Sandbox ID Central Nervous System: Difference between revisions

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===Brain abscess===
===Central Nervous System===
===='''Primary or contiguous source'''====
:*Preferred regimen:([[cefotaxime]] 2 gm IV q4h {{or}} [[ceftriaxone]] 2 gm IV q12h) {{and}} ([[metronidazole]] 7.5 mg/kg q6h {{or}} 15 mg/kg IV q12h)


:*Alternative regimen: [[Penicillin G]] 3-4 million units IV q4h {{and}} [[metronidazole]] 7.5 mg/kg q6h or 15 mg/kg IV q12h
====Brain abscess {{ID-returntotop-organ}}====


{{ID-Brain abscess}}


'''Post-surgical, post-traumatic'''
====Cerebrospinal fluid shunt infection {{ID-returntotop-organ}}====
:*Preferred regimen: ([[Nafcillin]] {{or}} [[oxacillin]]) 2 gm IV q4h {{and}} ([[cefotaxime]] 2 gm IV q4h {{or}} [[ceftriaxone]] 2 gm IV q12h)


:*Alternative regimen:
{{ID-Cerebrospinal fluid shunt infection}}


'''HIV-1 infected (AIDS)'''
====Encephalitis {{ID-returntotop-organ}}====
:*Preferred regimen: ([[Pyrimethamine]] 200 mg x 1 po, then 75 mg/day po) {{and}} ([[sulfadiazine]] [Wt based dose: 1 gm if <60 kg, 1.5 gm if ≥60 kg] po q6h) {{and}} [[folinic]] acid 10–25 mg/day po for minimum of 6 wks {{or}} [[TMP-SMX]] 10/50 mg/kg per day po or IV div. q12h x 30 days
:*Alternative regimen:


----
{{ID-Encephalitis}}


===Encephalitis===
====Epidural abscess {{ID-returntotop-organ}}====
:* Viruses
::* [[Adenovirus]]
:::* Preferred regimen: supportive
::* [[Influenza|B virus]]
:::'''prophylactic antiviral therapy after bite or scratch'''
::::* Preferred regimen: [[Valacyclovir]]
:::'''established disease'''
::::* Preferred regimen: [[Valacyclovir]] {{or}} [[Acyclovir]] {{or}} [[Ganciclovir]]
::* [[CMV]]
:::* Preferred regimen: [[Ganciclovir]] {{and}} [[foscarnet]]
::* [[Eastern equine encephalitis virus]]
:::* Preferred regimen: supportive
::* [[EBV]]
:::* Preferred regimen: supportive {{and}} [[Corticosteroids]]
::* [[Hendra virus]]
:::* Preferred regimen: supportive
::* [[Human herpesvirus 6|HHV-6]]
:::* Preferred regimen: [[Ganciclovir]] {{or}} [[Foscarnet]]
::* [[HIV]]
:::* Preferred regimen: [[HAART]]
::* [[HSV]]-1 and -2
:::* Preferred regimen: [[Acyclovir]]
::* [[Influenza virus]]
:::* Preferred regimen: [[Oseltamivir]]
::* [[Japanese encephalitis virus]]
:::* Preferred regimen: supportive
::* [[JC virus]]
:::* Preferred regimen: Reversal or control of immunosuppression {{and}} [[HAART]] in patients with [[AIDS]]
::* [[La Crosse virus]]
:::* Preferred regimen: supportive
::* [[Measles virus]]
:::'''life-threatening disease'''
::::* Preferred regimen: [[Ribavirin]]
:::'''SSPE'''
::::* Preferred regimen: [[Ribavirin]] intrathecal
::* [[Mumps virus]]
:::* Preferred regimen: supportive
::* [[Murray Valley encephalitis virus]]
:::* Preferred regimen: supportive
::* [[Nipah virus]]
:::* Preferred regimen: supportive {{and}} [[Ribavirin]]
::* [[Non-Polio enterovirus infections|Nonpolio enteroviruses]]
:::* Preferred regimen: supportive {{and}} Intraventricular γ-globulin (for chronic and/or severe disease)
::* [[Poliovirus]]
:::* Preferred regimen: supportive
::* [[Powassan virus]]
:::* Preferred regimen: supportive
::* [[Rabies virus]]
:::'''postxposure prophylaxis'''
::::* Preferred regimen: rabies immunoglobulin {{and}} vaccine
:::'''after onset of disease'''
::::* Preferred regimen: supportive
::* [[Rubella virus]]
:::* Preferred regimen: supportive
::* St. Louis encephalitis virus
:::* Preferred regimen: supportive
:::* Alternative regimen: IFN-a-2b
::* Tickborne encephalitis virus
:::* Preferred regimen: supportive
::* [[Vaccinia]]
:::* Preferred regimen: supportive {{withorwithout}} [[Corticosteroids]]
::* [[Venezuelan equine encephalitis virus]]
:::* Preferred regimen: supportive
::* [[VZV]]
:::* Preferred regimen: [[Acyclovir]] {{withorwithout}} [[Corticosteroids]]
:::* Preferred regimen: [[Ganciclovir]] {{withorwithout}} [[Corticosteroids]]
::* [[West Nile virus]]
:::* Preferred regimen: supportive
::* [[Western equine encephalitis virus]]
:::* Preferred regimen: supportive


:* Bacteria
{{ID-Epidural abscess}}
::* [[Anaplasma phagocytophilum]] (human granulocytotrophic ehrlichiosis)
:::* Preferred regimen: [[Doxycycline]]
::* [[Bartonella bacilliformis]] ([[Oroya fever]])
:::* Preferred regimen: [[Chloramphenicol]] {{or}} [[Ciprofloxacin]]] {{or}} [[Doxycycline]] {{or}} [[Ampicillin]] {{or}} [[trimethoprim-sulfamethoxazole]]
::* [[Bartonella henselae]] ([[Cat scratch disease]])
:::* Preferred regimen: [[Doxycycline]] {{or}} [[Azithromycin]] {{withorwithout}} [[Rifampin]]
::* [[Borrelia burgdorferi]] ([[Lyme disease]])
:::* preferred regimen: [[Ceftriaxone]] {{or}} [[Cefotaxime]] {{or}} [[Penicillin G]]
::* [[Coxiella burnetii]] ([[Q fever]])
:::* Preferred regimen:  [[Doxycycline]] {{and}} [[Fluoroquinolone]] {{and}} [[Rifampin]]
::* Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
:::* Preferred regimen: [[Doxycycline]]
::* [[Listeria monocytogenes]]
:::* Preferred regimen: [[Ampicillin]] {{or}} [[Trimethoprim-sulfamethoxazole]] {{and}} [[Gentamicin]]
::* [[Mycobacterium tuberculosis]]
:::'''with meningitis'''
:::* Preferred regimen: [[Dexamethasone]]
:::'''without meningitis'''
:::* Preferred regimen: [[Isoniazid]] {{or}} [[Rifampin]] {{or}} [[Pyrazinamide]] {{or}} [[Ethambutol]]
::* [[Mycoplasma pneumoniae]]
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Doxycycline]] {{or}} [[Fluoroquinolone]]
::* [[Rickettsia rickettsii]] ([[Rocky Mountain spotted fever]])
:::* Preferred regimen: [[Doxycycline]]
:::* Alternative regimen: [[Chloramphenicol]]
::* [[Treponema pallidum]] ([[syphilis]])
:::* preferred regimen: [[Ceftriaxone]] {{or}} [[Penicillin G]]
::* [[Tropheryma whipplei]] ([[Whipple's disease]])
:::* Preferred regimen: [[Ceftriaxone]] for 2–4 weeks, followed by [[Trimethoprim-sulfamethoxazole]] {{or}} [[Cefixime]] for 1–2 years


:* Fungi
====Lyme neuroborreliosis {{ID-returntotop-organ}}====
::* [[Coccidioides posadasii|Coccidioides]]
:::* Preferred regimen: [[Fluconazole]]
:::* Alternative regimen: [[Itraconazole]] {{or}} [[Voriconazole]] {{or}} [[Amphotericin B]] (intravenous and intrathecal)
::* [[Cryptococcus neoformans]]
:::* Preferred regimen: [[Amphotericin B]] [[deoxycholate]] {{and}} [[flucytosine]] for 2 weeks, followed by [[fluconazole]] for 8 weeks {{or}}v Lipid formulation of amphotericin B {{and}} flucytosine for 2 weeks, followed by fluconazole for 8 weeks {{or}} Amphotericin B {{and}} flucytosine for 6–10 weeks
::* [[Histoplasma capsulatum]]
:::* Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities


:* Protozoa
{{ID-Lyme neuroborreliosis}}
::* [[Acanthamoeba]]
:::* Preferred regimen: Trimethoprim-sulfamethoxazole {{and}} [[rifampin]] {{and}} [[ketoconazole]] {{or}} [[Fluconazole]] {{and}} [[sulfadiazine]] {{and}} [[pyrimethamine]]
::* [[Balamuthia mandrillaris]]
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Clarithromycin]] {{and}} [[pentamidine]] {{and}} [[flucytosine]] {{and}} [[fluconazole]] {{and}} [[sulfadiazine]] {{and}} [[thioridazine]] {{or}} [[trifluoperazine]]
::* [[Naegleria fowleri]]
:::* Preferred regimen: Amphotericin B (intravenous and intrathecal) {{and}} rifampin {{and}} [[azithromycin]] {{or}} [[sulfisoxazole]] {{or}} [[miconazole]]
::* [[Plasmodium falciparum]]
:::* Preferred regimen: [[Quinine]] {{or}} [[quinidine]] {{or}} [[artesunate]] {{or}} [[artemether]]
:::* Alternative regimen: Atovaquone {{or}} proguanil {{or}} Exchange transfusion (less than 10% parasitemia or cere- bral malaria)
::* [[Toxoplasma gondii]]
:::* Preferred regimen: [[Pyrimethamine]] {{and}} [[Sulfadiazine]] {{or}} [[Clindamycin]] [[and}} [[Pyrimethamine]]
:::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]]
:::* Alternative regimen (2): [[Pyrimethamine]] {{and}} atovaqone {{or}} [[Pyrimethamine]] {{and}} [[clarithromycin]] {{or}} Pyrimethamine {{and}} [[azithromycin]] {{or}} Pyrimethamine {{and}} [[dapsone]]
::* [[Trypanosoma brucei gambiense]] (West African trypanosomiasis)
:::* Preferred regimen: [[Eflornithine]] {{or}} [[Melarsoprol]]
::* [[Trypanosoma brucei rhodesiense]] (East African trypanosomiasis)
:::* Preferred regimen: [[Melarsoprol]]


:* Helminths
====Meningitis {{ID-returntotop-organ}}====
::* [[Baylisascaris|Baylisascaris procyonis]]
:::* Preferred regimen: [[Corticosteroids]]
:::* Alternative regimen: [[Albendazole]] {{and}} [[diethylcarbamazine]]
::* [[Gnathostoma spinigerum|Gnathostoma]]
:::* Preferred regimen: [[Albendazole]] {{or}} [[Ivermectin]]
::* [[Taenia solium]] ([[cysticercosis]])
:::* Preferred regimen: [[Albendazole]] {{or}} [[Corticosteroids]]
:::* Alternative regimen: [[Praziquantel]]


:* Prion
{{ID-Bacterial meningitis}}
::* [[Transmissible spongiform encephalopathy|Human transmissible spongiform encephalopathy]]
:::* Preferred regimen: supportive


----
=====Meningitis, bacterial {{ID-returntotop-organ}}=====


===Epidural abscess===
=====Meningitis, tuberculous {{ID-returntotop-organ}}=====


----
{{ID-Tuberculous meningitis}}


===Lyme neuroborreliosis===
=====Meningitis, parasitic {{ID-returntotop-organ}}=====


* Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines<ref>{{Cite journal| doi = 10.1086/508667| issn = 1537-6591| volume = 43| issue = 9| pages = 1089–1134| last1 = Wormser| first1 = Gary P.| last2 = Dattwyler| first2 = Raymond J.| last3 = Shapiro| first3 = Eugene D.| last4 = Halperin| first4 = John J.| last5 = Steere| first5 = Allen C.| last6 = Klempner| first6 = Mark S.| last7 = Krause| first7 = Peter J.| last8 = Bakken| first8 = Johan S.| last9 = Strle| first9 = Franc| last10 = Stanek| first10 = Gerold| last11 = Bockenstedt| first11 = Linda| last12 = Fish| first12 = Durland| last13 = Dumler| first13 = J. Stephen| last14 = Nadelman| first14 = Robert B.| title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2006-11-01| pmid = 17029130}}</ref>
{{ID-Parasitic meningitis}}
:* Early neurologic disease
::* '''Cranial nerve palsy (adult)'''
:::* Preferred regimen: [[Amoxicillin]] 500 mg PO tid for 14 (14–21) days {{or}} [[Doxycycline]] 100 mg PO bid for 14 (14–21) days {{or}} [[Cefuroxime]] 500 mg PO bid for 14 (14–21) days
:::* Alternative regimen: [[Azithromycin]] 500 mg PO qd for 7–10 days {{or}} [[Clarithromycin]] 500 mg PO bid for 14–21 days (not for pregnant) {{or}} [[Erythromycin]] 500 mg PO qid for 14–21 days


::* '''Cranial nerve palsy (pediatric)'''
=====Meningitis, fungal {{ID-returntotop-organ}}=====
:::* Preferred regimen: [[Amoxicillin]] 50 mg/kg/day PO in 3 divided doses, max 500 mg/dose for 14 (14–21) days {{or}} [[Doxycycline]] (for children aged ≥ 8 years) 4 mg/kg/day PO q12h, max 100 mg/dose for 14 (14–21) days {{or}} [[Cefuroxime]] 30 mg/kg/day PO q12h, max 500 mg/dose for 14 (14–21) days
:::* Alternative regimen: [[Azithromycin]] 10 mg/kg/day PO, max 500 mg/dose for 7–10 days {{or}} [[Clarithromycin]] 7.5 mg/kg PO bid, max 500 mg/dose for 14–21 days {{or}} [[Erythromycin]] 12.5 mg/kg PO aid, max 500 mg/dose for 14–21 days


::* '''Meningitis or radiculopathy (adult)'''
{{ID-Fungal meningitis}}
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days.
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days
:::: Note: for nonpregnant adult patients intolerant of β-lactam agents, [[Doxycycline]] 200–400 mg/day PO/IV q12h may be considered.


::* '''Meningitis or radiculopathy (pediatric)'''
=====Meningitis, viral {{ID-returntotop-organ}}=====
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h, max 2 g/day for 14 (10–28) days
:::* Alternative regimen: [[Cefotaxime]] 150–200 mg/kg/day IV in 3–4 divided doses, max 6 g/day for 14 (10–28) days {{or}} [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days
:::: Note: for children ≥ 8 years of age intolerant of β-lactam agents, [[Doxycycline]] 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered.


:* Late neurologic disease
{{ID-Viral meningitis}}
::* '''Central or peripheral nervous system disease (adult)'''
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 (10–28) days


::* '''Central or peripheral nervous system disease (pediatric)'''
====Septic thrombosis of cavernous or dural venous sinus {{ID-returntotop-organ}}====
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h, max 2 g for 14 (10–28) days.
:::* Alternative regimen: [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day for 14 (10–28) days {{or}} [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days


* American Academy of Neurology (AAN) Practice Parameter<ref>{{Cite journal| doi = 10.1212/01.wnl.0000265517.66976.28| issn = 1526-632X| volume = 69| issue = 1| pages = 91–102| last1 = Halperin| first1 = J. J.| last2 = Shapiro| first2 = E. D.| last3 = Logigian| first3 = E.| last4 = Belman| first4 = A. L.| last5 = Dotevall| first5 = L.| last6 = Wormser| first6 = G. P.| last7 = Krupp| first7 = L.| last8 = Gronseth| first8 = G.| last9 = Bever| first9 = C. T.| last10 = Quality Standards Subcommittee of the American Academy of Neurology| title = Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology| journal = Neurology| date = 2007-07-03| pmid = 17522387}}</ref>
{{ID-Septic thrombosis of cavernous or dural venous sinus}}
:* '''Meningitis'''
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Pediatric dose: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day


:* '''Any neurologic syndrome with CSF pleocytosis'''
====Subdural empyema {{ID-returntotop-organ}}====
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 days
::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Pediatric dose: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day


:* '''Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)'''
{{ID-Subdural empyema}}
::* Preferred regimen: [[Doxycycline]] 100–200 mg BID for 14 days
::* Alternative regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day IV q4h for 14 days
::* Pediatric dose: [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
 
:* '''Encephalomyelitis'''
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Pediatric dose: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
 
:* '''Encephalopathy'''
::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 days {{or}} [[Cefotaxime]] 2 g IV q8h for 14 days {{or}} [[Penicillin G]] 18–24 MU/day q4h for 14 days
::* Pediatric dose: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day; [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day; [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
 
:* '''Post-treatment Lyme syndrome'''
::* Preferred regimen: symptomatic management; antibiotics not indicated
 
----
 
===Meningitis, bacteria===
 
:*Streptococcus pneumoniae (adult)
::*Penicillin MIC
:::*<0.1 μg/mL
::::* Preferred regimen: [[Penicillin G]] 24 mU 6 times per day {{or}} [[ampicillin]] 12g 6 times per day
::::* Alternative regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day {{or}} [[chloramphenicol]] 4-6g qid
:::*0.1–1.0 μg/mL
::::* Preferred regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
::::* Alternative regimen: [[Cefepime]] 6g tid {{or}} [[meropenem]] 6g tid
:::*≥2.0 μg/mL
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[Ceftriaxone]] 4g bid/OD {{or}} [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[cefotaxime]] 8-12g 4-6 times per day
::::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
::*Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[Ceftriaxone]] 4g bid/OD {{or}} [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[cefotaxime]] 8-12g 4-6 times per day
::::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
 
:*Streptococcus pneumoniae (pediatric)
::*Penicillin MIC
:::*<0.1 μg/mL
::::* Preferred regimen: [[Penicillin G]] 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates;  0.3 mU/kg 4-6 times per day for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
::::* Alternative regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children {{or}} [[chloramphenicol]]  25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children
:::*0.1–1.0 μg/mL
::::* Preferred regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
::::* Alternative regimen: [[Cefepime]] 150 mg/kg tid for children {{or}} [[meropenem]] 120 mg/kg tid for children
:::*≥2.0 μg/mL
::::* Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
::::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
::*Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
::::* Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
::::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
 
:*Neisseria meningitidis (adult)
::*Penicillin MIC
:::*<0.1 μg/mL
::::* Preferred regimen: [[Penicillin G]] 24 mU 6 times per day {{or}} [[ampicillin]] 12g 6 times per day
::::* Alternative regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day {{or}} [[chloramphenicol]] 4-6g qid
:::*0.1–1.0 μg/mL
::::* Preferred regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
::::* Alternative regimen: [[chloramphenicol]] 4-6g qid {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD  {{or}} [[meropenem]] 6g tid
 
:*Neisseria meningitidis (pediatric)
::*Penicillin MIC
:::*<0.1 μg/mL
::::* Preferred regimen: [[Penicillin G]] 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates;  0.3 mU/kg 4-6 times per day for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
::::* Alternative regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
:::*0.1–1.0 μg/mL
::::* Preferred regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
::::* Alternative regimen: [[chloramphenicol]]  25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD  {{or}} [[meropenem]] 120 mg/kg tid for children
 
:*Listeria monocytogenes (adult)
::*Preferred regimen: [[Penicillin G]] 24 mU 6 times per day {{or}} [[ampicillin]] 12g 6 times per day
::*Alternative regimen: [[Trimethoprim-sulfamethoxazole]] 10–20 mg/kg bid-qid {{or]} [[meropenem]] 6g tid
 
:*Listeria monocytogenes (pediatric)
::*Preferred regimen: [[Penicillin G]] 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates;  0.3 mU/kg 4-6 times per day for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
::*Alternative regimen: [[Trimethoprim-sulfamethoxazole]]10–20 mg/kg bid-qid for children {{or]} [[meropenem]] 120 mg/kg tid for children
 
:*Streptococcus agalactiae (adult)
::*Preferred regimen: [[Penicillin G]] 24 mU 6 times per day {{or}} [[ampicillin]] 12g 6 times per day
::*Alternative regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
 
:*Streptococcus agalactiae (pediatric)
::*Preferred regimen: [[Penicillin G]] 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates;  0.3 mU/kg 4-6 times per day for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
::*Alternative regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
 
:*Escherichia coli and other Enterobacteriaceae (adult)
::*Preferred regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
::*Alternative regimen: [[Aztreonam]] 6–8 g tid/qid {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD {{or}} [[meropenem]] 6g tid {{or}} [[Trimethoprim-sulfamethoxazole]] 10–20 mg/kg bid-qid {{or]} [[ampicillin]] 12g 6 times per day
 
:*Escherichia coli and other Enterobacteriaceae (pediatric)
::*Preferred regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
::*Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD {{or}} [[meropenem]] 120 mg/kg tid for children {{or}} [[Trimethoprim-sulfamethoxazole]]10–20 mg/kg bid-qid for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
 
:*Pseudomonas aeruginosa (adult)
::*Preferred regimen: [[Cefepime]] 6g tid {{or}} [[ceftazidime]] 6g tid
::*Alternative regimen: [[Aztreonam]] 6–8 g tid/qid {{or}} [[ciprofloxacin]] 800–1200 mg bid/tid {or}} [[meropenem]] 6g tid
 
:*Pseudomonas aeruginosa (pediatric)
::*Preferred regimen: [[Cefepime]] 150 mg/kg tid for children {{or}} [[ceftazidime]]  100–150 mg/kg tid/bid for 0-7 days neonates; 150 mg/kg tid for 8-28 days neonates; 150 mg/kg tid for children
::*Alternative regimen: [[meropenem]] 120 mg/kg tid for children
 
:*Haemophilus influenzae (adult)
::*β-Lactamase negative
:::*Preferred regimen: [[ampicillin]] 12g 6 times per day
:::*Alternative regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day {{or}} [[Cefepime]] 6g tid {{or}} [[chloramphenicol]] 4-6g qid {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
::*β-Lactamase positive
:::*Preferred regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
:::*Alternative regimen: [[Cefepime]] 6g tid {{or}} [[chloramphenicol]] 4-6g qid {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
 
:*Haemophilus influenzae (pediatric)
::*β-Lactamase negative
:::*Preferred regimen:[[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
:::*Alternative regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children {{or}} [[Cefepime]] 150 mg/kg tid for children {{or}} [[chloramphenicol]]  25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
::*β-Lactamase positive
:::*Preferred regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
:::*Alternative regimen: [[Cefepime]] 150 mg/kg tid for children {{or}} [[chloramphenicol]]  25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
 
:*Staphylococcus aureus (adult)
::*Methicillin susceptible
:::*Preferred regimen:  [[Nafcillin]] 9–12 g 6 times per day {{or}} [[oxacillin]] 9–12 g 6 times per day
:::*Alternative regimen: [[Vancomycin]] 30–45 mg/kg tid/bid {{or}} [[meropenem]] 6g tid
::*Methicillin resistant
:::*Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid
:::*Alternative regimen: [[Trimethoprim-sulfamethoxazole]] 10–20 mg/kg bid-qid {{or}} [[linezolid]]
 
:*Staphylococcus aureus (pediatric)
::*Methicillin susceptible
:::*Preferred regimen: [[Nafcillin]] 75 mg/kg bid/tid for 0-7 days neonates;  100–150 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children {{or}} [[oxacillin]] 75 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children
:::*Alternative regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{or}} [[meropenem]] 120 mg/kg tid for children
::*Methicillin resistant
:::*Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
:::*Alternative regimen: [[Trimethoprim-sulfamethoxazole]] 10–20 mg/kg bid-qid for children {{or}} [[linezolid]]
 
:*Staphylococcus epidermidis (adult)
::*Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid
::*Alternative regimen: [[Linezolid]]
 
:*Staphylococcus epidermidis (pediatric)
::*Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
::*Alternative regimen: [[Linezolid]]
 
:*Enterococcus species (adult)
::*Ampicillin susceptible
:::*Preferred regimen:  [[ampicillin]] 12g 6 times per day {{and}} [[gentamicin]] 5 mg/kg tid
::*Ampicillin resistant
:::*Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[gentamicin]] 5 mg/kg tid
::*Ampicillin and vancomycin resistant
:::*Preferred regimen:  [[Linezolid]]
 
:*Enterococcus species (pediatric)
::*Ampicillin susceptible
:::*Preferred regimen:  [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children {{and}} [[gentamicin]] 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
::*Ampicillin resistant
:::*Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[gentamicin]] 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
::*Ampicillin and vancomycin resistant
:::*Preferred regimen:  [[Linezolid]]
 
----
 
===Meningitis, MRSA===
 
:* Preferred regimen: [[Vancomycin]] 15–20 mg/kg/dose IV every 8–12 h for 2 weeks       
:* Alternative regimen: [[linezolid]] 600 mg PO/IV bid {{or}} [[TMP-SMX]] 5 mg/kg/dose IV every 8–12 h
:* Pediatric regimen: [[Vancomycin]] 15 mg/kg/dose IV every 6 h {{or}} [[linezolid]] 10 mg/kg/dose PO/IV every 8 h
NOTE: Some experts recommend the addition of [[rifampin]] 600 mg QD or 300–450 mg BID to [[vancomycin]] for adult patients. For children >12 years of age, [[linezolid]] 600 mg BID
 
----
 
===Meningitis, tuberculous===
 
:* Preferred regimen: 2 months of [[Isoniazid]] 5 (4–6)mg/kg OD {{and}} [[Rifampicin]] 10 (8–12)mg/kg OD {{and}} [[Pyrazinamide]] 25 (20–30)mg/kg OD {{and}} [[Streptomycin]] 15 (12–18)mg/kg OD followed by 7-10 months of [[Isoniazid]] 5 (4–6)mg/kg OD {{and}} [[Rifampicin]] 10 (8–12)mg/kg OD
:* Alternative regimen (1): 2 months of [[Isoniazid]] 5 (4–6)mg/kg OD {{and}} [[Rifampicin]] 10 (8–12)mg/kg OD {{and}} [[Pyrazinamide]] 25 (20–30)mg/kg OD {{and}} [[Streptomycin]] 15 (12–18)mg/kg OD followed by 7-10 months of [[Isoniazid]] 10 (8–12)mg/kg 3 times per week {{and}} [[Rifampicin]] 10 (8–12)mg/kg 3 times per week
:* Alternative regimen (2): 2 months of [[Isoniazid]] 10 (8–12)mg/kg 3 times per week {{and}} [[Rifampicin]] 10 (8–12)mg/kg 3 times per week {{and}} [[Pyrazinamide]] 35 (30–40)mg/kg 3 times per week {{and}} [[Streptomycina]] 15 (12–18)mg/kg 3 times per week followed by 7-10 months of [[Isoniazid]] 10 (8–12)mg/kg 3 times per week {{and}} [[Rifampicin]] 10 (8–12)mg/kg 3 times per week
 
----
 
===Septic thrombosis of cavernous or dural venous sinus===
 
====Cavernous Sinus====
:* Preferred regimen: ([[Vancomycin]] 13-20mcg/ml {{and}} [[ceftriaxone]] 2mg IV q12h) {{and}} [[metronidazole]] 500mg IV q8h (if dental/sinus source)
 
:* Alternative regimen: ([[Daptomycin]] 8-12mg/kg IV q24h {{or}} [[Linezolid]] 600mg IV q12h) {{and}} [[metronidazole]] 500mg IV q8h (if dental/sinus source)
 
====Lateral Sinus====
:* Preferred regimen: [[cefepime]] 2mg IV q8h {{and}} [[metronidazole]] 500mg IV q8h {{and}} [[vancomycin]] 15-20 mcg/ml
 
:* Alternative regimen: [[meropenem]] 1-2mg IV q8h {{and}} [[Linezolid]] 600 mg IV q12h
 
====Superior Sagittal Sinus====
:* Preferred regimen: [[ceftriaxone]] 2 mg IV q12h {{and}} [[vancomycin]] 15-20 mcg/ml {{and}} [[dexamethasone]]
:* Alternative regimen: [[meropenem]] 1-2mg IV q8h {{and}} [[vancomycin]] 15-20 mcg/ml {{and}} [[dexamethasone]]
 
----
 
===Septic thrombosis of cavernous or dural venous sinus, MRSA===
 
:* Preferred regimen: [[Vancomycin]] 15–20 mg/kg/dose IV every 8–12 h {{or}} [[Linezolid]] 600 mg PO/IV BID
:* Alternative regimen: [[TMP-SMX]] 5 mg/kg/dose PO/IV every 8-12 h
:* Pediatric regimen: [[Vancomycin]] 15 mg/kg/dose IV every 6 h {{or}} [[Linezolid]] 10 mg/kg/dose PO/IV every 8 h
NOTE: Some experts recommend the addition of [[rifampin]] 600 mg QD or 300–450 mg BID to [[vancomycin]] for adult patients. For children >12 years of age, [[linezolid]] 600 mg BID 
 
 
----
 
===Subdural empyema===
:*In adult 60–90% are extension of sinusitis or otitis media
 
:*Rx same as primary brain abscess


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 18:58, 26 June 2015

Central Nervous System

Brain abscess ⇧ Return to Top ⇧

  • 1. Empiric antimicrobial therapy[1][2]
Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
  • 1.1 Brain abscess in otherwise healthy patients
  • 1.2 Brain abscess with comorbidities
  • 1.2.1 Otitis media, mastoiditis, or sinusitis
  • 1.2.2 Dental infection
  • 1.2.3 Penetrating trauma or post-neurosurgy
  • 1.2.4 Lung abscess, empyema, or bronchiectasis
  • 1.2.5 Bacterial endocarditis
  • 1.2.6 Congenital heart disease
  • 1.2.7 Transplant recipients
  • 1.2.8 Patients with HIV/AIDS
  • 1.2.9 Staphylococcus aureus coverage
  • Preferred regimen: Vancomycin 30–45 mg/kg/day q8–12h
  • 1.2.10 Mycobacterium tuberculosis coverage
  • 2. Pathogen-directed antimicrobial therapy[3][4][5]
Note: The optimal duration of antimicrobial therapy remains unclear. A 4- to 6-week course of treatment is usually required.
  • 2.1 Bacteria
  • 2.1.1 Actinomyces
  • 2.1.2 Bacteroides fragilis
  • 2.1.3 Enterobacteriaceae
  • Preferred regimen (1): Cefotaxime 2 g IV q4-6h
  • Preferred regimen (2): Ceftriaxone 2 g IV q12h
  • Preferred regimen (3): Cefepime 2 g IV q12h
  • Alternative regimen (1): Aztreonam 6–8 g/day IV q6–8h
  • Alternative regimen (2): TMP-SMZ 10–20 mg/kg/day q6–12h
  • Alternative regimen (3): Ciprofloxacin 800–1200 mg/day IV q8–12h
  • Alternative regimen (4): Meropenem 2 g IV q8h
  • 2.1.4 Fusobacterium
  • 2.1.5 Haemophilus
  • Preferred regimen (1): Cefotaxime 2 g IV q4-6h
  • Preferred regimen (2): Ceftriaxone 2 g IV q12h
  • Preferred regimen (3): Cefepime 2 g IV q12h
  • Alternative regimen (1): Aztreonam 6–8 g/day IV q6–8h
  • Alternative regimen (2): TMP-SMZ 10–20 mg/kg/day q6–12h
  • 2.1.6 Listeria monocytogenes
  • Preferred regimen (1): Ampicillin 12 g/day q4h
  • Preferred regimen (2): Penicillin G 4 MU IV q4h
  • Alternative regimen (1): TMP-SMZ 10–20 mg/kg/day q6–12h
  • 2.1.7 Nocardia
  • Preferred regimen (1): TMP-SMZ 10–20 mg/kg/day q6–12h
  • Preferred regimen (2): Sulfadiazine 4–6 g/day q6h
  • Alternative regimen (1): Meropenem 2 g IV q8h
  • Alternative regimen (2): Cefotaxime 2 g IV q4-6h
  • Alternative regimen (3): Ceftriaxone 2 g IV q12h
  • Alternative regimen (4): Amikacin 15 mg/kg/day IV q8h
  • 2.1.8 Prevotella melaninogenica
  • 2.1.9 Pseudomonas aeruginosa
  • Preferred regimen (1): Ceftazidime 6 g/day q8h
  • Preferred regimen (2): Cefepime 6 g/day q8h
  • Alternative regimen (1): Aztreonam 6–8 g/day IV q6–8h
  • Alternative regimen (2): Ciprofloxacin 800–1200 mg/day IV q8–12h
  • Alternative regimen (3): Meropenem 2 g IV q8h
  • 2.1.10 Staphylococcus aureus, methicillin-resistant (MRSA)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
  • Alternative regimen (1): Linezolid 600 mg PO/IV q12h for 4–6 weeks
  • Alternative regimen (2):TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • Pediatric dose (1): Vancomycin 15 mg/kg/dose IV q6h
  • Pediatric dose (2): Linezolid 10 mg/kg/dose PO/IV q8h
  • Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin.
  • 2.1.11 Staphylococcus aureus, methicillin-susceptible (MSSA)
  • Preferred regimen (1): Nafcillin 2 g IV q4h
  • Preferred regimen (2): Oxacillin 2 g IV q4h
  • Alternative regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
  • 2.1.12 Streptococcus
  • 2.2 Fungi
  • 2.2.1 Aspergillus
  • Preferred regimen: Voriconazole 8 mg/kg/day q12h
  • Alternative regimen (1): Amphotericin B deoxycholate 0.6–1.0 mg/kg/day IV q24h
  • Alternative regimen (2): Amphotericin B lipid complex 5 mg/kg/day IV q24h
  • Alternative regimen (3): Itraconazole 400–600 mg/day IV q12h
  • Alternative regimen (4): Posaconazole 800 mg/kg/day IV q6–12h
  • 2.2.2 Candida
  • 2.2.3 Cryptococcus neoformans
  • 2.2.4 Mucorales
  • 2.2.5 Pseudallescheria boydii (Scedosporium apiospermum)
  • 2.3 Protozoa
  • 2.3.1 Toxoplasma gondii

Cerebrospinal fluid shunt infection ⇧ Return to Top ⇧

  • 1. Empiric antimicrobial therapy[6][7]
  • 2. Pathogen-directed antimicrobial therapy[8][9]
  • 2.1 Enterococcus
  • 2.2 Gram-negative bacilli
  • 2.3 Propionibacterium acnes
  • 2.4 Staphylococcus, coagulase-negative
  • 2.5 Staphylococcus aureus, methicillin-resistant (MRSA)
Note: Shunt removal is recommended, and it should not be replaced until cerebrospinal fluid cultures are repeatedly negative.
  • 2.6 Staphylococcus aureus, methicillin-susceptible (MSSA)
  • 2.7 Streptococcus agalactiae
  • 2.8 Fungi

Encephalitis ⇧ Return to Top ⇧

  • 1. Empiric antimicrobial therapy[10]
  • Preferred regimen: Acyclovir 10 mg/kg IV q8h for 14–21 days
  • Note (1): Acyclovir should be initiated in all patients with suspected encephalitis, pending results of diagnostic studies.
  • Note (2): Other empiric antimicrobial agents should be administered on the basis of specific epidemiologic or clinical clues.
  • 2. Specific epidemiologic considerations[10]
  • 2.1 Agammaglobulinemia — Enteroviruses, Mycoplasma pneumoniae
  • 2.2 Age
  • 2.2.1 Neonates — Herpes simplex virus type 2, cytomegalovirus, rubella virus, Listeria monocytogenes, Treponema pallidum, Toxoplasma gondii
  • 2.2.2 Infants and children — Eastern equine encephalitis virus, Japanese encephalitis virus, Murray Valley encephalitis virus, influenza virus, La Crosse virus
  • 2.2.3 Elderly persons — Eastern equine encephalitis virus, St. Louis encephalitis virus, West Nile virus, sporadic CJD, L. monocytogenes
  • 2.3 Animal contact
  • 2.3.1 Bats — Rabies virus, Nipah virus
  • 2.3.2 Birds — West Nile virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, Cryptococcus neoformans (bird droppings)
  • 2.3.3 Cats — Rabies virus, Coxiella burnetii, Bartonella henselae, T. gondii
  • 2.3.4 Dogs — Rabies virus
  • 2.3.5 Horses — Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, Hendra virus
  • 2.3.6 Old World primates — B virus
  • 2.3.7 Raccoons — Rabies virus, Baylisascaris procyonis
  • 2.3.8 Rodents — Eastern equine encephalitis virus (South America), Venezuelan equine encephalitis virus, tickborne encephalitis virus, Powassan virus (woodchucks), La Crosse virus (chipmunks and squirrels), Bartonella quintana
  • 2.3.9 Sheep and goats — C. burnetii
  • 2.3.10 Skunks — Rabies virus
  • 2.3.11 Swine — Japanese encephalitis virus, Nipah virus
  • 2.3.12 White-tailed deer — Borrelia burgdorferi
  • 2.4 Immunocompromised persons — Varicella zoster virus, cytomegalovirus, human herpesvirus 6, West Nile virus, HIV, JC virus, L. monocytogenes, Mycobacterium tuberculosis, C. neoformans, Coccidioides species, Histoplasma capsulatum, T. gondii
  • 2.5 Ingestion
  • 2.5.1 Raw or partially cooked meat — T. gondii
  • 2.5.2 Raw meat, fish, or reptiles — Gnanthostoma species
  • 2.5.3 Unpasteurized milk — Tickborne encephalitis virus, L. monocytogenes, C. burnetii
  • 2.6 Insect contact
  • 2.6.1 Mosquitoes — Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, Murray Valley encephalitis virus, Japanese encephalitis virus, West Nile virus, La Crosse virus, Plasmodium falciparum
  • 2.6.2 Sandflies — Bartonella bacilliformis
  • 2.6.3 Ticks — Tickborne encephalitis virus, Powassan virus, Rickettsia rickettsii, Ehrlichia chaffeensis, Anaplasma phagocytophilum, C. burnetii (rare), B. burgdorferi
  • 2.6.4 Tsetse flies — Trypanosoma brucei gambiense, Trypanosoma brucei rhodesiense
  • 2.7 Occupation
  • 2.7.1 Exposure to animals — Rabies virus, C. burnetii, Bartonella species
  • 2.7.2 Exposure to horses — Hendra virus
  • 2.7.3 Exposure to Old World primates — B virus
  • 2.7.4 Laboratory workers — West Nile virus, HIV, C. burnetii, Coccidioides species
  • 2.7.5 Physicians and health care workers — Varicella zoster virus, HIV, influenza virus, measles virus, M. tuberculosis
  • 2.7.6 Veterinarians — Rabies virus, Bartonella species, C. burnetii
  • 2.8 Person-to-person transmission — Herpes simplex virus (neonatal), varicella zoster virus, Venezuelan equine encephalitis virus (rare), poliovirus, nonpolio enteroviruses, measles virus, Nipah virus, mumps virus, rubella virus, Epstein-Barr virus, human herpesvirus 6, B virus, West Nile virus (transfusion, transplantation, breast feeding), HIV, rabies virus (transplantation), influenza virus, M. pneumoniae, M. tuberculosis, T. pallidum
  • 2.9 Recent vaccination — Acute disseminated encephalomyelitis
  • 2.10 Recreational activities
  • 2.10.1 Camping/hunting — Agents transmitted by mosquitoes and ticks
  • 2.10.2 Sexual contact — HIV, T. pallidum
  • 2.10.3 Spelunking — Rabies virus, H. capsulatum
  • 2.10.4 Swimming — Enteroviruses, Naegleria fowleri
  • 2.11 Season
  • 2.11.1 Late summer/early fall — Agents transmitted by mosquitoes and ticks, enteroviruses
  • 2.11.2 Winter — Influenza virus
  • 2.12 Transfusion and transplantation — Cytomegalovirus, Epstein-Barr virus, West Nile virus, HIV, tickborne encephalitis virus, rabies virus, iatrogenic CJD, T. pallidum, A. phagocytophilum, R. rickettsii, C. neoformans, Coccidioides species, H. capsulatum, T. gondii
  • 2.13 Travel
  • 2.13.1 Africa — Rabies virus, West Nile virus, P. falciparum, T. brucei gambiense, T. brucei rhodesiense
  • 2.13.2 Australia — Murray Valley encephalitis virus, Japanese encephalitis virus, Hendra virus
  • 2.13.3 Central America — Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, R. rickettsii, P. falciparum, Taenia solium
  • 2.13.4 Europe — West Nile virus, tickborne encephalitis virus, A. phagocytophilum, B. burgdorferi
  • 2.13.5 India, Nepal — Rabies virus, Japanese encephalitis virus, P. falciparum
  • 2.13.6 Middle East — West Nile virus, P. falciparum
  • 2.13.7 Russia — Tickborne encephalitis virus
  • 2.13.8 South America — Rabies virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Venezuelan equine encephalitis virus, St. Louis encephalitis virus, R. rickettsii, B. bacilliformis (Andes mountains), P. falciparum, T. solium
  • 2.13.9 Southeast Asia, China, Pacific Rim — Japanese encephalitis virus, tickborne encephalitis virus, Nipah virus, P. falciparum, Gnanthostoma species, T. solium
  • 2.13.10 Unvaccinated status — Varicella zoster virus, Japanese encephalitis virus, poliovirus, measles virus, mumps virus, rubella virus
  • 3. Specific clinical considerations[10]
  • 3.1 General findings
  • 3.1.1 Hepatitis — Coxiella burnetii
  • 3.1.2 Lymphadenopathy — HIV, Epstein-Barr virus, cytomegalovirus, measles virus, rubella virus, West Nile virus, Treponema pallidum, Bartonella henselae and other Bartonella species, Mycobacterium tuberculosis, Toxoplasma gondii, Trypanosoma brucei gambiense
  • 3.1.3 Parotitis — Mumps virus
  • 3.1.4 Rash — Varicella zoster virus, B virus, human herpesvirus 6, West Nile virus, rubella virus, some enteroviruses, HIV, Rickettsia rickettsii, Mycoplasma pneumoniae, Borrelia burgdorferi, T. pallidum, Ehrlichia chaffeensis, Anaplasma phagocytophilum
  • 3.1.5 Respiratory tract findings — Venezuelan equine encephalitis virus, Nipah virus, Hendra virus, influenza virus, adenovirus, M. pneumoniae, C. burnetii, M. tuberculosis, Histoplasma capsulatum
  • 3.1.6 Retinitis — Cytomegalovirus, West Nile virus, B. henselae, T. pallidum
  • 3.1.7 Urinary symptoms — St. Louis encephalitis virus
  • 3.2 Neurologic findings
  • 3.2.1 Cerebellar ataxia — Varicella zoster virus (children), Epstein-Barr virus, mumps virus, St. Louis encephalitis virus, Tropheryma whipplei, T. brucei gambiense
  • 3.2.2 Cranial nerve abnormalities — Herpes simplex virus, Epstein-Barr virus, Listeria monocytogenes, M. tuberculosis, T. pallidum, B. burgdorferi, T. whipplei, Cryptococcus neoformans, Coccidioides species, H. capsulatum
  • 3.2.3 Dementia — HIV, human transmissible spongiform encephalopathies (sCJD and vCJD), measles virus (SSPE), T. pallidum, T. whipplei
  • 3.2.4 Myorhythmia — T. whipplei (oculomasticatory)
  • 3.2.5 Parkinsonism — Japanese encephalitis virus, St. Louis encephalitis virus, West Nile virus, Nipah virus, T. gondii, T. brucei gambiense
  • 3.2.6 Poliomyelitis-like flaccid paralysis — Japanese encephalitis virus, West Nile virus, tickborne encephalitis virus; enteroviruses (enterovirus-71, coxsackieviruses), poliovirus
  • 3.2.7 Rhombencephalitis — Herpes simplex virus, West Nile virus, enterovirus 71, L. monocytogenes
  • 4. Pathogen-directed antimicrobial therapy[10]
  • 4.1 Viruses
  • 4.1.1 Adenovirus
  • Preferred regimen: supportive
  • 4.1.2 B virus (herpes B virus)
  • 4.1.2.1 Established disease
  • Preferred regimen: Valacyclovir 1,000 mg PO tid OR Ganciclovir 5 mg/kg IV q12h for ≥ 14 days until resolution of neurologic symptoms, then Acyclovir 800 mg PO 5 times daily indefinitely OR Valacyclovir 1 g PO tid indefinitely
  • Alternative regimen: Acyclovir 15 mg/kg IV q8h for ≥ 14 days until resolution of neurologic symptoms, then Acyclovir 800 mg PO 5 times daily OR Valacyclovir 1 g PO tid indefinitely
  • 4.1.2.2 Prophylaxis after bite or scratch
  • 4.1.3 Cytomegalovirus (CMV)
  • Preferred regimen: Ganciclovir 5 mg/kg IV q12h for 14–21 days, followed by 5 mg/kg IV qd for maintenance AND Foscarnet 90 mg/kg IV q12h for 14–21 days, followed by 90-120 mg/kg IV qd for maintenance
  • 4.1.4 Chikungunya virus
  • Preferred regimen: supportive
  • 4.1.5 Eastern equine encephalitis virus
  • Preferred regimen: supportive
  • 4.1.6 Epstein-Barr virus (EBV)
  • Preferred regimen: supportive ± Corticosteroids
  • Note: Acyclovir is not recommended.
  • 4.1.7 Hendra virus
  • Preferred regimen: supportive
  • 4.1.8 HSV-1 and HSV-2
  • Preferred regimen: Acyclovir 10 mg/kg IV q8h for 14–21 days
  • Preferred regimen (neonates): Acyclovir 20 mg/kg IV q8h for 21 days
  • 4.1.9 Human herpesvirus 6 (HHV-6)
  • Preferred regimen (1): Ganciclovir 5 mg/kg IV q12h for 14–21 days, followed by 5 mg/kg IV qd for maintenance
  • Preferred regimen (2): Foscarnet 90 mg/kg IV q12h for 14–21 days, followed by 90-120 mg/kg IV qd for maintenance
  • 4.1.10 Human immunodeficiency virus (HIV)
  • 4.1.11 Influenza virus
  • 4.1.12 Japanese encephalitis virus
  • Preferred regimen: supportive
  • Note: Interferon alpha is not recommended.
  • 4.1.13 JC virus
  • Preferred regimen: Reversal or control of immunosuppression OR HAART in patients with AIDS
  • 4.1.14 La Crosse virus
  • Preferred regimen: supportive
  • 4.1.15 Louping ill virus
  • Preferred regimen: supportive
  • 4.1.16 Lymphocytic choriomeningitis virus (LCMV)
  • Preferred regimen: supportive
  • 4.1.17 Me Tri virus
  • Preferred regimen: supportive
  • 4.1.18 Measles virus
  • Preferred regimen: supportive
  • Note: Ribavirin is not approved by the US Food and Drug Administration (FDA) for this indication, and such use should be considered experimental.
  • 4.1.19 Monkeypox virus
  • Preferred regimen: supportive
  • Alternative regimen: Cidofovir OR vaccinia immune globulin
  • 4.1.20 Mumps virus
  • Preferred regimen: supportive
  • 4.1.21 Murray Valley encephalitis virus
  • Preferred regimen: supportive
  • 4.1.22 Nipah virus
  • Preferred regimen: supportive
  • Alternative regimen: Ribavirin
  • 4.1.23 Nonpolio enteroviruses
  • Preferred regimen: supportive
  • Note: Consider intraventricular γ-globulin for chronic and/or severe disease.
  • 4.1.24 Poliovirus
  • Preferred regimen: supportive
  • 4.1.25 Powassan virus
  • Preferred regimen: supportive
  • 4.1.26 Rabies virus[11]
  • 4.1.26.1 Not previously vaccinated
  • Preferred regimen (1): Wound cleansing with soap and water followed by povidine-iodine solution irrigation if available.
  • Preferred regimen (2): Human rabies immune globulin (HRIG) 20 IU/kg
  • Preferred regimen (3): Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 0, 3, 7, and 14
  • 4.1.26.2 Previously vaccinated
  • Preferred regimen (1): Wound cleansing with soap and water followed by povidine-iodine solution irrigation if available.
  • Preferred regimen (2): Human diploid cell vaccine (HDCV) or purified chick embryo cell vaccine (PCECV) 1.0 mL, IM (deltoid area), 1 each on days 0 and 3
  • Note: If anatomically feasible, the full dose of HRIG should be infiltrated around and into the wounds, and any remaining volume should be administered at an anatomical site intramuscularly distant from vaccine administration. In addition, HRIG should not be administered in the same syringe as vaccine. Because RIG might partially suppress active production of rabies virus antibody, no more than the recommended dose should be administered.
  • 4.1.27 Rocio virus
  • Preferred regimen: supportive
  • 4.1.28 Rubella virus
  • Preferred regimen: supportive
  • 4.1.29 Snowshoe hare virus
  • Preferred regimen: supportive
  • 4.1.30 St. Louis encephalitis virus
  • Preferred regimen: supportive
  • Alternative regimen: IFN-α-2b
  • 4.1.31 Tickborne encephalitis virus
  • Preferred regimen: supportive
  • 4.1.32 Toscana virus
  • Preferred regimen: supportive
  • 4.1.33 Vaccinia
  • Preferred regimen: supportive ± Corticosteroids (if suggestive of post-immunization)
  • 4.1.34 Venezuelan equine encephalitis virus
  • Preferred regimen: supportive
  • 4.1.35 Varicella zoster virus (VZV)
  • 4.1.36 West Nile virus
  • Preferred regimen: supportive
  • 4.1.37 Western equine encephalitis virus
  • Preferred regimen: supportive
  • 4.2 Bacteria
  • 4.2.1 Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)
  • Preferred regimen: Doxycycline 100 mg PO/IV bid for 8 weeks
  • 4.2.2 Bartonella bacilliformis (Oroya fever, Carrion's disease)
  • 4.2.3 Bartonella henselae (cat scratch disease)
  • 4.2.4 Borrelia burgdorferi (Lyme disease)
  • 4.2.5 Coxiella burnetii (Q fever)
  • 4.2.6 Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
  • Preferred regimen: Doxycycline 100 mg IV/PO bid for 8 weeks
  • 4.2.7 Listeria monocytogenes
  • 4.2.8 Mycobacterium tuberculosis
  • 4.2.9 Mycoplasma pneumoniae
  • 4.2.10 Rickettsia rickettsii (Rocky Mountain spotted fever)
  • Preferred regimen: Doxycycline 100 mg PO/IV bid for 8 weeks
  • Alternative regimen, pregnant patient: Chloramphenicol 25 mg/kg q6h for 14 days
  • 4.2.11 Treponema pallidum (syphilis)
  • Preferred regimen: Penicillin G 20MU IV q4hr in divided doses for 2-4 weeks
  • Alternative regimen: Ceftriaxone 2g IV q24h for 2-4 weeks
  • 4.2.12 Tropheryma whipplei (Whipple's disease)
  • 4.3 Fungi
  • 4.3.1 Coccidioides
  • 4.3.2 Cryptococcus neoformans
  • 4.3.3 Histoplasma capsulatum
  • Preferred regimen: Amphotericin B liposomal for 4–6 weeks, followed by Itraconazole for at least 1 year and until resolution of CSF abnormalities
  • 4.4 Protozoa
  • 4.4.1 Acanthamoeba
  • 4.4.2 Balamuthia mandrillaris
  • 4.4.3 Naegleria fowleri
  • 4.4.4 Plasmodium falciparum
  • 4.4.5 Toxoplasma gondii
  • 4.4.6 Trypanosoma brucei gambiense (West African trypanosomiasis)
  • Preferred regimen: Eflornithine OR Melarsoprol 2-3.6 mg/kg IV q24h for 3 days THEN repeat the same regimen after 7 days THEN repeat the same regimen again (total of 3 regimens after 7 days of the 2nd regimen
  • 4.4.7 Trypanosoma brucei rhodesiense (East African trypanosomiasis)
  • 4.5 Helminths
  • 4.5.1 Baylisascaris procyonis
  • 4.5.2 Gnathostoma
  • 4.5.3 Taenia solium (cysticercosis)
  • 4.6 Prion
  • 4.6.1 Human transmissible spongiform encephalopathy
  • Preferred regimen: supportive

References

  1. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  2. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  3. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  4. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  5. ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
  6. ↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.
  7. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  8. ↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.
  9. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  10. ↑ 10.0 10.1 10.2 10.3 Tunkel, Allan R.; Glaser, Carol A.; Bloch, Karen C.; Sejvar, James J.; Marra, Christina M.; Roos, Karen L.; Hartman, Barry J.; Kaplan, Sheldon L.; Scheld, W. Michael; Whitley, Richard J.; Infectious Diseases Society of America (2008-08-01). "The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 47 (3): 303–327. doi:10.1086/589747. ISSN 1537-6591. PMID 18582201.
  11. ↑ Rupprecht, Charles E.; Briggs, Deborah; Brown, Catherine M.; Franka, Richard; Katz, Samuel L.; Kerr, Harry D.; Lett, Susan M.; Levis, Robin; Meltzer, Martin I.; Schaffner, William; Cieslak, Paul R.; Centers for Disease Control and Prevention (CDC) (2010-03-19). "Use of a reduced (4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the advisory committee on immunization practices". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR-2): 1–9. ISSN 1545-8601. PMID 20300058.
  12. ↑ Thwaites G, Fisher M, Hemingway C, Scott G, Solomon T, Innes J; et al. (2009). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". J Infect. 59 (3): 167–87. doi:10.1016/j.jinf.2009.06.011. PMID 19643501.

Epidural abscess ⇧ Return to Top ⇧

  • 1.1 Empiric antimicrobial therapy
  • Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks AND Ceftriaxone 2 g IV q24h for 2–4 weeks, then PO to complete 6–8 weeks
  • Note (1): Decompressive laminectomy in conjunction with long-term antibiotic therapy tailored to culture results is required.
  • Note (2): For critically ill patients, a loading dose of Vancomycin 20–25 mg/kg may be considered.
  • 1.2 Pathogen-directed antimicrobial therapy
  • 1.2.1 Penicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen: Penicillin G 4 MU IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.2 Methicillin-susceptible Staphylococcus aureus or Streptococcus
  • Preferred regimen (1): Cefazolin 2 g IV q8h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Nafcillin 2 g IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (3): Oxacillin 2 g IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen: Clindamycin 600 mg IV q6h for 2–4 weeks, then PO to complete 6–8 weeks
  • 1.2.3 Methicillin-resistant Staphylococcus aureus (MRSA)
  • Preferred regimen: Vancomycin loading dose 25–30 mg/kg IV followed by 15–20 mg/kg IV q8–12h for 2–4 weeks, then PO to complete 6–8 weeks
  • Alternative regimen: Linezolid 600 mg PO/IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • Pediatric dose: Vancomycin 15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h
  • Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to Vancomycin in adult patients.
  • 1.2.4 Streptococcus
  • Preferred regimen (1): Penicillin G 3–4 MU IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Ampicillin 2 g IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.5 Enterococcus
  • Preferred regimen (1): Penicillin G 3–4 MU IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Ampicillin 2 g IV q4h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.6 Enterobacteriaceae
  • Preferred regimen (1): Ceftriaxone 1–2 g IV q12h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Cefotaxime 2 g IV q6–8h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.7 Gram-negative bacteria
  • Preferred regimen (1): Ceftazidime 2 g IV q8h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (2): Cefepime 2 g IV q12h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (1): Ciprofloxacin 400 mg IV q12h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (2): Levofloxacin 750 mg IV q24h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (3): Moxifloxacin 400 mg IV q24h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.8 Anaerobes
  • Preferred regimen: Metronidazole 500 mg IV q6h for 2–4 weeks THEN PO to complete 6–8 weeks
  • 1.2.9 Staphylococcus, Gram-negative bacteria, and anaerobes (mixed infection)
  • Preferred regimen (1): Ampicillin-Sulbactam 3 g IV q6h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q4–6h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (1): Imipenem 500–1000 mg IV q6h for 2–4 weeks THEN PO to complete 6–8 weeks
  • Alternative regimen (2): Meropenem 1–2 g IV q8h for 2–4 weeks THEN PO to complete 6–8 weeks

Lyme neuroborreliosis ⇧ Return to Top ⇧

  • 1. Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines[5]
  • 1.1 Early neurologic disease
  • 1.1.1 Cranial nerve palsy (adult)
  • Preferred regimen (1): Amoxicillin 500 mg PO tid for 14 (14–21) days
  • Preferred regimen (2): Doxycycline 100 mg PO bid for 14 (14–21) days
  • Preferred regimen (3): Cefuroxime 500 mg PO bid for 14 (14–21) days
  • Alternative regimen (1): Azithromycin 500 mg PO qd for 7–10 days
  • Alternative regimen (2): Clarithromycin 500 mg PO bid for 14–21 days (not for pregnant)
  • Alternative regimen (3): Erythromycin 500 mg PO qid for 14–21 days
  • 1.1.2 Cranial nerve palsy (pediatric)
  • Preferred regimen (1): Amoxicillin 50 mg/kg/day PO tid (Maxmum, 500 mg/dose) for 14 (14–21) days
  • Preferred regimen (2): Doxycycline (for children aged ≥ 8 years) 4 mg/kg/day PO q12h (Maxmum, 100 mg/dose) for 14 (14–21) days
  • Preferred regimen (3): Cefuroxime 30 mg/kg/day PO q12h (Maxmum, 500 mg/dose) for 14 (14–21) days
  • Alternative regimen (1): Azithromycin 10 mg/kg/day PO (Maxmum, 500 mg/dose) for 7–10 days
  • Alternative regimen (2): Clarithromycin 7.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
  • Alternative regimen (3): Erythromycin 12.5 mg/kg PO bid (Maxmum, 500 mg/dose) for 14–21 days
  • 1.1.3 Meningitis or radiculopathy (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 2 g IV q8h for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
  • Note: for nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV q12h may be considered.
  • 1.1.4 Meningitis or radiculopathy (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 150–200 mg/kg/day IV q6-8h (Maxmum, 6 g/day) for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
  • Note: for children ≥ 8 years of age intolerant of β-lactam agents, Doxycycline 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day may be considered
  • 1.2 Late neurologic disease
  • 1.2.1 Central or peripheral nervous system disease (adult)
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days
  • Alternative regimen (1): Cefotaxime 2 g IV q8h for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 18–24 MU/day IV q4h for 14 (10–28) days
  • 1.2.2 Central or peripheral nervous system disease (pediatric)
  • Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (Maxmum, 2 g/day) for 14 (10–28) days.
  • Alternative regimen (1): Cefotaxime 150–200 mg/kg/day IV q6–8h (Maxmum, 6 g/day) for 14 (10–28) days
  • Alternative regimen (2): Penicillin G 200,000–400,000 U/kg/day IV q4h (Maxmum, 18–24 MU/day) for 14 (10–28) days
  • 2. American Academy of Neurology (AAN) Practice Parameter[6]
  • 2.1 Meningitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.2 Any neurologic syndrome with CSF pleocytosis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.3 Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)
  • Preferred regimen: Doxycycline 100–200 mg BID for 14 days
  • Alternative regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day IV q4h for 14 days
  • Pediatric regimen: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 2.4 Encephalomyelitis
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
  • 2.5 Encephalopathy
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
  • 2.6 Post-treatment Lyme syndrome
  • Preferred regimen: symptomatic management
  • Note: Antibiotic therapy is not indicated.

References

  1. ↑ Kasper, Dennis (2015). Harrison's principles of internal medicine. New York: McGraw Hill Education. ISBN 978-0071802154.
  2. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
  3. ↑ Darouiche, Rabih O. (2006-11-09). "Spinal epidural abscess". The New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 1533-4406. PMID 17093252.
  4. ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
  5. ↑ Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (2006-11-01). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1537-6591. PMID 17029130.
  6. ↑ Halperin, J. J.; Shapiro, E. D.; Logigian, E.; Belman, A. L.; Dotevall, L.; Wormser, G. P.; Krupp, L.; Gronseth, G.; Bever, C. T.; Quality Standards Subcommittee of the American Academy of Neurology (2007-07-03). "Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 69 (1): 91–102. doi:10.1212/01.wnl.0000265517.66976.28. ISSN 1526-632X. PMID 17522387.

Meningitis ⇧ Return to Top ⇧

  • Bacterial meningitis[1]
  • 1. Empiric antimicrobial therapy based on specific predisposing factors
  • 1.1 Age
  • 1.1.1 Age < 1 month
  • Common causative pathogens: Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species
  • Preferred regimen: Ampicillin 12 g/day IV q4h AND (Cefotaxime 8–12 g/day q4–6h OR Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
  • 1.1.2 Age 1–23 months
  • Common causative pathogens: Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
  • 1.1.3 Age 2–50 years
  • Common causative pathogens: N . meningitidis, S. pneumoniae
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
  • 1.1.4 Age > 50 years
  • Common causative pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic Gram-negative bacilli
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Ampicillin 12 g/day IV q4h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
  • 1.2 Head trauma
  • 1.2.1 Basilar skull fracture
  • Common causative pathogens: S. pneumoniae, H. influenzae, group A β-hemolytic streptococci
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
  • 1.2.2 Penetrating trauma
  • Common causative pathogens: Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic Gram-negative bacilli (including Pseudomonas aeruginosa)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h)
  • 1.3 Postneurosurgery
  • Common causative pathogens: Aerobic Gram-negative bacilli (including P. aeruginosa), S. aureus, coagulase-negative staphylococci (especially S. epidermidis)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h)
  • 1.4 CSF shunt
  • Common causative pathogens: Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic Gram-negative bacilli (including P. aeruginosa), Propionibacterium acnes
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h)
  • 2. CSF Gram stain-directed antimicrobial therapy
  • 2.1 Gram positive, lancet-shaped diplococci suggestive of Streptococcus pneumoniae
  • 2.2 Gram negative diplococci suggestive of Neisseria meningitidis
  • 2.3 Gram positive, short bacilli suggestive of Listeria monocytogenes
  • 2.4 Gram positive cocci in short chains suggestive of Streptococcus agalactiae
  • 2.5 Gram negative coccobacilli suggestive of Haemophilus influenzae
  • 2.6 Gram negative bacilli suggestive of Escherichia coli
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 Acinetobacter baumannii
  • 3.2 Borrelia burgdorferi[2]
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 10—28 days
  • Alternative regimen: Cefotaxime 2 g IV q8h for 10—28 days OR Penicillin G 3—4 MU IV q4h for 10—28 days OR Doxycycline 100—200 mg PO q12h for 10—28 days
  • 3.3 Enterococcus species
  • 3.3.1 Ampicillin susceptible
  • 3.3.2 Ampicillin resistant
  • 3.3.3 Ampicillin and vancomycin resistant
  • 3.4 Escherichia coli and other Enterobacteriaceae
  • 3.5 Haemophilus influenzae
  • 3.5.1 β-Lactamase negative
  • 3.5.2 β-Lactamase positive
  • 3.6 Listeria monocytogenes
  • 3.7 Mycobacterium tuberculosis
  • 3.7.1 First-line therapy (dosing information: [1][2][3])
  • 3.7.2 Second-line therapy (dosing information: [4][5][6])
  • 3.7.3 Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis[3][4][5][6]
  • 3.7.3.1 Intensive phase (adult)
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 2 months AND Rifampin 10 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
  • 3.7.3.2 Continuation phase (adult)
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 7–10 months AND Rifampin 10 mg/kg (max: 600 mg) for 7–10 months
  • 3.7.3.3 Intensive phase (pediatric)
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 2 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
  • 3.7.3.3 Continuation phase (pediatric)
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 7–10 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 7–10 months
  • Note (1): World Health Organization guidelines recommend that Ethambutol should be replaced by Streptomycin in tuberculous meningitis.[7] Streptomycin is contraindicated in pregnancy.
  • Note (2): A 9– to 12–month course of treatment is recommended for tuberculous meningitis.[8][9]
Note (3): Adjuvant Dexamethasone 0.3–0.4 mg/kg/day (max: 24 mg) is recommended unless drug resistance is suspected.[10][11]
Note (4): Liaise with microbiology laboratory about genotype testing for drug resistance if there is high risk for MDR-TB.[12]
  • 3.7.4 Tuberculous meningitis caused by Mycobacterium tuberculosis resistant to isoniazid or rifampin
  • 3.7.4.1 Isoniazid monoresistance[13]
  • 3.7.4.2 Rifampin monoresistance[14]
  • 3.7.4.3 MDR-TB (resistant to Isoniazid and Rifampin)[15]
  • MDR tuberculosis therapy should be considered if there is a history of prior tuberculosis treatment, contact with a patient with MDR tuberculosis, or a poor clinical response to first-line TB therapy within 2 weeks despite a firm diagnosis and an adequate adherence to treatment.
  • Second-line agents such as Aminoglycosides penetrate the BBB only in the presence of inflamed meninges, and Fluoroquinolones, while able to penetrate into the CNS, have lower CSF levels than in the serum or brain parenchyma.
  • Consult infectious disease specialist.
  • 3.7.4.4 XDR-TB (resistant to Isoniazid, Rifampin, Fluoroquinolones, and either Capreomycin, Kanamycin, or Amikacin)[16]
  • Preferred regimen: Ceftriaxone 1–2 g IV q12h for 10–14 days
  • 3.9 Neisseria meningitidis
  • 3.9.1 Penicillin MIC < 0.1 μg/mL
  • 3.9.2 Penicillin MIC 0.1–1.0 μg/mL
  • 3.10 Pseudomonas aeruginosa
  • 3.11 Staphylococcus aureus
  • 3.11.1 Methicillin susceptible (MSSA)
  • 3.11.2 Methicillin resistant (MRSA)
  • 3.12 Staphylococcus epidermidis
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
  • Alternative regimen: Linezolid 600 mg IV q12h
  • 3.13 Streptococcus agalactiae
  • 3.14 Streptococcus pneumoniae
  • 3.14.1 Penicillin MIC < 0.1 μg/mL
  • 3.14.2 Penicillin MIC 0.1–1.0 μg/mL
  • 3.14.3 Penicillin MIC ≥ 2.0 μg/mL
  • 3.14.4 Cefotaxime or ceftriaxone MIC ≥ 1.0 μg/mL
  • 3.15 Treponema pallidum (neurosyphilis)[19]
  • 3.16 Borrelia burgdorferi (Lyme meningitis)
  • Preferred regimen (1): Ceftriaxone 2 g IV q24h for 14 days
  • Preferred regimen (2):Cefotaxime 2 g IV q8h for 14 days
  • Preferred regimen (3):Penicillin G 18–24 MU/day q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day OR Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day OR Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day OR Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 4. Pediatric dose:
  • Neonates age 0–7 days: 15–20 mg/kg/day q12h
  • Neonates age 8–28 days: 30 mg/kg/day q8h
  • Infants and children: 20–30 mg/kg/day q8h
  • Neonates age 0–7 days: 150 mg/kg/day q8h
  • Neonates age 8–28 days: 200 mg/kg/day q6–8h
  • Infants and children: 300 mg/kg/day q6h
  • Infants and children: 150 mg/kg/day q8h
  • Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
  • Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
  • Infants and children: 225–300 mg/kg/day q6–8h
  • Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
  • Neonates age 8–28 days: 150 mg/kg q8h
  • Infants and children: 150 mg/kg
  • Infants and children: 80–100 mg/kg/day q12–24h
  • Neonates age 0–7 days: 25 mg/kg/day q24h
  • Neonates age 8–28 days: 50 mg/kg/day q12–24h
  • Infants and children: 75–100 mg/kg/day q6h
  • Neonates age 0–7 days: 5 mg/kg/day q12h
  • Neonates age 8–28 days: 7.5 mg/kg/day q8h
  • Infants and children: 7.5 mg/kg/day q8h
  • Infants and children: 120 mg/kg/day q8h
  • Neonates age 0–7 days: 75 mg/kg/day q8–12h
  • Neonates age 8–28 days: 100–150 mg/kg/day q6–8h
  • Infants and children: 200 mg/kg/day q6h
  • Neonates age 0–7 days: 75 mg/kg/day q8–12h
  • Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
  • Infants and children: 200 mg/kg/day q6h
  • Neonates age 0–7 days: 0.15 MU/kg/day q8–12h
  • Neonates age 8–28 days: 0.2 MU/kg/day q6–8h
  • Infants and children: 0.3 MU/kg/day q4–6h
  • Neonates age 8–28 days: 10–20 mg/kg/day q12h
  • Infants and children: 10–20 mg/kg/day q12–24h
  • Neonates age 0–7 days: 5 mg/kg/day q12h
  • Neonates age 8–28 days: 7.5 mg/kg/day q8h
  • Infants and children: 7.5 mg/kg/day q8h
  • Infants and children: 10–20 mg/kg q6–12h
  • Neonates age 0–7 days: 20–30 mg/kg/day q8–12h
  • Neonates age 8–28 days: 30–45 mg/kg/day q6–8h
  • Infants and children: 60 mg/kg/day q6h

References

  1. ↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.
  2. ↑ Wormser, GP.; Dattwyler, RJ.; Shapiro, ED.; Halperin, JJ.; Steere, AC.; Klempner, MS.; Krause, PJ.; Bakken, JS.; Strle, F. (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. Unknown parameter |month= ignored (help)
  3. ↑ Blumberg, Henry M.; Burman, William J.; Chaisson, Richard E.; Daley, Charles L.; Etkind, Sue C.; Friedman, Lloyd N.; Fujiwara, Paula; Grzemska, Malgosia; Hopewell, Philip C.; Iseman, Michael D.; Jasmer, Robert M.; Koppaka, Venkatarama; Menzies, Richard I.; O'Brien, Richard J.; Reves, Randall R.; Reichman, Lee B.; Simone, Patricia M.; Starke, Jeffrey R.; Vernon, Andrew A.; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society (2003-02-15). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". American Journal of Respiratory and Critical Care Medicine. 167 (4): 603–662. doi:10.1164/rccm.167.4.603. ISSN 1073-449X. PMID 12588714.
  4. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  5. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  6. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  7. ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786. Retrieved 2015-06-08.
  8. ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786. Retrieved 2015-06-08.
  9. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  10. ↑ Thwaites, Guy E.; Nguyen, Duc Bang; Nguyen, Huy Dung; Hoang, Thi Quy; Do, Thi Tuong Oanh; Nguyen, Thi Cam Thoa; Nguyen, Quang Hien; Nguyen, Tri Thuc; Nguyen, Ngoc Hai; Nguyen, Thi Ngoc Lan; Nguyen, Ngoc Lan; Nguyen, Hong Duc; Vu, Ngoc Tuan; Cao, Huu Hiep; Tran, Thi Hong Chau; Pham, Phuong Mai; Nguyen, Thi Dung; Stepniewska, Kasia; White, Nicholas J.; Tran, Tinh Hien; Farrar, Jeremy J. (2004-10-21). "Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults". The New England Journal of Medicine. 351 (17): 1741–1751. doi:10.1056/NEJMoa040573. ISSN 1533-4406. PMID 15496623.
  11. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  12. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  13. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  14. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  15. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  16. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  17. ↑ Workowski, Kimberly A.; Berman, Stuart; Centers for Disease Control and Prevention (CDC) (2010–12–17). "Sexually transmitted diseases treatment guidelines, 2010". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR–12): 1–110. ISSN 1545-8601. PMID 21160459. Check date values in: |date= (help)
  18. ↑ Centers for Disease Control and Prevention (CDC) (2012–08–10). "Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections". MMWR. Morbidity and mortality weekly report. 61 (31): 590–594. ISSN 1545-861X. PMID 22874837. Check date values in: |date= (help)
  19. ↑ Workowski, Kimberly A.; Berman, Stuart; Centers for Disease Control and Prevention (CDC) (2010–12–17). "Sexually transmitted diseases treatment guidelines, 2010". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR–12): 1–110. ISSN 1545-8601. PMID 21160459. Check date values in: |date= (help)
Meningitis, bacterial ⇧ Return to Top ⇧
Meningitis, tuberculous ⇧ Return to Top ⇧
  • Tuberculous meningitis (TB meningitis)
  • First-line therapy (dosing information: [7][8][9])
  • Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis[1][2][3][4]
  • Intensive phase (adult)
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 2 months AND Rifampin 10 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
  • Continuation phase (adult)
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 7–10 months AND Rifampin 10 mg/kg (max: 600 mg) for 7–10 months
  • Intensive phase (pediatric)
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 2 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
  • Continuation phase (pediatric)
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 7–10 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 7–10 months
Note (1): World Health Organization guidelines recommend that Ethambutol should be replaced by Streptomycin (contraindicated in pregnancy) in tuberculous meningitis.[5]
Note (2): A 9– to 12–month course of treatment is recommended for tuberculous meningitis.[6][7]
Note (3): Adjuvant Dexamethasone 0.3–0.4 mg/kg/day (max: 24 mg) is recommended unless drug resistance is suspected.[8][9]
Note (4): Liaise with microbiology laboratory about genotype testing for drug resistance if there is high risk for MDR-TB.[10]
  • Tuberculous meningitis caused by Mycobacterium tuberculosis resistant to isoniazid or rifampin
  • Isoniazid monoresistance[11]
  • Substitute fluoroquinolone for isoniazid in intensive phase regimen.
  • Continue treatment with rifampin, pyrazinamide, and fluoroquinolone for 12 months.
  • Rifampin monoresistance[12]
  • Substitute Fluoroquinolones for Rifampin in intensive phase regimen.
  • Continue treatment with isoniazid, pyrazinamide, and fluoroquinolone for 18 months.
  • MDR-TB (resistant to Isoniazid and Rifampin)[13]
  • MDR tuberculosis therapy should be considered if there is a history of prior tuberculosis treatment, contact with a patient with MDR tuberculosis, or a poor clinical response to first-line TB therapy within 2 weeks despite a firm diagnosis and an adequate adherence to treatment.
  • Second-line agents such as Aminoglycosides penetrate the BBB only in the presence of inflamed meninges, and Fluoroquinolones, while able to penetrate into the CNS, have lower CSF levels than in the serum or brain parenchyma.
  • Consult infectious disease specialist.
  • XDR-TB (resistant to Isoniazid, Rifampin, Fluoroquinolones, and either Capreomycin, Kanamycin, or Amikacin)[14]
  • Consider Ethionamide or Cycloserine to build the treatment regimen.
  • Consult infectious disease specialist.

References

  1. ↑ Blumberg, Henry M.; Burman, William J.; Chaisson, Richard E.; Daley, Charles L.; Etkind, Sue C.; Friedman, Lloyd N.; Fujiwara, Paula; Grzemska, Malgosia; Hopewell, Philip C.; Iseman, Michael D.; Jasmer, Robert M.; Koppaka, Venkatarama; Menzies, Richard I.; O'Brien, Richard J.; Reves, Randall R.; Reichman, Lee B.; Simone, Patricia M.; Starke, Jeffrey R.; Vernon, Andrew A.; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society (2003-02-15). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". American Journal of Respiratory and Critical Care Medicine. 167 (4): 603–662. doi:10.1164/rccm.167.4.603. ISSN 1073-449X. PMID 12588714.
  2. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  3. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  4. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  5. ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786.
  6. ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786.
  7. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  8. ↑ Thwaites, Guy E.; Nguyen, Duc Bang; Nguyen, Huy Dung; Hoang, Thi Quy; Do, Thi Tuong Oanh; Nguyen, Thi Cam Thoa; Nguyen, Quang Hien; Nguyen, Tri Thuc; Nguyen, Ngoc Hai; Nguyen, Thi Ngoc Lan; Nguyen, Ngoc Lan; Nguyen, Hong Duc; Vu, Ngoc Tuan; Cao, Huu Hiep; Tran, Thi Hong Chau; Pham, Phuong Mai; Nguyen, Thi Dung; Stepniewska, Kasia; White, Nicholas J.; Tran, Tinh Hien; Farrar, Jeremy J. (2004-10-21). "Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults". The New England Journal of Medicine. 351 (17): 1741–1751. doi:10.1056/NEJMoa040573. ISSN 1533-4406. PMID 15496623.
  9. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  10. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  11. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  12. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  13. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  14. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
Meningitis, parasitic ⇧ Return to Top ⇧
  • Meningitis, parasitic
  • 1. Protozoal meningitis
  • 1.1 Naegleria fowleri (primary amebic meningoencephalitis)[1][2]
  • 1.2 Toxoplasma gondii[3]
  • 2. Helminthic meningitis
  • 2.1 Angiostrongylus cantonensis[4][5]
  • Preferred regimen: Albendazole 15–20 mg/kg/day PO qd–bid for 10–20 days AND Dexamethasone 10–20 mg PO qd for 10–20 days
  • Alternative regimen: Mebendazole 100 mg PO bid for 10–20 days AND Dexamethasone 10–20 mg PO qd for 10–20 days
  • 2.2 Baylisascaris procyonis[6][7]
  • 2.3 Gnathostoma spinigerum[8][9]


References

  1. ↑ Linam, W. Matthew; Ahmed, Mubbasheer; Cope, Jennifer R.; Chu, Craig; Visvesvara, Govinda S.; da Silva, Alexandre J.; Qvarnstrom, Yvonne; Green, Jerril (2015-03). "Successful treatment of an adolescent with Naegleria fowleri primary amebic meningoencephalitis". Pediatrics. 135 (3): –744-748. doi:10.1542/peds.2014-2292. ISSN 1098-4275. PMID 25667249. Check date values in: |date= (help)
  2. ↑ Vargas-Zepeda, Jesús; Gómez-Alcalá, Alejandro V.; Vásquez-Morales, José Alfonso; Licea-Amaya, Leonardo; De Jonckheere, Johan F.; Lares-Villa, Fernando (2005-02). "Successful treatment of Naegleria fowleri meningoencephalitis by using intravenous amphotericin B, fluconazole and rifampicin". Archives of Medical Research. 36 (1): 83–86. ISSN 0188-4409. PMID 15900627. Check date values in: |date= (help)
  3. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  4. ↑ Wang, Qiao-Ping; Lai, De-Hua; Zhu, Xing-Quan; Chen, Xiao-Guang; Lun, Zhao-Rong (2008-10). "Human angiostrongyliasis". The Lancet. Infectious Diseases. 8 (10): 621–630. doi:10.1016/S1473-3099(08)70229-9. ISSN 1473-3099. PMID 18922484. Check date values in: |date= (help)
  5. ↑ Ramirez-Avila, Lynn; Slome, Sally; Schuster, Frederick L.; Gavali, Shilpa; Schantz, Peter M.; Sejvar, James; Glaser, Carol A. (2009-02-01). "Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 48 (3): 322–327. doi:10.1086/595852. ISSN 1537-6591. PMID 19123863.
  6. ↑ Gavin, Patrick J.; Kazacos, Kevin R.; Shulman, Stanford T. (2005-10). "Baylisascariasis". Clinical Microbiology Reviews. 18 (4): 703–718. doi:10.1128/CMR.18.4.703-718.2005. ISSN 0893-8512. PMC 1265913. PMID 16223954. Check date values in: |date= (help)
  7. ↑ Murray, William J.; Kazacos, Kevin R. (2004-11-15). "Raccoon roundworm encephalitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (10): 1484–1492. doi:10.1086/425364. ISSN 1537-6591. PMID 15546085.
  8. ↑ Herman, Joanna S.; Chiodini, Peter L. (2009-07). "Gnathostomiasis, another emerging imported disease". Clinical Microbiology Reviews. 22 (3): 484–492. doi:10.1128/CMR.00003-09. ISSN 1098-6618. PMC 2708391. PMID 19597010. Check date values in: |date= (help)
  9. ↑ Ramirez-Avila, Lynn; Slome, Sally; Schuster, Frederick L.; Gavali, Shilpa; Schantz, Peter M.; Sejvar, James; Glaser, Carol A. (2009-02-01). "Eosinophilic meningitis due to Angiostrongylus and Gnathostoma species". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 48 (3): 322–327. doi:10.1086/595852. ISSN 1537-6591. PMID 19123863.
Meningitis, fungal ⇧ Return to Top ⇧
  • Fungal meningitis
  • 1. Blastomyces dermatitidis[1]
  • 2. Candida spp.[2]
  • Preferred regimen: Liposomal Amphotericin B 3–5 mg/kg/day IV ± Flucytosine 25 mg/kg PO qid for several weeks, followed by Fluconazole 400–800 mg (6–12 mg/kg) PO qd until CSF abnl resolves
  • Alternative regimen: Fluconazole 400–800 mg PO qd (6–12 mg/kg IV q24h) OR Voriconazole 400 mg PO bid for 2 doses, followed by 200 mg PO bid OR Voriconazole 6 mg/kg IV q12h for 2 doses, followed by 3 mg/kg IV q12h
Note: Removal of intraventricular devices is recommended.
  • 3. Coccidioides immitis[3]
  • 4. Cryptococcus neoformans[4]
  • 4.1 Non–HIV/AIDS hosts, non–transplant recipients
  • 4.2 HIV/AIDS hosts
  • 4.3 Transplant recipients
  • 5. Histoplasma capsulatum[5]
Meningitis, viral ⇧ Return to Top ⇧
  • Viral meningitis[6]
  • 1. Chronic enterovirus meningoencephalitis
  • Preferred regimen: supportive care ± Pleconaril (investigational)
  • 2. HSV-2 meningitis
  • Preferred regimen: supportive care AND Acyclovir 10 mg/kg IV q8h for 10–14 days, followed by Valacyclovir 1 g PO tid
  • 3. Mollaret's meningitis
  • 4. VZV meningitis
  • Preferred regimen: supportive care AND Acyclovir 10 mg/kg IV q8h for 10–14 days, followed by Valacyclovir 1 g PO tid


References

  1. ↑ Chapman, Stanley W.; Dismukes, William E.; Proia, Laurie A.; Bradsher, Robert W.; Pappas, Peter G.; Threlkeld, Michael G.; Kauffman, Carol A.; Infectious Diseases Society of America (2008-06-15). "Clinical practice guidelines for the management of blastomycosis: 2008 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 46 (12): 1801–1812. doi:10.1086/588300. ISSN 1537-6591. PMID 18462107.
  2. ↑ Pappas, Peter G.; Kauffman, Carol A.; Andes, David; Benjamin, Daniel K.; Calandra, Thierry F.; Edwards, John E.; Filler, Scott G.; Fisher, John F.; Kullberg, Bart-Jan; Ostrosky-Zeichner, Luis; Reboli, Annette C.; Rex, John H.; Walsh, Thomas J.; Sobel, Jack D.; Infectious Diseases Society of America (2009-03-01). "Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 48 (5): 503–535. doi:10.1086/596757. ISSN 1537-6591. PMID 19191635.
  3. ↑ Galgiani, John N.; Ampel, Neil M.; Blair, Janis E.; Catanzaro, Antonino; Johnson, Royce H.; Stevens, David A.; Williams, Paul L.; Infectious Diseases Society of America (2005-11-01). "Coccidioidomycosis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 41 (9): 1217–1223. doi:10.1086/496991. ISSN 1537-6591. PMID 16206093.
  4. ↑ Perfect, John R.; Dismukes, William E.; Dromer, Francoise; Goldman, David L.; Graybill, John R.; Hamill, Richard J.; Harrison, Thomas S.; Larsen, Robert A.; Lortholary, Olivier; Nguyen, Minh-Hong; Pappas, Peter G.; Powderly, William G.; Singh, Nina; Sobel, Jack D.; Sorrell, Tania C. (2010-02-01). "Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 50 (3): 291–322. doi:10.1086/649858. ISSN 1537-6591. PMID 20047480.
  5. ↑ Wheat, L. Joseph; Freifeld, Alison G.; Kleiman, Martin B.; Baddley, John W.; McKinsey, David S.; Loyd, James E.; Kauffman, Carol A.; Infectious Diseases Society of America (2007-10-01). "Clinical practice guidelines for the management of patients with histoplasmosis: 2007 update by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 45 (7): 807–825. doi:10.1086/521259. ISSN 1537-6591. PMID 17806045.
  6. ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.

Septic thrombosis of cavernous or dural venous sinus ⇧ Return to Top ⇧

  • Cavernous sinus thrombosis is considered a medical emergency.
  • Duration of therapy is usually a total of 3-4 weeks. More prolonged administration of antimicrobial therapy (total of 6-8 weeks) may be indicated among patients who are suspected to have developed complications (e.g. suppurative intracranial disease).
  • ENT surgery must be consulted to evaluate the need of surgical drainage (e.g. sphenoidotomy if sphenoid sinus infection is the primary cause).
  • Septic thrombosis of cavernous or dural venous sinus
Note (1): If risk of MRSA is high, Vancomycin should be administered instead of either nafcillin or oxacillin
Note (2): The optimal duration of therapy remains unclear
  • 2. Specific anatomic considerations
  • 2.1 Cavernous sinus
Note: Daptomycin 8–12 mg/kg IV q24h OR Linezolid 600 mg IV q12h could be considered for patients unable to tolerate vancomycin
  • 2.2 Lateral sinus
  • 2.3 Superior sagittal sinus
  • Preferred regimen: Ceftriaxone 2 g IV q12h for 3-4 weeks AND Vancomycin 15–20 mg/kg for 3-4 weeks AND Dexamethasone 10 mg IV q6h continued until symptomatic improvement and tailed gradually over several weeks
  • Alternative regimen: Meropenem 1–2 g IV q8h for 3-4 weeks AND Vancomycin 15–20 mg/kg for 3-4 weeks AND Dexamethasone 10 mg IV q6h continued until symptomatic improvement and tailed gradually over several weeks
  • 3. Pathogen-directed antimicrobial therapy
  • Staphylococcus aureus, methicillin-resistant (MRSA)[5]
  • Preferred regimen: Vancomycin 15–20 mg/kg/dose IV q8–12h for 4–6 weeks
  • Alternative regimen: Linezolid 600 mg PO/IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • Pediatric dose: Vancomycin 15 mg/kg/dose IV q6h 4–6 weeks OR Linezolid 10 mg/kg/dose PO/IV q8h 4–6 weeks
  • Note (1): Surgical evaluation for incision and drainage of contiguous sites of infection or abscess is recommended whenever possible
  • Note (2): Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin

Subdural empyema ⇧ Return to Top ⇧

  • Empiric antimicrobial therapy
  • Metronidazole is recommended if anaerobes are suspected. Metronidazole is not necessary for antianaerobic activity if Meropenem is used.
  • For coverage of aerobic Gram-negative bacilli, empiric therapy with Cefepime, Ceftazidime, or Meropenem is appropriate.
  • Depending on the clinical response, parenteral antimicrobial therapy should be administered for 3 to 4 weeks after drainage. Parenteral or oral therapy is frequently continued for up to a total of 6 weeks of therapy.
  • A longer course of treatment (minimum of 6–8 weeks) may be required if the patient has accompanying osteomyelitis.
  • Consider adjunctive medications including prophylactic anticonvulsants, corticosteroids, and mannitol if clinically indicated.
  • Intracranial subdural empyema with unclear source of infection
  • Preferred regimen: (Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks) AND (Ceftriaxone 2 g IV q12h for 3-4 weeks OR Cefotaxime 8–12 g/day IV q4–6h for 3-4 weeks) AND Metronidazole 7.5 mg/kg IV q6h for 3-4 weeks
  • Note: Vancomycin 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • Intracranial subdural empyema associated with sinusitis or otitis media
  • Preferred regimen: (Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks) AND (Ceftriaxone 2 g IV q12h for 3-4 weeks OR Cefotaxime 8–12 g/day IV q4–6h for 3-4 weeks) AND Metronidazole 7.5 mg/kg IV q6h for 3-4 weeks
  • Note: Vancomycin 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • Intracranial subdural empyema after cranial trauma
  • Preferred regimen: Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks
  • Note: Vancomycin should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • Intracranial subdural empyema after neurosurgical procedures
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 3-4 weeks AND Ceftazidime 2 g IV q8h for 3-4 weeks
  • Intracranial subdural empyema in neonates (usually associated with meningitis)
  • Infants < 1 month
  • Preferred regimen: Ampicillin 200 mg/kg/day IV q4h for 3-4 weeks AND Cefotaxime 200 mg/kg/day IV q6h for 3-4 weeks
  • Infants 1–3 months
  • Preferred regimen: Ampicillin 200 mg/kg/day IV q4h for 3-4 weeks AND (Cefotaxime 200 mg/kg/day IV q6h for 3-4 weeks OR Ceftriaxone 100 mg/kg/day IV q12h for 3-4 weeks)
  • Infants > 3 months
  • Preferred regimen: Vancomycin 60 mg/kg/day IV q6h for 3-4 weeks AND (Cefotaxime 200 mg/kg/day IV q6h for 3-4 weeksOR Ceftriaxone 100 mg/kg/day IV q12h for 3-4 weeks OR Cefepime 150 mg/kg/day IV q8h for 3-4 weeks)
  • Spinal subdural empyema
  • Preferred regimen: Nafcillin 2 g IV q4h for 3-4 weeks OR Oxacillin 2 g IV q4h for 3-4 weeks
  • Note: Vancomycin 30–45 mg/kg/day IV q8–12h should be used in place of nafcillin or oxacillin if MRSA is suspected or if penicillin allergy is present.
  • Pathogen-directed antimicrobial therapy
  • Staphylococcus aureus, methicillin-resistant (MRSA)[8]
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h for 4–6 weeks
  • Alternative regimen: Linezolid 600 mg PO/IV q12h for 4–6 weeks OR TMP-SMX 5 mg/kg/dose PO/IV q8–12h for 4–6 weeks
  • Pediatric dose: Vancomycin 15 mg/kg/dose IV q6h OR Linezolid 10 mg/kg/dose PO/IV q8h
  • Note: Consider the addition of Rifampin 600 mg qd or 300–450 mg bid to vancomycin therapy.

References

  1. ↑ Saposnik, Gustavo; Barinagarrementeria, Fernando; Brown, Robert D.; Bushnell, Cheryl D.; Cucchiara, Brett; Cushman, Mary; deVeber, Gabrielle; Ferro, Jose M.; Tsai, Fong Y.; American Heart Association Stroke Council and the Council on Epidemiology and Prevention (2011-04). "Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association". Stroke; a Journal of Cerebral Circulation. 42 (4): 1158–1192. doi:10.1161/STR.0b013e31820a8364. ISSN 1524-4628. PMID 21293023. Check date values in: |date= (help)
  2. ↑ Ebright, J. R.; Pace, M. T.; Niazi, A. F. (2001-12-10). "Septic thrombosis of the cavernous sinuses". Archives of Internal Medicine. 161 (22): 2671–2676. ISSN 0003-9926. PMID 11732931.
  3. ↑ Singh, B. (1993-09). "The management of lateral sinus thrombosis". The Journal of Laryngology and Otology. 107 (9): 803–808. ISSN 0022-2151. PMID 8228594. Check date values in: |date= (help)
  4. ↑ Southwick, F. S.; Richardson, E. P.; Swartz, M. N. (1986-03). "Septic thrombosis of the dural venous sinuses". Medicine. 65 (2): 82–106. ISSN 0025-7974. PMID 3512953. Check date values in: |date= (help)
  5. ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
  6. ↑ Osborn, Melissa K.; Steinberg, James P. (2007-01). "Subdural empyema and other suppurative complications of paranasal sinusitis". The Lancet. Infectious Diseases. 7 (1): 62–67. doi:10.1016/S1473-3099(06)70688-0. ISSN 1473-3099. PMID 17182345. Check date values in: |date= (help)
  7. ↑ Greenlee, John E. (2003-01). "Subdural Empyema". Current Treatment Options in Neurology. 5 (1): 13–22. ISSN 1092-8480. PMID 12521560. Check date values in: |date= (help)
  8. ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.

References

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