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:::*[[Ampicillin]] resistant and [[vancomycin]] susceptible or [[Penicillin]] allergy : ([[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg q8h) {{or}} [[Linezolid]] 600 mg q12h {{or}} [[Daptomycin]] 6 mg/kg per day.
:::*[[Ampicillin]] resistant and [[vancomycin]] susceptible or [[Penicillin]] allergy : ([[Vancomycin]] 15 mg/kg IV q12h {{and}} [[Gentamicin]] 1 mg/kg q8h) {{or}} [[Linezolid]] 600 mg q12h {{or}} [[Daptomycin]] 6 mg/kg per day.
:::*[[Ampicillin]] and [[Vancomycin]] resistant : [[Linezolid]] 600 mg q12h {{or}} [[Daptomycin]] 6 mg/kg IV per day  
:::*[[Ampicillin]] and [[Vancomycin]] resistant : [[Linezolid]] 600 mg q12h {{or}} [[Daptomycin]] 6 mg/kg IV per day  
::*Endocarditis  
::*Endocarditis in Adults
:::*Strains Susceptible to [[Penicillin]], [[Gentamicin]], and [[Vancomycin]]
:::*Strains Susceptible to [[Penicillin]], [[Gentamicin]], and [[Vancomycin]]
::::*Preferred regimen : ([[Ampicillin|Ampicillin sodium]] 12 g/day IV for 4–6weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 18–30 MU/day IV for 4–6weeks) {{and}} [[Gentamicin|Gentamicin sulfate]] 3 mg/kg/day IV/IM for 4–6 weeks
'''Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended '''
::::*Alternate regimen : [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV for 6 weeks {{and}} Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks
Pediatric dose: vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses


::::*Preferred regimen : [[Ampicillin|Ampicillin sodium]] 12 g/day IV for 4–6weeks {{or}} Aqueous crystalline penicillin G sodium 18–30 MU/day IV for 4–6weeks IA Prosthetic valve or other prosthetic cardiac material: minimum of 6 wk of therapy recommended plus Gentamicin sulfate† 3 mg/kg per 24 h IV/IM in 3 equally divided doses 4–6 Pediatric dose‡: ampicillin 300 mg/kg per 24 h IV in 4–6 equally divided doses; penicillin 300 000 U/kg per 24 h IV in 4–6 equally divided doses; gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses Vancomycin hydrochloride§ 30 mg/kg per 24 h IV in 2 equally divided doses 6 IB Vancomycin therapy recommended only for patients unable to tolerate penicillin or ampicillin plus Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses 6 6 wk of vancomycin therapy recommended because of decreased activity against enterococci Pediatric dose: vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses  
Pediatric dose‡: ampicillin 300 mg/kg per 24 h IV in 4–6 equally divided doses; penicillin 300 000 U/kg per 24 h IV in 4–6 equally divided doses; gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses Vancomycin hydrochloride§ 30 mg/kg per 24 h IV in 2 equally divided doses 6 IB Vancomycin therapy recommended only for patients unable to tolerate penicillin or ampicillin plus Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses 6 6 wk of vancomycin therapy recommended because of decreased activity against enterococci Pediatric dose: vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses  


:::*Strains Susceptible to [[Penicillin]], [[Streptomycin]], and [[Vancomycin]] and Resistant to [[Gentamicin]]
::::*Preferred regimen : ([[Ampicillin sodium]] 12 g/day IV for 4–6 weeks {{or}} [[Penicillin G|Aqueous crystalline penicillin G sodium]] 24 MU/day IV for 4–6weeks){{and}} [[Streptomycin|Streptomycin sulfate]] 15 mg/kg/day IV/IM for 4–6weeks


::::*Alternate regimen: [[Vancomycin|Vancomycin hydrochloride]] 30 mg/kg/day IV 6weeks IB Vancomycin therapy recommended only for patients unable to tolerate penicillin or ampicillin plus Streptomycin sulfate 15 mg/kg per 24 h IV/IM in 2 equally divided doses 6 Pediatric dose: vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; streptomycin 20–30 mg/kg per 24 h IV/IM in 2 equally divided doses
Pediatric dose‡: ampicillin 300 mg/kg per 24 h IV in 4–6 equally divided doses; penicillin 300 000 U/kg per 24 h IV in 4–6 equally divided doses; streptomycin 20–30 mg/kg per 24 h IV/IM in 2 equally divided doses


:::*Endocarditits Adult
::::*Preferred regimen : [[Ampicillin]] 2 g IV q4h for 4—6 weeks {{or}} [[Penicillin G]] 18—30 MU/day IV continuously or q4h for 4—6 weeks {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 4—6 weeks
::::*Alternative Regimen : [[Vancomycin]] 15 mg/kg IV q12h for 6 weeks {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 6 weeks
:::*4-wk therapy recommended for patients with symptoms of illness ≤3 mo; 6-wk therapy recommended for patients with symptoms >3 mo. Prosthetic valve or other prosthetic cardiac material: minimum of 6 wk of therapy recommended.
:::*Endocarditis Pediatrics :
::::*Preferred regimen : [[Ampicillin]] 300 mg/kg/day IV q4—6h for 4—6 weeks {{or}} [[Penicillin G]] 0.3 MU/kg/day IV q4—6h for 4—6 weeks {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 4—6 weeks.
::::*Alternative Regimen : [[Vancomycin]] 40 mg/kg/day IV q8—12h for 6 weeks {{and}} [[Gentamicin]] 1 mg/kg IV/IM q8h for 6 weeks
:::*Endocarditits Adult (Gentamicin resistant)
::::*Preferred regimen : ([[Ampicillin]] 2 g IV q4h for 4—6 weeks {{or}} [[Penicillin G]] 24 MU/day IV continuously or q4h for 4—6 weeks) {{and}} [[Streptomycin]] 7.5 mg/kg IV/IM q12h for 4—6 weeks
::::*Alternative Regimen : [[Vancomycin]] 15 mg/kg IV q12h for 6 weeks {{and}} [[Streptomycin]] 7.5 mg/kg IV/IM q12h for 6 weeks
:::*Endocarditits Pediatrics (Gentamicin resistant)
::::*Preferred regimen : ([[Ampicillin]] 300 mg/kg/day IV q4—6h for 4—6 weeks {{or}} [[Penicillin G]] 0.3 MU/kg/day IV q4—6h for 4—6 weeks) {{and}} [[Streptomycin]] 40 mg/kg/day IV q8—12h for 6 weeks
::::*Alternative Regimen : [[Vancomycin]] 15 mg/kg IV q12h for 6 weeks {{and}} [[Streptomycin]] 10—15 mg/kg IV/IM q12h for 6 weeks
::*Meningitis   
::*Meningitis   
:::*Ampicillin susceptible
:::*Ampicillin susceptible

Revision as of 14:50, 26 June 2015

Pathogens of Clinical Relevance

Bacteria – Gram-Positive Cocci

  • BacteremiaBartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  • Endocarditis in Adults

Note : In case of native valve endocarditis, 4-wk therapy recommended for patients with symptoms of illness ≤3 months and 6-wk therapy recommended for patients with symptoms >3 months and prosthetic valve or other prosthetic cardiac material a minimum of 6 wk of therapy recommended

  • Alternate regimen : Vancomycin hydrochloride 30 mg/kg/day IV for 6 weeks AND Gentamicin sulfate 3 mg/kg/day IV/IM for 6weeks

Pediatric dose: vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses 

Pediatric dose‡: ampicillin 300 mg/kg per 24 h IV in 4–6 equally divided doses; penicillin 300 000 U/kg per 24 h IV in 4–6 equally divided doses; gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses Vancomycin hydrochloride§ 30 mg/kg per 24 h IV in 2 equally divided doses 6 IB Vancomycin therapy recommended only for patients unable to tolerate penicillin or ampicillin plus Gentamicin sulfate 3 mg/kg per 24 h IV/IM in 3 equally divided doses 6 6 wk of vancomycin therapy recommended because of decreased activity against enterococci Pediatric dose: vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; gentamicin 3 mg/kg per 24 h IV/IM in 3 equally divided doses
  • Alternate regimen: Vancomycin hydrochloride 30 mg/kg/day IV 6weeks IB Vancomycin therapy recommended only for patients unable to tolerate penicillin or ampicillin plus Streptomycin sulfate 15 mg/kg per 24 h IV/IM in 2 equally divided doses 6 Pediatric dose: vancomycin 40 mg/kg per 24 h IV in 2 or 3 equally divided doses; streptomycin 20–30 mg/kg per 24 h IV/IM in 2 equally divided doses

Pediatric dose‡: ampicillin 300 mg/kg per 24 h IV in 4–6 equally divided doses; penicillin 300 000 U/kg per 24 h IV in 4–6 equally divided doses; streptomycin 20–30 mg/kg per 24 h IV/IM in 2 equally divided doses

  • Meningitis
  • Ampicillin susceptible
  • Ampicillin resistant
  • Ampicillin and vancomycin resistant
  • Urinary tract infections
  • Intra abdominal or Wound infections
  • Penicillin or ampicillin are preferred agents, vancomycin in setting of penicillin

allergy or high-level penicillin resistance.


  • In adults
  • (2) Intravascular catheter-related infections[1]
  • Methicillin susceptible Staphylococcus aureus (MSSA)
  • Neonates
  • 0–4 weeks of age and 1200 g- 50 mg/kg/day q12h.
  • ≤7 days and 1200–2000 g- 50 mg/kg/day q12h.
  • >7 days of age and <2000g- 75 mg/kg/day q8h.
  • >7 days of age and >1200 g - 100 mg/kg/day q6h.
  • Neonates
  • 0–4 weeks of age and 1200 g - 50 mg/kg/day q12h.
  • Postnatal age <7 days and 1200–2000 g- 50–100 mg/kg/day q12h.
  • Postnatal age <7 days and >2000 g, 75–150 mg/kg/day q8h.
  • Postnatal age ≥7 days and 1200–2000 g- 75–150 mg/kg/day q8h.
  • Postnatal age ≥7 days and >2000 g, 100–200 mg/kg/day q6h.
  • Infants and children Nafcillin 100–200 mg/kg/day q4–6h.
  • Neonates
  • Postnatal age ≤7 days: 40 mg/kg/day q12h.
  • Postnatal age >7 days and 2000 g: 40 mg/kg/day q12h.
  • Postnatal age >7 days and 12000 g: 60 mg/kg/day q8h.
  • Infants and children: 50 mg/kg/day q8h.
  • Neonates
  • Postnatal age ≤7 days and <1200 g, 15 mg/kg/day q24h.
  • Postnatal age ≤7 days and 1200–2000 g, 10–15 mg/kg q12–18h.
  • Postnatal age ≤7 days and >2000 g, 10–15 mg/kg q8–12h.
  • Postnatal age >7 days and <1200 g, 15 mg/kg/day q24h.
  • Postnatal age >7 days and 1200–2000 g, 10–15 mg/kg q8–12h.
  • Postnatal age >7 days and >2000 g, 15–20 mg/kg q8h.
  • Infants and children: 40 mg/kg/day q6–8h.
  • Methicillin resistant Staphylococcus aureus (MRSA)
  • Neonates
  • 0–4 weeks of age and birthweight <1200 g: 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age).
  • <7 days of age and birthweight >1200 g, 10 mg/kg q8–12h (note: q12h in patients <34 weeks gestation and <1 week of age).
  • 7 days and birthweight >1200 g, 10 mg/kg q8h.
  • Infants and children <12 years of age: 10 mg/kg q8h Children 12 years of age and adolescents: 10 mg/kg q12h.
  • Neonates
  • Premature neonates and <1000 g, 3.5 mg/kg q24h; 0–4 weeks and <1200 g, 2.5 mg/kg q18-24h.
  • Postnatal age 7 days: 2.5 mg/kg q12h.
  • Postnatal age 17 days and 1200–2000 g, 2.5 mg/kg q8-12h.
  • Postnatal age 17 days and 12000 g, 2.5 mg/kg q8h.
  • Once daily dosing for premature neonates with normal renal function, 3.5–4 mg/kg q24h.
  • Once daily dosing for term neonates with normal renal function, 3.5–5 mg/kg q24h.
  • Infants and children <5 years of age: 2.5 mg/kg q8h; qd dosing in patients with normal renal function, 5–7.5 mg/kg q24h.
  • Children >5 years of age: 2–2.5 mg/kg q8h; qd s with normal renal function, 5–7.5 mg/kg every 24 h.
  • Infants 12 months of age and children: mild-to-moderate infections, 6–12 mg TMP/kg/day q12h; serious infection, 15–20 mg TMP/kg/day q6-8h.
  • (3) Purulent cellulitis (defined as cellulitis associated with purulent drainage or exudate in the absence of a drainable abscess)
  • In adults
  • In childern
Doxycycline If patient body weight 45kg: adult dose OR Minocycline 4 mg/kg PO 200 mg as a single dose, then 2 mg/kg/dose PO q12h OR Linezolid 10 mg/kg PO q8h, not to exceed 600 mg/dose
  • Nonpurulent cellulitis (defined as cellulitis with no purulent drainage or exudate and no associated abscess)
  • In adults
Note: Empirical therapy for b-hemolytic streptococci is recommended. Empirical coverage for CA-MRSA is recommended in patients who do not respond to b-lactam therapy and may be considered in those with systemic toxicity.
Note: Provide coverage for both b-hemolytic streptococci and CA-MRSA b-lactam (eg, amoxicillin) and/or TMP-SMX or a tetracycline
  • In childern
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.
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • In adults
  • In childern
Note: Consider the addition of Rifampin 600 mg qd OR 300–450 mg bid to Vancomycin.
  • Methicillin-susceptible Staphylococcus aureus (MSSA)
  • (5) Cerebrospinal fluid shunt infection [5][6]
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND/OR 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.
  • Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 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
  • Methicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen: Cefazolin 2 g IV q8h for 2–4 weeks, then PO to complete 6–8 weeks OR Nafcillin 2 g IV q4h for 2–4 weeks, then PO to complete 6–8 weeks OR 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
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks
  • Alternative regimen: Linezolid 600 mg PO or IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg PO or IV q8–12h for 4–6 weeks
  • Pediatric dose: Vancomycin 15 mg/kg IV q6h OR Linezolid 10 mg/kg PO or IV q8h
Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.
  • (7) Bacterial meningitis
  • Methicillin susceptible Staphylococcus aureus (MSSA)
  • Methicillin resistant Staphylococcus aureus (MRSA)
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[11]
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h for 4–6 weeks
  • Alternative regimen: Linezolid 600 mg PO IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • Pediatric dose: Vancomycin 15 mg/kg IV q6h OR Linezolid 10 mg/kg PO or IV q8h
Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible.
Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.
  • (9) Subdural empyema
  • Methicillin-resistant Staphylococcus aureus (MRSA)[12]
  • In adults
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
  • Alternative regimen: Linezolid 600 mg PO or IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • In childern
Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin.
  • (10) Acute conjunctivitis [13]
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • (11) Appendicitis
Health Care–Associated Complicated Intra-abdominal Infection [14]
Methicillin-resistant Staphylococcus aureus (MRSA):
Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
  • (12) Diverticulitis
Health Care–Associated Complicated Intra-abdominal Infection [14]
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
Health Care–Associated Complicated Intra-abdominal Infection [14]
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin 15–20 mg/kg IV q8–12h
  • (14) Cystic fibrosis [15]
  • Preferred Regimen (Adult)
  • If methicillin sensitive staphylococcus aureus: Nafcillin 2 gm IV q4hs OR Oxacillin 2 gm IV q4hs
  • If methicillin resistant staphylococcus aureus: Vancomycin 15-20 mg/kg IV q8-12h OR Linezolid 600 mg po/IV q12h
  • Preferred regimen (Pediatric)
  • If methicillin sensitive staphylococcus aureus: Nafcillin 5 mg/kg q6h (Age >28 days) OR Oxacillin 75 mg/kg q6h (Age >28 days)]]
  • If methicillin resistant staphylococcus aureus: Vancomycin 40 mg/kg q6-8h (Age >28 days) OR Linezolid 10 mg/kg po or IV q8h (up to age 12)
  • (15) Bronchiectasis [16]
  • (a) Preferred Regimen in adults
  • Recommended first-line treatment and length of treatment
Methicillin-susceptible Staphylococcus aureus (MSSA): Flucloxacillin 500 mg oral qds for 14 days
Methicillin-resistant Staphylococcus aureus (MRSA): Patient's body weight is <50 kg: Rifampicin 450 mg oral od AND Trimethoprim 200 mg oral bd for 14 days ; Patient's body weight is >50 kg: Rifampicin 600 mg oral od AND Trimethoprim 200 mg oral bd for 14 days
Methicillin-resistant Staphylococcus aureus (MRSA): Vancomycin 1 g IV bd (monitor serum levels and adjust dose accordingly) OR Teicoplanin 400 mg od for 14 days
  • Recommended second-line treatment and length of treatment
Methicillin-susceptible Staphylococcus aureus (MSSA): Clarithromycin 500 mg oral bd 14 days
Methicillin-resistant Staphylococcus aureus (MRSA): Patient's body weight is <50 kg: Rifampicin 450 mg oral od AND Doxycycline 200 mg oral od 14 days, Patient's body weight is >50 kg: Rifampicin 600 mg oral AND Doxycycline 200 mg oral od 14 days. Third-line: Linezolid 600 mg bd 14 days
Methicillin-resistant Staphylococcus aureus (MRSA): Linezolid 600 mg IV bd 14 days
  • (b) Preferred Regimen in children
  • Recommended first-line treatment and length of treatment
Methicillin-susceptible Staphylococcus aureus (MSSA): Flucloxacillin
Methicillin-resistant Staphylococcus aureus (MRSA): Children (< 12 yr): Trimethoprim 4-6 mg/kg/24 hr divided q 12 hr PO Children (> 12 yr) : Trimethoprim 100-200 mg q 12 hr PO. Rifampicin 450 mg oral od  : Rifampicin 600 mg oral od AND
Methicillin-resistant Staphylococcus aureus (MRSA): Vancomycin 45-60 mg/kg/24 hr divided q 8-12 hr IV OR Teicoplanin
  • Recommended second-line treatment and length of treatment
Methicillin-susceptible Staphylococcus aureus (MSSA): Clarithromycin 15 mg/kg/24 hr divided q 12 hr PO
Methicillin-resistant Staphylococcus aureus (MRSA): Rifampicin AND Doxycycline 2-5 mg/kg/24 hr divided q 12-24 hr PO or IV (max dose: 200 mg/24 hr) ; Rifampicin AND Doxycycline 2-5 mg/kg/24 hr divided q 12-24 hr PO or IV (max dose: 200 mg/24 hr) . Third-line: Linezolid 10 mg/kg q 12 hr IV or PO
Methicillin-resistant Staphylococcus aureus (MRSA): Linezolid 10 mg/kg q 12 hr IV or PO
  • (B)Long-term oral antibiotic treatment
  • (a) Preferred Regimen in adults
  • Recommended first-line treatment and length of treatment
Methicillin-susceptible Staphylococcus aureus (MSSA): Flucloxacillin 500 mg oral bd
  • Recommended second-line treatment and length of treatment
Methicillin-susceptible Staphylococcus aureus (MSSA): Clarithromycin 250 mg oral bd
  • (16) Empyema
  • (17) Community-acquired pneumonia
  • Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred Regimen : Vancomycin 45-60 mg/kg/day divided q8-12h (max: 2000 mg/dose) for 7-21 days OR 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
  • Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Methicillin-resistant Staphylococcus aureus (MRSA)
Note: Initially aspirate q24h and treat for a minimum of 2–3 weeks.
  • (19) Septic arthritis
  • In adults
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regime: 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
  • In childern
  • Methicillin-susceptible Staphylococcus aureus (MSSA)
  • (20) Septic arthritis, prosthetic joint infection (device-related osteoarticular infections)
  • Methicillin-susceptible Staphylococcus aureus (MSSA)
  • 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: (Daptomycin 6 mg/kg IV q24h OR 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 plus a fluoroquinolone, TMP/SMX, a tetracycline or Clindamycin for 3 or 6 months for hips and knees, respectively.
  • (21) Hematogenous osteomyelitis
  • Adult (>21 yrs)
  • Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • Preferred regimen: Vancomycin 1 gm IV q12h (if over 100 kg, 1.5 gm IV q12h)
  • Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • Children (>4 mos.)-Adult
  • Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
Note: Add Ceftazidime 50 q8h or Cefepime 150 div q8h if Gm-neg. bacilli on Gram stain
  • Newborn (<4 mos.)
  • Methicillin-resistant Staphylococcus aureus (MRSA) possible
  • Methicillin-resistant Staphylococcus aureus (MRSA) unlikely
  • Specific therapy
  • Methicillin-susceptible Staphylococcus aureus (MSSA)
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • (22) Diabetic foot osteomyelitis
  • High Risk for MRSA
  • (23) Necrotizing fasciitis[17]
  • In adult
  • In childern
  • (24) Staphylococcal toxic shock syndrome [18]
  • Methicillin sensitive Staphylococcus aureus
  • Preferred regimen: Cloxacillin 250-500 mg PO q6h (max dose: 4 g/24 hr) OR Nafcillin 4-12 g/24 hr divided IV q4-6hr (max dose: 12 g/24 hr) OR Cefazolin 0.5-2g IV or IM q8h (max dose: 12 g/24 hr), AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
  • Alternative regimen (1):Clarithromycin 250-500 mg PO q12h (max dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
  • Alternative regimen (1):Rifampicin, AND Linezolid 600 mg IV or PO q12h OR Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg IV q12h
  • Methicillin resistant Staphylococcus aureus
  • Glycopeptide resistant or intermediate Staphylococcus aureus
  • Preferred regimen: Linezolid 600 mg IV or PO q12h AND Clindamycin 150-600 mg IV, IM, or PO q6-8h (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) (if sensitive)
  • Alternative regimen (1):Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg IV q12h
Note: Incidence increasing. Geographical patterns highly variable.


  • Prophylaxis for coronary artery bypass graft-associated acute mediastinitis[19]
  • Methicillin susceptible staphylococcus aureus (MSSA)
  • Preferred regimen: A first- or second-generation Cephalosporin is recommended for prophylaxis in patients without methicillin-resistant Staphylococcus aureus colonization.
  • Methicillin resistant staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin alone or in combination with other antibiotics to achieve broader coverage is recommended for prophylaxis in patients with proven or suspected methicillin-resistant S. aureus colonization
Note (1): Preoperative antibiotics should be administered to all patients to reduce the risk of mediastinitis in cardiac surgery.
Note (2): The use of intranasal Mupirocin is reasonable in nasal carriers of Staphylococcus aureus.


  • Bacteremia: most often due to IV lines, vascular grafts, cardiac valves (30-40% of all coagulase-negative staphylococcus infections)
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.
  • CSF shunt: meningitis
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.
  • Peritoneal dialysis catheter: peritonitis
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.
  • Prosthetic joint: septic arthritis
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).
  • Prosthetic or natural cardiac valve: endocarditis
Note: Site sepcific recommendation is consider valve replacement and antibiotics for 6 wks.
  • Post-sternotomy: osteomyelitis
  • Implants (breast, penile, pacemaker) and other prosthetic devices: local infection
Note: Site sepcific recommendation for vascular graft is to remove graft, antibiotics for 6 wks.
  • Post-ocular surgery: endophthalmitis
  • Surgical site infections
Note: only assume Methicillin susceptible if multiple isolates are so identified.
  • Urinary tract infection
  • Uncomplicated urinary tract infection







Bacteria – Gram-Positive Bacilli

  • Erysipeloid of Rosenbach (localized cutaneous infection)[20]
  • Diffuse cutaneous infection
  • Preferred regimen: As for localized infection
Note: Assess for endocarditis
  • 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.
  • Endovascular Infection [21]
  • Odontogenic Infection
  • Intrabdominal Abscess
  • Sulfonamide-based therapies [22]
  • 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
  • Pulmonary alternatives
  • 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
  • CNS alternatives
  • Severe disease, compromised host, multiple sites
  • 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
  • Sulfonamide alternatives
  • Severe
  • Mild
  • Systemic infection[23]
  • Shoulder prosthesis infection
  • Acne vulgaris
  • Rhodococcus equi [24]
  • Preferred regimen:
  • 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)
  • Oral/maintenance therapy (after infiltrate clears): Ciprofloxacin 750 mg PO twice daily OR Erythromycin 500 mg PO four times a day
  • 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


Bacteria – Gram-Negative Cocci and Coccobacilli

Bacteria – Spirochetes

  • Lyme disease
  • Early Lyme Disease
  • 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)
  • 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)
  • 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)
  • 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)
  • Borrelial lymphocytoma
  • Preferred regimen: The same regimens used to treat patients with erythema migrans (see above)
  • Late Lyme Disease
  • 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
  • patients with arthritis and objective evidence of neurologic disease
  • Late neurologic Lyme disease
  • Acrodermatitis chronica atrophicans
  • 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)
  • 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
  • Louse-Borne Relapsing Fever
  • Treatment
  • Preferred regimen: Penicillin 1.5 million units IV q6hr for 5-7 days
  • Less severe
  • Prophylaxis
  • Leptospira interrogans [28]
  • Syphilis Among non-HIV-Infected Persons[29]
  • 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
  • Latent Syphilis
  • 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
  • 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)
  • 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
  • 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
  • Syphilis Among HIV-Infected Persons
  • Primary and Secondary Syphilis Among HIV-Infected Persons
  • Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
  • Latent Syphilis Among HIV-Infected Persons
  • early latent
  • Preferred regimen: Benzathine penicillin G 2.4 million units IM in a single dose.
  • late latent
  • Preferred regimen: Benzathine penicillin G at weekly doses of 2.4 million units for 3 weeks.
  • 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
  • Syphilis During Pregnancy
  • Preferred regimen: Pregnant women should be treated with the penicillin regimen appropriate for their stage of infection
  • Congenital Syphilis in neonates
  • 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.
  • 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.
  • 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
  • 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.
  • 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

  • Enteric flora
  • Non-fermenters

Bacteria – Atypical Organisms

  • 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.
  • Pediatric
  • Preferred regimen (1):Erythromycin suspension,PO 50 mg/kg/day for 10 to 14 days
  • Preferred regimen (2):Clarithromycin suspension, 15 mg/kg/day for 10 days
  • Preferred regimen (3): Azithromycin suspension, PO 10 mg/kg once on the first day, followed by 5 mg/kg qd daily for 4 days
  • Upper respiratory tract infection[31]
  • Bronchitis
  • Antibiotic therapy for C. pneumoniae is not required.
  • Pharyngitis
  • Antibiotic therapy for C. pneumoniae is not required.
  • Sinusitis
  • Antibiotic therapy is advisable if symptoms remain beyond 7-10 days.
  • Chlaymydial infections [32]
  • Chlamydial Infections in Adolescents and Adults
  • Preferred regimen : Doxycycline 100 mg PO bid for 7 days OR Azithromycin 1 g PO in a single dose
  • Alternative regimen (1): Erythromycin base 500 mg PO qid for 7 days OR Erythromycin ethylsuccinate 800 mg PO qid for 7 days
  • Alternative regimen (2): Levofloxacin 500 mg PO qd for 7 days OR Ofloxacin 300 mg PO bid for 7 days.
  • Note: 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.
  • Chlamydial Infections in patients with HIV Infection
  • Pregancy
  • Chlamydial infection among neonates
  • Ophthalmia Neonatorumcaused by C. trachomatis
  • Preferred regimen :Erythromycin base or ethylsuccinate ,PO 50 mg/kg/ day divided into 4 doses daily for 14 days
  • Alternative regimen : Azithromycin suspension, PO 20 mg/kg /day qd for 3 days
  • Note: The mothers of infants who have chlamydial infection and the sex partners of these women should be evaluated and treated.
  • Infant Pneumonia
  • Preferred regimen :Erythromycin base or ethylsuccinate PO 50 mg/kg/ day divided into 4 doses daily for 14 days
  • Alternative regimen : Azithromycin suspension, PO 20 mg/kg /day qd for 3 days
  • Chlamydial infection among infants and childern
  • Infants and childern who weigh < 45 kg
  • Preferred regimen :Erythromycin base or ethylsuccinate PO 50 mg/kg/ day divided into 4 doses daily for 14 days
  • Infants and childern who weigh ≥45 kg but who are aged <8 years
  • Infants and childern aged ≥8 years
  • Lymphogranuloma venereum (LGV)
  • Lymphogranuloma venereum (LGV) is caused by C. trachomatis serovars L1, L2, or L3[33]
  • Preferred regimen : Doxycycline 100 mg PO bid for 21 days
  • Alternative regimen: Erythromycin base 500 mg PO qid for 21 days
  • Note (1): azithromycin 1 g orally once weekly for 3 weeks is probably effective based on its chlamydial antimicrobial activity. Fluoroquinolone-based treatments might also be effective, but extended treatment intervals are likely required.
  • Note (2): Patients should be followed clinically until signs and symptoms have resolved.
  • 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).
  • Adult
  • Pediatric
  • Preferred regimen: Azithromycin
  • Alternative regimen: fluoroquinolones
  • Pregnant Patients
  • Preferred regimen : Azithromycin
  • Alternative regimen: fluoroquinolones
  • Endocarditis in valve replacement patients
  • Preferred regimen : Doxycycline
  • Alternative regimen : fluoroquinolones.
  • Q fever [35]
  • Acute Q fever
  • Adults:
  • Preferred Regimen: DoxycyclinePO 100 mg bid for 14 days
  • Children
  • Children with age ≥8 years:
  • Preferred regimen:Doxycycline PO 2.2 mg/kg per dose bid for 14 days (maximum 100 mg per dose)
  • children with age <8 years with high risk criteria
  • Preferred regimen:Doxycycline PO 2.2 mg/kg per dose bid for 14 days (maximum: 100 mg per dose)
  • children with age <8 years with mild or uncomplicated illness:
  • Preferred regimen:Doxycycline PO 2.2 mg/kg per dose bid for 5 days (maximum 100 mg per dose). If patient remains febrile past 5 days of treatment: Trimethoprim/Sulfamethoxazole 4-20 mg/kg bid for 14 days (maximum: 800 mg per dose)
  • Pregnant women
  • Chronic Q fever
  • Endocarditis or vascular infection
  • Preferred regimen:Doxycycline PO 100 mg bid and Hydroxychloroquine PO 200 mg tid for ≥18 months
  • Note: childern and pregnant women- consultation Recommended
  • Noncardiac organ disease
  • Postpartumwith serologic profile for chronic Q fever
  • Preferred regimen:Doxycycline PO 100 mg bid and Hydroxychloroquine PO 200 mg tid for 12 months
  • Note: Women should only be treated postpartum if serologic titers remain elevated >12 months after delivery (immunoglobulin G phase I titer ≥1:1024). Women treated during pregnancy for acute Q fever should be monitored similarly to other patients who are at high risk for progression to chronic disease (e.g., serologic monitoring at 3, 6, 12, 18, and 24 months after delivery)
  • Note:Post-Q fever fatigue syndrome- no current recommendation


  • Legionella pneumonia (atypical bacterial pneumonia) [36]


  • Atypical pneumonia caused by Mycoplasma pneumoniae[37]
  • Preferred regimen (1): Azithromycin 500 mg PO day 1 and 250 mg day 2 to 5
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 14 days
  • Preferred regimen (3): Moxifloxacin 400 mg PO qd for 14 days
  • Urethritis and cervicitis caused due to Mycoplasma Genitalium[38]
  • Preferred regimen: Azithromycin 1 g PO single dose
  • Note(1): Resistant strains -Azithromycin PO in 500 mg single dose followed by 250 mg qd for 4 days
  • Note(2): previous treatment failures- Moxifloxacin PO 400 mg qd for 7, 10 or 14 days) has been successfully used to treat both men and women
  • PID caused due to Mycoplasma Genitalium

Bacteria – Miscellaneous

Bacteria – Anaerobic Gram-Negative Bacilli

Fungi

  • Mild to moderate pulmonary blastomycosis
  • Preferred regimen: Itraconazole 200 mg PO once or twice per day for 6–12 months
  • Note: Oral Itraconazole, 200 mg 3 times per day for 3 days and then once or twice per day for 6–12 months, is recommended
  • Moderately severe to severe pulmonary blastomycosis
  • Preferred regimen(1): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Preferred regimen(2): Amphotericin B deoxycholate 0.7–1 mg/kg per day for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Note: Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
  • Mild to moderate disseminated blastomycosis
  • Preferred regimen: Itraconazole 200 mg PO once or twice per day for 6–12 months
  • Note(1): Treat osteoarticular disease for 12 months
  • Note(2): Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
  • Moderately severe to severe disseminated blastomycosis
  • Preferred regimen(1): Lipid amphotericin B(Lipid AmB) 3–5 mg/kg per day, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Preferred regimen(2): Amphotericin B deoxycholate 0.7–1 mg/kg per day, for 1–2 weeks AND Itraconazole 200 mg PO bid for 6–12 months
  • Note: oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 6–12 months, is recommended
  • CNS disease
  • Preferred regimen: Lipid amphotericin B (Lipid AmB) 5 mg/kg per day for 4–6 weeks AND an oral azole for at least 1 year
  • Note(1): Step-down therapy can be with Fluconazole, 800 mg per day OR Itraconazole, 200 mg 2–3 times per day OR voriconazole, 200–400 mg twice per day.
  • Note(2): Longer treatment may be required for immunosuppressed patients.
  • Immunosuppressed patients
  • Preferred regimen(1): Lipid amphotericin B (Lipid AmB), 3–5 mg/kg per day, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
  • Preferred regimen(2): Amphotericin B deoxycholate, 0.7–1 mg/kg per day, for 1–2 weeks, AND Itraconazole, 200 mg PO bid for 12 months
  • Note(1): Oral Itraconazole, 200 mg 3 times per day for 3 days and then 200 mg twice per day, for a total of 12 months, is recommended
  • Note(2): Life-long suppressive treatment may be required if immunosuppression cannot be reversed.
  • Pregnant women
  • Preferred regimen: Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day
  • Note(1): Azoles should be avoided because of possible teratogenicity
  • Note(2): If the newborn shows evidence of infection, treatment is recommended with Amphotericin B deoxycholate, 1.0 mg/kg per day
  • Children with mild to moderate disease
  • Preferred regimen: Itraconazole 10 mg/kg PO per day for 6–12 months
  • Note: Maximum dose 400 mg per day
  • Children with moderately severe to severe disease
  • Preferred regimen(1): Amphotericin B deoxycholate 0.7–1 mg/kg per day for 1–2 weeks AND Itraconazole 10 mg/kg PO per day to a maximum of 400 mg per day for 6–12 months
  • Preferred regimen(2): Lipid amphotericin B (Lipid AmB) 3–5 mg/kg per day for 1–2 weeks AND Itraconazole 10 mg/kg PO per day to a maximum of 400 mg per day for 6–12 months
  • Note: Children tolerate Amphotericin B deoxycholate better than adults do.


  • Preferred regimen(1): Griseofulvin 10-20 mg/kg/day for minimum 6 weeks
  • Preferred regimen(2): Itraconazole 4-6 mg/kg pulsed dose weekly
  • Preferred regimen(3): Terbinafine if <20 kg: 62.5 mg/day, if 20-40 kg: 125 mg/day, if >40 kg: 250 mg/day
  • Small, well-defined lesions
  • Larger lesionss
  • Athlete's foot
  • Interdigital
  • “Dry type”
  • Preferred regimen: Terbinafine 250 mg/day PO for 2-4 weeks OR Itraconazole 400 mg/day PO for 1 week per month (repeated if necessary) OR Fluconazole 200 mg PO weekly for 4-8 weeks

Mycobacteria

Parasites – Intestinal Protozoa

Parasites – Extraintestinal Protozoa

Parasites – Intestinal Nematodes (Roundworms)

Parasites – Extraintestinal Nematodes (Roundworms)

Parasites – Trematodes (Flukes)

Parasites – Cestodes (Tapeworms)

Parasites – Ectoparasites

Viruses

References

  1. ↑ 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.
  2. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  3. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  4. ↑ 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.
  5. ↑ 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.
  6. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  7. ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
  8. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  9. ↑ 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.
  10. ↑ 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.
  11. ↑ 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.
  12. ↑ 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.
  13. ↑ 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.
  14. ↑ 14.0 14.1 14.2 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.
  15. ↑ 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.
  16. ↑ 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.
  17. ↑ 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.
  18. ↑ 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.
  19. ↑ 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.
  20. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  21. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  22. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  23. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  24. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  25. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  26. ↑ LastName, FirstName (2003). Human leptospirosis guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.
  27. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  28. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  29. ↑ 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.
  30. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  31. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  32. ↑ "Chlamydial Infections".
  33. ↑ "LGV".
  34. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  35. ↑ "q fever".
  36. ↑ 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.
  37. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  38. ↑ "mycoplasma genitalium".
  39. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  40. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  41. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
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