Sandbox ID3

Ð

WikiDoc Infectious Disease Project — Pathogen-Based Infections

Pathogens of Public Health Significance

3

Pathogens of Clinical Significance

3

Bacteria – Gram-Positive Cocci

Enterococcus faecalis Return to Top

1. Bacteremia^[1]

1.1 Ampicillin or Penicillin susceptible

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

1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy

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

1.3 Ampicillin and Vancomycin resistant

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

2. Endocarditis^[2]^[3]

2.1 Endocarditis in Adults

2.1.1 Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

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

2.1.2 Strains Susceptible to Penicillin, Streptomycin, and Vancomycin and Resistant to Gentamicin

Preferred regimen: (Ampicillin 12 g IV q24h for 4–6 weeks OR Aqueous crystalline penicillin G sodium 24 MU IV q24h for 4–6 weeks) 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 Return to Top

1. Bacteremia^[7]

1.1 Ampicillin or Penicillin susceptible

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

1.2 Ampicillin resistant and vancomycin susceptible or Penicillin allergy

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

1.3 Ampicillin and Vancomycin resistant

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

2. Endocarditis

2.1 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 Return to Top

Staphylococcus aureus treatment

1. Infectious endocarditis^[10]

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^[11]

2.1 Methicillin susceptible Staphylococcus aureus (MSSA)

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

2.1.1 Pediatric dose of Nafcillin

2.1.1.1 Neonates (< 4 weeks)

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

2.1.1.2 Infants and children (> 4 weeks)

Nafcillin 100–200 mg/kg/day q4–6h

2.1.2 Pediatric dose of Oxacillin

2.1.2.1 Neonates (< 4 weeks)

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

2.1.2.2 Infants and children(> 4weeks)

Oxacillin 150–200 mg/kg/day q4–6h

2.1.3 Pediatric dose of Cefazolin

2.1.3.1 Neonates (< 4 weeks)

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

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

2.1.3.2 Infants and children (> 4 weeks)

Cefazolin 50 mg/kg/day q8h.

2.1.4 Pediatric dose of Vancomycin

2.1.4.1 Neonates (< 4 weeks)

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

2.1.4.2 Infants and children (> 4 weeks)

Vancomycin 40 mg/kg/day q6–8h.

2.2 Methicillin resistant Staphylococcus aureus (MRSA)

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

2.2.1 Pediatric dose of Linezolid

2.2.1.1 Neonates (< 4 weeks)

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

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

Linezolid 10 mg/kg q8h

2.2.1.3 Children ≥ 12 years and adolescents

Linezolid 10 mg/kg q12h

2.2.2 Pediatric dose of Gentamycin

2.2.2.1 Neonates (< 4 weeks)

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

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

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

2.2.2.3 Children ≥ 5 years

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

2.2.3 Pediatric dose of Trimethoprim-Sulfamethoxazole

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

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

3. Cellulitis^[12]

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

3.1.1 In adults

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

3.1.2 In children

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

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

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

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

3.2.1 In adults

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

3.2.2 In children

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

4. Brain abscess^[13]^[14]^[15]

4.1 Methicillin-resistant Staphylococcus aureus (MRSA)

4.1.1 In adults

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

4.1.2 In children

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

4.2 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

5. Cerebrospinal fluid shunt infection^[16]^[17]

5.1 Methicillin-resistant Staphylococcus aureus (MRSA)

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

5.2 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

6. Spinal epidural abscess^[18]^[19]^[20]^[21]

6.1 Penicillin-susceptible Staphylococcus aureus or Streptococcus

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

6.2 Methicillin-susceptible Staphylococcus aureus or Streptococcus

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

6.3 Methicillin-resistant Staphylococcus aureus (MRSA)

6.3.1 In adults

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

6.3.2 Pediatric dose

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

7. Bacterial meningitis

7.1 Methicillin susceptible Staphylococcus aureus (MSSA)

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

7.2 Methicillin resistant Staphylococcus aureus (MRSA)

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

8. Septic thrombosis of cavernous or dural venous sinus^[22]

8.1 Methicillin-resistant Staphylococcus aureus (MRSA)

8.1.1 In adults

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

8.1.2 Pediatric dose

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

9. Subdural empyema

9.1 Methicillin-resistant Staphylococcus aureus (MRSA)^[23]

9.1.1 In adults

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

9.1.2 In children

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

10. Acute conjunctivitis^[24]

10.1 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Vancomycin ointment 1% qid

11. Appendicitis

11.1 Health care–associated complicated intra-abdominal infection^[25]

11.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

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

12. Diverticulitis

12.1 Health care–associated complicated intra-abdominal infection^[25]

12.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

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

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

13.1 Health care–associated complicated intra-abdominal infection^[25]

13.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

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

14. Cystic fibrosis^[26]

14.1 Adults

14.1.1 If methicillin sensitive staphylococcus aureus

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

14.1.2 If methicillin resistant staphylococcus aureus

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

14.2 Pediatric

14.2.1 If methicillin sensitive staphylococcus aureus

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

14.2.2 If methicillin resistant staphylococcus aureus

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

15. Bronchiectasis^[27]

15.1 In adults

15.1.1 Recommended first-line treatment and length of treatment

15.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin 500 mg PO qds for 14 days

15.1.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Patient's body weight is < 50 kg

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

Patient's body weight is > 50 kg

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

15.1.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)

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

15.1.2 Recommended second-line treatment and length of treatment

15.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 500 mg PO bd 14 days

15.1.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

Patient's body weight is < 50 kg

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

Patient's body weight is > 50 kg

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

Third-line: Linezolid 600 mg bd for 14 days

15.1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)

Preferred regimen: Linezolid 600 mg IV bd for 14 days

15.2 In children

15.2.1 Recommended first-line treatment and length of treatment

15.2.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin

15.2.1.2 Methicillin-resistant Staphylococcus aureus (MRSA)

15.2.1.2.1 Children (< 12 yr)

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

15.2.1.2.2 Children (> 12 yr)

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

15.2.1.3 Methicillin-resistant Staphylococcus aureus (MRSA)

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

15.2.2 Recommended second-line treatment and length of treatment

15.2.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

15.2.2.2 Methicillin-resistant Staphylococcus aureus (MRSA)

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

15.2.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)

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

15.3 Long-term oral antibiotic treatment

15.3.1 In adults

15.3.1.1 Recommended first-line treatment and length of treatment

15.3.1.1.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Flucloxacillin 500 mg PO bd

15.3.1.2 Recommended second-line treatment and length of treatment

15.3.1.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

Preferred regimen: Clarithromycin 250 mg PO bd

16. Empyema^[28]

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

17. Community-acquired pneumonia^[29]

17.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

17.2 Methicillin-resistant Staphylococcus aureus (MRSA)

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

18. Olecranon bursitis or prepatellar bursitis

18.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

18.2 Methicillin-resistant Staphylococcus aureus (MRSA)

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

19. Septic arthritis

19.1 In adults

19.1.1 Methicillin-resistant Staphylococcus aureus (MRSA)

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

19.2.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

19.2 In childern

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

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

20.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

20.2 Methicillin-resistant Staphylococcus aureus (MRSA)

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

21. Hematogenous osteomyelitis

21.1 Adult (> 21 yrs)

21.1.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

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

21.1.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

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

21.2 Children (> 4 months)-Adult

21.2.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

Preferred regimen: Vancomycin 40 mg IV q6–8h

21.2.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

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

21.3 Newborn (< 4 months.)

21.3.1 Methicillin-resistant Staphylococcus aureus (MRSA) possible

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

21.3.2 Methicillin-resistant Staphylococcus aureus (MRSA) unlikely

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

21.4 Specific therapy

21.4.1 Methicillin-susceptible Staphylococcus aureus (MSSA)

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

21.4.2 Methicillin-resistant Staphylococcus aureus (MRSA)

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

22. Diabetic foot osteomyelitis

High risk for MRSA

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

23. Necrotizing fasciitis^[30]

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^[31]

24.1 Methicillin sensitive Staphylococcus aureus

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

24.2 Methicillin resistant Staphylococcus aureus

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

24.3 Glycopeptide resistant or intermediate Staphylococcus aureus

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

Staphylococcus aureus ,prophylaxis

1. Prophylaxis for coronary artery bypass graft-associated acute mediastinitis^[32]

1.1 Methicillin susceptible staphylococcus aureus (MSSA)

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

1.2 Methicillin resistant staphylococcus aureus (MRSA)

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

Staphylococcus epidermidis Return to Top
Staphylococcus haemolyticus Return to Top

Staphylococcus, coagulase-negative species (CoNS)

Staphylococcus epidermidis group (Staphylococcus epidermidis, Staphylococcus haemolyticus)

1. Bacteremia: most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)

Preferred regimen: Vancomycin 15 mg/kg IV q12h with or without Rifampin 300 mg q8h IV/PO OR Gentamicin 3 mg/kg/day IV q8h AND Vancomycin AND Rifampin 300 mg q8h IV/PO for prosthetic valve IE.
Alternative regimen (methicillin resistent Staphylococcus epidermidis) (1): Linezolid 600 mg IV/PO bd OR Daptomycin IV 6 mg/kg/day with or without Rifampin 300 mg q8h IV/PO.
Alternative regimen (methicillin-sensitive Staphylococcus epidermidis) (2): (Oxacillin 1.5-3 g IV q6h OR Nafcillin 1.5-3 g IV q6h), OR Cefazolin 1-2 g IV q8h OR Ciprofloxacin 400 mg IV q12h OR Clindamycin 600 mg IV q8h OR Trimethoprim-Sulfamethoxazole.

Note: Site sepcific recommendation for peripheral line is to remove line, antibiotics for 5-7 days and for central line may often keep line and systemic antibiotics for 2 wks with antibiotics lock.

2. CSF shunt: meningitis

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 Return to Top
Staphylococcus lugdunensis Return to Top

Staphylococcus lugdunensis treatment

1. Skin and soft tissue infections^[33]

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

Note: Abscesses should be drained if possible.

2. Endocarditis^[34]

2.1 Native valve infectious endocarditis

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

Note: should consist of 6 weeks of parenteral beta-lactam therapy or Vancomycin (depending on susceptibility testing and beta-lactam hypersensitivity).

2.2 Prosthetic valve infective endocarditis

Preferred regimen: Combination therapy including a beta-lactam (or Vancomycin) with an Aminoglycoside- Gentamicin 3 mg/kg/day in 1-3 divided doses and Rifampin 300 mg PO/IV q8h for at least 6 weeks

Note (1): Combine with Vancomycin for the entire duration of therapy and Gentamicin for the first 2 weeks.
Note (2): The Gentamicin should be administered for the first 2 weeks of therapy; the beta-lactam (or Vancomycin) and Rifampin should be continued for 6 weeks.
Note (3): Surgery must be considered given the frequency of valvular compromise in the setting of Staphylococcus lugdunensis infective endocarditis.
Note (4): The treatment of Staphylococcus lugdunensis pacemaker endocarditis includes antibiotic therapy as well as removal of the pacer system

3. Bacteremia^[11]

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

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

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

4. Prosthetic devices^[35],^[11]

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

5. Vertebral osteomyelitis, discitis

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

6. Septic arthritis in adults

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

Staphylococcus saprophyticus Return to Top

Staphylococcus saprophyticus treatment
1. Urinary tract infection ^[36]

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 Return to Top

Streptococcus moniliformis treatment^[37]

1. Migratory arthropathy and arthritis

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

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

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

3. Undifferentiated fever

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

4. Endocarditis, myocarditis, pericarditis (cardiac)

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

5. Meningitis, brain abscess

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

6. Anemia

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

7. Pneumonia

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

8. Amnionitis (pregnancy)

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

9. Renal abscess

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

Streptococcus anginosus Return to Top

Streptococcus anginosus treatment^[38]

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 (Community-acquired pneumonia)^[29]

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

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

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

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

2.Endocarditis^[10]

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

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

3. Sinuses (sinusitis)^[39]

Empiric therapy

3.1 For initial empiric treatment of acute bacterial rhinosinusitis in adults

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

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

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

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

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

4. Bronchi (acute exacerbation of chronic bronchitis)^[40]

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

Preferred regimen (2): Doxycycline 100 mg PO q12h

5. CNS (meningitis)^[4]

Empiric therapy

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

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

Prevention

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

Streptococcus pyogenes Return to Top

Streptococcus pyogenes treatment^[41]

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.

11. “Hot” tender parotid swelling

Preferred regimen: Nafcillin OR Oxacillin 2 gm IV q4h

Note: Predisposing factors are stone(s) in Stensen’s duct, dehydration. Therapy depends on ID of specific etiologic organism.

12. Diabetic foot ulcer (ulcer with <2 cm of superficial inflammation)

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-Sulfamethoxazole 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 (GBS-group B Streptococcus)

1. Early onset group B streptococcal infections^[42]

1.1 Bacteremia or sepsis or pneumonia

1.1.1 Empiric therapy

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

1.1.2 Definitive therapy

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

1.2 Meningitis

1.2.1 Empiric therapy

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

1.2.2 Definitive therapy

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

2. Late onset group b streptococcus infections in neonates and young infants (age > 1 week and body weight ≥ 1 kg with normal renal function)^[43]

2.1 Bacteremia without a focus

2.1.1 Empiric therapy

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

2.1.2 Definitive therapy

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

2.2 Meningitis

2.2.1 Empiric therapy

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

2.2.2 Definitive therapy

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

2.3 Cellulitis or adenitis

2.3.1 Empiric therapy

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

2.3.2 Definitive therapy

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

2.4 Septic arthritis

2.4.1 Empiric therapy

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

2.4.2 Definitive therapy

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

2.5 Osteomyelitis

2.5.1 Empiric therapy

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

2.5.2 Definitive therapy

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

2.6 Urinary tract infection

2.6.1 Empiric therapy

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

2.6.2 Definitive therapy

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

Neonatal prophylaxis^[44]

Group B streptococcus infection (maternal dose for neonatal prophylaxis)

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

Bacteria – Gram-Positive Bacilli

Actinomyces israelii Return to Top

Actinomyces israelii treatment^[45]

Preferred regimen: Penicillin G 6 MU q4-6h IV or IM OR Ampicillin 250-500 mg q4-8h IV or IM / Amoxicillin 250-500 mg q8-12h PO OR antipseudomonal Penicillin OR most Cephalosporins OR Macrolides OR Tetracycline OR Imipenem OR Clindamycin

Arcanobacterium haemolyticum Return to Top

Arcanobacterium haemolyticum treatment

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

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

Bacillus anthracis Return to Top

Bacillus anthracis treatment

1. Treatment for cutaneous anthrax, without systemic involvement^[46]

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

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

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

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

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

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

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

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

2. Treatment for systemic anthrax including anthrax meningitis, inhalational anthrax, injectional anthrax, and gastrointestinal anthrax; and cutaneous anthrax with systemic involvement, extensive edema, or lesions of the head or neck^[46]

2.1 Systemic anthrax with possible/confirmed meningitis

2.1.1 Bactericidal agent (fluoroquinolone)

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

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

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

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

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

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

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

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

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

2.1.3 Protein synthesis inhibitor

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

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

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

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

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

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

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

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

2.2 Systemic anthrax when meningitis has been excluded

2.2.1 Bactericidal agent

Preferred regimen (1): Ciprofloxacin 400 mg IV q8hfor 2 weeks

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

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

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

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

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

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

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

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

2.2.2 Protein synthesis inhibitor

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

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

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

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

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

3. Specific considerations

3.1 Treatment of anthrax for pregnant Women

3.1.1 Intravenous antimicrobial treatment for systemic anthrax with possible/confirmed meningitis ^[47]

3.1.1.1 A Bactericidal Agent (Fluoroquinolone)

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

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

3.1.1.2 A Bactericidal Agent (ß-lactam)

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

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

3.1.1.2.2 Alternatives for penicillin-susceptible strains

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

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

3.1.1.3 A Protein Synthesis Inhibitor

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

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

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

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

3.1.2.1 A Bactericidal Antimicrobial

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

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

3.1.2.2 A Bactericidal Agent (ß-lactam)

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

Preferred regimen: Meropenem 2 g q8h for 2 weeks OR

3.1.2.2.2 Alternatives for penicillin-susceptible strains

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

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

3.1.2.3 A Protein Synthesis Inhibitor

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

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

3.1.3 Oral antimicrobial treatment for cutaneous anthrax without systemic involvement

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

Preferred regimen: Ciprofloxacin 400 mg IV q8h

Note: Duration of treatment is 60 days

3.2 Treatment for anthrax in childern ^[48]

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

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

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

Preferred regimen (2):

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

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

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

Preferred regimen (4):

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

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

3.2.1.2 Alternatives for penicillin-susceptible strains

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

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

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

3.2.2.1 A bactericidal antimicrobial

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

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

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

Preferred regimen (3):

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

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

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

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

3.2.2.1.2 Alternatives for penicillin-susceptible strains

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

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

3.2.2.2 A Protein Synthesis Inhibitor

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

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

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

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

Preferred regimen (3):

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

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

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

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

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

3.2.3.1 A bactericidal antimicrobial (fluoroquinolone)

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

Preferred regimen (2):

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

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

Preferred regimen (3):

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

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

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

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

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

3.2.3.2 A bactericidal antimicrobial (ß-lactam or glycopeptide)

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

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

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

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

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

3.2.3.2.2 Alternatives for penicillin-susceptible strains

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

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

3.2.3.3 A Protein Synthesis Inhibitor

Preferred regimen (1):

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

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

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

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

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

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

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

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

3.2.4.1 A bactericidal antimicrobial

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

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

Preferred regimen (2):

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

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

3.2.4.1.2 Alternatives for penicillin-susceptible strains

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

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

3.2.4.2 A protein synthesis inhibitor:

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

Preferred regimen (2):

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

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

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

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

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

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

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

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

3.2.5.1.1 Bactericidal antimicrobial (fluoroquinolone) therapy

3.2.5.1.1.1 For 32–34 weeks gestational age

For 0–1 week of age

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

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

For 1–4 weeks of age

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

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

3.2.5.1.1.2 For 34–37 week gestational age

For 0–1 wk of age

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

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

For 1–4 wk of age

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

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

3.2.5.1.1.3 Term newborn infant

For 0–1 week of age

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

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

For 1–4 weeks of age

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

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

3.2.5.1.2 A bactericidal antimicrobial (ß-lactam)

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

3.2.5.1.2.1.1 For 32–34 weeks gestational age

For 0–1 week of Age :

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

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

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

For 1–4 wk of Age :

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

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

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

3.2.5.1.2.1.2 For 34–37 week gestational age

For 0–1 week of Age :

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

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

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

For 1–4 week of Age :

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

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

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

3.2.5.1.2.1.3 Term newborn infant

For < 1 week of age

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

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

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

For 1–4 week of age

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

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

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

3.2.5.1.2.2 Alternatives for penicillin-susceptible strains

3.2.5.1.2.2.1 For 32–34 weeks gestational age

For 0–1 week of age

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

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

For 1–4 week of age :

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

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

3.2.5.1.2.2.2 For 34–37 week gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.1.2.2.3 Term newborn infant

For 0–1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.1.3 A protein synthesis inhibitor

3.2.5.1.3.1 For 32–34 weeks gestational age

For < 1 week of age

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

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

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

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

For 1–4 week of age

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

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

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

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

3.2.5.1.3.2 For 34–37 week gestational age

For < 1 week of age

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

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

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

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

For 1–4 week of age

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

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

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

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

3.2.5.1.3.3 Term newborn infant

For < 1 week of age

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

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

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

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

For 1–4 week of age

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

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

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

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

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

3.2.5.2 Therapy for severe anthrax when meningitis can be ruled out

3.2.5.2.1 A bactericidal antimicrobial

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

3.2.5.2.1.1.1 For 32–34 weeks gestational age

For < 1 week of age

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

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

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

For 1–4 week of age

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

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

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

3.2.5.2.1.1.2 For 34–37 week gestational age

For < 1 week of age

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

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

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

For 1–4 week of age

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

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

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

3.2.5.2.1.1.3 Term Newborn Infant

For < 1 week of age

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

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

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

For 1–4 week of age

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

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

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

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

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

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

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

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

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

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

3.2.5.2.1.2 Alternatives for penicillin-susceptible strains

3.2.5.2.1.2.1 For 32–34 weeks gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.2.1.2.2 For 34–37 week gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

3.2.5.2.1.2.3 Term newborn infant

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.2.2 A protein synthesis inhibitor

3.2.5.2.2.1 For 32–34 weeks gestational age

For < 1 week of age

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

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

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

For 1–4 week of age

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

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

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

3.2.5.2.2.2 For 34–37 week gestational age

For < 1 week of age

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

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

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

For 1–4 week of age

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

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

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

3.2.5.2.2.3 Term newborn infant

For 0–1 week of age :

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

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

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

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

For 1–4 week of age :

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

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

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

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

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

3.2.5.3 Oral follow-up combination therapy for severe anthrax

3.2.5.3.1 A bactericidal antimicrobial

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

3.2.5.3.1.1.1 For 32–34 weeks gestational age

For < 1 week of age

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

For 1–4 week of age

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

3.2.5.3.1.1.2 For 34–37 week gestational age

For < 1 week of age

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

For 1–4 week of age

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

3.2.5.3.1.1.3 Term newborn infant

For < 1 week of age

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

For 1–4 week of age

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

3.2.5.3.1.2 Alternatives for penicillin-susceptible strains

3.2.5.3.1.2.1 For 32–34 weeks gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.3.1.2.2 For 34–37 week gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.3.1.2.3 Term newborn infant

For < 1 week of age

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

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

For 1–4 week of age

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

3.2.5.3.2 A protein synthesis inhibitor

3.2.5.3.2.1 For 32–34 weeks gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.3.2.2 For 34–37 week gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.3.2.3 Term newborn infant

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.4 Treatment of cutaneous anthrax without systemic involvement

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

3.2.5.4.1.1 For 32–34 weeks gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

3.2.5.4.1.2 For 34–37 week gestational age

For < 1 week of age

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

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

For 1–4 week of age

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

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

3.2.5.4.1.3 Term newborn infant

For < 1 week of age

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

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

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

For 1–4 week of age

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

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

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

3.2.5.4.2 Alternatives for penicillin-susceptible strains

3.2.5.4.2.1 For 32–34 weeks gestational age

For < 1 week of age

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

For 1–4 week of age

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

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

3.2.5.4.2.2 For 34–37 week gestational age

For < 1 week of age

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

For 1–4 week of age

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

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

3.2.5.4.2.3 Term newborn infant

For < 1 week of age

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

For 1–4 week of age

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

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

Bacillus anthracis, postexposure prophylaxis

1. For adults^[46]

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

Preferred regimen (1): Ciprofloxacin 500 mg IV q12h

Preferred regimen (2): Doxycycline 100 mg IV q12h

Preferred regimen (3): Levofloxacin 750 mg IV q24h

Preferred regimen (4): Moxifloxacin 400 mg IV q24h

Preferred regimen (5): Clindamycin 600 mg IV q8h

1.2 Alternatives for penicillin-susceptible strain

Preferred regimen (1): Amoxicillin 1 g IV q8h

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

2. For children = 1 month^[48]

2.1 For penicillin-resistant strains or prior to susceptibility testing

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

Preferred regimen (2):

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

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

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

Preferred regimen (4):

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

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

2.2 For penicillin-susceptible strains

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

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

Note: Duration of Therapy is 60 days after exposure

3. For children < 1 month

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

3.1.1 For 32–34 weeks gestational age

3.1.1.1 For < 1 week of Age

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

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

3.1.1.2 For 1–4 week of age

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

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

3.1.2 For 34–37 week gestational age

3.1.2.1 For < 1 week of age

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

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

3.1.2.2 For 1–4 week of age

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

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

3.1.3 Term newborn infant

3.1.3.1 For < 1 week of age

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

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

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

3.1.3.2 For 1–4 week of Age

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

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

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

3.2 Alternatives for penicillin-susceptible strains

3.2.1 For 32–34 weeks gestational age

3.2.1.1 For < 1 week of age

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

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

3.2.1.2 For 1–4 week of age

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

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

3.2.2 For 34–37 week gestational age

3.2.2.1 For < 1 week of age

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

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

3.2.2.2 For 1–4 week of age

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

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

3.2.3 Term newborn infant

3.2.3.1 For < 1 week of age

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

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

3.2.3.2 For 1–4 week of age

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

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

Note: Duration of therapy is 60 days from exposure

Bacillus cereus Return to Top

Bacillus cereus

Bacillus cereus treatment^[49]

1. Food poisoning

Preferred treatment: Food poisoning is self-limited, no antibiotics necessary. Treatment is Supportive therapy, hydration, and anti-emetics. Prevention is by fried/boiled rice should be maintained >60° C or rapidly cooled <8 ° C to avoid room temperature germination of spores and toxin.

Note (1): Bacillus cereus with two forms.(a) Emetic phase: 1-6 hrs after ingestion contaminated usually starchy food, e.g., fried rice. (b) Diarrheal phase: 10-12 hrs after eating e.g. tainted meats, milk, vegetables, etc. with watery diarrhea, tenesmus lasting <2-10 days.

2. Bacteremia

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

Note (1): Bacillus cereus often resistant to beta-lactams.

Note (2): Uncommon, may complicate mixed infections including surgical wounds or infected necrotic tumors.

Note (3): Source of pseudobacteremia is contaminated blood cultures, gloves, syringes, etc. Often transient bacteremia of no significance in intravenous drug user population.

3. Meningitis, brain abscess

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

Note (1): Blood culture isolates are mostly contaminates until proven otherwise, especially in intravenous drug user population.

Note(2): Uncommon presentations, may complicate otitis, mastoiditis, neurosurgical procedures, and shunts.

4. Endophthalmitis

Preferred regimen: Clindamycin 450 mcg intravitreal AND Gentamicin 400 mcg intravitreal OR Dexamethasone intravitreal AND Vancomycin 15 mg/kg IV q12h.
Alternative regimen: Clindamycin 600 mg IV q8h

Note (1): Prognosis for sight retention poor.

Note (2): Rapid, massive destruction of vitreous/retina in intravenous drug user or posttraumatic with ringabscess within 48 hrs. Pathognomic Bacillus cereus panophthalmitis.

Note (3): Early ophthalmological consultation, culture ocular fluids. Early vitrectomy and intravitreal antibiotics is advocated.

Note (4): Ocular infections devastating and require quick intervention.

Note (5): primary pathogen of post-traumatic , risk factor also intravenous drug use. May also cause keratitis, orbital abscess, conjunctivitis, dacryocystitis.

5. Endocarditis

Preferred regimen: Vancomycin 15 mg/kg IV q12h.

Note (1): Well-described but rare complication seen in intravenous drug user . Most blood cultures in intravenous drug user positive for bacillus are contaminates or represent transient bacteremia.

Note (2): Evidence of valvular involvement should be sought by echocardiography to prove endocarditis. Tricuspid valve involvement most common. Course indolent.

Note (3): Tricuspid valve endocarditis mostly indolent in nature.

6. Soft tissue

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

note: rare reports of fasciitis.

7. Pneumonia

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

Note: rare pathogen of compromised host. May mimic Bacillus anthracis-type presentation.

Bacillus subtilis Return to Top

Bacillus subtilis infection treatment^[50]^[51]^[52]

1. Food poisoning

Preferred regimen: supportive treatment

2. Other infections

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

Clostridium botulinum Return to Top
1.Antitoxin ^[53]

Preferred regimen: Trivalent antitoxin (A 7,500 IU, B 5,000 IU, and E 5,000 IU) 1 vial diluted 1:10, IV infusion over 30 min
Alternative regimen: Equine antitoxin

2.General Therapy

Preferred regimen: Mechanical ventilation; IV hydration; tube feedings

Clostridium difficile Return to Top
Clostridium perfringens Return to Top

Clostridium perfringens ^[54]

Preferred regimen: Penicillin G ± Clindamycin
Alternative regimen: Doxycycline

Clostridium tetani Return to Top

1. General measures

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

2. Immunotherapy

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

3. Antibiotic treatment

Preferred regimen: Metronidazole 500 mg intravenously or orally every six hours OR Penicillin G 100,000–200,000 IU/kg/day intravenously, given in 2–4 divided doses
Alternative regimen: Tetracyclines OR Macrolides OR Clindamycin OR Cephalosporins OR Chloramphenicol

4. Muscle spasm control

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

5. Autonomic dysfunction control

Preferred regimen: Magnesium sulphate OR Morphine OR Esmolol

Corynebacterium diphtheriae Return to Top

1.Diphtheria treatment^[55]

1.1 Antitoxin

Preferred regimen: 20,000-40,000 U pharyngeal disease <48 hrs; 40-60,000 U nasopharyngeal; 80-120,000 U for extensive disease, brawny neck or sx >72 hrs; Adiminister IV (severe disease) or IM

1.2 Antibiotics:

Preferred regimen: Procaine Penicillin G (<20 lbs: 300,000 U; >20 lbs: 600,000 U) IM q12h until patient can swallow then Penicillin VK 125-250 mg PO QID OR Erythromycin 125-500 mg PO QID for 14 days total.
Alternative regimen (1): Erythromycin 20-25mg/kg IV q6h (max 4g/day; β-lactam allergic patients)
Alternative regimen (2): Clindamycin 600 mg IV q8h

2.C. diphtheriae carrier

Preferred regimen: Erythromycin 250-500 mg PO QID
Alternative regimen: Benzathine Penicillin G 600,000-1,200,000 units IM single dose

3.Endocarditis treatment

Preferred regimen: Penicillin G OR Ampicillin IV for 4-6 weeks ± Aminoglycoside

Corynebacterium jeikeium Return to Top

Corynebacterium jeikeium^[56]

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

Corynebacterium urealyticum Return to Top

Corynebacterium urealyticum^[57]

Preferred regimen : Vancomycin 1gm IV q12h OR Teicoplanin 6mg/kg/day IV q24h

Coxiella burnetii Return to Top

Q fever^[58]

1. Acute Q fever

1.1 Adults

Preferred Regimen: Doxycycline 100 mg PO bid for 14 days

1.2 Children

1.2.1 Children with age ≥8 years

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

1.2.2 Children with age <8 years with high risk criteria

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

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

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

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

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

1.3 Pregnant women

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

2. Chronic Q fever

2.1 Endocarditis or vascular infection

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

2.2 Noncardiac organ disease

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

2.3 Postpartum with serologic profile for chronic Q fever

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

Ehrlichia Return to Top

1. Human Monocytic Ehrlichiosis or Human Granulocytic Anaplasmosis (adult) ^[59]

Preferred regimen: Doxycycline 100 mg PO/IV q12h for 7-14 days
NOTE: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
Alternative regimen: Chloramphenicol 500mg QID OR Rifampin 600 mg PO/IV daily for 7-10 days

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

2.1 ≥8 years old

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

2.2 <8 years old without Lyme disease

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

2.3 co-infected with Lyme disease

Preferred regimen: At the conclusion of Doxycycline then give Amoxicillin 50 mg/kg in 3 divided doses (max 500 mg/dose) OR Cefuroxime 30 mg/kg in 2 divided doses (max 500 mg/dose) for 14 days

Erysipelothrix rhusiopathiae Return to Top

1. Erysipeloid of Rosenbach (localized cutaneous infection)^[60]

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

2. Diffuse cutaneous infection

Preferred regimen: As for localized infection

Note: Assess for endocarditis

3. Bacteremia or endocarditis

Preferred regimen: Penicillin G benzathine 2-4 MU IV q4h for 4-6 weeks
Alternative regimen (1): Ceftriaxone 2 g IV q24h for 4-6 weeks
Alternative regimen (2): Imipenem 500 mg IV q6h for 4-6 weeks
Alternative regimen (3): Ciprofloxacin 400 mg IV q12h for 4-6 weeks
Alternative regimen (4): Daptomycin 6 mg/kg IV q24h for 4-6 weeks

Note: Recommended duration of therapy for endocarditis is 4 to 6 weeks, although shorter courses consisting of 2 weeks of intravenous therapy followed by 2 to 4 weeks of oral therapy have been successful.

Listeria monocytogenes Return to Top

1. Meningitis ^[61]

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

2. Bacteremia

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

3. Brain abscess or rhomboencephalitis

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

4. Gastroenteritis

Preferred regimen: Amoxicillin OR TMP-SMX for 7 days

Lactobacillus Return to Top

1. Endovascular Infection ^[62]

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

2. Odontogenic Infection

Preferred regiemn: Clindamycin 450 mg PO q6h

3. Intrabdominal Abscess

Preferred regiemn: Clindamycin 450 mg PO q6h

Leuconostoc Return to Top

Preferred regimen: Penicillin G OR Ampicillin
Alternative regimen: Clindamycin OR Erythromycin OR Minocycline

Nocardia Return to Top

1. Sulfonamide-based therapies ^[63]

1.1 Pulmonary

Preferred regimen: TMP-SMX 10 mg/kg/day (TMP) in 2-4 doses IV for 3-6 weeks, then PO (2 DS BID) for >5 months

1.2 Pulmonary alternatives

Preferred regimen: Sulfisoxazole OR Sulfadiazine OR Trisulfapyrimidine 3-6 g/day PO 2- 4 doses OR TMP-SMX 2 DS twice daily up to 2 DS TID

1.3 CNS (AIDS, severe or disseminated disease)

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

1.4 CNS alternatives

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

1.5 Severe disease, compromised host, multiple sites

Preferred regimen: TMP-SMX IV (above doses) AND Amikacin 7.5 mg/kg q12h (adjust per levels) OR Sulfonamide PO 6-12 m/day

1.6 Sporotrichoid (cutaneous)

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

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

2. Sulfonamide alternatives

2.1 Severe

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

2.2 Mild

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

Propionibacterium acnes Return to Top

1. Systemic infection^[64]

Preferred regimen: Penicillin G 2 MU IV q4h for 2-4 weeks
Alternative regimen: Clindamycin 600 mg IV q8h for 2-4 weeks OR Vancomycin 15 mg/kg IV q12h for 2-4 weeks

2. Shoulder prosthesis infection

Preferred regimen: Amoxicillin AND Rifampin for 3-6 months

3. Acne vulgaris

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

Rhodococcus equi Return to Top

Rhodococcus equi ^[65]

1. Preferred regimen:

1.1 First line: vancomycin 1 g IV q12h (15 mg/kg q12 for >70 kg) OR Imipenem 500 mg IV q6h AND Rifampin 600 mg PO once daily OR Ciprofloxacin 750 mg PO twice daily OR Erythromycin 500 mg PO four times a day for at least 4 weeks or until infiltrate disappears (at least 8 weeks in immunocompromised patients)
1.2 Oral/maintenance therapy (after infiltrate clears): Ciprofloxacin 750 mg PO twice daily OR Erythromycin 500 mg PO four times a day

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

Rickettsia prowazekii Return to Top
Rickettsia rickettsii Return to Top

Rickettsia rickettsii ^[66]

Preferred regimen: Doxycycline 200 mg load (severe disease) and then 100 mg PO/IV BID for 3-7 days after defervescence
Alternative regimen: Chloramphenicol 500 mg PO QID for 3-7 days after defervescence
Pediatric regimen: Doxycycline 2-4 mg/kg/day (up to 200 mg/day) q12h OR Tetracycline 25-50 mg/kg/day PO in 4 divided doses OR Chloramphenicol 50-75 mg/kg/day PO in 4 divided doses

Rickettsia typhi Return to Top

Bacteria – Gram-Negative Cocci and Coccobacilli

Aggregatibacter aphrophilus Return to Top

Bordetella pertussis Return to Top

Brucella

Brucella Return to Top

Brucellosis ^[67],^[68]

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

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

2. Complications of brucellosis

2.1 Spondylitis

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

2.2 Neurobrucellosis

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

2.3 Brucella endocarditis

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

3. Pregnancy

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

4.For children < 8 yrs of age

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

Eikenella corrodens Return to Top

1. Human bite/soft tissue infections ^[69]

1.1 Severe

Preferred regimen: Ampicillin/Sulbactam 1.5-3 g IV q6h
Alternative regimen: Doxycycline 100 mg IV BID OR Moxifloxacin 400 mg IV OD OR Levofloxacin 500 mg IV OD

1.2 Mild

Preferred regimen: Amoxicillin/Clavulanate 250-500 mg TID or 875/125 mg PO BID
Alternative regimen: Doxycycline 100 mg PO BID OR Moxifloxacin 400 mg PO OD OR Levofloxacin 500 mg PO OD

2. Head and neck infections

2.1 Severe

Preferred regimen: Ampicillin/Sulbactam 1.5-3 g IV q6h
Alternative regimen: Doxycycline 100 mg IV BID OR Moxifloxacin 400 mg IV OD OR Levofloxacin 500 mg IV OD

2.2 Mild

Preferred regimen: Amoxicillin/Clavulanate 250-500 mg TID or 875/125 mg PO BID
Alternative regimen: Doxycycline 100 mg PO BID OR Moxifloxacin 400 mg PO OD OR Levofloxacin 500 mg PO OD

3. Endocarditis

Preferred regimen: Ceftriaxone 1g IV q12h OR Cefotaxime 1-2 g IV q8h OR Cefepime 1-2g IV q8h

Haemophilus ducreyi

Haemophilus ducreyi Return to Top

1. Chancroid^[70]

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

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

1.2 Management of sex partners

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

1.3 Pregnancy

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

1.4 HIV Infection

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

Haemophilus influenzae Return to Top
Haemophilus influenzae^[71]

1.Non-threatening infections^[72]

1.1.Adults

Preferred regimen (1) : Amoxicillin-clavulanate 500mg PO tid or 875mg PO bid.
Preferred regimen (2) : Amoxicillin 500mg PO tid.
Preferred regimen (3) : TMP-SMX DS PO bid.
Preferred regimen (4) : Cefuroxime 250-500mg PO bid.
Preferred regimen (5) : Moxifloxacin 400mg PO OD,
Preferred regimen (6) : Levofloxacin 500mg PO daily
Preferred regimen (7) : Azithromycin 500mg PO single dose then 250mg for 4days OR Clarithromycin 500mg bid or XL 500mg/day.
Note: Treatment duration of Otitis media is 10-14days, Acute exacerbation of Chronic Bronchitis is (5days[quinolone]-14days), Sinusitis is 10-14days.

2.Meningitis^[73]

Preferred regimen : Dexamethasone (0.15mg/kg)15-20min before first dose of abx and then q6h for 4days.

2.1.Adults

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

2.2.Pediatric

2.2.1.Neonates <7days

2.2.1.1.<2kg : Cefotaxime 50mg/kg IVq12h for 10-14days
2.2.1.2.>2kg : Cefotaxime 50mg/kg IVq8h OR Ceftriaxone 50mg/kg IV q24h for 10-14days

2.2.2.Neonates >7days

2.2.2.1.>2kg: Cefotaxime 50mg/kg IV q6-8h OR Ceftriaxone 75mg/kg IV q24h for 10-14days

2.2.3.Children: Cefotaxime 200mg/kg/day IV q6h OR Ceftriaxone 100mg/kg IV q12-24h for 10-14days

2.3.Post-meningitis exposure prophylaxis : Rifampin 600mg PO OD for 4days ^[74]

3.Severe infections^[75]

3.1.Adults

Preferred regimen : Ceftriaxone 1-2g IV q24 or q12h OR Cefotaxime 2g IV q6h.
Pencillin alternative : Ciprofloxacin 400mg IV q8h OR other Fluoroquinolones ORUse Ampicillin 2g IV q6h if sensitive.

Neisseria gonorrhoeae

Neisseria gonorrhoeae Return to Top

Neisseria gonorrhoeae treatment^[76]

1. Gonococcal infections in adolescents and adults

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

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

1.2 Uncomplicated gonococcal infections of the pharynx

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

1.2.1 Management of sex partners

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

1.2.2 Allergy, intolerance, and adverse reactions

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

1.2.3 Pregnancy

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

1.2.4 Suspected cephalosporin treatment failure

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

1.3 Gonococcal conjunctivitis

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

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

1.3.1 Management of sex partners

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

1.4 Disseminated gonococcal infection

1.4.1 Arthritis and arthritis-dermatitis syndrome

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

1.4.2 Gonococcal meningitis and endocarditis

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

2. Gonococcal infections among neonates

2.1 Ophthalmia neonatorum caused by N. gonorrhoeae

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

2.1.1 Management of mothers and their sex partners

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

2.2 Disseminated gonococcal infection and gonococcal scalp abscesses in neonates

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

2.2.1 Management of mothers and their sex partners

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

2.3 Neonates born to mothers who have gonococcal infection

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

2.3.1 Management of mothers and their sex partners

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

3. Gonococcal infections among infants and children

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

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

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

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

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

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

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

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

Neisseria meningitidis

Neisseria meningitidis Return to Top

1. Meningococcal meningitis or meningococcemia, treatment^[4]^[77]

1.1 Adults

1.1.1 Penicillin MIC < 0.1 mcg/mL

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

1.1.2 Penicillin MIC 0.1-1.0 mcg/mL

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

1.2 Neonates (birth-7 days old)

1.2.1 Penicillin MIC < 0.1 mcg/mL

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

1.2.2 Penicillin MIC 0.1-1.0 mcg/mL

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

1.3 Neonates (8-28 days old)

1.3.1 Penicillin MIC < 0.1 mcg/mL

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

1.3.2 Penicillin MIC 0.1-1.0 mcg/mL

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

1.4 Infants and children

1.4.1 Penicillin MIC < 0.1 mcg/mL

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

1.4.2 Penicillin MIC 0.1-1.0 mcg/mL

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

Note (1): Dexamethasone has not been shown to be beneficial in meningococcal meningitis and should be discontinued once this diagnosis is established.^[78]^[79]
Note (2): Clinical data are limited on the use of fluoroquinolones for therapy for meningococcal meningitis but may be considered in patients not responding to standard therapy or when disease is caused by resistant organisms.

2. Meningococcal meningitis, prophylaxis for household and close contacts^[80]

2.1 Adults

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

2.2 Children < 15 years

Preferred regimen: Ceftriaxone 12 mg IM single dose

2.3 Children ≥ 1 month

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

2.4 Children < 1 month

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

Moraxella catarrhalis Return to Top
Pasteurella multocida Return to Top

Pasteurella multocida ^[81]

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

Bacteria – Spirochetes

Borrelia burgdorferi Return to Top

Lyme disease

1. Early Lyme Disease

1.1 Erythema migrans

Preferred regimen: Doxycycline 100 mg twice per day for 10-21 days OR Amoxicillin 500 mg 3 times per day for 14-21 days OR Cefuroxime axetil 500 mg twice per day for 14-21 days
Alternatie regimen: : Azithromycin 500 mg PO per day for 7–10 days OR Clarithromycin 500 mg PO twice per day for 14–21 days (if the patient is not pregnant) OR Erythromycin 500 mg PO 4 times per day for 14–21 days
Pediatric regimen (1): (children <8 years of age) Amoxicillin 50 mg/kg per day in 3 divided doses [maximum of 500 mg per dose] OR Cefuroxime axetil 30 mg/kg per day in 2 divided doses （maximum of 500 mg per dose)
Pediatric regimen (2):（children ≥8 years of age）Doxycycline 4 mg/kg per day in 2 divided doses（maximum of 100 mg per dose）
Pediatric regimen (3): Azithromycin 10 mg/kg per day (maximum of 500 mg per day) OR Clarithromycin 7.5 mg/kg twice per day (maximum of 500 mg per dose) OR Erythromycin 12.5 mg/kg 4 times per day (maximum of 500 mg per dose)

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

Preferred regimen: Amoxicillin–clavulanic acid 500 mg 3 times per day;
Pediatric regimen；Amoxicillin–clavulanic acid 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose)

1.3 Lyme meningitis and other manifestations of early neurologic Lyme disease

Preferred regimen: Ceftriaxone 2g once per day IV for 10–28 days
Alternative regimen (1): Cefotaxime 2 g IV q8h OR Penicillin G 18–24 million U q4h per day for patients with normal renal function
Alternative regimen (2): Doxycycline 200–400 mg per day in 2 divided doses PO for 10–28 days
Pediatric regimen (1): Ceftriaxone 50–75 mg/kg per day in a single daily intravenous dose (maximum, 2g)
Pediatric regimen (2): Cefotaxime 150–200 mg/kg per day divided into 3 or 4 intravenous doses per day (maximum, 6 g per day)
Pediatric regimen (3): Penicillin G 200,000–400,000 units/kg per day (maximum, 18–24 million U per day) divided into doses given intravenously q4h for those with normal renal function
Pediatric regimen (4): (≥8 years old) Doxycycline 4–8 mg/kg PO per day in 2 divided doses (maximum, 100–200 mg per dose)

1.4 Lyme carditis

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

1.5 Borrelial lymphocytoma

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

Late Lyme Disease

1.6 Lyme arthritis

Preferred regimen: Doxycycline 100 mg twice per day OR Amoxicillin 500 mg 3 times per day
Alternative regimen: Cefuroxime axetil 500 mg twice per day for 28 days
Pediatric regimen: Amoxicillin 50 mg/kg per day in 3 divided doses (maximum of 500 mg per dose) OR Cefuroxime axetil 30 mg/kg per day in 2 divided doses (maximum of 500 mg per dose) OR (≥8 years of age) Doxycycline 4 mg/ kg per day in 2 divided doses (maximum of 100 mg per dose)
NOTE: For patients who have persistent or recurrent joint swelling after a recommended course of oral antibiotic therapy, we recommend re-treatment with another 4-week course of oral antibiotics or with a 2–4-week course of Ceftriaxone IV

1.7 patients with arthritis and objective evidence of neurologic disease

Preferred regimen: Ceftriaxone IV for 2–4 weeks
Alternative regimen: Cefotaxime OR Penicillin G IV
Pediatric regime: Ceftriaxone OR Cefotaxime OR Penicillin G IV

1.8 Late neurologic Lyme disease

Preferred regimen: Ceftriaxone IV for 2 to 4 weeks
Alternative regimen: Cefotaxime OR Penicillin G IV
Pediatric regimen: Ceftriaxone OR Cefotaxime OR Penicillin G

1.9 Acrodermatitis chronica atrophicans

Preferred regimen: Doxycycline 100 mg twice per day OR Amoxicillin 500 mg 3 times per day OR Cefuroxime axetil 500 mg twice per day for 21 days

2. Post–Lyme Disease Syndromes

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

Borrelia recurrentis Return to Top

1. Tick-Borne Relapsing Fever ^[82]

Preferred regimen: Doxycycline 100 mg PO twice daily for 5-10 days
Alternative regimen: Erythromycin 500 mg PO four times a day for 5-10 days
NOTE: If meningitis/encephalitis present, use Ceftriaxone 2 g IV q12h for 14 days

2. Louse-Borne Relapsing Fever

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

Leptospira Return to Top

1. Treatment

1.1 Severe ^[83] ^[84]

Preferred regimen: Penicillin 1.5 million units IV q6hr for 5-7 days

1.2 Less severe

Preferred regimen: Amoxycillin OR Ampicillin OR Doxycycline 100 mg BID IV or PO for 5-7 days OR Erythromycin OR Ceftriaxone 1g IV per day for 5-7 days OR Cefotaxime OR Quinolone PO

2. Prophylaxis

Leptospira interrogans ^[85]

Preferred regimen: Doxycycline 200 mg PO once per week

Treponema pallidum Return to Top

1. Syphilis Among non-HIV-Infected Persons^[86]

1.1 Primary and Secondary Syphilis

Preferred regimen (adult): Benzathine penicillin G 2.4 million units IM in a single dose
Preferred regimen (pediatric): Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose

1.2 Latent Syphilis

1.2.1 Early Latent Syphilis

Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose
Pediatric regimen: Benzathine penicillin G 50,000 units/kg IM, up to the adult dose of 2.4 million units in a single dose

1.2.2 Late Latent Syphilis or Latent Syphilis of Unknown Duration

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

1.3 Tertiary Syphilis

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

1.4 Neurosyphilis and ocular syphilis

Preferred regimen: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
Alternative regimen: Procaine penicillin 2.4 million units IM once daily AND Probenecid 500 mg orally four times a day, both for 10--14 days

2. Syphilis Among HIV-Infected Persons

2.1 Primary and Secondary Syphilis Among HIV-Infected Persons

Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.

2.2 Latent Syphilis Among HIV-Infected Persons

2.2.1 early latent

Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.

2.2.2 late latent

Preferred regimen: Benzathine penicillin G at weekly doses of 2.4 million units for 3 weeks.

2.3 Neurosyphilis Among HIV-Infected Persons

Preferred regimen: Aqueous crystalline penicillin G 18--24 million units per day, administered as 3--4 million units IV every 4 hours or continuous infusion, for 10--14 days
Alternative regimen: Procaine penicillin 2.4 million units IM once daily AND Probenecid 500 mg orally four times a day, both for 10--14 days

3. Syphilis During Pregnancy

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

4. Congenital Syphilis in neonates

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

Preferred regimen: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days OR Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days
NOTE: If more than 1 day of therapy is missed, the entire course should be restarted. Data are insufficient regarding the use of other antimicrobial agents (e.g., ampicillin). When possible, a full 10-day course of penicillin is preferred, even if ampicillin was initially provided for possible sepsis. The use of agents other than penicillin requires close serologic follow-up to assess adequacy of therapy. In all other situations, the maternal history of infection with T. pallidum and treatment for syphilis must be considered when evaluating and treating the infant.

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

Preferred regimen: Aqueous crystalline penicillin G 100,000--150,000 units/kg/day, administered as 50,000 units/kg/dose IV every 12 hours during the first 7 days of life and every 8 hours thereafter for a total of 10 days OR Procaine penicillin G 50,000 units/kg/dose IM in a single daily dose for 10 days OR Benzathine penicillin G 50,000 units/kg/dose IM in a single dose
NOTE:If the mother has untreated early syphilis at delivery, 10 days of parenteral therapy can be considered.

4.3 condition 3:Infants who have a normal physical examination and a serum quantitative nontreponemal serologic titer the same or less than fourfold the maternal titer and the (1)mother was treated during pregnancy, treatment was appropriate for the stage of infection, and treatment was administered >4 weeks before delivery and (2)mother has no evidence of reinfection or relapse.

Preferred regimen: Benzathine penicillin G 50,000 units/kg/dose IM in a single dose

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

Preferred regimen: No treatment is required; however, benzathine penicillin G 50,000 units/kg as a single IM injection might be considered, particularly if follow-up is uncertain.

5. Congenital Syphilis in infants and children

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

Bacteria – Gram-Negative Bacilli

Achromobacter xylosoxidans Return to Top

Acinetobacter baumannii

Acinetobacter baumannii Return to Top

Acinetobacter baumannii^[87]

Preferred regimen (1): Imipenem 0.5-1 g IV q6h
Preferred regimen (2): Ampicillin/sulbactam 3 g IV q4h
Preferred regimen (3): Cefepime 1-2 g IV q8h
Preferred regimen (4): Colistin 2.5 mg/kg IV q12h
Preferred regimen (5): Tigecycline 100 mg IV single dose THEN 50 mg IV q12h
Preferred regimen (6): Amikacin 7.5 mg/kg IV q12h or 15 mg/kg IV q24h
Preferred regimen (7) (pan-resistant isolates): Colistin 5 mg/kg/day IV q12h ± Imipenem
Preferred regimen (8) (pan-resistant isolates): Ampicillin-sulbactam 3 g IV q4h
Alternative regimen (1): Ceftriaxone 1-2 g IV qd
Alternative regimen (2): Cefotaxime 2-3 g IV q6-8h
Alternative regimen (3): Ciprofloxacin 400 mg IV q8-12h or 750 mg PO bid
Alternative regimen (4): TMP-SMX 15-20 mg (TMP)/kg/day IV q6-8h or 2 DS PO bid

Aeromonas hydrophila

Aeromonas hydrophila Return to Top

Aeromonas hydrophila ^[88]

1. Diarrhea

Preferred regimen (if not self-limiting, or if severe): Ciprofloxacin 500 mg PO bid.
Alternate regimen: TMP-SMX 1 DS PO bid
Note: High resistance to sulfa agents described in Taiwan and Spain

2. Skin and soft tissue infection

2.1 Mild infection

Preferred regimen(1): Ciprofloxacin 500 mg PO bid
Preferred regimen(2): Levofloxacin 500 mg qd

2.2 Severe infection or sepsis

Preferred regimen(1): Ciprofloxacin 400 mg IV q8h
Preferred regimen(2): Levofloxacin 750 mg IV q24h
Note(1): For suspicion of water-based injury,empiric coverage for Vibrio doxycycline 100 mg bid, although flouroquinolones may also cover and vancomycin 15 mg/kg IV q12h with or without clindamycin or linezolid for inhibition of gram-positive toxin production
Note(2): Alternatives to fluoroquinolones for Aeromonas coverage include carbapenems (ertapenem, doripenem, imipenem or meropenem), ceftriaxone, cefepime and aztreonam

3. Prevention

Preferred regimen: Frequent recommendations include using a Cephalosporin (e.g.,cefuroxime,ceftriaxone or cefixime) OR a Fluoroquinolone (e.g.,ciprofloxacin or levofloxacin) during treatment with medicinal leeches
Note (1): Duration of antibiotic use is 3-5 days, some recommend continuing until wound or eschar resolves
Note (2): Aeromonas isolates from leeches have been described as uniformly susceptible to fluoroquinolones

Bartonella

Bartonella Return to Top

Bartonella^[89]

1. Bartonella quintana

1.1 Acute or chronic infections without endocarditis^[90]

Preferred regimen: Doxycycline 200 mg PO qd or 100 mg bid for 4 weeks AND Gentamicin 3 mg/kg IV qd for the first 2 weeks

1.2 Endocarditis^[10]

Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks ± Doxycycline 100 mg PO bid for 6 weeks

2. Bartonella elizabethae

2.1 Endocarditis^[10]

Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g IV q24h for 6 weeks ± Doxycycline 100 mg PO bid for 6 weeks

3. Bartonella bacilliformis

3.1 Oroya fever

Preferred regimen: Ciprofloxacin 500 mg PO bid for 14 days
Note: If severe disease, add Ceftriaxone 1 g IV qd for 14 days

3.2 Verruga peruana^[91]

Preferred regimen: Azithromycin 500 mg PO qd for 7 days
Alternative regimen (1): Rifampin 600 mg PO qd for 14-21 days
Alternative regimen (2): Ciprofloxacin 500 mg bid for 7-10 days

4. Bartonella henselae^[92]

4.1 Cat scratch disease

No treatment recommended for typical cat scratch disease, consider treatment if there is an extensive lymphadenopathy
4.1.1 If extensive lymphadenopathy

Preferred regimen (1) (pediatrics): Azithromycin 500 mg PO on day 1 THEN 250 mg PO qd on days 2 to 5
Preferred regimen (2) (adults): Azithromycin 1 g PO at day 1 THEN 500 mg PO for 4 days

4.2 Endocarditis

Preferred regimen: Gentamicin 3 mg/kg/day IV q8h for 14 days AND Ceftriaxone 2 g/day IV for 6weeks ± Doxycycline 100 mg PO bid for 6 weeks

4.3 Retinitis

Preferred regimen: Doxycycline 100 mg bid AND Rifampin 300 mg bid PO for 4-6 weeks

4.4 Bacillary angiomatosis^[93]

Preferred regimen (1): Erythromycin 500 mg PO qid for 2 months at least
Preferred regimen (2): Doxycycline 100 mg PO bid for 2 months at least

4.5 Bacillary Pelliosis^[93]

Preferred regimen (1): Erythromycin 500 mg PO qid for 4 months at least
Preferred regimen (2): Doxycycline 100 mg PO bid for 4 months at least

Bordetella pertussis

Bordetella pertussis Return to Top

Bordetella pertussis^[94]

1. Whooping cough

1.1 Adults

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

1.2 Infants <6 months of age

1.2.1 Infants <1 month

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

1.2.2 Infants of 1-5 months of age

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

1.3 Infants ≥6 months of age-children

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

2. Post exposure prophylaxis^[95]

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

Burkholderia cepacia

Burkholderia cepacia Return to Top

Burkholderia cepacia complex^[96]

Preferred regimen (1): Ceftazidime 2 g IV q8h
Preferred regimen (2): Imipenem 1 g IV q6h
Preferred regimen (3): Meropenem 1-2 g IV q8h
Preferred regimen (4): Minocycline 100 mg IV/PO bid

Burkholderia pseudomallei

Burkholderia pseudomallei Return to Top

Burkholderia pseudomallei

1. Melioidosis^[97]

1.1 Intial intensive therapy (Minimum of 10-14 days)

Preferred regimen (1): Ceftazidime 50 mg/kg upto 2 g q6h
Preferred regimen (2): Meropenem 25 mg/kg upto 1 g q8h
Preferred regimen (3): Imipenem 25 mg/kg upto 1 g q6h
Note: Any one of the three may be combined with TMP-SMX 6/30 mg/kg upto 320/1600 mg/kg q12h (recommended for neurologic, bone, joint, cutaneous and prostatic melioidosis)

1.2 Eradication therapy (Minimum of 3 months)

Preferred regimen: TMP-SMX 6/30 mg/kg upto 320/1600 mg/kg q12h

Campylobacter fetus

Campylobacter fetus Return to Top

Campylobacter fetus^[98]

Serious infections

Preferred regimen : Gentamicin 5mg/kg/day IV OR Imipenem 1mg IV q6h OR Ceftriaxone 2g IV q12h.

Endovascular infections

Preferred regimen : Aminoglycoside4-6weeks combined with Carbapenem.

CNS

preferred regimen : Ceftriaxone OR Chloramphenicol for 2-3weeks.

Campylobacter jejuni Return to Top

Capnocytophaga canimorsus

Capnocytophaga canimorsus Return to Top

Capnocytophaga canimorsus^[99]

1. Severe cellulitis/sepsis or endocarditis

Preferred regimen (1) (Beta-lactam/beta-lactamase inhibitor): Ampicillin/sulbactam 3 g IV q6h
Preferred regimen (2) (Non-beta-lactamase producing): Penicillin G 2-4 MU IV q24h
Alternative regimen (1): Ceftriaxone 1-2 g IV q24h
Alternative regimen (2): Meropenem 1 g IV q8h
Alternative regimen (3) (complicated infections or immunocompromise): Clindamycin 600 mg IV q8h may be combined with above agents
Note (1): Resistance to aztreonam described, and variable susceptibility reported to TMP-SMX and aminoglycosides
Note (2): For endocarditis, alternatives to penicillins not well established, treated for duration of 6 weeks
Note (3): For non-endocarditis infections, duration not well established, but most authorities recommend at least 14-21 days of therapy

2. Mild cellulitis/dog or cat bites

Preferred regimen (1): Amoxicillin/clavulanate 500 mg PO q8h or 875 mg PO bid
Preferred regimen (2): Amoxicillin 500 mg PO q8h
Alternative regimen (1): Clindamycin 300 mg PO q6h
Alternative regimen (2): Doxycycline 100 mg PO bid
Alternative regimen (3): Clarithromycin 500 mg PO bid
Alternative regimen (4): Moxifloxacin 400 mg PO qd

3. Meningitis or brain abscess

Preferred regimen (1): Ceftriaxone 2 g IV q12h AND Ampicillin 2 g IV q4h
Preferred regimen (2) (if beta-lactamase producing or polymicrobial brain abscess): Imipenem/Cilastin 1000 mg q6-8h AND Clindamycin 600 mg IV q8h

4. Prevention

Although no firm data supports this recommendation, many clinicians do give prophylaxis for dog and cat bites in asplenic patients with Amoxicillin/clavulanate for 7-10 days.

Citrobacter freundii

Citrobacter freundii Return to Top

Citrobacter freundii^[100]

Preferred regimen (1): Meropenem 1-2 g IV q8h
Preferred regimen (2): Imipenem 1 g IV q6h
Preferred regimen (3): Doripenem 500 mg IV q8h
Preferred regimen (4): Cefepime 1-2 g IV q8h
Preferred regimen (5): Ciprofloxacin 400 mg IV q12h or 500 mg PO bid for UTI
Preferred regimen (6): Gentamicin 5 mg/kg IV q24h
Alternate regimen (1): Piperacillin-tazobactam 3.375 mg IV q6h
Alternate regimen (2): Aztreonam 1-2 g IV q6h
Alternate regimen (3): TMP-SMX 5 mg/kg q6h IV or DS PO bid for UTI
Note: Usually carbenicillin sensitive, cephalothin resistant

Citrobacter koseri

Citrobacter koseri Return to Top

Citrobacter koseri^[101]

Preferred regimen (1): Ceftriaxone 1-2 g IV q12-24h
Preferred regimen (2): Cefotaxime 1-2 g IV q6h
Preferred regimen (3): Cefepime 1-2 IV q8h
Alternate regimen (1): Ciprofloxacin 400 mg IV q12h or 500 mg PO q12h for UTI
Alternate regimen (2): Imipenem 1 g IV q6h
Alternate regimen (3): Doripenem 500 mg IV q8h
Alternate regimen (4): Meropenem 1-2 g IV q8h
Alternate regimen (5): Aztreonam 1-2 g IV q6h
Alternate regimen (6): TMP-SMX 5 mg/kg IV q6h or DS PO bid for UTI
Note: Usually Ampicillin resistant, but may be sensitive to first generation cephalosporins

Elizabethkingia meningoseptica Return to Top

Enterobacter

Enterobacter Return to Top

Enterobacter species including E. aerogenes and E. cloacae^[102]^[103]^[104]^[105]^[106]

1. Empiric antimicrobial therapy pending in vitro susceptibility

1.1 Non–life-threatening infections or MDR-GNB prevalence < 20%

Preferred regimen: Piperacillin-Tazobactam 3.375 g IV q6h ± Aminoglycosides
Alternative regimen: Ciprofloxacin 400 mg IV q8–12h

1.2 Life-threatening infections or MDR-GNB prevalence > 20%

Preferred regimen: Meropenem 0.5–1 g IV q8h
Alternative regimen (1): Colistin AND Meropenem 0.5–1 g IV q8h
Alternative regimen (2): Colistin AND Imipenem 500 mg IV q6h
Alternative regimen (3): Colistin AND Doripenem 500 mg IV q8h
Alternative regimen (4): Colistin AND Ertapenem 1 g IV q24h
Alternative regimen (5): Colistin AND Fosfomycin 6 g IV q6h

2. In vitro susceptibility available

2.1 Susceptible to all tested agents

Preferred regimen: Piperacillin-Tazobactam 3.375 g IV q6h
Alternative regimen (1): Ciprofloxacin 400 mg IV q8–12h
Alternative regimen (2): Cefepime 2 g IV q8h (if MIC ≤ 1 μg/mL)

2.2 Extended spectrum beta-lactamase (ESBL)-producing Enterobacter spp.

Preferred regimen: Meropenem 0.5–1 g IV q8h
Alternative regimen (1): Imipenem 500 mg IV q6h
Alternative regimen (2): Doripenem 500 mg IV q8h
Alternative regimen (3): Ertapenem 1 g IV q24h
Alternative regimen (4): Cefepime 2 g IV q8h (if MIC ≤ 1 μg/mL)

2.3 Resistant to all tested agents

Preferred regimen: Colistin AND Meropenem 0.5–1 g IV q8h
Alternative regimen (1): Colistin AND Imipenem 500 mg IV q6h
Alternative regimen (2): Colistin AND Doripenem 500 mg IV q8h
Alternative regimen (3): Colistin AND Ertapenem 1 g IV q24h
Alternative regimen (4): Colistin AND Minocycline 100 mg IV q12h

Escherichia coli

{PBI|Escherichia coli}}

Escherichia coli^[107]

1.Meningitits

1.1.Preferred regimen: Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h
1.2.Alternative regimen: Aztreonam 6–8 g/day IV q6–8h OR Gatifloxacin 400 mg/day IV q24h OR Moxifloxacin 400 mg/day IV q24h OR Meropenem 6 g/day IV q8h OR Trimethoprim-Sulfamethoxazole 10–20 mg/kg/day q6–12h OR Ampicillin 12 g/day IV q4h

2.Uncomplicated urinary tract infection

2.1.Preferred agents (IDSA/AUA Guidelines): TMP-SMX DS PO bid for 3-day
2.2.Alternative regimen(1): Ciprofloxacin 250 mg PO bid OR Ciprofloxacin 500 mg XR once daily for 3 days OR Levofloxacin 250 mg PO OD for 3 days.
2.3.Alternative regimen(2): Nitrofurantoin 100 mg PO q6h OR Nitrofurantoin macrocrystals (Macrobid) 100 mg PO bid for 7 days.
2.4.Alternative regimen(3): Fosfomycin 3 g sachet PO single dose.

Note: For older patients, those with comorbidities (e.g., diabetes mellitus) use 7-10 days course.

3.Pyelonephritis

3.1.Acute uncomplicated pyelonephritis

Preferred regimen: Ciprofloxacin 500 mg bid PO for 5-7 days OR Ciprofloxacin-Erythromycin 1000 mg q24h OR Levofloxacin 750 mg q24h OR Ofloxacin 400 mg bid, Moxifloxacin 400 mg q24h
Alternative regimen: Amoxicillin-Clavulanic acid875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid OR Oral Cephalosporins OR TMP-SMX 2 mg/kg IV q6h PO for 14 days

3.1.Acute pyelonephritis (Hospitalized)

Preferred regimen: Ciprofloxacin 400 mg IV q12h OR Ampicillin and Gentamicin OR Piperacillin-Tazobactam 3.375 gm IV q4-6h for 14 days.
Alternative regimen: Ticarcillin-Clavulanate3.1 gm IV q6h or Ampicillin-Sulbactam 3 gm IV q6h or Piperacillin-Tazobactam 3.375 gm IV q4-6h OR Ertapenem 1 gm IV q24h or Doripenem 500 mg q8h for 14 days.

4.Traveler’s diarrhea

Preferred regimen : Ciprofloxacin 750 mg PO OD for 1-3 days or other Fluoroquinolones
Pediatrics & pregnancy: Azithromycin 10 mg/kg/day single dose OR Ceftriaxone 50 mg/kg/day IV OD for 3 days.

Avoid Fluoroquinolones in Pediatrics and pregnancy.

5.Malacoplakia

Bethanechol chloride AND (Ciprofloxacin 400 mg IV q12h OR TMP-SMX 2 mg/kg (TMP component) IV q6h)

6. Bacteremia/Pneumonia

Preferred regimen : Ceftriaxone 1-2g IV q24h OR other third or fourth generation cephalosporin OR Ciprofloxacin 400mg IV q12h or 500mg PO q12h OR Levofloxacin 500mg PO/IV q24h OR Moxifloxacin 400mg IV/PO q24h OR Ampicillin(if sensitive) 2g IV q6h OR TMP-SMX(if sensitive) 5-10mg/kg/day for q6-8hIV
Alternative regimen (1): Imipenem, Meropenem, Ertapenem, Doripenem, Ceftazidime, Cefepime, Cefazolin or Cefuroxime(if sensitive), Aztreonam, Ticarcillin, Piperacillin, Piperacillin-Tazobactam, Aminoglycosides, Tigecycline(intra-abd or skin/softtissue).
Alternative regimen (2): Ampicillin-sulbactam 3g IV q6h ANDGentamicin 1.5mg/kg/q8h or 5-7mg/kg/dayIV OR Gentamicin 5mg/kg/day OR Tobramycin 5mg/kg/dayIV for 7-14days
Note: Monotherapy generally not recommended for bacteremia/pneumonia

Francisella tularensis

Francisella tularensis Return to Top

Francisella tularensis^[108]

1. Tularemia

Preferred regimen (1): Streptomycin 1 g IM bid
Preferred regimen (2): Gentamicin 5 mg/kg IV q24h for 10 days
Preferred regimen (3) (pregnancy): Gentamicin 5 mg/kg IV q24h for 10 days
Alternative regimen (1): Doxycycline 100 mg IV bid
Alternative regimen (2): Chloramphenicol 1 g IV q6h
Alternative regimen (3): Ciprofloxacin 400 mg IV bid until stable THEN PO for 14-21 days (total)

Helicobacter pylori

Helicobacter pylori Return to Top

Helicobacter pylori^[109]

1.Peptic ulcer disease

1.1.Regimens for Initial Treatment

1.1.1.Triple therapy : PPI(standard dose twice daily) AND Amoxicillin 1 g bid AND Clarithromycin 500 mg bid for 7-14 days
1.1.2.Quadruple therapy: PPI (standard dose twice daily) AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
1.1.3.Sequential therapy: PPI (standard dose twice daily)AND Amoxicillin 1 g bid for 1-5 days followed by PPI (standard dose twice daily)AND Clarithromycin 500 mg bid AND Tinidazole 500 mg bid for 6-10 days

1.2. Second-Line Therapies

1.2.1.Triple therapy: PPI (standard dose twice daily) AND Amoxicillin 1 g bid AND Metronidazole 500 mg bid
1.2.2.Quadruple therapy: PPI (standard dose twice daily)AND Metronidazole 250 mg q6h AND Tetracycline 500 mg q6h AND Bismuth (dose depends on preparation) for 10-14 days
1.2.3.Levofloxacin triple therapy: PPI (standard dose twice daily) AND Amoxicillin 1 g bid AND Levofloxacin 500 mg bid for 10 days
1.2.4.Rifabutin triple therapy: PPI (standard dose twice daily) and Amoxicillin 1 g bid AND Rifabutin 150-300 mg/day for 10 days

1.3.Alternative triple therapies appropriate for patients with an allergy to Amoxicillin include (PPI AND Clarithromycin AND Metronidazole)OR (PPI AND Tetracycline AND Metronidazole).

Klebsiella granulomatis

Klebsiella granulomatis Return to Top

Klebsiella granulomatis (formly known as Calymmatobacterium granulomatis)

1. Granuloma inguinale (donovanosis)^[110]

Preferred regimen: Azithromycin 1 g PO once a week or 500 mg qd for 3 weeks THEN until all lesions have completely healed
Alternative regimen (1): Doxycycline 100 mg PO bid for 3 weeks THEN until all lesions have completely healed
Alternative regimen (2): Ciprofloxacin 750 mg PO bid for at least 3 weeks THEN until all lesions have completely healed
Alternative regimen (3): Erythromycin base 500 mg PO qid for at least 3 weeks THEN until all lesions have completely healed
Alternative regimen (4): Trimethoprim-sulfamethoxazole DS (160 mg/800 mg) tablet PO bid for at least 3 weeks THEN until all lesions have completely healed

Klebsiella pneumoniae

Klebsiella pneumoniae Return to Top

Klebsiella pneumoniae^[111]

1. Severe, nosocomial infections

1.1 Non-ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections

Preferred regimen (1): Cefepime 2 g IV q8h
Preferred regimen (2): Ceftazidime 2 g IV q8h
Preferred regimen (3): Imipenem 500 mg IV q6h
Preferred regimen (4): Meropenem 1 g IV q8h
Preferred regimen (5): Piperacillin-tazobactam 4.5 g IV q6h AND Aminoglycoside
Alternative regimen (1): Ceftriaxone 1 g IV q24h AND Metronidazole 500 mg IV q6h or 1 g IV q12h
Alternative regimen (2): Moxifloxacin 400 mg IV/PO q24h

1.2 ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections

Preferred regimen (1): Imipenem 500 mg IV q6h
Preferred regimen (2): Meropenem 1 g IV q8h
Preferred regimen (3): Ertapenem 1 g IV q24h
Preferred regimen (4): Doripenem 500 mg IV q8h
Note: In ESBLs, inconsistent activity is seen with aminoglycosides, fluoroquinolones, and piperacillin-tazobactam. Avoid cephalosporins.

Klebsiella rhinoscleromatis

Klebsiella rhinoscleromatis Return to Top

1. Rhinoscleroma^[112]^[113]^[114]

Preferred regimen (1): Ciprofloxacin 500–750 mg PO bid for 2–3 months
Preferred regimen (2): Levofloxacin 750 mg PO qd for 2–3 months
Preferred regimen (3): Trimethoprim-Sulfamethoxazole 1 DS tab PO bid for 3 months AND Rifampicin 300 mg PO bid for 3 months
Alternative regimen: Tetracycline OR Streptomycin OR Doxycycline OR Ceftriaxone OR Ofloxacin
Note (1): The optimal duration of antimicrobial therapy remains unclear. A 6-week to 6-month course of antibiotics until histology exams and cultures are negative may be required.
Note (2): Use of topical antiseptics such as Acriflavinium and Rifampin ointment has been reported with resolution of symptoms.^[115]

Legionella pneumophila

Legionella pneumophila Return to Top

1.Atypical pneumonia (Legionnaires' disease )^[116]

1.1 Mild pneumonia inpatient or outpatient, non immunocompromised

Preferred regimen (1): Azithromycin 500 mg PO qd for 3-5 days
Preferred regimen (2): Levofloxacin 500 mg PO qd for 7-10 days
Preferred regimen (3): Ciprofloxacin 500 mg PO bid for 7-10 days
Preferred regimen (4): Moxifloxacin 400 mg PO qd for 7-10 days
Preferred regimen (5): Clarithromycin 500 mg PO bid for 10-14 days
Alternative regimen (1): Doxycycline 200 mg PO loading dose, then 100 mg PO bid for 10-14 days
Alternative regimen (2): Erythromycin 500 mg PO qid for 10-14 days
Note: Patients with mild disease may be treated entirely with oral therapy.

1.2 Moderate to severe pneumonia or immunocompromised

Preferred regimen (1): Azithromycin 500 mg PO/IV q24h for 5-7 days
Preferred regimen (2): Levofloxacin 500 mg PO/IV q24h for 7-10 days OR 750 mg PO/IV q24h for 5-7 days
Alternative regimen (1): Ciprofloxacin 750 mg PO bid for 14 days
Alternative regimen (2): Moxifloxacin 400 mg PO qd for 14 days
Alternative regimen (3): Erythromycin 750-1000 mg IV q6h for 3-7 days, then 500 mg PO qid for a total course of 21 days
Alternative regimen (4): Clarithromycin 500 mg IV q12h for 3-7 days, and then 500 mg PO bid for a total course of 21 days
Note: Severely ill patients parenteral therapy is advised until improvement is seen and oral absorption is sufficient.

2 Pontiac fever

Pontiac fever is febrile, self-limited form of Legionella infection which requires only symptomatic therapy, such as analgesics for headache. Antibiotics are not indicated.

Moraxella catarrhalis

Moraxella catarrhalis Return to Top

Moraxella catarrhalis^[117]

Preferred regimen (1): TMP-SMX 1DS PO bid
Preferred regimen (2): Erythromycin 500 mg PO q6h
Preferred regimen (3): Clarithromycin 500 mg bid or XL 1 g PO qd
Preferred regimen (4): Azithromycin 500 mg single dose THEN 250 mg PO qd
Preferred regimen (5): Doxycycline 100 mg PO/IV bid
Preferred regimen (6): Parenteral cephalosporins such as Cefuroxime OR Cefotaxime OR Ceftriaxone
Preferred regimen (7): Cefprozil 200-500 mg PO bid
Preferred regimen (8): Cefpodoxime 200-400 mg PO bid
Preferred regimen (9): Cefuroxime 250-500 mg PO bid
Preferred regimen (10): Cefdinir 300 mg bid
Preferred regimen (11): Moxifloxacin 400 mg IV/PO qd
Preferred regimen (12): Levofloxacin 500 mg IV/PO qd
Preferred regimen (13): Amoxicillin-Clavulanate 875/125 mg PO bid or XL 2000/125 PO bid

Morganella morganii

Morganella morganii Return to Top

Morganella morganii^[118]

Preferred regimen (1): Imipenem 500 mg IV q6h
Preferred regimen (2): Meropenem 1.0 g IV q8h (adjust dose if necessary for renal function).
Note (1): Carbapenems are considered first line therapy due to inducible cephalosporinases, and presence of extended-spectrum beta-lactamases in some isolates
Note (2): Duration of treatment for UTI (generally complicated) is 7 days and duration of treatment for bacteremia is 14 days
Note (3): Tigecycline is not reliably effective
Alternative Regimen (1): Cefepime 2.0 g IV q8-12h
Alternative Regimen (2): Ciprofloxacin 500 mg PO/400 mg IV q12h
Alternative Regimen (3): Piperacillin 3 g IV q6h
Alternative Regimen (4): Ticarcillin 3 g IV q4h
Alternative Regimen (5): Gentamicin
Alternative Regimen (6): Tobramycin 1 mg/kg IV q24h
Alternative Regimen (7): Amikacin 3 mg/kg IV q24h
Note: Aminoglycosides can be used alone for treatment of UTI

Plesiomonas shigelloides

Plesiomonas shigelloides Return to Top

Plesiomonas shigelloides^[119]

1.Immunocompetent Hosts or Severe Infection

Preferred regimen : Ciprofloxacin 500mg PO bid or 400mg IV q12h.
Alternative regimen (1): Ofloxacin 300mg PO bid OR Norfloxacin 400mg PO bid OR TMP-SMX DS PO bid for 3days.
Alternative regimen (2): Ceftriaxone 1-2g IV OD used successfully in severe cases.

2.Immunocompromised Hosts

Preferred regimen : Ciprofloxacin 500mg PO bid for 3days.
Alternative regimen : Ofloxacin 300mg PO bid OR Norfloxacin 400mg PO bid OR TMP-SMX DS PO(if susceptible) bid for 3days

Proteus mirabilis

Proteus mirabilis Return to Top

Proteus mirabilis^[120]

Preferred regimen (1): Ampicillin 500 mg PO q6h or 2 g IV q6h.
Preferred regimen (2): Cefuroxime 250 mg PO bid or 750 mg IV q8h.
Preferred regimen (3): Ciprofloxacin 250-500 mg PO bid or 400 mg IV q12h.
Preferred regimen (4): Levofloxacin 500 mg PO OD or 500 mg IV q24h.
Note: Uncomplicated UTI 3 days, pyelonephritis 7-14 days, complicated UTI 10-21 days and bacteremia 7-14 days.

Indole positive Proteus species Return to Top

Indole positive Proteus species^[121]

Preferred regimen (1): Ceftriaxone 1 g IV q24h.
Preferred regimen (2): Imipenem 500 mg IV q6h.
Preferred regimen (3): Ciprofloxacin 400 mg IV q12h or 250-500 mg PO bid.
Preferred regimen (4): Levofloxacin 500 mg IV/PO q24h.

Providencia

Providencia Return to Top

Providencia^[122]

Complicated UTI/Bacteremia/Acute prostatitis

Preferred regimen : Ciprofloxacin 500-750mg PO q12h or 400 mg IV q8-12h OR Levofloxacin 500mg IV/PO q24h OR Piperacillin-Tazobactam 3.375 mg IV q6h ORCeftriaxone 1-2g IV q24h (donot use if ESBL suspected or critically ill)OR Meropenem 1g IV q8h (consider if critically ill or ESBL suspected)ORAmikacin 7.5mg/kg IV q12h OR Gentamicin OR Tobramycin acceptable if susceptible but many species are resistant.
Note (1) : Duration of treatment for (UTI)is 7days common or 3-5days after defervescence or control/elimination of complicating factors (e.g.,removal of foreign material catheter).
Note (2) : Duration of treatment for (bacteremia)is 10-14days or 3-5days after defervescence or control/elimination of complicatingfactors.
Note (3) : Duration for acute prostatitis(2weeks), shorter than chronic prostatitis(4-6wks)
Alternative regimen : TMP-SMX(Bactrim)DS1 PO q12h for 10-14days OR TMP 5-10 mg/kg/day IV q6h.

Pseudomonas aeruginosa

Pseudomonas aeruginosa Return to Top

Pseudomonas aeruginosa^[123]

Preferred regimen (1) : Cefepime 2g IV q8h OR Ceftazidime 2g IV q8h OR Piperacillin 3-4g IV q4h in (no benefit for pseudomonas from beta-lactamase inhibitor)OR Ticarcillin 3-4g IV q4h(no benefit for pseudomonas from beta-lactamase inhibitor).
Preferred regimen (2) : Imipenem 500mg—1g IV q6h OR Meropenem 1g IV q8h OR Doripenem 500mg IV q8h OR Ciprofloxacin 400mg IV q8h OR750mg PO q12h(for less serious infections). Aztreonam 2g IV q6-8h.Colistin 2.5 mg/kg IV q12h. Polymyxin B 0.75-1.25 mg/kg IV q12h Gentamicin OR Tobramycin 1.7-2.0 mg/Kg IV q8h or 5-7mg/kg IV OR Amikacin 2.5mg/kg IV q12h.Usually used in combination with other antimicrobials(preferably beta-lactams).

Note : Amikacin > Tobramycin > Gentamicin with respect to P.aeruginosa susceptibility percentages at most institutions.

Salmonella

Salmonella Return to Top

Salmonella^[124]

1.Gastroenteritis

Preferred treatment

Immunocompetent : TMP-SMX DS PO bid OR Ciprofloxacin 500mg PO bid OR Ceftriaxone 2gIV/day for 5-7days.
Immunosuppressed : TMP-SMX DS PO bid OR Ciprofloxacin 500mg PO bid OR Ceftriaxone 2gIV/day for ≥14days.

2.Typhoidfever

Preferred regimen : Ceftriaxone 1-2g IV q24h then Cefixime 400mg PO for 10-14days OR Ciprofloxacin 400mg IV q12h or 500mg PO bid.

3.Non-typhoid(seriousinfection)

Preferred regimen : 3rd generation Cephalosporin (Ceftriaxone/Cefotaxime)OR Fluoroquinolone(Ciprofloxacin, Levofloxacin)

4.Bacteremia

Preferred regimen : Ceftriaxone 2g IV q24h OR Cefotaxime 2g IV q6-8h for 7-14days OR Ciprofloxacin 400mg IV q12h for 7-14days

5.Vascular prosthesis infection

Preferred regimen : Ceftriaxone, Cefotaxime OR Ciprofloxacin 400mg IV q12h for 6wks

6.Osteomyelitis

Preferred regimen : Ceftriaxone 2g IV q24h OR Cefotaxime 2g IV q6-8h OR Ciprofloxacin 750mg PO bid for ≥4wks

7.Arthritis

Preferred regimen : Ceftriaxone 2g IV q24h OR Cefotaxime 2g IVq 6-8h for 6weeks.

8.Endocarditis

Preferred regimen : Ceftriaxone 2g IV q24h OR Cefotaxime 2g IV q6-8h for 6weeks.

9.UTI

Preferred regimen : Ceftriaxone, Cefotaxime OR Ciprofloxacin IV for 1-2weeks, then oral Ciprofloxacin OR TMP-SMX for 6weeks

10.HIV and salmonellosis

Preferred regimen : IV Cephalosporin OR IV Fluoroquinolone, then oral Flouroquinolones(Ciprofloxacin 500-750mg PO bid for 4weeks).
Note : If relapse occurs within 6weeks give life-long abx or until immune recovery post-ART

11.Carrier state : Ciprofloxacin 500mg PO bid for 4-6weeks OR TMP-SMX 1DS bid PO for 6weeksOR Amoxicillin 500mg PO for 6weeks.

Serratia marcescens

Serratia marcescens Return to Top

Serratia marcescens^[125]

1.Bacteremia,Pneumonia or SeriousInfections

Preferred regimen : Cefepime 1-2 g IV q8h OR Imipenem 0.5-1.0 g IV q6h OR Ciprofloxacin 400mg IV q8h.
Alternative regimen : Aztreonam, Gentamicin OR Amikacin OR Piperacillin/tazobactam also often effective.
Note : Duration depends on clinical response,usually 7-14days.

2.Endocarditis

Preferred regimen : Choice dictated by sensitivities. 4to6 week duration of parenteral therapy.

3.Osteomyelitis

Preferred regimen : Choice dictated by sensitivity profile. Treat for 6-12weeks depending upon response. Use IV treatment until stable/clinically improved(10-14days min)then may convert to PO therapy if appropriate

4.UTI

Preferred regimen : Ciprofloxacin 250mg PO bid or 400mg IV q12h OR Levofloxacin 250mg PO everyday or 500mg IV q24h
Note : Fluoroquinolones often sensitive but in seriously ill patient consider empiric coverage with two drugs(e.g.,Beta-lactam and Aminoglycoside OR Fluoroquinolones AND Carbapenem)until susceptibilities known.

Shigella

Shigella Return to Top

Shigella^[126]

Preferred regimen

If known sulfa sensitive : TMP(160mg)/SMX(800mg) PO q12h for 3-5days.
Pediatric dose : TMP5mg/SMX 25mg/kg PO bid.
If TMP/SMX resistant or unknown susceptibility : Ciprofloxacin 500mg OR Norfloxacin 400mg OR Ofloxacin 200mg PO bid for 3-5days.

Alternative regimen : Ceftriaxone 1g IV q24h OR} Azithromycin 500mg PO single dose, then 250mg PO for 4days OR Nalidixicacid 250mg PO q6h or pediatric dose 55kg/day) OR Ampicillin(500mg PO q6h depending on susceptibility patterns.
Note : In southeast Asia, growing resistance seen to fluoroquinolones, azithromycin maybe preferred.

Stenotrophomonas maltophilia

Stenotrophomonas maltophilia Return to Top

Stenotrophomonas maltophilia^[127]

Preferred treatment : TMP-SMX 15-20(TMP component)mg/kg/day IV/PO q8h.
Alternative treatment (1) : Ceftazidime 2g IV q8h OR Ticarcillin/clavulanate 3.1g IV q4h OR Tigecycline 100mg IV Single dose,then 50mg IV q12h.
Alternative treatment (2) : Ciprofloxacin 500-750mg PO /400mg IV q12h OR Moxifloxacin 400mg PO/IV OR Levofloxacin 750mg PO/IV .
Alternative treatment (3) : Multiply-resistantance Colistin 2.5mg/kg q12h IV.
Note : Treatment duration uncertain,but usually ≥14days

Vibrio cholerae Return to Top
Vibrio parahaemolyticus Return to Top
Vibrio vulnificus Return to Top

Bacteria – Atypical Organisms

Chlamydophila pneumoniae

Chlamydophila pneumoniae Return to Top

1. Atypical pneumonia ^[128]

1.1 Adult

Preferred regimen (1): Doxycycline 100 mg PO bid for 14-21 days
Preferred regimen (2): Tetracycline 250 mg PO qid for 14-21 days
Preferred regimen (3): Azithromycin 500 mg PO as a single dose, followed by 250 mg PO qd for 4 days
Preferred regimen (4): Clarithromycin 500 mg PO bid for 10 days
Preferred regimen (5): Levofloxacin 500 mg IV OR PO qd for 7 to 14 days
Preferred regimen (6): Moxifloxacin 400 mg PO qd for 10 days.

1.2 Pediatric

Preferred regimen (1): Erythromycin suspension PO 50 mg/kg/day for 10 to 14 days
Preferred regimen (2): Clarithromycin suspension PO 15 mg/kg/day for 10 days
Preferred regimen (3): Azithromycin suspension PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days

2. Upper respiratory tract infection^[129]

2.1 Bronchitis

Antibiotic therapy for C. pneumoniae is not required.

2.2 Pharyngitis

Antibiotic therapy for C. pneumoniae is not required.

2.3 Sinusitis

Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.

Chlamydia trachomatis

Chlamydia trachomatis Return to Top

1 Chlaymydial infections ^[130]

1.1 Chlamydial Infections in Adolescents and Adults

Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
Preferred regimen (2): Azithromycin 1 g PO in a single dose
Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
Note: Patients should be instructed to refer their sex partners for evaluation, testing, and treatment if they had sexual contact with the patient during the 60 days preceding onset of the patient's symptoms or chlamydia diagnosis.

1.2 Chlamydial Infections in patients with HIV Infection

Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
Preferred regimen (2): Azithromycin 1 g PO in a single dose
Preferred regimen (3): Azithromycin 1 g PO in a single dose
Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.

1.3 Pregancy

Preferred regimen: Azithromycin 1 g PO in a single dose
Alternative regimen (1): Amoxicillin 500 mg PO tid for 7 days
Alternative regimen (2): Erythromycin base 500 mg PO qid for 7 days
Alternative regimen (3): Erythromycin base 250 mg PO qid for 14 days
Alternative regimen (4): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
Alternative regimen (5): Erythromycin ethylsuccinate 400 mg PO qid for 14 days
Note:Doxycycline, Ofloxacin, and Levofloxacin are contraindicated in pregnant women

1.4 Management of sex partners

Preferred regimen (1): Doxycycline 100 mg PO bid for 7 days
Preferred regimen (2): Azithromycin 1 g PO in a single dose
Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days
Alternative regimen (2): Erythromycin ethylsuccinate 800 mg PO qid for 7 days
Alternative regimen (3): Levofloxacin 500 mg PO qd for 7 days
Alternative regimen (4): Ofloxacin 300 mg PO bid for 7 days.
Note (1): Recent sex partners (i.e., persons having sexual contact with the infected patient within the 60 days preceding onset of symptoms or Chlamydia diagnosis) should be referred for evaluation, testing, and presumptive dual treatment.
Note (2): If the patient’s last potential sexual exposure was >60 days before onset of symptoms or diagnosis, the most recent sex partner should be treated.
Note (3): To avoid reinfection, sex partners should be instructed to abstain from unprotected sexual intercourse for 7 days after they and their sexual partner(s) have completed treatment and after resolution of symptoms, if present

2. Chlamydial infection among neonates

2.1 Ophthalmia Neonatorumcaused by C. trachomatis

Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days
Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days
Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.

2.2 Infant Pneumonia

Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days
Alternative regimen: Azithromycin suspension 20 mg/kg /day PO qd for 3 days

3.Chlamydial infection among infants and childern

3.1 Infants and childern who weigh < 45 kg

Preferred regimen: Erythromycin base or ethylsuccinate 50 mg/kg/ day PO qid for 14 days

3.2 Infants and childern who weigh ≥45 kg but who are aged <8 years

Preferred regimen: Azithromycin 1 g PO in a single dose

3.3 Infants and childern aged ≥8 years

Preferred regimen (1): Azithromycin 1 g PO in a single dose
Preferred regimen (2): Doxycycline 100 mg PO bid for 7 days

4. Lymphogranuloma venereum (LGV) ^[131]

Preferred regimen: Doxycycline 100 mg PO bid for 21 days
Alternative regimen: Erythromycin base 500 mg PO qid for 21 days
Note (1): Azithromycin 1 g PO once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
Note (2): Pregnant and lactating women should be treated with Erythromycin. Azithromycin might prove useful for treatment of LGV in pregnancy, but no published data are available regarding its safety and efficacy. Doxycycline is contraindicated in pregnant women.
Note (3): Persons with both LGV and HIV infection should receive the same regimens as those who are HIV negative. Prolonged therapy might be required, and delay in resolution of symptoms might occur.
Note (4): Persons who have had sexual contact with a patient who has LGV within the 60 days before onset of the patient’s symptoms should be examined and tested for urethral, cervical, or rectal chlamydial infection depending on anatomic site of exposure. They should be presumptively treated with a chlamydia regimen ( Azithromycin 1 g PO single dose OR Doxycycline 100 mg PO bid for 7 days).

Chlamydophila psittaci

Chlamydophila psittaci Return to Top

1. Respiratory psittacosis(Pneumonia)^[132]

1.1 Adult

Preferred regimen (1): Doxycycline 100 mg PO bid for 10-21 days
Preferred regimen (2): Tetracycline 500 mg PO qid for 10-21 days
Alternative regimen: Minocycline

1.2 Pediatric

1.2.1 Mild infection, Infants >3 months

Preferred regimen: Azithromycin 10 mg/kg PO qd on day 1 ,then 5 mg/kg PO q24h for 4 days; (Maximum 500 mg for 1st dose, 250 mg for subsequent doses)

1.2.2 Moderate-severe infection, Infants >3 months

Preferred regimen: Azithromycin 10 mg/kg IV q24h for 2 days, then 5 mg/kg PO qd for 3 days; (Maximum 500 mg/dose IV; 250 mg/dose PO)

1.3 Pregnant Patients

Preferred regimen: Azithromycin 500 mg PO on day 1 followed by 250 mg qd on days 2-5 OR 500 mg IV as a single dose for at least 2 days, followed by 500 mg PO qd for 7- 10 days

Coxiella burnetii

Coxiella burnetii Return to Top

Q fever ^[133]

1. Acute Q fever

1.1 Adults

Preferred Regimen: Doxycycline 100 mg PO bid for 14 days

1.2 Children

1.2.1 Children with age ≥8 years

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

1.2.2 Children with age <8 years with high risk criteria

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

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

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

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

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

1.3 Pregnant women

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

2. Chronic Q fever

2.1 Endocarditis or vascular infection

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

2.2 Noncardiac organ disease

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

2.3 Postpartumwith serologic profile for chronic Q fever

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

Mycoplasma pneumoniae

Mycoplasma pneumoniae Return to Top

1. Atypical pneumonia^[134]^[135]

Preferred regimen (1): Azithromycin 500 mg PO qd on day 1 and 250 mg PO qd on days 2 to 5
Preferred regimen (2): Clarithromycin 500 mg PO qd for 14 days
Preferred regimen (3): Moxifloxacin 400 mg PO qd for 14 days
Preferred regimen (4): Levofloxacin 750 mg PO qd for 14 days
Alternative regimen : Doxycycline 100 mg PO bid for 14 days

Mycoplasma genitalium

Mycoplasma genitalium Return to Top

1. Urethritis and cervicitis^[136]

Preferred regimen (macrolide-susceptible strains) (1): Azithromycin 1 g PO as a single dose
Preferred regimen (macrolide-susceptible strains) (2): Azithromycin 500 mg PO as a dose followed by 250 mg PO qd for 4 days
Preferred regimen (for patients with previous treatment failures): Moxifloxacin 400 mg PO qd for 7–14 days

2. Pelvic inflammatory disease (PID)^[137]

Preferred regimen: Moxifloxacin 400 mg PO qd for 14 days

3. Specific considerations^[138]

3.1 Management of sex partners
Sex partners should be managed according to guidelines for patients with nongonococcal urethritis, cervicitis, and pelvic inflammatory disease.
3.2 HIV infection
Persons who have an M. genitalium infection and HIV infection should receive the same treatment regimen as those who are HIV negative.

Bacteria – Miscellaneous

Gardnerella vaginalis Return to Top

1.Bacterial Vaginosis^[139]

Gardnerella vaginalis is one of the anaerobic bacteria causing Bacterial Vaginosis,which is a polymicrobial clinical syndrome

Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
Preferred regimen (3): Clindamycin cream 2%, one full applicator (5 g) intravaginally at bedtime for 7 days
Alternative regimen (1): Tinidazole 2 g PO qd for 2 days
Alternative regimen (2): Tinidazole 1 g PO qd for 5 days
Alternative regimen (3): Clindamycin 300 mg PO bid for 7 days
Alternative regimen (4): Clindamycin ovules 100 mg intravaginally once at bedtime for 3 days
Note: Clindamycin ovules use an oleaginous base that might weaken latex or rubber products (e.g., condoms and vaginal contraceptive diaphragms). Use of such products within 72 hours following treatment with clindamycin ovules is not recommended.

2. Management of Sex Partners

Routine treatment of sex partners is not recommended.

3. Special Considerations

3.1 Allergy, Intolerance, or Adverse Reactions
Intravaginal Clindamycin cream is preferred in case of allergy or intolerance to Metronidazole or Tinidazole. Intravaginal Metronidazole gel can be considered for women who are not allergic to Metronidazole but do not tolerate oral metronidazole. It is advised to avoid consuming alcohol during treatment with nitroimidazoles. To reduce the possibility of a disulfiram-like reaction, abstinence from alcohol use should continue for 24 hours after completion of metronidazole or 72 hours after completion of tinidazole.

3.2 Pregnancy

Preferred regimen (1): Metronidazole 500 mg PO bid for 7 days
Preferred regimen (2): Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, qd for 5 days
Note: Tinidazole should be avoided during pregnancy

3.3 HIV Infection

Women with HIV who have BV should receive the same treatment regimen as those who do not have HIV infection.

Eikenella corrodens Return to Top
Bordetella pertussis Return to Top
Bartonella Return to Top
Stenotrophomonas maltophilia Return to Top
Acinetobacter baumannii Return to Top

Bacteria – Anaerobic Gram-Negative Bacilli

Bacteroides fragilis Return to Top

1. Monotherapy ^[140]

Preferred regimen: Imipenem (Primaxin) OR Ertapenem OR Meropenem OR Doripenem 0.5-1.0 g IV q6h OR Piperacillin-tazobactam (Zosyn) 3.375 g IV q6h OR Ampicillin-sulbactam (Unasyn) 1-2 g IV q6h OR Tigecycline (Tygacil) 100 mg IV, then 50 mg IV q12h

2. Combination therapy

Preferred regimen: Metronidazole 0.75-1.0 g IV q12h AND Cefotaxime 1.5-2 g IV q6h OR Aztreonam 1-2 g IV q8h OR Ceftriaxone 1 g IV q12h

Fusobacterium necrophorum Return to Top

Fungi

Aspergillosis Return to Top
^[141]
1. Invasive pulmonary aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

2. Invasive sinus aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

3. Tracheobronchial aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

4. Chronic necrotizing pulmonary aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

5. Aspergillosis of the CNS

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

Note: There are drug interactions with anticonvulsant therapy.

6. Aspergillus infections of the heart (endocarditis, pericarditis, and myocarditis)

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
Note: endocardial lesions generally require surgical treatment. Aspergillus pericarditis usually requires pericardiectomy.

7. Aspergillus osteomyelitis and septic arthritis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
Note: Surgical resection of devitalized bone and cartilage is important for curative intent.

8. Aspergillus infections of the eye (endophthalmitis and keratitis)

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
Note: Topical therapy is indicated for keratitis, ophthalmologic intervention and management is recommended for all forms of ocular infection. Systemic therapy may be beneficial when treating aspergillus endophthalmitis.

9. Cutaneous aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.
Note: Surgical resection is indicated when feasible.

10. Aspergillus peritonitis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

11. Prophylaxis against invasive aspergillosis

Preferred regimen: Posaconazole PO 200 mg tid
Alternative regimen: (1) Itraconazole 200 mg IV bid for 2 days then 200 mg IV qd OR Itraconazole PO 200mg bid
Alternative regimen: (2) Micafungin 50 mg/day PO qd

12. Aspergilloma

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen: Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd

13. Chronic cavitary pulmonary aspergillosis

Preferred regimen: Voriconazole 6 mg/kg IV q12h single dose, THEN 4 mg/kg IV q12h or PO 200 mg q12h
Alternative regimen (1): Liposomal Amphotericin B (L-AMB) 3–5 mg/kg/day IV qd
Alternative regimen (2): Amphotericin B lipid complex (ABLC) 5 mg/ kg/day IV qd
Alternative regimen (3): Caspofungin 70 mg IV single dose THEN 50 mg/day IV qd
Alternative regimen (4): Posaconazole 200 mg PO qid if patient is critical, then 400 mg PO bid after stabilization of the disease.
Alternative regimen (5): Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (6): Micafungin 100–150 mg/day PO qd^[142]^[141]
Note: Micafungin has been evaluated as salvage therapy for invasive aspergillosis but remains investigational for this indication, and the dosage has not been established.

Note: long-term therapy might be needed.

14. Allergic bronchopulmonary Itraconazole aspergillosis

Preferred regimen: Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Alternative regimen (1): Voriconazole PO 200 mg bid
Alternative regimen (2): Posaconazole PO 400 mg bid
Note: Corticosteroids are a cornerstone of the therapy.

15. Allergic aspergillus sinusitis

Preferred regimen: None or Itraconazole dosage depends upon formulation - 600 mg/day PO for 3 days, THEN 400 mg/day PO OR 200 mg q12h IV for 2 days, THEN 200 mg IV qd
Note: Few data available for other agents.

16. Relative indications for surgical treatment of invasive aspergillosis

Pulmonary lesion in proximity to great vessels or pericardium;
Pericardial infection;
Invasion of chest wall from contiguous pulmonary lesion;
Aspergillus empyema;
Persistent hemoptysis from a single cavitary lesion;
Infection of skin and soft tissues;
Infected vascular catheters and prosthetic devices;
Endocarditis;
Osteomyelitis;
Sinusitis;
Cerebral lesions.

Blastomycosis Return to Top
Blastomycosis^[143]

1. Mild to moderate pulmonary blastomycosis

Preferred regimen: Itraconazole 200 mg PO qd or bid for 6–12 months
Note: Oral Itraconazole, 200 mg tid PO for 3 days and THEN 200 mg PO qd or bid for 6–12 months

2. Moderately severe to severe pulmonary blastomycosis

Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV qd for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
Preferred regimen (2): Amphotericin B deoxycholate 0.7–1 mg/kg IV qd for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
Note: Oral Itraconazole, 200 mg tid PO for 3 days THEN 200 mg PO bid, for a total of 6–12 months

3. Mild to moderate disseminated blastomycosis

Preferred regimen: Itraconazole 200 mg PO qd or bid for 6–12 months
Note (1): Treat osteoarticular disease for 12 months
Note (2): Oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 6–12 months

4. Moderately severe to severe disseminated blastomycosis

Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV qd, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
Preferred regimen (2): Amphotericin B deoxycholate 0.7–1 mg/kg IV qd, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
Note: oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 6–12 months

5. CNS disease

Preferred regimen: Lipid Amphotericin B 5 mg/kg IV qd for 4–6 weeks AND an oral azole for at least 1 year
Note (1): Step-down therapy can be with Fluconazole, 800 mg/day PO qd or bid OR Itraconazole, 200 mg bid or tid OR voriconazole, 200–400 mg bid.
Note (2): Longer treatment may be required for immunosuppressed patients.

6. Immunosuppressed patients

Preferred regimen (1): Lipid Amphotericin B 3–5 mg/kg IV qd, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
Preferred regimen (2): Amphotericin B deoxycholate, 0.7–1 mg/kg IV qd, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
Note (1): Oral Itraconazole, 200 mg PO tid for 3 days THEN 200 mg PO bid, for 12 months
Note (2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.

7. Pregnant women

Preferred regimen: Lipid Amphotericin B 3–5 mg/kg IV qd
Note (1): Azoles should be avoided because of possible teratogenicity
Note (2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg IV qd

8. Children with mild to moderate disease

Preferred regimen: Itraconazole 10 mg/kg PO qd for 6–12 months
Note: Maximum dose 400 mg/day

9. Children with moderately severe to severe disease

Preferred regimen (1): Amphotericin B deoxycholate 0.7–1 mg/kg IV qd for 1–2 weeks AND Itraconazole 10 mg/kg PO qd to a maximum of 400 mg/day for 6–12 months
Preferred regimen (2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg IV qd for 1–2 weeks AND Itraconazole 10 mg/kg PO qd to a maximum of 400 mg/day for 6–12 months
Note: Children tolerate Amphotericin B deoxycholate better than adults do.

Paracoccidioidomycosis Return to Top

Preferred regimen (1): ^[144]

Adults: Itraconazole 200 mg/day PO
Children: Itraconazole (<30/kg and >5 yr) 5-10 mg/kg/day PO
Note: Treatment duration based on organ involvement:

Mild involvement: 6-9 months
Moderate involvement: 12-18 months

Preferred regimen (2): ^[144]

Adults Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 160-240 mg/day PO/IV, SMX: 800-1200 mg/day PO/IV bid
Children Trimethoprim/sulfamethoxazole (TMP/SMX) TMP: 8-10 mg/kg PO/IV, SMX: 40-50 mg/kg PO/IV, bid
Note (1): Treatment duration based on organ involvement:

Minor involvement: 12 months
Moderate involvement: 18-24 months

Note (2): Preferred treatment in children due to larger experience.
Note (3): Preferred in IV formulation in severe forms of the disease - 2 ampules IV tid until patient condition improves so that oral medication can be given.

Preferred regimen (3): Amphotericin B deoxycholate 1 mg/kg/day IV until patient improves and can be treated by the oral route.^[144]

Note: Preferred in severe forms of the disease.^[144]

Alternative regimen (4): Ketoconazole 200-400 mg/day PO for 9-12 months^[145]
Alternative regimen (5): Voriconazole initial dose 400 mg PO/IV q12h for one day, then 200 mg q12h for 6 months^[146]

Note: Diminish the dose to 50% if weight is <40 kg.

Candidiasis Return to Top
Chromoblastomycosis Return to Top
^[147]

Preferred regimen: Itraconazole 200-400 mg PO q24h OR 400 mg pulse therapy once daily for 1 week monthly for 6-12 months
Note: Pulse therapy reduces cost but it is questionable if it produces resistance to the drug.
Alternative regimen (1): Terbinafine 500-1000 mg PO qd for 6-12 months
Alternative regimen (2): Posaconazole 800 mg PO qd for 6-12 months
Alternative regimen (3): 5-fluorocytosine 100-150 mg/kg/day PO qd for 6-12 months
Note: This disease has a low cure ratio and high relapse ratio. Physical treatment is needed to achieve better results:

Cryosurgery with liquid nitrogen - most used physical therapy, it's used in localized lesions and it has a very good treatment response, probably achieved by immune mechanisms since fungi are eliminated from lesions as late as 1-2 weeks after the therapy.
Thermotherapy - used in conjunction with systemic therapy, was developed by Japanese authors and consists in placing "pocket warmers" in the lesions for 24h/day for some months, as the fungi is sensible to heat.
Laser vaporization - studied in Germany as an alternative therapy, reported to successfully treat relapsing lesions.

Coccidioidomycosis Return to Top

Cryptococcosis Return to Top
Cryptococcus Return to Top

1. Cryptococcus neoformans

1.1 Cryptococcus neoformans meningitis in HIV infected patients^[148]

Preferred regimen for induction and consolidation: (Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction) OR Liposomal AmB 3-4mg/kg IV qd OR Amphotericin B lipid complex (ABLC) 5mg/kg IV qd) PLUS Flucytosine 100mg/kg/day PO or IV qid for at least 2 weeks followed by Fluconazole 400mg (6mg/kg) PO qd for at least 8 weeks.
Alternative regimen for induction and consolidation (1): Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd OR Liposomal AmB 3-4 mg/kg IV qd OR AmB lipid complex 5mg/kg IV qd for 4-6 weeks
Alternative regimen for induction and consolidation (2): Amphotericin B deoxycholate 0.7 mg/kg IV qd PLUS Fluconazole 800mg PO qd for 2 weeks, followed by Fluconazole 800mg PO qd for at least 8 weeks
Alternative regimen for induction and consolidation (3): Fluconazole (>800 mg PO qd, 1200mg PO qd is favored) PLUS Flucytosine (100mg/kg/day PO qid) for 6 weeks
Alternative regimen for induction and consolidation (4): Fluconazole PO 800-2000mg qd for 10-12 weeks
Preferred regimen for maintenance and prophylactic therapy: Initiate HAART 2-10 weeks after commencing initial antifungal therapy AND Fluconazole 200mg PO qd
Alternative regimen for maintenance and prophylactic therapy: Itraconazole 200mg PO bid - monitor drug-level OR Amphotericin B deoxycholate (1 mg/kg) per week IV (should be used in azole-intolerant patients).
Note (1): Consider discontinuing supressive therapy if CD4 count is higher than 100 cells/uL AND undetectable OR very low HIV RNA level for more than 3 months. Consider reinstitution of maintenance therapy if CD4 count <100 cels/uL.
Note (2): Do not use acetazolamide OR mannitol OR corticosteroids to treat increased intracranial pressure, instead it should be used lombar puncture in the absence of focal neurologic signs or impaired mentation (which, if present, patient must be submitted to CT or MRI scan first).

1.2. Cerebral cryptococcomas

Preferred regimen for induction and consolidation: (Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction) OR Liposomal AmB 3-4mg/kg IV qd OR Amphotericin B lipid complex (ABLC) 5mg/kg IV qd) PLUS Flucytosine 100mg/kg/day PO or IV qid for at least 2 weeks followed by Fluconazole 400mg (6mg/kg) PO qd for at least 8 weeks
Note: Consider surgery if lesions are larger than 3cm, accessible lesions with mass effect or lesions that are enlarging and not explained by IRIS.

1.3. Cryptococcus neoformans meningitis in HIV negative patients

Preferred regimen: Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd PLUS Flucytosine 100mg/kg/day PO or IV qid for at least 4 weeks (which may be extended to 6 weeks if there is any neurological complication) followed by Fluconazole 400mg PO qd for 8 weeks. If there's toxicity to AmBd, consider changing to LFAmB in the second 2 weeks.
Note (1): After induction and consolidation therapy, start Fluconazole 200mg (3mg/kg) PO qd for 6-12 months.
Note (2): If Flucytosine is not given, consider lengthening the induction therapy for at least 2 weeks.

1.4. Cryptococcus neoformans pulmonary disease - immunosupressed

Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:

Preferred regimen: Fluconazole 400mg PO qd for 6-12 months

Severe pneumonia or disseminated disease or CNS infection:

Preferred regimen: treat like CNS cryptococcosis.

Note (1): In HIV- infected patients, treatment should be stopped after 1 year if CD4 count is >100 and a cryptococcal antigen titer is <1:512 and not increasing.
Note (2): Consider corticosteroid if ARDS is present in a context which it might be attributed to IRIS.

1.5 Cryptococcus neoformans pulmonary disease - non-immunosupressed

Mild-moderate symptoms, without severe immunosupression and absence of diffuse pulmonary infiltrates:

Preferred regimen: Fluconazole 400mg PO qd for 6-12 months
Alternative regimen: if Fluconazole is unavailable or contraindicated, Itraconazole 200mg PO bid, Voriconazole 200 mg PO bid, and Posaconazole 400mg PO bid

If there's severe pneumonia, disseminated disease or CNS infection:

Preferred regimen: treat like CNS cryptococcosis for 6-12 months.

1.6 Cryptococcus neoformans non-lung, non-CNS infection

Cryptococcemia or disseminated cryptococcic disease (involvement of at least 2 noncontiguous sites or cryptococcal antigen titer >1:512):

Preferred regimen: treat like CNS infection.

If infection occurs at a single site and no immunosupressive risk factors

Preferred regimen: Fluconazole 400mg PO qd for 6-12 months

1.7. Cryptococcosis in Children

Preferred regimen for induction and consolidation: Amphotericin B deoxycholate 1.0 mg/kg qd IV PLUS Flucytosine 100mg/kg PO or IV qid for 2 weeks followed by Fluconazole 10-12mg/kg PO qd for 8 weeks
Alternative regimen: patients with renal dysfunction: change Amphotericin B deoxycholate by Liposomal AmB 5mg/kg IV qd or Amphotericin B lipid complex (ABLC) 5mg/kg IV qd
Preferred regimen for maintenance: Fluconazole 6mg/kg PO qd. Discontinuation of maintenance therapy is poorly studied and should be individualized.

Cryptococcal pneumonia:

Preferred regimen Fluconazole 6-12mg/kg PO qd for 6-12 months

1.8. Cryptococcosis in Pregnant Women

Preferred regimen for induction and consolidation: Amphotericin B deoxycholate 0.7-1.0 mg/kg IV qd (consider using lipid formulations for patients with renal dysfunction - Liposomal AmB 3-4mg/kg IV qd OR Amphotericin B lipid complex (ABLC) 5mg/kg IV qd. Consider using Flucytosine in relationship to benefit risk basis, since it is a Category C drug for pregnancy. Start Fluconazole after delivery. Avoid use during first trimester and consider use in the last 2 trimesters with the need for continuous antifungal therapy during pregnancy.
Note: If pulmonary cryptococcosis: perform close follow-up and administer fluconazole after delivery.

2. Cryptococcus gatti

Disseminated cryptococcosis or CNS disease:

Preferred regimen: treatment is the same as C. neoformans.

Pulmonary disease: single and small cryptococcoma:

Preferred regimen: Fluconazole 400mg per day PO for 6-18months

Pulmonary disease: Very large or multiple cryptococcomas:

Preferred regimen: administer Flucytosine AND AmB deocycholate for 4-6 weeks, followed by fluconazole for 6-18 months.
Note: Surgery should be considered if there is compression of vital structures OR failure to reduce the size of the cryptococcoma after 4 weeks of therapy

Tinea cruris Return to Top

Tinea Cruris^[149]

Preferred regimen: Interdigital: Topical cream/ointment: terbinafine, imidazoles (miconazole, econazole, clotrimazole), Griseofulvin 250mg tid PO for 14 days should be used in resistant to topic therapy cases.

Tinea corporis Return to Top

Tinea Corporis

2.1 Small, well-defined lesions:

Preferred regimen: Topical cream/ointment: terbinafine, imidazoles (miconazole, econazole, clotrimazole).

2.2 Larger lesions:

Preferred regimen: Larger lesions: terbinafine PO 250mg/day for 2 weeks; itraconazole PO 200mg/day for 1 week, fluconazole PO 250mg weekly for 2-4 weeks.

Tinea pedis Return to Top

1. Tinea Pedis

Preferred regimen: Interdigital: Topical cream/ointment: terbinafine, imidazoles (miconazole, econazole, clotrimazole), undecenoic acid, tolnaftate.
Note (1): If "Dry type": Oral: terbinafine PO 250mg/day for 2-4 weeks, itraconazole PO 400mg/day for 1 week per month (repeat if necessary), fluconazole PO 200mg weekly for 4-8 weeks.

Tinea capitis Return to Top

Tinea Capitis

Preferred regimen: Griseofulvin PO 10-20mg/kg/day for at least 6 weeks (Preferred for children).
Alternative regimens: Terbinafine PO 62.5mg/day if <20kg; 125 mg/day if 20-40kg; 250mg/day if >40kg OR Itraconazole PO 4-6mg/kg pulsed dose weekly.

Note: Nistatin is not effective in the treatment of dermatophytosis.

Tinea barbae Return to Top

Tinea Barbae

Preferred regimen: Terbinafine PO 250mg/day for 4 weeks.
Alternative regimen: Itraconazole PO 200mg/day for 2 weeks.

Tinea incognito Return to Top

Tinea Incognito

Preferred regimen: Stop topical steroids and treat with topical 1% terbinafine cream for 6 weeks.

Tinea manuum Return to Top

Tinea Manuum

Preferred regimen: topical or systemic terbinafine PO 250 mg/day por 2-4 weeks.

Tinea versicolor Return to Top

Tinea Versicolor

Preferred regimen: Itraconazole 200mg daily for a week.
Alternative regimen: Ketoconazole 200mg daily for 4 weeks.

Majocchi's granuloma Return to Top

Majocchi's Granuloma

Preferred regimen: Terbinafine PO 250mg/day for 2-4 weeks.
Alternative regimen: Itraconazole 200mg PO bid for 1 week, per month for 2 months.

Onychomycosis Return to Top

Onychomycosis^[150]

10.1 Fingernails

Preferred regimen: Terbinafine PO 250mg/day for 6 weeks OR Itraconazole PO 200mg twice a day for a week a month for 2 months (European guidelines).

10.2 Toenails

Preferred regimen: Toenails Terbinafine PO 250mg/day for 12 weeks OR Itraconazole PO 200mg/day for 12 weeks (U.S. guidelines) OR Itraconazole PO 200mg twice a day for a week a month for 3 months (European guidelines).

Note (1): There is no evidence that combining systemic and topic treatments has any benefit to the patient.

Histoplasmosis Return to Top
Mucormycosis Return to Top
Penicilliosis Return to Top
Sporotrichosis Return to Top
Pneumocystis jiroveci Return to Top

1. Preventing First Episode of PCP (Primary Prophylaxis)^[151]

Preferred regimen: TMP-SMX 1 Double-Strength(DS) PO daily OR TMP-SMX 1 Single-Strength(SS) PO daily
Alternative regimen (1): TMP-SMX 1 Double-Strength(DS) tid weekly OR Dapsone 100 mg PO daily or 50 mg PO BID
Alternative regimen (2): Dapsone 50 mg PO daily AND (Pyrimethamine 50 mg + Leucovorin 25 mg) PO weekly
Alternative regimen (3): Dapsone 200 mg AND Pyrimethamine 75 mg AND Leucovorin 25 mg PO weekly
Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
Alternative regimen (5): Atovaquone 1500 mg PO daily with food
Alternative regimen (6): Atovaquone 1500 mg AND Pyrimethamine 25 mg AND Leucovorin 10 mg PO daily with food

2. Treatment of Pneumocystis Pneumonia^[152]

2.1. Moderate to Severe PCP

Preferred regimen: TMP-SMX (TMP 15–20 mg and SMX 75–100 mg)/kg/day IV given q6h or q8h
Note: May switch to PO after clinical improvement
Alternative regimen (1): Pentamidine 4 mg/kg IV once daily infused over at least 60 minutes
Note: May reduce the dose to 3 mg/kg IV once daily because of toxicities.
Alternative regimen (2): Primaquine 30 mg (base) PO once daily AND (Clindamycin [IV 600 mg q6h or 900 mg q8h] or [PO 450 mg q6h or 600 mg q8h])

Note (1): Duration of PCP treatment is 21 days
Note (2): Adjunctive corticosteroid may be indicated in some moderate to severe cases.Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy) (AI):
Note (3): Prednisone doses (beginning as early as possible and within 72 hours of PCP therapy)

Days 1–5 40 mg PO BID
Days 6–10 40 mg PO daily
Days 11–21 20 mg PO daily

2.2. Mild to Moderate PCP

Preferred regimen: TMP-SMX (TMP 15–20 mg/kg/day and SMX 75–100 mg/kg/day), given PO in 3 divided doses OR TMP-SMX Double-Strength(DS) - 2 tablets tid
Alternative regimen (1): Dapsone 100 mg PO daily AND TMP 15 mg/kg/day PO (3 divided doses)
Alternative regimen (2): Primaquine 30 mg (base) PO daily AND Clindamycin PO (450 mg q6h or 600 mg q8h)
Alternative regimen (3): Atovaquone 750 mg PO BID with food

Note: Duration of PCP treatment is 21 days

3. Preventing Subsequent Episode of PCP (Secondary Prophylaxis)^[153]

Preferred regimen: TMP-SMX 1 Double-Strength(DS) PO daily OR TMP-SMX 1 Single-Strength(SS) PO daily
Alternative regimen (1): TMP-SMX 1 Double-Strength(DS) tid weekly OR Dapsone 100 mg PO daily or 50 mg PO BID
Alternative regimen (2): Dapsone 50 mg PO daily AND (Pyrimethamine 50 mg + Leucovorin 25 mg) PO weekly
Alternative regimen (3): Dapsone 200 mg AND Pyrimethamine 75 mg AND Leucovorin 25 mg PO weekly
Alternative regimen (4): Aerosolized Pentamidinec 300 mg via Respigard II™ nebulizer every month
Alternative regimen (5): Atovaquone 1500 mg PO daily with food
Alternative regimen (6): Atovaquone 1500 mg AND Pyrimethamine 25 mg AND Leucovorin 10 mg PO daily with food

Mycobacteria

Mycobacterium tuberculosis Return to Top

1. Standard Regimens for new patients ^[154]

1.1 Adult

1.1.1 Initial phase

Preferred regimen: Isoniazid 300 mg PO (5 mg/kg/day) qd for 8 weeks AND Rifampicin 600 mg PO (10 mg/kg/day) qd for 8 weeks AND Pyrazinamide 2 g PO (25 mg/kg/day) qd for 8 weeks AND Ethambutol 1.6 g PO (15 mg/kg/day) qd for 8 weeks
Alternative regimen (1): Isoniazid 300 mg/day PO for 2 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO for 2 weeks (10 mg/kg/day) AND Pyrazinamide 2 g/day PO for 2 weeks (25 mg/kg/day) AND Ethambutol 1.6 g PO for 2 weeks (15 mg/kg/day), followed by Isoniazid 300 mg/day PO twice weekly for 6 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly for 6 weeks (10 mg/kg/day) AND Pyrazinamide 2 g/day PO twice weekly for 6 weeks AND Ethambutol 1.6 g PO for 2 weeks (15 mg/kg/day)
Alternative regimen (2): Isoniazid 300 mg/day PO thrice weekly for 8 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO thrice weekly for 8 weeks (10 mg/kg/day) AND Pyrazinamide 2g/day PO thrice weekly for 8 week (25 mg/kg/day) AND Ethambutol 1.6 g PO thrice weekly for 8 weeks (15 mg/kg/day)

1.1.2 Continuation phase

Preferred regimen (1): Isoniazid 300 mg PO (5 mg/kg/day) qd AND Rifampicin 600 mg PO (10 mg/kg/day) qd for 18 weeks
Preferred regimen (2): Isoniazid 300 mg PO twice weekly (5 mg/kg/day) AND Rifampicin 600 mg/day PO twice weekly (10 mg/kg/day) for 18 weeks
Alternative regimen (1): Isoniazid 300 mg/day PO biweekly for 18 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO biweekly for 18 weeks (10 mg/kg/day)
Alternative regimen (2): Isoniazid 300 mg/day PO thrice weekly for 18 weeks (5 mg/kg/day) AND Rifampicin 600 mg/day PO thrice weekly for 18 weeks (10 mg/kg/day)

1.2 Pediatric

1.2.1 Initial phasef

Preferred regimen: Isoniazid 10 mg/kg PO (Maximum, 300 mg/day) AND Rifampicin 15 mg/kg PO (Maximum, 600 mg/day) AND Pyrazinamide 35 mg/kg PO (Maximum, 2 g/day) AND Ethambutol 20 mg/kg PO (Maximum, 1.6 g/day), each for 8 weeks

1.2.2 Continuation phase

Preferred regimen: Isoniazid 10 mg/kg PO (Maximum, 300 mg/day) AND Rifampicin 15 mg/kg PO (Maximum, 600 mg/day), each drug daily for 18 weeks

2. MDR Tuberculosis ^[155]

2.1 Adult

Preferred regimen: 4 agents combination

Agent 1: Pyrazinamide 20–30 mg/kg OR Ethambutol 15–25 mg/kg OR Rifabutin 5 mg/kg
Agent 2: Capreomycin 15 mg/kg OR Kanamycin 15 mg/kg OR Amikacin 7.5-10 mg/kg OR Streptomycin 12–18 mg/kg
Agent 3: Levofloxacin 500-1000 mg OR Moxifloxacin 400 mg OR Ofloxacin 400 mg
Agent 4: Ethionamide 15-20 mg/kg OR Protionamide 15-20 mg/kg OR Cycloserine 10-15 mg/kg OR Terizidone 10-20 mg/kg OR Para-aminosalicylic acid 8-12 g/day IV q8-12h

2.2 Pediatric

Preferred regimen: 4 agents combination

Agent 1: Pyrazinamide 20-30 mg/kg (Maximum: 600 mg) OR Ethambutol 15-20 mg/kg OR Rifabutin 5 mg/kg
Agent 2: Capreomycin 15-30 mg/kg (Maximum: 1000 mg) OR Kanamycin 15-30 mg/kg (Maximum: 1000 mg) OR Amikacin 15-22.5 mg/kg (Maximum: 1000 mg) OR Streptomycin 12-18 mg/kg AND
Agent 3: Levofloxacin 7.5-10 mg/kg OR Moxifloxacin 7.5-10 mg/kg OR Ofloxacin 15-20 mg/kg/day q12h (Maximum: 800 mg)
Agent 4: Ethionamide 15-20 mg/kg/day q12h (Maximum: 1000 mg) OR Protionamide 15-20 mg/kg/day q12h (Maximum: 1000 mg) OR Cycloserine 10-20 mg/kg (Maximum: 1000 mg) OR Terizidone 10-20 mg/kg (Maximum: 1000 mg) OR Para-aminosalicylic acid 150 mg/kg/day q8-12h(Maximum: 12,000 mg)

3. XDR Tuberculosis ^[156]

3.1 Adult

Preferred regimen: 3 agents combination

Agent 1: Pyrazinamide 20–30 mg/kg OR Ethambutol 15–25 mg/kg OR Rifabutin 5 mg/kg
Agent 2: Ethionamide 15-20 mg/kg OR Protionamide 15-20 mg/kg OR Cycloserine 10-15 mg/kg OR Terizidone 10-20 kg/mg OR Para-aminosalicylic acid 8-12 g/day q8-12h
Agent 3: Clofazimine 50 mg/d AND 300 mg once a month OR Amoxicillin/clavulanate 500 mg/125 mg q12h OR Linezolid 300-600 mg OR Imipenem 500mg q6h OR Clarithromycin 500-1000 mg q12h OR Thioacetazone 2.5 mg/kg OR Isoniazid (high-dose) 16–20 mg/kg

3.2 Pediatric

Preferred regimen: 3 agents combination

Agent 1: Pyrazinamide 20-30 mg/kg (Maximum: 600 mg) OR Ethambutol 15 mg/kg OR Rifabutin 5 mg/kg

Agent 2: Ethionamide 15-20 mg/kg (Maximum: 1000 mg) OR Protionamide 15-20 mg/kg (Maximum: 1000 mg) OR Cycloserine 10-20 mg/kg (Maximum: 1000 mg) OR Terizidone 10-20 mg/kg (Maximum: 1000 mg) OR Para-aminosalicylic acid 150 mg/kg/day q8-12h

Agent 3: Clofazimine 50 mg/d AND 300 mg once a month OR Amoxicillin/clavulanate OR Linezolid 300-600 mg OR Imipenem 500mg q6h OR Clarithromycin 500-1000 mg q12h OR Thioacetazone 2.5 mg/kg OR Isoniazid (high-dose) 16–20 mg/kg

Mycobacterium abscessus Return to Top

1.Limited, localized extrapulmonary disease ^[157]

Preferred regimen: Clarithromycin 500 mg PO twice daily ± Amikacin 10-15 mg/kg/day IV or 25 mg/kg three times weekly for 4 months

Alternative regimen (1): Amikacin AND Cefoxitin 12 g/day typically for two weeks until clinical improvement in severe cases

Alternative regimen (2): Amikacin AND Imipenem 500 mg IV q6-8h for two weeks until clinical improvement in severe cases
NOTE: Osteomyelitis should be treated for as least 6 months; Infected foreign bodies should be removed

2.Pulmonary or serious extrapulmonary disease

Preferred regimen: Clarithromycin 500 mg PO twice daily AND Amikacin 15 mg/kg/day IV AND Cefoxitin 2g q4h IV OR Imipenem 1g q6h IV for at least 2-4 months, if limited by adverse effects, then switch toClarithromycin 500 mg PO BID or 1000 mg XR OD OR Azithromycin 250 mg PO OD
Alternative regimen(1): Tigecycline 100 mg IV load then 50 mg IV q12h could be substituted as one of the injectables
Alternative regimen(2): Linezolid 600 mg PO q12h or 600 mg PO OD AND Clarithromycin could replace parental tx if not tolerated or feasible

Mycobacterium bovis Return to Top

Mycobacterium bovis ^[158]

Note: Is intrinsically resistant to Pyrazinamide (PZA). The treatment of M. bovis is extrapolated from experience with the treatment of PZA-resistant M. tuberculosis
1. Pulmonary and most extrapulmonary disease

Preferred regimen: Isoniazid AND Rifampin AND Ethambutol for 2 months, followed by Isoniazid AND Rifampin for 7 months

2. Meningitis

Preferred regimen: Isoniazid AND Rifampin AND Ethambutol for 2 months, followed by Isoniazid AND Rifampin for 10 months

Mycobacterium avium-intracellulare Return to Top

1. Treatment of MAC pulmonary disease ^[159]

1.1 Patients with nodular/bronchiectatic disease

Preferreday regimen: Clarithromycin 1,000 mg three times weekly OR Azithromycin 500–600 mg three times weekly AND Ethambutol 25 mg/kg three times weekly AND Rifampin 600 mg three times weekly
Note: Patients should be treated until culture negative on therapy for 1 year

1.2 Patients with fibrocavitary or severe nodular/bronchiectatic disease

Preferreday regimen: Clarithromycin 500–1,000 mg/day OR Azithromycin 250–300 mg/day OR Rifampin 600 mg/day OR Rifabutin 150–300 mg/day AND Ethambutol 15 mg/kg/day
Note(1): Amikacin OR Streptomycin threetimes-weekly can be used early in therapy
Note(2): Patients should be treated until culture negative on therapy for 1 year

2. Disseminateday MAC disease

Preferreday regimen: Clarithromycin 1,000 mg/day OR Azithromycin 250 mg/day AND Ethambutol 15 mg/kg/day ± Rifabutin 150–350 mg/day

Mycobacterium celatum Return to Top

Mycobacterium celatum ^[160]

Preferred regimen: Clarithromycin AND Ethambutol AND Ciprofloxacin ± Rifabutin

Mycobacterium chelonae Return to Top

Mycobacterium chelonae ^[161]
1. Localized infections

Preferred regimen: Clarithromycin 500 mg PO bid
Alternative regimen: Azithromycin

2. Disseminated or extensive disease

2.1 monotherapy

Preferred regimen: Clarithromycin 500 mg PO bid for 6 months

2.2 multidrug therapy

preferred regimen: Clarithromycin 500 mg PO bid AND Tobramycin 5 mg/kg IV q24h OR Imipenem 0.5-1 g IV q6h OR Linezolid 600 mg IV/PO q12h/bid for 4-8 weeks
Alternative regimen: Moxifloxacin 400 mg PO qd AND Linezolid 600 mg PO bid
Note(1): During initial treatment, multidrug therapy may prevent development of acquired resistance
Note(2): Total treatment duration is 6 months

3. Keratitis (LASIK-related)

Preferred regimen: Clarithromycin 500 mg PO bid AND Tobramycin 0.3% 2 gtts q4h AND Gatifloxacin 0.3% 1 gtt q4h OR Moxifloxacin 0.5% 1 gtt q4h

Mycobacterium foruitum Return to Top

Mycobacterium foruitum ^[162]

1. In vitro isolates

Susceptible agents: Amikacin (100%), Ciprofloxacin and Ofloxacin (100%), Sulfonamides (100%), Cefoxitin (50%), Imipenem (100%), Clarithromycin (80%), and Doxycycline (50%)

2. Disease

2.1 M. fortuitum lung disease

At least two agents with in vitro activity against the clinical isolate should be given for at least 12 months of negative sputum cultures

2.2 Serious skin, bone, and soft tissue M fortuitum disease

At least two agents with in vitro activity against the clinical isolate should be given for a minimum of 4 months; For bone infections, 6 months of therapy is recommended

Mycobacterium haemophilum Return to Top

Mycobacterium haemophilum ^[163]

1. In vitro

Susceptible: Amikacin, Clarithromycin, Ciprofloxacin, Rifampin, and Rifabutin
Less susceptible: Doxycycline and Sulfonamides

2. Infection

2.1 Disseminated disease

Preferred regimen: Clarithromycin AND Rifampin AND Rifabutin AND Ciprofloxacin

Mycobacterium genavense Return to Top

Mycobacterium genavense ^[164]

Susceptibility: Amikacin, Rifamycin, Fluoroquinolones, Streptomycin, and Macrolides
Note(1): Ethambutol has limited activity
Note(2): Optimal therapy is not determined, but multidrug therapies including Clarithromycin appear to be more effective than those without Clarithromycin

Mycobacterium gordonae Return to Top

Mycobacterium gordonae ^[165]

Preferred regimen: Ethambutol OR Rifabutin OR Clarithromycin OR Linezolid OR Fluoroquinolones

Mycobacterium kansasii Return to Top

Mycobacterium kansasii ^[166]

1. pulmonary disease

Preferred regimen: Rifampin 10 mg/kg/day (Maximum, 600 mg) PO AND Ethambutol 15 mg/kg/ day PO AND Isoniazid 5 mg/kg/day (Maximum 300 mg) PO AND Pyridoxine 50 mg/day PO
Note: Treatment duration for M. kansasii lung disease should include 12 months of negative sputum cultures

2. Rifampin-resistant M. kansasii disease

Preferred regimen: Clarithromycin OR Azithromycin OR Moxifloxacin OR Ethambutol OR Sulfamethoxazole OR Streptomycin
Note(1): Use three-drug regimen
Note(2): Patients undergoing therapy for M. kansasii lung disease should have close clinical monitoring with frequent sputum examinations for mycobacterial culture throughout therapy

3. Disseminated M. kansasii disease

Note: The treatment regimen for disseminated disease should be the same as for pulmonary disease

Mycobacterium marinum Return to Top

Mycobacterium marinum ^[167]

1. In vitro M. marinum isolates

Susceptible: Rifampin, Rifabutin, Ethambutol, Clarithromycin, Sulfonamides, and Trimethoprim sulfamethoxazole
Intermediately susceptible: Streptomycin, Doxycycline, and Minocycline
Resistant: Isoniazid and Pyrazinamide
Note: Two active agents for 1 to 2 months after resolution of symptoms, typically 3 to 4 months in total

2. Infection

2.1 skin and soft tissue infections

Preferred regimen (1): Clarithromycin AND Ethambutol
Preferred regimen (2): Ethambutol AND Rifampin
Note: Azithromycin can replace Clarithromycin

2.2 osteomyelitis or deep structure infection

Preferred regimen: Clarithromycin AND Ethambutol AND Rifampin

Mycobacterium scrofulaceum Return to Top

Mycobacterium scrofulaceum ^[168]

Susceptibility data are lacking and standard treatment regimens for M. scrofulaceum are controversial, emphasizing the need to perform susceptibility testing on confirmed disease-producing isolates of M. scrofulaceum

Mycobacterium simiae Return to Top

Mycobacterium simiae ^[169]

Preferred regimen: Clarithromycin AND Moxifloxacin AND Trimethoprim/sulfamethoxazole

Mycobacterium ulcerans Return to Top

Mycobacterium ulcerans ^[170]

1. Preulcerative lesions

Excision and primary closure, Rifampin monotherapy, or heat therapy

2. Established ulcers

Most antimycobacterial agents are ineffective for the treatment of the ulcer; Surgical debridement combined with skin grafting is the usual treatment of choice

3. Control complications of the ulcer

Preferred regimen: Clarithromycin AND Rifampin

Mycobacterium xenopi Return to Top

Mycobacterium xenopi ^[171]

1. The cornerstone of therapy for M. xenopi

Preferred regimen: Clarithromycin AND Rifampin AND Ethambutol
Note: Therapy should be continued until the patient has maintained negative sputum cultures while on therapy for 12 months

2. Pulmonary disease

Preferred regimen: INH AND Rifabutin OR Rifampin AND Ethambutol AND Clarithromycin ± Streptomycin
Note: A quinolone, preferably Moxifloxacin, could be substituted for one of the antituberculous drugs

3. Extrapulmonary disease

Note: Therapy for extrapulmonary disease would include the same agents as for pulmonary disease

Mycobacterium leprae Return to Top

Mycobacterium leprae ^[172]

1. Multibacillary Leprosy (Skin smear positive)

Preferred regimen: Dapsone 100 mg/day PO AND Rifampin 600 mg PO 4 times per week AND Clofazimine 50 mg/day PO supplemented by Clofazimine 300 mg PO loading dose monthly
Pediatric regimen: Dapsone 1-2 mg/kg/day PO AND Rifampin 450 mg PO <35 kg, 300 mg PO <20 kg, 150 mg PO <12 kg
Length of treatment: 12-24 months

2. Paucibacillary Leprosy (Skin Smear negative)

Preferred regimen: Rifampin 600 mg PO once a month for 6 months AND Dapsone 100 mg/day PO for 6 months

3. Erythema Nodosum Leprosum (ENL)

Continue anti-leprosy drugs throughout
3.1 Mild

Preferred regimen: Rest affect limb, analgesics, follow-up twice a week, check for iridocyclitis; Chloroquine OR Aspirin may be useful

3.2 Severe (numerous nodules + fever, ulcerating/pustular ENL, visceral involvement, nodules + neuritis, recurrent ENL)

Preferred regimen: Prednisolone 30-40 mg/day PO (not to exceed 1 mg/kg) for 1-2 weeks, then taper over 12 weeks
Alternative regimen (1): (If unresponsive to corticosteroids or if risk of corticosteroids prevent administration) Start Clofazimine 100 mg PO TID for maximum of 12 weeks, taper the dose to 100 mg PO BID for 12 weeks and then 100 mg qd for 12-24 weeks
Alternative regimen (2): (if not contraindicated) Thalidomide 200-400 mg/day PO, reduced to 50-100 mg/day after 1-2 weeks

4. Reversal Reaction

Preferred regimen: Prednisolone start with 40 mg/day PO then taper by 10 mg twice a week for 12 weeks

Mycobacterium smegmatis Return to Top

Mycobacterium smegmatis ^[173]

1. Mild disease

Preferred regimen: Doxycycline PO AND Trimethoprim sulfamethoxazole PO

2. Severe disease

Preferred regimen: Amikacin IV OR Imipenem IV

Mycobacterium immunogenum Return to Top

Mycobacterium immunogenum ^[174]

In vitro

susceptible: Amikacin AND Clarithromycin but
resistant: Ciprofloxacin, Doxycycline, Cefoxitin, Tobramycin, and Sulfamethoxazole
NOTE: The optimal therapy for this organism is unknown; however, successful therapy is likely difficult due to the extensive antibiotic resistance of the organism

Mycobacterium malmoense Return to Top

Mycobacterium malmoense^[175]

in vitro

Susceptible: Ethambutol, Ethionamide, Kanamycin, and Cycloserine
Resistant: INH, Streptomycin, Rifampin, and Capreomycin

Pulmonary M. malmoense infection

Preferred regimen: INH AND Rifampin AND Ethambutol ± Quinolones AND Macrolides

Mycobacterium mucogenicum Return to Top

Mycobacterium mucogenicum ^[176]

In vitro susceptible agents: Aminoglycosides, Cefoxitin, Clarithromycin, Minocycline, Doxycycline, Quinolones, Trimethoprim/sulfamethoxazole, and Imipenem

Mycobacterium szulgai Return to Top

Mycobacterium szulgai ^[177]^[178]

1. in vitro susceptibility

M. szulgai is susceptible in vitro to most antituberculous drugs including Quinolones and newer Macrolides.

2. Pulmonary infection

Preferred regimen: three- or four-drug regimen based on susceptibility that includes 12 months of negative sputum cultures while on therapy

3. Extrapulmonary infection

Preferred regimen: combination anti-tuberculous medications based on in vitro susceptibilities for 4 to 6 months

Mycobacterium terrae Return to Top

Mycobacterium terrae ^[179]

1. In vitro susceptibility

All six of the isolates from a single center and 90% or more of an additional 22 isolates of M. terrae complex were susceptible to Ciprofloxacin and Sulfonamides. Recently, 11 isolates of M. terrae complex were also shown to be susceptible to Linezolid

2. Antimicrobial therapy

Preferred regimen: Macrolide AND Ethambutol or other agent based on in vitro susceptibility results

Parasites – Intestinal Protozoa

Balantidium coli Return to Top

Blastocystis hominis Return to Top

Cryptosporidium parvum Return to Top

1. Immunocompetent^[180]

Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: Nitazoxanide 500 mg PO bid for 3 days.

2. HIV^[181]

Preferred regimen: Nitazoxanide 500 mg PO bid for 3 days

3. HIV and Immunodeficiency^[182]

Preferred regimen: Effective antiretroviral therapy
Note: Nitazoxanide is not licensed for immunodeficient patients

Cryptosporidium hominis Return to Top

1. Immunocompetent^[183]

Preferred regimen: No specific therapy recommended since healthy patients usually recover within a few weeks, but if needed: Nitazoxanide 500 mg PO bid for 3 days.^[184]

2. HIV^[185]

Preferred regimen: Nitazoxanide 500 mg PO bid for 3 days

3. HIV and Immunodeficiency^[186]

Preferred regimen: Effective antiretroviral therapy
Note: Nitazoxanide is not licensed for immunodeficient patients

Cyclospora cayetanensis Return to Top

Preferred regimen: Trimethoprim-sulfamethoxazole one double-strength tablet PO bid for 7-10 days^[187]
Alternative regimen(1): Ciprofloxacin 500 mg PO bid for 7 days^[188]
Alternative regimen(2): Nitazoxanide 500 mg PO bid for 7 days^[189]
Note(1): One double-strength tablet (160 mg TMP/800 mg SMX) .
Note(2): Treatment is continued for 7 days in immunocompetent hosts and for 7 to 10 days in patients with HIV infection.

Dientamoeba fragilis Return to Top

Dientamoebiasis^[190]^[191]^[192]

Preferred regimen: Iodoquinol 650 mg PO tid for 20 days
Alternative regimen (1): Paromomycin 25–35 mg/kg/day PO in three divided doses for 7 days
Alternative regimen (2): Metronidazole 500–750 mg PO tid for 10 days
Alternative regimen (3): Tetracycline 500 mg PO qid for 10 days

1.1 Treatment in pregnancy

The use of Iodoquinol in pregnancy is limited, and risk to the embryo-fetus is unknown, should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Oral dose of Paromomycin generally is poorly absorbed from the gastrointestinal tract, with minimal, if any, systemic availability.
Metronidazole is in pregnancy category B. Data on the use of this drug in pregnant women are conflicting. The available evidence suggests use during pregnancy has a low risk of congenital anomalies. May be used during pregnancy in those patients who will clearly benefit from the drug, although its use in the first trimester is generally not advised.

1.2 Treatment during lactation

Iodoquinol should be used with caution in breastfeeding women.
Oral dose of Paromomycin is unlikely to be excreted in breast milk, and the drug generally is poorly absorbed from the gastrointestinal tract.
Metronidazole should be used during lactation only if the potential benefit of therapy to the mother justifies the potential risk to the infant.

1.3 Treatment in pediatric patients

Iodoquinol 30–40 mg/kg/day (maximum 2 g) PO in 3 doses for 􏰄20 days. The safety of iodoquinol in children has not been established.
Paromomycin 25–35 mg/kg/day PO in 3 doses􏰄 for 7 days. The safety of oral dose in children has not been formally evaluated. However, the safety profiles likely are comparable in children and adults.
Metronidazole 35–50 mg/kg/day PO in 3 doses for􏰄 10 days. The safety in children has not been established, is listed as an antiamebic and antigiardiasis medicine on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.
Tetracycline 40 mg/kg/day (maximum 2 g) PO in 4 doses for􏰄 10 days

Entamoeba histolytica Return to Top

1. Amebic Liver Abscess^[193]

Preferred regimen: (Metronidazole 750 mg PO tid for 10 days OR Tinidazole 2 g PO qd for 5 days) AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
Alternative regimen (1): Nitazoxanide 500 mg bid for 10 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
Alternative regimen (2): Tinidazole 2 g PO qd for 5 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
Alternative regimen (2): Tinidazole 2 g PO qd for 5 days

2. Amebic Colitis^[194]

Preferred regimen: Metronidazole 500-750 mg PO tid for 7-10 days. Pediatric dose: 35-50 mg/kg per day tid AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)
Alternative regimen: Tinidazole 2 g PO qd for 5 days AND (Paromomycin 30 mg/kg/day PO tid for 5-10 days OR Diloxanide furoate 500 mg PO tid for 10 days)

3. Asymptomatic Intestinal Colonization^[195]

Preferred regimen: Paromomycin 30 mg/kg/day PO tid for 5-10 days
Alternative regimen (1): Diloxanide furoate 500 mg PO tid for 10 days
Alternative regimen (2): Diiodohydroxyquin 650 mg PO tid for 20 days for adults and 30 to 40 mg/kg per day tid for 20 days for children

Giardia lamblia Return to Top

1. Giardiasis^[196]^[197]

1.1 Adult

Preferred regimen (1): Metronidazole 250 mg tid 5–7 days
Preferred regimen (2): Tinidazole 2 g single dose
Preferred regimen (3): Nitazoxanide 500 mg PO bid (with food)
Alternative regimen (1): Paromomycin 500 mg tid 3 5–10 days
Alternative regimen (2): Quinacrine 100 mg tid 3 5–7 days
Alternative regimen (3): Furazolidone 100 mg qid 3 7–10 days

1.2 Pediatric

Preferred regimen (1): Metronidazole 5 mg/kg tid 3 5–7 days
Preferred regimen (2): Tinidazole 50 mg/kg single dose (max, 2 g)
Preferred regimen (3): Nitazoxanide 100 mg PO bid for age 1-3 years or 200 mg PO bid for age 4-11 years (with food)
Alternative regimen (1): Paromomycin 30 mg/kg/day in 3 doses 3 5–10 days
Alternative regimen (2): Quinacrine 2 mg/kg tid 3 7 days
Alternative regimen (3): Furazolidone 2 mg/kg qid 3 10 days

Cystoisospora belli Return to Top

1. Cystoisospora belli treatment^[198]

1.1 Immunocompetent hosts

In the immunocompetent hosts, symptoms of Cystoisospora infection are usually self-limited.
Antimicrobial therapy to immunocompetent patients may be considered if symptoms do not start to resolve spontaneously after 5 to 7 days (depending upon severity)
Prefered regimen: Trimethoprim-sulfamethoxazole 160 mg/800 mg PO bid for 7-10 days
Alternative regimen (1) (for patients who are allergic to or intolerant of TMP-SMX): Pyrimethamine 50-75 mg/day PO qd or divided in 2 equal doses AND Leucovorin 10–25 mg PO qd
Alternative regimen (2): Ciprofloxacin 500 mg PO bid for 7 days (second-line alternative)

1.1.1 In pregnancy

TMP-SMX should be avoided near-term because of the potential for hyperbilirubinemia and kernicterus in the newborn.
Ciprofloxacin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

1.1.2 During lactation

TMP-SMX generally should be avoided by women when nursing infants who are premature, jaundiced, ill, or stressed, or who have glucose-6-phosphate dehydrogenase deficiency.
The American Academy of Pediatrics classifies Ciprofloxacin as usually compatible with breastfeeding, whereas the World Health Organization recommends avoiding Ciprofloxacin while breastfeeding and CDC recommends Ciprofloxacin should be used during lactation only if the potential benefit justifies the potential risk to the fetus.

1.1.3 In pediatric patients

The use of TMP-SMX in children less than 2 months of age generally is not recommended.
Available evidence is conflicting regarding the potential for growth defects and arthropathies in exposed children. Use of Ciprofloxacin in children requires assessment of potential risks and benefits.

1.2 Immunocompromised hosts

Preferred regimen (1): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO/IV qid for 10 days
Preferred regimen (2): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO/IV bid for 7-10 days
Note (1): One approach is to start with TMP-SMX (160 mg/800 mg) bid regimen first, and increase daily dose and/or duration (up to 3–4 weeks) if symptoms worsen or persist.
Note (2): IV therapy is recommended for patients with potential or documented malabsorption.
Alternative regimen (1): Pyrimethamine 50–75 mg PO qd AND Leucovorin 10–25 mg PO qd
Alternative regimen (2): Ciprofloxacin 500 mg PO bid for 7 days

2. Cystoisospora belli prophylaxis^[199]

2.1 Primary prophylaxis

Insufficient evidence is available to support a general recommendation for primary prophylaxis for Cystoisosporiasis per se, especially for U.S. travelers in isoporiasis-endemic areas.

2.2 Secondary prophylaxis (preventing recurrence in patients with CD4 count < 200 cells/mm³)

Prefered regimen: Trimethoprim-sulfamethoxazole 160 mg/800 mg PO 3 times weekly
Alternative regimen (1): Trimethoprim-sulfamethoxazole 160 mg/800 mg PO qd
Alternative regimen (2): Trimethoprim-sulfamethoxazole 320 mg/1600 mg PO 3 times weekly
Alternative regimen (3): Pyrimethamine 25 mg PO qd AND Leucovorin 5–10 mg PO qd
Alternative regimen (4): Ciprofloxacin 500 mg PO 3 times weekly (second-line alternative)
Note (1): Criteria for discontinuation of chronic maintenance therapy: sustained increase in CD4 count > 200 cells/mm³ for > 6 months in response to ART and without evidence of active Cystoisospora belli infection
Note (2): Because of concerns about possible teratogenicity associated with first-trimester drug exposure, clinicians may withhold secondary prophylaxis during the first trimester and treat only symptomatic infection.

Microsporidiosis Return to Top

1. Ocular^[200]

Preferred regimen: Albendazole 400 mg PO bid for 3 weeks AND Fumagillin eye drops.

2. Intestinal (diarrhea)^[201]

Preferred regimen:

Adult: Albendazole 400 mg PO bid for 3 weeks for E. intestinalis.
Pediatric: Albendazole 15 mg/kg per day divided into 2 daily doses for 7 days for E. intestinalis.

Note: Fumagillin 20 mg PO tid is the only reported effective treatment for E. bieneusi.

3. Disseminated^[202]

Preferred regimen: Albendazole 400 mg po bid for 3 weeks.

Parasites – Extraintestinal Protozoa

Acanthamoeba

Acanthamoeba Return to Top

1.Keratitis^[203]

Preferred regimen: Miltefosine OR Voriconazole.

2. Acanthamoeba Granulomatous Amebic Encephalitis and Disseminated Disease

Preferred regimen: Adults: Success with IV Pentamidine AND Sulfadiazine AND Flucytosine AND (Fluconazole OR Itraconazole )

Note: 2 children responded to PO rx: TMP-SMX AND Rifampin AND Ketoconazole

Balamuthia mandrillaris

Balamuthia mandrillaris Return to Top

Chronic granulomatous meningitis^[204]

Preferred regimen (1): Pentamidine AND Clarithromycin
Preferred regimen (2): Azithromycin AND Fluconazole AND Sulfadiazine AND Flucytosine

Naegleria fowleri

Naegleria fowleri Return to Top

Primary amoebic meningoencephalitis^[205]^[206]

Preferred regimen: Amphotericin B 1.5 mg/kg/day bid for 3 days; then 1 mg/kg/day for 6 days AND 1.5 mg/day intrathecal for 2 days; then 1 mg/day intrathecal qd for 8 days.
Note: Investigational drug called miltefosine also available for treatment.

Babesia microti

Babesia microti Return to Top

Babesiosis

1. Mild/moderate disease^[207]
Preferred regimen: Atovaquone 750 mg PO bid AND Azithromycin 600 mg PO qd for 7-10 days

2. Severe disease:

Preferred regimen: Clindamycin 600 mg PO tid AND Quinine 650 mg PO tid for 7–10 days
Preferred regimen: Clindamycin 1.2 g IV q12h
Note (1): For overwhelming infection in asplenic patients and immunocompromised patients, treat for 6 or more weeks.
Note (2): Consider transfusion if 􀂕10% parasitemia.

Leishmania

Leishmania Return to Top

Leishmaniasis

1. Cutaneous Leishmaniasis^[208]

Different Leishmania species cause Old World versus New World (American) cutaneous leishmaniasis. In the Old World (the Eastern Hemisphere), the etiologic agents include Leishmania tropica, L. major, and L. aethiopica, as well as L. infantum and L. donovani. The main species in the New World (the Western Hemisphere) are either in the L. mexicana species complex (L. mexicana, L. amazonensis, and L. venezuelensis) or the subgenus Viannia (L. [V.] braziliensis, L. [V.] guyanensis, L. [V.] panamensis, and L. [V.] peruviana). The Viannia subgenus is also referred to as the L. (V.) braziliensis species complex.

1.1 Systemic Therapy (Parenteral)

Preferred Regimen (1): Sodium stibogluconate 20 mg/kg IV/IM q24h for 10-20 days
Preferred Regimen (2): Meglumine antimoniate 20 mg/kg IV/IM q24h for 10-20 days
Alternative Regimen (1): Liposomal amphotericin B 3 mg/kg/day IV infusion for 6-10 days
Alternative Regimen (2): Pentamidine 2-3 mg/kg/day IV/IM for 4-7 days
Note: Data supporting the use of amphotericin B for treatment of cutaneous and mucosal leishmaniasis are anecdotal; standard dosage regimens have not been established. In the United States, pentamidine isethionate is uncommonly used for treatment of cutaneous leishmaniasis. Its limitations include the potential for irreversible toxicity and variable effectiveness.

1.2 Systemic Therapy (Oral)

1.2.1 Adults and adolescents at least 12 years of age, who weigh from 33-44 kg

Preferred Regimen:Miltefosine 50 mg PO q12h for 28 days

1.2.2 Adults and adolescents at least 12 years of age, who weigh >45 kg

Preferred Regimen:Miltefosine 50 mg PO q8h for 28 days
Alternative Regimen (1): Ketoconazole 600 mg qd for 28 days OR qd for 6 weeks
Alternative Regimen (2): Fluconazole 200 mg qd for 6 weeks
Note:The FDA-approved indications are limited to infection caused by three particular species, all three of which are New World species in the Viannia subgenus—namely, Leishmania (V.) braziliensis, L. (V.) panamensis, and L. (V.) guyanensis. The "azoles" showed modest activity against some Leishmania species in some cases, but are not FDA approved

1.3 Local Therapy

List of possible local therapies
Cryotherapy (with liquid nitrogen OR Thermotherapy (use of localized current field radiofrequency heat) OR Intralesional administration of SbV OR Topical application of Paromomycin (such as an ointment containing 15% Paromomycin/12% methylbenzethonium chloride in soft white paraffin)

2. Visceral Leishmaniasis

Visceral leishmaniasis usually is caused by the species L. donovani and L. infantum (L. chagasi generally is considered synonymous with L. infantum)

2.1 Systemic Therapy (Parenteral)

Preferred Regimen (1): Liposomal amphotericin B 3 mg/kg/day IV for 5 days, then once on day 14 and once on day 21 (Total dose: 21 mg/kg)
Preferred Regimen (2): Sodium stibogluconate 20 mg/kg IV/IM q24h for 28 days
Preferred Regimen (3): Meglumine antimoniate 20 mg/kg IV/IM q24h for 28 days
Alternative Regimen: Amphotericin B deoxycholate 0.5-1 mg/kg IV q24h (Total dose: 15-20 mg/kg)
Note: In immunosuppressed patients, dose is 4 mg/kg/day for 5 days, then once on day 10, 17, 24, 31, and 38 (Total dose: 40 mg/kg)

2.2 Systemic Therapy (Oral)

2.2.1 Adults and adolescents at least 12 years of age, who weigh from 33-44 kg

Preferred Regimen: Miltefosine 50 mg PO q12h for 28 days

2.2.2 Adults and adolescents at least 12 years of age, who weigh >45 kg

Preferred Regimen: Miltefosine 50 mg PO q8h for 28 days

Plasmodium

Plasmodium Return to Top

1. Plasmodium falciparum^[209]

1.1 Treatment of uncomplicated P. falciparum malaria

1.1.1 Treat children and adults with uncomplicated P. falciparum malaria (except pregnant women in their first trimester) with one of the following recommended ACT (artemisinin-based combination therapy)

Preferred regimen (1): Artemether 5–24 mg/kg/day PO bid AND Lumefantrine 29–144 mg/kg/day PO bid for 3 days.

Note: The first two doses should, ideally, be given 8 h apart.
Dosage regimen based on Body weight (kg)
Body weight (kg)-5 to < 15- Artemether 20 mg PO bid AND Lumefantrine 120 mg PO bid for 3 days
Body weight (kg)-15 to < 25- Artemether 40 mg PO bid AND Lumefantrine 240 mg PO bid for 3 days
Body weight (kg)-25 to < 35- Artemether 60 mg PO bid AND Lumefantrine 360 mg PO bid for 3 days
Body weight (kg) ≥ 35- Artemether 80 mg PO bid AND Lumefantrine 480 mg PO bid for 3 days

Preferred regimen (2): Artesunate 2–10 mg/kg/day PO qd AND Amodiaquine 7.5–15 mg/kg/day PO qd for 3 days

Note: A total therapeutic dose range of 6–30 mg/kg/day artesunate and 22.5–45 mg/kg/day per dose amodiaquine is recommended.
Dosage regimen based on Body weight (kg)
Body weight (kg)-4.5 to < 9- Artesunate 25 mg PO qd AND Amodiaquine 67.5 mg PO qd for 3 days
Body weight (kg)-9 to < 18 - Artesunate 50 mg PO qd AND Amodiaquine 135 mg PO qd for 3 days
Body weight (kg)-18 to < 36- Artesunate 100 mg PO qd AND Amodiaquine 270 mg PO qd for 3 days
Body weight (kg) ≥ 36 - Artesunate 200 mg PO qd AND Amodiaquine 540 mg PO qd for 3 days

Preferred regimen (3): Artesunate 2–10 mg/kg/day PO qd AND Mefloquine 2–10 mg/kg/day PO qd for 3 days

Dosage regimen based on Body weight (kg)
Body weight (kg)-5 to < 9- Artesunate 25 mg PO qd AND Mefloquine 55 mg PO qd for 3 days
Body weight (kg)-9to < 18- Artesunate 50 mg PO qd AND Mefloquine 110 mg PO qd for 3 days
Body weight (kg)-18 to < 36- Artesunate 100 mg PO qd AND Mefloquine 220 mg PO qd for 3 days
Body weight (kg)- ≥ 36 - Artesunate 200 mg PO qd AND Mefloquine 440 mg PO qd for 3 days

Preferred regimen (4): Artesunate 2–10 mg/kg/day PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1.25 (25–70 / 1.25–3.5) mg/kg/day PO given as a single dose on day 1

Dosage regimen based on Body weight (kg)
Body weight (kg)-5 to < 10- Artesunate 25 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 250/12 mg PO given as a single dose on day 1
Body weight (kg)-10 to < 25- Artesunate 50 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 500/25 mg PO given as a single dose on day 1
Body weight (kg)-25 to < 50- Artesunate 100 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1000/50 mg PO given as a single dose on day 1
Body weight (kg)- ≥50- Artesunate 200 mg PO qd for 3 days AND Sulfadoxine-Pyrimethamine 1500/75 mg PO given as a single dose on day 1

Preferred regimen (5): Dihydroartemisinin 2–10 mg/kg/day PO qd AND Piperaquine16–27 mg/kg/day PO qd for 3 days

Dosage regimen based on Body weight (kg)
Body weight (kg)-5 to < 8- Dihydroartemisinin 20 mg PO qd AND Piperaquine 160 mg PO qd for 3 days
Body weight (kg)-8 to < 11- Dihydroartemisinin 30 mg PO qd AND Piperaquine 240 mg PO qd for 3 days
Body weight (kg)-11 to < 17 - Dihydroartemisinin 40 mg PO qd AND Piperaquine 320 mg PO qd for 3 days
Body weight (kg)-17 to < 25- Dihydroartemisinin 60 mg PO qd AND Piperaquine 480 mg PO qd for 3 days
Body weight (kg)-25 to < 36- Dihydroartemisinin 80 mg PO qd AND Piperaquine 640 mg PO qd for 3 days
Body weight (kg)-36 to < 60- Dihydroartemisinin 120 mg PO qd AND Piperaquine 960 mg PO qd for 3 days
Body weight (kg)-60 < 80 - Dihydroartemisinin 160 mg PO qd AND Piperaquine 1280 mg PO qd for 3 days
Body weight (kg)- >80- Dose of Dihydroartemisinin 200 mg PO qd AND Piperaquine 1600 mg PO qd for 3 days

1.1.2 Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)

Preferred regimen: Single dose of 0.25 mg/kg Primaquine with ACT

1.2 Recurrent Falciparum Malaria

1.2.1 Failure within 28 days

Note:The recommended second-line treatment is an alternative ACT known to be effective in the region. Adherence to 7-day treatment regimens (with artesunate or quinine both of which should be co-administered with + tetracycline, or doxycycline or clindamycin) is likely to be poor if treatment is not directly observed; these regimens are no longer generally recommended.

1.2.2 Failure after 28 days

Note: all presumed treatment failures after 4 weeks of initial treatment should, from an operational standpoint, be considered new infections and be treated with the first-line ACT. However, reuse of mefloquine within 60 days of first treatment is associated with an increased risk for neuropsychiatric reactions, and an alternative ACT should be used.

1.3 Reducing the transmissibility of treated P. falciparum infections In low-transmission areas in patients with P. falciparum malaria (except pregnant women, infants aged < 6 months and women breastfeeding infants aged < 6 months)

Note: Single dose of 0.25 mg/kg bw Primaquine with ACT

1.4 Treating uncomplicated P. falciparum malaria in special risk groups

1.4.1 Pregnancy

First trimester of pregnancy : Quinine AND Clindamycin 10mg/kg/day PO bid for 7 days
Second and third trimesters : Mefloquine is considered safe for the treatment of malaria during the second and third trimesters; however, it should be given only in combination with an artemisinin derivative.
Note (1): Quinine is associated with an increased risk for hypoglycaemia in late pregnancy, and it should be used (with clindamycin) only if effective alternatives are not available.
Note (2): Primaquine and tetracyclines should not be used in pregnancy.

1.4.2 Infants less than 5kg body weight : with an ACT at the same mg/kg bw target dose as for children weighing 5 kg.
1.4.3 Patients co-infected with HIV: should avoid Artesunate + SP if they are also receiving Co-trimoxazole, and avoid Artesunate AND Amodiaquine if they are also receiving efavirenz or zidovudine.
1.4.4 Large and Obese adults: For obese patients, less drug is often distributed to fat than to other tissues; therefore, they should be dosed on the basis of an estimate of lean body weight, ideal body weight. Patients who are heavy but not obese require the same mg/kg bw doses as lighter patients.
1.4.5 Patients co-infected with TB: Rifamycins, in particular rifampicin, are potent CYP3A4 inducers with weak antimalarial activity. Concomitant administration of rifampicin during quinine treatment of adults with malaria was associated with a significant decrease in exposure to quinine and a five-fold higher recrudescence rate
1.4.6 Non-immune travellers : Treat travellers with uncomplicated P. falciparum malaria returning to nonendemic settings with an ACT.
1.4.7 Uncomplicated hyperparasitaemia: People with P. falciparum hyperparasitaemia are at increased risk of treatment failure, severe malaria and death so should be closely monitored, in addition to receiving an ACT.

2. Treatment of uncomplicated malaria caused by P. vivax, P. ovale, P. malariae or P. knowlesi

2.1 Blood Stage infection

2.1.1. Uncomplicated malaria caused by P. vivax

2.1.1.1 In areas with chloroquine-sensitive P. vivax

Preferred regimen: Chloroquine total dose of 25 mg/kg PO. Chloroquine is given at an initial dose of 10 mg/kg, followed by 10 mg/kg on the second day and 5 mg/kg on the third day.

2.1.1.2 In areas with chloroquine-resistant P. vivax

Note: ACTs containing Piperaquine, Mefloquine OR Lumefantrine are the recommended treatment, although Artesunate + Amodiaquine may also be effective in some areas. In the systematic review of ACTs for treating P. vivax malaria, Dihydroartemisinin + Piperaquine provided a longer prophylactic effect than ACTs with shorter half-lives (Artemether + Lumefantrine, Artesunate + Amodiaquine), with significantly fewer recurrent parasitaemias during 9 weeks of follow-up.

2.1.2 Uncomplicated malaria caused by P. ovale, P. malariae or P. knowlesi malaria

Note: Resistance of P. ovale, P. malariae and P. knowlesi to antimalarial drugs is not well characterized, and infections caused by these three species are generally considered to be sensitive to chloroquine. In only one study, conducted in Indonesia, was resistance to chloroquine reported in P. malariae. The blood stages of P. ovale, P. malariae and P. knowlesi should therefore be treated with the standard regimen of ACT or Chloroquine, as for vivax malaria.

2.1.3 Mixed malaria infections

Note: ACTs are effective against all malaria species and so are the treatment of choice for mixed infections.

2.2 Liver stages (hypnozoites) of P. vivax and P. ovale

Note: To prevent relapse, treat P. vivax or P. ovale malaria in children and adults (except pregnant women, infants aged < 6 months, women breastfeeding infants < 6 months, women breastfeeding older infants unless they are known not to be G6PD deficient and people with G6PD deficiency) with a 14-day course of primaquine in all transmission settings. Strong recommendation, high-quality evidence In people with G6PD deficiency, consider preventing relapse by giving primaquine base at 0.75 mg base/kg bw once a week for 8 weeks, with close medical supervision for potential primaquine-induced adverse haematological effects.]

2.2.1 Primaquine for preventive relapse

Preferred regimen: Primaquine 0.25–0.5 mg/kg/day PO qd for 14 days

2.2.2 Primaquine and glucose-6-phosphate dehydrogenase deficiency

Preferred regimen: Primaquine 0.75 mg base/kg/day PO once a week for 8 weeks.
Note: The decision to give or withhold Primaquine should depend on the possibility of giving the treatment under close medical supervision, with ready access to health facilities with blood transfusion services.

2.2.3 Prevention of relapse in pregnant or lacating women and infants

Note: Primaquine is contraindicated in pregnant women, infants < 6 months of age and in lactating women (unless the infant is known not to be G6PD deficient).

3. Treatment of severe malaria

3.1 Treatment of severe falciparum infection with Artesunate

3.1.1 Adults and children with severe malaria (including infants, pregnant women in all trimesters and lactating women):-

Preferred regimen: Artesunate IV/IM for at least 24 h and until they can tolerate oral medication. Once a patient has received at least 24 h of parenteral therapy and can tolerate oral therapy, complete treatment with 3 days of an ACT (add single dose Primaquine in areas of low transmission).

3.1.2 Young children weighing < 20 kg

Preferred regimen:Artesunate 3 mg/kg per dose IV/IM q24h
Alternatives regimen: use Artemether in preference to quinine for treating children and adults with severe malaria

3.2.Treating cases of suspected severe malaria pending transfer to a higher-level facility (pre-referral treatment)

3.2.1 Adults and children

Preferred regimen: Artesunate IM q24h
Alternative regimen: Artemether IM OR Quinine IM

3.2.2 Children < 6 years

Preferred regimen: Where intramuscular injections of artesunate are not available, treat with a single rectal dose (10 mg/kg) of Artesunate, and refer immediately to an appropriate facility for further care.
Note: Do not use rectal artesunate in older children and adults.

3.3 Pregancy

Note: Parenteral artesunate is the treatment of choice in all trimesters. Treatment must not be delayed.

3.4 Treatment of severe P. Vivax infection

Note: parenteral artesunate, treatment can be completed with a full treatment course of oral ACT or chloroquine (in countries where chloroquine is the treatment of choice). A full course of radical treatment with primaquine should be given after recovery.

3.5 Additional aspects of management in severe malaria

Fluid therapy: It is not possible to give general recommendations on fluid replacement; each patient must be assessed individually and fluid resuscitation based on the estimated deficit.
Blood Transfusion :In high-transmission settings, blood transfusion is generally recommended for children with a haemoglobin level of < 5 g/100 mL(haematocrit < 15%). In low-transmission settings, a threshold of 20% (haemoglobin,7 g/100 mL) is recommended.
Exchange blood transfusion: Exchange blood transfusion requires intensive nursing care and a relatively large volume of blood, and it carries significant risks. There is no consensus on the indications, benefits and dangers involved or on practical details such as the volume of blood that should be exchanged. It is, therefore, not possible to make any recommendation regarding the use of exchange blood transfusion.

Toxoplasma gondii Return to Top

Trichomonas vaginalis

Trichomonas vaginalis Return to Top

1. T. vaginalis infection in adults ^[210]

Preferred regimen (1): Metronidazole 2 g PO in a single dose
Preferred regimen (2): Tinidazole 2 g PO in a single dose
Alternative regimen: Metronidazole 500 mg PO bid for 7 days

2. T. vaginalis infection in pregnant and lactating Women

2.1 Pregnant women

Preferred regimen: Metronidazole 2 g PO in a single dose.

2.2 Post-partum and Breastfeeding

Preferred regimen (1): Metronidazole 2 g PO in a single dose.
Preferred regimen (2): Tinidazole 2 g PO in a single dose
Note (1): Do not breastfeed for 12-24 hrs following Metronidazole and 72 hrs following Tinidazole
Note (2): Symptomatic pregnant women, regardless of pregnancy stage, should be tested and considered for treatment. Pregnant women should be advised of the risk and benefits to treatment as infection (definitely) and treatment (possibly)
Note (3): Pregnant women with HIV who are treated for T. vaginalis infection should be retested 3 months after treatment.

3. T. vaginalis infection in patients with HIV

Preferred regimen: Metronidazole 500 mg PO bid for 7 days

4. Persistent or recurrent trichomoniasis

4.1 Treatment failure

Preferred regimen: Metronidazole 500 mg PO bid for 7 days

4.2 Treatment failure again

Preferred regimen (1): Metronidazole 2 g PO for 7 days
Preferred regimen (2): Tinidazole 2 g PO for 7 days

4.3 Nitroimidazole-resistant cases

Preferred regimen: Tinidazole 2-3 g PO for 14 days

African trypanosomiasis

African trypanosomiasis Return to Top

Sleeping sickness^[211]

1. East african trypanosomiasis

1.1 T. b. rhodesiense, hemolymphatic stage

1.1.1 Adult

Preferred regimen: Suramin 1 gm IV on days 1,3,5,14, and 21

1.1.2 Pediatric

Preferred regimen: Suramin 20 mg/kg IV on days 1, 3, 5, 14, and 21

1.2 T. b. rhodesiense, CNS involvement

1.2.1 Adult

Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days. After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days.

1.2.2 Pediatric

Preferred regimen: Melarsoprol 2-3.6 mg/kg/day IV for 3 days. After 7 days, 3.6 mg/kg/day for 3 days. Give a 3rd series of 3.6 mg/kg/d after 7 days

2. West african trypanosomiasis

2.1 T. b. gambiense, hemolymphatic stage

2.1.1 Adult

Preferred regimen: Pentamidine 4 mg/kg/day IM/ IV for 7-10 days

2.1.2 Pediatric

Preferred regimen: Pentamidine 4 mg/kg/day IM/IV for 7-10 days
Note (1): Pentamidine should be used during pregnancy and lacation only if the potential benefit justifies the potential risk
Note (2): IM/IV Pentamidine have a similar safety profile in children age 4 months and older as in adults. Pentamidine is listed as a medicine for the treatment of 1st stage African trypanosomiasis infection (Trypanosoma brucei gambiense) on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.

2.2 T. b. gambiense, CNS involvement

2.2.1 Adult

Preferred regimen: Eflornithine 400 mg/kg/day IV qid for 14 days

2.2.2 Pediatric

Preferred regimen: Eflornithine 400 mg/kg/day IV qid for 14 days
Note (1): Eflornithine should be used during pregnancy and lactation, only if the potential benefit justifies the potential risk
Note (2): The safety of Eflornithine in children has not been established. Eflornithine is not approved by the Food and Drug Administration (FDA) for use in pediatric patients. Eflornithine is listed for the treatment of 1st stage African trypanosomiasis inTrypanosoma brucei gambiense infection on the WHO Model List of Essential Medicines for Children, intended for the use of children up to 12 years of age.

American trypanosomiasis

American trypanosomiasis Return to Top

Chagas disease^[212]

1. Preferred regimen(1):

Patients of age < 12 years- Benznidazole 5-7.5 mg/kg/ day PO bid for 60 days
Patients of age 12 years or older- Benznidazole 5-7 mg/kg/day PO bid for 60 days

2. Preferred regimen(2):

Patients of age ≤ 10 years- Nifurtimox 15-20 mg/kg/day PO tid/ qid for 90 days
Patients of age 11-16 years- Nifurtimox 12.5-15 mg/kg/day PO tid/ qid for 90 days
Patients of age 17 years or older- Nifurtimox 8-10 mg/kg/day PO tid/ qid for 90 days

Note: In the United States, Nifurtimox and Benznidazole are not FDA approved and are available only from CDC under investigational protocols.

Parasites – Intestinal Nematodes (Roundworms)

Gnathostoma spinigerum Return to Top

Eosinophilic Meningitis
- Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.^[213]
Cutaneous disease:

Preferred regimen: Albendazole 400 mg bid for 21 days OR Ivermectin 200 mcg/kg qd for 2 days^[214]
Alternative regimen: Albendazole 400 mg qd for 21 days OR Ivermectin 200 mcg/kg qd single dose^[215]

Ancylostoma braziliense Return to Top

Preferred regimen^[216]

Adult: Albendazole 400 mg PO qd for 3 to 7 days
Pediatric: Albendazole > 2 years 400 mg PO qd for 3 days
Note: This drug is contraindicated in children younger than 2 years age

Alternative regimen^[217]

Adult: Ivermectin 200 mcg/kg PO qd for one or two days
Pediatric: Ivermectin >15 kg give 200 mcg/kg single dose

Angiostrongylus cantonensis Return to Top

Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60 mg qd for 2 weeks) and analgesics.^[218]
Note: Albendazole and Mebendazole are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.^[219]

Ascaris lumbricoides Return to Top

Preferred regimen: Albendazole 400 mg PO qd OR Mebendazole 500 mg PO qd or 100 mg bid for 3 days^[220]

Note: Albendazole dose for children of 1-2 years is 200 mg instead of 400 mg.

Alternative regimen (1): Ivermectin 150 to 200 µg/kg PO single dose^[221]
Alternative regimen (2): Nitazoxanide 500 mg bid for 3 days ^[222]
Alternative regimen (3): Levamisole 150 mg PO single dose
Note: Pediatric dose: 2.5 mg/kg single dose ^[223]
Alternative regimen (4): Pyrantel Pamoate 11 mg/kg single dose PO - maximum 1.0 g^[223]
Alternative regimen (5): Piperazine citrate 75 mg/kg qd for 2 days - maximum 3.5 g^[223]

Capillaria philippinensis Return to Top

1. Intestinal capillariasis^[224]^[225]^[226]

Preferred regimen: Albendazole 400 mg/day PO for 10-30 days
Alternative regimen: Mebendazole 200 mg PO bid for 20-30 days

Enterobius vermicularis Return to Top

Preferred regimen (1): Albendazole 400 mg PO single dose - repeat in 2 weeks^[227]
Preferred regimen (2): Mebendazole 100 mg PO single dose - repeat in 2 weeks
Alternative regimen (1): Ivermectin 200 µg/kg PO single dose - repeat in 10 days^[228]
Alternative regimen (2): Pyrantel pamoate 11 mg/kg up to 1.0 g PO single dose - repeat in 2 weeks^[229]

Necator americanus Return to Top

Preferred regimen: Albendazole 400 mg PO single dose^[230]
Alternative regimen (1): Mebendazole 100 mg PO bid or 500 mg daily for 3 days
Alternative regimen (2): Pyrantel pamoate 11 mg/kg PO qd (maximum 1 g/day) for 3 days^[231]

Ancylostoma duodenale Return to Top

Preferred regimen: Albendazole 400 mg PO single dose^[230]
Alternative regimen (1): Mebendazole 100 mg PO bid or 500 mg daily for 3 days
Alternative regimen (2): Pyrantel pamoate 11 mg/kg PO qd (maximum 1 g/day) for 3 days^[232]

Strongyloides stercoralis Return to Top

Preferred regimen: Ivermectin 200 mcg/kg/day PO qd for 2 days or two doses 2 weeks apart from each other^[233]
Alternative regimen: Albendazole 400 mg PO bid for 3-7 days^[234]

Trichuris trichiura Return to Top

Preferred regimen: Albendazole 400 mg PO qd for 3 days
Alternatie regimen (1): Mebendazole 100 mg PO bid for 3 days
Alternative regimen (2): Ivermectin 200 mcg/kg/day PO qd for 3 days^[235]

Parasites – Extraintestinal Nematodes (Roundworms)

Ancylostoma braziliense Return to Top

Preferred regimen^[236]

Adult: Albendazole 400mg PO qd for 3-7 days.
Pediatric: Albendazole > 2 years 400mg PO qd for 3 days
Note: This drug is contraindicated in children younger than 2 years.

Alternative regimen^[237]

Adult: Ivermectin 200 mcg/kg PO qd for one or two days.
Pediatric: Ivermectin >15 kg give 200mcg/kg single dose.

Angiostrongylus cantonensis Return to Top

Preferred: Symptomatic therapy, serial lumber puncture, corticosteroids (prednisone 60mg qd for 2 weeks) and analgesics^[238]
Note: Albendazole and Mebendazole are generally not recommended due to the risk of exacerbation of neurological symptoms following anthelminthic therapy.^[219]

Filariasis Return to Top

Filariasis

1. Lymphatic filariasis- Wuchereria bancrofti, Brugia malayi Brugia timori

2. Cutaneous filariasis- Onchocercia volvulus, Loa loa

Onchocerciasis Return to Top

Onchoceria volvulus cutaneous filariasis (river blindness) treatment^[239]

Preferred regimen: Ivermectin Single dose of 150mcg/kg po; repeat every 6-12 months until asymptomatic.
Alternative regimen: If Ivermectin fails, consider Suramin.

Note (1): Onchocercia and Loa loa may both be present. Check peripheral smear; if Loa loa microfilaria present, treat onchocercia first with Ivermectin before Diethylcarbamazine (DEC) for Loa loa.

Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.

Note (3): Do not use Diethylcarbamazine (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.

Treatment of endosymbiont Wolbachia (bacteria) may help clear infection

Preferred regimen: Doxycycline 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.

Loiasis Return to Top

Loa loa cutaneous filariasis (eyeworm disease) treatment^[240]

Preferred regimen: Diethylcarbamazine (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-21, 8-10mg/kg/day in 3 divided dose

Alternative regimen: Albendazole 200mg po bid for 21 days

Note: If concomitant onchocercia Loa loa, treat oncho first. Ifover 5,000 microfilaria/mL of blood, Diethylcarbamazine (DEC) can cause encephalopathy. Might start with albendazole for few days with or without steroids, then Diethylcarbamazine (DEC).

Wuchereria bancrofti Return to Top

Wuchereria bancrofti lymphatic filariasis (elephantiasis) treatment^[241]

Preferred regimen (1): Scaled dose Diethylcarbamazine (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. (Diethylcarbamazine(DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).

Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.

Preferred regimen (2): Albendazole 400 mg PO single dose regimen AND (Ivermectin 200 mcg/kg PO OR Diethylcarbamazine 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.

Note (1): Most symptoms with Wuchereria bancrofti are due to the adultworm.

Note (2): Retreatment for microfilaremia often necessary q6-12 months as demonstrated by repeat blood smear or antigen testing.

Note (3): Do not use Diethylcarbamazine (DEC) in Onchocerca volvulus due to increased risks of precipitating blindness.

Note (4): Skin snip technique is skin snips can be obtained using a corneal scleral punch, or more simply a scalpel and needle. The sample must be allowed to incubate for 30 minutes to 2 hrs in saline or culture medium, and then examined for microfilariae that would have migrated from the tissue to the liquid phase of the specimen.

Note (5): Site of infection

5.1 General: filarial fever includes fever, chills, malaise during acute or recurrent episode.

5.2 Lymph:localized lymphadenitis, may be painful(red,warm) or painless, unilateral or bilateral groin swelling. May be due to adult worm or complicating bacterial infection.

5.3 Derm:pruritus,dermatitis,subcutaneous nodules.

5.4 Genital:scrotal or vulvar swelling/ hydrocele; may be able to visualize adult W.bancrofti worm by ultrasound.

5.5 Extremities:unilateral or bilateral swelling, acute or chronic. May be extreme (classic elephantiasis) or mild. May be associated with recurrent bacterial cellulitis (abrupt onset of redness ,fever).

5.6 Lungs:tropical pulmonary eosinophilia (miliary pattern on CXR, nocturnal paroxysmal cough, wheezing, accompanied by marked eosinophilia, responds to DEC, usually amicrofilaremic).

5.7 Renal: chyluria, hematuria (rupture of dilated lymphatics into urinary excretory system). May see weightloss, hypoproteinemia, lymphopenia, anemia.

5.8 Musculoskeletal:acute monoarthritis (knee>ankle) which responds to DEC, tenosynovitis (rare), thrombophlebitis (rare).

Note (6)

Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);

Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.

Diagnosis 3.skin snips (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.

Treatment of endosymbiont Wolbachia (bacteria) may help clear infection

Preferred regimen: Doxycycline 100 mg qd or bid for 6-8 wks in lymphatic filariasis although effect may be more important for co-infecting pathogens such as Wuchereria or Onchocerca than loaloa.

Brugia malayi Return to Top

Brugia malayi, Brugia timori lymphatic filariasis (elephantiasis) treatment^[242]

Preferred regimen (1): Scaled dose Diethylcarbamazine (DEC) escalation recommended to reduce reactions on day 1-50 mg, day 2-50 mg tid, day 3-100 mg tid, Days 4-14, 2 mg/kg q8h for total of 72 mg over 14 days. (Diethylcarbamazine(DEC) 2 mg/kg PO tid for 12 days (may be accompanied by systemic reaction to dying worms,local reactions include lymphadenitis, transient lymphedema)).

Note: Corticosteroids or antihistamines may be needed to treat allergic reactions that develop as a consequence of dying microfilariae.

Preferred regimen (2): Albendazole 400 mg PO single dose regimen AND (Ivermectin 200 mcg/kg PO OR Diethylcarbamazine 6mg/kg) may reduce or suppress microfilariae; however, this will not affect adultworms.

Note

Diagnosis 1.serological-antigen detection by commercially available card test ; IgG4 antibody (not filaria species specific and may cross react with other helminths);

Diagnosis 2.special maneuvers DEC provocative days test (induce microfilaremia with dose of DEC); polymerase chain reaction.

Diagnosis 3.skin snips (detect Onchocerca volvulus, Mansonella streptocerca). Ultrasonography can detect adult W.bancrofti worms in scrotal lymphatics.

Gnathostoma spinigerum Return to Top

Eosinophilic Meningitis
- Preferred regimen: Supportive measures. Anthelminthic therapy might be deleterious by augmenting the inflammation due to the death of the larvae. The use of corticosteroids is generally favored for suppression of the inflammation but there are no clinical trials that prove its efficacy.^[213]
Cutaneous disease:

Preferred regimen: Albendazole 400 mg bid for 21 days OR Ivermectin 200 mcg/kg once daily for 2 days^[243]
Alternative regimen: Albendazole 400 mg daily for 21 days OR Ivermectin 200 mcg/kg once daily for 1 day^[244]

Toxocariasis Return to Top

1.1 Visceral toxocariasis

Preferred regimen: Albendazole 400 mg PO bid for five days (both adult and pediatric dosage)
Alternative regimen: Mebendazole 100-200 mg PO bid for five days (both adult and pediatric dosage)
Note: Treatment is indicated for moderate-severe cases. Patients with mild symptoms of toxocariasis may not require anthelminthic therapy as symptoms are limited.^[245]

1.2 Ocular toxocariasis

Preferred regimen: Prednisone 0.5-1mg/kg/day PO q24h AND Albendazole 400mg PO bid for 2 to 4 weeks (pediatric dose: 400mg PO qd)^[246]
Note: Surgical therapy might be neeeded.

Trichinella spiralis Return to Top

Preferred regimen: Albendazole 400 mg PO bid for 8 to 14 days OR Mebendazole 200 to 400 mg PO tid for 3 days, then 400 to 500 mg PO tid for 10 days^[247]
Note(1): Albendazole and Mebendazole are contraindicated during pregnancy and not recommended in children aged 2 years.
Note(2): Prednisone administered at a dose of 30 mg/day to 60 mg/day for 10 to 15 days for severe symptoms

Parasites – Trematodes (Flukes)

Clonorchis sinensis Return to Top

Preferred regimen: Praziquantel 75mg/kg/day PO tid for 2 days^[248]
Alternative regimen (1): Albendazole 10mg/kg/day PO qd for 7 days^[249]
Alternative regimen (2): Tribendimidine 400mg PO single dose^[250]
This regimen is still under investigation, but it appears to be as effective as Praziquantel.
Note: Urgent biliary decompression might be required for patients with acute cholangitis.

Dicrocoelium dendriticum Return to Top

Preferred regimen: Praziquantel 25 mg/kg PO tid for 2 days^[251]
Note: Praziquantel is not approved for treatment of children less than 4 years old.^[252]
Alternative regimen (1): Myrrh (commiphora molmol) 12 mg/kg/day PO for 6 days^[253]
Alternative regimen (2): Triclabendazole 10 mg/kg PO single dose^[253]

Fasciola hepatica Return to Top

Preferred regimen: Triclabendazole 10 mg/kg PO one dose^[254]
Note: Two-dose (double-dose) triclabendazole therapy can be given to patients who have severe or heavy Fasciola infections (many parasites) or who did not respond to single-dose therapy.
Alternative regimen: Nitazoxanide 500mg PO bid for 7 days

Paragonimus westermani Return to Top

Preferred regimen (1): Praziquantel 25 mg/kg PO tid for 3 days^[255]
Preferred regimen (2): Triclabendazole 10 mg/kg PO qd or bid
Alternative regimen (1): Bithinol 30-50mg/kg PO on alternate days for 10-15 doses
Alternative regimen (2): Niclosamide 2mg/kg PO single dose

Schistosomiasis Return to Top

1. Schistosoma mansoni, S. haematobium, S. intercalatum^[256]

Preferred regimen: Praziquantel 40 mg/kg per day PO in qd or bid for one day
Alternative regimen (1): Oxamniquine 20 mg/kg PO single dose^[257]^[258]
Alternative regimen (2): Artemisinin no dose is established yet^[256]
Alternative regimen (3): Mefloquine 250 mg PO single dose
Note: There is no benefit in associating the alternative therapies to Praziquantel.
Note: Praziquantel is not effective against larval/egg stages of the disease.^[142]

2. S. japonicum, S. mekongi^[256]

Preferred regimen: Praziquantel 60 mg/kg per day PO bid for one day
Alternative regimen (1): Artemisinin no dose is established yet
Alternative regimen (2): Mefloquine 250 mg PO single dose
Note: There is no benefit in associating the alternative therapies to Praziquantel.

3. Katayama Fever

Preferred regimen: Prednisone 20-40 mg/day PO for 5 days, THEN Praziquantel^[259]
Note: Praziquantel should be used after 4-6 weeks of exposure, because it cannot kill the larvae stages of the Schistosoma. Praziquantel should be used after acute schistosomiasis syndrome symptoms have resolved always together with corticosteroids, only when ova are detected in stool or urine samples.^[260]

4. Neuroschistosomiasis

Preferred regimen: prednisone 1-2 mg/kg
Note: Praziquantel should only be introduced after a few days of the initiation of corticosteroid therapy, due to the risk of increasing the inflammatory response.

Parasites – Cestodes (Tapeworms)

Echinococcus Return to Top

1.1 Echinococcus granulosus (hydatid disease) treatment^[261]

Preferred regimen: Percutaneous aspiration-injection-reaspiration (PAIR) and Albendazole.Before & after drainage:Albendazole ≥60 kg, 400 mg PO bid or <60 kg, 15 mg/kg per day divided bid, with meals. Then: Puncture (P) & needle aspirate (A) cyst content. Instill (I) hypertonic saline (15–30%) or absolute alcohol, wait 20–30 min, then re-aspirate (R) with final irrigation.

Note: Continue Albendazole for 28 days Cure in 96% as comp to 90% patients with surgical resection

1.2 Echinococcus multilocularis (alveolar cyst disease) treatment^[262]

Preferred regimen: Albendazole ≥60 kg, 400 mg PO bid or <60 kg, 15 mg/kg per day divided bid, with meals.

Note (1): Albendazole efficacy not clearly demonstrated, can try in dosages used for hydatid disease.

Note (2): Wide surgical resection only reliable treatment; technique evolving.

Neurocysticercosis

Neurocysticercosis Return to Top

Neurocysticercosis treatment (NCC)^[263]

1. Larval form of Taenia solium

Preferred regimen: Treat Taenia solium intestinal tapeworms, if present, with Praziquante l5-10 mg/kg PO for 1 dose for children & adults.

2. Parenchymal neurocysticercosis

Preferred regimen: Patients body weight of ≥60 kg,Albendazole 400mg bid with meals or Patients body weight of 60 kg, Albendazole 15 mg/kg per day in 2 divided doses (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days

Note : “Viable” cysts by CT/MRI Meta-analysis: treatment associated with cyst resolution, decreased seizures, and decreased seizure recurrence.

Alternative regimen: (Praziquantel 100 mg/kg per day in 3 div. doses PO for 1 day, then 50 mg/kg/d in 3 doses and [[Dexamethasone]} ANDDexamethasone 0.1mg/kg per day with or without anti-seizure medication) all for 29 days.

Note (1): Albendazole associated with 46% decrease in seizures.

Note (2): Praziquantel less cysticidal activity.

Note (3): Steroids decrease serum levels of [[Praziquantel].

Note (4): NIH reports Methotrexate at 20 mg/wk allows a reduction in steroid use.

3. Degenerating cysts

Preferred regimen: Patients body weight of ≥60 kg,Albendazole 400mg bid with meals or Patients body weight of 60 kg, Albendazole 15 mg/kg per day in 2 divided doses (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days

Note (1): Treatment improves prognosis of associated seizures.

Note (2): For dead calcified cysts, no treatment indicated

4. Subarachnoid neurocysticercosis

Preferred regimen: (Patients body weight of ≥60 kg,Albendazole 400mg bid with meals or Patients body weight of 60 kg, Albendazole 15 mg/kg per day in 2 divided doses (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days) AND shunting for hydrocephalus.

Note: Without shunt, 50% died within 9 years.

5. Intraventricular neurocysticercosis

Preferred regimen: (Patients body weight of ≥60 kg,Albendazole 400mg bid with meals or Patients body weight of 60 kg, Albendazole 15 mg/kg per day in 2 divided doses (max. 800 mg/day) AND Dexamethasone 0.1 mg/kg per day with or without anti-seizure medication] all for 8-30 days) AND perhaps neuroendoscopic removal if obstruction of CSF circulation.

Sparganosis Return to Top

Sparganosis (Spirometra mansonoides) treatment ^[264]

Preferred treatment: Surgical resection or ethanol injection of subcutaneous masses

Note: Source for Spirometra mansonoides larval cysts is frogs or snakes

Parasites – Ectoparasites

Body lice Return to Top

Body lice

Pediculus humanus, corporis treatment^[265]

Preferred regimen (1): Success with Ivermectin in home shelter with 12 mg PO on days 0, 7, & 14

Preferred regimen (2): Treat clothing with 1% Malathion powder OR 0.5% Permethrin powder.

Note (1): No drugs for the patient.

Note (2): Organism lives in and deposits eggs in seams of clothing. Discard clothing; if not possible treat clothes with 1% Malathion powder OR 0.5% Permethrin powder.

Head lice Return to Top

Head lice

Pediculus humanus, capitis treatment^[266]

Preferred regimen: Permethrin 1% lotion apply to shampooed dried hair for 10 min.; repeat in 9-10 days OR Malathion 0.5% lotion (Ovide) apply to dry hair for 8–12hrs, then shampoo. 2 doses 7-9 days apart.

Alternative regimen: Ivermectin 200 μg/kg PO once; 3 doses at 7 day intervals reported effective. Malathion 0.5% lotion report that 1–2 20-minutes applications 98% effective.

Note (1):Malathion in alcohol is potentially flammable.

Note (2): Permethrin success in 78%.

Note (3): Extra combing of no benefit.

Note (4): Resistance increasing.No advantage to 5% permethrin.

Pubic lice Return to Top

Pubic lice

Phthirus pubis treatment^[267]

Preferred regimen: Pubic hair with Permethrin 1% lotion OR Malathion 0.5% lotion as for head lice

Alternative regimen: For eyelids apply Petroleum jelly qid for 10 days OR Yellow oxide of mercury 1% qid for 14 days.

Myiasis Return to Top

Preferred regimen: No medications approved by the FDA are available for treatment^[268]
Note: Fly larvae need to be surgically removed.

Fly larvae treatment ^[269]
Preferred treatment (1): Occlude punctum to prevent gas exchange with petrolatum, fingernail polish, makeup cream or bacon.
Preferred treatment (2): When larva migrates, manually remove.
Note (1): Myiasis is due to larvae of flies.
Note (2): Usually cutaneous/subcutaneous nodule with central punctum.

Scabies Return to Top

Scabies

Sarcoptes scabiei treatment ^[270]

1. Immunocompetent patisent

Preferred regimen: (Primary) Permethrin 5% cream (ELIMITE).

Note (1): Apply entire skin from chin down to and including toes with Permethrin 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.

Note (2): Safe for children >2 months old.

Alternative regimen: Ivermectin 200 μg/kg PO once. As above, second dose if persistent symptoms.

Note (1): Trim fingernails.

Note (2): Reapply to hands after hand washing.

Note (3): Pruritus may persist times 2 weeks after mites gone.

Alternative regimen (2): Less effective is Crotamiton 10% cream, apply for 24 hours, rinse off, then reapply for 24 hours.

2. AIDS patients (CD4 <150 per mm3), debilitated or developmentally disabled patients

* preferred regimen (for Norwegian scabies) : Permethrin 5% cream-2 or more applications a week apart may be needed. After each Permethrin dose (days 2-7) apply 6% Sulfur in petrolatum.

Note: Apply entire skin from chin down to and including toes with Permethrin 5% cream. Leave on 8–14hours. Repeat if itching persists for >2-4 wks after treatment or new pustules occur.

Alternative regimen: Ivermectin 200 mcg/kg PO once is reported effective; may need 2 or more doses separated by 14 days.

Note: Norwegian scabies in AIDS patients is extensive, crusted. Can mimic psoriasis and not pruritic but highly contagious—isolate.

Viruses

Adenovirus Return to Top

Adenovirus^[271]

1. In severe cases of pneumonia or post hematopoietic stem cell transplantation

Preferred regimen (1): Cidofovir 5 mg/kg/week IV for 2 weeks, then q 2 weeks AND Probenecid 1.25 g/M² PO given 3 hours before Cidofovir and 3 & 9 hours after each infusion

Preferred regimen (2): Cidofovir 1 mg/kg IV 3 times per week

2. For hemorrhagic cystitis

Preferred regimen: Cidofovir (5 mg/kg in 100 mL saline instilled into bladder) intravesical.

Note (1): Adenovirus is the cause of respiratory tract infections including fatal pneumonia in children and young adults and 60% mortality in transplant patients.

Note (2): Adenovirus is frequent cause of cystitis in transplant patients.

Note (3): Adenovirus 14 associated with severe pneumonia in otherwise healthy young adults .Findings include fever, decreases liver enzymes, leukopenia, thrombocytopenia, diarrhea, pneumonia, or hemorrhagic cystitis.

note (4): Cidofovir is successful in 3/8 immunosuppressed children and 8 of 10 children with post Hematopoietic stem cell transplantation. Decrease in virus load predicted response to Cidofovir.

3. Pink eye (viral conjunctivitis)

Note (1): Usually unilateral Adenovirus (types 3 & 7 in children, 8, 11 & 19 in adults)

Note (2): No treatment.

Note (3): If symptomatic, cold artificial tears may help.

Note (4): Highly contagious.

Note (5): Onset of ocular pain and photophobia in an adult suggests associated keratitis—rare.

4.Bronchitis

Infants/children (≤ age 5)

< Age 2: Adenovirus;

Note:Antibiotics indicated only with associated sinusitis or heavy growth on throat culture for S. pneumo., Group A strep, H. influenzae or no improvement in 1 week. Otherwise treatment is symptomatic.

SARS Return to Top

Severe acute respiratory distress syndrome- coronavirus^[272]

Supportive therapy

Ribavirin—ineffective.
Interferon alfa with or without steroids—small case series.
Pegylated IFN-α effective in monkeys.
Low dose steroids alone successful.
High dose steroids increases serious fungal infections.
Inhaled Nitric oxide improved oxygenation and improved chest x-ray.

Note (1): Therapy remains predominantly supportive care.Therapy tried or under evaluation

Note (2):Transmission by close contact: effective infection control practices (mask [changed frequently], eye protection, gown, gloves) key to stopping transmission.

Note (3):Other coronaviruses implicated as cause of croup, asthma exacerbations and other RTIs in children.May be associated with Kawasaki disease.

Cytomegalovirus Return to Top

Cytomegalovirus treatment^[273]

1.Retinitis

1.1 In HIV-infected adults

Preferred regimen (1): Ganciclovir IV

Preferred regimen (2): Valganciclovir PO

Preferred regimen (3): Foscarnet IV, Cidofovir IV AND Ganciclovir intraocular implant coupled with Valganciclovir.

1.2 In HIV-infected infants and children

Initial treatment (induction therapy): Ganciclovir IV for acquired CMV disease, including CMV retinitis and other end-organ disseminated CMV disease (e.g., colitis, esophagitis, CNS disease).

Note (1): Oral Valganciclovir, a prodrug of Ganciclovir, is one of the first-line treatments for HIV infected adults with CMV retinitis and is an option in older children who weigh enough to receive the adult dose and tablet formulation of Valganciclovir. The drug is well absorbed from the GI tract and rapidly metabolized to Ganciclovir in the intestine and liver.

Note (2): Valganciclovir oral solution has not been studied in pediatric patients for treatment of CMV retinitis, but consideration can be given to its use for transitioning from Ganciclovir IV to Valganciclovir oral to complete treatment and or for secondary prophylaxis once improvement in retinitis is noted.

1.3 An alternative drug for treating CMV disease or for use in Ganciclovir-resistant CMV infections in HIV infected children : Foscarnet.

Note (1): Foscarnet used as suppressive therapy has been associated with increased length of survival relative to Ganciclovir in HIV-infected adults. Doses should be modified in patients with renal insufficiency.

Note (2): Cidofovir is effective in treating CMV retinitis in adults who are intolerant of other therapies.

Note (3): Combination therapy with Ganciclovir and Foscarnet delays progression of retinitis in certain patients in whom monotherapy fails and can be used as initial therapy in children with sight-threatening disease.

Note (4): Combination therapy also has been used for adults with retinitis that has relapsed on single-agent therapy.

2. In Transplant patients

Preferred regimen: Valganciclovir

Note (1): Use of Valganciclovir to prevent infections in CMV seronegative recipients who receive organs from a seropositive donor and in seropositive receivers has been highly effective.

Note (2): Others suggest preemptive treatment when pt develops CMV antigenemia or positive PCR post-transplant.

3. Colitis, Esophagitis

Preferred regimen (1): Valganciclovir 900 mg PO q24h.
Preferred regimen (2): Valganciclovir 900 mg PO q12h for 14–21 days, then 900 mg PO q24h for maintenance therapy
Alternative regimen: Ganciclovir 5 mg/kg IV q12h for 14–21 days ,Ganciclovir as with retinitis except induction period extended for 3–6 wks (No agreement on use of maintenance; may not be necessary except after relapse. Responses less predictable than for retinitis.), then Valganciclovir 900 mg PO q24h OR Foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h for 14–21 days, then 90–120 mg/kg IV q24h OR Cidofovir 5 mg/kg IV for 2wks, then 5 mg/kg every other wk; each dose should be administered with IV saline hydration AND oral probenecid OR repeated intravitreal injections with Fomivirsen (for relapses only, not as initial therapy)

Note (1): Diagnosis by biopsy of ulcer base or edge with demonstration of CMV inclusions and other pathogen.

Note (2): Switch to oral Valganciclovir when PO tolerated & when symptoms not severe enough to interfere with absorption.

Note (3): Antiretroviral therapy is essential in long term suppression.

4. Pneumonia

Preferred regimen: : Valganciclovir 900 mg PO q12h for 14–21 days, then 900 mg PO q24h for maintenance therapy
Alternative regimen for retinitis: Ganciclovir 5 mg/kg IV q12h for 14–21 days, then Valganciclovir 900 mg PO q24h OR Foscarnet 60 mg/kg IV q8h or 90 mg/kg IV q12h for 14–21 days, then 90–120 mg/kg IV q24h OR Cidofovir 5 mg/kg IV for 2wks, then 5 mg/kg every other wk; each dose should be administered with IV saline hydration AND oral probenecid.

Note (1): CMV pneumonia seen predominantly in transplants (esp. bone marrow), rare in HIV.

Note (2): Treat only when histological evidence resent in IDS patients and other pathogens not identified.

Note (3): High rate of CMV reactivation in immunocompetent ICU patients; prolonged hospitalizations and increased mortality.

Note (4): In bone marrow transplant patients, combination therapy with CMV immune globulin. In bone marrow transplant patients, serial measure of pp65 antigen was useful in establishing early diagnosis of CMV interstitial pneumonia with good results if Ganciclovir was initiated within 6 days of antigen positivity.

5. Encephalitis, Ventriculitis

Note: Treatment not defined, but should be considered the same as retinitis. Disease may develop while taking Ganciclovir as suppressive therapy.

6. Lumbosacral polyradiculopathy

Preferred regimen: Ganciclovir, as with retinitis. Foscarnet 40 mg/kg IV q12h another option.Switch to Valganciclovir when possible.

Note (1): Diagnosis by CMV DNA in CSF.

Note (2): Suppression continued until CD4 remains >100/mm3 for 6 months.

Note (3): About 50% will respond; survival increases (5.4wks to 14.6wks).

7. Mononeuritis multiplex

Note (1): Due to vasculitis and may not be responsive to antiviral therapy

Note (2): Marked decrease in HIV associated CMV infections & death with Highly Active Antiretroviral Therapy. Initial treatment should optimize HAART.

Note (3): Primary prophylaxis not generally recommended. Preemptive therapy in patients with increased in CMV DNA titers in plasma and CD4 <100/mm3. Recommended by some is Valganciclovir 900 mg PO q24h.

Note (4): Risk for developing CMV disease correlates with quantity of CMV DNA in plasma is each log 10. increase associated with 3.1-fold increase in disease.

8. Specific considerations

Note (1): Currently, no therapies are available for the treatment of maternal or fetal CMV infection.

Note (2): Antiviral medications such as Ganciclovir, Valganciclovir and Foscarnet are approved by the U.S. Food and Drug Administration (FDA) only for treatment of patients with acquired immunodeficiency syndrome (AIDS) or organ transplants.

Prevention

1. Prevention of opportunistic infections in human stem cell transplantation (HSCT) by CMV (Recipient with CMV positive or Donor with CMV positive /Recipient with negative CMV)

Preemptive therapy: Monitor ≥1 wk (days 10-100) CMV viremia by PCR or CMV-antigenemia and start treatment if positive. Traditional approach was to use Ganciclovir 5 mg/kg IV q12h for 7-14 days, then 5 mg/kg IV q24h 5 days/wk to the longer of: d 100 or ≥3 wks.

Note (1): More recently, Valganciclovir used more often in those who can take oral medications. Continue therapy until viral load negative (preferably twice).

Note (2): One study found Valganciclovir 900 mg po bid comparable to Ganciclovir 5 mg/kg iv bid in preemptive regimen

Note (3): Valganciclovir 900 mg po bid for 2 wks, then 900 mg PO q24h for ≥7 days after negative viral assay, was effective

Note (4): Preemptive regimen of Valganciclovir 900 mg po bid×2 wks, then 450 mg po bid, was effective OR

Alternatively Prophylaxis approach (for high-risk pts or when CMV detection tests not rapidly available): From engraftment to day 100, ganciclovir 5 mg/kg IV q12h for 7 days, then 5 mg/kg IV q24h 5 to 6 days per week.

2. Prevention of opportunistic infections in Solid organ transplant (SOT) by CMV (Recipient with CMV positive or Donor with CMV positive /Recipient with negative CMV)

2.1 Kidney, Kidney/Pancreas, Heart

Preferred regimen: Valganciclovir 900 mg PO q24h; start by day 10 and continue to at least day 100.

2.2 Liver

Preferred regimen: Ganciclovir 5 mg/kg IV qd or Ganciclovir 1 gm PO tid; start by day 10 and continue to at least day 100. Or, with caution, Valganciclovir.

2.3 Lung

Preferred regimen: Ganciclovir 5 mg/kg iv q12h for 5-7 days, then Valganciclovir 900 mg po q24h for 6 mos (or at least 3 months).

Note (1): With antiviral prophylaxis, onset of CMV is appearing later; optimal duration of prophylaxis under study.

Note (2): Valganciclovir does not have FDA indication for CMV prevention in liver or lung transplantation, but commonly used.

Note (3): In selected cases, some institutions add CMV immune globulin to antiviral drug in high risk cases. Regimen for lung, heart, liver, pancreas: 150 mg/kg within 72h of transplant and at 2, 4, 6 & 8 weeks post-transplant; then 100 mg/kg at weeks 12 & 16.

3. Post treatment suppression for retinitis (prophylactic) if CD4 count <100/mm3

Preferred regimen: Valganciclovir 900 mg PO q24h.

Note (1): Discontinue if CD4 >100/mm3 for 6 months on ART.

Note (2): Patients who discontinue suppression therapy should undergo regular eye examination for early detection of relapses.

Enterovirus D68 Return to Top

Enterovirus treatment

Aseptic Meningitis^[274]

Preferred regimen: Immunoglobulins IV typical dose is 2 g/kg IV infused over 24hrs.
Alternative regimen: Pleconaril

Note (1): Pleocytosis of 100s of cells, CSF glucose normal, negative culture for bacteria

Note (2): Enterovirus is the most common cause of aseptic meningitis.

Note (3): Rapid CSF PCR test is accurate; reduces costs and hospital stay for infants.

Note (4): No treatment currently recommended; however, still under investigation.

Note (5): Hot tender parotid swelling and vesicular,ulcerative pharyingitis are also caused by Enterovirus.

Ebola virus Return to Top

Ebola virus treatment^[275]

Supportive therapy

Providing intravenous fluids (IV) and balancing electrolytes (body salts).

Maintaining oxygen status and blood pressure

Treating other infections if they occur.

Note (1): No FDA-approved vaccine or medicine (e.g., antiviral drug) is available for Ebola.

Note (2): Recovery from Ebola depends on good supportive care and the patient’s immune response.

Note (3): People who recover from Ebola infection develop antibodies that last for at least 10 years, possibly longer. It is not known if people who recover are immune for life or if they can become infected with a different species of Ebola.

Note (4): Some people who have recovered from Ebola have developed long-term complications, such as joint and vision problems.

Marburg virus Return to Top

Hantavirus Return to Top

Hanta virus treatment^[276]

Supportive therapy

ICU management should include careful assessment, monitoring and adjustment of volume status and cardiac function, including inotropic and vasopressor support if needed.
Fluids should be administered carefully due to the potential for capillary leakage.
Supplemental oxygen should be administered if patients become hypoxic.
Equipment and materials for intubation and mechanical ventilation should be readily available since onset of respiratory failure may be precipitous.

Note (1): There is no specific treatment or cure for hantavirus infection.

Note (2):if the individual is experiencing fever and fatigue and has a history of potential rural rodent exposure, together with shortness of breath, would be strongly suggestive of Hantavirus pulmonary syndrome.

Note (3): Treatment of patients with Hantavirus pulmonary syndrome remains supportive in nature.

Note (4): If there is a high degree of suspicion of Hantavirus pulmonary syndrome, patients should be immediately transferred to an emergency department or intensive care unit (ICU) for close monitoring and care.

Note (5): Patients should receive appropriate, broad-spectrum antibiotic therapy while awaiting confirmation of a diagnosis of Hantavirus pulmonary syndrome. Care during the initial stages of the disease should include antipyretics and analgesia as needed.

Dengue virus Return to Top

Dengue virus ^[277]

1. Patients who may be sent home

These are patients who are able to tolerate adequate volumes of oral fluids and pass urine at least once every six hours, and do not have any of the warning signs, particularly when fever subsides
Patients who are sent home should be monitored daily by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, signs of plasma leakage and bleeding, haematocrit, and white blood cell and platelet counts

2. Ambulatory patients with stable haematocrit can be sent home

Encourage oral intake of oral rehydration solution (ORS), fruit juice and other fluids containing electrolytes and sugar to replace losses from fever and vomiting
Give Paracetamol for high fever if the patient is uncomfortable. The interval of paracetamol dosing should not be less than six hours. Tepid sponge if the patient still has high fever
Should be brought to hospital immediately if any of the following occur: no clinical improvement, deterioration around the time of defervescence, severe abdominal pain, persistent vomiting, cold and clammy extremities, lethargy or irritability/restlessness, bleeding (e.g. black stools or coffee-ground vomiting), not passing urine for more than 4–6 hours

3. Patients who should be referred for in-hospital management

Patients may need to be admitted to a secondary health care centre for close observation, particularly as they approach the critical phase. These include patients with warning signs (Abdominal pain or tenderness, Persistent vomiting, Clinical fluid accumulation, Mucosal bleed, Lethargy, restlessness, Liver enlargment >2cm, Laboratory:increase in HCT concurrent with rapid decrease in platelet count), those with co-existing conditions that may make dengue or its management more complicated (such as pregnancy, infancy, old age, obesity, diabetes mellitus, renal failure, chronic haemolytic diseases), and those with certain social circumstances (such as living alone, or living far from a health facility without reliable means of transport)

3.1 With warning signs

Obtain a reference haematocrit before fluid therapy. Give only isotonic solutions such as 0.9% saline, Ringer’s lactate, or Hartmann’s solution. Start with 5–7 ml/ kg/hour for 1–2 hours, then reduce to 3–5 ml/kg/hr for 2–4 hours, and then reduce to 2–3 ml/kg/hr or less according to the clinical response
Reassess the clinical status and repeat the haematocrit. If the haematocrit remains the same or rises only minimally, continue with the same rate (2–3 ml/kg/hr) for another 2–4 hours. If the vital signs are worsening and haematocrit is rising rapidly, increase the rate to 5–10 ml/kg/hour for 1–2 hours. Reassess the clinical status, repeat the haematocrit and review fluid infusion rates accordingly
Give the minimum intravenous fluid volume required to maintain good perfusion and urine output of about 0.5 ml/kg/hr. Intravenous fluids are usually needed for only 24–48 hours. Reduce intravenous fluids gradually when the rate of plasma leakage decreases towards the end of the critical phase. This is indicated by urine output and/or oral fluid intake that is/are adequate, or haematocrit decreasing below the baseline value in a stable patient
Patients with warning signs should be monitored by health care providers until the period of risk is over. A detailed fluid balance should be maintained. Parameters that should be monitored include vital signs and peripheral perfusion (1–4 hourly until the patient is out of the critical phase), urine output (4–6 hourly), haematocrit (before and after fluid replacement, then 6–12 hourly), blood glucose, and other organ functions (such as renal profile, liver profile, coagulation profile, as indicated)

3.2 Without warning signs

Encourage oral fluids. If not tolerated, start intravenous fluid therapy of 0.9% saline or Ringer’s lactate with or without dextrose at maintenance rate. For obese and overweight patients, use the ideal body weight for calculation of fluid infusion. Patients may be able to take oral fluids after a few hours of intravenous fluid therapy. Thus, it is necessary to revise the fluid infusion frequently. Give the minimum volume required to maintain good perfusion and urine output. Intravenous fluids are usually needed only for 24–48 hours
Patients should be monitored by health care providers for temperature pattern, volume of fluid intake and losses, urine output (volume and frequency), warning signs, haematocrit, and white blood cell and platelet counts. Other laboratory tests (such as liver and renal functions tests) can be done, depending on the clinical picture and the facilities of the hospital or health centre

4. Severe dengue

Severe dengue: Severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress; severe haemorrhages; severe organ impairment (hepatic damage, renal impairment, cardiomyopathy, encephalopathy or encephalitis)
4.1 Treatment of shock

4.1.1 Compensated shock

Start intravenous fluid resuscitation with isotonic crystalloid solutions at 5–10 ml/kg/hour over one hour. Then reassess the patient’s condition (vital signs, capillary refill time, haematocrit, urine output). The next steps depend on the situation
If the patient’s condition improves, intravenous fluids should be gradually reduced to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, then to 2–3 ml/kg/hr, and then further depending on haemodynamic status, which can be maintained for up to 24–48 hours
If vital signs are still unstable (i.e. shock persists), check the haematocrit after the first bolus. If the haematocrit increases or is still high (>50%), repeat a second bolus of crystalloid solution at 10–20 ml/kg/hr for one hour. After this second bolus, if there is improvement, reduce the rate to 7–10 ml/ kg/hr for 1–2 hours, and then continue to reduce as above. If haematocrit decreases compared to the initial reference haematocrit (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible
Further boluses of crystalloid or colloidal solutions may need to be given during the next 24–48 hours

4.1.2 Hypotensive shock

Initiate intravenous fluid resuscitation with crystalloid or colloid solution (if available) at 20 ml/kg as a bolus given over 15 minutes to bring the patient out of shock as quickly as possible
If the patient’s condition improves, give a crystalloid/colloid infusion of 10 ml/kg/hr for one hour. Then continue with crystalloid infusion and gradually reduce to 5–7 ml/kg/hr for 1–2 hours, then to 3–5 ml/kg/hr for 2–4 hours, and then to 2–3 ml/kg/hr or less, which can be maintained for up to 24–48 hours
If vital signs are still unstable (i.e. shock persists), review the haematocrit obtained before the first bolus. If the haematocrit was low (<40% in children and adult females, <45% in adult males), this indicates bleeding and the need to cross- match and transfuse blood as soon as possible (see treatment for haemorrhagic complications)
If the haematocrit was high compared to the baseline value (if not available, use population baseline), change intravenous fluids to colloid solutions at 10–20 ml/kg as a second bolus over 30 minutes to one hour. After the second bolus, reassess the patient. If the condition improves, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above. If the condition is still unstable, repeat the haematocrit after the second bolus
If the haematocrit decreases compared to the previous value (<40% in children and adult females, less than 45% in adult males), this indicates bleeding and the need to cross-match and transfuse blood as soon as possible (see treatment for haemorrhagic complications). If the haematocrit increases compared to the previous value or remains very high ( more than 50%), continue colloid solutions at 10–20 ml/kg as a third bolus over one hour. After this dose, reduce the rate to 7–10 ml/kg/hr for 1–2 hours, then change back to crystalloid solution and reduce the rate of infusion as mentioned above when the patient’s condition improves
Further boluses of fluids may need to be given during the next 24 hours. The rate and volume of each bolus infusion should be titrated to the clinical response. Patients with severe dengue should be admitted to the high-dependency or intensive care area

4.2 Treatment of haemorrhagic complications

Blood transfusion required

Give 5–10ml/kg of fresh-packed red cells or 10–20 ml/kg of fresh whole blood at an appropriate rate and observe the clinical response. It is important that fresh whole blood or fresh red cells are given. Oxygen delivery at tissue level is optimal with high levels of 2,3 di-phosphoglycerate (2,3 DPG). Stored blood loses 2,3 DPG, low levels of which impede the oxygen-releasing capacity of haemoglobin, resulting in functional tissue hypoxia. A good clinical response includes improving haemodynamic status and acid-base balance
Consider repeating the blood transfusion if there is further blood loss or no appropriate rise in haematocrit after blood transfusion. There is little evidence to support the practice of transfusing platelet concentrates and/or fresh-frozen plasma for severe bleeding. It is being practised when massive bleeding can not be managed with just fresh whole blood/fresh-packed cells, but it may exacerbate the fluid overload
Great care should be taken when inserting a naso-gastric tube which may cause severe haemorrhage and may block the airway. A lubricated oro-gastric tube may minimize the trauma during insertion. Insertion of central venous catheters should be done with ultra-sound guidance or by a very experienced person

5. Treatment of complications and other areas of treatment

5.1 Fluid overload

Oxygen therapy should be given immediately
When the following signs are present, intravenous fluids should be discontinued or reduced to the minimum rate necessary to maintain euglycaemia

signs of cessation of plasma leakage; stable blood pressure, pulse and peripheral perfusion; haematocrit decreases in the presence of a good pulse volume; afebrile for more than 24–48 days (without the use of antipyretics); resolving bowel/abdominal symptoms; improving urine output

The management of fluid overload varies according to the phase of the disease and the patient’s haemodynamic status. If the patient has stable haemodynamic status and is out of the critical phase (more than 24–48 hours of defervescence), stop intravenous fluids but continue close monitoring. If necessary, give oral or intravenous furosemide 0.1–0.5 mg/kg/dose once or twice daily, or a continuous infusion of furosemide 0.1 mg/kg/hour. Monitor serum potassium and correct the ensuing hypokalaemia
If the patient has stable haemodynamic status but is still within the critical phase, reduce the intravenous fluid accordingly. Avoid diuretics during the plasma leakage phase because they may lead to intravascular volume depletion
Patients who remain in shock with low or normal haematocrit levels but show signs of fluid overload may have occult haemorrhage. Further infusion of large volumes of intravenous fluids will lead only to a poor outcome. Careful fresh whole blood transfusion should be initiated as soon as possible. If the patient remains in shock and the haematocrit is elevated, repeated small boluses of a colloid solution may help

5.2 Other complications of dengue

Both hyperglycaemia and hypoglycaemia may occur, even in the absence of diabetes mellitus and/or hypoglycaemic agents. Electrolyte and acid-base imbalances are also common observations in severe dengue and are probably related to gastrointestinal losses through vomiting and diarrhoea or to the use of hypotonic solutions for resuscitation and correction of dehydration. Hyponatraemia, hypokalaemia, hyperkalaemia, serum calcium imbalances and metabolic acidosis (sodium bicarbonate for metabolic acidosis is not recommended for pH ≥ 7.15) can occur. One should also be alert for co-infections and nosocomial infections.

5.3 Supportive care and adjuvant therapy

renal replacement therapy, with a preference to continuous veno-venous haemodialysis (CWH), since peritoneal dialysis has a risk of bleeding;
vasopressor and inotropic therapies as temporary measures to prevent life- threatening hypotension in dengue shock and during induction for intubation, while correction of intravascular volume is being vigorously carried out;
further treatment of organ impairment, such as severe hepatic involvement or encephalopathy or encephalitis;
further treatment of cardiac abnormalities, such as conduction abnormalities, may occur (the latter usually not requiring interventions)

West Nile virus Return to Top
Yellow Fever Return to Top

Yellow fever^[278]^[279]

Preferred regimen: No specific treatment is available for yellow fever. In the toxic phase, supportive treatment includes therapies for treating dehydration and fever. Ribavirin has failed in several studies in the monkey model.

Note: An international seminar held by WHO in 1984 recommended maintenance of nutrition, prevention of hypoglycemia, maintenance of the blood pressure with fluids and vasoactive drugs, prevention of bleeding with fresh-frozen plasma, dialysis if renal failure, correction of metabolic acidosis, administration of cimetidine IV to avoid gastric bleeding and oxygen if needed.

Chikungunya virus Return to Top

Chikungunya Fever ^[280]

Preferred regimen: no specific therapeutics agents are available and there are no licensed vaccines to prevent Chikungunya Fever.

Note: Anti inflammatory drugs can be used to control joint swelling and arthritis.

Hepatitis A virus Return to Top

Preferred regimen: No therapy recommended. If within 2 wks of exposure, IVIG 0.02 mL per kg IM times 1 protective.

Hepatitis B virus Return to Top
Acute Hepatitis B

Chronic Hepatitis B

1. Patients with HBeAg-positive chronic hepatitis B^[281]

1.1. HBV DNA >20,000, ALT <2 times upper limit normal (ULN)^[281]

Observe; consider treatment when ALT becomes elevated.
Consider biopsy in persons 40 years, ALT persistently high normal >2 times upper limit normal (ULN), or with family history of HCC.
Consider treatment if HBV DNA >20,000 IU/mL and biopsy shows moderate/severe inflammation or significant fibrosis.

1.2. HBV DNA >20,000, ALT >2 times upper limit normal (ULN)^[281]

Preferred regimen (1): Pegylated IFN-alpha 180 mcg weekly SC for 48 weeks
Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
If creatinine clearance 30–49 give 300 mg q48 hrs
If creatinine clearance 10–29 give 300 mg q72-96 hrs
If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
If creatinine clearance <10 without dialysis there is no recommendation
Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion

Preferred regimen (3): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine for minimum 1 year, continue for at least 6 months after HBeAg seroconversion.
Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion

Alternative regimen (1): Interferon alpha (IFNα) 5 MU daily or 10 MU thrice weekly SC for 16 weeks
Alternative regimen (2): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 100 mg PO qd
If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion

Alternative regimen (3): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis
Note: duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion

Alternative regimen (4): Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 600 mg PO once daily
If creatinine clearance 30–49 600 give mg PO once every 48 hours
If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis

Note (1): duration of treatment is minimum 1 year, continue for at least 6 months after HBeAg seroconversion
Note (2): Observe for 3-6 months and treat if no spontaneous HBeAg loss.
Note (3): Consider liver biopsy prior to treatment if compensated.
Note (4): Immediate treatment if icteric or clinical decompensation.
Note (5): Interferon alpha (IFNα)/ pegylated interferon-alpha (peg-IFNα), Lamivudine (LAM), Adefovir (ADV), Entecavir (ETV), tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) may be used as initial therapy.
Note (6): Adefovir (ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
Note (7): Lamivudine (LAM) and Telbivudine (LdT) not preferred due to high rate of drug resistance.
Note (8): End-point of treatment – Seroconversion from HBeAg to anti-HBe.
Note (9): Interferon alpha (IFNα) non-responders / contraindications to IFNα change to Tenofovir (TDF)/Entecavir (ETV).

1.3. Children with elevated ALT greater than 2 times normal^[281]

Preferred regimen(1): Interferon alpha (IFNα) 6 MU/m2 SC thrice weekly with a maximum of 10 MU
Preferred regimen(2): Lamivudine (LAM) 3 mg/kg/d PO with a maximum of 100 mg/d.

2. Patients with HBeAg-negative chronic hepatitis B^[281]

2.1. HBV DNA >2,000 IU/mL and elevated ALT >2 times normal

Preferred regimen (1): Pegylated IFN-alpha 180 mcg weekly SC for 1 year
Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
If creatinine clearance 30–49 give 300 mg q48 hrs
If creatinine clearance 10–29 give 300 mg q72-96 hrs
If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
If creatinine clearance <10 without dialysis there is no recommendation
Note: duration of treatment is more than 1 year

Preferred regimen (3): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine
If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine
If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine
If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.
Note: duration of treatment is more than 1 year

Alternative regimen (1): Interferon alpha (IFNα) 5 MU daily or 10 MU thrice weekly SC for 1 year
Alternative regimen (2): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 100 mg PO qd
If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.
Note: duration of treatment is more than 1 year

Alternative regimen (3): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis
Note: duration of treatment is more than 1 year

Alternative regimen (4): Telbivudine (LdT)Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 600 mg PO once daily
If creatinine clearance 30–49 600 give mg PO once every 48 hours
If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis

Note (1): duration of treatment is more than 1 year
Note (2): Interferon alpha (IFNα)/ pegylated interferon-alpha (peg-IFNα), Lamivudine (LAM), Adefovir (ADV), Entecavir (ETV), tenofovir disoproxil fumarate (TDF) or telbivudine (LdT) may be used as initial therapy.
Note (3): Adefovir (ADV) not preferred due to weak antiviral activity and high rate of resistance after 1st year.
Note (4): Lamivudine (LAM) and Telbivudine (LdT) not preferred due to high rate of drug resistance.
Note (5): End-point of treatment – not defined
Note (6): Interferon alpha (IFNα) non-responders / contraindications to IFNα change to Tenofovir (TDF)/Entecavir (ETV).

3. HBV DNA >2,000 IU/mL and elevated ALT 1->2 times normal^[281]

Consider liver biopsy and treat if liver biopsy shows moderate/severe necroinflammation or significant fibrosis.

4. HBV DNA <2,000 IU/mL and ALT < upper limit normal (ULN)^[281]

Observe, treat if HBV DNA or ALT becomes higher.

5. +/- HBeAg and detectable HBV DNA with Cirrhosis^[281]

5.1. Compensated Cirrhosis and HBV DNA >2,000

Preferred regimen (1): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.

Preferred regimen (2): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
If creatinine clearance 30–49 give 300 mg q48 hrs
If creatinine clearance 10–29 give 300 mg q72-96 hrs
If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
If creatinine clearance <10 without dialysis there is no recommendation

Alternative regimen (1): Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 100 mg PO qd
If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.

Alternative regimen (2): Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 give 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis

Alternative regimen (3): Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 600 mg PO once daily
If creatinine clearance 30–49 600 give mg PO once every 48 hours
If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis

Note (1): LAM and LdT not preferred due to high rate of drug resistance.
Note (2): ADV not preferred due to weak antiviral activity and high risk of resistance after 1st year.
Note (3): These patients should receive long-term treatment. However, treatment may be stopped in HBeAg-positive patients if they have confirmed HBeAg seroconversion and have completed at least 6 months of consolidation therapy and in HBeAg-negative patients if they have confirmed HBsAg clearance.

5.2. Compensated Cirrhosis and HBV DNA <2,000

Consider treatment if ALT elevated.

5.3. Decompensated Cirrhosis

Preferred regimen (1): Tenofovir (TDF) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 300 mg q24 hrs
If creatinine clearance 30–49 give 300 mg q48 hrs
If creatinine clearance 10–29 give 300 mg q72-96 hrs
If creatinine clearance <10 with dialysis give 300 mg once a week or after a total of approximately 12 hours of dialysis
If creatinine clearance <10 without dialysis there is no recommendation

Preferred regimen (2): Entecavir (ETV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 give 0.5 mg PO daily for patients with no prior Lamivudine treatment, and 1 mg PO daily for patients who are refractory/resistant to lamivudine.
If creatinine clearance 30–49 give 0.25 mg PO qd OR 0.5 mg PO q48 hr for patients with no prior Lamivudine treatment, and 0.5 mg PO qd OR 1 mg PO q 48 hr for patients who are refractory/resistant to lamivudine.
If creatinine clearance 10–29 give 0.15 mg PO qd OR 0.5 mg PO q 72 hr for patients with no prior Lamivudine treatment, and 0.3 mg PO qd OR 1 mg PO q 72 hr for patients who are refractory/resistant to lamivudine.
If creatinine clearance <10 or hemodialysis or continuous ambulatory peritoneal dialysis give 0.05 mg PO qd OR 0.5 mg PO q7 days for patients with no prior Lamivudine treatment, and 0.1 mg PO qd OR 1 mg PO q 7 days for patients who are refractory/resistant to lamivudine.

Preferred regimen (3): Lamivudine (LAM) AND Adefovir (ADV)

Lamivudine (LAM) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 100 mg PO qd
If creatinine clearance 30–49 give 100 mg PO first dose, then 50 mg PO qd
If creatinine clearance 15–29 give 100 mg PO first dose, then 25 mg PO qd
If creatinine clearance 5-14 give 35 mg PO first dose, then 15 mg PO qd
If creatinine clearance <5 give 35 mg PO first dose, then 10 mg PO qd
The recommended dose of lamivudine for persons coinfected with HIV is 150mg PO twice daily.

Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 give 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis

Preferred regimen (4): Telbivudine (LdT) AND Adefovir (ADV)

Telbivudine (LdT) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 600 mg PO once daily
If creatinine clearance 30–49 600 give mg PO once every 48 hours
If creatinine clearance <30 (not requiring dialysis) give 600 mg PO once every 72 hours
If End-stage renal disease give 600 mg PO once every 96 hours after hemodialysis

Adefovir (ADV) Adjustment of Adult Dosage in Accordance with Creatinine Clearance:

If creatinine clearance >50 or normal renal function give 10 mg PO daily
If creatinine clearance 30–49 give 10 mg PO every other day
If creatinine clearance 10–19 give 10 mg PO every third day
If hemodialysis patients give 10 mg PO every week following dialysis

Note: coordinate treatment with transplant center and refer for liver transplant.
Life-long treatment is recommended.

6. +/- HBeAg and undetectable HBV DNA with Cirrhosis^[281]

Compensated Cirrhosis: Observe
Uncompensated Cirrhosis: Refer for liver transplant

Hepatitis C virus Return to Top

Chronic Hepatitis C

1. Treatment regimens for chronic hepatitis C virus genotype 1^[282]

1.1. Treatment regimens for genotype 1a:

Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
Preferred regimen (2): Paritaprevir 150 mg PO qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND Dasabuvir 250 mg PO bid AND weight-based Ribavirin PO qd ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) OR 24 weeks (cirrhosis)
Preferred regimen (3): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd ± weight-based Ribavirin PO qd ([1000 mg <75 kg] to [1200 mg >75 kg]) for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
Note: these regimens are recommended for treatment-naive patients with HCV genotype 1a infection.

1.2. Treatment regimens for genotype 1b:

Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
Preferred regimen (2): Paritaprevir PO 150 mg qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND Dasabuvir 250 mg PO bid for 12 weeks. The addition of weight-based Ribavirin PO qd (1000 mg [<75kg] to 1200 mg [>75 kg]) is recommended in patients with cirrhosis
Preferred regimen (3): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd for 12 weeks (no cirrhosis) or 24 weeks (cirrhosis)
Note: these regimens are recommended for treatment-naive patients with HCV genotype 1b infection.

2. Treatment regimens for chronic hepatitis C virus genotype 2^[283]

Preferred regimen: Sofosbuvir 400 mg PO qd AND weight-based RBV (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
Note (1): This regimen are recommended for treatment-naive patients with HCV genotype 2 infection.
Note (2): Extending treatment to 16 weeks is recommended in patients with cirrhosis.

3. Treatment regimens for chronic hepatitis C virus genotype 3^[284]

Preferred regimen: Sofosbuvir 400 mg PO qd and weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) PO qd for 24 weeks
Alternative regimen: Sofosbuvir 400 mg and weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) PO qd AND weekly PEG-IFN for 12 weeks is an acceptable regimen for IFN-eligible, treatment-naive patients with HCV genotype 3 infection.
Note: These regimens are recommended for treatment-naive patients with HCV genotype 3 infection.

4. Treatment regimens for chronic hepatitis C virus genotype 4

Preferred regimen (1): Ledipasvir 90 mg PO qd AND Sofosbuvir 400 mg PO qd for 12 weeks
Preferred regimen (2): Paritaprevir 150 mg PO qd AND Ritonavir 100 mg PO qd AND Ombitasvir 25 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
Preferred regimen (3): Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 24 weeks
Alternative regimen (1): Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks
Alternative regimen (2): Sofosbuvir 400 mg PO qd AND Simeprevir 150 mg PO qd ± weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 12 weeks
Note: These regimens are accpetable for treatment-naive patients with HCV genotype 3 infection.

5. Treatment regimens for chronic hepatitis C virus genotype 5^[285]

Preferred regimen: Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd(1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks is recommended for treatment-naive patients with HCV genotype 5 infection.
Alternative regimen: Weekly PEG-IFN AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) for 48 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 5 infection.

6. Treatment regimens for chronic hepatitis C virus genotype 6^[286]

Preferred regimen: Ledipasvir 90 mg PO qd AND Sofosbuvir PO qd 400 mg for 12 weeks is recommended for treatment-naive patients with HCV genotype 6 infection.
Alternative regimen: Sofosbuvir 400 mg PO qd AND weight-based Ribavirin PO qd (1000 mg [<75 kg] to 1200 mg [>75 kg]) AND weekly PEG-IFN for 12 weeks is an alternative regimen for IFN-eligible, treatment-naive patients with HCV genotype 6 infection.

Hepatitis E virus Return to Top
Hepatitis E treatment^[287]

Supportive therapy

Hepatitis E is usually self-limiting, hospitalization is generally not required.
Hospitalization is required for people with fulminant hepatitis and should also be considered for symptomatic pregnant women.

Note (1): There is no available treatment capable of altering the course of acute hepatitis.

Note (2): Prevention is the most effective approach against the disease.

Prevention

The risk of infection and transmission can be reduced by

(1) Maintaining quality standards for public water supplies;
(2) Establishing proper disposal systems to eliminate sanitary waste.

On an individual level, infection risk can be reduced by

(1) Maintaining hygienic practices such as hand washing with safe water, particularly before handling food;
(2) Avoiding drinking water and/or ice of unknown purity;
(3) Adhering to WHO safe food practices-determining the mode of transmission; identifying the population specifically exposed to increased risk of infection; eliminating a common source of infection; improving sanitary and hygienic practices to eliminate faecal contamination of food and water raising awareness, promoting partnerships and mobilizing resources;formulating evidence-based policy and data for action;preventing transmission; and executing screening, care and treatment.

Epstein-Barr virus Return to Top

Epstein-Barr Virus (EBV) ^[288]

There is no vaccine to protect against EBV infection. You can help protect yourself by not kissing or sharing drinks, food, or personal items, like toothbrushes, with people who have EBV infection.
There is no specific treatment for EBV. However, some things can be done to help relieve symptoms, including

drinking fluids to stay hydrated
getting plenty of rest
taking over-the-counter medications for pain and fever

Human herpesvirus 6 Return to Top

Human herpesvirus 6 treatment^[289]

Preferred regimen: Ganciclovir decreased viral copies in response to treatment and Foscarnet therapy improved thrombotic microangiopathy.

Note (1): Human herpesvirus 6 (HHV-6) infects lymphocytes. It is typically acquired in early infancy and causes exanthem subitum (roseola infantum) and other febrile diseases of childhood.

Note (2): Fever & rash documented in transplant patients .

Note (3): Reactivation in hematopoietic stem cell transplant patients associated with delayed monocytes & platelet engraftment.

Note (4): Recognized in assocation with meningoencephalitis in immunocompetent adults.

Note (5): Diagnosis made by positive PCR in CSF.

Roseola Return to Top

Human herpesvirus 7 (roseola virus) treatment

Supportive therapy

Most patients with infection with HHV-7 will be asymptomatic. It is unknown whether treatment in asymptomatic patients will lead to a reduction in subsequent infection.^[290]
Immunocompetent hosts with uncomplicated skin manifestations associated with HHV-7, particularly roseola infantum and pityriasis rosea, need only symptomatic management.^[291]
For HIV-positive patients, antiretroviral therapy may be advisable.^[292]
There are no defined circumstances that warrant specific antiviral therapy for HHV-7.^[293]
The most active antiviral compounds against HHV-7 are Cidofovir and Foscarnet.^[294]

Note (1) Ubiquitous virus (>90% of the population is infected by age 3 yrs).
Note (2) Infects CD4 lymphocytes via CD4 receptor; transmitted via saliva.

Human herpesvirus 8 (KSHV) Return to Top

1. Mild to moderate Kaposi sarcoma^[295]

Preferred regimen: initiate or optimize ART

2. Advanced Kaposi sarcoma (ACTG Stage T1, including disseminated cutaneous or visceral Kaposi sarcoma)

Preferred regimen: chemotherapy (per oncology consult) AND ART

3. Primary effusion lymphoma

Preferred regimen: chemotherapy (per oncology consult) AND ART
Note: Valganciclovir PO or Ganciclovir IV can be used as adjunctive therapy.

4. Multicentric Castleman's disease

Preferred regimen (1): Valganciclovir 900 mg PO bid for 3 weeks
Preferred regimen (2): Ganciclovir 5 mg/kg IV q12h for 3 weeks
Preferred regimen (3): Valganciclovir 900 mg PO BID AND Zidovudine 600 mg PO q6h for 7–21 days
Alternative regimen: Rituximab 375 mg/m2 given weekly for 4–8 weeks (may be an alternative to or used adjunctively with antiviral therapy)

Herpes simplex virus

Herpes simplex virus Return to Top

Genital Herpes^[296]

1.First Clinical Episode of Genital Herpes

Preferred Regimen (1): Acyclovir 400 mg PO tid for 7–10 days
Preferred Regimen (2): Acyclovir 200 mg PO five times a day for 7–10 days
Preferred Regimen (3): Valacyclovir 1 g PO bid for 7–10 days
Preferred Regimen (4): Famciclovir 250 mg PO tid for 7–10 days
Note:Treatment can be extended if healing is incomplete after 10 days of therapy.

2.Established HSV-2 Infection

2.1 Suppressive Therapy for Recurrent Genital Herpes

Preferred Regimen (1): Acyclovir 400 mg PO bid
Preferred Regimen (2): Valacyclovir 500 mg PO qd
Preferred Regimen (3): Valacyclovir 1 g PO qd
Preferred Regimen (4): Famciclovir 250 mg PO bid
Note(1):Daily therapy with Acyclovir for as long as 6 years and with Valacyclovir OR Famciclovir for 1 year
Note(2):Valacyclovir 500 mg qd might be less effective than other Valacyclovir OR Acyclovir dosing regimens in persons who have very frequent recurrences (i.e., ≥10 episodes per year).

2.2 Episodic Therapy for Recurrent Genital Herpes

Preferred Regimen (1): Acyclovir 400 mg PO tid for 5 days
Preferred Regimen (2): Acyclovir 800 mg PO bid for 5 days
Preferred Regimen (3): Acyclovir 800 mg PO tid for 2 days
Preferred Regimen (4): Valacyclovir 500 mg PO bid for 3 days
Preferred Regimen (5): Valacyclovir 1 g PO qd for 5 days
Preferred Regimen (6): Famciclovir 125 mg PO bid for 5 days
Preferred Regimen (7): Famciclovir 1 g PO bid for 1 day
Preferred Regimen (8): Famciclovir 500 mg once, followed by 250 mg PO bid for 2 days

3. Severe Disease (disseminated infection, pneumonitis, or hepatitis) or CNS complications (e.g., meningoencephalitis).

Preferred Regimen: Acyclovir 5–10 mg/kg IV q8h for 2–7 days or until clinical improvement is observed, followed by oral antiviral therapy to complete at least 10 days of total therapy. HSV encephalitis requires 21 days of intravenous therapy. Impaired renal function warrants an adjustment in acyclovir dosage.

4. Special Considerations

4.1 HIV Infection

4.1.1 Daily Suppressive Therapy in Persons with HIV

Preferred Regimen (1): Acyclovir 400–800 mg PO bid /tid
Preferred Regimen (2): Valacyclovir 500 mg PO bid
Preferred Regimen (3): Famciclovir 500 mg PO bid

4.1.2 Episodic Infection in Persons with HIV

Preferred Regimen (1): Acyclovir 400 mg PO tid for 5–10 days
Preferred Regimen (2): Valacyclovir 1 g PO bid for 5–10 days
Preferred Regimen (3): Famciclovir 500 mg PO bid for 5–10 days
Note: For severe HSV disease, initiating therapy with Acyclovir 5–10 mg/kg IV q8 h might be necessary.

4.2 Genital Herpes in Pregnancy

Suppressive therapy of pregnant women with recurrent genital herpes
Preferred Regimen (1): Acyclovir 400–800 mg PO bid /tid
Preferred Regimen (2): Valacyclovir 500 mg PO bid
Note:Treatment recommended starting at 36 weeks of gestation.

4.3 Neonatal Herpes

Known or suspected neonatal herpes

Preferred Regimen: Acyclovir 20 mg/kg IV q 8 h
Note (1): Treatment for 14 days if disease is limited to the skin and mucous membranes, or
Note (2): Treatment for 21 days for disseminated disease and that involving the central nervous system.

4.4 Acyclovir-resistant genital herpes

Preferred Regimens: Foscarnet 40–80 mg/kg IV q8 h until clinical resolution is attained
Alternative Regimen (1): Cidofovir 5 mg/kg IV once weekly might also be effective.
Alternative Regimen (2): Imiquimod topical preparations should be applied to the lesions qd for 5 consecutive days.

4.5 Management of Sex Partners

Preferred Regimen (1): Acyclovir 400 mg PO tid for 7–10 days
Preferred Regimen (2): Acyclovir 200 mg PO five times a day for 7–10 days
Preferred Regimen (3): Valacyclovir 1 g PO bid for 7–10 days
Preferred Regimen (4): Famciclovir 250 mg PO tid for 7–10 days
Note:The sex partners of persons who have genital herpes can benefit from evaluation and counseling. Symptomatic sex partners should be evaluated and treated

4.6 Allergy, Intolerance, and Adverse Reactions

Allergic and other adverse reactions to oral Acyclovir, Valacyclovir, and Famciclovir are rare. Desensitization to acyclovir has been described.

Varicella-zoster virus Return to Top

Human papillomavirus

Human papillomavirus Return to Top

Anogenital Warts^[297]

1.Preferred regimen for External Anogenital Warts(i.e., penis, groin, scrotum, vulva, perineum, external anus, and perianus)

1.1 Patient-Applied: Imiquimod 3.75% or 5% cream OR Podofilox 0.5% solution or gel OR Sinecatechins 15% ointment
1.2 Provider-Administered: Cryotherapy with liquid nitrogen or cryoprobe OR Surgical removal either by tangential scissor excision, tangential shave excision, curettage, laser,or electrosurgery OR Trichloroacetic acid (TCA) OR Bichloroacetic acid (BCA) 80%-90% solution
Note (1): Many persons with external anal warts also have intra-anal warts. Thus, persons with external anal warts might benefit from an inspection of the anal canal by digital examination, standard anoscopy, or high-resolution anoscopy.
Note (2): Might weaken condoms and vaginal diaphragms.

2.Alternative Regimens for External Genital Warts

2.1 Urethral Meatus Warts

Preferred regimen: Cryotherapy with liquid nitrogen OR Surgical removal

2.2 Vaginal Warts

Preferred regimen: Cryotherapy with liquid nitrogen OR Surgical removal OR (TCA OR BCA 80%–90% solution)
Note: The use of a cryoprobe in the vagina is not recommended because of the risk for vaginal perforation and fistula formation

2.3 Cervical Warts

Preferred regimen: Cryotherapy with liquid nitrogen OR Surgical removal OR (TCA OR BCA 80%–90% solution)
Note: Management of cervical warts should include consultation with a specialist.For women who have exophytic cervical warts, a biopsy evaluation to exclude high-grade SIL must be performed before treatment is initiated.

2.4 Intra-anal Warts

Preferred regimen: Cryotherapy with liquid nitrogen OR Surgical removal OR (TCA OR BCA 80%–90% solution)
Note: Management of intra-anal warts should include consultation with a specialist.

3. Specific considerations

3.1 Follow-up

Most anogenital warts respond within 3 months of therapy. Factors that might affect response to therapy include immunosuppression and treatment compliance. In general, warts located on moist surfaces or in intertriginous areas respond best to topical treatment. A new treatment modality should be selected when no substantial improvement is observed after a complete course of treatment or in the event of severe side effects; treatment response and therapy-associated side effects should be evaluated throughout the course of therapy.

3.2 Management of sex partners

Persons should inform current partner(s) about having genital warts because the types of HPV that cause warts can be passed on to partners. Partners should receive counseling messages that partners might already have HPV despite no visible signs of warts, so HPV testing of sex partners of persons with genital warts is not recommended.

3.3 Pregnancy

Podofilox (podophyllotoxin), Podophyllin, and Sinecatechins should not be used during pregnancy. Imiquimod appears to pose low risk but should be avoided until more data are available.
Cesarean delivery is indicated for women with anogenital warts if the pelvic outlet is obstructed or if vaginal delivery would result in excessive bleeding.
Pregnant women with anogenital warts should be counseled concerning the low risk for warts on the larynx of their infants or children (recurrent respiratory papillomatosis).

3.4 HIV infection

Data do not support altered approaches to treatment for persons with HIV infection.
Squamous cell carcinomas arising in or resembling anogenital warts might occur more frequently among immunosuppressed persons, therefore requiring biopsy for confirmation of diagnosis for suspicious cases

3.5 High-grade squamous intraepithelial lesions

Biopsy of an atypical wart might reveal HSIL or cancer of the anogenital tract. In this instance, referral to a specialist for treatment is recommended.

Influenza A Return to Top

Influenza B Return to Top

Avian influenza

Avian influenza Return to Top

1. Preferred regimen:Oseltamivir 75 mg PO qd for a minimum 10 days ^[298]^[299]

Note:Patients with severe disease may have diarrhea and may not absorb oseltamivir efficiently

2. Patients with Avian Influenza who have diarrhea and malabsorption

Preferred regimen (1): Zanamivir 10 mg inhaled bid for minimum 5 days
Preferred regimen (2): [[Peramivir] ]600 mg IV as a single dose for 1 day
Note(1): Preliminary evidence demonstrates that Neuraminidase inhibitor can reduce the duration of viral replication and improve survival among patients with avian influenza. In cases of suspected avian influenza, one of the following 3 neuraminidase inhibitors should be administered as soon possible, preferably within 48 hours of symptom onset.
Note(2): The use of Corticosteroids is not recommended.
Note(3): Physicians may consider increasing either the recommended daily dose and/or the duration of treatment in cases of severe disease.
Note(4): The use of Amantadine is not recommended as most H5N1 and H7N9 avian influenza viruses are resistant to it.^[300]
Note(5): Supportive care is also an important cornerstone of the care of patients with avian influenza. Considering the severity of the illness and the possible complications, patients may require fluid resuscitation, vasopressors, intubation and ventilation, paracentesis, hemodialysis or hemofiltration, and parentral nutrition.

Swine influenza Return to Top
Swine influenza ^[301]

1. Condition1: Patients who have severe or progressive clinical illness

Preferred regimen: Oseltamivir 150 mg PO BID, treatment duration depends on clinical response
Note (1): Where the clinical course remains severe or progressive, despite 5 or more days of antiviral treatment, monitoring of virus replication and shedding, and antiviral drug susceptibility testing is desirable
Note (2): Antiviral treatment should be maintained without a break until virus infection is resolved or there is satisfactory clinical improvement
Note (3): Patients who have severe or progressive clinical illness, but who are unable to take oral medication may be treated with oseltamivir administered by nasogastric or orogastric tube

2. Condition2: In situations where oseltamivir is not available, or not possible to use, patients who have severe or progressive clinical illness

Preferred regimen: Zanamivir inhaled
NOTE: Intravenous Zanamivir should be considered where available and is recommended for those with serious or progressive illness. If not available, intravenous Peramivir may be considered

3. Condition3: Severely immunosuppressed patients

Preferred regimen: Antiviral chemoprophylaxis by using Oseltamivir OR Zanamivir

Measles Return to Top
Middle East respiratory syndrome Return to Top
Parainfluenza virus Return to Top

Parainfluenza virus^[302]

1.Adults

Preferred regimen : Ribavirin PO/IV 10 mg/kg q8h

Day 1: Start with 600 mg loading dose,then 200 mg q8h
Day 2: 400 mg q8h
Day 3: Increase the dose to a maximum of 10 mg/kg q8h

2.In case of adverse events: Decrease dose or Discontinue Ribavirin
3.Creatinine clearance

30–50 mL/min : Ribavirin PO/IV Maximal 200 mg q8h
10–30 mL/ min : No recommendation can be given

Parvovirus B19 Return to Top

Parvovirus B19^[303]

1. Erythema infectiosum

Supportive therapy: Symptomatic treatment only

2. Arthritis/arthalgia

Preferred regimen: Nonsteroidal anti-inflammatory drugs (NSAID)

3.Transient aplastic crisis

Supportive therapy: Transfusions and oxygen

4. Fetal hydrops

Supportive therapy: Intrauterine blood transfusion

5. Chronic infection with anemia

Preferred regimen: IVIG and transfusion

6.Chronic infection without anemia

Preferred regimen: IVIG

Note (1): Diagnostic tools are IgM and Igb antibody titers.Perhaps better is blood Parvovirus PCR.

Note (2): Dose of IVIG not standardized; suggest 400 mg/kg IV of commercial IVIG for 5 or 10 days or 1000 mg/kg IV for 3 days.

Note (3): Most dramatic anemias in pts with pre-existing hemolytic anemia.

Note (4): Bone marrow shown erythrocyte maturation arrest with giant pronormoblasts.

BK virus Return to Top

Human polyomavirus (BK virus) treatment

Maintenance regimen consisting of triple immunosuppression therapy: Calcineurin inhibitor (Cyclosporine or Tacrolimus) AND an antimetabolite (Azathioprine, Mycophenolate mofetil, or Mycophenolate sodium), AND Prednisone is to discontinue completely the antimetabolite (usually Mycophenolate) and decrease the dose of the Calcineurin inhibitor.
Alternative regimen (1): Decrease the Mycophenolate dose by 50 percent, followed by a 50 percent decrease in the Calcineurin inhibitor at three months if decoy cells persist. If using this approach, the target serum Tacrolimus trough level is 4 to 6, and the target serum Cyclosporine trough level is 60 to 100 ng/mL. Mycophenolate may be discontinued completely if viral activation persists. Maintenance immunosuppression then consists of Tacrolimus and low-dose Prednisone.
Alternative regimen (2): Reduce both the Calcineurin inhibitor and the Mycophenolate, which allows both the targeting of two pathways and lower total immunosuppression.

Note (1): For those who are hypogammaglobulinemic, we administer intravenous immunoglobulins (IV IG) in replacement doses of 500 mg/kg. Quantitative immunoglobulins should be checked two to three months later to determine whether hypogammaglobulinemia has recurred. Intravenous immunoglobulins (IV IG) is also an option in certain settings, based upon polymerase chain reaction (PCR) and kidney biopsy results. IVIG may contain antibodies against BK and JC virus since these viruses are ubiquitous in the general population.
Note (2): The goals of decreased immunosuppressive therapy are to restrain viral replication without triggering rejection.
Note (3): Reduced immunosuppression (defined as lowering mean doses of Mycophenolate and Tacrolimus) resulted in the successful elimination of viremia (mean period of six months) and allograft survival.
Note (4): Alternative approaches to reducing immunosuppression have also been effective

4.1 Changing from Tacrolimus to low-dose Cyclosporine not only reduces the effect of the Calcineurin inhibitor, but also reduces Mycophenolate concentrations.
4.2 Replacing the Calcineurin inhibitor with Sirolimus, with or without discontinuation of the antimetabolite, has the advantage of avoiding the long-term Calcineurin inhibitor-related nephrotoxic effects.
4.3 Lowering the dose of Calcineurin inhibitors may slow the loss of renal function.

Primary Regimens

Decrease immunosuppression if possible. (Cornerstone of Treatment)
Suggested antiviral therapy is based on anecdotal data. If progressive renal dysfunction:
Fluoroquinolone AND IVIG 500 mg/kg IV AND Leflunomide 100 mg for daily for 3 days, then 10-20 mg PO daily
If refractory to all of the above, add Cidofovir 5 mg/kg once per week for 2 weeks, then once every other week if refractory to all of the above

Ancillary Therapies in BK Virus Nephropathy

Cidofovir 0.25-1.0 mg/kg IV biweekly for 8 wk without Probenecid, prehydration recommended
Leflunomide 100 mg loading dose for 3 days, 20-60 mg/day, goal Leflunomide trough 50-100 ng/mL (consider lower trough goals of 20-40 ng/mL given hemolysis risk)
IV Ig 1-2 g/kg IV for 1-2 doses or 150 mg/kg IV biweekly for 8 wk
Fluoroquinolones-Ciproflaxacin 500 mg/day, duration dependent on virological response.

JC virus Return to Top

Progressive Multifocal Leukoencephalopathy (PML) caused by JC Virus ( John Cunningham virus) infections^[304]

There is no specific antiviral therapy for JC virus infection.

The main treatment approach is to reverse the immunosuppression caused by HIV.

Initiate anti retroviral therapy (ART) immediately in ART-naive patients .

Optimize ART in patients who develop Progressive Multifocal Leukoencephalopathy in phase of HIV viremia on ART .

Corticosteroids may be used for Progressive Multifocal Leukoencephalopathy- immune reconstitution inflammatory syndrome (IRIS) characterized by contrast enhancement, edema or mass effect, and with clinical deterioration

Rabies Return to Top

Preferred regimen: no specific therapeutics agents are available once the disease is established.

Note: There are vaccines and immune globulins available for postexposure prophylaxis:

Postexposure Prophylaxis for non immunized individuals: Wound cleansing, human rabies immune globulin - administer full dose infiltrated around any wound. Administer any remaining volume IM at other site anatomically distant from the wound. Administer vaccine 1,0ml, IM at deltoid area one each on days 0, 3, 7 and 14.
Postexposure Prophylaxis for immunized individuals: Wound cleansing, do not administer human rabies immune globulin. Administer vaccine 1,0ml, IM at deltoid area one each on days 0 and 3.

Respiratory Syncytial Virus Return to Top
Respiratory syncytial virus treatment

Supportive therapy

Hydration and supplemental oxygen.
Routine use of Ribavirin not recommended. Ribavirin therapy associated with small increases in O2 saturation.
No consistent decrease in need for mechanical ventilation or ICU stays. High cost, aerosol administration and potential toxicity^[305]

Note (1) In adults, Respiratory syncytial virus accounted for 10.6% of hospitalizations for pneumonia, 11.4% for COPD, 7.2% for asthma & 5.4% for CHF in pts >65 yrs of age ^[306]. Respiratory syncytial virus caused 11% of clinically important respiratory illnesses in military recruits^[307]

Note (2) Respiratory Syncytial Virus major cause of morbidity in neonates/infants.

Note (3) Nucleic acid test now approved to detect 12 respiratory viruses (xTAG Respiratory Viral Panel, Luminex Molecular Diagnostics).

Prevention of Respiratory syncytial virus

1. In children <24 months old with chronic lung disease of prematurity (formerly broncho-pulmonary dysplasia) requiring supplemental oxygen or
2. In premature infants (<32 wks gestation) and <6 months old at start of Respiratory syncytial virus season or
3. In children with selected congenital heart diseases.

Preferred regimen for prevention of Respiratory syncytial virus: Palivizumab (Synagis) 15 mg per kg IM q month Nov.-April^[305]

Note : Significant reduction in Respiratory syncytial virus hospitalization among children with congenital heart disease^[308]

Rhinovirus Return to Top
Rhinovirus treatment (commom cold)

Supportive therapy

Symptomatic treatment-Ipratropium bromide intranasal (2 sprays tid) AND Clemastine 1.34 mg 1–2 tab PO bid–tid (over the counter)
Symptomatic relief by Ipratropium nasal spray decreases rhinorrhea and sneezing vs placebo.^[309] AND Clemastine (an antihistamine) decreases sneezing, rhinorrhea but associated with dry nose, mouth & throat in 6–19%.^[310]OR Oral pleconaril given within 24 hrs of onset reduced duration (1 day) & severity of “cold symptoms” in DBPCT (p < .001).^[311]

Note (1)No antiviral rx indicated . ^[312]

Note (2) Found in 1/2 of children with community-acquired pneumonia; role in pathogenesis unclear (CID 39:681, 2004). ^[313]
Note (3) High rate of rhinovirus identified in children with significant lower resp tract infections ^[314]

Rotavirus Return to Top
Rotavirus treatment^[315], ^[316]

Treatment of diarrhoea caused by rotavirus

Rehydration with oral rehydration salts (ORS) solution. oral rehydration salts (ORS) solution is a mixture of clean water, salt and sugar. It costs a few cents per treatment. oral rehydration salts (ORS) solution is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces.

Zinc supplements-with zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
Rehydration with intravenous fluids in case of severe dehydration or shock.
Nutrient-rich foods the vicious circle of malnutrition and diarrhoea can be broken by continuing to give nutrient-rich foods including breast milk during an episode, and by giving a nutritious diet including exclusive breastfeeding for the first six months of life to children when they are well.
Consulting a health professional , in particular for management of persistent diarrhoea or when there is blood in stool or if there are signs of dehydration.

Note (1): Rotavirus and Escherichia coli are the two most common etiological agents of diarrhoea in developing countries.

Note (2): There is no antiviral drug to treat rotavirus infection. Antibiotic drugs will not help because antibiotics fight against bacteria not viruses.

Note (3): Rotavirus infection can cause severe vomiting and diarrhea. This can lead to dehydration (loss of body fluids). During rotavirus infection, infants and young children, older adults, and people with other illnesses are most at risk becoming dehydrated.

Note (4): Symptoms of dehydration include decrease in urination, dry mouth and throat, feeling dizzy when standing up. A dehydrated child may also cry with few or no tears and be unusually sleepy or fussy.

Prevention

Access to safe drinking-water
Use of improved sanitation
Hand washing with soap

Exclusive breastfeeding for the first six months of life

Good personal and food hygiene
Health education about how infections spread; and Rotavirus vaccination.

Smallpox Return to Top

Smallpox ^[317]

Supportive care is the mainstay of therapy.
Currently, there are no anti-viral drugs of proven efficacy.
Recently, animal studies suggest that cidofovir and its cyclic analogues, given at the time of or immediately after exposure, have promise for the prevention of cowpox, vaccinia, and monkeypox.
Patients need adequate hydration and nutrition, because substantial amounts of fluid and protein can be lost by febrile persons with dense, often weeping lesions.

Secondary baceterial infection

Penicillinase-resistant antimicrobial agents should be used if smallpox lesions are secondarily infected, if bacterial infection endangers the eyes, or if the eruption is very dense and widespread.
Daily eye rinsing is required in severe cases. Topical idoxuridine (Dendrid, Herplex, or Stoxil) should be considered for the treatment of corneal lesions, although its efficacy is unproved for smallpox.

HIV/AIDS Return to Top
HIV/AIDS
1. Antiretroviral regimen options for treatment-naive patients^[318]

1.1 Integrase strand transfer inhibitor-based regimens

Preferred regimen (1): Dolutegravir 50 mg PO qd AND Abacavir 600 mg-Lamivudine 300 mg PO qd in patients who are HLA-B*5701-negative
Preferred regimen (2): Dolutegravir 50 mg PO qd AND Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Preferred regimen (3): Elvitegravir 150 mg-Cobicistat 150 mg-Tenofovir 300 mg-Emtricitabine 200 mg PO qd in patients with estimated CrCl ≥ 70 mL/min/1.73
Preferred regimen (4): Raltegravir 400 mg PO bid AND Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (1): Efavirenz 600 mg PO qd OR Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (2): Rilpivirine 25 mg PO qd AND (Tenofovir 300 mg PO qd OR Emtricitabine 200 mg PO qd) for patients with CD4 count >200 cells/microL
Alternative regimen (3): Raltegravir 400 mg PO bid AND (Abacavir 600 mg PO qd OR Lamivudine 300 mg PO qd) in patients who are HLA-B*5701-negative

1.2 Protease inhibitor-based regimen

Preferred regimen: Darunavir 800 mg-Ritonavir 100 mg PO qd AND Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (1): Atazanavir 300 mg-Cobicistat 150 mg PO qd AND Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd only for patients with pre-treatment estimated CrCl ≥70 mL/min
Alternative regimen (2): Atazanavir 300 mg-Ritonavir 100 mg PO qd AND Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (3): (Darunavir 800 mg-Cobicistat 150 mg PO qd OR Darunavir 800 mg-Ritonavir 100 mg PO qd) AND Abacavir 600 mg-Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative
Alternative regimen (4): Darunavir 800 mg-Cobicistat 150 mg PO qd AND Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd only for patients with pre-treatment estimated CrCl ≥70 mL/min
Alternative regimen (5): Atazanavir 300 mg-Ritonavir 100 mg PO qd AND Abacavir 600 mg-Lamivudine 300 mg PO qd in patients who are HLA-B*5701-negative and with pre-treatment HIV RNA <100,000 copies/mL
Alternative regimen (6): Lopinavir 400 mg-Ritonavir 100 mg PO qd or bid AND Abacavir 600 mg-Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative
Alternative regimen (7): Lopinavir 400 mg-Ritonavir 100 mg PO qd or bid AND Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd

1.3 A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen

Alternative regimen (1): Efavirenz 600 mg-Tenofovir 300 mg-Emtricitabine 200 mg PO qd
Alternative regimen (2): Rilpivirine 25 mg-Tenofovir 300 mg-Emtricitabine 200 mg PO qd

1.4 Other Regimen Options

1.4.1. A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen

Preferred regimen (1): Efavirenz 600 mg PO qd AND Abacavir 600 mg-Lamivudine 300 mg PO qd only for patients who are HLA-B*5701 negative and with pre-treatment HIV RNA <100,000 copies/mL.

1.4.2 Other regimens when tenofovir or abacavir cannot be used

Preferred regimen (1): Darunavir 800 mg-Ritonavir 100 mg PO qd AND Raltegravir 400 mg PO qd only for patients with pre-treatment HIV RNA <100,000 copies/mL and CD4 cell count >200 cells/mm3.
Preferred regimen (2): Lopinavir 400 mg-Ritonavir 100 mg PO bid AND Lamivudine 300 mg PO bid

1.5 Pediatric doses

Abacavir 300 mg PO bid
Lamivudine 4 mg/kg/dose PO bid; maximum 150 mg PO bid
Stavudine 1 mg/kg/dose PO bid
Tenofovir 8 mg/kg/dose PO bid
Zidovudine 180 - 240 mg/m²/dose PO bid or 160 mg/m²/dose PO tid (range 90 mg/m²/dose-180 mg/m²/dose)
Lopinavir 400 mg PO bid
Nelfinavir 50 mg/kg/dose PO bid
Raltegravir 300 mg PO bid
Didanosine

20 to < 25 kg: 200 mg PO qd
25 to < 60 kg: 250 mg PO qd
≥60 kg: 400 mg PO qd

Efavirenz

10 to < 15 kg: 200 mg PO qd
15 to <20 kg: 250 mg PO qd
20 to < 25 kg: 300 mg PO qd
25 to < 32.5 kg: 350 mg PO qd
32.5 to <40 kg: 400 mg PO qd
≥ 40 kg: 600 mg PO qd

Nevirapine maximum 200 mg per dose

Between 1 day and 8 years: 200 mg/m²/dose PO qd for 14 days, then 200 mg/m²/dose PO bid
8 years and above: 120-150 mg/m²/dose PO qd for 14 days, then 120-150 mg/m²/dose PO bid

Note (1): Anti retroviral therapy for treatment naive patients is a life long therapy.
Note (2): Tenofovir disoproxil fumarate should be avoided in patients with a creatinine clearance <50 mL/min.
Note (3): Rilpivirine should be used in patients with a CD4 cell count >200 copies/mL and should not be used with proton pump inhibitors.
Note (4): Efavirenz should not be used in pregnant women.

2. Pre-exposure prophylaxis (PrEP)

Preferred regimen: Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd for ≤90-days
Note (1): People with high risk behavior such as men who have sex with men, intravenous drug abusers, HIV-positive sexual partner, recent bacterial STI, high number of sex partners, history of inconsistent or no condom use, commercial sex work, people in high-prevalence area or network are advised to take pre-exposure prophylaxis of drugs.
Note (2): Follow-up visits at least every 3 months to provide the following: HIV test, medication adherence counseling, behavioral risk reduction support, side effect assessment, STI symptom assessment, pregnancy testing.
Note (3): At 3 months and every 6 months thereafter, assess renal function.
Note (4): Every 6 months, test for bacterial STIs.

3. Post- exposure prophylaxis

Preferred HIV PEP regimen- Raltegravir 400 mg PO bid AND Tenofovir disoproxil fumarate 300 mg-Emtricitabine 200 mg PO qd
Preferred basic regimen for low-risk exposures (Eg: mucus membrane):
- Zidovudine 100 mg PO qd AND Lamivudine 300 mg PO qd
- Zidovudine 100 mg PO qd AND Emtricitabine 200 mg PO qd
- Tenofovir 300 mg PO qd AND Lamivudine 300 mg PO qd
- Tenofovir 300 mg PO qd AND Emtricitabine 200 mg PO qd
Preferred expanded regimen for high-risk exposure (Eg: percutaneous needle stick)
- Zidovudine 100 mg PO qd AND Lamivudine 300 mg PO qd AND Lopinavir 400 mg-Ritonavir 100 mg PO qd
- Zidovudine 100 mg PO qd AND Emtricitabine 200 mg PO qd AND Lopinavir 400 mg-Ritonavir 100 mg PO qd
- Tenofovir 300 mg PO qd AND Lamivudine 300 mg PO qd AND Lopinavir 400 mg-Ritonavir 100 mg PO qd
- Tenofovir 300 mg PO qd AND Emtricitabine 200 mg PO qdAND Lopinavir 400 mg-Ritonavir 100 mg PO qd
Note: Ideally therapy should be started within hours of exposure and continued for 28 days.

4. Perinatal antiretroviral regimen

4.1 Antepartum

4.1.1 Protease inhibitor-based regimen

Preferred regimen: (Tenofovir 300 mg-Emtricitabine 200 mg PO qd (fixed dose combination) OR Tenofovir 300 mg-Lamivudine 300 mg PO qd OR Abacavir 600 mg-Lamivudine 300 mg PO qd OR Zidovudine 100 mg-Lamivudine 300 mg PO qd) AND (Atazanavir 300 mg-Ritonavir 100 mg PO qd OR Lopinavir 400 mg-Ritonavir 100 mg PO qd)

4.1.2 A non-nucleoside reverse transcriptase inhibitor (NNRTI) based regimen:

Preferred regimen (1): Efavirenz 600 mg-Tenofovir 300 mg-Emtricitabine 200 mg (fixed dose combination) PO qd
Preferred regimen (2): Efavirenz 600 mg-Tenofovir 300 mg-Lamivudine 300 mg PO qd
Alternative regimen: (Abacavir 600 mg-Lamivudine 300 mg PO qd OR Zidovudine 100 mg-Lamivudine 300 mg PO qd) AND Efavirenz 600 mg PO qd

4.2 Intrapartum

HIV RNA <1000 copies/mL and good adherance-Continue the regimen during delivery or cessarean section.
HIV RNA >1000 copies/mL near delivery, possible poor adherence, or unknown HIV RNA levels- Intravenous Zidovudine 2 mg/kg IV over 1 hr should be given three hours before cesarean section or delivery and then 1 mg/kg/hr IV continuous infusion until umbilical cord clamping.

4.3 Postpartum

Initiate anti retroviral therapy (ART) and continue after delivery and cessation of breastfeeding.

5.Infant antiretroviral prophylaxis for prevention of mother-to-child transmission of HIV

5.1 Prophylaxis for HIV-exposed infants of women who received antepartum antiretroviral prophylaxis

Preferred regimen: Zidovudine (ZDV) 100 mg oral given at birth and continued till six weeks
Note (1): Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.
Note (2): ≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
Note (3): ≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
Note (4): <30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.

5.2 Prophylaxis for HIV-exposed infants of women who received no antepartum antiretroviral prophylaxis

Nevirapine

Dose based on birth weight, initiated as soon after birth as possible.
Birth weight 1.5 to 2 kg: 8 mg/dose orally.
Birth weight >2 kg: 12 mg/dose orally.

AND

Zidovudine (ZDV)

Dose based on gestational age at birth and weight, initiated as soon after birth as possible and preferably within 6 to 12 hours of delivery.

≥35 weeks gestation at birth: 4 mg/kg/dose orally (or, if unable to tolerate oral agents, 3 mg/kg/dose IV) every 12 hours.
≥30 to <35 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours at age 15 days.
<30 weeks gestation at birth: 2 mg/kg/dose orally (or 1.5 mg/kg/dose IV) every 12 hours, advanced to 3 mg/kg/dose orally (or 2.3 mg/kg/dose IV) every 12 hours after age four weeks.

Note (1): Three doses in the first week of life.
Note (2): First dose within 48 hours of birth (birth to 48 hrs).
Note (3): Second dose 48 hours after first.
Note (4): Third dose 96 hours after second.

6. Treatment and prevention of opportunistic infections

6.1. Pneumocystis pneumonia (PCP)

6.1.1. Prevention

Indication

CD4 count <200 cells/mm3
Oropharyngeal candidiasis
CD4 <14%
History of AIDS-defining illness
CD4 count >200 but <250 cells/mm3 if monitoring CD4 cell count every 3 months is not possible.

Preferred regimen: Trimethoprim/sulfamethoxazole 160 mg/800 mg PO qd or 80 mg/400 mg PO qd
Alternative regimen (1): Trimethoprim/sulfamethoxazole 160 mg/800 mg PO three times weekly
Alternative regimen (2): Dapsone 100 mg PO qd or 50 mg PO bid
Alternative regimen (3): Dapsone 50 mg PO qd AND (Pyrimethamine 50 mg-Leucovorin 25 mg) PO weekly
Alternative regimen (4): Dapsone 200 mg PO qd AND (Pyrimethamine 75 mg-Leucovorin 25 mg) PO weekly
Alternative regimen (5): Aerosolized Pentamidine 300 mg via Respigard nebulizer every month
Alternative regimen (6): Atovaquone 1500 mg PO qd
Alternative regimen (7): Atovaquone 1500 mg AND (Pyrimethamine 25 mg AND Leucovorin 10 mg) PO qd

6.1.2 Treatment

Preferred regimen:
For Moderate-to-Severe PCP Trimethoprim 15–20 mg AND Sulfamethoxazole 75–100 mg/kg/day IV given q6h or q8h, may switch to PO after clinical improvement
For Mild-to-Moderate PCP Trimethoprim 15–20 mg AND Sulfamethoxazole 75–100 mg/kg/day, given PO in 3 divided doses OR Trimethoprim/sulfamethoxazole 160 mg/800 mg or DS) 2 tablets PO tid
Secondary Prophylaxis, after completion of PCP treatment Trimethoprim/Sulfamethoxazole 160 mg/800 mg PO qd OR Trimethoprim/Sulfamethoxazole 80 mg/400 mg PO qd
Alternative regimen:
For Moderate-to-Severe PCP: Pentamidine 4 mg/kg IV daily infused over ≥60 minutes; can reduce dose to 3 mg/kg IV daily because of toxicities OR Primaquine 30 mg (base) PO qd AND Clindamycin 600 mg q6h IV OR 900 mg IV q8h OR Clindamycin 450 mg PO qid or 600 mg PO tid
For Mild-to-Moderate PCP: Dapsone 100 mg PO qd AND TMP 5 mg/kg PO tid OR Primaquine 30 mg (base) PO qd AND Clindamycin 450 mg PO qid or 600 mg PO tid OR Atovaquone 750 mg PO bid with food

6.1.3 Secondary prophylaxis, after completion of PCP treatment

Alternative regimen (1): Trimethoprim/sulfamethoxazole 160 mg/800 mg PO three times weekly
Alternative regimen (2): Dapsone 100 mg PO qd
Alternative regimen (3): Dapsone 50 mg PO qd AND Pyrimethamine 50 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (4): Dapsone 200 mg PO AND Pyrimethamine 75 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (5): Dapsone 100 mg PO qd
Alternative regimen (6): Dapsone 50 mg PO qd AND Pyrimethamine 50 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (7): Dapsone 200 mg PO AND Pyrimethamine 75 mg PO AND Leucovorin 25 mg PO weekly
Alternative regimen (8): Aerosolized Pentamidine 300 mg monthly via Respirgard nebulizer
Alternative regimen (9): Atovaquone 1500 mg PO qd
Alternative regimen(10):Atovaquone 1500 mg PO AND Pyrimethamine 25 mg PO AND Leucovorin 10 mg PO qd

6.1.4 Adjunctive corticosteroids

Indications- PaO2 <70 mmHg at room air OR Alveolar-arterial O2 gradient >35 mmHg.
Preferred regimen:

Days 1–5: 40 mg PO bid
Days 6–10: 40 mg PO qd
Days 11–21: 20 mg PO qd

Note (1): Trimethoprim/sulfamethoxazole should be permanently discontinued in patients with possible or definite stevens johnson syndrome or toxic epidermal necrosis.
Note (2): Whenever possible, patients should be tested for G6PD before use of Dapsone or Primaquine. Alternative regimen should be used in patients found to have G6PD deficiency.

6.2 Toxoplasma gondii encephalitis

6.2.1 Prevention

6.2.1.1 Indication

Toxoplasma IgG-positive patients with CD4 count <100 cells/µL.
Seronegative patients receiving PCP prophylaxis not active against toxoplasmosis should have toxoplasma serology retested if CD4 count decline to <100 cellsµL.
Prophylaxis should be initiated if seroconversion occurred.

Preferred regimen: Trimethoprim/sulfamethoxazole 160 mg/800 mg PO qd
Alternative regimen (1): Trimethoprim/sulfamethoxazole 160 mg/800 mg PO three times weekly
Alternative regimen (2): Trimethoprim/sulfamethoxazole 80 mg/400 mg PO qd
Alternative regimen (3): Dapsone 50 mg PO qd AND Pyrimethamine 50 mg AND Leucovorin 25 mg PO weekly
Alternative regimen (4): Dapsone 200 mg AND Pyrimethamine 75 mg AND Leucovorin 25 mg PO weekly
Alternative regimen (5): Atovaquone 1500 mg PO qd
Alternative regimen (6): Atovaquone 1500 mg AND Pyrimethamine 25 mg AND Leucovorin 10 mg PO qd

6.2.2 Treatment

6.2.2.1 Treatment of acute infection

Preferred regimen: Pyrimethamine 200 mg PO single dose, followed by weight-based therapy:

If <60 kg, Pyrimethamine 50 mg PO qd AND Sulfadiazine 1000 mg PO qid AND Leucovorin 10–25 mg PO qd
If ≥60 kg, Pyrimethamine 75 mg PO qd AND Sulfadiazine 1500 mg PO qid AND Leucovorin 10–25 mg PO qd
Note: At least 6 weeks; longer duration if clinical or radiologic disease is extensive or response is incomplete at 6 weeks.

Alternative regimen (1): Pyrimethamine 50 mg AND Leucovorin 10–25 mg AND Clindamycin 600 mg IV or PO q6h
Alternative regimen (2): Trimethoprim 5 mg/kg-Sulfamethoxazole 25 mg/kg IV or PO bid
Alternative regimen (3): Atovaquone 1500 mg PO bid with food AND Pyrimethamine 50 mg AND Leucovorin 10–25 mg
Alternative regimen (4): Atovaquone 1500 mg PO bid with food AND Sulfadiazine 1000–1500 mg PO q6h (weight-based dosing, as in preferred therapy)
Alternative regimen (5): Atovaquone 1500 mg PO bid with food
Alternative regimen (6): Pyrimethamine 50 mg-Leucovorin 10–25 mg PO qd AND Azithromycin 900–1200 mg PO qd

6.2.2.2 Chronic maintenance therapy

Preferred regimen: Pyrimethamine 25–50 mg PO qd AND Sulfadiazine 2000–4000 mg PO qd (in 2–4 divided doses) AND Leucovorin 10–25 mg PO qd
Alternative regimen (1): Clindamycin 600 mg PO tid AND Pyrimethamine 25–50 mg-Leucovorin 10–25 mg PO qd
Alternative regimen (2): Trimethoprim/sulfamethoxazole 160 mg/800 mg bid
Alternative regimen (3): Atovaquone 750–1500 mg PO bid AND Pyrimethamine 25 mg-Leucovorin 10 mg PO qd
Alternative regimen (4): Atovaquone 750–1500 mg PO bid AND Sulfadiazine 2000–4000 mg PO qd in 2–4 divided doses
Alternative regimen (5): Atovaquone 750–1500 mg PO bid with food

References

↑ 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 |month= ignored (help)
↑ "Infective Endocarditis Diagnosis, Antimicrobial Therapy, and Management of Complications A Statement for Healthcare Professionals From the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association".
↑ ^4.0 ^4.1 ^4.2 ^4.3 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ 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.
↑ ^10.0 ^10.1 ^10.2 ^10.3 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.
↑ ^11.0 ^11.1 ^11.2 Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP; et al. (2009). "Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America". Clin Infect Dis. 49 (1): 1–45. doi:10.1086/599376. PMC 4039170. PMID 19489710.
↑ Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America". Clin Infect Dis. 59 (2): e10–52. doi:10.1093/cid/ciu444. PMID 24973422.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ 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.CS1 maint: PMC format (link)
↑ ^25.0 ^25.1 ^25.2 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.
↑ ^29.0 ^29.1 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.
↑ Tashima Y, Hasegawa M (1975). "Specific inhibition of ouabain sensitive and K+-dependent p-nitrophenylphosphatase by polyamines". Biochem Biophys Res Commun. 66 (4): 1344–8. PMID 172078.
↑ Anguera I, Del Río A, Miró JM, Matínez-Lacasa X, Marco F, Gumá JR; et al. (2005). "Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles". Heart. 91 (2): e10. doi:10.1136/hrt.2004.040659. PMC 1768720. PMID 15657200.
↑ Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ; et al. (2011). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clin Infect Dis. 52 (3): e18–55. doi:10.1093/cid/ciq146. PMID 21208910.
↑ 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.
↑ Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA; et al. (2012). "IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults". Clin Infect Dis. 54 (8): e72–e112. doi:10.1093/cid/cir1043. PMID 22438350.
↑ 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.
↑ "group B Streptococcus infections".
↑ "group B Streptococcus infections".
↑ Mukhopadhyay S, Dukhovny D, Mao W, Eichenwald EC, Puopolo KM (2014). "2010 perinatal GBS prevention guideline and resource utilization". Pediatrics. 133 (2): 196–203. doi:10.1542/peds.2013-1866. PMC 3904275. PMID 24446442.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ ^46.0 ^46.1 ^46.2 Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.
↑ Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA; et al. (2014). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130611. PMC 3901460. PMID 24457117.
↑ ^48.0 ^48.1 Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D; et al. (2014). "Pediatric anthrax clinical management". Pediatrics. 133 (5): e1411–36. doi:10.1542/peds.2014-0563. PMID 24777226.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Andrews, J. M.; Wise, R. (2002-06). "Susceptibility testing of Bacillus species". The Journal of Antimicrobial Chemotherapy. 49 (6): 1040–1042. ISSN 0305-7453. PMID 12039902. Check date values in: |date= (help)
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ "q fever".
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ 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.
↑ Centers for Disease Control (CDC) (1982). "Prevention of secondary cases of Haemophilus influenzae type b disease". MMWR Morb Mortal Wkly Rep. 31 (50): 672–4, 679–80. PMID 6819447.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ van de Beek D, Brouwer MC, Thwaites GE, Tunkel AR (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618.
↑ de Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002). "Dexamethasone in adults with bacterial meningitis". N Engl J Med. 347 (20): 1549–56. doi:10.1056/NEJMoa021334. PMID 12432041. Review in: ACP J Club. 2003 May-Jun;138(3):60
↑ Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D (2010). "Corticosteroids for acute bacterial meningitis". Cochrane Database Syst Rev (9): CD004405. doi:10.1002/14651858.CD004405.pub3. PMID 20824838.
↑ Bilukha OO, Rosenstein N, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC) (2005). "Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR Recomm Rep. 54 (RR-7): 1–21. PMID 15917737.
↑ 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.
↑ LastName, FirstName (2003). Human leptospirosis guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.
↑ 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.
↑ Workowski KA, Bolan GA (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports / Centers for Disease Control. 64 (RR-03): 1–137. PMID 26042815.
↑ 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.
↑ Foucault C, Raoult D, Brouqui P (2003). "Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia". Antimicrob Agents Chemother. 47 (7): 2204–7. PMC 161867. PMID 12821469.
↑ Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.
↑ Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob Agents Chemother. 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180.
↑ ^93.0 ^93.1 Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.
↑ "Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis 2005 CDC Guidelines".
↑ "Recommended Antimicrobial Agents for the Treatment and Post exposure Prophylaxis of Pertussis 2005 CDC Guidelines".
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Wiersinga WJ, Currie BJ, Peacock SJ (2012). "Melioidosis". N. Engl. J. Med. 367 (11): 1035–44. doi:10.1056/NEJMra1204699. PMID 22970946.
↑ 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.
↑ Sanders, W. E.; Sanders, C. C. (1997-04). "Enterobacter spp.: pathogens poised to flourish at the turn of the century". Clinical Microbiology Reviews. 10 (2): 220–241. ISSN 0893-8512. PMC 172917. PMID 9105752. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Jacoby, George A. (2009-01). "AmpC beta-lactamases". Clinical Microbiology Reviews. 22 (1): 161–182. doi:10.1128/CMR.00036-08. ISSN 1098-6618. PMC 2620637. PMID 19136439. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Paterson, David L.; Bonomo, Robert A. (2005-10). "Extended-spectrum beta-lactamases: a clinical update". Clinical Microbiology Reviews. 18 (4): 657–686. doi:10.1128/CMR.18.4.657-686.2005. ISSN 0893-8512. PMC 1265908. PMID 16223952. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Lua error: expandTemplate: template "citation error" does not exist.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Mukara, B. K.; Munyarugamba, P.; Dazert, S.; Löhler, J. (2014-07). "Rhinoscleroma: a case series report and review of the literature". European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 271 (7): 1851–1856. doi:10.1007/s00405-013-2649-z. ISSN 1434-4726. PMID 23904142. Check date values in: |date= (help)
↑ de Pontual, Loïc; Ovetchkine, Philippe; Rodriguez, Diana; Grant, Audrey; Puel, Anne; Bustamante, Jacinta; Plancoulaine, Sabine; Yona, Laurent; Lienhart, Pierre-Yves; Dehesdin, Danièle; Huerre, Michel; Tournebize, Régis; Sansonetti, Philippe; Abel, Laurent; Casanova, Jean Laurent (2008-12-01). "Rhinoscleroma: a French national retrospective study of epidemiological and clinical features". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (11): 1396–1402. doi:10.1086/592966. ISSN 1537-6591. PMID 18947330.
↑ Gaafar, Hazem A.; Gaafar, Alaa H.; Nour, Yasser A. (2011-04). "Rhinoscleroma: an updated experience through the last 10 years". Acta Oto-Laryngologica. 131 (4): 440–446. doi:10.3109/00016489.2010.539264. ISSN 1651-2251. PMID 21198342. Check date values in: |date= (help)
↑ Mukara, B. K.; Munyarugamba, P.; Dazert, S.; Löhler, J. (2014-07). "Rhinoscleroma: a case series report and review of the literature". European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 271 (7): 1851–1856. doi:10.1007/s00405-013-2649-z. ISSN 1434-4726. PMID 23904142. Check date values in: |date= (help)
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ 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.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ "q fever".
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ ^141.00 ^141.01 ^141.02 ^141.03 ^141.04 ^141.05 ^141.06 ^141.07 ^141.08 ^141.09 ^141.10 ^141.11 Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA; et al. (2008). "Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America". Clin Infect Dis. 46 (3): 327–60. doi:10.1086/525258. PMID 18177225.
↑ ^142.00 ^142.01 ^142.02 ^142.03 ^142.04 ^142.05 ^142.06 ^142.07 ^142.08 ^142.09 ^142.10 ^142.11 Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G (2014). "Invasive fungal infections in the ICU: how to approach, how to treat". Molecules. 19 (1): 1085–119. doi:10.3390/molecules19011085. PMID 24445340.
↑ Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG; et al. (2008). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clin Infect Dis. 46 (12): 1801–12. doi:10.1086/588300. PMID 18462107.
↑ ^144.0 ^144.1 ^144.2 ^144.3 Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML (2006). "[Guidelines in paracoccidioidomycosis]". Rev Soc Bras Med Trop. 39 (3): 297–310. PMID 16906260.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Krzyściak PM, Pindycka-Piaszczyńska M, Piaszczyński M (2014). "Chromoblastomycosis". Postepy Dermatol Alergol. 31 (5): 310–21. doi:10.5114/pdia.2014.40949. PMC 4221348. PMID 25395928.
↑ Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ; et al. (2010). "Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america". Clin Infect Dis. 50 (3): 291–322. doi:10.1086/649858. PMID 20047480.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ de Berker D (2009). "Clinical practice. Fungal nail disease". N Engl J Med. 360 (20): 2108–16. doi:10.1056/NEJMcp0804878. PMID 19439745.
↑ "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".
↑ "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".
↑ "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".
↑ Treatment of tuberculosis guidelines. Geneva: World Health Organization. 2010. ISBN 9789241547833.
↑ "The use of delamanid in the treatment of multidrug-resistant tuberculosis" (PDF).
↑ "WHO".
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ American Thoracic Society. CDC. Infectious Diseases Society of America (2003). "Treatment of tuberculosis". MMWR Recomm Rep. 52 (RR-11): 1–77. PMID 12836625.
↑ Griffith, Daviday E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richarday J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, anday prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory anday Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. Unknown parameter |pmiday= ignored (help)
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Tortoli, E.; Besozzi, G.; Lacchini, C.; Penati, V.; Simonetti, M. T.; Emler, S. (1998-04). "Pulmonary infection due to Mycobacterium szulgai, case report and review of the literature". The European Respiratory Journal. 11 (4): 975–977. ISSN 0903-1936. PMID 9623706. Check date values in: |date= (help)
↑ Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.
↑ Rossignol JF, Ayoub A, Ayers MS (2001). "Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide". J Infect Dis. 184 (1): 103–6. doi:10.1086/321008. PMID 11398117.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Smith HV, Corcoran GD (2004). "New drugs and treatment for cryptosporidiosis". Curr Opin Infect Dis. 17 (6): 557–64. PMID 15640710.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Template:Citeweb
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Nagata, Noriyuki; Marriott, Deborah; Harkness, John; Ellis, John T.; Stark, Damien (2012-12). "Current treatment options for Dientamoeba fragilis infections". International Journal for Parasitology. Drugs and Drug Resistance. 2: 204–215. doi:10.1016/j.ijpddr.2012.08.002. ISSN 2211-3207. PMC 3862407. PMID 24533282. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ "CDC Parasites - Giardia".
↑ Gardner TB, Hill DR (2001). "Treatment of giardiasis". Clin Microbiol Rev. 14 (1): 114–28. doi:10.1128/CMR.14.1.114-128.2001. PMC 88965. PMID 11148005.CS1 maint: PMC format (link)
↑ "CDC - Cystoisosporiasis".
↑ "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents" (PDF).
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Template:Citeweb
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Template:Citeweb
↑ "Guidelines for the treatment of malaria. Third edition April 2015" (PDF).
↑ "trichomoniasis".
↑ "African Trypanosomiasis".
↑ "Parasites - American Trypanosomiasis (also known as Chagas Disease)".
↑ ^213.0 ^213.1 Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J; et al. (2009). "Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species". Clin Infect Dis. 48 (3): 322–7. doi:10.1086/595852. PMID 19123863.
↑ "Gnathostomiasis".
↑ "Gnathostomiasis".
↑ "Parasites - Zoonotic Hookworm".
↑ "Parasites - Zoonotic Hookworm".
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ ^219.0 ^219.1 Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y (2009). "Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis". Am J Trop Med Hyg. 81 (3): 443–5. PMID 19706911.
↑ "Parasites - Ascariasis".
↑ "Parasites - Ascariasis".
↑ Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A (1997). "Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico". Trans R Soc Trop Med Hyg. 91 (6): 701–3. PMID 9580117.
↑ ^223.0 ^223.1 ^223.2 Khuroo MS (1996). "Ascariasis". Gastroenterol Clin North Am. 25 (3): 553–77. PMID 8863040.
↑ Cross, J. H. (1992-04). "Intestinal capillariasis". Clinical Microbiology Reviews. 5 (2): 120–129. ISSN 0893-8512. PMC 358231. PMID 1576584. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Attia, Rasha A. H.; Tolba, Mohammed E. M.; Yones, Doaa A.; Bakir, Hanaa Y.; Eldeek, Hanan E. M.; Kamel, Shereef (2012-01). "Capillaria philippinensis in Upper Egypt: has it become endemic?". The American Journal of Tropical Medicine and Hygiene. 86 (1): 126–133. doi:10.4269/ajtmh.2012.11-0321. ISSN 1476-1645. PMC 3247121. PMID 22232463. Check date values in: |date= (help)CS1 maint: PMC format (link)
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Wang BR, Wang HC, Li LW, Zhang XL, Yue JQ, Wang GX; et al. (1987). "Comparative efficacy of thienpydin, pyrantel pamoate, mebendazole and albendazole in treating ascariasis and enterobiasis". Chin Med J (Engl). 100 (11): 928–30. PMID 3130234.
↑ Heukelbach J, Wilcke T, Winter B, Sales de Oliveira FA, Sabóia Moura RC, Harms G; et al. (2004). "Efficacy of ivermectin in a patient population concomitantly infected with intestinal helminths and ectoparasites". Arzneimittelforschung. 54 (7): 416–21. doi:10.1055/s-0031-1296993. PMID 15344847.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ ^230.0 ^230.1 Keiser J, Utzinger J (2008). "Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis". JAMA. 299 (16): 1937–48. doi:10.1001/jama.299.16.1937. PMID 18430913.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ "WGO Practice Guideline Management of Strongyloidiasis" (PDF).
↑ Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.
↑ "Parasites - Trichuriasis".
↑ "Parasites - Zoonotic Hookworm".
↑ "Parasites - Zoonotic Hookworm".
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ 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.
↑ "Gnathostomiasis".
↑ "Gnathostomiasis".
↑ Schantz PM, Glickman LT (1978). "Toxocaral visceral larva migrans". N Engl J Med. 298 (8): 436–9. doi:10.1056/NEJM197802232980806. PMID 622118.
↑ Barisani-Asenbauer T, Maca SM, Hauff W, Kaminski SL, Domanovits H, Theyer I; et al. (2001). "Treatment of ocular toxocariasis with albendazole". J Ocul Pharmacol Ther. 17 (3): 287–94. doi:10.1089/108076801750295317. PMID 11436948.
↑ Gottstein B, Pozio E, Nöckler K (2009). "Epidemiology, diagnosis, treatment, and control of trichinellosis". Clin Microbiol Rev. 22 (1): 127–45, Table of Contents. doi:10.1128/CMR.00026-08. PMC 2620635. PMID 19136437.
↑ "Clonorchis".
↑ "Clonorchis".
↑ Qian MB, Yap P, Yang YC, Liang H, Jiang ZH, Li W; et al. (2013). "Efficacy and safety of tribendimidine against Clonorchis sinensis". Clin Infect Dis. 56 (7): e76–82. doi:10.1093/cid/cis1011. PMC 3588115. PMID 23223597.
↑ "Dicrocoeliasis".
↑ "Dicrocoeliasis".
↑ ^253.0 ^253.1 Rana SS, Bhasin DK, Nanda M, Singh K (2007). "Parasitic infestations of the biliary tract". Curr Gastroenterol Rep. 9 (2): 156–64. PMID 17418062.
↑ "Parasites - Fascioliasis".
↑ "Parasites - Paragonimiasis".
↑ ^256.0 ^256.1 ^256.2 Colley DG, Bustinduy AL, Secor WE, King CH (2014). "Human schistosomiasis". Lancet. 383 (9936): 2253–64. doi:10.1016/S0140-6736(13)61949-2. PMID 24698483.
↑ National Center for Biotechnology Information. PubChem Compound Database; CID=4612, https://pubchem.ncbi.nlm.nih.gov/compound/4612 (accessed July 16, 2015).
↑ BINA, J. C. and PRATA, A.. Tratamento da esquistossomose com oxamniquine (xarope) em crianças. Rev. Soc. Bras. Med. Trop.[online]. 1975, vol.9, n.4 [cited 2015-07-16], pp. 175-178 . Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86821975000400002&lng=en&nrm=iso>. ISSN 0037-8682. http://dx.doi.org/10.1590/S0037-86821975000400002.
↑ Jauréguiberry S, Paris L, Caumes E (2010). "Acute schistosomiasis, a diagnostic and therapeutic challenge". Clin Microbiol Infect. 16 (3): 225–31. doi:10.1111/j.1469-0691.2009.03131.x. PMID 20222897.
↑ Jauréguiberry S, Paris L, Caumes E (2009). "Difficulties in the diagnosis and treatment of acute schistosomiasis". Clin Infect Dis. 48 (8): 1163–4, author reply 1164-5. doi:10.1086/597497. PMID 19292640.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ "Parasites - Myiasis".
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ "Ebola virus treatment".
↑ Template:Citeweb
↑ LastName, FirstName (2009). Dengue guidelines for diagnosis, treatment, prevention, and control. Geneva: TDR World Health Organization. ISBN 9789241547871.
↑ "District guidelines for yellow fever surveillance" (PDF).
↑ name="pmid3547569">Monath TP (1987). "Yellow fever: a medically neglected disease. Report on a seminar". Rev Infect Dis. 9 (1): 165–75. PMID 3547569.
↑ Weaver SC, Lecuit M (2015). "Chikungunya virus and the global spread of a mosquito-borne disease". N Engl J Med. 372 (13): 1231–9. doi:10.1056/NEJMra1406035. PMID 25806915.
↑ ^281.0 ^281.1 ^281.2 ^281.3 ^281.4 ^281.5 ^281.6 ^281.7 ^281.8 Lok AS, McMahon BJ (2009). "Chronic hepatitis B: update 2009". Hepatology. 50 (3): 661–2. doi:10.1002/hep.23190. PMID 19714720.
↑ "INITIAL TREATMENT OF HCV INFECTION".
↑ "INITIAL TREATMENT OF HCV INFECTION".
↑ "INITIAL TREATMENT OF HCV INFECTION".
↑ "INITIAL TREATMENT OF HCV INFECTION".
↑ "INITIAL TREATMENT OF HCV INFECTION".
↑ Template:Citeweb
↑ "Epstein-Barr Virus (EBV) center for disease control and prevention".
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ "Other herpesviruses: HHV-6, HHV-7, HHV-8, HSV-1 and -2, VZV". Am J Transplant. 4 Suppl 10: 66–71. 2004. doi:10.1111/j.1600-6135.2004.00697.x. PMID 15504215.
↑ Wolz MM, Sciallis GF, Pittelkow MR (2012). "Human herpesviruses 6, 7, and 8 from a dermatologic perspective". Mayo Clin Proc. 87 (10): 1004–14. doi:10.1016/j.mayocp.2012.04.010. PMC 3538396. PMID 22819486.
↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
↑ Black JB, Pellett PE (1999). "Human herpesvirus 7". Rev Med Virol. 9 (4): 245–62. PMID 10578120.
↑ De Clercq E, Naesens L, De Bolle L, Schols D, Zhang Y, Neyts J (2001). "Antiviral agents active against human herpesviruses HHV-6, HHV-7 and HHV-8". Rev Med Virol. 11 (6): 381–95. PMID 11747000.
↑ "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents" (PDF).
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.
↑ Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015
↑ "avian influenza".
↑ WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/ Accessed on April 22, 2015
↑ WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and Other Influenza Viruses. WHO Guidelines Approved by the Guidelines Review Committee. Geneva: World Health Organization. 2010. PMID 23741777. Retrieved 2015-07-14.
↑ Hirsch HH, Martino R, Ward KN, Boeckh M, Einsele H, Ljungman P (2013). "Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus". Clin Infect Dis. 56 (2): 258–66. doi:10.1093/cid/cis844. PMC 3526251. PMID 23024295.
↑ Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.
↑ Template:Citeweb
↑ ^305.0 ^305.1 Committee on Infectious Diseases (2009). "From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections". Pediatrics. 124 (6): 1694–701. doi:10.1542/peds.2009-2345. PMID 19736258.
↑ Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE (2005). "Respiratory syncytial virus infection in elderly and high-risk adults". N Engl J Med. 352 (17): 1749–59. doi:10.1056/NEJMoa043951. PMID 15858184.
↑ O'Shea MK, Ryan MA, Hawksworth AW, Alsip BJ, Gray GC (2005). "Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment". Clin Infect Dis. 41 (3): 311–7. doi:10.1086/431591. PMID 16007526.
↑ Feltes TF, Sondheimer HM (2007). "Palivizumab and the prevention of respiratory syncytial virus illness in pediatric patients with congenital heart disease". Expert Opin Biol Ther. 7 (9): 1471–80. doi:10.1517/14712598.7.9.1471. PMID 17727335.
↑ Gern JE, Busse WW (1999). "Association of rhinovirus infections with asthma". Clin Microbiol Rev. 12 (1): 9–18. PMC 88904. PMID 9880472.CS1 maint: PMC format (link)
↑ Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB (1996). "Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds". Clin Infect Dis. 22 (4): 656–62. PMC url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205 Check |pmc= value (help). PMID 8729205.
↑ Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA; et al. (2003). "Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials". Clin Infect Dis. 36 (12): 1523–32. doi:10.1086/375069. PMID 12802751.
↑ Turner RB (2005). "New considerations in the treatment and prevention of rhinovirus infections". Pediatr Ann. 34 (1): 53–7. PMID 15693216.
↑ Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.
↑ Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T; et al. (2009). "Rhinovirus associated with severe lower respiratory tract infections in children". Pediatr Infect Dis J. 28 (4): 337–9. doi:10.1097/INF.0b013e31818ffc1b. PMID 19258921.
↑ Template:Citeweb
↑ Template:Citeweb
↑ "DIAGNOSIS AND MANAGEMENT OF SMALLPOX".
↑ "AIDSinfoNIH".

[1] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[Baddour-2005-2] Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)

[3] "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".

[pmid15494903-4] 4.0 ^4.1 ^4.2 ^4.3 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM; et al. (2004). "Practice guidelines for the management of bacterial meningitis". Clin Infect Dis. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903.

[5] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[6] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[7] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[8] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[9] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid15956145-10] 10.0 ^10.1 ^10.2 ^10.3 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.

[pmid19489710-11] 11.0 ^11.1 ^11.2 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.

[pmid24973422-12] Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America". Clin Infect Dis. 59 (2): e10–52. doi:10.1093/cid/ciu444. PMID 24973422.

[13] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[14] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[15] 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.

[16] 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.

[17] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[18] Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.

[19] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[20] 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.

[21] 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.

[22] 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.

[23] 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.

[24] 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.CS1 maint: PMC format (link)

[pmid20034345-25] 25.0 ^25.1 ^25.2 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.

[pmid23540878-26] 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.

[pmid20627931-27] 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.

[28] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[pmid17278083-29] 29.0 ^29.1 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.

[pmid24947530-30] 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.

[pmid19393958-31] 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.

[pmid22070836-32] 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.

[pmid172078-33] Tashima Y, Hasegawa M (1975). "Specific inhibition of ouabain sensitive and K+-dependent p-nitrophenylphosphatase by polyamines". Biochem Biophys Res Commun. 66 (4): 1344–8. PMID 172078.

[pmid15657200-34] Anguera I, Del Río A, Miró JM, Matínez-Lacasa X, Marco F, Gumá JR; et al. (2005). "Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles". Heart. 91 (2): e10. doi:10.1136/hrt.2004.040659. PMC 1768720. PMID 15657200.

[pmid21208910-35] Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ; et al. (2011). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clin Infect Dis. 52 (3): e18–55. doi:10.1093/cid/ciq146. PMID 21208910.

[36] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[37] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[38] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid22438350-39] Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA; et al. (2012). "IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults". Clin Infect Dis. 54 (8): e72–e112. doi:10.1093/cid/cir1043. PMID 22438350.

[40] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[41] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[42] "group B Streptococcus infections".

[43] "group B Streptococcus infections".

[pmid24446442-44] Mukhopadhyay S, Dukhovny D, Mao W, Eichenwald EC, Puopolo KM (2014). "2010 perinatal GBS prevention guideline and resource utilization". Pediatrics. 133 (2): 196–203. doi:10.1542/peds.2013-1866. PMC 3904275. PMID 24446442.

[45] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid24447897-46] 46.0 ^46.1 ^46.2 Hendricks KA, Wright ME, Shadomy SV, Bradley JS, Morrow MG, Pavia AT; et al. (2014). "Centers for disease control and prevention expert panel meetings on prevention and treatment of anthrax in adults". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130687. PMC 3901462. PMID 24447897.

[pmid24457117-47] Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA; et al. (2014). "Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women". Emerg Infect Dis. 20 (2). doi:10.3201/eid2002.130611. PMC 3901460. PMID 24457117.

[pmid24777226-48] 48.0 ^48.1 Bradley JS, Peacock G, Krug SE, Bower WA, Cohn AC, Meaney-Delman D; et al. (2014). "Pediatric anthrax clinical management". Pediatrics. 133 (5): e1411–36. doi:10.1542/peds.2014-0563. PMID 24777226.

[49] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[50] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[51] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[52] Andrews, J. M.; Wise, R. (2002-06). "Susceptibility testing of Bacillus species". The Journal of Antimicrobial Chemotherapy. 49 (6): 1040–1042. ISSN 0305-7453. PMID 12039902. Check date values in: |date= (help)

[53] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[54] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[55] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[56] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[57] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[58] "q fever".

[59] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[60] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[61] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[62] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[63] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[64] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[65] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[66] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[67] Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.

[68] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[69] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[70] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[71] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[72] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[73] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid6819447-74] Centers for Disease Control (CDC) (1982). "Prevention of secondary cases of Haemophilus influenzae type b disease". MMWR Morb Mortal Wkly Rep. 31 (50): 672–4, 679–80. PMID 6819447.

[75] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[76] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[pmid23141618-77] van de Beek D, Brouwer MC, Thwaites GE, Tunkel AR (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618.

[pmid12432041-78] Gans J, van de Beek D, European Dexamethasone in Adulthood Bacterial Meningitis Study Investigators (2002). "Dexamethasone in adults with bacterial meningitis". N Engl J Med. 347 (20): 1549–56. doi:10.1056/NEJMoa021334. PMID 12432041. Review in: ACP J Club. 2003 May-Jun;138(3):60

[pmid20824838-79] Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D (2010). "Corticosteroids for acute bacterial meningitis". Cochrane Database Syst Rev (9): CD004405. doi:10.1002/14651858.CD004405.pub3. PMID 20824838.

[pmid15917737-80] Bilukha OO, Rosenstein N, National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC) (2005). "Prevention and control of meningococcal disease. Recommendations of the Advisory Committee on Immunization Practices (ACIP)". MMWR Recomm Rep. 54 (RR-7): 1–21. PMID 15917737.

[81] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[82] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[83] LastName, FirstName (2003). Human leptospirosis guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.

[84] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[85] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid26042815-86] Workowski KA, Bolan GA (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and Reports : Morbidity and Mortality Weekly Report. Recommendations and Reports / Centers for Disease Control. 64 (RR-03): 1–137. PMID 26042815.

[87] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[88] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[89] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid12821469-90] Foucault C, Raoult D, Brouqui P (2003). "Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia". Antimicrob Agents Chemother. 47 (7): 2204–7. PMC 161867. PMID 12821469.

[91] Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.

[pmid15155180-92] Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D (2004). "Recommendations for treatment of human infections caused by Bartonella species". Antimicrob Agents Chemother. 48 (6): 1921–33. doi:10.1128/AAC.48.6.1921-1933.2004. PMC 415619. PMID 15155180.

[pmid9494835-93] 93.0 ^93.1 Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.

[94] "Recommended Antimicrobial Agents for the Treatment and Postexposure Prophylaxis of Pertussis 2005 CDC Guidelines".

[95] "Recommended Antimicrobial Agents for the Treatment and Post exposure Prophylaxis of Pertussis 2005 CDC Guidelines".

[96] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid22970946-97] Wiersinga WJ, Currie BJ, Peacock SJ (2012). "Melioidosis". N. Engl. J. Med. 367 (11): 1035–44. doi:10.1056/NEJMra1204699. PMID 22970946.

[98] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[99] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[100] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[101] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[102] Sanders, W. E.; Sanders, C. C. (1997-04). "Enterobacter spp.: pathogens poised to flourish at the turn of the century". Clinical Microbiology Reviews. 10 (2): 220–241. ISSN 0893-8512. PMC 172917. PMID 9105752. Check date values in: |date= (help)CS1 maint: PMC format (link)

[103] Jacoby, George A. (2009-01). "AmpC beta-lactamases". Clinical Microbiology Reviews. 22 (1): 161–182. doi:10.1128/CMR.00036-08. ISSN 1098-6618. PMC 2620637. PMID 19136439. Check date values in: |date= (help)CS1 maint: PMC format (link)

[104] Paterson, David L.; Bonomo, Robert A. (2005-10). "Extended-spectrum beta-lactamases: a clinical update". Clinical Microbiology Reviews. 18 (4): 657–686. doi:10.1128/CMR.18.4.657-686.2005. ISSN 0893-8512. PMC 1265908. PMID 16223952. Check date values in: |date= (help)CS1 maint: PMC format (link)

[105] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[106] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[107] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[108] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid22491499-109] Lua error: expandTemplate: template "citation error" does not exist.

[110] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[111] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[112] Mukara, B. K.; Munyarugamba, P.; Dazert, S.; Löhler, J. (2014-07). "Rhinoscleroma: a case series report and review of the literature". European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 271 (7): 1851–1856. doi:10.1007/s00405-013-2649-z. ISSN 1434-4726. PMID 23904142. Check date values in: |date= (help)

[113] Pontual, Loïc; Ovetchkine, Philippe; Rodriguez, Diana; Grant, Audrey; Puel, Anne; Bustamante, Jacinta; Plancoulaine, Sabine; Yona, Laurent; Lienhart, Pierre-Yves; Dehesdin, Danièle; Huerre, Michel; Tournebize, Régis; Sansonetti, Philippe; Abel, Laurent; Casanova, Jean Laurent (2008-12-01). "Rhinoscleroma: a French national retrospective study of epidemiological and clinical features". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (11): 1396–1402. doi:10.1086/592966. ISSN 1537-6591. PMID 18947330.

[114] Gaafar, Hazem A.; Gaafar, Alaa H.; Nour, Yasser A. (2011-04). "Rhinoscleroma: an updated experience through the last 10 years". Acta Oto-Laryngologica. 131 (4): 440–446. doi:10.3109/00016489.2010.539264. ISSN 1651-2251. PMID 21198342. Check date values in: |date= (help)

[115] Mukara, B. K.; Munyarugamba, P.; Dazert, S.; Löhler, J. (2014-07). "Rhinoscleroma: a case series report and review of the literature". European archives of oto-rhino-laryngology: official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS): affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 271 (7): 1851–1856. doi:10.1007/s00405-013-2649-z. ISSN 1434-4726. PMID 23904142. Check date values in: |date= (help)

[116] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[117] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[118] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[119] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[120] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[121] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[122] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[123] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[124] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[125] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[126] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[127] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[128] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[129] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[130] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[131] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[132] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[133] "q fever".

[134] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[135] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[136] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[137] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[138] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[139] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[140] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid18177225-141] 141.00 ^141.01 ^141.02 ^141.03 ^141.04 ^141.05 ^141.06 ^141.07 ^141.08 ^141.09 ^141.10 ^141.11 Walsh TJ, Anaissie EJ, Denning DW, Herbrecht R, Kontoyiannis DP, Marr KA; et al. (2008). "Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America". Clin Infect Dis. 46 (3): 327–60. doi:10.1086/525258. PMID 18177225.

[pmid24445340-142] 142.00 ^142.01 ^142.02 ^142.03 ^142.04 ^142.05 ^142.06 ^142.07 ^142.08 ^142.09 ^142.10 ^142.11 Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A, Dimopoulos G (2014). "Invasive fungal infections in the ICU: how to approach, how to treat". Molecules. 19 (1): 1085–119. doi:10.3390/molecules19011085. PMID 24445340.

[pmid18462107-143] Chapman SW, Dismukes WE, Proia LA, Bradsher RW, Pappas PG, Threlkeld MG; et al. (2008). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clin Infect Dis. 46 (12): 1801–12. doi:10.1086/588300. PMID 18462107.

[pmid16906260-144] 144.0 ^144.1 ^144.2 ^144.3 Shikanai-Yasuda MA, Telles Filho Fde Q, Mendes RP, Colombo AL, Moretti ML (2006). "[Guidelines in paracoccidioidomycosis]". Rev Soc Bras Med Trop. 39 (3): 297–310. PMID 16906260.

[145] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[146] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[pmid25395928-147] Krzyściak PM, Pindycka-Piaszczyńska M, Piaszczyński M (2014). "Chromoblastomycosis". Postepy Dermatol Alergol. 31 (5): 310–21. doi:10.5114/pdia.2014.40949. PMC 4221348. PMID 25395928.

[pmid20047480-148] Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ; et al. (2010). "Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america". Clin Infect Dis. 50 (3): 291–322. doi:10.1086/649858. PMID 20047480.

[149] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[pmid19439745-150] Berker D (2009). "Clinical practice. Fungal nail disease". N Engl J Med. 360 (20): 2108–16. doi:10.1056/NEJMcp0804878. PMID 19439745.

[151] "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".

[152] "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".

[153] "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents".

[154] Treatment of tuberculosis guidelines. Geneva: World Health Organization. 2010. ISBN 9789241547833.

[WHO-155] "The use of delamanid in the treatment of multidrug-resistant tuberculosis" (PDF).

[156] "WHO".

[157] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid12836625-158] American Thoracic Society. CDC. Infectious Diseases Society of America (2003). "Treatment of tuberculosis". MMWR Recomm Rep. 52 (RR-11): 1–77. PMID 12836625.

[159] Griffith, Daviday E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richarday J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, anday prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory anday Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. Unknown parameter |pmiday= ignored (help)

[160] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[161] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[162] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[163] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[164] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[165] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[166] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[167] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[168] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[169] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[170] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[171] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[172] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[173] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[174] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[175] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[176] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[177] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[178] Tortoli, E.; Besozzi, G.; Lacchini, C.; Penati, V.; Simonetti, M. T.; Emler, S. (1998-04). "Pulmonary infection due to Mycobacterium szulgai, case report and review of the literature". The European Respiratory Journal. 11 (4): 975–977. ISSN 0903-1936. PMID 9623706. Check date values in: |date= (help)

[179] Griffith, David E.; Aksamit, Timothy; Brown-Elliott, Barbara A.; Catanzaro, Antonino; Daley, Charles; Gordin, Fred; Holland, Steven M.; Horsburgh, Robert; Huitt, Gwen; Iademarco, Michael F.; Iseman, Michael; Olivier, Kenneth; Ruoss, Stephen; von Reyn, C. Fordham; Wallace, Richard J.; Winthrop, Kevin; ATS Mycobacterial Diseases Subcommittee; American Thoracic Society; Infectious Disease Society of America (2007-02-15). "An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases". American Journal of Respiratory and Critical Care Medicine. 175 (4): 367–416. doi:10.1164/rccm.200604-571ST. ISSN 1073-449X. PMID 17277290.

[pmid11398117-180] Rossignol JF, Ayoub A, Ayers MS (2001). "Treatment of diarrhea caused by Cryptosporidium parvum: a prospective randomized, double-blind, placebo-controlled study of Nitazoxanide". J Infect Dis. 184 (1): 103–6. doi:10.1086/321008. PMID 11398117.

[181] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[182] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[183] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[pmid15640710-184] Smith HV, Corcoran GD (2004). "New drugs and treatment for cryptosporidiosis". Curr Opin Infect Dis. 17 (6): 557–64. PMID 15640710.

[185] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[186] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[187] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[188] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[189] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[190] Template:Citeweb

[191] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[192] Nagata, Noriyuki; Marriott, Deborah; Harkness, John; Ellis, John T.; Stark, Damien (2012-12). "Current treatment options for Dientamoeba fragilis infections". International Journal for Parasitology. Drugs and Drug Resistance. 2: 204–215. doi:10.1016/j.ijpddr.2012.08.002. ISSN 2211-3207. PMC 3862407. PMID 24533282. Check date values in: |date= (help)CS1 maint: PMC format (link)

[193] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[194] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[195] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[196] "CDC Parasites - Giardia".

[pmid11148005-197] Gardner TB, Hill DR (2001). "Treatment of giardiasis". Clin Microbiol Rev. 14 (1): 114–28. doi:10.1128/CMR.14.1.114-128.2001. PMC 88965. PMID 11148005.CS1 maint: PMC format (link)

[198] "CDC - Cystoisosporiasis".

[199] "Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents" (PDF).

[200] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[201] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[202] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[203] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[204] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[205] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[206] Template:Citeweb

[207] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[208] Template:Citeweb

[209] "Guidelines for the treatment of malaria. Third edition April 2015" (PDF).

[210] "trichomoniasis".

[211] "African Trypanosomiasis".

[212] "Parasites - American Trypanosomiasis (also known as Chagas Disease)".

[pmid19123863-213] 213.0 ^213.1 Ramirez-Avila L, Slome S, Schuster FL, Gavali S, Schantz PM, Sejvar J; et al. (2009). "Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species". Clin Infect Dis. 48 (3): 322–7. doi:10.1086/595852. PMID 19123863.

[214] "Gnathostomiasis".

[215] "Gnathostomiasis".

[216] "Parasites - Zoonotic Hookworm".

[217] "Parasites - Zoonotic Hookworm".

[218] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[pmid19706911-219] 219.0 ^219.1 Chotmongkol V, Kittimongkolma S, Niwattayakul K, Intapan PM, Thavornpitak Y (2009). "Comparison of prednisolone plus albendazole with prednisolone alone for treatment of patients with eosinophilic meningitis". Am J Trop Med Hyg. 81 (3): 443–5. PMID 19706911.

[220] "Parasites - Ascariasis".

[221] "Parasites - Ascariasis".

[pmid9580117-222] Romero Cabello R, Guerrero LR, Muñóz García MR, Geyne Cruz A (1997). "Nitazoxanide for the treatment of intestinal protozoan and helminthic infections in Mexico". Trans R Soc Trop Med Hyg. 91 (6): 701–3. PMID 9580117.

[pmid8863040-223] 223.0 ^223.1 ^223.2 Khuroo MS (1996). "Ascariasis". Gastroenterol Clin North Am. 25 (3): 553–77. PMID 8863040.

[224] Cross, J. H. (1992-04). "Intestinal capillariasis". Clinical Microbiology Reviews. 5 (2): 120–129. ISSN 0893-8512. PMC 358231. PMID 1576584. Check date values in: |date= (help)CS1 maint: PMC format (link)

[225] Attia, Rasha A. H.; Tolba, Mohammed E. M.; Yones, Doaa A.; Bakir, Hanaa Y.; Eldeek, Hanan E. M.; Kamel, Shereef (2012-01). "Capillaria philippinensis in Upper Egypt: has it become endemic?". The American Journal of Tropical Medicine and Hygiene. 86 (1): 126–133. doi:10.4269/ajtmh.2012.11-0321. ISSN 1476-1645. PMC 3247121. PMID 22232463. Check date values in: |date= (help)CS1 maint: PMC format (link)

[226] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[pmid3130234-227] Wang BR, Wang HC, Li LW, Zhang XL, Yue JQ, Wang GX; et al. (1987). "Comparative efficacy of thienpydin, pyrantel pamoate, mebendazole and albendazole in treating ascariasis and enterobiasis". Chin Med J (Engl). 100 (11): 928–30. PMID 3130234.

[pmid15344847-228] Heukelbach J, Wilcke T, Winter B, Sales de Oliveira FA, Sabóia Moura RC, Harms G; et al. (2004). "Efficacy of ivermectin in a patient population concomitantly infected with intestinal helminths and ectoparasites". Arzneimittelforschung. 54 (7): 416–21. doi:10.1055/s-0031-1296993. PMID 15344847.

[229] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[pmid18430913-230] 230.0 ^230.1 Keiser J, Utzinger J (2008). "Efficacy of current drugs against soil-transmitted helminth infections: systematic review and meta-analysis". JAMA. 299 (16): 1937–48. doi:10.1001/jama.299.16.1937. PMID 18430913.

[231] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[232] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[233] "WGO Practice Guideline Management of Strongyloidiasis" (PDF).

[pmid8483992-234] Archibald LK, Beeching NJ, Gill GV, Bailey JW, Bell DR (1993). "Albendazole is effective treatment for chronic strongyloidiasis". Q J Med. 86 (3): 191–5. PMID 8483992.

[235] "Parasites - Trichuriasis".

[236] "Parasites - Zoonotic Hookworm".

[237] "Parasites - Zoonotic Hookworm".

[238] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[239] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[240] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[241] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[242] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[243] "Gnathostomiasis".

[244] "Gnathostomiasis".

[pmid622118-245] Schantz PM, Glickman LT (1978). "Toxocaral visceral larva migrans". N Engl J Med. 298 (8): 436–9. doi:10.1056/NEJM197802232980806. PMID 622118.

[pmid11436948-246] Barisani-Asenbauer T, Maca SM, Hauff W, Kaminski SL, Domanovits H, Theyer I; et al. (2001). "Treatment of ocular toxocariasis with albendazole". J Ocul Pharmacol Ther. 17 (3): 287–94. doi:10.1089/108076801750295317. PMID 11436948.

[pmid19136437-247] Gottstein B, Pozio E, Nöckler K (2009). "Epidemiology, diagnosis, treatment, and control of trichinellosis". Clin Microbiol Rev. 22 (1): 127–45, Table of Contents. doi:10.1128/CMR.00026-08. PMC 2620635. PMID 19136437.

[248] "Clonorchis".

[249] "Clonorchis".

[pmid23223597-250] Qian MB, Yap P, Yang YC, Liang H, Jiang ZH, Li W; et al. (2013). "Efficacy and safety of tribendimidine against Clonorchis sinensis". Clin Infect Dis. 56 (7): e76–82. doi:10.1093/cid/cis1011. PMC 3588115. PMID 23223597.

[251] "Dicrocoeliasis".

[252] "Dicrocoeliasis".

[pmid17418062-253] 253.0 ^253.1 Rana SS, Bhasin DK, Nanda M, Singh K (2007). "Parasitic infestations of the biliary tract". Curr Gastroenterol Rep. 9 (2): 156–64. PMID 17418062.

[254] "Parasites - Fascioliasis".

[255] "Parasites - Paragonimiasis".

[pmid24698483-256] 256.0 ^256.1 ^256.2 Colley DG, Bustinduy AL, Secor WE, King CH (2014). "Human schistosomiasis". Lancet. 383 (9936): 2253–64. doi:10.1016/S0140-6736(13)61949-2. PMID 24698483.

[257] National Center for Biotechnology Information. PubChem Compound Database; CID=4612, https://pubchem.ncbi.nlm.nih.gov/compound/4612 (accessed July 16, 2015).

[258] BINA, J. C. and PRATA, A.. Tratamento da esquistossomose com oxamniquine (xarope) em crianças. Rev. Soc. Bras. Med. Trop.[online]. 1975, vol.9, n.4 [cited 2015-07-16], pp. 175-178 . Available from: <http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86821975000400002&lng=en&nrm=iso>. ISSN 0037-8682. http://dx.doi.org/10.1590/S0037-86821975000400002.

[pmid20222897-259] Jauréguiberry S, Paris L, Caumes E (2010). "Acute schistosomiasis, a diagnostic and therapeutic challenge". Clin Microbiol Infect. 16 (3): 225–31. doi:10.1111/j.1469-0691.2009.03131.x. PMID 20222897.

[pmid19292640-260] Jauréguiberry S, Paris L, Caumes E (2009). "Difficulties in the diagnosis and treatment of acute schistosomiasis". Clin Infect Dis. 48 (8): 1163–4, author reply 1164-5. doi:10.1086/597497. PMID 19292640.

[261] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[262] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[263] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[264] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[265] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[266] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[267] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[268] "Parasites - Myiasis".

[269] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[270] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[271] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[272] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[273] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[274] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[275] "Ebola virus treatment".

[276] Template:Citeweb

[277] LastName, FirstName (2009). Dengue guidelines for diagnosis, treatment, prevention, and control. Geneva: TDR World Health Organization. ISBN 9789241547871.

[278] "District guidelines for yellow fever surveillance" (PDF).

[279] ="pmid3547569">Monath TP (1987). "Yellow fever: a medically neglected disease. Report on a seminar". Rev Infect Dis. 9 (1): 165–75. PMID 3547569.

[pmid25806915-280] Weaver SC, Lecuit M (2015). "Chikungunya virus and the global spread of a mosquito-borne disease". N Engl J Med. 372 (13): 1231–9. doi:10.1056/NEJMra1406035. PMID 25806915.

[pmid19714720-281] 281.0 ^281.1 ^281.2 ^281.3 ^281.4 ^281.5 ^281.6 ^281.7 ^281.8 Lok AS, McMahon BJ (2009). "Chronic hepatitis B: update 2009". Hepatology. 50 (3): 661–2. doi:10.1002/hep.23190. PMID 19714720.

[282] "INITIAL TREATMENT OF HCV INFECTION".

[283] "INITIAL TREATMENT OF HCV INFECTION".

[284] "INITIAL TREATMENT OF HCV INFECTION".

[285] "INITIAL TREATMENT OF HCV INFECTION".

[286] "INITIAL TREATMENT OF HCV INFECTION".

[287] Template:Citeweb

[CDC-288] "Epstein-Barr Virus (EBV) center for disease control and prevention".

[289] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[pmid15504215-290] "Other herpesviruses: HHV-6, HHV-7, HHV-8, HSV-1 and -2, VZV". Am J Transplant. 4 Suppl 10: 66–71. 2004. doi:10.1111/j.1600-6135.2004.00697.x. PMID 15504215.

[pmid22819486-291] Wolz MM, Sciallis GF, Pittelkow MR (2012). "Human herpesviruses 6, 7, and 8 from a dermatologic perspective". Mayo Clin Proc. 87 (10): 1004–14. doi:10.1016/j.mayocp.2012.04.010. PMC 3538396. PMID 22819486.

[292] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[pmid10578120-293] Black JB, Pellett PE (1999). "Human herpesvirus 7". Rev Med Virol. 9 (4): 245–62. PMID 10578120.

[pmid11747000-294] De Clercq E, Naesens L, De Bolle L, Schols D, Zhang Y, Neyts J (2001). "Antiviral agents active against human herpesviruses HHV-6, HHV-7 and HHV-8". Rev Med Virol. 11 (6): 381–95. PMID 11747000.

[295] "Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents" (PDF).

[296] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[297] Workowski, Kimberly A.; Bolan, Gail A. (2015-06-05). "Sexually transmitted diseases treatment guidelines, 2015". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 64 (RR-03): 1–137. ISSN 1545-8601. PMID 26042815.

[:1-298] Avian Influenza Factsheet. World Health Organization. http://www.who.int/mediacentre/factsheets/avian_influenza/en/ Accessed on April 22, 2015

[299] "avian influenza".

[300] WHO guidelines for pharmacological management of pandemic (H1N1) 2009 influenza and other influenza viruses. http://www.who.int/csr/resources/publications/swineflu/h1n1_use_antivirals_20090820/en/ Accessed on April 22, 2015

[301] WHO Guidelines for Pharmacological Management of Pandemic Influenza A(H1N1) 2009 and Other Influenza Viruses. WHO Guidelines Approved by the Guidelines Review Committee. Geneva: World Health Organization. 2010. PMID 23741777. Retrieved 2015-07-14.

[pmid23024295-302] Hirsch HH, Martino R, Ward KN, Boeckh M, Einsele H, Ljungman P (2013). "Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis and treatment of human respiratory syncytial virus, parainfluenza virus, metapneumovirus, rhinovirus, and coronavirus". Clin Infect Dis. 56 (2): 258–66. doi:10.1093/cid/cis844. PMC 3526251. PMID 23024295.

[303] Gilbert, David (2014). The Sanford guide to antimicrobial therapy 2014. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808782.

[304] Template:Citeweb

[pmid19736258-305] 305.0 ^305.1 Committee on Infectious Diseases (2009). "From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections". Pediatrics. 124 (6): 1694–701. doi:10.1542/peds.2009-2345. PMID 19736258.

[pmid15858184-306] Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE (2005). "Respiratory syncytial virus infection in elderly and high-risk adults". N Engl J Med. 352 (17): 1749–59. doi:10.1056/NEJMoa043951. PMID 15858184.

[pmid16007526-307] O'Shea MK, Ryan MA, Hawksworth AW, Alsip BJ, Gray GC (2005). "Symptomatic respiratory syncytial virus infection in previously healthy young adults living in a crowded military environment". Clin Infect Dis. 41 (3): 311–7. doi:10.1086/431591. PMID 16007526.

[pmid17727335-308] Feltes TF, Sondheimer HM (2007). "Palivizumab and the prevention of respiratory syncytial virus illness in pediatric patients with congenital heart disease". Expert Opin Biol Ther. 7 (9): 1471–80. doi:10.1517/14712598.7.9.1471. PMID 17727335.

[pmid9880472-309] Gern JE, Busse WW (1999). "Association of rhinovirus infections with asthma". Clin Microbiol Rev. 12 (1): 9–18. PMC 88904. PMID 9880472.CS1 maint: PMC format (link)

[pmid8729205-310] Gwaltney JM, Park J, Paul RA, Edelman DA, O'Connor RR, Turner RB (1996). "Randomized controlled trial of clemastine fumarate for treatment of experimental rhinovirus colds". Clin Infect Dis. 22 (4): 656–62. PMC url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8729205 Check |pmc= value (help). PMID 8729205.

[pmid12802751-311] Hayden FG, Herrington DT, Coats TL, Kim K, Cooper EC, Villano SA; et al. (2003). "Efficacy and safety of oral pleconaril for treatment of colds due to picornaviruses in adults: results of 2 double-blind, randomized, placebo-controlled trials". Clin Infect Dis. 36 (12): 1523–32. doi:10.1086/375069. PMID 12802751.

[pmid15693216-312] Turner RB (2005). "New considerations in the treatment and prevention of rhinovirus infections". Pediatr Ann. 34 (1): 53–7. PMID 15693216.

[pmid12517470-313] Heikkinen T, Järvinen A (2003). "The common cold". Lancet. 361 (9351): 51–9. doi:10.1016/S0140-6736(03)12162-9. PMID 12517470.

[pmid19258921-314] Louie JK, Roy-Burman A, Guardia-Labar L, Boston EJ, Kiang D, Padilla T; et al. (2009). "Rhinovirus associated with severe lower respiratory tract infections in children". Pediatr Infect Dis J. 28 (4): 337–9. doi:10.1097/INF.0b013e31818ffc1b. PMID 19258921.

[315] Template:Citeweb

[316] Template:Citeweb

[317] "DIAGNOSIS AND MANAGEMENT OF SMALLPOX".

[AIDSinfoNIH-318] "AIDSinfoNIH".

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

[10]

[11]

[12]

[13]

[14]

[15]

[16]

[17]

[18]

[19]

[20]

[21]

[22]

[23]

[24]

[25]

[26]

[27]

[28]

[29]

[30]

[31]

[32]

[33]

[34]

[35]

[36]

[37]

[38]

[39]

[40]

[41]

[42]

[43]

[44]

[45]

[46]

[47]

[48]

[49]

[50]

[51]

[52]

[53]

[54]

[55]

[56]

[57]

[58]

[59]

[60]

[61]

[62]

[63]

[64]

[65]

[66]

[67]

[68]

[69]

[70]

[71]

[72]

[73]

[74]

[75]

[76]

[77]

[78]

[79]

[80]

[81]

[82]

[83]

[84]

[85]

[86]

[87]

[88]

[89]

[90]

[91]

[92]

[93]

[94]

[95]

[96]

[97]

[98]

[99]

[100]