRSA) include:

Known MRSA colonization or infection
Recent hospitalization
Nursing-home resident
Presence of leg ulcers
Indwelling catheters

Drainage or debridement of the joint space should always be performed in septic arthritis caused by MRSA. A 3- or 4-week course of therapy with vancomycin (15–20 mg/kg/dose IV every 8–12 hours in adults or 15 mg/kg/dose IV every 6 hours in children), daptomycin (6 mg/kg/day IV every 24 hours in adults or 6–10 mg/kg/dose IV every 24 hours in children), linezolid (600 mg PO/IV twice daily in adults or 10 mg/kg/dose PO/IV every 8 hours in children), clindamycin (600 mg PO/IV every 8 hours in adults or 10–13 mg/kg/dose PO/IV every 6–8 hours in children), and trimethoprim-sulfamethoxazole (3.5–4.0 mg/kg/dose PO/IV every 8–12 hours in adults) have been used with success. A prolonged treatment of 4 to 6 weeks may be required if the condition is complicated by osteomyelitis.

Prosthetic joint infection

Management of prosthetic joint infection typically requires both surgical intervention and extended courses of antimicrobial therapy. Options of surgical approach include debridement with retention of prosthesis, two-stage procedure (removal of prosthesis and cement with debridement of infected tissue and placement of a joint spacer, followed by prolonged antibiotics and replacement of prosthesis), one-stage procedure (removal of prosthesis, debridement, and replacement of prosthesis in a single procedure), permanent resection arthroplasty, and amputation. The surgical decision should be made by orthopedic surgeon with specialty consultation, such as infectious disease or plastic surgery as necessary.

Antibiotic selection and duration are determined according to the causative organisms and the surgical intervention performed. Antimicrobial agent should achieve adequate tissue concentrations and be effective against slow-growing organisms and biofilms in conformity with local antibiogram. Liaison with microbiology services is recommended. Empiric antibiotics may be required while culture results are pending and for the duration of treatment for culture-negative infection. MRSA coverage with glycopeptide (e.g., vancomycin, daptomycin) or Gram-negative coverage with ceftriaxone should be considered when necessary. Empiric or pathogen-directed antibiotic therapy is generally instituted following the procedure.

The duration of antibiotic treatment varies depending on the surgical procedure undertaken. A six-week course of parenteral therapy is preferred if an infected prosthesis is retained, while two to four weeks of intravenous antibiotics may be sufficient if revision arthroplasty is performed. Oral antibiotics are commonly prescribed for three to six months in the setting of retained prosthesis compared with six weeks for revision arthroplasty.

Antimicrobial Regimen – Empiric Therapy

Newborn (< 1 week)

High Risk for MRSA

Vancomycin 18 mg/kg/day IV q12h AND
Cefotaxime 50 mg/kg IV q12h

Low Risk for MRSA

Cefotaxime 50 mg/kg IV q12h AND
Nafcillin 25 mg/kg IV q8h OR Oxacillin 25 mg/kg IV q8h

Clindamycin 5 mg/kg IV q8h

Newborn (1–4 weeks)

High Risk for MRSA

Vancomycin 22 mg/kg/day IV q12h AND
Cefotaxime 50 mg/kg IV q8h

Low Risk for MRSA

Cefotaxime 50 mg/kg IV q8h AND
Nafcillin 37 mg/kg IV q6h OR Oxacillin 37 mg/kg IV q6h

Clindamycin 5 mg/kg IV q6h

Infants (1–3 months)

High Risk for MRSA

Vancomycin 40 mg/kg/day IV q6–8h AND
Cefotaxime 50 mg/kg IV q8h

Low Risk for MRSA

Cefotaxime 50 mg/kg IV q8h AND
Nafcillin 37 mg/kg IV q6h OR Oxacillin 37 mg/kg IV q6h

Clindamycin 7.5 mg/kg IV q6h

Children (3 months–14 years)

Vancomycin 40 mg/kg/day IV q6–8h AND
Cefotaxime 50 mg/kg IV q8h

Adults (Monoarticular)

At risk for sexually-transmitted disease

Ceftriaxone 1 g IV q24h OR Cefotaxime 1 g IV q8h OR Ceftizoxime 1 g IV q8h

Vancomycin 1 g IV q12h

Not at risk for sexually-transmitted disease

Vancomycin 1 g IV q12h AND
Ceftriaxone 1 g IV q24h OR Cefotaxime 1 g IV q8h OR Ceftizoxime 1 g IV q8h

Vancomycin 1 g IV q12h AND
Ciprofloxacin 400 mg IV q12h OR Levofloxacin 750 mg IV q 24 h

Adults (Polyarticular)

Ceftriaxone 1 g IV q24h

Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy

Negative Gram stain

Vancomycin 15–20 mg/kg q8–12h AND
Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q8–12h

Daptomycin 6-8 mg/kg IV q24h OR Linezolid 600 mg IV/PO q12h AND
Piperacillin-Tazobactam 4.5 g IV q6h OR Aztreonam 2 g IV q8h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h OR Doripenem 500 mg IV q8h OR Carbapenems

Gram-positive cocci

Vancomycin 15–20 mg/kg q8–12h

Daptomycin 6-8 mg/kg IV q24h OR Linezolid 600 mg IV/PO q12h

Gram-negative cocci

Ceftriaxone 1 g IV q24h OR Cefotaxime 1 g IV q8h

Gram-negative bacilli

Ceftazidime 2 g IV q8h OR Cefepime 2 g IV q8–12h OR Piperacillin-Tazobactam 4.5 g IV q6h

Aztreonam 2 g IV q8h OR Imipenem 500 mg IV q6h OR Meropenem 1 g IV q8h OR Doripenem 500 mg IV q8h OR Carbapenems

Antimicrobial Regimen – Pathogen-Based Therapy

Bacteroides fragilis

Clindamycin 900 mg IV/IM q8h OR Metronidazole 500 mg IV q8

Ampicillin-Sulbactam 3 g IV q6h OR Ticarcillin-Clavulanate 3.1 g IV q4–6h

Brucella melitensis

Doxycycline 100 mg PO bid for ≥ 6 weeks AND
Streptomycin 15 mg/kg IM qd for 2–3 weeks OR Rifampin 600–900 mg qd for ≥ 6 weeks

Doxycycline 100 mg PO bid for ≥ 6 weeks AND
Gentamicin 5 mg/kg IV qd for 7 days

Enterococcus

Ampicillin 2 g IV q6h OR Vancomycin 1 g IV q12h

Ampicillin-Sulbactam 3 g IV q6h OR Linezolid 600 mg PO/IV q12h

Escherichia coli

Ampicillin-Sulbactam 3 g IV q6h

Cefazolin 0.25–1 g IV/IM q6–8h OR Levofloxacin 500–750 mg IV/PO q24h OR Gentamicin 3–5 mg/kg/day IV q6–8h OR TMP-SMX 8–10 mg/kg/day IV/PO q6–12h (TMP component)

Haemophilus influenzae

Amoxicillin-Clavulanate 875/125 mg PO q12h OR Cefprozil 500 mg PO q12h OR Cefuroxime 500 mg PO q12h OR Cefdinir 600 mg PO q24h

Levofloxacin 750 mg IV/PO q24h OR Moxifloxacin 400 mg IV/PO q24h OR Clarithromycin 500 mg PO q12h

Morganella morganii

Cefotaxime 2 g IV q6h OR Imipenem 500 mg IV q6h OR Levofloxacin 500 mg IV/PO q24h

Gentamicin 3–5 mg/kg/day IV q6–8h OR Ticarcillin-Clavulanate 3.1 g IV q4–6h

Neisseria gonorrhoeae

Ceftriaxone 2 g IV q24h OR Cefotaxime 1 g IV q8h

Levofloxacin 500 mg IV/PO q24h OR Ampicillin 2 g IV q6h

Proteus mirabilis

Ampicillin 2 g IV q6h OR Levofloxacin 500 mg IV/PO q24h

Cefazolin 0.25–1 g IV/IM q6–8h OR Gentamicin 3–5 mg/kg/day IV q6–8h OR TMP-SMX 8–10 mg/kg/day IV/PO q6–12h (TMP component)

Proteus vulgaris or Proteus rettgeri

Cefotaxime 2 g IV q6h OR Imipenem 500 mg IV q6h OR Levofloxacin 500 mg IV/PO q24h

Gentamicin 3–5 mg/kg/day IV q6–8h OR Ticarcillin-Clavulanate 3.1 g IV q4–6h

Pseudomonas aeruginosa

Cefepime 2 g IV q12h OR Piperacillin 3–4 g IV q4–6h OR Imipenem 500 mg IV q6h

Ticarcillin-Clavulanate 3.1 g IV q4–6h OR Tobramycin 3-5 mg/kg/day IV q6–8h OR Amikacin 15 mg/kg/day IV/IM q8–12h OR Ciprofloxacin 400 mg IV q8–12h

Serratia marcescens

Cefotaxime 2 g IV q6h

Levofloxacin 500 mg IV/PO q24h OR Gentamicin 3–5 mg/kg/day IV q6–8h OR Imipenem 500 mg IV q6h

Staphylococcus aureus (methicillin-resistant)

Vancomycin 15–20 mg/kg IV q8–12h in adults or 15 mg/kg IV q6h in children

Daptomycin 6 mg/kg IV q24h in adults or 6–10 mg/kg IV q24h in children OR Linezolid 600 mg PO/IV q12h in adults or 10 mg/kg PO/IV q8h in children OR Clindamycin 600 mg PO/IV q8h in adults or 10–13 mg/kg/dose PO/IV q6–8h in children OR TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h in adults

Staphylococcus aureus (methicillin-susceptible)

Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV q8h

Cefazolin 0.25–1 g IV/IM q6–8h OR Vancomycin 500 mg IV q6h or 1 g IV q12h

Staphylococcus epidermidis (methicillin-resistant)

Vancomycin 500 mg IV q6h or 1 g IV q12h OR Linezolid 600 mg IV q12h

TMP-SMX 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) OR Minocycline 200 mg PO x 1 dose, then 100 mg PO q12h AND
Rifampin 300–600 mg PO/IV q12h

Staphylococcus aureus (methicillin-susceptible)

Nafcillin 2 g IV q6h OR Clindamycin 900 mg IV/IM q8h

Cefazolin 0.25–1 g IV/IM q6–8h OR Vancomycin 500 mg IV q6h or 1 g IV q12h

Streptococcus agalactiae

Penicillin G 2 MU IV/IM q4h OR Ampicillin 2 g IV q6h

Clindamycin 600–1200 mg/day IV/IM q6–12h OR Cefazolin 0.25–1 g IV/IM q6–8h

Streptococcus pyogenes

Penicillin G 2 MU IV/IM q4h OR Ampicillin 2 g IV q6h

Clindamycin 600–1200 mg/day IV/IM q6–12h OR Cefazolin 0.25–1 g IV/IM q6–8h

Tropheryma whipplei

Penicillin G 2 MU IV q4h for 2 weeks AND
Streptomycin 1 g IM/IV q24h for 2 weeks, then TMP-SMX 160mg/800mg PO q24h for 1 year

Ceftriaxone 2 g IV q24h, then TMP-SMX 160mg/800mg PO q24h for 1 year

Borrelia burgdorferi

Amoxicillin 500 mg q8h for 28 days OR Doxycycline 100 mg q12h for 28 days OR Cefuroxime 500 mg q12h for 28 days

Azithromycin 500 mg PO q24h for 7–10 days OR Clarithromycin 500 mg PO q12h for 14–21 days OR Erythromycin 500 mg PO q6h for 14–21 days

Treponema pallidum

Cefotaxime 2 g IV q6h

Levofloxacin 500 mg IV/PO q24h OR Gentamicin 3–5 mg/kg/day IV q6–8h OR Imipenem 500 mg IV q6h

Mycobacterium tuberculosis

Cefotaxime 2 g IV q6h

Levofloxacin 500 mg IV/PO q24h OR Gentamicin 3–5 mg/kg/day IV q6–8h OR Imipenem 500 mg IV q6h

@@ Line 1: / Line 1: @@
-__NOTOC__
+__NOTOC____NOEDITSECTION__
 {{Septic arthritis}}
-{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{AL}}; Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}
+{{CMG}}
 ==Overview==
-The treatment for septic arthritis requires an adequate drainage of the joint fluid and appropriate antibiotic therapy.
+Acute non-[[gonococcal]] septic arthritis is a medical emergency requiring prompt drainage followed by empiric antimicrobial therapy according to patient's history, clinical presentation, and [[synovial fluid]] analysis.  '''[[Vancomycin]]''' is recommended as empirical therapy for patients with [[Gram-positive cocci]] on a [[synovial fluid]] [[Gram stain]] or as a component of regimen for those with a negative [[Gram stain]] if [[MRSA|methicillin-resistant ''Staphylococcus aureus'' (MRSA)]] is prevalent.  If [[Gram-negative bacilli]] are observed, an anti-[[pseudomonal]] [[cephalosporin]] (e.g., '''[[ceftazidime]]''', '''[[cefepime]]''') should be administered.  '''[[Carbapenems]]''' should be considered in conditions such as colonization or infection by [[ESBL|extended-spectrum β-lactamase]]–producing pathogens.  [[Antibiotic]] regimen may be deescalated as culture results and susceptibility tests permit.  The optimal duration of therapy for septic arthritis remains uncertain.  A minimum 3- to 4-week course is suggested for septic arthritis caused by ''[[S. aureus]]'' or [[Gram-negative bacteria]].  The use of [[corticosteroids]] or intraarticular [[antibiotics]] is not advisable.
-Empiric therapy should be started after the collection joint fluid and blood sample for culture.
-There are no indications for intra-articular antibiotic therapy.
 ==Medical Therapy==
-Antibiotics are used to treat the infection and most of them achieve excellent bactericidal concentrations in the synovial fluid. The initial therapy depends on the clinical presentation, whether the patient is at risk for a Gonoccocal infection or not, and Gram stain of joint aspiration. The final therapy depends on the culture and sensitivity results. During the acute phase of the disease is important to keep the the joint still and raised, and the patient need to rest. Using cool compresses may help relieve pain. After the acute phase, exercise and physical therapy is important for the recovery process.  Severe cases may need surgery to drain the infected joint fluid.
+Empiric treatment should be commenced as soon as possible after culture samples have been obtained.  The choice of empiric antibiotics should be determined on the basis of:
+* [[Gram stain]] results of [[synovial fluid]] analysis
+* Local prevalence of organisms and resistance patterns
+* Predisposing factors including intravenous drug use, hospitalization, or colonization of infectious pathogens, and risk for [[MRSA|methicillin-resistant ''Staphylococcus aureus'' (MRSA)]]
-====Duration of Antimicrobial Therapy====
+If the patient fails to respond to initial treatment, consider:
-* The duration of antimicrobial therapy should be individualized in accordance with patient's clinical response.
+* Misidentification of causative pathogen
+* Infection with atypical pathogen
+* Concurrent [[osteomyelitis]]
+* Occult nidus of infection
-{| style="border: 2px solid #696969;"
+===Specific Considerations===
-|+ <SMALL>''Recommended Duration of Antimicrobial Therapy Based on Isolated Pathogen.''</SMALL>
-| style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 400px; color: #F8F8FF;"| '''''Microorganism''''' || style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 400px; color: #F8F8FF;" | '''Duration of Therapy'''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Staphylococcus aureus]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 3–4 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Streptococcus|Streptococcus groups A, B, C, G]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 3–4 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Gram-negative bacilli]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 4 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Brucella]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 6 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Borrelia burgdorferi]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 30 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Mycobacterium tuberculosis]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 9 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Candida albicans]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 6 weeks'''''
-|-
-|}
-<br>
-{| style="border: 2px solid #696969;"
+===Tailoring antibiotic coverage to clinical scenario===
-| style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 400px; color: #F8F8FF;"| '''''Special cases''''' || style="background: #545454; border: 0px solid #696969; padding: 0 5px; width: 400px; color: #F8F8FF;" | '''Duration of Therapy'''
+Organisms commonly isolated in specific setting:
-|-
+* Neonate
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''Prosthetic joint infection''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ''''' 6 weeks'''''
+: ''[[Staphylococcus aureus]]''
-|-
+* Infant &lt; 2 years
-| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''Post-intraarticular injection or post-arthroscopy infection''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |  '''''14 days'''''
+: [[Haemophilus influenzae]], ''[[Staphylococcus aureus]]''
-|-
+* Infant &gt; 2 years
-|}
+: ''[[Staphylococcus aureus]]''
+* Young adults (sexually active)
+: ''[[Neisseria gonorrhoeae]]''
+* Elderly adults
+: ''[[Staphylococcus aureus]]'', [[streptococci]], [[Gram-negative bacilli]]
+* Post-aspiration or injection
+: ''[[Staphylococcus aureus]]''
+* Trauma
+: [[Gram-negative bacilli]], [[anaerobes]], ''[[Staphylococcus aureus]]''
+* Prosthesis
+: ''[[Staphylococcus epidermidis]]'' (early infection)
+: [[Gram-positive cocci]], [[anaerobes]] (late infection)
+* Injecting drug use
+: Atypical [[gram-negative bacilli]] including [[Pseudomonas]]
+* Rheumatoid arthritis
+: ''[[Staphylococcus aureus]]''
+* Systemic lupus erythematosus
+: [[Salmonella]]
+* Sickle cell anemia
+: [[Salmonella]]
+* Hemophilia
-==Empiric Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Lancet 375:846, 2010.<ref name="Mathews-2010">{{Cite journal  | last1 = Mathews | first1 = CJ. | last2 = Weston | first2 = VC. | last3 = Jones | first3 = A. | last4 = Field | first4 = M. | last5 = Coakley | first5 = G. | title = Bacterial septic arthritis in adults. | journal = Lancet | volume = 375 | issue = 9717 | pages = 846-55 | month = Mar | year = 2010 | doi = 10.1016/S0140-6736(09)61595-6 | PMID = 20206778 }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
+: ''[[Staphylococcus aureus]]'', [[streptococci]], [[Gram-negative bacilli]]
+* Immunosuppression
+: ''[[Staphylococcus aureus]]'', [[Mycobacterium]], [[fungi]]
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
+====Methicillin-resistant ''Staphylococcus aureus'' (MRSA)====
+Risk factors for septic arthritis caused by methicillin-resistant Staphylococcus aureus (MRSA) include:
+* Known MRSA colonization or infection
+* Recent hospitalization
+* Nursing-home resident
+* Presence of leg ulcers
+* Indwelling catheters
-{|
+Drainage or [[debridement]] of the joint space should always be performed in septic arthritis caused by [[MRSA]].  A 3- or 4-week course of therapy with '''[[vancomycin]]''' (15–20 mg/kg/dose IV every 8–12 hours in adults or 15 mg/kg/dose IV every 6 hours in children), '''[[daptomycin]]''' (6 mg/kg/day IV every 24 hours in adults or 6–10 mg/kg/dose IV every 24 hours in children), '''[[linezolid]]''' (600 mg PO/IV twice daily in adults or 10 mg/kg/dose PO/IV every 8 hours in children), '''[[clindamycin]]''' (600 mg PO/IV every 8 hours in adults or 10–13 mg/kg/dose PO/IV every 6–8 hours in children), and '''[[trimethoprim-sulfamethoxazole]]''' (3.5–4.0 mg/kg/dose PO/IV every 8–12 hours in adults) have been used with success.  A prolonged treatment of 4 to 6 weeks may be required if the condition is complicated by [[osteomyelitis]].
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-&nbsp;&nbsp;&nbsp;&nbsp;'''Pediatric'''
-</font>
-</div>
-<div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+===Prosthetic joint infection===
-<font color="#FFF">
+Management of prosthetic joint infection typically requires both surgical intervention and extended courses of antimicrobial therapy.  Options of surgical approach include debridement with retention of [[prosthesis]], two-stage procedure (removal of [[prosthesis]] and cement with [[debridement]] of infected tissue and placement of a joint spacer, followed by prolonged [[antibiotics]] and replacement of [[prosthesis]]), one-stage procedure (removal of [[prosthesis]], [[debridement]], and replacement of [[prosthesis]] in a single procedure), permanent resection [[arthroplasty]], and [[amputation]].  The surgical decision should be made by orthopedic surgeon with specialty consultation, such as infectious disease or plastic surgery as necessary.
-&nbsp;&nbsp;&nbsp;&nbsp;'''''Newborns (< 1 week)'''''
-</font>
-</div>
-<div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+Antibiotic selection and duration are determined according to the causative organisms and the surgical intervention performed.  Antimicrobial agent should achieve adequate tissue concentrations and be effective against slow-growing organisms and [[biofilms]]  in conformity with local antibiogram.  Liaison with microbiology services is recommended.  Empiric antibiotics may be required while culture results are pending and for the duration of treatment for culture-negative infection.  [[MRSA]] coverage with [[glycopeptide]] (e.g., [[vancomycin]], [[daptomycin]]) or [[Gram-negative]] coverage with [[ceftriaxone]] should be considered when necessary.  Empiric or pathogen-directed antibiotic therapy is generally instituted following the procedure.
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Newborns (1 -4 week)'''''
-</font>
-</div>
-<div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+The duration of antibiotic treatment varies depending on the surgical procedure undertaken.  A six-week course of parenteral therapy is preferred if an infected [[prosthesis]] is retained, while two to four weeks of intravenous antibiotics may be sufficient if revision [[arthroplasty]] is performed.  Oral antibiotics are commonly prescribed for three to six months in the setting of retained [[prosthesis]] compared with six weeks for revision [[arthroplasty]].
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Infants (1 - 3 months)'''''
-</font>
-</div>
-<div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+==Antimicrobial Regimen – Empiric Therapy==
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Children (3 mo - 14 yr) '''''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+===Newborn (&lt; 1 week)===
-<font color="#FFF">
-&nbsp;&nbsp;&nbsp;&nbsp;'''Adults'''
-</font>
-</div>
-<div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====High Risk for MRSA====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Acute Monoarticular'''''
+* [[Vancomycin]] 18 mg/kg/day IV q12h {{and}}
-</font>
+* [[Cefotaxime]] 50 mg/kg IV q12h
-</div>
+</li>
-<div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Low Risk for MRSA====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Chronic Monoarticular'''''
+* [[Cefotaxime]] 50 mg/kg IV q12h {{and}}
-</font>
+* [[Nafcillin]] 25 mg/kg IV q8h {{or}} [[Oxacillin]] 25 mg/kg IV q8h
-</div>
+</li>
+{{rx|Alternative Regimen}}
+* [[Clindamycin]] 5 mg/kg IV q8h
+</li>
-<div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+===Newborn (1–4 weeks)===
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Polyarticular'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
+====High Risk for MRSA====
-| valign=top |
+{{rx|Preferred Regimen}}
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Vancomycin]] 22 mg/kg/day IV q12h {{and}}
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Newborn (< 1 week) ''}}
+* [[Cefotaxime]] 50 mg/kg IV q8h
-|-
+</li>
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | High suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 18 mg/kg IV divided q12h '''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Low suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 25 mg/kg q8h''''' <br> OR <br> ▸ '''''[[Oxacillin]] 25 mg/kg q8h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (For low suspicion of MRSA)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 5mg/kg q8h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
+====Low Risk for MRSA====
-| valign=top |
+{{rx|Preferred Regimen}}
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Newborn (1 - 4 weeks)''}}
+* [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
-|-
+</li>
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
+{{rx|Alternative Regimen}}
-|-
+* [[Clindamycin]] 5 mg/kg IV q6h
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | High suspicion of MRSA
+</li>
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 22 mg/kg q12h '''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Low suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 37 mg/kg q6h '''''<br> OR <br> ▸ '''''[[Oxacillin]] 37 mg/kg q6h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (For low suspicion of MRSA)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 5mg/kg q6h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
+===Infants (1–3 months)===
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Infants (1- 3 months) ''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | High suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg/day divided q6-8h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Low suspicion of MRSA
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 37 mg/kg q6h (max 8-12 g/day)'''''  <br> OR <br> ▸ '''''[[Oxacillin]] 37 mg/kg q6h (max 8-12 g/day)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[ Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (For low suspicion of MRSA)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 7.5mg/kg q6h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
+====High Risk for MRSA====
-| valign=top |
+{{rx|Preferred Regimen}}
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Children (3 mo - 14 yr)''}}
+* [[Cefotaxime]] 50 mg/kg IV q8h
-|-
+</li>
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 40 mg/kg/day IV q6-8h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 50 mg/kg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 10 mg/kg IV q8h''''' <br> OR <br>▸ ''''' [[Clindamycin]] 7.5 mg/kg IV q6h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 30 mg/kg IV q6h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+====Low Risk for MRSA====
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Acute Monoarticular''}}
+{{rx|Preferred Regimen}}
-|-
+* [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
+* [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
-|-
+</li>
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | At risk for Gonococcal infection
+{{rx|Alternative Regimen}}
-|-
+* [[Clindamycin]] 7.5 mg/kg IV q6h
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV q24h''''' <BR> OR <BR> ▸ '''''[[Cefotaxime]] 1 g IV q8h''''' <BR> OR <BR> ▸ '''''[[Ceftizoxime]] 1 g IV q8h'''''
+</li>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Not at risk for Gonococcal infection
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1g IV q24h''''' <br> OR <br> ▸ '''''[[Cefepime]] 2g IV q8h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (If not at risk for Gonococcal infection)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h <br> OR <br>▸ '''''[[Levofloxacin ]] 750 mg IV q24h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
+===Children (3 months–14 years)===
-| valign=top |
+{{rx|Preferred Regimen}}
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
+* [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Chronic Monoarticular''}}
+* [[Cefotaxime]] 50 mg/kg IV q8h
-|-
+</li>
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center |  Empirical therapy is not recommended. <br> Treatment should be addressed for the specific etiology
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Polyarticular''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 gm IV q24h'''''
-|-
-|}
-|}
-|}
-==Synovial Fluid Gram Stain-Based Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases<ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = | pages = }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
+===Adults (Monoarticular)===
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
+====At risk for sexually-transmitted disease====
+{{rx|Preferred Regimen}}
+* [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
+</li>
+{{rx|Alternative Regimen}}
+* [[Vancomycin]] 1 g IV q12h
+</li>
-{|
+====Not at risk for sexually-transmitted disease====
-| valign=top |
+{{rx|Preferred Regimen}}
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+* [[Vancomycin]] 1 g IV q12h {{and}}
-<font color="#FFF">
+* [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
-'''Gram-Positive'''
+</li>
-</font>
+{{rx|Alternative Regimen}}
-</div>
+* [[Vancomycin]] 1 g IV q12h {{and}}
+* [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q 24 h
+</li>
-<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+===Adults (Polyarticular)===
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Cocci'''
+* [[Ceftriaxone]] 1 g IV q24h
-</font>
+</li>
-</div>
-<div class="mw-customtoggle-table50" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+==Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy==
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Bacilli'''
-</font>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+===Negative Gram stain===
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-'''Gram-Negative'''
+* [[Vancomycin]] 15–20 mg/kg q8–12h {{and}}
-</font>
+* [[Ceftazidime]] 2 g IV q8h {{or}} [[Cefepime]] 2 g IV q8–12h
-</div>
+</li>
+{{rx|Alternative Regimen}}
+* [[Daptomycin]] 6-8 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV/PO q12h {{and}}
+* [[Piperacillin-Tazobactam]] 4.5 g IV q6h {{or}} [[Aztreonam]] 2 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Carbapenems]]
+</li>
-<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+===Gram-positive cocci===
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Cocci'''
+* [[Vancomycin]] 15–20 mg/kg q8–12h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Daptomycin]] 6-8 mg/kg IV q24h {{or}} [[Linezolid]] 600 mg IV/PO q12h
+</li>
-<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+===Gram-negative cocci===
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Rods'''
+* [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h
-</font>
+</li>
-</div>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+===Gram-negative bacilli===
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-'''Negative Gram Stain'''
+* [[Ceftazidime]] 2 g IV q8h {{or}} [[Cefepime]] 2 g IV q8–12h {{or}} [[Piperacillin-Tazobactam]] 4.5 g IV q6h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Aztreonam]] 2 g IV q8h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Meropenem]] 1 g IV q8h {{or}} [[Doripenem]] 500 mg IV q8h {{or}} [[Carbapenems]]
+</li>
-<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+==Antimicrobial Regimen – Pathogen-Based Therapy==
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''Negative Gram Stain'''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive Cocci}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen <br> (For patients allergic to vancomycin)
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg PO/IV q12h '''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table50" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive Bacilli}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 2 MU IV q4h '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL><BR> OR <BR> ▸ '''''[[Nafcillin]] 1.5-2 g IV q4h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Cocci}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV q24h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Rods}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2g IV q12h'''''<BR> OR <BR>
-▸ '''''[[Piperacillin-tazobactam]] 4.5 g q6h ''''' <BR> OR <BR> ▸ '''''[[Imipenem]] 500 mg IV q6h''''' <BR> OR <BR> ▸ '''''[[Meropenem]] 1 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen (For patients allergic to cephalosporins)<br>
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g q8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Negative Gram Stain}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8—12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Ceftazidime]] 2 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 750 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h''''' <BR> OR <BR> ▸ '''''[[Tobramycin]] 300mg q12h'''''<BR> OR <BR> ▸ '''''[[Gentamycin]] 5-7 mg/kg once daily or 5 mg/kg divided in 3 doses/day'''''
-|-
-|}
-|}
-|}
-==Pathogen-Based Therapy — Bacteria <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2010;375(9717):846-55.''<ref name="pmid20206778">{{cite journal| author=Mathews CJ, Weston VC, Jones A, Field M, Coakley G| title=Bacterial septic arthritis in adults. | journal=Lancet | year= 2010 | volume= 375 | issue= 9717 | pages= 846-55 | pmid=20206778 | doi=10.1016/S0140-6736(09)61595-6 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20206778  }} </ref> and ''Clin Microbiol Rev. 2002;15(4):527-44.''<ref name="pmid12364368">{{cite journal| author=Shirtliff ME, Mader JT| title=Acute septic arthritis. | journal=Clin Microbiol Rev | year= 2002 | volume= 15 | issue= 4 | pages= 527-44 | pmid=12364368 | doi= | pmc=PMC126863 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12364368  }} </ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
+====Bacteroides fragilis====
+{{rx|Preferred Regimen}}
+* [[Clindamycin]] 900 mg IV/IM q8h {{or}} [[Metronidazole]] 500 mg IV q8
+</li>
+{{rx|Alternative Regimen}}
+* [[Ampicillin-Sulbactam]] 3 g IV q6h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h
+</li>
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
+====Brucella melitensis====
+{{rx|Preferred Regimen}}
+* [[Doxycycline]] 100 mg PO bid for ≥ 6 weeks {{and}}
+* [[Streptomycin]] 15 mg/kg IM qd for 2–3 weeks {{or}} [[Rifampin]] 600–900 mg qd for ≥ 6 weeks
+</li>
+{{rx|Alternative Regimen}}
+* [[Doxycycline]] 100 mg PO bid for ≥ 6 weeks {{and}}
+* [[Gentamicin]] 5 mg/kg IV qd for 7 days
+</li>
-{|
+====Enterococcus====
-| valign=top |
+{{rx|Preferred Regimen}}
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+* [[Ampicillin]] 2 g IV q6h {{or}} [[Vancomycin]] 1 g IV q12h
-<font color="#FFF">
+</li>
-'''Bacteria'''
+{{rx|Alternative Regimen}}
-</font>
+* [[Ampicillin-Sulbactam]] 3 g IV q6h {{or}} [[Linezolid]] 600 mg PO/IV q12h
-</div>
+</li>
-<div class="mw-customtoggle-table001" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Escherichia coli====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Bacteroides fragilis'''''
+* [[Ampicillin-Sulbactam]] 3 g IV q6h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h {{or}} [[Levofloxacin]] 500–750 mg IV/PO q24h {{or}} [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[TMP-SMX]] 8–10 mg/kg/day IV/PO q6–12h (TMP component)
-<div class="mw-customtoggle-table00" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+</li>
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Brucella melitensis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table24" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Haemophilus influenzae====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterococcus spp.'''''
+* [[Amoxicillin-Clavulanate]] 875/125 mg PO q12h {{or}} [[Cefprozil]] 500 mg PO q12h {{or}} [[Cefuroxime]] 500 mg PO q12h {{or}} [[Cefdinir]] 600 mg PO q24h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Levofloxacin]] 750 mg IV/PO q24h {{or}} [[Moxifloxacin]] 400 mg IV/PO q24h {{or}} [[Clarithromycin]] 500 mg PO q12h
+</li>
-<div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Morganella morganii====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Escherichia coli'''''
+* [[Cefotaxime]] 2 g IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Levofloxacin]] 500 mg IV/PO q24h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h
+</li>
-<div class="mw-customtoggle-table19" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Neisseria gonorrhoeae====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Haemophilus influenzae'''''
+* [[Ceftriaxone]] 2 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Levofloxacin]] 500 mg IV/PO q24h {{or}} [[Ampicillin]] 2 g IV q6h
+</li>
-<div class="mw-customtoggle-table002" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Proteus mirabilis====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Morganella morganii'''''
+* [[Ampicillin ]] 2 g IV q6h {{or}} [[Levofloxacin]] 500 mg IV/PO q24h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h {{or}} [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[TMP-SMX]] 8–10 mg/kg/day IV/PO q6–12h (TMP component)
+</li>
-<div class="mw-customtoggle-table18" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Proteus vulgaris or Proteus rettgeri====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Neisseria gonorrhoeae'''''
+* [[Cefotaxime]] 2 g IV q6h {{or}} [[Imipenem]] 500 mg IV q6h {{or}} [[Levofloxacin]] 500 mg IV/PO q24h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h
+</li>
-<div class="mw-customtoggle-table25" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Pseudomonas aeruginosa====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Proteus mirabilis'''''
+* [[Cefepime]] 2 g IV q12h  {{or}} [[Piperacillin]] 3–4 g IV q4–6h {{or}} [[Imipenem]] 500 mg IV q6h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Ticarcillin-Clavulanate]] 3.1 g IV q4–6h {{or}} [[Tobramycin]] 3-5 mg/kg/day IV q6–8h {{or}} [[Amikacin]] 15 mg/kg/day IV/IM q8–12h {{or}} [[Ciprofloxacin]] 400 mg IV q8–12h
+</li>
-<div class="mw-customtoggle-table003" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Serratia marcescens====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Proteus vulgaris, Proteus rettgeri'''''
+* [[Cefotaxime]] 2 g IV q6h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Levofloxacin]] 500 mg IV/PO q24h {{or}} [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[Imipenem]] 500 mg IV q6h
+</li>
-<div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Staphylococcus aureus (methicillin-resistant)====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Pseudomonas aeruginosa'''''
+* [[Vancomycin]] 15–20 mg/kg IV q8–12h in adults or 15 mg/kg IV q6h in children
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Daptomycin]] 6 mg/kg IV q24h in adults or 6–10 mg/kg IV q24h in children {{or}} [[Linezolid]] 600 mg PO/IV q12h in adults or 10 mg/kg PO/IV q8h in children {{or}} [[Clindamycin]] 600 mg PO/IV q8h in adults or 10–13 mg/kg/dose PO/IV q6–8h in children {{or}} [[TMP-SMX]] 3.5–4.0 mg/kg PO/IV q8–12h in adults
+</li>
-<div class="mw-customtoggle-table004" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Staphylococcus aureus (methicillin-susceptible)====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Serratia marcescens'''''
+* [[Nafcillin]] 2 g IV q6h {{or}} [[Clindamycin]] 900 mg IV q8h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h {{or}} [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
+</li>
-<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Staphylococcus epidermidis (methicillin-resistant)====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococcus aureus'''''
+* [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h {{or}} [[Linezolid]] 600 mg IV q12h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[TMP-SMX]] 3.5–4.0 mg/kg PO/IV q8–12h (TMP component) {{or}} [[Minocycline]] 200 mg PO x 1 dose, then 100 mg PO q12h {{and}}
+* [[Rifampin]] 300–600 mg PO/IV q12h
+</li>
-<div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Staphylococcus aureus (methicillin-susceptible)====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococcus epidermidis'''''
+* [[Nafcillin]] 2 g IV q6h {{or}} [[Clindamycin]] 900 mg IV/IM q8h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Cefazolin]] 0.25–1 g IV/IM q6–8h {{or}} [[Vancomycin]] 500 mg IV q6h or 1 g IV q12h
+</li>
-<div class="mw-customtoggle-table15a" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Streptococcus agalactiae====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Streptococcus agalactiae'''''
+* [[Penicillin G]] 2 MU IV/IM q4h {{or}} [[Ampicillin]] 2 g IV q6h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h {{or}} [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+</li>
-<div class="mw-customtoggle-table15b" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Streptococcus pyogenes====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Streptococcus pyogenes'''''
+* [[Penicillin G]] 2 MU IV/IM q4h {{or}} [[Ampicillin]] 2 g IV q6h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Clindamycin]] 600–1200 mg/day IV/IM q6–12h {{or}} [[Cefazolin]] 0.25–1 g IV/IM q6–8h
+</li>
-<div class="mw-customtoggle-table23" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Tropheryma whipplei====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Tropheryma whipplei'''''
+* [[Penicillin G]] 2 MU IV q4h for 2 weeks {{and}}
-</font>
+* [[Streptomycin]] 1 g IM/IV q24h for 2 weeks, then [[TMP-SMX]] 160mg/800mg PO q24h for 1 year
-</div>
+</li>
+{{rx|Alternative Regimen}}
+* [[Ceftriaxone]] 2 g IV q24h, then [[TMP-SMX]] 160mg/800mg PO q24h for 1 year
+</li>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+====Borrelia burgdorferi====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-'''Mycobacteria'''
+* [[Amoxicillin]] 500 mg q8h for 28 days {{or}} [[Doxycycline]] 100 mg q12h for 28 days {{or}} [[Cefuroxime]] 500 mg q12h for 28 days
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Azithromycin]] 500 mg PO q24h for 7–10 days {{or}} [[Clarithromycin]] 500 mg PO q12h for 14–21 days {{or}} [[Erythromycin]] 500 mg PO q6h for 14–21 days
+</li>
-<div class="mw-customtoggle-table20" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+====Treponema pallidum====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Mycobacterium tuberculosis'''''
+* [[Cefotaxime]] 2 g IV q6h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Levofloxacin]] 500 mg IV/PO q24h {{or}} [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[Imipenem]] 500 mg IV q6h
+</li>
-<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
+====Mycobacterium tuberculosis====
-<font color="#FFF">
+{{rx|Preferred Regimen}}
-'''Spirochetes'''
+* [[Cefotaxime]] 2 g IV q6h
-</font>
+</li>
-</div>
+{{rx|Alternative Regimen}}
+* [[Levofloxacin]] 500 mg IV/PO q24h {{or}} [[Gentamicin]] 3–5 mg/kg/day IV q6–8h {{or}} [[Imipenem]] 500 mg IV q6h
-<div class="mw-customtoggle-table21" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
+</li>
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Borrelia burgdorferi'''''
-</font>
-</div>
-<div class="mw-customtoggle-table22" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Treponema pallidum'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table001" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Bacteroides fragilis''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV/IM q8h'''''<BR> OR <BR> ▸ '''''[[Metronidazole]] 500 mg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam|Ampicillin-Sulbactam]] 3 g IV q6h''''' <BR> OR <BR> ▸ '''''[[Ticarcillin clavulanate|Ticarcillin-Clavulanate]] 3.1 g IV q4–6h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table002" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Morganella morganii''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Imipenem]] 500 mg IV q6h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg IV/PO q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3–5 mg/kg/day IV q6–8h''''' <BR> OR <BR> ▸ '''''[[Ticarcillin clavulanate|Ticarcillin-Clavulanate]] 3.1 g IV q4–6h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table003" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Proteus vulgaris, Proteus rettgeri''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Imipenem]] 500 mg IV q6h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 500 mg IV/PO q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3–5 mg/kg/day IV q6–8h''''' <BR> OR <BR> ▸ '''''[[Ticarcillin clavulanate|Ticarcillin-Clavulanate]] 3.1 g IV q4–6h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table004" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Serratia marcescens''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q6h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 500 mg IV/PO q24h'''''<BR> OR <BR> ▸ '''''[[Gentamicin]] 3–5 mg/kg/day IV q6–8h'''''<BR> OR <BR> ▸ '''''[[Imipenem]] 500 mg IV q6h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table00" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Brucella melitensis''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg PO bid for ≥6 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Streptomycin]] 15 mg/kg IM qd for 2–3 weeks''''' <BR> OR <BR> ▸ '''''[[Rifampin]] 600–900 mg qd for ≥6 weeks'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg PO bid for ≥6 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 5 mg/kg IV qd for 7 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''PLoS Med. 2007;4(12):e317.''<ref name="ArizaBosilkovski2007">{{cite journal|last1=Ariza|first1=Javier|last2=Bosilkovski|first2=Mile|last3=Cascio|first3=Antonio|last4=Colmenero|first4=Juan D.|last5=Corbel|first5=Michael J.|last6=Falagas|first6=Matthew E.|last7=Memish|first7=Ziad A.|last8=Roushan|first8=Mohammad Reza Hasanjani|last9=Rubinstein|first9=Ethan|last10=Sipsas|first10=Nikolaos V.|last11=Solera|first11=Javier|last12=Young|first12=Edward J.|last13=Pappas|first13=Georgios|title=Perspectives for the Treatment of Brucellosis in the 21st Century: The Ioannina Recommendations|journal=PLoS Medicine|volume=4|issue=12|year=2007|pages=e317|issn=1549-1277|doi=10.1371/journal.pmed.0040317}}</ref> and ''Lancet Infect Dis. 2007;7(12):775-86.''<ref name="pmid18045560">{{cite journal| author=Franco MP, Mulder M, Gilman RH, Smits HL| title=Human brucellosis. | journal=Lancet Infect Dis | year= 2007 | volume= 7 | issue= 12 | pages= 775-86 | pmid=18045560 | doi=10.1016/S1473-3099(07)70286-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18045560  }}</ref> and ''Cochrane Database Syst Rev. 2012;10:CD007179.''<ref name="pmid23076931">{{cite journal| author=Yousefi-Nooraie R, Mortaz-Hejri S, Mehrani M, Sadeghipour P| title=Antibiotics for treating human brucellosis. | journal=Cochrane Database Syst Rev | year= 2012 | volume= 10 | issue=  | pages= CD007179 | pmid=23076931 | doi=10.1002/14651858.CD007179.pub2 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23076931  }}</ref></SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Methicillin-Sensitive ''S. aureus''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 2 g IV q6h'''''<br> OR <br> ▸ '''''[[Clindamycin]] 900 mg IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefazolin]] 0.25–1 g IV/IM q6–8h''''' <br> OR <br> ▸ '''''[[Vancomycin]] 500 mg IV q6h (or 1 g IV q12h)'''''
-|-
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Methicillin-Resistant ''S. aureus'' (Adult)}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15–20 mg/kg IV q8–12h'''''<br> OR <br> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen 1
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP-SMX]] 3.5–4.0 mg/kg PO/IV q8–12h (TMP component)'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 300–600 mg PO/IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen 2
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 600 mg IV/IM q8h'''''
-|-
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Methicillin-Resistant ''S. aureus'' (Pediatric)}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h'''''<br> OR <br> ▸ '''''[[Clindamycin]] 10 mg/kg PO/IV q6h (or 13 mg/kg PO/IV q8h)'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |  ▸ '''''[[Daptomycin]] 6–10 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 10 mg/kg PO/IV q8h (Maximum: 600 mg/dose)'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2011;52(3):e18-55.''<ref name="LiuBayer2011">{{cite journal|last1=Liu|first1=C.|last2=Bayer|first2=A.|last3=Cosgrove|first3=S. E.|last4=Daum|first4=R. S.|last5=Fridkin|first5=S. K.|last6=Gorwitz|first6=R. J.|last7=Kaplan|first7=S. L.|last8=Karchmer|first8=A. W.|last9=Levine|first9=D. P.|last10=Murray|first10=B. E.|last11=Rybak|first11=M. J.|last12=Talan|first12=D. A.|last13=Chambers|first13=H. F.|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|volume=52|issue=3|year=2011|pages=e18–e55|issn=1058-4838|doi=10.1093/cid/ciq146}}</ref></SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Methicillin-Sensitive ''S. epidermidis''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 2 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Clindamycin]] 900 mg IV/IM q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefazolin]] 0.25–1 g IV/IM q6–8h'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 500 mg IV q6h (or 1 g IV q12h)'''''
-|-
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Methicillin-Resistant ''S. epidermidis''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 500 mg IV q6h (or 1 g IV q12h)'''''<BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen 1
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP-SMX]] 3.5–4.0 mg/kg PO/IV q8–12h (TMP component)'''''<BR> OR <BR> ▸ '''''[[Minocycline]] 200 mg PO x 1 dose, then 100 mg PO q12h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 300–600 mg PO/IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen 2
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 900 mg IV/IM q8h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15a" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Streptococcus agalactiae''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 2 MU IV/IM q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q6h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 600–1200 mg/day IV/IM q6–12h'''''<BR> OR <BR> ▸ '''''[[Cefazolin]] 0.25–1 g IV/IM q6–8h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15b" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Streptococcus pyogenes''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 2 MU IV/IM q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q6h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 600–1200 mg/day IV/IM q6–12h'''''<BR> OR <BR> ▸ '''''[[Cefazolin]] 0.25–1 g IV/IM q6–8h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Escherichia coli''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam|Ampicillin-Sulbactam]] 3 g IV q6h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefazolin]] 0.25–1 g IV/IM q6–8h''''' <BR> OR <BR> ▸ '''''[[Levofloxacin]] 500–750 mg IV/PO q24h''''' <BR> OR <BR> ▸ '''''[[Gentamicin]] 3–5 mg/kg/day IV q6–8h''''' <BR> OR <BR>  ▸ '''''[[TMP-SMX]] 8–10 mg/kg/day IV/PO q6–12h (TMP component)'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Pseudomonas aeruginosa''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q12h''''' <BR> OR <BR> ▸ '''''[[Piperacillin]] 3–4 g IV q4–6h'''''<br> OR <br> ▸ '''''[[Imipenem]] 500 mg IV q6h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ticarcillin clavulanate|Ticarcillin-Clavulanate]] 3.1 g IV q4–6h'''''<BR> OR <BR> ▸ '''''[[Tobramycin]] 3-5 mg/kg/day IV q6–8h'''''<BR> OR <BR> ▸ '''''[[Amikacin]]''''' 15 mg/kg/day IV/IM q8–12h<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8–12h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table18" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Neisseria gonorrhoeae'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 g IV q24h'''''<BR> OR <BR> ▸ '''''[[Cefotaxime]] 1 g IV q8h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 500 mg IV/PO q24h''''' <BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q6h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table19" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Haemophilus influenzae'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin-clavulanate]] 875/125 mg PO q12h''''' <br> OR <br> ▸ '''''[[Cefprozil]] 500 mg PO q12h''''' <br> OR <br> ▸ '''''[[Cefuroxime]] 500 mg PO q12h''''' <br> OR <br> ▸ '''''[[Cefdinir]] 600 mg PO q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Levofloxacin]] 750 mg IV/PO q24h'''''<br> OR <br> ▸ '''''[[Moxifloxacin]] 400 mg IV/PO q24h'''''  <BR> OR <BR> ▸ '''''[[Clarithromycin]] 500 mg PO q12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table20" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Mycobacterium tuberculosis'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Intensive Phase
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Isoniazid]] 5mg/kg PO q24h for 2 months'''''<BR> OR <BR> ▸ '''''[[Isoniazid]] 10 mg/kg PO 3 times per week × 2 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampicin]] 10 mg/kg PO q24h for 2 months''''' <BR> OR <BR> ▸ '''''[[Rifampicin]] 10 mg/kg PO 3 times per week × 2 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Pyrazinamide]] 25mg/kg PO q24h for 2 months'''''<BR> OR <BR> ▸ '''''[[Pyrazinamide]] 35 mg/kg PO 3 times per week × 2 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ethambutol]] 15mg/kg PO q24h for 2 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Continuation Phase
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Isoniazid]] 5mg/kg PO for 4-7 months'''''<BR> OR <BR> ▸ '''''[[Isoniazid]] 10 mg/kg PO 3 times per week × 4-7 months'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampicin]] 10 mg/kg PO q24h for 4-7  months''''' <BR> OR <BR> ▸ '''''[[Rifampicin]] 10 mg/kg PO 3 times per week for 4-7  months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Treatment of Tuberculosis: Guidelines.''<ref>{{Cite book  | last1 =  | first1 =  | last2 =  | first2 =  | title = Treatment of tuberculosis : guidelin | date = 2010 | publisher = World Health Organization | location = Geneva | isbn = 978-92-4-154783-3 | pages =  }}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table21" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Borrelia burgdorferi'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin]] 500 mg q8h for 28 days''''' <br> OR <br>▸ '''''[[Doxycycline]] 100 mg q12h for 28 days'''''<br> OR <br>▸ '''''[[Cefuroxime]] 500 mg q12h for 28 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Azithromycin]] 500 mg PO q24h for 7–10 days''''' <br> OR <br> ▸ '''''[[Clarithromycin]] 500 mg PO q12h for 14–21 days''''' <br> OR <br> ▸ '''''[[Erythromycin]] 500 mg PO q6h for 14–21 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from IDSA Guidelines: The Clinical Assessment, Treatment, and Prevention of Lyme Disease, Human Granulocytic Anaplasmosis, and Babesiosis: <ref>{{cite journal|doi=10.1086/522848}}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table22" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Treponema pallidum'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]]  2.4 MU IM single dose'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Doxycycline]] 100 mg PO q12h x 14 days ''''' <BR> OR <BR> ▸ '''''[[Tetracycline]] 500 mg PO q6h x 14 days''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 1 g IM/IV q24h x 10 -14 days'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL> Adapted from MMWR Recomm Rep. 2006;55(RR-11):1-94<ref name="www.cdc.gov">{{Cite web  | last =  | first =  | title = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5511a1.htm | publisher =  | date =  | accessdate = 19 May 2014 }}</ref></SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table23" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Tropheryma whipplei'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 2 MU IV q4h for 2 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Streptomycin]] 1 g IM/IV q24h for 2 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trimethoprim/Sulfamethoxazole]] 160mg/800mg PO q24h for 1 year'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 g IV q24h'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trimethoprim/Sulfamethoxazole]] 160mg/800mg PO q24h for 1 year'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from N Engl J Med 2007; 356:55-66 <ref name="FenollarPuéchal2007">{{cite journal|last1=Fenollar|first1=Florence|last2=Puéchal|first2=Xavier|last3=Raoult|first3=Didier|title=Whipple's Disease|journal=New England Journal of Medicine|volume=356|issue=1|year=2007|pages=55–66|issn=0028-4793|doi=10.1056/NEJMra062477}}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table24" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterococcus spp.'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q6h ''''' <br> OR <br>▸ '''''[[Vancomycin]] 1 g IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin sulbactam|Ampicillin-Sulbactam]] 3 g IV q6h''''' <br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table25" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Proteus mirabilis'' }}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q6h''''' <br> OR <br>▸ '''''[[Levofloxacin]] 500 mg IV/PO q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefazolin]] 0.25–1 g IV/IM q6–8h''''' <BR> OR <BR> ▸ '''''[[TMP-SMX]] 8–10 mg/kg/day IV/PO q6–12h (TMP component)'''''<BR> OR <BR> ▸ '''''[[Gentamicin]] 3–5 mg/kg/day IV q6–8h'''''
-|}
-|}
-|}
-==Pathogen-Based Therapy — Fungi==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Fungi'''
-</font>
-</div>
-<div class="mw-customtoggle-table26" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D;border-bottom: 0px;; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Aspergillus spp.'''''
-</font>
-</div>
-<div class="mw-customtoggle-table27" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Blastomyces dermatitidis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table28" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Candida spp.'''''
-</font>
-</div>
-<div class="mw-customtoggle-table29" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Coccidioides immitis'''''
-</font>
-</div>
-<div class="mw-customtoggle-table30" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Histoplasma'''''
-</font>
-</div>
-<div class="mw-customtoggle-table31" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Sporothrix'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table26" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Aspergillus spp.''<sup>†</sup>}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Voriconazole]] 6 mg/kg IV q12h on day 1'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Voriconazole]] 4 mg/kg IV q12h (goal trough: 1.0–5.5 mg/L)'''''<sup>‡</sup><BR> OR <BR> ▸ '''''[[Voriconazole]] 200 mg PO q12h (for body weight ≥40 kg)'''''<BR> OR <BR> ▸ '''''[[Voriconazole]] 100 mg PO q12h (for body weight <40 kg)'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B|Liposomal amphotericin B]] 3-5 mg/kg/day IV'''''<br> OR <br> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg/day IV'''''<br> OR <br> ▸ '''''[[Caspofungin]] 70 mg IV on day 1, then 50 mg IV q24h''''' <br> OR <br> ▸ '''''[[Micafungin]] 100 mg IV q12h (or 250 mg IV q24h)'''''<sup>¶</sup><br> OR <br> ▸ '''''[[Itraconazole]] 200 mg PO tid for 3 days, then 200 mg PO bid'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL> <sup>†</sup> Adapted from ''Clin Infect Dis. 2008; 46:327–60.''<ref name="WalshAnaissie2008">{{cite journal|last1=Walsh|first1=Thomas J.|last2=Anaissie|first2=Elias J.|last3=Denning|first3=David W.|last4=Herbrecht|first4=Raoul|last5=Kontoyiannis|first5=Dimitrios P.|last6=Marr|first6=Kieren A.|last7=Morrison|first7=Vicki A.|last8=Segal|first8=Brahm H|last9=Steinbach|first9=William J.|last10=Stevens|first10=David A.|last11=Burik|first11=Jo‐Anne van|last12=Wingard|first12=John R.|last13=Patterson|first13=Thomas F.|title=Treatment of Aspergillosis: Clinical Practice Guidelines of the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=46|issue=3|year=2008|pages=327–360|issn=1058-4838|doi=10.1086/525258}}</ref>
-<sup>‡</sup> Adapted from ''Clin Infect Dis. 2012;55(8):1080-7.''<ref name="pmid22761409">{{cite journal| author=Park WB, Kim NH, Kim KH, Lee SH, Nam WS, Yoon SH et al.| title=The effect of therapeutic drug monitoring on safety and efficacy of voriconazole in invasive fungal infections: a randomized controlled trial. | journal=Clin Infect Dis | year= 2012 | volume= 55 | issue= 8 | pages= 1080-7 | pmid=22761409 | doi=10.1093/cid/cis599 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22761409  }} </ref><BR>
-<sup>¶</sup> Adapted from ''J Antimicrob Chemother. 2009;64(4):840-4.''<ref name="pmid19700475">{{cite journal| author=Ikawa K, Nomura K, Morikawa N, Ikeda K, Taniwaki M| title=Assessment of micafungin regimens by pharmacokinetic-pharmacodynamic analysis: a dosing strategy for Aspergillus infections. | journal=J Antimicrob Chemother | year= 2009 | volume= 64 | issue= 4 | pages= 840-4 | pmid=19700475 | doi=10.1093/jac/dkp298 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19700475  }}</ref></SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table27" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Blastomyces dermatitidis''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Moderately Severe to Severe Disease
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B|Liposomal amphotericin B]] 3–5 mg/kg/day IV for 1–2 weeks'''''<BR> OR <BR> ▸ '''''[[Amphotericin B]] 0.7–1 mg/kg/day IV for 1–2 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO tid for 3 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO bid for ≥12 months totally'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Mild to Moderate Disease
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO tid for 3 days'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO qd–bid for 6–12 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2008;46(12):1801-12.''<ref name="Chapman-2008">{{Cite journal  | last1 = Chapman | first1 = SW. | last2 = Dismukes | first2 = WE. | last3 = Proia | first3 = LA. | last4 = Bradsher | first4 = RW. | last5 = Pappas | first5 = PG. | last6 = Threlkeld | first6 = MG. | last7 = Kauffman | first7 = CA. | title = Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 46 | issue = 12 | pages = 1801-12 | month = Jun | year = 2008 | doi = 10.1086/588300 | PMID = 18462107 }}</ref></SMALL>
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table28" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Candida spp.''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400 mg/day (or 6 mg/kg/day) IV/PO for ≥2 weeks'''''<BR> OR <BR> ▸ '''''[[Liposomal Amphotericin B|Lipid-based amphotericin B]] 3–5 mg/kg/day IV for ≥2 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400 mg/day IV/PO for ≥6 weeks totally'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 85%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Anidulafungin]] 200 mg IV on day 1, then 100 mg/day IV for ≥2 weeks''''' <br> OR <br> ▸ '''''[[Caspofungin]] 70 mg IV on day 1, then 50 mg IV q24h for ≥2 weeks''''' <br> OR <br> ▸ '''''[[Micafungin]] 100 mg IV q24h for ≥2 weeks'''''<BR> OR <BR> ▸ '''''[[Amphotericin B]] 0.5–1 mg/kg/day IV for ≥2 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 400 mg/day IV/PO for ≥6 weeks totally'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2009;48(5):503-35.''<ref name="Pappas-2009">{{Cite journal  | last1 = Pappas | first1 = PG. | last2 = Kauffman | first2 = CA. | last3 = Andes | first3 = D. | last4 = Benjamin | first4 = DK. | last5 = Calandra | first5 = TF. | last6 = Edwards | first6 = JE. | last7 = Filler | first7 = SG. | last8 = Fisher | first8 = JF. | last9 = Kullberg | first9 = BJ. | title = Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 48 | issue = 5 | pages = 503-35 | month = Mar | year = 2009 | doi = 10.1086/596757 | PMID = 19191635 }}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table29" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Coccidioides immitis''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg q12h   (max: 800 mg/day) for ≥6 weeks ''''' <br> OR <br> ▸ '''''[[Fluconazole]] 400-600 mg/day  (max: 2000 mg/day) for ≥6 weeks''''' <br> OR <br> ▸ '''''[[Ketoconazole]] 400 mg/day for ≥6 weeks '''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B]] 0.5–1.5 mg/kg/day'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2005;41(9):1217-23.''<ref name="Galgiani-2005">{{Cite journal  | last1 = Galgiani | first1 = JN. | last2 = Ampel | first2 = NM. | last3 = Blair | first3 = JE. | last4 = Catanzaro | first4 = A. | last5 = Johnson | first5 = RH. | last6 = Stevens | first6 = DA. | last7 = Williams | first7 = PL. | title = Coccidioidomycosis. | journal = Clin Infect Dis | volume = 41 | issue = 9 | pages = 1217-23 | month = Nov | year = 2005 | doi = 10.1086/496991 | PMID = 16206093 }}</ref> and N Engl J Med 1995; 332:1077-1082 <ref name="Stevens1995">{{cite journal|last1=Stevens|first1=David A.|title=Coccidioidomycosis|journal=New England Journal of Medicine|volume=332|issue=16|year=1995|pages=1077–1082|issn=0028-4793|doi=10.1056/NEJM199504203321607}}</ref>
-</SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table30" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|''Histoplasma capsulatum''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Moderate Severe to Severe Disease
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 3 mg/kg/day IV × 1-2 weeks'''''   <br> OR <br> ▸ '''''[[Amphotericin B]] deoxycholate 0.7-1 mg/kg/day IV × 1-2 weeks'''''<br> OR <br> ▸ '''''[[Amphotericin B lipid complex]] 5 mg/kg/day IV × 1-2 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q12h x ≥12 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Mild to Moderate Disease
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q12h x ≥12 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2007;45(7):807-25.''<ref name="Wheat-2007">{{Cite journal  | last1 = Wheat | first1 = LJ. | last2 = Freifeld | first2 = AG. | last3 = Kleiman | first3 = MB. | last4 = Baddley | first4 = JW. | last5 = McKinsey | first5 = DS. | last6 = Loyd | first6 = JE. | last7 = Kauffman | first7 = CA. | title = Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 45 | issue = 7 | pages = 807-25 | month = Oct | year = 2007 | doi = 10.1086/521259 | PMID = 17806045 }}</ref></SMALL>
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table31" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Sporothrix}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg q12h x 12 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Liposomal Amphotericin B]] 3-5 mg/kg/day IV × for 1-2 weeks'''''   <br> OR <br> ▸ '''''[[Amphotericin B]] deoxycholate 0.7-1 mg/kg/day IV × 1-2 weeks'''''
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | FOLLOWED BY
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Itraconazole]] 200 mg PO q12h x 12 months'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL>Adapted from ''Clin Infect Dis. 2007; 45:1255–65<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>
-</SMALL>
-|-
-|}
-|}
-|}
-==Pathogen-Based Therapy — Virus ==
-The treatment for viral arthritis is symptomatic, with the use of analgesics and NSAID.  No antimicrobial therapy is recommended for treating arthritis caused by a virus.<ref name="Berner-2006">{{Cite journal  | last1 = Berner | first1 = IC. | last2 = Dudler | first2 = J. | title = [Viral arthritis]. | journal = Rev Med Suisse | volume = 2 | issue = 57 | pages = 732-4, 737 | month = Mar | year = 2006 | doi =  | PMID = 16604875 }}</ref><ref name="Märker-Hermann-2010">{{Cite journal  | last1 = Märker-Hermann | first1 = E. | last2 = Schütz | first2 = N. | last3 = Bauer | first3 = H. | title = [Viral arthritides]. | journal = Z Rheumatol | volume = 69 | issue = 10 | pages = 871-8 | month = Dec | year = 2010 | doi = 10.1007/s00393-010-0701-6 | PMID = 21128048 }}</ref> <br>
-Vaccination and safe sex are the most important measures to avoid viral infections in the joint.
-==Pathogen-Based Therapy in Patients with Prosthetic Joint <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from Diagnosis and Management of Prosthetic Joint Infection CID 2013:56<ref name="OsmonBerbari2012">{{cite journal|last1=Osmon|first1=D. R.|last2=Berbari|first2=E. F.|last3=Berendt|first3=A. R.|last4=Lew|first4=D.|last5=Zimmerli|first5=W.|last6=Steckelberg|first6=J. M.|last7=Rao|first7=N.|last8=Hanssen|first8=A.|last9=Wilson|first9=W. R.|title=Diagnosis and Management of Prosthetic Joint Infection: Clinical Practice Guidelines by the Infectious Diseases Society of America|journal=Clinical Infectious Diseases|volume=56|issue=1|year=2012|pages=e1–e25|issn=1058-4838|doi=10.1093/cid/cis803}}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
-<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
-{|
-| valign=top |
-<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #A1BCDD; text-align: center;">
-<font color="#FFF">
-'''Bacteria'''
-</font>
-</div>
-<div class="mw-customtoggle-table37" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococci, oxacillin-susceptible'''''
-</font>
-</div>
-<div class="mw-customtoggle-table39" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococci, oxacillin-resistant'''''
-</font>
-</div>
-<div class="mw-customtoggle-table40" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterococcus spp, penicillin-susceptible'''''
-</font>
-</div>
-<div class="mw-customtoggle-table41" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterococcus spp, penicillin-resistant'''''
-</font>
-</div>
-<div class="mw-customtoggle-table32" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Pseudomonas aeruginosa'''''
-</font>
-</div>
-<div class="mw-customtoggle-table33" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterobacter spp'''''
-</font>
-</div>
-<div class="mw-customtoggle-table34" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterobacteriaceae'''''
-</font>
-</div>
-<div class="mw-customtoggle-table35" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''β-hemolytic streptococci'''''
-</font>
-</div>
-<div class="mw-customtoggle-table36" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 300px; background: #4479BA;">
-<font color="#FFF">
-&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Propionibacterium acnes'''''
-</font>
-</div>
-| valign=top |
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table37" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococci, oxacillin-susceptible''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1.5-2 g IV q4-6h'''''<br> OR <br> ▸ '''''[[Cefazolin]] 1–2 g IV q8 h''''' <br> OR <br> ▸ '''''[[Ceftriaxone]] 1–2 g IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] IV 15 mg/kg q12h'''''<br> OR <br> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table39" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococci, oxacillin-resistant''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Vancomycin 15 mg/kg IV q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table40" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterococcus spp, penicillin-susceptible''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 20-40 MU IV q24h continuously or divided in 6 doses'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] IV 15 mg/kg q12h'''''<br> OR <br> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table41" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterococcus spp, penicillin-resistant''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Vancomycin]] IV 15 mg/kg q12h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''<br> OR <br> ▸ '''''[[Linezolid]] 600 mg PO/IV q12h'''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table32" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Pseudomonas aeruginosa''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q12 h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 1 g IV q8 h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |▸ '''''[[Ciprofloxacin]] 750 mg PO q12h or 400 mg IV q12h ''''' <BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table33" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterobacter spp''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Ertapenem]] 1 g IV q24 h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 750 mg PO q12h or 400 mg IV q12h '''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table34" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterobacteriaceae''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''IV β-lactam based on in vitro susceptibilities''''' <BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 750 mg PO q12h'''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table35" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''β-hemolytic streptococci''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 20-40 MU IV q24h continuously or divided in 6 doses''''' <br> OR <br> ▸ '''''[[Ceftriaxone]] 2 g IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15mg/kg IV q12h '''''
-|-
-|}
-|}
-{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table36" style="background: #FFFFFF;"
-| valign=top |
-{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
-! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Propionibacterium acnes''}}
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 20-40 MU IV q24h continuously or divided in 6 doses''''' <br> OR <br> ▸ '''''[[Ceftriaxone]] 2 g IV q24h'''''
-|-
-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen
-|-
-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Clindamycin]] 600–900 mg IV q8h <br> OR <br> ▸ '''''[[Clindamycin]]300–450 mg PO q6h''''' <br> OR <br> ▸ '''''[[Vancomycin]] 15mg/kg IV q12h '''''
-|-
-|}
-|}
-|}
-<br>
-==References==
-{{reflist|2}}
-[[Category:Arthritis]]
-[[Category:Medical emergencies]]
-[[Category:Signs and symptoms]]
-[[Category:Disease]]
-[[Category:Rheumatology]]
-[[Category:Infectious disease]]
-[[Category:Emergency medicine]]
-{{WikiDoc Help Menu}}
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Septic arthritis medical therapy: Difference between revisions

Revision as of 02:43, 2 May 2015

Overview

Medical Therapy

Specific Considerations

Tailoring antibiotic coverage to clinical scenario

Methicillin-resistant Staphylococcus aureus (MRSA)

Prosthetic joint infection

Antimicrobial Regimen – Empiric Therapy

Newborn (< 1 week)

High Risk for MRSA

Low Risk for MRSA

Newborn (1–4 weeks)

High Risk for MRSA

Low Risk for MRSA

Infants (1–3 months)

High Risk for MRSA

Low Risk for MRSA

Children (3 months–14 years)

Adults (Monoarticular)

At risk for sexually-transmitted disease

Not at risk for sexually-transmitted disease

Adults (Polyarticular)

Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy

Negative Gram stain

Gram-positive cocci

Gram-negative cocci

Gram-negative bacilli

Antimicrobial Regimen – Pathogen-Based Therapy

Bacteroides fragilis

Brucella melitensis

Enterococcus

Escherichia coli

Haemophilus influenzae

Morganella morganii

Neisseria gonorrhoeae

Proteus mirabilis

Proteus vulgaris or Proteus rettgeri

Pseudomonas aeruginosa

Serratia marcescens

Staphylococcus aureus (methicillin-resistant)

Staphylococcus aureus (methicillin-susceptible)

Staphylococcus epidermidis (methicillin-resistant)

Staphylococcus aureus (methicillin-susceptible)

Streptococcus agalactiae

Streptococcus pyogenes

Tropheryma whipplei

Borrelia burgdorferi

Treponema pallidum

Mycobacterium tuberculosis

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