Sandbox ID3
Bacteria – Gram-Positive Cocci
- Enterococcus faecalis
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- 1. Bacteremia[1]
- 1.1 Ampicillin or Penicillin susceptible
- Preferred regimen (1): Ampicillin 2 g IV q4-6h
- Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h
- 1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy
- Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
- Preferred regimen (2): Linezolid 600 mg IV q12h
- Preferred regimen (3): Daptomycin 6 mg/kg IV q24h
- 1.3 Ampicillin and Vancomycin resistant
- Preferred regimen (1): Linezolid 600 mg IV q12h
- Preferred regimen (2): Daptomycin 6 mg/kg IV q24h
- 2.1 Endocarditis in Adults
- 2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU IV q24h for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
- Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
- Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
- Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
- 2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU IV q24h for 4–6 weeks) ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks
- 2.1.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.1.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h 6 weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- 2.1.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- 2.1.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen (1): (Imipenem OR Cilastatin 2 g/day IV for ≥ 8weeks AND Ampicillin 12 g/day IV for ≥ 8weeks)
- Preferred regimen (2): (Ceftriaxone sodium 4 g IV/IM q24h for ≥ 8weeks AND Ampicillin 12 g IV q24h for ≥ 8weeks)
- 2.2 Endocarditis in Pediatrics
- 2.2.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
- Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
- Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
- Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
- Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- 2.2.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3 MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
- Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks
- 2.2.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.2.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- 2.2.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- 2.2.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen: Imipenem/Cilastatin 60–100 mg/kg IV q24h for ≥ 8weeks AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks
- Alternate regimen: Ceftriaxone 100 mg/kg IV/IM q24h AND Ampicillin 300 mg/kg IV q24h for ≥ 8 weeks
- 3. Meningitis[4]
- 3.1 Ampicillin susceptible
- Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h
- 3.2 Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h
- 3.3 Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid 600 mg IV q12h
- 4. Urinary tract infections [5]
- Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
- Preferred regimen (2): Fosfomycin 3 g PO single dose
- Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days
- 5. Intra abdominal or Wound infections [6]
- Preferred regimen(1): Penicillin
- Preferred regimen(2): Ampicillin
- Alternative regimen(Penicillin allergy or high-level Penicillin resistance): Vancomycin
- Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h
- Enterococcus faecium
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- 1. Bacteremia[7]
- 1.1 Ampicillin or Penicillin susceptible
- Preferred regimen (1): Ampicillin 2 g IV q4-6h
- Preferred regimen (2): Ampicillin 2 g IV q4-6h AND Gentamicin 1 mg/kg IV/IM q8h
- 1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy
- Preferred regimen (1): Vancomycin 15 mg/kg IV q12h AND Gentamicin 1 mg/kg IV/IM q8h
- Preferred regimen (2): Linezolid 600 mg IV q12h
- Preferred regimen (3): Daptomycin 6 mg/kg IV q24h.
- 1.3 Ampicillin and Vancomycin resistant
- Preferred regimen (1): Linezolid 600 mg IV q12h
- Preferred regimen (2): Daptomycin 6 mg/kg IV q24h
- 2. Endocarditis
- 2.1 Endocarditis in Adults
- 2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen: (Ampicillin 12 g/day IV for 4–6 weeks OR Aqueous crystalline penicillin G sodium 18–30 MU/day IV for 4–6 weeks) AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 4–6 weeks
- Alternative regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
- Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
- Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
- 2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen: (Ampicillin 12 g/day IV for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU/day IV q24h for 4–6 weeks) ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 4–6 weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Streptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks
- 2.1.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.1.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 12 g IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- Alternate regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- 2.1.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin hydrochloride 30 mg/kg IV q24h for 6 weeks AND Gentamicin sulfate 3 mg/kg IV/IM q24h for 6 weeks
- 2.1.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen(1): Linezolid 1200 mg IV/PO q24h ≥8 weeks
- Preferred regimen(2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks
- 2.2 Endocarditis in Pediatrics
- 2.2.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin
- Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3MU/kg IV q24h for 4–6 weeks) AND Gentamicin 3 mg/kg IV/IM q24h 4–6 weeks
- Alternate regimen : Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- Note (1): In case of native valve endocarditis with symptoms ≤ 3 months, a 4-week course of therapy is recommended.
- Note (2): In case of native valve endocarditis with symptoms > 3 months, a 6-week course of therapy is recommended.
- Note (3): In case of prosthetic valve or other prosthetic cardiac material, a minimum of 6-week course of therapy is recommended.
- 2.2.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin
- Preferred regimen: (Ampicillin 300 mg/kg IV q24h for 4–6 weeks OR Penicillin 0.3MU/kg IV q24h for 4–6 weeks) AND Streptomycin 20–30 mg/kg IV/IM q24h for 4–6 weeks
- Alternate regimen: Vancomycin hydrochloride 40 mg/kg IV q24h for 6 weeks ANDStreptomycin sulfate 15 mg/kg IV/IM q24h for 6 weeks
- 2.2.3 Strains Resistant to Penicillin and Susceptible to Aminoglycoside and Vancomycin
- 2.2.3.1 β Lactamase–producing strain
- Preferred regimen: Ampicillin-sulbactam 300 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- Alternate regimen: Vancomycin 40 mg/kg IV q24h for 6 weeks AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- 2.2.3.2 Intrinsic penicillin resistance
- Preferred regimen: Vancomycin 40 mg/kg IV q24h AND Gentamicin 3 mg/kg IV/IM q24h for 6 weeks
- 2.2.4 Strains Resistant to Penicillin, Aminoglycoside, and Vancomycin
- Preferred regimen(1): Linezolid 30 mg/kg IV/PO q24h ≥ 8 weeks
- Preferred regimen(2): Quinupristin-Dalfopristin 22.5 mg/kg IV q24h ≥ 8 weeks
- 3. Meningitis[4]
- 3.1 Ampicillin susceptible
- Preferred regimen: Ampicillin 12 g/day IV q4h AND Gentamicin 5 mg/kg/day IV q8h
- 3.2 Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Gentamicin 5 mg/kg/day IV q8h
- 3.3 Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid 600 mg IV q12h
- 4. Urinary tract infections[8]
- Preferred regimen (1): Nitrofurantoin 100 mg PO q6h for 5 days
- Preferred regimen (2): Fosfomycin 3 g PO single dose
- Preferred regimen (3): Amoxicillin 875 mg to 1 g PO q12h for 5 days
- 5. Intra abdominal or Wound infections [9]
- Preferred regimen(1): Penicillin
- Preferred regimen(2): Ampicillin
- Alternative regimen(Penicillin allergy or high-level Penicillin resistance): Vancomycin
- Alternative regimen(For complicated skin-skin structure and intra-abdominal infection): Tigecycline 100 mg IV single dose and 50 mg IV q12h
- Staphylococcus aureus
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- Staphylococcus aureus treatment
- 1. Infectious endocarditis
- 1.1 In adults
- Preferred regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
- Preferred regimen (2): Daptomycin 6mg/kg/dose IV qd
- 2. Intravascular catheter-related infections[10]
- 2.1 Methicillin susceptible Staphylococcus aureus (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q6h
- Preferred regimen (2): Oxacillin 2 g IV q6h
- Alternative regimen (1): Cefazolin 2 g IV q8h
- Alternative regimen (2): Vancomycin 15 mg/kg IV q12h
- 2.1.1 Pediatric dose
- 2.1.1.1 Nafcillin
- 2.1.1.1.1 Neonates
- 0–4 weeks of age and 1200 g- 50 mg/kg/day q12h
- ≤7 days and 1200–2000 g- 50 mg/kg/day q12h
- >7 days of age and <2000g- 75 mg/kg/day q8h
- >7 days of age and >1200 g - 100 mg/kg/day q6h
- 2.1.1.1.2 Infants and children is Nafcillin 100–200 mg/kg/day q4–6h
- 2.1.1.2 Oxacillin
- 2.1.1.2.1 Neonates
- 0–4 weeks of age and 1200 g is 50 mg/kg/day q12h
- Postnatal age <7 days and 1200–2000 g is 50–100 mg/kg/day q12h
- Postnatal age <7 days and >2000 g is 75–150 mg/kg/day q8h
- Postnatal age ≥7 days and 1200–2000 g is 75–150 mg/kg/day q8h
- Postnatal age ≥7 days and >2000 g is 100–200 mg/kg/day q6h
- 2.1.1.3 Cefazolin
- 2.1.1.3.1 Neonates
- Postnatal age ≤7 days is 40 mg/kg/day q12h
- Postnatal age >7 days and 2000 g is 40 mg/kg/day q12h
- Postnatal age >7 days and 12000 g is 60 mg/kg/day q8h
- 2.1.1.3.2 Infants and children is 50 mg/kg/day q8h
- 2.1.1.4 Vancomycin
- 2.1.1.4.1 Neonates
- Postnatal age ≤7 days and <1200 g is 15 mg/kg/day q24h
- Postnatal age ≤7 days and 1200–2000 g is 10–15 mg/kg q12–18h
- Postnatal age ≤7 days and >2000 g is 10–15 mg/kg q8–12h
- Postnatal age >7 days and <1200 g is 15 mg/kg/day q24h
- Postnatal age >7 days and 1200–2000 g is 10–15 mg/kg q8–12h
- Postnatal age >7 days and >2000 g is 15–20 mg/kg q8h
- 2.1.1.4.2 Infants and children is 40 mg/kg/day q6–8h
- 2.2 Methicillin resistant Staphylococcus aureus (MRSA)
- Preferred regimen (1): Vancomycin 15 mg/kg IV q12h
- Preferred regimen (2): Daptomycin 6–8 mg/kg/day IV
- Preferred regimen (3): Linezolid 10 mg/kg q12h IV or PO
- Preferred regimen (4): Vancomycin 15 mg/kg IV q12h AND (Rifampicin IV or Gentamycin IV)
- Preferred regimen (5): Trimethoprim-Sulfamethoxazole 6–12 mg TMP/kg/day in divided doses q12h alone (if susceptible)
- 2.2.1 Pediatric dose
- 2.2.1.1 Linezolid 10 mg/kg IV or PO q12h
- 2.2.1.1.1 Neonates
- 0–4 weeks of age and birthweight <1200 g is 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age)
- <7 days of age and birthweight >1200 g is 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age)
- 7 days and birthweight >1200 g is 10 mg/kg q8h
- 2.2.1.1.2 Infants and children <12 years of age is 10 mg/kg q8h Children 12 years of age and adolescents is 10 mg/kg q12h
- 2.2.1.2 Gentamycin
- 2.2.1.2.1 Neonates
- Premature neonates and <1000 g is 3.5 mg/kg q24h; 0–4 weeks and <1200 g is 2.5 mg/kg q18-24h
- Postnatal age 7 days is 2.5 mg/kg q12h
- Postnatal age 17 days and 1200–2000 g is 2.5 mg/kg q8-12h
- Postnatal age 17 days and 12000 g is 2.5 mg/kg q8h
- Premature neonates with normal renal function is 3.5–4 mg/kg q24h
- Term neonates with normal renal function is 3.5–5 mg/kg q24h
- 2.2.1.2.2 Infants and children <5 years of age is 2.5 mg/kg q8h; qd dosing in patients with normal renal function, 5–7.5 mg/kg q24h
- 2.2.1.2.3 Children >5 years of age is 2–2.5 mg/kg q8h; qd with normal renal function, 5–7.5 mg/kg q24h
- 2.2.1.3 Trimethoprim-Sulfamethoxazole
- 2.2.1.3.1 Infants 12 months of age and children of mild-to-moderate infections is 6–12 mg TMP/kg/day q12h; serious infection, 15–20 mg TMP/kg/day q6-8h
- 3. Cellulitis
- 3.1 Purulent cellulitis (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)
- 3.1.1 In adults
- Preferred regimen (1): Clindamycin 300–450 mg PO tid
- Preferred regimen (2): Trimethoprim-Sulfamethoxazole 1–2 DS tab PO bid
- Preferred regimen (3): Doxycycline 100 mg PO bid
- Preferred regimen (4): Minocycline 200 mg as a single dose, then 100 mg PO bid
- Preferred regimen (5): Linezolid 600 mg PO bid
- 3.1.2 In children
- Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
- Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
- Preferred regimen (3)
- 3.1 If patient body weight <45kg then Doxycycline 2 mg/kg PO q12h
- 3.2 If patient body weight 45kg then Doxycycline adult dose
- Preferred regimen (4): Minocycline 4 mg/kg PO 200 mg as a single dose, then 2 mg/kg PO q12h
- Preferred regimen (5): Linezolid 10 mg/kg PO q8h, not to exceed 600 mg
- 3.2 Nonpurulent cellulitis (defined as cellulitis with no purulent drainage or exudate and no associated abscess)
- 3.2.1 In adults
- Preferred regimen (1): Beta-lactam (eg, Cephalexin and Dicloxacillin) 500 mg PO qid
- Preferred regimen (2): Clindamycin 300–450 mg PO tid
- Preferred regimen (3): Amoxicillin 500 PO mg tid
- Preferred regimen (4): Linezolid 600 mg PO bid
- Note (1): Empirical therapy for beta-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to beta-lactam therapy and may be considered in those with systemic toxicity
- Note (2): Provide coverage for both beta-hemolytic streptococci and CA-MRSA beta-lactam (eg, Amoxicillin) with or without Trimethoprim-Sulfamethoxazole or a Tetracycline
- 3.2.2 In children
- Preferred regimen (1): Clindamycin 10–13 mg/kg PO q6–8h, not to exceed 40 mg/kg/day
- Preferred regimen (2): Trimethoprim 4–6 mg/kg, Sulfamethoxazole 20–30 mg/kg PO q12h
- Preferred regimen (3): Linezolid 10 mg/kg PO q8h, not to exceed 600 mg
- Note (1): Clindamycin causes Clostridium difficile–associated disease may occur more frequently, compared with other oral agents
- Note (2): Trimethoprim-Sulfamethoxazole not recommended for women in the third trimester of pregnancy and for children ,2 months of age
- Note (3): Tetracyclines are not recommended for children under 8 years of age and are pregnancy category D
-
- 4.1 Methicillin-resistant Staphylococcus aureus (MRSA)
- 4.1.1 In adults
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
- Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
- Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO/IV q8–12h for 4–6 weeks
- 4.1.2 In children
- Preferred regimen (1): Vancomycin15 mg/kg/dose IV q6h
- Preferred regimen (2): Linezolid 10 mg/kg/dose PO/IV q8h
- Note: Consider the addition of Rifampin 600 mg qd OR 300–450 mg bid to Vancomycin.
- 4.2 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q4h
- Preferred regimen (2): Oxacillin 2 g IV q4h
- Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
-
-
- 5.1 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h with or without Rifampin 600 mg IV or PO q24h
- Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.
-
-
- 6.1 Penicillin-susceptible Staphylococcus aureus or Streptococcus
- Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
- 6.2 Methicillin-susceptible Staphylococcus aureus or Streptococcus
- Preferred regimen (1): Cefazolin 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks
- Preferred regimen (2): Nafcillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
- Preferred regimen (3): Oxacillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks
- Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks
- 6.3 Methicillin-resistant Staphylococcus aureus (MRSA)
- 6.3.1 In adults
- Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks
- Alternative regimen (1): Linezolid 600 mg PO or IV q12h for 4–6 weeks
- Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO or IV q8–12h for 4–6 weeks
- 6.3.2 Pediatric dose
- Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
- Preferred regimen (2): Linezolid 10 mg/kg PO or IV q8h
- Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.
-
- 7. Bacterial meningitis
- 7.1 Methicillin susceptible Staphylococcus aureus (MSSA)
- Preferred regimen (1): Nafcillin 9–12 g/day IV q4h
- Preferred regimen (2): Oxacillin 9–12 g/day IV q4h
- Alternative regimen (1): Vancomycin 30–45 mg/kg/day IV q8–12h
- Alternative regimen (2): Meropenem 6 g/day IV q8h
- 7.2 Methicillin resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
- Alternative regimen (1): Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h
- Alternative regimen (2): Linezolid 600 mg IV q12h
- Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.
- 8. Septic thrombosis of cavernous or dural venous sinus[20]
- 8.1 Methicillin-resistant Staphylococcus aureus (MRSA)
- 8.1.1 In adults
- Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h for 4–6 weeks
- Alternative regimen (1): Linezolid 600 mg PO or IV q12h for 4–6 weeks
- Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg/dose PO or IV q8–12h for 4–6 weeks
- 8.1.2 Pediatric dose
- Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
- Preferred regimen (2): Linezolid 10 mg/kg PO or IV q8h
- Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
- Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.
- 9. Subdural empyema
- 9.1 Methicillin-resistant Staphylococcus aureus (MRSA)[21]
- 9.1.1 In adults
- Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
- Alternative regimen (1): Linezolid 600 mg PO or IV q12h for 4–6 weeks
- Alternative regimen (2): Trimethoprim-Sulfamethoxazole 5 mg/kg PO or IV q8–12h for 4–6 weeks
- 9.1.2 In children
- Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
- Preferred regimen (2): Linezolid 10 mg/kg PO or IV q8h
- Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.
- 10. Acute conjunctivitis [22]
- 10.1 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin ointment 1% qid
- 11. Appendicitis
- 11.1 Health Care–Associated Complicated Intra-abdominal Infection [23]
- 11.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
- 11.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
- 12. Diverticulitis
- 12.1 Health Care–Associated Complicated Intra-abdominal Infection [23]
- 12.1.1Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h.
- 12.1.1Methicillin-resistant Staphylococcus aureus (MRSA)
- 13. Peritonitis secondary to bowel perforation, peritonitis secondary to ruptured appendix, peritonitis secondary to ruptured appendix, typhlitis
- 13.1 Health Care–Associated Complicated Intra-abdominal Infection [23]
- 13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
- 14. Cystic fibrosis [24]
- 14.1 Adults
- 14.1.1 If methicillin sensitive staphylococcus aureus
- 14.1.2 If methicillin resistant staphylococcus aureus
- Preferred Regimen (1): Vancomycin 15-20 mg/kg IV q8-12h
- Preferred Regimen (2): Linezolid 600 mg PO or IV q12h
- 14.2 Pediatric
- 14.2.1 If methicillin sensitive staphylococcus aureus
- 14.2.2 If methicillin resistant staphylococcus aureus
- Preferred Regimen (1): Vancomycin 40 mg/kg q6-8h (Age >28 days)
- Preferred Regimen (2): Linezolid 10 mg/kg PO or IV q8h (up to age 12)
- 15. Bronchiectasis [25]
- 15.1 In adults
- 15.1.1 Recommended first-line treatment and length of treatment
- 15.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Flucloxacillin 500 mg oral qds for 14 days
- 15.1.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)
- 15.1.1.2.1 Patient's body weight is <50 kg
- Preferred regimen: Rifampicin 450 mg PO qd AND Trimethoprim 200 mg PO bd for 14 days
- 15.1.1.2.2 Patient's body weight is >50 kg
- Preferred regimen: Rifampicin 600 mg PO qdAND Trimethoprim 200 mg PO bd for 14 days
- 15.1.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen (1): Vancomycin 1 g IV bd (monitor serum levels and adjust dose accordingly)
- Preferred regimen (2): Teicoplanin 400 mg qd for 14 days
- 15.1.2 Recommended second-line treatment and length of treatment
- 15.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Clarithromycin 500 mg oral bd 14 days
- 15.1.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)
- 15.1.2.2.1 Patient's body weight is <50 kg
- Preferred regimen: Rifampicin 450 mg PO qd AND Doxycycline 200 mg PO qd 14 days,
- 15.1.2.2.2 Patient's body weight is >50 kg
- Preferred regimen: Rifampicin 600 mg PO AND Doxycycline 200 mg PO qd 14 days
- Third-line is Linezolid 600 mg bd 14 days
- 15.1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Linezolid 600 mg IV bd 14 days
- 15.2 In children
- 15.2.1 Recommended first-line treatment and length of treatment
- 15.2.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Flucloxacillin
- 15.2.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)
- 15.2.1.2.1 Children (< 12 yr)
- Preferred regimen: Trimethoprim 4-6 mg/kg/day divided q12h PO
- 15.2.1.2.2 Children (> 12 yr)
- Preferred regimen (1): Trimethoprim 100-200 mg q12hr PO
- Preferred regimen (2): Rifampicin 450 mg PO od
- 15.2.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen (1): Vancomycin 45-60 mg/kg/day divided q8-12h IV
- Preferred regimen (2): Teicoplanin
- 15.2.2 Recommended second-line treatment and length of treatment
- 15.2.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Clarithromycin 15 mg/kg/24 hr divided q12h PO
- 15.2.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen (1): Rifampicin AND Doxycycline 2-5 mg/kg/day divided q12-24h PO or IV (max dose: 200 mg/24 hr)
- Preferred regimen (2): Rifampicin AND Doxycycline 2-5 mg/kg/day divided q12-24h PO or IV (max dose: 200 mg/24 hr)
- Third-line: Linezolid 10 mg/kg q12h IV or PO
- 15.2.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Linezolid 10 mg/kg q12h IV or PO
- 15.3 Long-term oral antibiotic treatment
- 15.3.1 In adults
- 15.3.1.1 Recommended first-line treatment and length of treatment
- 15.3.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Flucloxacillin 500 mg PO bd
- 15.3.1.2 Recommended second-line treatment and length of treatment
- 15.3.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen: Clarithromycin 250 mg PO bd
- 16. Empyema[26]
- Preferred regimen: Nafcillin 2 gm IV q4h OR oxacillin 2 gm IV q4h if MSSA
- Alternate regimen: Vancomycin 1 gm IV q12h OR Linezolid 600 mg PO bid if MRSA
- 17. Community-acquired pneumonia[27]
- 17.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred Regimen (1): Nafcillin 1000-2000 mg q4h
- Preferred Regimen (2): Oxacillin 2 g IV q4h
- Preferred Regimen (3): Flucloxacillin 250 mg IM/IV q6h
- Alternative Regimen (1): Cefazolin 500 mg IV q12h
- Alternative Regimen (2): Clindamycin 150-450 mg PO q6-8h
- 17.2 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred Regimen (1): Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days
- Preferred Regimen (2): Linezolid 600 mg PO/IV q12h for 10-14 days
- Alternative Regimen: Trimethoprim-Sulfamethoxazole 1-2 double-strength tablets (800/160 mg) q12-24h
- 18. Olecranon bursitis or prepatellar bursitis
- 18.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q4h
- Preferred regimen (2): Oxacillin 2 g IV q4h
- Preferred regimen (3): Dicloxacillin 500 mg PO qid
- 18.2 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen (1): Vancomycin 1 g IV q12h
- Preferred regimen (2): Linezolid 600 mg PO qd
- Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.
- 19. Septic arthritis
- 19.1 In adults
- 19.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
- Alternative regimen (1): Daptomycin 6 mg/kg IV q24h in adults
- Alternative regimen (2): Linezolid 600 mg PO or IV q12h
- Alternative regimen (3): Clindamycin 600 mg PO or IV q8h
- Alternative regimen (4): TMP-SMX 3.5–4.0 mg/kg PO or IV q8–12h
- 19.2 In childern
- Preferred regimen (1): Vancomycin 15 mg/kg IV q6h
- Preferred regimen (2): Daptomycin 6–10 mg/kg IV q24h
- Preferred regimen (3): Linezolid 10 mg/kg PO or IV q8h
- Preferred regimen (4): Clindamycin 10–13 mg/kg PO or IV q6–8h
- 19.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q6h
- Preferred regimen (2): Clindamycin 900 mg IV q8h
- Alternative regimen (1): Cefazolin 0.25–1 g IV/IM q6–8h
- Alternative regimen (2): Vancomycin 500 mg IV q6h or 1 g IV q12h
- 20. Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)
- 20.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen (1): Nafcillin 2 g IV q4–6h
- Preferred regimen (2): Oxacillin 2 g IV q4–6h
- Alternative regimen (1): Cefazolin 1–2 g IV q8h
- Alternative regimen (2): Ceftriaxone 2 g IV q24h
- Alternative regimen (if allergic to penicillins) (3): Clindamycin 900 mg IV q8h
- Alternative regimen (if allergic to penicillins) (4): Vancomycin 15–20 mg/kg IV q8–12h, not to exceed 2 g per dose
- 20.2 Methicillin-resistant Staphylococcus aureus (MRSA)
- Early-onset (2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (< 3 weeks) of symptoms and debridement (but device retention)
- Preferred regimen: Vancomycin AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
- Alternative regimen (1): Daptomycin 6 mg/kg IV q24h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
- Alternative regimen (2): Linezolid 600 IV q8h AND Rifampin 600 mg PO qd or 300–450 mg PO bid for 2 weeks
- Note: The above regimen should be followed by Rifampin and Fluoroquinolone, Trimethoprim/Sulfamethoxazole, a Tetracycline or Clindamycin for 3 or 6 months for hips and knees, respectively.
- 21. Hematogenous osteomyelitis
- 21.1 Adult (>21 yrs)
- 21.1.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
- Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
- 21.1.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
- 21.2 Children (>4 months)-Adult
- 21.2.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
- Preferred regimen: Vancomycin 40 div q6–8h
- 21.2.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
-
- Note: Add Ceftazidime 50 mg q8h or Cefepime 150 mg q8h if gram negative bacilli on Gram stain
- 21.3 Newborn (<4 months.)
- 21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible
- Preferred regimen (1): Vancomycin AND Ceftazidime 2 gm IV q8h
- Preferred regimen (2): Vancomycin AND Cefepime 2 gm IV q12h
- 21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
- Preferred regimen (1): Nafcillin AND Ceftazidime
- Preferred regimen (2): Oxacillin AND Cefepime
- 21.4 Specific therapy
- 21.4.1 Methicillin-susceptible Staphylococcus aureus (MSSA)
- Preferred regimen (1): Nafcillin
- Preferred regimen (2): Oxacillin 2 gm IV q4h
- Preferred regimen (3): Cefazolin 2 gm IV q8h
- Alternative regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
- 21.4.2 Methicillin-resistant Staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin 1 gm IV q12h
- Alternative regimen: Linezolid 600 mg q12h IV or PO with or without Rifampin 300 mg PO or IV bid
- 22. Diabetic foot osteomyelitis
- High risk for MRSA
- Preferred regimen (1): Linezolid 600 mg IV or PO q12h
- Preferred regimen (2): Daptomycin 4 mg/kg IV q24h
- Preferred regimen (3): Vancomycin 15–20 mg/kg IV q8–12h (trough: 10–20 mg/L)
- 23. Necrotizing fasciitis[28]
- 23.1 In adult
- Preferred regimen (1): Nafcillin 1–2 g IV q4h (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
- Preferred regimen (2): Oxacillin 1–2 g IV q4h
- Preferred regimen (3): Cefazolin 1 g IV q8h
- Preferred regimen (4): Vancomycin 15 mg/kg IV bid
- Preferred regimen (5): Clindamycin 600–900 mg IV q8h
- 23.2 In childern
- Preferred regimen (1): Nafcillin 50 mg/kg/dose IV q6h (Severe Pencillin allergy: Vancomycin, linezolid, quinupristin/dalfopristin, daptomycin)
- Preferred regimen (2): Oxacillin 50 mg/kg/dose IV q6h
- Preferred regimen (3): Cefazolin 33 mg/kg/dose IV q8h
- Preferred regimen (4): Vancomycin 15 mg/kg/dose IV q6h
- Preferred regimen (5): Clindamycin 10–13 mg/kg/dose IV q8h (Bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in methicillin resistent staphylococcus aureus)
- 24. Staphylococcal toxic shock syndrome [29]
- 24.1 Methicillin sensitive Staphylococcus aureus
- Preferred regimen (1): Cloxacillin 250-500 mg PO q6h (max dose: 4 g/24 hr)
- Preferred regimen (2): Nafcillin 4-12 g/24 hr divided IV q4-6hr (max dose: 12 g/24 hr)
- Preferred regimen (3): Cefazolin 0.5-2g IV or IM q8h (max dose: 12 g/24 hr), AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
- Alternative regimen (1): Clarithromycin 250-500 mg PO q12h (max dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
- Alternative regimen (2): Rifampicin, AND Linezolid 600 mg IV or PO q12h
- Alternative regimen (3): Daptomycin ::::* Alternative regimen (4): Tigecycline 100 mg loading dose followed by 50 mg IV q12h
- 24.2 Methicillin resistant Staphylococcus aureus
- Preferred regimen (1): Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
- Preferred regimen (2): Linezolid 600 mg IV or PO q12h AND Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
- Preferred regimen (3): Teicoplanin
- Alternative regimen (1): Rifampicin, AND Linezolid 600 mg q12h IV or PO
- Alternative regimen (2): Daptomycin
- Alternative regimen (3): Tigecycline 100 mg loading dose followed by 50 mg q12h IV
- 24.3 Glycopeptide resistant or intermediate Staphylococcus aureus
- Preferred regimen: Linezolid 600 mg IV or PO q12h AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) (if sensitive)
- Alternative regimen (1): Daptomycin
- Alternative regimen (2): Tigecycline 100 mg loading dose followed by 50 mg IV q12h
- Note: Incidence increasing. Geographical patterns highly variable.
- Staphylococcus aureus ,prophylaxis
- 1. Prophylaxis for coronary artery bypass graft-associated acute mediastinitis[30]
- 1.1 Methicillin susceptible staphylococcus aureus (MSSA)
- Preferred regimen: A first- or second-generation Cephalosporin is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization.
- 1.2 Methicillin resistant staphylococcus aureus (MRSA)
- Preferred regimen: Vancomycin alone or in combination with other antibiotics to achieve broader coverage is recommended for prophylaxis in patients with proven or suspected methicillin-resistant S. aureus colonization
- Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.
- Note (2): The use of intranasal Mupirocin is reasonable in nasal carriers of Staphylococcus aureus.
- Staphylococcus epidermidis
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- Staphylococcus haemolyticus
Return to Top
-
-
- 1. Bacteremia: most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h AND Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- Note: Site sepcific recommendation for peripheral line is to remove line, antibiotics for 5-7 days and for central line may often keep line and systemic antibiotics for 2 wks with antibiotics lock.
-
- 2. CSF shunt: meningitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg IV/PO q8h for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg IV/PO q8h.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- Note: Shunt removal usually recommended but variable. Vancomycin 22.5 mg/kg IV q12h and rifampin PO/IV and possible intraventricular antibiotics: Vancomycin 20 mg/day with or without Gentamicin 4-8 mg/day is recommended.
- 3. Peritoneal dialysis catheter: peritonitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- Note: Site sepcific recommendation is to keep dialysis catheter (at least for first effort) and IV Vancomycin (usually 2 g IV/wk and redose when level <15 mcg/mL) with antibiotics lock for 10-14 days.
- 4. Prosthetic joint: septic arthritis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- Note: Site sepcific recommendation is typically remove joint (two stage more common than single stage replacement), antibiotics for 6 wks. If very early infection (less than 3 wks post-op, debridement and retention an option).
- 5. Prosthetic or natural cardiac valve: endocarditis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- Note: Site sepcific recommendation is consider valve replacement and antibiotics for 6 wks.
- 6. Post-sternotomy: osteomyelitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 7. Implants (breast, penile, pacemaker) and other prosthetic devices: local infection
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- Note: Site sepcific recommendation for vascular graft is to remove graft, antibiotics for 6 wks.
- 8. Post-ocular surgery: endophthalmitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- 9. Surgical site infections
- Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h added to Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
- Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
- Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.
- Note: only assume Methicillin susceptible if multiple isolates are so identified.
- Staphylococcus lugdunensis
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- Staphylococcus lugdunensis
- 1. Postpartum mastitis with or without abscess [31]
- Preferred regimen: In outpatient is Dicloxacillin 500 mg po qid OR Cephalexin 500 mg po qid and in inpatient is Oxacillin OR Nafcillin 2 gm IV q4h
- Alternative regimen: In outpatient is Trimethoprim-Sulfamethoxazole-DS tabs 1-2 po bid or, if susceptible, Clindamycin 300 mg po qid and in inpatient is Vancomycin 1 gm IV q12h; if over 100 kg, 1.5 gm IV q12h.
- Note (1): Mastitis with no abscess- increase frequency of nursing may hasten response.
- Note (2): Mastitis with abscess- needle aspiration reported successful. Resume breast feeding from affected breast as soon as pain allows.
- 2. Non-puerperal mastitis with abscess
- Preferred regimen: In outpatient is Dicloxacillin 500 mg po qid OR Cephalexin 500 mg po qid and in inpatient is Oxacillin OR Nafcillin 2 gm IV q4h
- Alternative regimen: In outpatient is Trimethoprim-Sulfamethoxazole-DS tabs 1-2 po bid or, if susceptible, Clindamycin 300 mg po qid and in inpatient is Vancomycin 1 gm IV q12h; if over 100 kg, 1.5 gm IV q12h.
- Note (1): If subareolar & odoriferous, most likely anaerobes; need to add Metronidazole 500 mg IV/po tid.
- Note (2): If not subareolar, staph. Need pretreatment aerobic/anaerobic cultures. Surgical drainage for abscess.
- Note (3):Staphylococcus lugdunensis usually susceptible to gentamicin. 75% are penicillin-susceptible.
- Staphylococcus saprophyticus
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- Staphylococcus saprophyticus treatment
- 1. Urinary tract infection [32]
- 1.1 Acute uncomplicated urinary tract infection (cystitis-urethritis) in females
- Preferred regimen : Cephalosporin PO OR Amoxicillin-Clavulanate 625 mg PO OR Trimethoprim-Sulfamethoxazole-DS bid for 3 days; if sulfa allergy, Nitrofurantoin 100 mg po bid for 5 days OR Fosfomycin 3 gm po as a single dose AND Pyridium.
- Alternative regimen (in sulfa allergy): then 3 days of Ciprofloxacin 250 mg bid OR Ciprofloxacin-Erythromycin 500 mg q24h OR Levofloxacin 250 mg q24h OR Moxifloxacin 400 mg q24h OR Nitrofurantoin 100 mg bid OR Fosfomycin single 3 gm dose AND Phenazopyridine Pyridium 200 mg po tid times 2 days.
- Note (1): Pyridium non-prescription—may relieve dysuria. Hemolysis if G6PD deficient.
- Note (2): >7-day treatment recommended in pregnancy [discontinue or do not use sulfonamides (Trimethoprim-Sulfamethoxazole) near term (2 weeks before EDC) because of potential increase in kernicterus]. If failure on 3-day course, culture and treat for 2 weeks.
- 1.2 Recurrent urinary tract infection in postmenopausal women
- Preferred regimen : Trimethoprim-Sulfamethoxazole-DS bid for 3 days; if sulfa allergy, Nitrofurantoin 100 mg po bid for 5 days OR Fosfomycin 3 gm po as a single dose AND Pyridium.
- Alternative regimen (in sulfa allergy): then 3 days of Ciprofloxacin 250 mg bid OR Ciprofloxacin-Erythromycin 500 mg q24h OR Levofloxacin 250 mg q24h OR Moxifloxacin 400 mg q24h OR Nitrofurantoin 100 mg bid OR Fosfomycin single 3 gm dose AND Phenazopyridine Pyridium 200 mg po tid times 2 days.
- Note (1): Recurrent urinary tract infection definition is ≥3 culture and symptomatic urinary tract infection in 1 year or 2 urinary tract infection in 6 months. Evaluate for potentially correctable urologic factors like (1) cystocele (2) incontinence (3) increased residual urine volume (≥50 mL).
- Note (2): Nitrofurantoin more effective than vaginal cream in decreasing frequency, but adverse effect is pulmonary fibrosis with long-term Nitrofurantoin treatment.
- Streptobacillus moniliformis
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- Streptococcus moniliformis treatment[33]
- 1. Migratory arthropathy and arthritis
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 2. Diarrhea, (especially kids) liver or spleen abscess
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 3. Undifferentiated fever
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 4. Endocarditis, myocarditis, pericarditis (cardiac)
- Preferred regimen: Penicillin 20 MU/day IV divided q4h. Optimal duration recommendation for infective endocarditis is 4 weeks.
- Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.
- 5. Meningitis, brain abscess
- Preferred regimen: Penicillin 20 MU/day IV divided q4h.
- Alternative regimen: Cephalosporins-Ceftriaxone OR Clindamycin OR Erythromycin OR Chloramphenicol AND Streptomycin.
- 6. Anemia
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 7. Pneumonia
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 8. Amnionitis (pregnancy)
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- 9. Renal abscess
- Preferred regimen (uncomplicated disease): Penicillin G 2.4-4.8 MU/day IV divided q6h. If better after 1 wk, switch to oral Amoxicillin OR Penicillin Vk complete 14 days.
- Streptococcus anginosus
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- Streptococcus anginosus treatment[34]
- Preferred regimen: Penicillin G 2-4 MU IV q4h .
- Alternative regimen: Ceftriaxone 2 g IV qd; Clindamycin 600-900 mg IV q8h or 300-450 mg PO qid OR Vancomycin 15 mg/kg IV q12h ([[Penicillin-allergic)
- Note (1): Endocarditis caused by Steptococcus anginosus module for management is follow viridans Streptococci recommendations.
- Note (2): Dental abscesses,sinusitis,fasciitis of head and neck caused by Steptococcus anginosus can be life threatening and require aggressive surgical management and appropriate HEENT module for specific management.
- Note (3): Bacteremia caused by Steptococcus anginosus often associated with deep-seated abscess—most often intraabdominal investigation for abscess is required.Drainage is usually recommended.
- Note (4): Brain abscesses caused by Steptococcus anginosus is often polymicrobial,but S.intermedius found in 50-80%.
- Note (5): Infection caused by Steptococcus anginosus is implicated in aspiration pneumonia,lung abscess and empyema.
- Streptococcus pneumoniae
Return to Top
- Streptococcus pneumonia treatment
- 1. Lung (pneumonia)
- Community-acquired pneumonia [27]
- 1.1 Penicillin sensitive (minimum inhibitory concentration ≤ 2)
- Preferred regimen: Penicillin G 1-2 MU q6h IV OR Amoxicillin 500-1000 mg PO tid
- Alternative regimen: Macrolides and Oral Cephalosporins-Cefpodoxime 200 mg PO bd, (Cefprozil 500 mg PO bd, Cefditoren 400 mg PO bd, Cefdinir 300 mg PO bd), OR parenteral Cephalosporins-Ceftriaxone 2 g IV q24h (or Cefotaxime 1-2 g IV q6-8h), Clindamycin, Doxycycline 100 mg PO bd, respiratory flouroquniolones.
- 1.2 Penicillin-resistant (Penicillin minimum inhibitory concentration >8)
- Preferred regimen:: Ceftriaxone 2 g IV q24h (or Cefotaxime 1-2 g IV q6-8h) OR respiratory flouroquniolones Levofloxacin (Levaquin) 750 mg OR Moxifloxacin (Avelox) 400 mg IV/PO q24h,OR Doxycycline 100 mg PO bd
- Alternative regimen: Vancomycin 15 mg/kg IV q12h OR Linezolid 600 mg IV/PO q12h, high-dose Amoxicillin (3 g qd with Penicillin minimum concentration of inhibitory 4 mcg/mL).
- 2.Endocarditis[35]
- Preferred regimen (1): Aqueous crystalline Penicillin-G 6 MU q4-6h IV for 4 weeks
- Preferred regimen (2) (who are unable to tolerate beta lactams therapy): Vancomycin 15 mg/kg/day IV q12h
- Preferred regimen (3) (If the isolate is resistant (MIC 2 g/mL) to cefotaxime): Cefotaxime 1-2 g q8-12h IV or IM (max dose: 12 g/24 hr) AND Vancomycin 15 mg/kg/day IV q12h AND Rifampin
- Alternative regimen: Cefazolin 0.5-2 g q8h IV or IM (max dose: 12 g/24 hr) OR Ceftriaxone 2 g IV q12h
- Note : S pneumoniae with intermediate doses Minimum inhibitory concentration (MIC) 0.12 g/mL–0.5 g/mL penicillin resistance (MIC 0.1 to 1.0 g/mL) or high penicillin resistance (MIC 2.0 g/mL) is being recovered from patients with bacteremia.
- 3. Sinuses (sinusitis)[36]
- Sinusitis (empiric therapy)
- Preferred regimen: amoxicillin 500-1000 mg PO tid OR Amoxicillin/Clavulanate 875/125 mg PO bd.
- 4. Bronchi (acute exacerbation of chronic bronchitis)[37]
- Preferred regimen: amoxicillin 2-3 PO g/day OR Doxycycline 100 mg PO bd.
- 5. CNS (meningitis)[4]
- Empiric therapy
- Preferred regimen: Vancomycin 15 mg/kg/day IV q12h AND a third-generation cephalosporin (Ceftriaxone 2 g IV q12h OR Cefotaxime 2 g IV q4h or 3 g q6h).
- Alternative regimen: Meropenem, fluoroquinolones
- Note: Middle ear infections (otitis media), peritoneum infections (spontaneous bacterial peritonitis), pericardium infections (purulent pericarditis), skin infections (cellulitis) and eye infections (conjunctivitis) caused by Streptococcus pneumonia.
- Prevention
- 1. Pneumovax (23-valent) prevents bacteremia; impact on rates of CAP are modest or nil.
- 2. Prevnar vaccine for children <2 yrs age prevents invasive pneumococcal infection in adults by herd effect. Impact is impressive with rates of invasive pneumococcal infection down 80% in peds and 20-40% in adults.
- 3. Risk for bacteremia in splenectomy, HIV, smokers, black race, multiple myeloma, asthma.
- Streptococcus pyogenes
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- Streptococcus pyogenes treatment[38]
- 1. Pharynx
- 1.1 Pharyngitis
- Preferred regimen: Penicillin-benzathine]] Penicillin 1.2 mU IM once OR Penicillin VK 500 mg PO bd or tid for 10 days.
- Alternative regimen (1): Amoxicillin 750 PO bd or tid for 10 days.
- Alternative regimen (Penicillin allergy) (2): Erythromycin 500 mg PO bd or tid for 10 days OR (Azithromycin 500 mg, then 250 mg for 5 days, Clarithromycin (Biaxin) 1 g XR/day or 500 mg bd for 10 days. Note: 5-10% isolates are macrolide resistant) OR Cefpodoxime proxetil (Vantin) 200 mg bd for 5 days OR Cefdinir 300 mg bd PO for 5 days OR Cefadroxil 500 mg bd PO for 5 days OR Loracarbef 200 mg PO bd for 5 days.
- 1.2 Epiglottitis in childern
- Preferred regimen: Cefotaxime 50 mg/kg IV q8h OR Ceftriaxone 50 mg/kg IV q24h
- alternative regimen: Amoxicillin-SB 100–200 mg/kg qd q6h OR Trimethoprim-Sulfamethoxazole 8–12 mg Trimethoprim/kg qd div q12h
- Note: Have tracheostomy set “at bedside.” Chloro is effective, but potentially less toxic alternative agents available.
- 2. Skin
- 2.1 Erysipelas, lymphangitis, cellulitis
- Preferred regimen (1): Clindamycin 600 mg IV q8h AND Penicillin G G 4 mU IV q4h. (clindamycin to stop toxin production).
- Preferred regimen (2) topical antimicrobials: Retapamulin (Altabax) 1% ointment 5, 10 & 15 gm bid tubes.
- Note: Microbiologic success with Retapamulin (Altabax) 1% ointment in 90% S. aureus infections and 97% of S. pyogenes infections(do not use for MRSA)
- Alternative regimen: Penicillin G 2-4 mU IV q4h OR Clindamycin 600 mg IV q8h OR Cefazolin 1-2 g IV q6-8h OR Cefotaxime 2-3 g IV q6-8h OR Ceftriaxone 2 g/day IV OR Vancomycin 15 mg/kg IV q12h.
- 2.2 Burn wound sepsis
- Preferred regimen: Vancomycin 1 gm IV q12h) AND (Amikacin 10 mg/kg IV loading dose then 7.5 mg/kg IV q12h) AND [ Piperacillin 4 gm IV q4h (give ½ q24h dose of Piperacillin into subeschar tissues with surgical eschar removal within 12 hours)]. Can use Piperacillin-Tazobactam if Piperacillin not available.
- Note: Erythema multiformedue to Herpes simplex type 1, mycoplasma, Streptococcus pyogenes, drugs (sulfonamides, phenytoin, penicillins)
- 3. Soft tissue
- Note: For necrotizing fasciitis, surgical consultation for emergent fasciotomy and debridement; repeat debridements usually necessary.
- 4. Muscle
- Note: For myositis-debirdement is recommended.
- 5. Toxin mediated
- 5.1 Toxic shock syndrome
- Preferred regimen (1): Penicillin G 24 MU qd IV AND Clindamycin 900 mg IV q8h
- Preferred regimen (2): Immunoglobulin-G IV 1 gm/kg day 1, then 0.5 gm/kg days 2 & 3.,massive IV fluids (10-20 L/day), Albumin if <2 g/dL, debridement of necrotic tissue
- Alternative regimen: Ceftriaxone 2 gm IV q24h AND Clindamycin 900 mg IV q8h
- Note (1): Surgery usually required.
- Note (2): Mortality with fasciitis 30–50%, myositis 80% even with early treatment.
- Note (3): Clindamycin decreases toxin production.
- Note (4): Use of NSAID may predispose to TSS.
- Note (5): For reasons Penicillin G may fail in fulminant Streptococcus pyogenes infections
- Note (6):Immunoglobulin-G IV associated with decreased in sepsis-related organ failure. IVIG preparations vary in neutralizing antibody content.
- 6. Breast implant infection
- Preferred regimen for acute infection: Vancomycin 1 gm IV q12h; if over 100 kg, 1.5 gm q12h.
- Note: Acute infection caused by Staphylococcus aureus, Sreptococcus pyogenes. Toxic shock syndrome reported.
- Preferred regimen for chronic infection:
- Note (1): For chronic infections look for rapidly growing Mycobacteria
- Note (2): For chronic infections wait for culture results.
- 7. Acute mastoiditis
- 7.1 Outpatient treatment
- 7.1.1 Adult doses for sinusitis
- Preferred regimen: Amoxicillin-Clavulanate-ES 2000/125 mg PO bid OR Amoxicillin HD high dose 1 gm PO tid OR Clarithromycin 500 mg PO bid or Clarithromycin ext. release 1 gm PO q24h OR Doxycycline 100 mg PO bid, respiratory Fluoroquinolones (Gatifloxacin 400 mg PO q24h (not available in USA) due to hypo/hyperglycemia OR Gemifloxacin 320 mg PO q24h (not FDA indication but should work) OR Levofloxacin 750 mg PO q24h for 5 days OR Moxifloxacin 400 mg PO q24h) OR Cephalosporins (Cefdinir 300 mg PO q12h or 600 mg PO q24h OR Cefpodoxime 200 mg PO bid OR Cefprozil 250–500 mg PO bid OR Cefuroxime 250 mg PO bid), OR Trimethoprim-Sulfamethoxazole 1 double-strength (Trimethoprim 160 mg PO) bid (results after 3- and 10-day treatment similar).
- 7.1.2 Pediatric doses for sinusitis
- Preferred regimen: Amoxicillin HD high dose 90 mg/kg PO q8h or q12h OR Amoxicillin-Clavulanate-ES (extra strength) pediatric susp 90 mg Amoxicillin/kg/day PO qd q12h OR Azithromycin 10 mg/kg PO qd, then 5 mg/kg PO qd 3 days OR Clarithromycin 15 mg/kg PO qd q12h OR Cefpodoxime 10 mg/kg PO qd (max. 400 mg) q12–24h OR Cefuroxime axetil 30 mg/kg PO qd q12h OR Cefdinir 14 mg/kg PO qd q24h or bid OR Trimethoprim-Sulfamethoxazole 8–12 mg Trimethoprim/40–60 mg Sulfamethoxazole/kg PO qd q12h
- Note: need Vancomycin OR Nafcillin/Oxacillin if culture positive for Staphylococcus aureus.
- 7.2 Hospitalized treatment
- Preferred regimen: Cefotaxime 1–2 gm IV q4–8h (depends on severity) OR Ceftriaxone 1 gm IV q24h)
- 8. Eye
- 8.1 Keratitis
- 8.1.1 Acute bacterial keratitis
- Preferred regimen: Moxifloxacin eye gtts. 1 gtt tid for 7 days
- Alternative therapy: Gatifloxacin eye gtts. 1-2 gtts q2h while awake for 2 days, then q4h for 3-7 days.
- Note: Prefer Moxifloxacin due to enhanced lipophilicity and penetration into aqueous humor (1 gtt = 1 drop).
- 8.1.2 Keratitis due to dry cornea, diabetes, immunosuppression
- Preferred regimen: Cefazolin (50 mg/mL) AND (Gentamicin OR Tobramycin (14 mg/mL) q15–60 min around clock for 24–72 hrs, then slow reduction)
- Alternative therapy: Vancomycin (50 mg/mL) AND Ceftazidime (50 mg/mL) q15–60 min around clock for 24–72 hrs, then slow reduction.
- Note: Specific therapy guided by results of alginate swab culture and sensitivity. Ciprofloxacin 0.3% found clinically equivalent to CefazolinAND Tobramycin; only concern was efficacy of Ciprofloxacin vs S. pneumoniae
- 8.2 Dacryocystitis (lacrimal sac)
- Preferred regimen: Moxifloxacin eye gtts. 1 gtt tid for 7 days OR Cefazolin (50 mg/mL) (1 gtt = 1 drop)
- 9. Suppurative phlebitis
- Preferred regimen: Vancomycin 15 mg/kg IV q12h (normal weight):::* Alternative regimen: Daptomycin 6 mg/kg IV q12h:::: Note: Retrospective study for suppurative phlebitis recommends 2-3 weeks IV therapy and 2 weeks PO therapy.
- 10. Infected prosthetic joint
- Preferred regimen: Penicillin G 2 MU IV q4h OR Ceftriaxone 2 gm IV q24h for 4 wks.
- Note: Debridement & prosthesis retention with intravenous antibiotics.
- 12. Diabetic foot ulcer (ulcer with <2 cm of superficial inflammation)
- Preferred regimen: (Trimethoprim-Sulfamethoxazole-DS 1-2 tabs PO bid OR Minocycline 100 mg PO bid) AND ([[Penicillin VK 500 mg PO qidOR selected Cephalosporins 2, 3 generation - cefprozil 500 mg PO q12h OR cefuroxime axetil 500 mg PO q12h OR cefdinir 300 mg PO q12h or 600 mg PO q24h OR cefpodoxime 200 mgPO q12h OR Fluoroquinolones Levo 750 mg po q24h).
- Note (1): Common infections are bacterial pharyngitis and cellulitis. Rare but devastating are toxic shock syndrome, necrotizing fasciitis.
- Note (2): Diagnosis recovery from normally sterile site, ASO antibody response (rheumatic fever),anti-DNAase B (pyoderma). Supportive are positive throat culture or rapid strep antigen test.
- Note (3): Cellulitis is very hard to detect Group A streptococcus by culture (needle aspiration or blood culture).
- Note (4): Ecologic niche is pharynx. 2-3% of adults colonized, 15-20% school children. Virulence depends on proteins that represent toxins, mimic host macromolecules and after immune responses.
- Note (5): Predisposing factors: soft tissue (IDU, diabetes, surgery, trauma, varicella, vein donor, lymphedema); pneumonia (influenza), contacts w/ gas (pharyngitis and fasciitis).
- Note (6): Mastoiditis has become a rare entity, presumably as result of the aggressive treatment of acute otitis media.
- Streptococcus pyogenes prophylaxis
- 1. Acute rheumatic fever prophylaxis
- Preferred regimen: Benzathine Penicillin 1.2 mu IM q mo, Penicillin V 250 mg PO bd, Erythromycin 250 mg PO bd until >5 yrs post-acute rheumatic fever and age in 20years.
- 2. Recurrent cellulitis, chronic lymphedema prophylaxis
- Preferred regimen: Clindamycin 150 mg PO qd OR Trimethoprim-Sulfamethoxaole 1 DS PO qd OR “stand-by therapy” immediate treatment with Penicillin V OR Amoxicillin 500-750 mg PO bd at onset of symptoms.
- Streptococcus agalactiae
Return to Top
- Streptococcus agalactiae treatment [39]
- 1. Bacteremia, soft tissue infections
- Preferred regimen: Penicillin G 10-12 MU/day for 10 days [e.g., give 2 MU q4h or six divided doses/day].
- 2. Meningitis (Adult)
- Preferred regimen: Penicillin G 20-24 MU/day for 14-21 days.
- 3. Osteomyelitis
- Preferred regimen: Penicillin G 10-20 MU/d for 21-28 days.
- 4. Endocarditis
- Preferred regimen: Penicillin G 20-24 MU/day for 4-6 wks AND Gentamicin 1 mg/kg q8h for first 2 wks.
- Note (1):Gentamicin 1 mg/kg q8h IV additionally for any serious group B Streptococcus infection.
- Note (2): Penicillin allergic may substitute Vancomycin 15 mg/kg IV q12h for Penicillin.
- Note (3): Clindamycin can be considered, but rates of resistance vary. Consider confirming absence of inducible Clindamycin resistance (typically associated with macrolide resistance) before using as monotherapy.
- Note (4): Streptococcus agalactiae causes neonatal sepsis or meningitis, puerperal sepsis, chorioamnionitis; also bacteremia (often without clear source), skin and soft-tissue infections, septic arthritis. Found in gastrointestinal,genitourinary tracts. More common in adults >65 years and those with comorbidities.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter
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ignored (help) - ↑ "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".
- ↑ 4.0 4.1 4.2 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
- ↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.
- ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
- ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
- ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
- ↑ Azari, Amir A.; Barney, Neal P. (2013-10-23). "Conjunctivitis: a systematic review of diagnosis and treatment". JAMA. 310 (16): 1721–1729. doi:10.1001/jama.2013.280318. ISSN 1538-3598. PMC 4049531. PMID 24150468.
- ↑ 23.0 23.1 23.2 Solomkin JS, Mazuski JE, Bradley JS, Rodvold KA, Goldstein EJ, Baron EJ; et al. (2010). "Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America". Clin Infect Dis. 50 (2): 133–64. doi:10.1086/649554. PMID 20034345.
- ↑ Mogayzel PJ, Naureckas ET, Robinson KA, Mueller G, Hadjiliadis D, Hoag JB; et al. (2013). "Cystic fibrosis pulmonary guidelines. Chronic medications for maintenance of lung health". Am J Respir Crit Care Med. 187 (7): 680–9. PMID 23540878.
- ↑ Pasteur MC, Bilton D, Hill AT, British Thoracic Society Bronchiectasis non-CF Guideline Group (2010). "British Thoracic Society guideline for non-CF bronchiectasis". Thorax. 65 Suppl 1: i1–58. doi:10.1136/thx.2010.136119. PMID 20627931.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ 27.0 27.1 Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC; et al. (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clin Infect Dis. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083.
- ↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
- ↑ Lappin E, Ferguson AJ (2009). "Gram-positive toxic shock syndromes". Lancet Infect Dis. 9 (5): 281–90. doi:10.1016/S1473-3099(09)70066-0. PMID 19393958.
- ↑ Hillis LD, Smith PK, Anderson JL, Bittl JA, Bridges CR, Byrne JG; et al. (2011). "2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons". J Am Coll Cardiol. 58 (24): e123–210. doi:10.1016/j.jacc.2011.08.009. PMID 22070836.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME; et al. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.