Sandbox ID Systemic: Difference between revisions

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Babesiosis

1. Mild/moderate disease^[1]

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.

Bartonella

Bartonella^[2]

1. Bartonella quintana

1.1 Acute or chronic infections without endocarditis^[3]

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^[4]

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^[4]

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^[5]

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^[6]

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^[7]

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^[7]

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

Botulism

Botulism

1.Foodborne botulism^[8]

1.1 Adult

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min

1.2 Children

1.2.1 Children < 1 year

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (10% of adult dose regardless of body weight)

1.2.1 Children 1-17 years

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (20 – 100% of adult dose)
Note:Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. A patient with severe botulism may require a ventilator as well as intensive medical and nursing care for several months.

2. Infant botulism^[9]

Preferred regimen: BabyBIG, Botulism Immune Globulin Intravenous (Human) (BIG-IV) is for the treatment of patients below one year of age.The recommended total dosage is 1mL/kg (50mg/kg), given as a single IV infusion as soon as the clinical diagnosis of infant botulism is made
Note: infant with botulism must receive supportive care during their recovery. This includes ensuring proper nutrition,keeping the airway clear,watching for respiratory failure and if it develops,ventilator may be needed.

3. Wound botulism

3.1 Adult

Preferred regimen (adult): Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min

3.2 Children

3.2.1 Children < 1 year

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (10% of adult dose regardless of body weight)

3.2.2 Children 1-17 years

Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.01 mL/kg/min; incremental infusion rate if tolerated (every 30 minutes): 0.01 mL/kg/min ; maximum infusion rate: 0.03 mL/kg/min (20 – 100% of adult dose)
Note (1): Physicians may try to remove contaminated food still in the gut by inducing vomiting or by using enemas. A patient with severe botulism may require a ventilator as well as intensive medical and nursing care for several months.
Note (2): For wound botulism, antibiotics are used in addition to appropriate debridement.
Note (3): Antibiotic therapy is recommended for wound botulism after antitoxin has been administered. Penicillin G 3 MU IV q4h in adults is frequently used. Metronidazole 500 mg IV q8h may be used as an alternative for penicillin-allergic patients.

Boutonneuese fever

Boutonneuese fever^[10]

1. Adult

Preferred regimen (1): Doxycycline 200 mg PO bid for 1 day
Preferred regimen (2): Doxycycline 200 mg or 100 mg PO bid for 2-5 days
Alternative regimen (1): Josamycin 1g q8h for 7 days
Alternative regimen (2):Ciprofloxacin

2. Children

Preferred regimen (Children <100 lbs): Doxycycline 2.2 mg/kg PO bid
Preferred regimen (Children >100lbs): Doxycycline 200 mg PO bid in one day and 200 mg bid/qid or 100 mg bid for 2-5 days
Alternative regimen (Children <8 years) (1): Josamycin 2.2mg/kg q12h for 5 days
Alternative regimen (Children <8 years) (2): Clarithromycin 15 mg/ kg in bid for 7 days AND Azithromycin 10 mg/kg/day qd for 3 days

Diphtheria

Diphtheria treatment ^[11]

Preferred Regimen (1): Erythromycin 40 mg/kg/day; maximum, 2 gm/day) PO for 14 days
Preferred Regimen (2): Procaine penicillin G 3MU/day (for weight < 10 kg ) IM q24h for 14 days & 6MU/day (for weight >10 kg ) IM q24h for 14 days
Note: Since 1997, diphtheria antitoxin has been available only from CDC, through an Investigational New Drug (IND) protocol.

Fever of unknown origin

Fever of unknown origin (FUO)^[12]

Management should generally be withheld until the etiology of the fever has been ascertained, so that treatment can be directed against a specific pathology.
Specific clinical considerations

1.Neutropenic fever

Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications.
After samples for cultures are obtained, patients with febrile neutropenia should be aggressively treated with broad-spectrum antibiotics covering Pseudomonas

2.HIV/AIDS individuals

HIV/AIDS individuals with pyrexia and hypoxia should be placed on empiric therapy for Pneumocystis jirovecii.

3.Giant cell arteritis

Empiric corticosteroids may be considered in patients with suspected giant cell arteritis to prevent vascular complications.
Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms:

Newly onset headaches
Abrupt onset of blurry vision
Symptoms of polymyalgia rheumatica
Jaw claudication
Unexplained anemia
Elevated ESR and/or CRP

Lymphangitis

1.Lymphangitis treatment

Preferred regimen: Dicloxacillin

Preferred regimen: Cephalexin 500 mg PO qid for 1 week

2. Patient with lymphangitis and if Community-Associated Methicillin-Resistant Staphylococcus Aureus (CA-MRSA) suspected:

Trimethoprim-sulfamethoxazole PO bid AND vancomycin 1 g IV every 12 hr

3.Patient with lymphangitis allergic to penicillin:

Clindamycin 300 mg PO qid for 7 days OR Erythromycin 500 mg PO qid for 7 days OR Levofloxacin 500 mg PO daily OR Moxifloxacin 400 mg PO daily for 7 days.

Neutropenic fever, prophylaxis

Neutropenic fever, prophylaxis^[13]

1.Low risk (standard chemotherapy regimen for soild tumor, anticipated neutropenia < 7 days)

Antibacterial agent: none
Antifungal agent: none
Antiviral agent: none unless prior HSV episode

2. Intermediate risk (autologous HSCT, lymphoma, multiple myeloma, CLL, Purine analog therapy [i.e., Fludarabine, Clofarabine, Nelarabine, Cladribine], anticipated neutropenia 7-10 days)

2.1 Antibacterial agent: consider fluroquinolone prophylaxis
2.2 Antifungal agent: consider fluconozole during neutropenia and for anticipated mucositis
2.3 Antiviral agent:

2.3.1 HSV prophylaxis

Preferred regimen (1): Acyclovir 400-800 mg PO bid
Preferred regimen (2): Famciclovir 250 mg PO bid
Preferred regimen (3): Valacyclovir 500 mg PO bid-tid

2.3.2 VZV prophylaxis

Preferred regimen (1): Acyclovir 800 mg PO bid (in allogeneic HSCT)
Preferred regimen (2): Famciclovir 250 mg PO bid
Preferred regimen (3): Valacyclovir 500 mg PO bid-tid

Note (1): Antiviral agents should be administered during active therapy and for at least 30 days after HSCT.

Note (2): Consider VZV prophylaxis for at least 1 year after allogeneic HSCT and for at least 6-12 months after autologous HSCT.

3.High risk (acute leukemia, Alemutuzumab therapy, in allogenic HSCT including cord blood, GVHD treated with high dose steriods, anticipated neutropenia > 10 days)

3.1 Antibacterial agent: Levofloxacin 500-750 mg PO/IV q24h
3.2 Antifungal agent:

3.2.1 ALL

Preferred regimen: Fluconazole in adult with normal renal function 400 mg IV/ PO daily
Alternative regimen: Amphotericin B

3.2.2 MDS or AML

Preferred regimen: Posaconazole EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
Alternative regimen: Voriconazole 6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h until resolution of neutropenia
Alternative regimen: Fluconazole in adult with normal renal function 400mg IV/PO q24h
Alternative regimen: Amphotericin B until resolution of neutropenia

3.2.3 Autologous HSCT with mucositis

Preferred regimen: Fluconazole 400mg IV/PO q24h (in adult with normal renal function) OR Micafungin 50-100mg/ d IV until resolution of neutropenia

3.2.4 Allogenic HSCT

Preferred regimen: Fluconazole 400mg IV/PO q24h (in adult with normal renal function) OR Micafungin 50-100mg/ d IV until resolution of neutropenia
Alternative regimen (1): Itraconazole
Alternative regimen (2): Voriconazole 6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h
Alternative regimen (3): Posaconazole EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
Alternative regimen (4): Amphotericin B continue during neutropenia and for at least 75 days after transplant

3.2.5 Significant GVHD

Preferred regimen: Posaconazole EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
Alternative regimen (1): Voriconazole6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h
Alternative regimen (2): Echinocandin
Alternative regimen (3): Amphotericin B until resolution of Significant GVHD

3.3 Antiviral agent:

3.3.1 Acute Leukemia

HSV prophylaxis

Preferred regimen (1): Acyclovir 400-800 mg PO bid
Preferred regimen (2): Famciclovir 250 mg PO bid
Preferred regimen (3): Valacyclovir 500 mg PO bid-tid

Proteasome inhibitors

VZV prophylaxis

Preferred regimen (1): Acyclovir 800 mg PO bid (in allogeneic HSCT)
Preferred regimen (2): Famciclovir 250 mg PO bid
Preferred regimen (3): Valacyclovir 500 mg PO bid-tid

Note (1): Antiviral agents should be administered during active therapy and for at least 30 days after HSCT.

Note (2): Consider VZV prophylaxis for at least 1 year after allogeneic HSCT and for at least 6-12 months after autologous HSCT.

Alemutuzumab Therapy, allogenic HSCT ,GVDH requiring steriod treatment

HSV prophylaxis

Preferred regimen (1): Acyclovir 400-800 mg PO bid
Preferred regimen (2): Famciclovir 250 mg PO bid
Preferred regimen (3): Valacyclovir 500 mg PO bid-tid

VZV prophylaxis

Preferred regimen (1): Acyclovir 800 mg PO bid (in allogeneic HSCT)
Preferred regimen (2): Famciclovir 250 mg PO bid
Preferred regimen (3): Valacyclovir 500 mg PO bid-tid

Note (1): Antiviral agents should be administered during active therapy and for at least 30 days after HSCT.

Note (2): Consider VZV prophylaxis for at least 1 year after allogeneic HSCT and for at least 6-12 months after autologous HSCT.

Anti CMV prophylaxis

Allogenic stem cell transplant (surveillance period: 1-6 months after transplant, GVDH requiring therapy)

Preferred regimen: Valganciclovir900 mg daily PO OR Ganciclovir5 mg / kg IV q 12 h for 2 weeks followed by 5-6mg / kg daily for at least an additional 2-4 weeks and resolution of all symptoms
Alternative regimen: Foscarnet 60 mg / kg IV q 8-12 h for 7 d followed by 90-120mg / kg daily until day 100 after HSCTOR Cidofovir IV

Alemtuzumab therapy (suveillance period: for a minimum of 2 months after alemtuzumab)

Preferred regimen: Valganciclovir 900 mg daily PO OR Ganciclovir5 mg / kg IV q 12 h for 2 weeks followed by 5-6mg / kg daily for at least an additional 2-4 weeks and resolution of all symptoms
Alternative regimen: Foscarnet 60 mg / kg IV q 8-12 h for 7 d followed by 90-120mg / kg daily until day 100 after HSCT OR Cidofovir IV

Anti Pneumocystis prophylaxis

Duration of prophylaxis:

Allogenic stem cell recipients: for at least 6 months and while receving immunosuppresive therapy
Acute lymphocytic leukemia: throughout anti-leukemic therapy
Alemtuzumab therapy: for a minimum of 2 months after Alemtuzumab and until CD4 count > 200 cells/mcL

Preferred regimen: TMP/SMZ
Alternative regimen (if TMP-SMZ intolerant): Atovaquone OR Dapsone OR Pentamidine aersolized or IV

Note: Anti-Pneumocystis prophylaxis may be considered in (1) recipients of purine analog therapy and other T-cell-depleting agents; (2) recipients of prolonged corticosteroids or receiving temozolomide + radiation therapy; and (3) autologous stem cell recipients.

HBV prophylaxis

Allogenic stem cell transplant, Anti CD20 or Anti CD52 monoclonal antibodies

Therapy considerations

ID consult to determine possible antiviral prophylaxis, consider delayed transplant if active infection

Antiviral therapy

Preferred regimen (1): Entecavir0.5 mg PO q24h ( nucleoside- treatment- naive with compensated liver disease) or 1 mg PO 24 h ( lamivudine - refractory or known Lamivudine or telbivudine resistance mutation or decompensated liver disease
Preferred regimen (2): Tenofovir300 mg PO q 24 h
Preferred regimen (3): Lamivudine 100mg PO q 24 h
Preferred regimen (4): Adefovir 10mg PO q 24 h
Preferred regimen (5): Telbivudine60 mg PO q 24 h

Surveillance

At least 6-12 months following conclusion of treatment

Prophylaxis in HIV

Chemotherapy, targeted therapies

Therapy considerations

ID consult to adjust dosing and regimen for concurrent treatment

Antiviral therapy

Preferred regimen: antiretroviral therapy

Surveillance

Monthly during therapy then as clinically indicated

Neutropenic fever, treatment

Salmonella bacteremia

1. Salmonella bacteremia treatment

Preferred regimen: Ciprofloxacin 400 mg IV q12h AND Ceftriaxone 1 to 2 g IV q12-24h^[14]

2.When the salmonellae are known to be susceptible

Preferred regimen: Ampicillin 1 to 2 g IV q4-6h
Preferred regimen: Trimethoprim-sulfamethoxazole 8 mg/kg/day PO

Clostridial toxic shock syndrome

Clostridium sordelli toxic shock syndrome ^[15]

Preferred regimen (1): Ampicillin 250-500 mg IV/IM q4-8h
Preferred regimen (2): Amoxicillin-clavulanate 250-500 mg PO bid/tid
Preferred regimen (3): Piperacillin-tazobactam 4.5 g IV q8h
Preferred regimen (4): Ticarcillin 3.1 g IV q8h
Preferred regimen (5): Clindamycin 600 to 900 mg IV q8h
Preferred regimen (6): Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
Preferred regimen (7): Imipenem 500 mg IV q6h
Preferred regimen (8): Linezolid 600 mg IV/PO q12h
Preferred regimen (9): Metronidazole 30 mg/kg/24 hr PO/IV q6h (maximum dose: 4 g/24 hr)
Note (1): Clostridium sordellii is a cause of toxic shock syndrome (CSTS) associated with gynecologic procedures, childbirth, and abortion (including spontaneous, surgical, and medical abortion). Gastrointestinal and vaginal colonization of Clostridium sordellii can occur in healthy individuals.
Note (2): Treatment of Clostridium sordellii toxic shock syndrome consists of antibiotic therapy, surgical debridement, and aggressive resuscitation

Staphylococcal toxic shock syndrome

Staphylococcal toxic shock syndrome ^[16]

1. Methicillin sensitive Staphylococcus aureus

Preferred regimen (1): Cloxacillin 250-500 mg PO qid (maximum dose: 4 g/24 hr)
Preferred regimen (2): Nafcillin 4-12 g/24 hr IV q4-6hr (maximum dose: 12 g/24 hr)
Preferred regimen (3): Cefazolin 0.5-2g IV/IM q8h (maximum dose: 12 g/24 hr), AND Clindamycin 150-600 mg IV/IM/PO q6-8h (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
Alternative regimen (1): Clarithromycin 250-500 mg PO q12h (maximum dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV/IM/PO q6-8h (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
Alternative regimen (1): Rifampicin, AND Linezolid 600 mg IV/PO q12hr
Alternative regimen (2): Daptomycin
Alternative regimen (3): Tigecycline 100 mg IV loading dose followed by 50 mg q12h

2. Methicillin resistant Staphylococcus aureus

Preferred regimen: Clindamycin 150-600 mg q6-8h IV/IM/PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
Preferred regimen: Linezolid 600 mg IV/PO q12h AND (Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose or Teicoplanin)
Alternative regimen (1): Rifampicin AND Linezolid 600 mg IV/PO q12h
Alternative regimen (2): Daptomycin
Alternative regimen (3): Tigecycline 100 mg loading dose followed by 50 mg IV q12h

3. Glycopeptide resistant or intermediate Staphylococcus aureus

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

Streptococcal toxic shock syndrome

Streptococcal toxic shock syndrome ^[16]

1. Group A streptococcus

Preferred regimen: Penicillin G, 2–4 MU IV q4–6h AND Clindamycin 600–900 mg q8h IV, (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
Alternative regimen (1): (Macrolide Azithromycin 500 mg PO day 1 followed by 250 mg for 4 days
Alternative regimen (2): Fluoroquinolone Oxacillin 2-12 g/24 hr divided q4-6h IV (maximum dose: 12 g/24 hr)), AND Clindamycin 150-600 mg q6-8h IV, IM, or PO (max dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
Alternative regimen (3): Linezolid 600 mg IV/PO q12h
Alternative regimen (4): Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg q12h IV
Note: Macrolide and Fluoroquinolone resistance increasing

2. Macrolide, lincosamide, and streptogramin B (MLS) resistant group A streptococcus

Preferred regimen: Penicillin G 2-24 MU/24h IV/IM q4-6h AND (Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g/dose OR Teicoplanin)
Alternative regimen (1): Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g/dose OR Teicoplanin
Alternative regimen (2): Linezolid 600 mg IV/PO q12h
Alternative regimen (3): Daptomycin
Alternative regimen (4): Tigecycline 100 mg IV loading dose followed by 50 mg q12h
Alternative regimen (5): Teicoplanin
Note: Macrolide resistance associated with Clindamycin resistance

Typhus, louse-borne

Louse born typhus, Rickettsia prowazekii (epidemic typhus, sylvatic typhus and Brill–Zinsser typhus ^[10]

Pathogen-directed antimicrobial therapy

In adults

Preferred regimen (1): Doxycycline 200 mg PO for 5 days or 2-3 days after defervescence
Preferred regimen (2): Doxycycline 100-200 mg PO single dose in outbreak situation
Alternative regimen: Chloramphenicol 60 to 75 mg/kg/day PO in four divided doses

In childern

Preferred regimen (1): Doxycycline 100-200 mg PO single dose

In pregnant women

Preferred regimen: Doxycycline 100-200 mg PO single dose

Typhus, murine

Murine typhus,Rickettsia typhi (flea-borne infection) ^[10]

Pathogen-directed antimicrobial therapy

1. Adults

Preferred regimen : Doxycycline 100 mg PO bid continued for 3 days after the symptoms have resolved, Doxycycline 100-200 mg, PO single dose
Alternative regimen (1): Oxacillin 2-12 g/24 hr IV q4-6h IV (maximum dose: 12 g/24)
Alternative regimen (2): Chloramphenicol 60 to 75 mg/kg/day PO in qid

2. Childern

Preferred regimen: Doxycycline 100-200 mg, PO for 3-7 days
Alternative regimen: Chloramphenicol 50-75 mg/kg/24 hr IV/PO q 6-8 hr

3. Pregnant women

Preferred regimen: Doxycycline 100-200 mg, PO single dose ( late trimester)
Alternative regimen (1): Erythromycin Base: 333 mg PO tid or estolate/stearate/ base: 250-500 mg PO qid
Alternative regimen (2): Chloramphenicol 50 mg/kg/24 hr IV/PO q6h (maximum dose: 4 g/24 hr) (early trimester: first and second trimesters)

Typhus, scrub

Scrub typhus, Orientia tsutsugamushi (previously called Rickettsia tsutsugamushi- mite-borne infectious disease) ^[17]

Pathogen-directed antimicrobial therapy

Preferred regimen (1): Doxycycline 100 mg PO/IV q12h for 3 days
Preferred regimen (2): Chloramphenicol 500 mg PO/IV q6h
Alternative regimen: Azithromycin 500 mg PO day 1 followed by 250 mg for 4 days

Anaplasmosis

Human granulocytic anaplasmosis, suspected or symptomatic ^[18]

Preferred regimen: Doxycycline 100 mg PO bid (or IV for those patients unable to take an oral medication) for 10 days
Alternative regimen: Rifampin 300 mg PO bid for 7–10 days (For patients with mild illness due to HGA who are not optimally suited for doxycycline treatment because of a history of drug allergy, pregnancy, or age <8 years)
Pediatric regimen:

Children ≥ 8 years of age

Preferred regimen: Doxycycline 4 mg/kg/day PO bid (Maximum, 100 mg/dose) (or IV for children unable to take an oral medication) for 10 days

Children < 8 years of age

Preferred regimen: Rifampin 10 mg/kg bid (Maximum, 300 mg/dose) for 4-5 days

Note (1): If the patient has concomitant Lyme disease, then Amoxicillin 50 mg/kg/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) should be initiated at the conclusion of the course of Doxycycline to complete a 14-day total course of antibiotic therapy
Note (2): Rifampin is not effective therapy for Lyme disease, patients coinfected with B. burgdorferi should also be treated with Amoxicillin OR Cefuroxime axetil

Brucellosis

1. Uncomplicated brucellosis in adults ^[19]

Preferred regimen (1): (Streptomycin 1 g IM q24h for the first 2-3 weeks of therapy OR Gentamicin 5 mg/kg/day IV/IM for 7-10 days) AND Doxycycline 100 mg PO bid for six weeks

Preferred regimen (2): (Streptomycin 1 g IM q24h for the first 2-3 weeks of therapy OR Gentamicin 5 mg/kg/day IV/IM for 7-10 days) AND Tetracycline 500 mg PO qid for at least six weeks
Alternative regimen (1): Doxycycline 200 mg/day PO for 6 weeks AND Rifampicin 600–900 mg/day PO for six weeks
Alternative regimen (2): Fluoroquinolones
Note (1): Quinolones should always be used in combination with other drugs, such as Doxycycline or Rifampicin
Alternative regimen (3): TMP/SMZ 80 mg TMP/400 mg SMZ (in a fixed ratio of 1:5)
Note (2): TMP/SMZ should always be used in combination with another agent, such as Doxycycline, Rifampicin or Streptomycin

2. Complications of brucellosis

2.1 Spondylitis

Continuation of Doxycycline for eight weeks or more; Surgical drainage is rarely necessary.

2.2 Neurobrucellosis

Rifampicin OR Trimethoprim/sulfamethoxazole, be added to the standard regimen of Doxycycline and Streptomycin for 6-8 weeks, and possibly longer, depending on the clinical response

2.3 Brucella endocarditis

Preferred regimen: Doxycycline AND an Aminoglycoside for at least eight weeks
Note: Therapy should be continued for several weeks after surgery when valve replacement is necessary

3. For children

3.1 less than eight years of age

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

3.2 eight years of age and older

See adult treatment

Ehrlichiosis

Ehrlichiosis, suspected Invalid parameter in <ref> tag

Preferred regimen: Doxycycline 100 mg IV q12h for 7-14 days
Alternative regimen (1): Chloramphenicol
Alternative regimen (2): Rifampin
Pediatric regimen: Doxycycline 2.2 mg/kg PO bid (Children under 45 kg (100 lbs)) 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

Tularemia

For treatment and prophylaxis ^[20]

Preferred regimen: Gentamicin 5 mg/kg/day PO bid
Alternative regimen (1): Streptomycin 2 g/day IM q12h for 10 days
Alternative regimen (2): Ciprofloxacin 800–1000 mg/day IV/PO q12h/bid for 10–14 days
Alternative regimen (3): Doxycycline 200 mg/day PO bid for at least 15 days
Pediatric regimen: Gentamicin 5–6 mg/kg/day q8-12h for at least 10 days; Streptomycin 15 mg/kg PO bid (Maximum, 2 g/day) for at least 10 days; Ciprofloxacin 15 mg/kg PO bid (Maximum, 1 g/day) for at least 10 days

Typhoid fever

1. Uncomplicated typhoid fever^[21]

1.1 Fully sensitive

Preferred regimen (1): Ofloxacin 15 mg/kg/day for 5-7 days

Preferred regimen (2): Ciprofloxacin 15 mg/kg/day for 5-7 days
Alternative regimen (1): Chloramphenicol 50-75 mg/kg/day for 14-21 days
Alternative regimen (2): Amoxicillin 75-100 mg/kg/day for 14 days
Alternative regimen (3): TMP-SMX 8-40 mg/kg/day for 14 days

1.2 Multidrug resistance

Preferred regimen (1): Fluoroquinolone 15 mg/kg/day for 5-7 days

Preferred regimen (2): Cefixime 15-20 mg/kg/day for 7-14 days
Alternative regimen (1): Azithromycin 8-10 mg/kg/day for 7 days
Alternative regimen (2): Cefixime 15-20 mg/kg/day for 7-14 days

1.3 Quinolone resistance

Preferred regimen (1): Azithromycin 8-10 mg/kg/day for 7 days

Preferred regimen (2): Ceftriaxone 75 mg/kg/day for 10-14 days
Alternative regimen: Cefixime 20 mg/kg/day for 7-14 days

2. Severe typhoid fever

2.1 Fully sensitive

Preferred regimen: Ofloxacin 15 mg/kg/day for 10-14 days
Alternative regimen (1): Chloramphenicol 100 mg/kg/day for 14-21 days
Alternative regimen (2): Amoxicillin 100 mg/kg/day for 14 days
Alternative regimen (3): TMP-SMX 8-40 mg/kg/day for 14 days

2.2 Multidrug resistant

Preferred regimen: Fluoroquinolone 15 mg/kg/day for 10-14 days
Alternative regimen (1): Ceftriaxone 60 mg/kg/day for 10-14 days
Alternative regimen (2): Cefotaxime 80 mg/kg/day for 10-14 days

2.3 Quinolone resistant

Preferred regimen (1): Ceftriaxone 60 mg/kg/day for 10-14 days

Preferred regimen (2): Cefotaxime 80 mg/kg/day for 10-14 days
Alternative regimen: Fluoroquinolone 20 mg/kg/day for 7-14 days

Kawasaki syndrome

1. Initial treatment ^[22]

Preferred regimen: IVIG 2 g/kg single infusion within the first 7-10 days of illness AND Aspirin 80-100 mg/kg/day qid , reduce the aspirin dose after the child has been afebrile for 48 to 72 hours, then begin low-dose aspirin (3 to 5 mg/kg/day) and maintain it until the patient shows no evidence of coronary changes by 6 to 8 weeks after the onset of illness
Note (1): Other clinicians continue highdose aspirin until day 14 of illness and 48 to 72 hours after fever cessation
Note (2): For children who develop coronary abnormalities, aspirin may be continued indefinitely

2. Treatment of Patients Who Failed to Respond to Initial Therapy (persistent or recrudescent fever ≥ 36 hours after completion of the initial IVIG infusion)

Preferred regimen: IVIG 2 g/kg q24h for 1-3 days OR Methylprednisolone 30 mg/kg IV for 2-3 hours q24h for 1-3 days

Leptospirosis

1. Severe ^[23]

High doses of Penicillin IV

2. Less severe

Preferred regimen: Amoxycillin OR Ampicillin OR Doxycycline OR Erythromycin
Alternative regimen: Ceftriaxone OR Cefotaxime OR Quinolone
Note (1): Treatment with effective antibiotics should be initiated as soon as the diagnosis of leptospirosis is suspected and preferably before the fifth day after the onset of illness
Note (2): Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics because serological tests do not become positive until about a week after the onset of illness, and cultures may not become positive for several weeks.

Rocky Mountain spotted fever

R. rickettsii Invalid parameter in <ref> tag

Preferred regimen: Doxycycline 100 mg q12h
Alternative regimen: Chloramphenicol
Pediatric regimen: Doxycycline 2.2 mg/kg PO bid (under 45 kg (100 lbs))
Note: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement; Standard duration of treatment is 7-14 days.

Relapsing fever

1. Tick-Borne Relapsing Fever ^[24]

Preferred regimen: Doxycycline 100 mg PO bid for 5-10 days
Alternative regimen: Erythromycin 500 mg PO qid 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: Tetracycline 500 mg PO single dose
Alternative regimen: Erythromycin 500 mg PO single dose

Tetanus

1. General measures Invalid parameter in <ref> tag

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. Antitoxin and other immunotherapy

Preferred regimen: Human TIG 500 U IM/IV as soon as possible AND Age-appropriate TT-containing vaccine, 0.5 cc IM 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 (1): Metronidazole 500 mg PO/IV qid/q6h

Preferred regimen (2): Penicillin G 100,000–200,000 IU/kg/day IV q6-12h
Alternative regimen (1): Tetracyclines

Alternative regimen (2): Macrolides

Alternative regimen (3): Clindamycin

Alternative regimen (4): Cephalosporins

Alternative regimen (5): Chloramphenicol

4. Muscle spasm control

Preferred regimen: Diazepam 5 mg IV OR Lorazepam 2 mg
Note: Lorazepam should be titrated to achieve spasm control without excessive sedation and hypoventilation
Alternative regimen (1): Magnesium sulphate 5 gm (or 75mg/kg) IV THEN 2–3 gm/hr 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 IV/PO q4h

Alternative regimen (3): Barbiturates 100–150 mg q1-4h

Alternative regimen (4): Chlorpromazine 50–150 mg IM q4–8h
Pediatric regimen: Lorazepam 0.1–0.2 mg/kg q2–6h, titrating upward as needed; Barbiturates 6–10 mg/kg by any route; Chlorpromazine 4–12 mg IM q4–8h
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

Lymphadenitis

Lymphadenitis

Pathogen-directed antimicrobial therapy

1. Nocardia^[25]

Preferred regimen: TMP-SMX 5–10 mg/kg/day (TMP component) IV/PO q6-12h for 3 months
Alternative regimen (1): Sulfisoxazole 2 g PO qid for 3 months

Alternative regimen (2): Minocycline 100-200 mg PO bid for 3 months

2. Bartonella henselae (cat-scratch disease)^[26]

Preferred regimen (adult): Azithromycin 500 mg PO single dose THEN 250 mg/day for 4 days
Preferred regimen (pediatric): Azithromycin 10 mg/kg PO single dose THEN 5 mg/kg/day for 4 days

Sepsis, adult

1. Sepsis, adult

1.1 Empiric antimicrobial therapy^[27]

1.1.1 History of intravenous drug use with high prevalence of MRSA

Perferred regimen: Vancomycin 1 g IV q12h

1.1.2 Sepsis associated with petechiae

Perferred regimen: Ceftriaxone 2 g IV q12h

1.1.3 Biliary source

Perferred regimen (1): Ampicillin-Sulbactam 3 g IV q6h

Perferred regimen (2): Piperacillin-Tazobactam 3.375 g IV q4h

Perferred regimen (3): Ticarcillin-Clavulanate 3.1 g IV q4h

1.1.4 Community-acquired pneumonia

Perferred regimen: (Levofloxacin 750 mg IV q24h OR Moxifloxacin 400 mg IV q24h) AND Piperacillin-Tazobactam 3.375 g IV q4h AND Vancomycin 1 g IV q12h

1.1.5 Unclear infection source

Perferred regimen: (Doripenem 500 mg IV q8h OR Ertapenem 1 g IV q24h OR Imipenem 0.5 g IV q6h OR Meropenem 1 g IV q8h) AND Vancomycin 1 g IV q12h

1.1.6 Low prevalence of ESBL and/or carbapenemase-producing aerobic GNB

Perferred regimen: Piperacillin-Tazobactam 3.375 g IV q4h AND Vancomycin 1 g IV q12h

1.1.7 High prevalence of ESBL and/or carbapenemase-producing aerobic GNB

Perferred regimen: Colistin 2.5 mg/kg single dose followed by 1.5 mg/kg IV q12h AND Meropenem 1 g IV q8h AND Vancomycin 1 g IV q12h

Sepsis, pediatric

1. Sepsis, pediatric

1.1 Empiric antimicrobial therapy^[28]

1.1.1 Children aged > 1 month

Preferred regimen: (Cefotaxime 50 mg/kg IV q8h OR Ceftriaxone 100 mg/kg IV q24h) AND Vancomycin 15 mg/kg IV q6h
Alternative regimen: Aztreonam 7.5 mg/kg IV q6h AND Linezolid 10 mg/kg IV q8h

1.1.2 Children aged < 1 month

Preferred regimen: Ampicillin 25 mg/kg IV q8h AND Cefotaxime 50 mg/kg q12h ± Vancomycin 15 mg/kg IV q12h (if suspecting MRSA)
Alternative regimen: Ampicillin 25 mg/kg IV q6h AND Ceftriaxone 75 mg/kg IV q24h ± Vancomycin 15 mg/kg IV q12h (if suspecting MRSA)

References

↑ 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.
↑ 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.
↑ ^4.0 ^4.1 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.
↑ 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.
↑ ^7.0 ^7.1 Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.
↑ "CDC Drug Service".
↑ "BabyBIG".
↑ ^10.0 ^10.1 ^10.2 Botelho-Nevers E, Socolovschi C, Raoult D, Parola P (2012). "Treatment of Rickettsia spp. infections: a review". Expert Rev Anti Infect Ther. 10 (12): 1425–37. doi:10.1586/eri.12.139. PMID 23253320.
↑ "diptheria".
↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
↑ "neutropenic fever prophylaxis" (PDF).
↑ Goldman, Lee (2012). Goldman's Cecil Medicine, Twenty-Fourth Edition. Saunders, an imprint of Elsevier Inc. ISBN 978-1-4377-1604-7.
↑ Aldape MJ, Bryant AE, Stevens DL (2006). "Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment". Clin Infect Dis. 43 (11): 1436–46. doi:10.1086/508866. PMID 17083018.
↑ ^16.0 ^16.1 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.
↑ Panpanich R, Garner P (2002). "Antibiotics for treating scrub typhus". Cochrane Database Syst Rev (3): CD002150. doi:10.1002/14651858.CD002150. PMID 12137646.
↑ Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS; et al. (2006). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130.
↑ Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.
↑ LastName, FirstName (2007). WHO guidelines on tularaemia epidemic and pandemic alert and response. Geneva: World Health Organization. ISBN 9789241547376.
↑ "The diagnosis, treatment and prevention of typhoid fever" (PDF).
↑ "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease".
↑ 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.
↑ 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.
↑ Dellinger, R. Phillip; Levy, Mitchell M.; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M.; Sevransky, Jonathan E.; Sprung, Charles L.; Douglas, Ivor S.; Jaeschke, Roman; Osborn, Tiffany M.; Nunnally, Mark E.; Townsend, Sean R.; Reinhart, Konrad; Kleinpell, Ruth M.; Angus, Derek C.; Deutschman, Clifford S.; Machado, Flavia R.; Rubenfeld, Gordon D.; Webb, Steven A.; Beale, Richard J.; Vincent, Jean-Louis; Moreno, Rui; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup (2013-02). "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012". Critical Care Medicine. 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. ISSN 1530-0293. PMID 23353941. Check date values in: |date= (help)
↑ Dellinger, R. Phillip; Levy, Mitchell M.; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M.; Sevransky, Jonathan E.; Sprung, Charles L.; Douglas, Ivor S.; Jaeschke, Roman; Osborn, Tiffany M.; Nunnally, Mark E.; Townsend, Sean R.; Reinhart, Konrad; Kleinpell, Ruth M.; Angus, Derek C.; Deutschman, Clifford S.; Machado, Flavia R.; Rubenfeld, Gordon D.; Webb, Steven A.; Beale, Richard J.; Vincent, Jean-Louis; Moreno, Rui; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup (2013-02). "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012". Critical Care Medicine. 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. ISSN 1530-0293. PMID 23353941. Check date values in: |date= (help)

[1] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[2] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[pmid12821469-3] 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.

[pmid15956145-4] 4.0 ^4.1 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.

[5] Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.

[pmid15155180-6] 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.

[pmid9494835-7] 7.0 ^7.1 Spach DH, Koehler JE (1998). "Bartonella-associated infections". Infect Dis Clin North Am. 12 (1): 137–55. PMID 9494835.

[8] "CDC Drug Service".

[9] "BabyBIG".

[pmid23253320-10] 10.0 ^10.1 ^10.2 Botelho-Nevers E, Socolovschi C, Raoult D, Parola P (2012). "Treatment of Rickettsia spp. infections: a review". Expert Rev Anti Infect Ther. 10 (12): 1425–37. doi:10.1586/eri.12.139. PMID 23253320.

[11] "diptheria".

[12] Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.

[13] "neutropenic fever prophylaxis" (PDF).

[14] Goldman, Lee (2012). Goldman's Cecil Medicine, Twenty-Fourth Edition. Saunders, an imprint of Elsevier Inc. ISBN 978-1-4377-1604-7.

[pmid17083018-15] Aldape MJ, Bryant AE, Stevens DL (2006). "Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment". Clin Infect Dis. 43 (11): 1436–46. doi:10.1086/508866. PMID 17083018.

[pmid19393958-16] 16.0 ^16.1 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.

[pmid12137646-17] Panpanich R, Garner P (2002). "Antibiotics for treating scrub typhus". Cochrane Database Syst Rev (3): CD002150. doi:10.1002/14651858.CD002150. PMID 12137646.

[pmid17029130-18] Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS; et al. (2006). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130.

[19] Corbel, Michael (2006). Brucellosis in humans and animals. Geneva: World Health Organization. ISBN 9241547138.

[20] LastName, FirstName (2007). WHO guidelines on tularaemia epidemic and pandemic alert and response. Geneva: World Health Organization. ISBN 9789241547376.

[21] "The diagnosis, treatment and prevention of typhoid fever" (PDF).

[22] "Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease".

[23] LastName, FirstName (2003). Human leptospirosis guidance for diagnosis, surveillance and control. Geneva: World Health Organization. ISBN 9241545895.

[24] Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

[25] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[26] Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.

[27] Dellinger, R. Phillip; Levy, Mitchell M.; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M.; Sevransky, Jonathan E.; Sprung, Charles L.; Douglas, Ivor S.; Jaeschke, Roman; Osborn, Tiffany M.; Nunnally, Mark E.; Townsend, Sean R.; Reinhart, Konrad; Kleinpell, Ruth M.; Angus, Derek C.; Deutschman, Clifford S.; Machado, Flavia R.; Rubenfeld, Gordon D.; Webb, Steven A.; Beale, Richard J.; Vincent, Jean-Louis; Moreno, Rui; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup (2013-02). "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012". Critical Care Medicine. 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. ISSN 1530-0293. PMID 23353941. Check date values in: |date= (help)

[28] Dellinger, R. Phillip; Levy, Mitchell M.; Rhodes, Andrew; Annane, Djillali; Gerlach, Herwig; Opal, Steven M.; Sevransky, Jonathan E.; Sprung, Charles L.; Douglas, Ivor S.; Jaeschke, Roman; Osborn, Tiffany M.; Nunnally, Mark E.; Townsend, Sean R.; Reinhart, Konrad; Kleinpell, Ruth M.; Angus, Derek C.; Deutschman, Clifford S.; Machado, Flavia R.; Rubenfeld, Gordon D.; Webb, Steven A.; Beale, Richard J.; Vincent, Jean-Louis; Moreno, Rui; Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup (2013-02). "Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012". Critical Care Medicine. 41 (2): 580–637. doi:10.1097/CCM.0b013e31827e83af. ISSN 1530-0293. PMID 23353941. Check date values in: |date= (help)

[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]

Sandbox ID Systemic: Difference between revisions

Latest revision as of 13:22, 12 August 2015

Contents

Babesiosis

Bartonella

Botulism

Boutonneuese fever

Diphtheria

Fever of unknown origin

Lymphangitis

Neutropenic fever, prophylaxis

Neutropenic fever, treatment

Salmonella bacteremia

Clostridial toxic shock syndrome

Staphylococcal toxic shock syndrome

Streptococcal toxic shock syndrome

Typhus, louse-borne

Typhus, murine

Typhus, scrub

Anaplasmosis

Brucellosis

Ehrlichiosis

Tularemia

Typhoid fever

Kawasaki syndrome

Leptospirosis

Rocky Mountain spotted fever

Relapsing fever

Tetanus

Lymphadenitis

Sepsis, adult

Sepsis, pediatric

References

Navigation menu

@@ Line 9: / Line 9: @@
 ===Bartonella===
-:*'''Bartonellosis or Carrion's disease''' <ref name="pmid15798808">{{cite journal| author=Huarcaya E, Maguiña C, Torres R, Rupay J, Fuentes L| title=Bartonelosis (Carrion's Disease) in the pediatric population of Peru: an overview and update. | journal=Braz J Infect Dis | year= 2004 | volume= 8 | issue= 5 | pages= 331-9 | pmid=15798808 | doi=/S1413-86702004000500001 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15798808  }} </ref>
+:* Bartonella<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-::* The acute phase, or hematic phase, known as Oroya Fever
+::* 1. '''Bartonella quintana'''
-:::* Preferred regimen: [[Ciprofloxacin]]  for 10 days- for patients younger than 7 years old, the scheme is 10 mg/kg divided into two doses, for patients between 7 and 14 years old the dose is 250 mg BID, and for patients older than 14 years old the dose is 500 mg BID
+:::* 1.1 '''Acute or chronic infections without endocarditis'''<ref name="pmid12821469">{{cite journal| author=Foucault C, Raoult D, Brouqui P| title=Randomized open trial of gentamicin and doxycycline for eradication of Bartonella quintana from blood in patients with chronic bacteremia. | journal=Antimicrob Agents Chemother | year= 2003 | volume= 47 | issue= 7 | pages= 2204-7 | pmid=12821469 | doi= | pmc=PMC161867 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12821469  }} </ref>
-:::* Alternative regimen: [[Chloramphenicol]] 50mg/kg/day, divided into four doses during the first three days, and then 25 mg/kg/day until completing 14 days of treatment
+::::* 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
-:::: Note (1): If a complication occurs during the acute phase, and the patient is not pregnant, then the treatment would be [[Ciprofloxacin]] {{and}} ([[Ceftriaxone]] or [[Ceftazidime]]) during 10 days.
+:::* 1.2 '''Endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=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. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
-:::: Note (2): If a pregnant patient has complicated acute Bartonellosis, the treatment is [[Chloramphenicol]] 50-100 mg/kg/day, divided into four doses, {{and}} [[Penicillin G]] 50,000-100,000 IU/kg/day divided into 4 or 6 doses, for 14 days. (A complication should be suspected if there is no improvement within the first 72 hours of treatment.)
+::::* Preferred regimen: [[Gentamicin]] 3 mg/kg/day IV q8h for 14 days {{and}} [[Ceftriaxone]] 2 g IV q24h for 6 weeks {{withorwithout}} [[Doxycycline]] 100 mg PO bid for 6 weeks
-:::: Note (3): The treatment schemes based on ciprofloxacin and chloramphenicol have the advantage of also covering the possibility of Salmonella species and Haemophilus influenzae in the pediatric population
+::* 2. '''Bartonella elizabethae'''
-:::: Note (4): Patients with neurobartonellosis, respiratory distress syndrome, coagulopathy, and/or moderate to severe pericarditis may benefit from corticosteroids, such as [[Dexamethasone]] (0.5-1 mg/kg/day for three days).
+:::* 2.1 '''Endocarditis'''<ref name="pmid15956145">{{cite journal| author=Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME et al.| title=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. | journal=Circulation | year= 2005 | volume= 111 | issue= 23 | pages= e394-434 | pmid=15956145 | doi=10.1161/CIRCULATIONAHA.105.165564 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15956145  }} </ref>
-:::: Note (5): Red blood cell transfusions in the amount of 10-20mL/kg are given when the hematocrit is less than 20%.
+::::* Preferred regimen: [[Gentamicin]] 3 mg/kg/day IV q8h for 14 days {{and}}  [[Ceftriaxone]] 2 g IV q24h for 6 weeks {{withorwithout}} [[Doxycycline]] 100 mg PO bid for 6 weeks
-:::: Note (6): In case of severe pericardial tamponade, a pericardiectomy is done.
+::* 3. '''Bartonella bacilliformis'''
+:::* 3.1 '''Oroya fever'''
-::* The eruptive phase or tissue phase, known as Peruvian Wart
+::::* Preferred regimen: [[Ciprofloxacin]] 500 mg PO bid for 14 days
-:::* Preferred regimen: [[Rifampin]] 10 mg/kg/day QID during 14 to 21 days.
+::::* Note: If severe disease, add [[Ceftriaxone]] 1 g IV qd for 14 days
-:::* Alternative regimen: [[Azithromycin]] {{or}} [[Erythromycin]], {{or}} [[Ciprofloxacin]] can be given for 7 to 14 days.
+:::* 3.2 '''Verruga peruana'''<ref>Bradley JS, Jackson MA, Committee on Infectious Diseases, American Academy of Pediatrics. The use of systemic and topical fluoroquinolones. Pediatrics 2011; 128:e1034.</ref>
-::::Note (1): In this phase, [[Chloramphenicol]] and [[Penicillin]] are not useful.
+::::* Preferred regimen: [[Azithromycin]] 500 mg PO qd for 7 days
-::::Note (2): In vitro analysis, Bacillus bacilliformis showed susceptibility to most beta-lactams, [[Rifampin]], [[Erythromycin]], [[Macrolides]], [[Tetracycline]], [[Quinolones]], and [[Chloramphenicol]].
+::::* Alternative regimen (1): [[Rifampin]] 600 mg PO qd for 14-21 days
-::::Note (2): The bacterium is resistant to [[Vancomycin]], [[Clindamycin]], and [[Aminoglycosides]].
+::::* Alternative regimen (2): [[Ciprofloxacin]] 500 mg bid for 7-10 days
+::* 4. '''Bartonella henselae'''<ref name="pmid15155180">{{cite journal| author=Rolain JM, Brouqui P, Koehler JE, Maguina C, Dolan MJ, Raoult D| title=Recommendations for treatment of human infections caused by Bartonella species. | journal=Antimicrob Agents Chemother | year= 2004 | volume= 48 | issue= 6 | pages= 1921-33 | pmid=15155180 | doi=10.1128/AAC.48.6.1921-1933.2004 | pmc=PMC415619 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15155180  }} </ref>
+:::* 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 {{withorwithout}} [[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'''<ref name="pmid9494835">{{cite journal| author=Spach DH, Koehler JE| title=Bartonella-associated infections. | journal=Infect Dis Clin North Am | year= 1998 | volume= 12 | issue= 1 | pages= 137-55 | pmid=9494835 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9494835  }} </ref>
+::::* 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'''<ref name="pmid9494835">{{cite journal| author=Spach DH, Koehler JE| title=Bartonella-associated infections. | journal=Infect Dis Clin North Am | year= 1998 | volume= 12 | issue= 1 | pages= 137-55 | pmid=9494835 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9494835  }} </ref>
+::::* 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
 ===Botulism===
 :* '''Botulism'''
 ::* 1.'''Foodborne botulism'''<ref>{{cite web | title = CDC Drug Service  | url = http://www.cdc.gov/laboratory/drugservice/formulary.html#tbat }}</ref>
 :::*  1.1 '''Adult'''
-::::* Preferred regimen (adult): Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min
+::::* Preferred regimen: Heptavalent botulism antitoxin IV starting infusion rate (first 30 minutes): 0.5 mL/min; incremental infusion rate if tolerated (every 30 minutes): double the rate; maximum infusion rate: 2 mL/min
 :::* 1.2 '''Children'''
 ::::* 1.2.1 '''Children < 1 year'''
@@ Line 55: / Line 70: @@
 ===Boutonneuese fever===
-* Boutonneuese fever    <ref name="pmid23253320">{{cite journal| author=Botelho-Nevers E, Socolovschi C, Raoult D, Parola P| title=Treatment of Rickettsia spp. infections: a review. | journal=Expert Rev Anti Infect Ther | year= 2012 | volume= 10 | issue= 12 | pages= 1425-37 | pmid=23253320 | doi=10.1586/eri.12.139 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23253320  }} </ref>
+:* Boutonneuese fever<ref name="pmid23253320">{{cite journal| author=Botelho-Nevers E, Socolovschi C, Raoult D, Parola P| title=Treatment of Rickettsia spp. infections: a review. | journal=Expert Rev Anti Infect Ther | year= 2012 | volume= 10 | issue= 12 | pages= 1425-37 | pmid=23253320 | doi=10.1586/eri.12.139 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23253320  }} </ref>
-:*Preferred Regimen ( adult)(1): [[Doxycycline]] 200 mg two oral doses in a single day
+::* 1. '''Adult'''
-:*Preferred Regimen ( adult)(2): [[Doxycycline]] 200 mg  or 100 mg bid for 2-5 days
+:::* Preferred regimen (1): [[Doxycycline]] 200 mg PO bid for 1 day
-:*Alternative regimen (adult)(1):  [[josamycin]] 1g q8h for 7 days
+:::* Preferred regimen (2): [[Doxycycline]] 200 mg  or 100 mg PO bid for 2-5 days
-:*Alternative regimen (adult)(2):[[Ciprofloxacin]]
+:::* Alternative regimen (1): [[Josamycin]] 1g q8h for 7 days
-:* Preferred Regimen ( Children <100 lbs): [[Doxycycline]] 2.2 mg/kg body weight PO  q 12 h or( Children >100lbs )  200 mg bid in one day and 200 mg bid qid or 100 mg bid for 2-5 days
+:::* Alternative regimen (2):[[Ciprofloxacin]]
-:*Alternative regimen (Children <8 y.o.)(1): [[josamycin]] 2.2mg/kg q12h for 5 days
+::* 2. '''Children'''
-:*Alternative regimen (Children <8 y.o)(2):   [[clarithromycin]] 15 mg/ kg in 2 divided doses for 7 days   &  [[azithromycin]] 10 mg per kg/day 1 dose for 3 days
+:::* Preferred regimen (Children <100 lbs): [[Doxycycline]] 2.2 mg/kg PO bid
+:::* Preferred regimen (Children >100lbs): [[Doxycycline]] 200 mg PO bid in one day and 200 mg bid/qid or 100 mg bid for 2-5 days
+:::* Alternative regimen (Children <8 years) (1): [[Josamycin]] 2.2mg/kg q12h for 5 days
+:::* Alternative regimen (Children <8 years) (2): [[Clarithromycin]] 15 mg/ kg in bid for 7 days {{and}} [[Azithromycin]] 10 mg/kg/day qd for 3 days
 ===Diphtheria===
@@ Line 68: / Line 86: @@
 ::* Preferred Regimen (1): [[ Erythromycin]] 40 mg/kg/day; maximum, 2 gm/day) PO for 14 days
 ::* Preferred Regimen (2): [[Procaine penicillin G ]] 3MU/day (for  weight < 10 kg ) IM q24h for 14 days & 6MU/day (for weight >10 kg ) IM q24h for 14 days
 ::* Note: Since 1997, diphtheria antitoxin has been available only from CDC, through an Investigational New Drug (IND) protocol.
 ===Fever of unknown origin===
+:* Fever of unknown origin (FUO)<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
-* Fever of unknown origin (FUO)<ref>{{cite book | last = Bennett | first = John | title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases | publisher = Elsevier/Saunders | location = Philadelphia, PA | year = 2015 | isbn = 978-1455748013 }}</ref>
+::* Management should generally be withheld until the etiology of the fever has been ascertained, so that treatment can be directed against a specific pathology.
-:* Management should generally be withheld until the etiology of the fever has been ascertained, so that treatment can be directed against a specific pathology.
+::* Specific clinical considerations
-:* Specific clinical considerations
+:::* 1.'''Neutropenic fever'''
-::* '''Neutropenic fever'''
+::::* Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications.
-:::* Exception may be made for neutropenic patients in which delayed treatment could lead to serious complications.
+::::* After samples for cultures are obtained, patients with febrile neutropenia should be aggressively treated with broad-spectrum antibiotics covering ''Pseudomonas''
-:::* After samples for cultures are obtained, patients with febrile neutropenia should be aggressively treated with broad-spectrum antibiotics covering ''Pseudomonas''
+:::* 2.'''HIV/AIDS individuals'''
+::::* HIV/AIDS individuals with pyrexia and hypoxia should be placed on empiric therapy for ''Pneumocystis jirovecii''.
-::* '''HIV/AIDS individuals'''
+:::* 3.'''Giant cell arteritis'''
-:::* HIV/AIDS individuals with pyrexia and hypoxia should be placed on empiric therapy for ''Pneumocystis jirovecii''.
+::::* Empiric corticosteroids may be considered in patients with suspected giant cell arteritis to prevent vascular complications.
+::::* Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms:
-::* '''Giant cell arteritis'''
+:::::* Newly onset headaches
-:::* Empiric corticosteroids may be considered in patients with suspected giant cell arteritis to prevent vascular complications.
+:::::* Abrupt onset of blurry vision
-:::* Giant cell arteritis should be suspected in a patient over the age of 50 with the following symptoms:
+:::::* Symptoms of polymyalgia rheumatica
-::::* Newly onset headaches
+:::::* Jaw claudication
-::::* Abrupt onset of blurry vision
+:::::* Unexplained anemia
-::::* Symptoms of polymyalgia rheumatica
+:::::* Elevated ESR and/or CRP
-::::* Jaw claudication
-::::* Unexplained anemia
-::::* Elevated ESR and/or CRP
 ===Lymphangitis===
-*Preferred regimen: [[Dicloxacillin]] {{or}} [[Cephalexin]] 500 mg PO qid for 1 week
+:* 1.'''Lymphangitis treatment'''
+::* Preferred regimen: [[Dicloxacillin]]
-*If Community-Associated Methicillin-Resistant Staphylococcus Aureus (CA-MRSA) suspected:
+::* Preferred regimen: [[Cephalexin]] 500 mg PO qid for 1 week
-:* [[Trimethoprim-sulfamethoxazole]] PO bid  {{and}}  vancomycin 1 g IV every 12 hr
+:*2. '''Patient with lymphangitis and if Community-Associated Methicillin-Resistant Staphylococcus Aureus (CA-MRSA) suspected''':
+::* [[Trimethoprim-sulfamethoxazole]] PO bid  {{and}}  vancomycin 1 g IV every 12 hr
-*If allergic to penicillin:
+:* 3.'''Patient with lymphangitis allergic to penicillin''':
-:*[[Clindamycin]] 300 mg PO qid for 7 days {{or}} [[Erythromycin]] 500 mg PO qid for 7 days {{or}} [[Levofloxacin]] 500 mg PO daily {{or}} [[Moxifloxacin]] 400 mg PO daily for 7 days.
+::* [[Clindamycin]] 300 mg PO qid for 7 days {{or}} [[Erythromycin]] 500 mg PO qid for 7 days {{or}} [[Levofloxacin]] 500 mg PO daily {{or}} [[Moxifloxacin]] 400 mg PO daily for 7 days.
 ===Neutropenic fever, prophylaxis===
+:* Neutropenic fever, prophylaxis<ref>{{cite web |title = neutropenic fever prophylaxis |url =http://oralcancerfoundation.org/treatment/pdf/infections.pdf }}</ref>
+::* 1.'''Low risk''' (standard chemotherapy regimen for soild tumor, anticipated neutropenia &lt; 7 days)
+:::* '''Antibacterial agent''': none
+:::* '''Antifungal agent''': none
+:::* '''Antiviral agent''': none unless prior HSV episode
-* Neutropenic fever, prophylaxis<ref>{{cite web |title = neutropenic fever prophylaxis |url =http://oralcancerfoundation.org/treatment/pdf/infections.pdf }}</ref>
+::* 2. '''Intermediate risk''' (autologous HSCT, lymphoma, multiple myeloma, CLL, Purine analog therapy [i.e., Fludarabine, Clofarabine, Nelarabine, Cladribine], anticipated neutropenia 7-10 days)
-:* '''Low risk''' (standard chemotherapy regimen for soild tumor, anticipated neutropenia &lt; 7 days)
+:::* 2.1 '''Antibacterial agent''': consider fluroquinolone prophylaxis
-::* '''Antibacterial agent''': none
+:::* 2.2 '''Antifungal agent''': consider fluconozole during neutropenia and for anticipated mucositis
-::* '''Antifungal agent''': none
+:::* 2.3 '''Antiviral agent''':
-::* '''Antiviral agent''': none unless prior HSV episode
+::::* 2.3.1 '''HSV prophylaxis'''
-:* '''Intermediate risk''' (autologous HSCT, lymphoma, multiple myeloma, CLL, Purine analog therapy [i.e., Fludarabine, Clofarabine, Nelarabine, Cladribine], anticipated neutropenia 7-10 days)
-::* '''Antibacterial agent''': consider fluroquinolone prophylaxis
-::* '''Antifungal agent''': consider fluconozole during neutropenia and for anticipated mucositis
-::* '''Antiviral agent''':
-:::* HSV prophylaxis
-::::* Preferred regimen (1): [[Acyclovir]] 400-800 mg PO bid
-::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
-::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
-:::* VZV prophylaxis
-::::* Preferred regimen (1): [[Acyclovir]] 800 mg PO bid (in allogeneic HSCT)
-::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
-::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
-::::: Note (1): Antiviral agents should be administered during active therapy and for at least 30 days after HSCT.
-::::: Note (2): Consider VZV prophylaxis for at least 1 year after allogeneic HSCT and for at least 6-12 months after autologous HSCT.
-:* '''High risk''' (acute leukemia, Alemutuzumab therapy, in allogenic HSCT including cord blood, GVHD treated with high dose steriods, anticipated neutropenia > 10 days)
-::* '''Antibacterial agent''': [[Levofloxacin]] 500-750 mg PO/IV q24h
-::* '''Antifungal agent''':
-:::* ALL
-::::* Preferred regimen:  [[Fluconazole]] in adult with normal renal function 400 mg IV/ PO daily
-::::* Alternative regimen:  [[Amphotericin B]]
-:::* MDS or AML
-::::* Preferred regimen: [[Posaconazole]] EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
-::::* Alternative regimen: [[Voriconazole ]]  6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h  until resolution of neutropenia
-::::* Alternative regimen: [[Fluconazole]] in adult with normal renal function 400mg IV/PO q24h
-::::* Alternative regimen: [[Amphotericin B]] until resolution of neutropenia
-:::* Autologous HSCT with mucositis
-::::* Preferred regimen: [[Fluconazole]] 400mg IV/PO q24h (in adult with normal renal function) {{or}} [[Micafungin]] 50-100mg/ d IV until resolution of neutropenia
-:::* Allogenic HSCT
-::::* Preferred regimen: [[Fluconazole]] 400mg IV/PO q24h (in adult with normal renal function) {{or}} [[Micafungin]] 50-100mg/ d IV until resolution of neutropenia
-::::* Alternative regimen (1): [[Itraconazole]]
-::::* Alternative regimen (2): [[Voriconazole]] 6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h
-::::* Alternative regimen (3): [[Posaconazole]]  EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
-::::* Alternative regimen (4): [[Amphotericin B]] continue during neutropenia and for at least 75 days after transplant
-:::* Significant GVHD
-::::* Preferred regimen: [[Posaconazole]]  EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
-::::* Alternative regimen (1): [[Voriconazole]]6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h
-::::* Alternative regimen (2): [[Echinocandin]]
-::::* Alternative regimen (3): [[Amphotericin B]] until resolution of Significant GVHD
-::* '''Antiviral agent''':
-:::* Acute Leukemia
-::::* HSV prophylaxis
 :::::* Preferred regimen (1): [[Acyclovir]] 400-800 mg PO bid
 :::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
 :::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
-:::*Proteasome inhibitors
+::::* 2.3.2 '''VZV prophylaxis'''
-::::* VZV prophylaxis
 :::::* Preferred regimen (1): [[Acyclovir]] 800 mg PO bid (in allogeneic HSCT)
 :::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
@@ Line 170: / Line 140: @@
 :::::: Note (2): Consider VZV prophylaxis for at least 1 year after allogeneic HSCT and for at least 6-12 months after autologous HSCT.
-:::*Alemutuzumab Therapy, allogenic HSCT ,GVDH requiring  steriod treatment
+::* 3.'''High risk''' (acute leukemia, Alemutuzumab therapy, in allogenic HSCT including cord blood, GVHD treated with high dose steriods, anticipated neutropenia > 10 days)
-::::* HSV prophylaxis
+:::* 3.1 '''Antibacterial agent''': [[Levofloxacin]] 500-750 mg PO/IV q24h
-:::::* Preferred regimen (1): [[Acyclovir]] 400-800 mg PO bid
+:::* 3.2 '''Antifungal agent''':
-:::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
+::::* 3.2.1 '''ALL'''
-:::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
+:::::* Preferred regimen:  [[Fluconazole]] in adult with normal renal function 400 mg IV/ PO daily
+:::::* Alternative regimen:  [[Amphotericin B]]
+::::* 3.2.2 '''MDS or AML'''
+:::::* Preferred regimen: [[Posaconazole]] EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
+:::::* Alternative regimen: [[Voriconazole ]]  6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h  until resolution of neutropenia
+:::::* Alternative regimen: [[Fluconazole]] in adult with normal renal function 400mg IV/PO q24h
+:::::* Alternative regimen: [[Amphotericin B]] until resolution of neutropenia
+::::* 3.2.3 Autologous HSCT with mucositis
+:::::* Preferred regimen: [[Fluconazole]] 400mg IV/PO q24h (in adult with normal renal function) {{or}} [[Micafungin]] 50-100mg/ d IV until resolution of neutropenia
+::::* 3.2.4 Allogenic HSCT
+:::::* Preferred regimen: [[Fluconazole]] 400mg IV/PO q24h (in adult with normal renal function) {{or}} [[Micafungin]] 50-100mg/ d IV until resolution of neutropenia
+:::::* Alternative regimen (1): [[Itraconazole]]
+:::::* Alternative regimen (2): [[Voriconazole]] 6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h
+:::::* Alternative regimen (3): [[Posaconazole]]  EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
+:::::* Alternative regimen (4): [[Amphotericin B]] continue during neutropenia and for at least 75 days after transplant
+::::* 3.2.5 Significant GVHD
+:::::* Preferred regimen: [[Posaconazole]]  EC 300 mg bid on day 1 and then 300 mg IV q day after or IV 300 mg q day after
+:::::* Alternative regimen (1): [[Voriconazole]]6mg/kg IV q 12 h X 2 doses then 4 mg/kg q 12 h
+:::::* Alternative regimen (2): [[Echinocandin]]
+:::::* Alternative regimen (3): [[Amphotericin B]] until resolution of Significant GVHD
+:::* 3.3 '''Antiviral agent''':
+::::* 3.3.1 Acute Leukemia
+:::::* HSV prophylaxis
+::::::* Preferred regimen (1): [[Acyclovir]] 400-800 mg PO bid
+::::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
+::::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
+::::* Proteasome inhibitors
+:::::* VZV prophylaxis
+::::::* Preferred regimen (1): [[Acyclovir]] 800 mg PO bid (in allogeneic HSCT)
+::::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
+::::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
+::::::: Note (1): Antiviral agents should be administered during active therapy and for at least 30 days after HSCT.
+::::::: Note (2): Consider VZV prophylaxis for at least 1 year after allogeneic HSCT and for at least 6-12 months after autologous HSCT.
+::::* Alemutuzumab Therapy, allogenic HSCT ,GVDH requiring  steriod treatment
+:::::* HSV prophylaxis
+::::::* Preferred regimen (1): [[Acyclovir]] 400-800 mg PO bid
+::::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
+::::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
-::::* VZV prophylaxis
+:::::* VZV prophylaxis
-:::::* Preferred regimen (1): [[Acyclovir]] 800 mg PO bid (in allogeneic HSCT)
+::::::* Preferred regimen (1): [[Acyclovir]] 800 mg PO bid (in allogeneic HSCT)
-:::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
+::::::* Preferred regimen (2): [[Famciclovir]] 250 mg PO bid
-:::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
+::::::* Preferred regimen (3): [[Valacyclovir]] 500 mg PO bid-tid
-:::::: Note (1): Antiviral agents should be administered during active therapy and for at least 30 days after HSCT.
+::::::: Note (1): Antiviral agents should be administered during active therapy and for at least 30 days after HSCT.
-:::::: Note (2): Consider VZV prophylaxis for at least 1 year after allogeneic HSCT and for at least 6-12 months after autologous HSCT.
+::::::: Note (2): Consider VZV prophylaxis for at least 1 year after allogeneic HSCT and for at least 6-12 months after autologous HSCT.
-:* '''Anti CMV prophylaxis'''
+::* '''Anti CMV prophylaxis'''
-::* Allogenic stem cell transplant (surveillance period: 1-6 months after transplant, GVDH requiring therapy)
+:::* Allogenic stem cell transplant (surveillance period: 1-6 months after transplant, GVDH requiring therapy)
-:::* Preferred regimen: [[Valganciclovir]]900 mg daily PO {{or}} [[Ganciclovir]]5 mg / kg IV q 12 h for 2 weeks followed by 5-6mg / kg daily for at least an additional 2-4 weeks and resolution of all symptoms
+::::* Preferred regimen: [[Valganciclovir]]900 mg daily PO {{or}} [[Ganciclovir]]5 mg / kg IV q 12 h for 2 weeks followed by 5-6mg / kg daily for at least an additional 2-4 weeks and resolution of all symptoms
-:::* Alternative regimen: [[Foscarnet]] 60 mg / kg IV q 8-12 h for 7 d followed by 90-120mg / kg daily until day 100 after HSCT{{or}} [[Cidofovir]] IV
+::::* Alternative regimen: [[Foscarnet]] 60 mg / kg IV q 8-12 h for 7 d followed by 90-120mg / kg daily until day 100 after HSCT{{or}} [[Cidofovir]] IV
-::* Alemtuzumab therapy (suveillance period: for a minimum of 2 months after alemtuzumab)
+:::* Alemtuzumab therapy (suveillance period: for a minimum of 2 months after alemtuzumab)
-:::* Preferred regimen: [[Valganciclovir]] 900 mg daily PO {{or}} [[Ganciclovir]]5 mg / kg IV q 12 h for 2 weeks followed by 5-6mg / kg daily for at least an additional 2-4 weeks and resolution of all symptoms
+::::* Preferred regimen: [[Valganciclovir]] 900 mg daily PO {{or}} [[Ganciclovir]]5 mg / kg IV q 12 h for 2 weeks followed by 5-6mg / kg daily for at least an additional 2-4 weeks and resolution of all symptoms
-:::* Alternative regimen: [[Foscarnet]] 60 mg / kg IV q 8-12 h for 7 d followed by 90-120mg / kg daily until day 100 after HSCT {{or}} [[Cidofovir]] IV
+::::* Alternative regimen: [[Foscarnet]] 60 mg / kg IV q 8-12 h for 7 d followed by 90-120mg / kg daily until day 100 after HSCT {{or}} [[Cidofovir]] IV
-:* '''Anti Pneumocystis prophylaxis'''
+::* '''Anti Pneumocystis prophylaxis'''
-::* Duration of prophylaxis:
+:::* Duration of prophylaxis:
-:::* Allogenic stem cell recipients: for at least 6 months and while receving immunosuppresive therapy
+::::* Allogenic stem cell recipients: for at least 6 months and while receving immunosuppresive therapy
-:::* Acute lymphocytic leukemia: throughout anti-leukemic therapy
+::::* Acute lymphocytic leukemia: throughout anti-leukemic therapy
-:::* Alemtuzumab therapy: for a minimum of 2 months after Alemtuzumab and until CD4 count > 200 cells/mcL
+::::* Alemtuzumab therapy: for a minimum of 2 months after Alemtuzumab and until CD4 count > 200 cells/mcL
-::* Preferred regimen: [[TMP/SMZ]]
+:::* Preferred regimen: [[TMP/SMZ]]
-::* Alternative regimen (if TMP-SMZ intolerant): [[Atovaquone]] {{or}} [[Dapsone]] {{or}} [[Pentamidine]] aersolized or IV
+:::* Alternative regimen (if TMP-SMZ intolerant): [[Atovaquone]] {{or}} [[Dapsone]] {{or}} [[Pentamidine]] aersolized or IV
-::: Note: Anti-Pneumocystis prophylaxis may be considered in (1) recipients of purine analog therapy and other T-cell-depleting agents; (2) recipients of prolonged corticosteroids or receiving temozolomide + radiation therapy; and (3) autologous stem cell recipients.
+:::: Note: Anti-Pneumocystis prophylaxis may be considered in (1) recipients of purine analog therapy and other T-cell-depleting agents; (2) recipients of prolonged corticosteroids or receiving temozolomide + radiation therapy; and (3) autologous stem cell recipients.
-:* '''HBV prophylaxis'''
+::* '''HBV prophylaxis'''
-::* Allogenic stem cell transplant, Anti CD20 or Anti CD52 monoclonal antibodies
+:::* Allogenic stem cell transplant, Anti CD20 or Anti CD52 monoclonal antibodies
-:::* Therapy considerations
+::::* Therapy considerations
-::::* ID consult to determine possible antiviral prophylaxis, consider delayed transplant if active infection
+:::::* ID consult to determine possible antiviral prophylaxis, consider delayed transplant if active infection
-:::* Antiviral therapy
+::::* Antiviral therapy
-::::* Preferred regimen (1): [[Entecavir]]0.5 mg PO q24h ( nucleoside- treatment- naive with compensated liver disease) or 1 mg PO 24 h ( lamivudine - refractory or known Lamivudine or telbivudine resistance mutation or decompensated liver disease
+:::::* Preferred regimen (1): [[Entecavir]]0.5 mg PO q24h ( nucleoside- treatment- naive with compensated liver disease) or 1 mg PO 24 h ( lamivudine - refractory or known Lamivudine or telbivudine resistance mutation or decompensated liver disease
-::::* Preferred regimen (2): [[Tenofovir]]300 mg PO q 24 h
+:::::* Preferred regimen (2): [[Tenofovir]]300 mg PO q 24 h
-::::* Preferred regimen (3): [[Lamivudine]] 100mg PO q 24 h
+:::::* Preferred regimen (3): [[Lamivudine]] 100mg PO q 24 h
-::::* Preferred regimen (4): [[Adefovir]] 10mg PO q 24 h
+:::::* Preferred regimen (4): [[Adefovir]] 10mg PO q 24 h
-::::* Preferred regimen (5): [[Telbivudine]]60 mg PO q 24 h
+:::::* Preferred regimen (5): [[Telbivudine]]60 mg PO q 24 h
-:::* Surveillance
+::::* Surveillance
-::::* At least 6-12 months following conclusion of treatment
+:::::* At least 6-12 months following conclusion of treatment
-:* '''Prophylaxis in HIV'''
+::* '''Prophylaxis in HIV'''
-::* Chemotherapy, targeted therapies
+:::* Chemotherapy, targeted therapies
-:::* Therapy considerations
+::::* Therapy considerations
-::::* ID consult to adjust dosing and regimen for concurrent treatment
+:::::* ID consult to adjust dosing and regimen for concurrent treatment
-:::* Antiviral therapy
+::::* Antiviral therapy
-::::* Preferred regimen: antiretroviral therapy
+:::::* Preferred regimen: antiretroviral therapy
-:::* Surveillance
+::::* Surveillance
-::::* Monthly during therapy then as clinically indicated
+:::::* Monthly during therapy then as clinically indicated
 ===Neutropenic fever, treatment===
 ===Salmonella bacteremia===
-*Preferred regimen: [[Ciprofloxacin]] 400 mg every 12 hours IV {{and}} [[Ceftriaxone]] 1 to 2 g every 12 to 24 hrs IV.<ref> {{cite book | last =   Goldman | first = Lee  | title = Goldman's Cecil Medicine, Twenty-Fourth Edition
+:* 1. '''Salmonella bacteremia treatment'''
+::* Preferred regimen: [[Ciprofloxacin]] 400 mg IV q12h {{and}} [[Ceftriaxone]] 1 to 2 g IV q12-24h<ref> {{cite book | last =   Goldman | first = Lee  | title = Goldman's Cecil Medicine, Twenty-Fourth Edition
   | publisher = Saunders, an imprint of Elsevier Inc. | location =  | year = 2012 | isbn = 978-1-4377-1604-7}}</ref>
+:* 2.'''When the salmonellae are known to be susceptible'''
-*When the salmonellae are known to be susceptible:
+::* Preferred regimen: [[Ampicillin]] 1 to 2 g IV  q4-6h
-:*Preferred regimen: [[Ampicillin]] 1 to 2 g IV every 4 to 6 hrs {{or}} [[Trimethoprim-sulfamethoxazole]] 8 mg/kg/day
+::* Preferred regimen: [[Trimethoprim-sulfamethoxazole]] 8 mg/kg/day PO
 ===Clostridial toxic shock syndrome===
-* '''Clostridium sordelli toxic shock syndrome'''
+:* '''Clostridium sordelli toxic shock syndrome''' <ref name="pmid17083018">{{cite journal| author=Aldape MJ, Bryant AE, Stevens DL| title=Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment. | journal=Clin Infect Dis | year= 2006 | volume= 43 | issue= 11 | pages= 1436-46 | pmid=17083018 | doi=10.1086/508866 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17083018  }} </ref>
-:* Pathogen-directed antimicrobial therapy <ref name="pmid17083018">{{cite journal| author=Aldape MJ, Bryant AE, Stevens DL| title=Clostridium sordellii infection: epidemiology, clinical findings, and current perspectives on diagnosis and treatment. | journal=Clin Infect Dis | year= 2006 | volume= 43 | issue= 11 | pages= 1436-46 | pmid=17083018 | doi=10.1086/508866 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17083018  }} </ref>
+::* Preferred regimen (1): [[Ampicillin]] 250-500 mg IV/IM  q4-8h
-::* Preferred regimen:  [[Ampicillin]] 250-500 mg q4-8h IV or IM {{or}} [[Amoxicillin-clavulanate]] 250-500 mg q8-12h PO {{or}} [[Piperacillin-tazobactam]] 4.5 g IV q8h {{or}} [[Ticarcillin]] 3.1 g IV q8h {{or}} [[Clindamycin]] 600 to 900 mg IV q8h {{or}} [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose {{or}} [[Imipenem]] 500 mg IV q6h {{or}}  [[Linezolid]] 600 mg q12h IV or PO {{or}} [[Metronidazole]] 30 mg/kg/24 hr divided q6h PO or IV (max dose: 4 g/24 hr)
+::* Preferred regimen (2): [[Amoxicillin-clavulanate]] 250-500 mg PO bid/tid
-::: Note (1): '''Clostridium sordellii''' is a cause of toxic shock syndrome (CSTS) associated with gynecologic procedures, childbirth, and abortion (including spontaneous, surgical, and medical abortion). Gastrointestinal and vaginal colonization of Clostridium sordellii can occur in healthy individuals.
+::* Preferred regimen (3): [[Piperacillin-tazobactam]] 4.5 g IV q8h
-::: Note (2): Treatment of '''Clostridium sordellii''' toxic shock syndrome consists of antibiotic therapy, surgical debridement, and aggressive resuscitation
+::* Preferred regimen (4): [[Ticarcillin]] 3.1 g IV q8h
+::* Preferred regimen (5): [[Clindamycin]] 600 to 900 mg IV q8h
+::* Preferred regimen (6): [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose
+::* Preferred regimen (7): [[Imipenem]] 500 mg IV q6h
+::* Preferred regimen (8): [[Linezolid]] 600 mg IV/PO q12h
+::* Preferred regimen (9): [[Metronidazole]] 30 mg/kg/24 hr PO/IV q6h  (maximum dose: 4 g/24 hr)
+::* Note (1): '''Clostridium sordellii''' is a cause of toxic shock syndrome (CSTS) associated with gynecologic procedures, childbirth, and abortion (including spontaneous, surgical, and medical abortion). Gastrointestinal and vaginal colonization of Clostridium sordellii can occur in healthy individuals.
+::* Note (2): Treatment of '''Clostridium sordellii''' toxic shock syndrome consists of antibiotic therapy, surgical debridement, and aggressive resuscitation
 ===Staphylococcal toxic shock syndrome===
-* Staphylococcal toxic shock syndrome <ref name="pmid19393958">{{cite journal| author=Lappin E, Ferguson AJ| title=Gram-positive toxic shock syndromes. | journal=Lancet Infect Dis | year= 2009 | volume= 9 | issue= 5 | pages= 281-90 | pmid=19393958 | doi=10.1016/S1473-3099(09)70066-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19393958  }} </ref>
+:* Staphylococcal toxic shock syndrome <ref name="pmid19393958">{{cite journal| author=Lappin E, Ferguson AJ| title=Gram-positive toxic shock syndromes. | journal=Lancet Infect Dis | year= 2009 | volume= 9 | issue= 5 | pages= 281-90 | pmid=19393958 | doi=10.1016/S1473-3099(09)70066-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19393958  }} </ref>
-:* (1) '''Methicillin sensitive Staphylococcus aureus'''
+::* 1. '''Methicillin sensitive Staphylococcus aureus'''
-::* Preferred regimen: [[Cloxacillin]]  250-500 mg q6h PO (max dose: 4 g/24 hr) {{or}} [[Nafcillin]]  4-12 g/24 hr divided q4-6hr IV (max dose: 12 g/24 hr) {{or}} [[Cefazolin]] 0.5-2g q8h IV or IM (max dose: 12 g/24 hr), {{and}} [[Clindamycin]] 150-600 mg q6-8h IV, IM, or PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
+:::* Preferred regimen (1): [[Cloxacillin]]  250-500 mg PO qid (maximum dose: 4 g/24 hr)
-::* Alternative regimen (1):[[Clarithromycin]] 250-500 mg q12h PO (max dose: 1 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg q6-8h IV, IM, or PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
+:::* Preferred regimen (2): [[Nafcillin]]  4-12 g/24 hr IV q4-6hr (maximum dose: 12 g/24 hr)
-::* Alternative regimen (1):[[Rifampicin]], {{and}} [[Linezolid]] 600 mg q 12 hr IV or PO {{or}} [[Daptomycin]] {{or}} [[Tigecycline]] 100 mg loading dose followed by 50 mg q12h IV
+:::* Preferred regimen (3): [[Cefazolin]] 0.5-2g IV/IM q8h (maximum dose: 12 g/24 hr), {{and}} [[Clindamycin]] 150-600 mg IV/IM/PO q6-8h (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
-:* (2) '''Methicillin resistant Staphylococcus  aureus'''
+:::* Alternative regimen (1): [[Clarithromycin]] 250-500 mg PO q12h (maximum dose: 1 g/24 hr) {{and}} [[Clindamycin]] 150-600 mg  IV/IM/PO q6-8h (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
-::* Preferred regimen: [[Clindamycin]] 150-600 mg q6-8h IV, IM, or PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) {{or}} [[Linezolid]] 600 mg q12h IV or PO , {{and}} [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose or [[Teicoplanin]]
+:::* Alternative regimen (1): [[Rifampicin]], {{and}} [[Linezolid]] 600 mg  IV/PO q12hr
-::* Alternative regimen (1):[[Rifampicin]], {{and}} [[Linezolid]] 600 mg q12h IV or PO {{or}} [[Daptomycin]] {{or}} [[Tigecycline]] 100 mg loading dose followed by 50 mg q12h IV
+:::* Alternative regimen (2): [[Daptomycin]]
-:* (3) '''Glycopeptide resistant or intermediate Staphylococcus aureus'''
+:::* Alternative regimen (3): [[Tigecycline]] 100 mg IV loading dose followed by 50 mg q12h
-::* Preferred regimen: [[Linezolid]] 600 mg q12h IV or PO {{and}} [[Clindamycin]] 150-600 mg q6-8h IV, IM, or PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO) (if sensitive)
+::* 2. '''Methicillin resistant Staphylococcus  aureus'''
-::* Alternative regimen (1):[[Daptomycin]] {{or}} [[Tigecycline]] 100 mg loading dose followed by 50 mg q12 IV
+:::* Preferred regimen: [[Clindamycin]] 150-600 mg q6-8h IV/IM/PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
-::: Note: Incidence increasing. Geographical patterns highly variable
+:::* Preferred regimen: [[Linezolid]] 600 mg IV/PO q12h {{and}} ([[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose or [[Teicoplanin]])
+:::* Alternative regimen (1): [[Rifampicin]] {{and}} [[Linezolid]] 600 mg IV/PO q12h
+:::* Alternative regimen (2): [[Daptomycin]]
+:::* Alternative regimen (3): [[Tigecycline]] 100 mg loading dose followed by 50 mg IV q12h
+::* 3. '''Glycopeptide resistant or intermediate Staphylococcus aureus'''
+:::* Preferred regimen: [[Linezolid]] 600 mg IV/PO q12h {{and}} [[Clindamycin]] 150-600 mg IM/IV/PO q6-8h (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO) (if sensitive)
+:::* Alternative regimen: [[Daptomycin]] {{or}} [[Tigecycline]] 100 mg loading dose followed by 50 mg  IV q12h
 ===Streptococcal toxic shock syndrome===
-* Streptococcal toxic shock syndrome <ref name="pmid19393958">{{cite journal| author=Lappin E, Ferguson AJ| title=Gram-positive toxic shock syndromes. | journal=Lancet Infect Dis | year= 2009 | volume= 9 | issue= 5 | pages= 281-90 | pmid=19393958 | doi=10.1016/S1473-3099(09)70066-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19393958  }} </ref>
+:* Streptococcal toxic shock syndrome <ref name="pmid19393958">{{cite journal| author=Lappin E, Ferguson AJ| title=Gram-positive toxic shock syndromes. | journal=Lancet Infect Dis | year= 2009 | volume= 9 | issue= 5 | pages= 281-90 | pmid=19393958 | doi=10.1016/S1473-3099(09)70066-0 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19393958  }} </ref>
-:* (1) '''Group A streptococcus'''
+::* 1. '''Group A streptococcus'''
-::* Preferred regimen: [[Penicillin G]], 2–4 million units q4–6h IV {{and}} [[Clindamycin]] 600–900 mg q8h IV, (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
+:::* Preferred regimen: [[Penicillin G]], 2–4 MU IV q4–6h {{and}} [[Clindamycin]] 600–900 mg q8h IV, (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
-::* Alternative regimen (1): (Macrolide [[Azithromycin]] 500 mg PO day 1 followed by 250 mg for 4 days {{or}} Fluoroquinolone [[Oxacillin]] 2-12 g/24 hr divided q4-6h IV (max dose: 12 g/24 hr)), {{and}} [[Clindamycin]] 150-600 mg q6-8h IV, IM, or PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
+:::* Alternative regimen (1): (Macrolide [[Azithromycin]] 500 mg PO day 1 followed by 250 mg for 4 days
-::* Alternative regimen (2): [[Linezolid]] 600 mg q 12 hr IV or PO {{or}} [[Daptomycin]] {{or}} [[Tigecycline]] 100 mg loading dose followed by 50 mg q12h IV
+:::* Alternative regimen (2): Fluoroquinolone [[Oxacillin]] 2-12 g/24 hr divided q4-6h IV (maximum dose: 12 g/24 hr)), {{and}} [[Clindamycin]] 150-600 mg q6-8h IV, IM, or PO (max dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
-::: Note : [[Macrolide]] and [[Fluoroquinolone]] resistance increasing
+:::* Alternative regimen (3): [[Linezolid]] 600 mg IV/PO q12h
-:* (2) '''Macrolide, lincosamide, and streptogramin B (MLS) resistant group A streptococcus'''
+:::* Alternative regimen (4): [[Daptomycin]] {{or}} [[Tigecycline]] 100 mg loading dose followed by 50 mg q12h IV
-::* Preferred regimen: [[Penicillin G]] 2-24 million units/24 hr divided q4-6h  IV or IM , {{and}} ([[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose{{or}} [[Teicoplanin]])
+:::* Note: [[Macrolide]] and [[Fluoroquinolone]] resistance increasing
-::* Alternative regimen (1): [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose{{or}} [[Teicoplanin]]
+::* 2. '''Macrolide, lincosamide, and streptogramin B (MLS) resistant group A streptococcus'''
-::* Alternative regimen (2): [[Linezolid]] 600 mg q12h IV or PO {{or}} [[Daptomycin]] {{or}} [[Tigecycline]] 100 mg loading dose followed by 50 mg q 12 hr IV
+:::* Preferred regimen: [[Penicillin G]] 2-24 MU/24h IV/IM  q4-6h  {{and}} ([[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g/dose {{or}} [[Teicoplanin]])
-::: Note : Macrolide resistance associated with [[Clindamycin]] resistance
+:::* Alternative regimen (1): [[Vancomycin]] 15 to 20 mg/kg IV q8-12h, not to exceed 2 g/dose {{or}} [[Teicoplanin]]
+:::* Alternative regimen (2): [[Linezolid]] 600 mg IV/PO q12h
+:::* Alternative regimen (3): [[Daptomycin]]
+:::* Alternative regimen (4): [[Tigecycline]] 100 mg IV loading dose followed by 50 mg q12h
+:::* Alternative regimen (5): [[Teicoplanin]]
+:::* Note: Macrolide resistance associated with [[Clindamycin]] resistance
 ===Typhus, louse-borne===
@@ Line 281: / Line 314: @@
 * '''Murine typhus,Rickettsia typhi''' (flea-borne infection) <ref name="pmid23253320">{{cite journal| author=Botelho-Nevers E, Socolovschi C, Raoult D, Parola P| title=Treatment of Rickettsia spp. infections: a review. | journal=Expert Rev Anti Infect Ther | year= 2012 | volume= 10 | issue= 12 | pages= 1425-37 | pmid=23253320 | doi=10.1586/eri.12.139 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23253320  }} </ref>
 :* Pathogen-directed antimicrobial therapy
-::* In adults
+::*  1. '''Adults'''
-:::* Preferred regimen : [[Doxycycline]] 100 mg bid PO continued for 3 days after the symptoms have resolved, [[Doxycycline]] 100-200 mg, PO single dose
+:::* Preferred regimen : [[Doxycycline]] 100 mg PO bid continued for 3 days after the symptoms have resolved, [[Doxycycline]] 100-200 mg, PO single dose
-:::* Alternative regimen (1): Fluoroquinolones [[Oxacillin]] 2-12 g/24 hr divided q4-6h IV (max dose: 12 g/24
+:::* Alternative regimen (1): [[Oxacillin]] 2-12 g/24 hr  IV q4-6h IV (maximum dose: 12 g/24)
-:::* Alternative regimen (2): [[Chloramphenicol]] 60 to 75 mg/kg/day PO in four divided doses
+:::* Alternative regimen (2): [[Chloramphenicol]] 60 to 75 mg/kg/day PO in qid
-::* In childern
+::*  2. '''Childern'''
 :::* Preferred regimen: [[Doxycycline]] 100-200 mg, PO for 3-7 days
-:::* Alternative regimen: [[Chloramphenicol]] 50-75 mg/kg/24 hr divided q 6-8 hr IV or PO
+:::* Alternative regimen: [[Chloramphenicol]] 50-75 mg/kg/24 hr IV/PO q 6-8 hr
-::* In pregnant women
+::*  3. '''Pregnant women'''
-:::* Preferred regimen: [[Doxycycline]] 100-200 mg, PO single dose late trimester
+:::* Preferred regimen: [[Doxycycline]] 100-200 mg, PO single dose ( late trimester)
-:::* Alternative regimen (1): [[Erythromycin]] Base: 333 mg PO q 8 hr; estolate/stearate/ base: 250-500 mg q 6 hr PO
+:::* Alternative regimen (1): [[Erythromycin]] Base: 333 mg PO tid or estolate/stearate/ base: 250-500 mg PO qid
-:::* Alternative regimen (2): [[Chloramphenicol]]  50 mg/kg/24 hr divided q 6 hr IV or PO (max dose: 4 g/24 hr) (early trimester: first and second trimesters)
+:::* Alternative regimen (2): [[Chloramphenicol]] 50 mg/kg/24 hr IV/PO  q6h (maximum dose: 4 g/24 hr) (early trimester: first and second trimesters)
 ===Typhus, scrub===
 * '''Scrub typhus,  Orientia tsutsugamushi''' (previously called Rickettsia tsutsugamushi- mite-borne infectious disease) <ref name="pmid12137646">{{cite journal| author=Panpanich R, Garner P| title=Antibiotics for treating scrub typhus. | journal=Cochrane Database Syst Rev | year= 2002 | volume=  | issue= 3 | pages= CD002150 | pmid=12137646 | doi=10.1002/14651858.CD002150 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12137646  }} </ref>
 :* Pathogen-directed antimicrobial therapy
-::* Preferred regimen: [[Doxycycline]] (100 mg PO or IV bd) for 3 days {{or}} [[Chloramphenicol]] 500 mg PO or IV q6h
+::* Preferred regimen (1): [[Doxycycline]] 100 mg PO/IV q12h for 3 days
+::* Preferred regimen (2): [[Chloramphenicol]] 500 mg PO/IV q6h
 ::* Alternative regimen: [[Azithromycin]] 500 mg PO day 1 followed by 250 mg for 4 days
@@ Line 314: / Line 348: @@
 ===Brucellosis===
-* Uncomplicated brucellosis in adults and children eight years of age and older <ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>
+*1. '''Uncomplicated brucellosis in adults''' <ref>{{cite book | last = Corbel | first = Michael | title = Brucellosis in humans and animals | publisher = World Health Organization | location = Geneva | year = 2006 | isbn = 9241547138 }}</ref>
-:* Preferred regimen: [[Doxycycline]] 100 mg BID for six weeks {{or}} [[Tetracycline]] 500 mg q6h PO administered for at least six weeks
+:* Preferred regimen (1): ([[Streptomycin]] 1 g IM q24h for the first 2-3 weeks of therapy {{or}} [[Gentamicin]] 5 mg/kg/day IV/IM for 7-10 days) {{and}} [[Doxycycline]] 100 mg PO bid for six weeks
-:* NOTE: [[Streptomycin]] 1 g/day IM administered for the first two to three weeks of therapy {{or}} [[Gentamicin]] 5mg/kg/day IV/IM for 7-10 days in combination with [[Doxycycline]] administered for six weeks
-:* Alternative regimen (1): [[Doxycycline]] 200 mg/day PO {{and}} [[Rifampicin]] 600–900 mg/day PO, both drugs administered for six weeks
+:* Preferred regimen (2): ([[Streptomycin]] 1 g IM q24h for the first 2-3 weeks of therapy {{or}} [[Gentamicin]] 5 mg/kg/day IV/IM for 7-10 days) {{and}} [[Tetracycline]] 500 mg PO qid  for at least six weeks
+:* Alternative regimen (1): [[Doxycycline]] 200 mg/day PO for 6 weeks {{and}} [[Rifampicin]] 600–900 mg/day PO for six weeks
 :* Alternative regimen (2): Fluoroquinolones
-:* NTOE: Quinolones should always be used in combination with other drugs, such as Doxycycline or Rifampicin
+:* Note (1): Quinolones should always be used in combination with other drugs, such as Doxycycline or Rifampicin
-:* Alternative regimen (3): [[TMP/SMZ]] in a fixed ratio of 1:5 (80 mg TMP/400 mg SMZ)
+:* Alternative regimen (3): [[TMP/SMZ]] 80 mg TMP/400 mg SMZ (in a fixed ratio of 1:5)
-:* NOTE: TMP/SMZ should always be used in combination with another agent, such as Doxycycline, Rifampicin or Streptomycin
+:* Note (2): TMP/SMZ should always be used in combination with another agent, such as Doxycycline, Rifampicin or Streptomycin
-* Complications of brucellosis
+*2. '''Complications of brucellosis'''
-:* Spondylitis
+:*2.1 '''Spondylitis'''
-::* Preferred regimen: Continuation of [[Doxycycline]] for eight weeks or more; Surgical drainage is rarely necessary.
+::* Continuation of [[Doxycycline]] for eight weeks or more; Surgical drainage is rarely necessary.
-:* Neurobrucellosis
+:*2.2 '''Neurobrucellosis'''
-::* Preferred regimen: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]], be added to the standard regimen of [[Doxycycline]] {{and}} [[Streptomycin]] for 6-8 weeks, and possibly longer, depending on the clinical response
+::* [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]], be added to the standard regimen of [[Doxycycline]] and [[Streptomycin]] for 6-8 weeks, and possibly longer, depending on the clinical response
-:* Brucella endocarditis
+:*2.3 '''Brucella endocarditis'''
-::* Preferred regimen: [[Doxycycline]] {{and}} an [[Aminoglycoside]] for at least eight weeks, and therapy should be continued for several weeks after surgery when valve replacement is necessary
+::* Preferred regimen: [[Doxycycline]] {{and}} an [[Aminoglycoside]] for at least eight weeks
-::* NOTE: [[Rifampicin]] {{or}} [[Trimethoprim/sulfamethoxazole]] are used for their ability to penetrate cell membranes
+::* Note: Therapy should be continued for several weeks after surgery when valve replacement is necessary
-* For children less than eight years of age
+*3. ''' For children'''
-:* Preferred regimen: [[TMP/SMZ]] 8/40 mg/ kg/day PO BID for six weeks {{and}} [[Streptomycin]] 30 mg/kg/day IM qd for three weeks {{or}} [[Gentamicin]] 5 mg/kg/day IV/IM qd for 7-10 days
+:*3.1 '''less than eight years of age'''
-:* Alternative regimen (1): [[TMP/SMZ]] {{and}} [[Rifampicin]] 15 mg/kg/day PO each administered for 6 weeks
+::* Preferred regimen: [[TMP/SMZ]] 8/40 mg/ kg/day PO bid for 6 weeks {{and}} ([[Streptomycin]] 30 mg/kg/day IM q24h for 3 weeks {{or}} [[Gentamicin]] 5 mg/kg/day IV/IM q24h for 7-10 days)
+::* Alternative regimen (1): [[TMP/SMZ]] {{and}} [[Rifampicin]] 15 mg/kg/day PO each administered for 6 weeks
-:* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
+::* Alternative regimen (2): [[Rifampicin]] {{and}} an [[Aminoglycoside]]
+:*3.2 '''eight years of age and older'''
+::* See adult treatment
 ===Ehrlichiosis===
 * Ehrlichiosis, suspected <ref name=CDC centers for the disease control and prevention>{{cite web | title =Ehrlichiosis CDC centers for the disease control and prevention| url= http://www.cdc.gov/ehrlichiosis/symptoms/index.html#treatment }}</ref>
-:* Preferred regimen: [[Doxycycline]] 100 mg q12h for 7-14 days
+:* Preferred regimen: [[Doxycycline]] 100 mg IV q12h for 7-14 days
-:* Alternative regimen: [[Chloramphenicol]] {{or}} [[Rifampin]]
+:* Alternative regimen (1): [[Chloramphenicol]]
-:* Pediatric regimen: [[Doxycycline]] 2.2 mg/kg PO BID (Children under 45 kg (100 lbs)) for 7-14 days
+:* Alternative regimen (2): [[Rifampin]]
-:* NOTE: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement
+:* Pediatric regimen: [[Doxycycline]] 2.2 mg/kg PO bid (Children under 45 kg (100 lbs)) 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
 ===Tularemia===
 * For treatment and prophylaxis <ref>{{cite book | last = LastName | first = FirstName | title = WHO guidelines on tularaemia epidemic and pandemic alert and response | publisher = World Health Organization | location = Geneva | year = 2007 | isbn = 9789241547376 }}</ref>
-:* Preferred regimen: [[Gentamicin]] 5 mg/kg PO daily, divided into two doses
+:* Preferred regimen: [[Gentamicin]] 5 mg/kg/day PO bid
-:* Alternative regimen (1): [[Streptomycin]] 2 g IM daily, divided in two doses, for 10 days
+:* Alternative regimen (1): [[Streptomycin]] 2 g/day IM q12h for 10 days
-:* Alternative regimen (2): [[Ciprofloxacin]] 800–1000 mg IV or PO daily, divided into two doses, for 10–14 days
+:* Alternative regimen (2): [[Ciprofloxacin]] 800–1000 mg/day IV/PO q12h/bid for 10–14 days
-:* Alternative regimen (3): [[Doxycycline]], 200 mg PO daily, divided in two, for at least 15 days
+:* Alternative regimen (3): [[Doxycycline]] 200 mg/day PO bid for at least 15 days
-:* Pediatric regimen: [[Gentamicin]] 5–6 mg/kg divided into two or three doses for at least 10 days; [[Streptomycin]] 15 mg/kg PO  BID(up to 2 g daily) for at least 10 days; [[Ciprofloxacin]] 15 mg/kg PO BID (up to 1 g daily) for at least 10 days
+:* Pediatric regimen: [[Gentamicin]] 5–6 mg/kg/day q8-12h for at least 10 days; [[Streptomycin]] 15 mg/kg PO bid (Maximum, 2 g/day) for at least 10 days; [[Ciprofloxacin]] 15 mg/kg PO bid (Maximum, 1 g/day) for at least 10 days
 ===Typhoid fever===
-* Uncomplicated typhoid fever<ref>{{ cite web | title = The diagnosis, treatment and prevention of typhoid fever  | url = http://www.who.int/rpc/TFGuideWHO.pdf }}</ref>
+*1. '''Uncomplicated typhoid fever'''<ref>{{ cite web | title = The diagnosis, treatment and prevention of typhoid fever  | url = http://www.who.int/rpc/TFGuideWHO.pdf }}</ref>
-:* Fully sensitive
+:*1.1 '''Fully sensitive '''
-::* Preferred regimen: [[Ofloxacin]] {{or}} [[Ciprofloxacin]] 15 mg/kg qd for 5-7 days
+::* Preferred regimen (1): [[Ofloxacin]] 15 mg/kg/day for 5-7 days
-::* Alternative regimen (1): [[Chloramphenicol]] 50-75 mg/kg qd for 14-21 days
-::* Alternative regimen (2): [[Amoxicillin]] 75-100 mg/kg qd for 14 days
-::* Alternative regimen (3): [[TMP-SMX]]  8-40 mg/kg qd for 14 days
-:* Multidrug resistance
-::* Preferred regimen: [[Fluoroquinolone]] 15 mg/kg qd for 5-7 days {{or}} [[Cefixime]] 15-20 mg/kg qd for 7-14 days
-::* Alternative regimen (1): [[Azithromycin]] 8-10 mg/kg qd for 7 days
-::* Alternative regimen (2): [[Cefixime]] 15-20 mg/kg qd for 7-14 days
-:* Quinolone resistance
-::* Preferred regimen: [[Azithromycin]] 8-10 mg/kg qd for 7 days {{or}} [[Ceftriaxone]] 75 mg/kg qd for 10-14 days
-::* Alternative regimen: [[Cefixime]] 20 mg/kg qd for 7-14 days
-* Severe typhoid fever
+::* Preferred regimen (2): [[Ciprofloxacin]] 15 mg/kg/day for 5-7 days
-:* Fully sensitive
+::* Alternative regimen (1): [[Chloramphenicol]] 50-75 mg/kg/day for 14-21 days
-::* Preferred regimen: [[Ofloxacin]] 15 mg/kg qd for 10-14 days
+::* Alternative regimen (2): [[Amoxicillin]] 75-100 mg/kg/day for 14 days
-::* Alternative regimen (1): [[Chloramphenicol]] 100 mg/kg qd for 14-21 days
+::* Alternative regimen (3): [[TMP-SMX]]  8-40 mg/kg/day for 14 days
-::* Alternative regimen (2): [[Amoxicillin]] 100 mg/kg qd for 14 days
+:*1.2 '''Multidrug resistance '''
-::* Alternative regimen (3): [[TMP-SMX]]  8-40 mg/kg qd for 14 days
+::* Preferred regimen (1): [[Fluoroquinolone]] 15 mg/kg/day for 5-7 days
-:* Multidrug resistant
+::* Preferred regimen (2): [[Cefixime]] 15-20 mg/kg/day for 7-14 days
-::* Preferred regimen: [[Fluoroquinolone]] 15 mg/kg qd for 10-14 days
+::* Alternative regimen (1): [[Azithromycin]] 8-10 mg/kg/day for 7 days
-::* Alternative regimen (1): [[Ceftriaxone]] 60 mg/kg qd for 10-14 days
+::* Alternative regimen (2): [[Cefixime]] 15-20 mg/kg/day for 7-14 days
-::* Alternative regimen (2): [[Cefotaxime]] 80 mg/kg qd for 10-14 days
+:*1.3 '''Quinolone resistance'''
-:* Quinolone resistant
+::* Preferred regimen (1): [[Azithromycin]] 8-10 mg/kg/day for 7 days
-::* Preferred regimen: [[Ceftriaxone]] 60 mg/kg qd for 10-14 days {{or}} [[Cefotaxime]] 80 mg/kg qd for 10-14 days
-::* Alternative regimen: [[Fluoroquinolone]] 20 mg/kg qd for 7-14 days
+::* Preferred regimen (2): [[Ceftriaxone]] 75 mg/kg/day for 10-14 days
+::* Alternative regimen: [[Cefixime]] 20 mg/kg/day for 7-14 days
+*2. '''Severe typhoid fever'''
+:*2.1 '''Fully sensitive'''
+::* Preferred regimen: [[Ofloxacin]] 15 mg/kg/day for 10-14 days
+::* Alternative regimen (1): [[Chloramphenicol]] 100 mg/kg/day for 14-21 days
+::* Alternative regimen (2): [[Amoxicillin]] 100 mg/kg/day for 14 days
+::* Alternative regimen (3): [[TMP-SMX]]  8-40 mg/kg/day for 14 days
+:*2.2 '''Multidrug resistant'''
+::* Preferred regimen: [[Fluoroquinolone]] 15 mg/kg/day for 10-14 days
+::* Alternative regimen (1): [[Ceftriaxone]] 60 mg/kg/day for 10-14 days
+::* Alternative regimen (2): [[Cefotaxime]] 80 mg/kg/day for 10-14 days
+:*2.3 '''Quinolone resistant '''
+::* Preferred regimen (1): [[Ceftriaxone]] 60 mg/kg/day for 10-14 days
+::* Preferred regimen (2): [[Cefotaxime]] 80 mg/kg/day for 10-14 days
+::* Alternative regimen: [[Fluoroquinolone]] 20 mg/kg/day for 7-14 days
 ===Kawasaki syndrome===
-* Initial treatment <ref>{{cite web | title = Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease
+*1. '''Initial treatment''' <ref>{{cite web | title = Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease
 | url =http://circ.ahajournals.org/content/110/17/2747.full }}</ref>
-:* Preferred regimen: [[IVIG]] 2 g/kg in a single infusion within the first 7-10 days of illness {{and}} [[Aspirin]] 80-100 mg/kg per day in 4 doses , reduce the aspirin dose after the child has been afebrile for 48 to 72 hours, then begin low-dose aspirin (3 to 5 mg/kg per day) and maintain it until the patient shows no evidence of coronary changes by 6 to 8 weeks after the onset of illness
+:* Preferred regimen: [[IVIG]] 2 g/kg single infusion within the first 7-10 days of illness {{and}} [[Aspirin]] 80-100 mg/kg/day qid , reduce the aspirin dose after the child has been afebrile for 48 to 72 hours, then begin low-dose aspirin (3 to 5 mg/kg/day) and maintain it until the patient shows no evidence of coronary changes by 6 to 8 weeks after the onset of illness
-:* NOTE (1): Other clinicians continue highdose aspirin until day 14 of illness and 48 to 72 hours after fever cessation
+:* Note (1): Other clinicians continue highdose aspirin until day 14 of illness and 48 to 72 hours after fever cessation
-:* NOTE (2): For children who develop coronary abnormalities, aspirin may be continued indefinitely
+:* Note (2): For children who develop coronary abnormalities, aspirin may be continued indefinitely
-* Treatment of Patients Who Failed to Respond to Initial Therapy (persistent or recrudescent fever ≥36 hours after completion of the initial IVIG infusion)
+*2. '''Treatment of Patients Who Failed to Respond to Initial Therapy (persistent or recrudescent fever ≥ 36 hours after completion of the initial IVIG infusion)'''
-:* Preferred regimen: [[IVIG]] 2 g/kg {{or}} intravenous pulse [[Methylprednisolone]] 30 mg/kg for 2 to 3 hours, administered qd for 1 to 3 days
+:* Preferred regimen: [[IVIG]] 2 g/kg q24h for 1-3 days {{or}} [[Methylprednisolone]] 30 mg/kg IV for 2-3 hours q24h for 1-3 days
 ===Leptospirosis===
-* Severe <ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref>
+*1. '''Severe''' <ref>{{cite book | last = LastName | first = FirstName | title = Human leptospirosis guidance for diagnosis, surveillance and control | publisher = World Health Organization | location = Geneva | year = 2003 | isbn = 9241545895 }}</ref>
-:* Preferred regimen: High doses of intravenous [[Penicillin]]
+:* High doses of [[Penicillin]] IV
-* Less severe
+*2. '''Less severe'''
-:* Preferred regimen: [[Amoxycillin]] {{or}} [[Ampicillin]] {{or}} [[Doxycycline]] {{or}} [[Erythromycin]] PO
+:* Preferred regimen: [[Amoxycillin]] {{or}} [[Ampicillin]] {{or}} [[Doxycycline]] {{or}} [[Erythromycin]]
-:* Alternative regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Quinolone]] PO
+:* Alternative regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Quinolone]]
-:* NOTE (1): Treatment with effective antibiotics should be initiated as soon as the diagnosis of leptospirosis is suspected and preferably before the fifth day after the onset of illness
+:* Note (1): Treatment with effective antibiotics should be initiated as soon as the diagnosis of leptospirosis is suspected and preferably before the fifth day after the onset of illness
-:* NOTE (2): Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics because serological tests do not become positive until about a week after the onset of illness, and cultures may not become positive for several weeks.
+:* Note (2): Clinicians should never wait for the results of laboratory tests before starting treatment with antibiotics because serological tests do not become positive until about a week after the onset of illness, and cultures may not become positive for several weeks.
 ===Rocky Mountain spotted fever===
@@ Line 407: / Line 453: @@
 :* Preferred regimen: [[Doxycycline]] 100 mg q12h
 :* Alternative regimen: [[Chloramphenicol]]
-:* Pediatric regimen: [[Doxycycline]] 2.2 mg/kg PO BID (under 45 kg (100 lbs)
+:* Pediatric regimen: [[Doxycycline]] 2.2 mg/kg PO bid (under 45 kg (100 lbs))
-:* NOTE: Patients should be treated for at least 3 days after the fever subsides and until there is evidence of clinical improvement. Standard duration of treatment is 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; Standard duration of treatment is 7-14 days.
 ===Relapsing fever===
-* Tick-borne Relapsing Fever <ref name=CDC centers for disease control and prevention>{{cite web | title = Relapsing Fever CDC centers of disease control and prevention| url =http://www.cdc.gov/relapsing-fever/clinicians/#treatment }}</ref>
+*1. '''Tick-Borne Relapsing Fever''' <ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
-:* patients without central nervous system involvement
+:* Preferred regimen: [[Doxycycline]] 100 mg PO bid for 5-10 days
-::* Preferred regimen: [[Tetracycline]] 500 mg PO q6h for 10 days
+:* Alternative regimen: [[Erythromycin]] 500 mg PO qid for 5-10 days
-::* Alternative regimen: [[Erythromycin]] 500 mg PO (or 12.5 mg/kg q6h for 10 days
+:* Note: If meningitis/encephalitis present, use [[Ceftriaxone]] 2 g IV q12h for 14 days
-:* patients with central nervous system involvement
+*2. '''Louse-Borne Relapsing Fever'''
-::* Preferred regimen: [[Ceftriaxone]] 2 mg PO qd for 10-14 days
+:* Preferred regimen: [[Tetracycline]] 500 mg PO single dose
-* Louse-borne Relapsing Fever
+:* Alternative regimen: [[Erythromycin]] 500 mg PO single dose
-: ''Borrelia recurrentis''
-:* Preferred regimen: LBRF can be treated effectively with a single dose of antibiotics.
 ===Tetanus===
-* General measures <ref name=World Health Organization>{{cite web | title = Current recommendations for treatment of tetanus during humanitarian emergencies| url =http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/ }}</ref>
+*1. '''General measures''' <ref name=World Health Organization>{{cite web | title = Current recommendations for treatment of tetanus during humanitarian emergencies| url =http://www.who.int/diseasecontrol_emergencies/publications/who_hse_gar_dce_2010.2/en/ }}</ref>
-:* 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
+:* 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
-* Immunotherapy
+*2. '''Antitoxin and other 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
+:* Preferred regimen: Human TIG 500 U IM/IV as soon as possible {{and}} Age-appropriate TT-containing vaccine, 0.5 cc IM 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
+:* 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
-* Antibiotic treatment
+*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
+:* Preferred regimen (1): [[Metronidazole]] 500 mg PO/IV qid/q6h
-:* Alternative regimen: [[Tetracyclines]] {{or}} [[Macrolides]] {{or}} [[Clindamycin]] {{or}} [[Cephalosporins]] {{or}} [[Chloramphenicol]]
-* Muscle spasm control
+:* Preferred regimen (2): [[Penicillin G]] 100,000–200,000 IU/kg/day IV q6-12h
-:* Preferred regimen: [[Diazepam]] 5 mg intravenous {{or}} [[Lorazepam]] 2 mg titrating to achieve spasm control without excessive sedation and hypoventilation
+:* Alternative regimen (1): [[Tetracyclines]]
-:* Alternative regimen (1): [[Magnesium]] sulphate 5 gm (or 75mg/kg) intravenous loading dose, then 2–3 grams per hour until spasm control is achieved {{withorwithout}} [[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): [[Macrolides]]
-:* Alternative regimen (2): [[Baclofen]] {{or}} [[Dantrolene]] 1–2 mg/kg intravenous/orally every 4 hours
+:* Alternative regimen (3): [[Clindamycin]]
+:* Alternative regimen (4): [[Cephalosporins]]
+:* Alternative regimen (5): [[Chloramphenicol]]
+*4. '''Muscle spasm control'''
+:* Preferred regimen: [[Diazepam]] 5 mg IV {{or}} [[Lorazepam]] 2 mg
+:* Note: Lorazepam should be titrated to achieve spasm control without excessive sedation and hypoventilation
+:* Alternative regimen (1): [[Magnesium]] sulphate 5 gm (or 75mg/kg) IV {{then}} 2–3 gm/hr until spasm control is achieved {{withorwithout}} [[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 IV/PO q4h
-:* Alternative regimen (3): [[Barbiturates]] 100–150 mg every 1–4 hours by any route
+:* Alternative regimen (3): [[Barbiturates]] 100–150 mg q1-4h
-:* Alternative regimen (4): [[Chlorpromazine]] 50–150 mg by intramuscular injection every 4–8 hours
+:* Alternative regimen (4): [[Chlorpromazine]] 50–150 mg IM q4–8h
-:* 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
+:* Pediatric regimen: [[Lorazepam]] 0.1–0.2 mg/kg q2–6h, titrating upward as needed; [[Barbiturates]] 6–10 mg/kg by any route; [[Chlorpromazine]] 4–12 mg IM q4–8h
-:* 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
+:* 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
-* Autonomic dysfunction control
+*5. '''Autonomic dysfunction control'''
 :* Preferred regimen: [[Magnesium]] sulphate {{or}} [[Morphine]] {{or}} [[Esmolol]]
@@ Line 449: / Line 505: @@
 * Lymphadenitis
 :* Pathogen-directed antimicrobial therapy
-::* '''Nocardia'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::*1. '''Nocardia'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen: [[TMP-SMX]] 5–10 mg/kg/day (TMP component) IV/PO divided in 2–4 doses for 3 months
+:::* Preferred regimen: [[TMP-SMX]] 5–10 mg/kg/day (TMP component) IV/PO q6-12h for 3 months
-:::* Alternative regimen: [[Sulfisoxazole]] 2 g PO qid for 3 months {{or}} [[Minocycline]] 100-200 mg PO bid for 3 months
+:::* Alternative regimen (1): [[Sulfisoxazole]] 2 g PO qid for 3 months
+:::* Alternative regimen (2): [[Minocycline]] 100-200 mg PO bid for 3 months
-::* '''Bartonella henselae (cat-scratch disease)'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
+::*2. '''Bartonella henselae (cat-scratch disease)'''<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
-:::* Preferred regimen (adult): [[Azithromycin]] 500 mg PO for 1 dose, then 250 mg/day for 4 days
+:::* Preferred regimen (adult): [[Azithromycin]] 500 mg PO single dose {{then}} 250 mg/day for 4 days
-:::* Preferred regimen (pediatric): [[Azithromycin]] liquid 10 mg/kg PO for 1 dose, then 5 mg/kg per day x 4 days
+:::* Preferred regimen (pediatric): [[Azithromycin]] 10 mg/kg PO single dose {{then}} 5 mg/kg/day for 4 days
 ===Sepsis, adult===
-* Sepsis, adult
+*1. '''Sepsis, adult'''
-:* Empiric antimicrobial therapy<ref>{{Cite journal| doi = 10.1097/CCM.0b013e31827e83af| issn = 1530-0293| volume = 41| issue = 2| pages = 580–637| last1 = Dellinger| first1 = R. Phillip| last2 = Levy| first2 = Mitchell M.| last3 = Rhodes| first3 = Andrew| last4 = Annane| first4 = Djillali| last5 = Gerlach| first5 = Herwig| last6 = Opal| first6 = Steven M.| last7 = Sevransky| first7 = Jonathan E.| last8 = Sprung| first8 = Charles L.| last9 = Douglas| first9 = Ivor S.| last10 = Jaeschke| first10 = Roman| last11 = Osborn| first11 = Tiffany M.| last12 = Nunnally| first12 = Mark E.| last13 = Townsend| first13 = Sean R.| last14 = Reinhart| first14 = Konrad| last15 = Kleinpell| first15 = Ruth M.| last16 = Angus| first16 = Derek C.| last17 = Deutschman| first17 = Clifford S.| last18 = Machado| first18 = Flavia R.| last19 = Rubenfeld| first19 = Gordon D.| last20 = Webb| first20 = Steven A.| last21 = Beale| first21 = Richard J.| last22 = Vincent| first22 = Jean-Louis| last23 = Moreno| first23 = Rui| last24 = Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup| title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012| journal = Critical Care Medicine| date = 2013-02| pmid = 23353941}}</ref>
+:*1.1 '''Empiric antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1097/CCM.0b013e31827e83af| issn = 1530-0293| volume = 41| issue = 2| pages = 580–637| last1 = Dellinger| first1 = R. Phillip| last2 = Levy| first2 = Mitchell M.| last3 = Rhodes| first3 = Andrew| last4 = Annane| first4 = Djillali| last5 = Gerlach| first5 = Herwig| last6 = Opal| first6 = Steven M.| last7 = Sevransky| first7 = Jonathan E.| last8 = Sprung| first8 = Charles L.| last9 = Douglas| first9 = Ivor S.| last10 = Jaeschke| first10 = Roman| last11 = Osborn| first11 = Tiffany M.| last12 = Nunnally| first12 = Mark E.| last13 = Townsend| first13 = Sean R.| last14 = Reinhart| first14 = Konrad| last15 = Kleinpell| first15 = Ruth M.| last16 = Angus| first16 = Derek C.| last17 = Deutschman| first17 = Clifford S.| last18 = Machado| first18 = Flavia R.| last19 = Rubenfeld| first19 = Gordon D.| last20 = Webb| first20 = Steven A.| last21 = Beale| first21 = Richard J.| last22 = Vincent| first22 = Jean-Louis| last23 = Moreno| first23 = Rui| last24 = Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup| title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012| journal = Critical Care Medicine| date = 2013-02| pmid = 23353941}}</ref>
-::* '''History of intravenous drug use with high prevalence of MRSA'''
+::*1.1.1 '''History of intravenous drug use with high prevalence of MRSA'''
 :::* Perferred regimen: [[Vancomycin]] 1 g IV q12h
-::* '''Sepsis associated with petechiae'''
+::*1.1.2 '''Sepsis associated with petechiae'''
 :::* Perferred regimen: [[Ceftriaxone]] 2 g IV q12h
-::* '''Biliary source'''
+::*1.1.3 '''Biliary source'''
-:::* Perferred regimen: [[Ampicillin-Sulbactam]] 3 g IV q6h {{or}} [[Piperacillin-Tazobactam]] 3.375 g IV q4h {{or}} [[Ticarcillin-Clavulanate]] 3.1 g IV q4h
+:::* Perferred regimen (1): [[Ampicillin-Sulbactam]] 3 g IV q6h
+:::* Perferred regimen (2): [[Piperacillin-Tazobactam]] 3.375 g IV q4h
+:::* Perferred regimen (3): [[Ticarcillin-Clavulanate]] 3.1 g IV q4h
-::* '''Community-acquired pneumonia'''
+::*1.1.4 '''Community-acquired pneumonia'''
 :::* Perferred regimen: ([[Levofloxacin]] 750 mg IV q24h {{or}} [[Moxifloxacin]] 400 mg IV q24h) {{and}} [[Piperacillin-Tazobactam]] 3.375 g IV q4h {{and}} [[Vancomycin]] 1 g IV q12h
-::* '''Unclear infection source'''
+::*1.1.5 '''Unclear infection source'''
 :::* Perferred regimen: ([[Doripenem]] 500 mg IV q8h {{or}} [[Ertapenem]] 1 g IV q24h {{or}} [[Imipenem]] 0.5 g IV q6h {{or}} [[Meropenem]] 1 g IV q8h) {{and}} [[Vancomycin]] 1 g IV q12h
-::* '''Low prevalence of ESBL and/or carbapenemase-producing aerobic GNB'''
+::*1.1.6 '''Low prevalence of ESBL and/or carbapenemase-producing aerobic GNB'''
 :::* Perferred regimen: [[Piperacillin-Tazobactam]] 3.375 g IV q4h {{and}} [[Vancomycin]] 1 g IV q12h
-::* '''High prevalence of ESBL and/or carbapenemase-producing aerobic GNB'''
+::*1.1.7 '''High prevalence of ESBL and/or carbapenemase-producing aerobic GNB'''
-:::* Perferred regimen: [[Colistin]] 2.5 mg/kg for 1 dose followed by 1.5 mg/kg IV q12h {{and}}  [[Meropenem]] 1 g IV q8h {{and}} [[Vancomycin]] 1 g IV q12h
+:::* Perferred regimen: [[Colistin]] 2.5 mg/kg single dose followed by 1.5 mg/kg IV q12h {{and}}  [[Meropenem]] 1 g IV q8h {{and}} [[Vancomycin]] 1 g IV q12h
 ===Sepsis, pediatric===
-* Sepsis, pediatric
+*1. '''Sepsis, pediatric'''
-:* Empiric antimicrobial therapy<ref>{{Cite journal| doi = 10.1097/CCM.0b013e31827e83af| issn = 1530-0293| volume = 41| issue = 2| pages = 580–637| last1 = Dellinger| first1 = R. Phillip| last2 = Levy| first2 = Mitchell M.| last3 = Rhodes| first3 = Andrew| last4 = Annane| first4 = Djillali| last5 = Gerlach| first5 = Herwig| last6 = Opal| first6 = Steven M.| last7 = Sevransky| first7 = Jonathan E.| last8 = Sprung| first8 = Charles L.| last9 = Douglas| first9 = Ivor S.| last10 = Jaeschke| first10 = Roman| last11 = Osborn| first11 = Tiffany M.| last12 = Nunnally| first12 = Mark E.| last13 = Townsend| first13 = Sean R.| last14 = Reinhart| first14 = Konrad| last15 = Kleinpell| first15 = Ruth M.| last16 = Angus| first16 = Derek C.| last17 = Deutschman| first17 = Clifford S.| last18 = Machado| first18 = Flavia R.| last19 = Rubenfeld| first19 = Gordon D.| last20 = Webb| first20 = Steven A.| last21 = Beale| first21 = Richard J.| last22 = Vincent| first22 = Jean-Louis| last23 = Moreno| first23 = Rui| last24 = Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup| title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012| journal = Critical Care Medicine| date = 2013-02| pmid = 23353941}}</ref>
+:*1.1 '''Empiric antimicrobial therapy'''<ref>{{Cite journal| doi = 10.1097/CCM.0b013e31827e83af| issn = 1530-0293| volume = 41| issue = 2| pages = 580–637| last1 = Dellinger| first1 = R. Phillip| last2 = Levy| first2 = Mitchell M.| last3 = Rhodes| first3 = Andrew| last4 = Annane| first4 = Djillali| last5 = Gerlach| first5 = Herwig| last6 = Opal| first6 = Steven M.| last7 = Sevransky| first7 = Jonathan E.| last8 = Sprung| first8 = Charles L.| last9 = Douglas| first9 = Ivor S.| last10 = Jaeschke| first10 = Roman| last11 = Osborn| first11 = Tiffany M.| last12 = Nunnally| first12 = Mark E.| last13 = Townsend| first13 = Sean R.| last14 = Reinhart| first14 = Konrad| last15 = Kleinpell| first15 = Ruth M.| last16 = Angus| first16 = Derek C.| last17 = Deutschman| first17 = Clifford S.| last18 = Machado| first18 = Flavia R.| last19 = Rubenfeld| first19 = Gordon D.| last20 = Webb| first20 = Steven A.| last21 = Beale| first21 = Richard J.| last22 = Vincent| first22 = Jean-Louis| last23 = Moreno| first23 = Rui| last24 = Surviving Sepsis Campaign Guidelines Committee including the Pediatric Subgroup| title = Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012| journal = Critical Care Medicine| date = 2013-02| pmid = 23353941}}</ref>
-::* '''Children aged > 1 month'''
+::*1.1.1 '''Children aged > 1 month'''
 :::* Preferred regimen: ([[Cefotaxime]] 50 mg/kg IV q8h {{or}} [[Ceftriaxone]] 100 mg/kg IV q24h) {{and}} [[Vancomycin]] 15 mg/kg IV q6h
 :::* Alternative regimen: [[Aztreonam]] 7.5 mg/kg IV q6h {{and}} [[Linezolid]] 10 mg/kg IV q8h
-::* '''Children aged < 1 month'''
+::*1.1.2 '''Children aged < 1 month'''
-:::* Preferred regimen: [[Ampicillin]] 25 mg/kg IV q8h {{and}} [[Cefotaxime]] 50 mg/kg q12h ± [[Vancomycin]] 15 mg/kg IV q12h (if suspecting [[MRSA]])
+:::* Preferred regimen: [[Ampicillin]] 25 mg/kg IV q8h {{and}} [[Cefotaxime]] 50 mg/kg q12h {{withorwithout}} [[Vancomycin]] 15 mg/kg IV q12h (if suspecting [[MRSA]])
-:::* Alternative regimen: [[Ampicillin]] 25 mg/kg IV q6h {{and}} [[Ceftriaxone]] 75 mg/kg IV q24h ± [[Vancomycin]] 15 mg/kg IV q12h (if suspecting [[MRSA]])
+:::* Alternative regimen: [[Ampicillin]] 25 mg/kg IV q6h {{and}} [[Ceftriaxone]] 75 mg/kg IV q24h {{withorwithout}} [[Vancomycin]] 15 mg/kg IV q12h (if suspecting [[MRSA]])
 ==References==
 {{reflist}}

Sandbox ID Systemic: Difference between revisions

Latest revision as of 13:22, 12 August 2015

Babesiosis

Bartonella

Botulism

Boutonneuese fever

Diphtheria

Fever of unknown origin

Lymphangitis

Neutropenic fever, prophylaxis

Neutropenic fever, treatment

Salmonella bacteremia

Clostridial toxic shock syndrome

Staphylococcal toxic shock syndrome

Streptococcal toxic shock syndrome

Typhus, louse-borne

Typhus, murine

Typhus, scrub

Anaplasmosis

Brucellosis

Ehrlichiosis

Tularemia

Typhoid fever

Kawasaki syndrome

Leptospirosis

Rocky Mountain spotted fever

Relapsing fever

Tetanus

Lymphadenitis

Sepsis, adult

Sepsis, pediatric

References

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