Sandbox/Alejandro: Difference between revisions

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==Neutropenia and Cellular Immune Deficient Patients==
{| style="border: 0px; font-size: 90%; margin: 3px;" align=center
 
|+
<SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Tuberculin Rection}}
 
! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|Considered a Positive Result in:}}
{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Neutropenia'''
</font>
</div>
 
<div class="mw-customtoggle-table25" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Bacteria'''
</font>
</div>
 
<div class="mw-customtoggle-table26" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Bacteria'''
</font>
</div>
 
<div class="mw-customtoggle-table27" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Fungi'''
</font>
</div>
 
 
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Cellular Immune Deficiency'''
</font>
</div>
 
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Bacteria'''
</font>
</div>
 
<div class="mw-customtoggle-table28" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Nocardia spp'''
</font>
</div>
 
<div class="mw-customtoggle-table29" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Atypical mycobacteria'''
</font>
</div>
 
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Fungi'''
</font>
</div>
 
<div class="mw-customtoggle-table30" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Cryptococcus spp'''
</font>
</div>
 
<div class="mw-customtoggle-table31" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Histoplasma spp'''
</font>
</div>
 
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Viruses'''
</font>
</div>
 
<div class="mw-customtoggle-table32" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Varicella-zoster virus'''
</font>
</div>
 
<div class="mw-customtoggle-table33" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Herpes simplex virus'''
</font>
</div>
 
<div class="mw-customtoggle-table34" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 250px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Cytomegalovirus'''
</font>
</div>
 
 
| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table25" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Buccal Cellulitis <br> ''(H. influenzae)''}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 5 mm '''
| style="padding: 5px 5px; background: #F5F5F5;" | 
*HIV-positive person
*Recent contacts of TB case
*Persons with nodular or fibrotic changes on CXR consistent with old healed TB
*Patients with organ transplants and other immunosuppressed patients
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 1-2 g IV q24h'''''
| style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 10 mm  '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Recent arrivals (less than 5 years) from high-prevalent countries
*Injection drug users
*Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
*Mycobacteriology lab personnel
*Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc)
*Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 15 mm '''
| style="padding: 5px 5px; background: #F5F5F5;" |
*Persons with no known risk factors for TB
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Meropenem]] 0.5-1 g IV q8h (infuse over 15-30 min or in bolus over 3-5 min) ''''' <br> OR <br> ▸ '''''[[Imipenem/cilastatin]] 250-1000 mg IV (max: 50mg/kg/day)'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left | <small>Adapted from N Engl J Med 2004;350:904-12.<ref>{{Cite journal
| author = [[Morton N. Swartz]]
| title = Clinical practice. Cellulitis
| journal = [[The New England journal of medicine]]
| volume = 350
| issue = 9
| pages = 904–912
| year = 2004
| month = February
| doi = 10.1056/NEJMcp031807
| pmid = 14985488
}}</ref></small>
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table26" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Orbital Cellulitis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen 1'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<small> (trough 15—20 μg/mL)</small>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 2g IV q24h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 1g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen 2'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<small> (trough 15—20 μg/mL)</small>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Piperacillin-tazobactam]] 4.5g IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''<br>(if penicillin or cephalosporin allergic)
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<small> (trough 15—20 μg/mL)</small>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table27" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Facial Cellulitis}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<small> (trough 15—20 μg/mL)</small>
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Daptomycin]] 4 mg/kg IV q24h''''' <br> OR <br> ▸ '''''[[Linezolid]] 600mg IV q12h'''''
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table28" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Salt Water Wound Exposure <br> ''(Vibrio vulnificus)''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 200 mg IV initial dose, then 50-100 mg IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 1-2 g IV/IM q8-12 (up to 2 g q4-6h)''''' <br> OR <br> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8-12h  x 7-14 days'''''<br> OR <br> ▸ '''''[[Ciprofloxacin]] 500-750 mg PO q8-12h  x 7-14 days'''''
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table29" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Fresh Water Wound Exposure <br> ''(Aeromonas spp)''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ciprofloxacin]] 400mg IV q12h''''' <br> OR <br> ▸ '''''[[Ceftazidime]] 0.5 -2 g IV q8h''''' <BR> PLUS <BR>
▸ '''''[[Gentamicin]] 3-5 mg/kg/day IV/IM divided q6-8h or 4-7 mg/kg IV q24h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Meropenem]] 0.5-1 g IV q8h (infuse over 15-30 min or in bolus over 3-5 min)''''' <br> OR <br>  ▸ '''''[[Imipenem/cilastatin]] 250-1000 mg IV  (max: 50mg/kg/day)'''''
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table30" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Butcher, Fisherman, Veterinarian <br> ''(Erysipelothrix rhusiopathiae)''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin]] 500 mg PO q8hr'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left |▸ '''''[[Cefotaxime]] 1-2 g IV/IM q8-12 (up to 2 g q4-6h)''''' <br> OR <br> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8-12h  x 7-14 days'''''<br> OR <br> ▸ '''''[[Ciprofloxacin]] 500-750 mg PO q8-12h  x 7-14 days''''' <br> OR <br>  ▸ '''''[[Imipenem]]-cilastatin 250-1000 mg IV  (max: 50mg/kg/day)'''''
|}
|}
|}
|}

Latest revision as of 13:10, 4 September 2014

Tuberculin Rection Considered a Positive Result in:
≥ 5 mm
  • HIV-positive person
  • Recent contacts of TB case
  • Persons with nodular or fibrotic changes on CXR consistent with old healed TB
  • Patients with organ transplants and other immunosuppressed patients
≥ 10 mm
  • Recent arrivals (less than 5 years) from high-prevalent countries
  • Injection drug users
  • Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.)
  • Mycobacteriology lab personnel
  • Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc)
  • Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories
≥ 15 mm
  • Persons with no known risk factors for TB
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