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{{PBI|Coccidioidomycosis}}
===Epiglottitis===
*Epiglottitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*Pediatrics
::*Preferred regimen (1): [[Cefotaxime]] 50 mg/kg IV q8h
::*Preferred regimen (2): [[Ceftriaxone]] 50–75 mg/kg/day IV q12–24h {{and}} [[Vancomycin]] 10 mg/kg IV q6h
::*Alternate regimen (1): [[Levofloxacin]] 500 mg IV q24h (or 8 mg/kg IV q12h) {{and}} [[Clindamycin]] 20–40 mg/kg/day IV q6–8h


::* '''1. Primary pulmonary infection in patients low risk persistence/complication:''' Antifungal treatment not generally recommended. Treat fever weight loss and/or fatigue.
:*Adults
::*Preferred regimen (1): [[Cefotaxime]] 2 g IV q4–8h
::*Preferred regimen (2): [[Ceftriaxone]] 1–2 g/day IV q12–24h {{and}} [[Vancomycin]] 2 g/day IV q6–12h
::*Alternate regimen (1): [[Levofloxacin]] 750 mg IV q24h {{and}} [[Clindamycin]] 600–1200 mg IV q6–12h


:::* '''1.1 Uncomplicated acute coccidioidal pneumonia'''
===Jugular vein phlebitis===
::::* 1.1.1 For many (if not most) patients, management may rely on periodic reassessment of symptoms and radiographic findings to assure resolution without antifungal treatment.
* '''Septic jugular thrombophlebitis (Lemierre's syndrome)'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
::::* 1.1.2 Indications for antifungal therapy:
:* Causative pathogens
::::* Immunosupression (AIDS,therapy with high dose corticosteroids, receiptients of TNF-alpha, receiptients of an organ transplant)
::* Fusobacterium
::::* Diabetes
::* Viridans and other streptococci
::::* Preexisting cardiomyopathy
::* Staphylococcus
::::* Pregnancy (third trimester)
::* Peptostreptococcus
::::* Filipino or african
::* Bacteroides
::::* Weight loss of 110%
::* Other oral anaerobes
::::* Intense night sweats persisting longer than 3 weeks
:* Preferred regimen (immunocompetent host) (1): [[Penicillin G]] 2–4 MU IV q4–6h
::::* Infiltrates involving more than one-half of one lung or portions of both lungs
:* Preferred regimen (immunocompetent host) (2): [[Metronidazole]] 0.5 g IV q6h)
::::* Prominent or persistent hilar adenopathy
:* Preferred regimen (immunocompetent host) (3): [[Ampicillin-Sulbactam]] 2 g IV q4h
::::* Anticoccidiodial complement-fixing antibody concentrations in excess of 1:16
:* Preferred regimen (immunocompetent host) (4): [[Clindamycin]] 600 mg IV q6h
::::* 1.1.3 Antifungal regimenes
:* Preferred regimen (immunocomppromised host) (1): [[Cefotaxime]] 2 g IV q6h
::::* Preferred regimen: Oral azole antifungal agents at dosages of 200–400 mg qd. Courses of typically recommended treatment range from 3 to 6 months.
:* Preferred regimen (immunocomppromised host) (2): [[Ceftizoxime]] 4 g IV q8h
:* Preferred regimen (immunocomppromised host) (3): [[Piperacillin]] 3 g IV q4h
:* Preferred regimen (immunocomppromised host) (4): [[Imipenem]] 500 mg IV q6h
:* Preferred regimen (immunocomppromised host) (5): [[Imipenem]] 500 mg IV q6h
:* Preferred regimen (immunocomppromised host) (6): [[Gatifloxacin]] 400 mg IV q24h


::* '''2. Primary pulmonary infection in patients with increased risk of complications or dissemination:'''
===Laryngitis===
:::* 2.1 Preferred regimen in mild to moderate disease: [[Itraconazole]] solution 200 mg PO bid or IV q12h {{OR}} [[Fluconazole]] 400 mg PO q24h for 3–12 months
* Antibiotic use is not associated with significant improvement of objective symptoms<ref name="Reveiz-2005">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 1 | pages = CD004783 | month =  | year = 2005 | doi = 10.1002/14651858.CD004783.pub2 | PMID = 15674965 }}</ref><ref name="Reveiz-2007">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | last3 = Ospina | first3 = EG. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume =  | issue = 2 | pages = CD004783 | month =  | year = 2007 | doi = 10.1002/14651858.CD004783.pub3 | PMID = 17443555 }}</ref><ref name="Reveiz-2013">{{Cite journal  | last1 = Reveiz | first1 = L. | last2 = Cardona | first2 = AF. | title = Antibiotics for acute laryngitis in adults. | journal = Cochrane Database Syst Rev | volume = 3 | issue =  | pages = CD004783 | month =  | year = 2013 | doi = 10.1002/14651858.CD004783.pub4 | PMID = 23543536 }}</ref> and is not indicated in the treatment of acute laryngitis.<ref name="Schwartz-2009">{{Cite journal  | last1 = Schwartz | first1 = SR. | last2 = Cohen | first2 = SM. | last3 = Dailey | first3 = SH. | last4 = Rosenfeld | first4 = RM. | last5 = Deutsch | first5 = ES. | last6 = Gillespie | first6 = MB. | last7 = Granieri | first7 = E. | last8 = Hapner | first8 = ER. | last9 = Kimball | first9 = CE. | title = Clinical practice guideline: hoarseness (dysphonia). | journal = Otolaryngol Head Neck Surg | volume = 141 | issue = 3 Suppl 2 | pages = S1-S31 | month = Sep | year = 2009 | doi = 10.1016/j.otohns.2009.06.744 | PMID = 19729111 }}</ref>
:::* 2.2 Preferred regimen in locally severe or disseminated disease: [[Amphotericin B]] 0.6–1 mg/kg PO qd every 7 days {{then}} 0.8 mg/kg PO every other day {{or}} liposomal [[Amphotericin B]] 3-5 mg/kg IV q24 hrs or [[Amphotericin B lipid complex]] 5 mg/kg IV q24 hrs until clinical improvement (usually several weaks or longer in disseminated disease) followed by [[Itraconazole]] {{or}} [[Fluconazole]] for at least 1 year.
:::* Note (1): Some use combination of Amphotericin B and Fluconazole for progressive severe disease; controlled series lacking.
:::* Note (2): Consultation with specialist recommendation, surgery may be required.


::* '''Meningitis:'''
===Lemierre's syndrome===
:::* '''Adult:'''
* '''Septic jugular thrombophlebitis (Lemierre's syndrome)'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
::::* Preferred regimen: [[Fluconazole]] 400–1,000 mg po q24h indefinitely
:* Causative pathogens
::::* Alternative regimen: [[Amphotericin B]] IV as for pulmonary (above) + 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device {{OR}} itra 400–800 mg q24h {{OR}} [[Voriconazole]]
::* Fusobacterium
::::* Note (1): Some use combination of [[Amphotericin B]] and Flu for progressive severe disease; controlled series lacking.
::* Viridans and other streptococci
::* Staphylococcus
::* Peptostreptococcus
::* Bacteroides
::* Other oral anaerobes
:* Preferred regimen (immunocompetent host) (1): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h)
:* Preferred regimen (immunocompetent host) (2): [[Ampicillin-Sulbactam]] 2 g IV q4h
:* Preferred regimen (immunocompetent host) (3): [[Clindamycin]] 600 mg IV q6h
:* Preferred regimen (immunocomppromised host) (1): [[Cefotaxime]] 2 g IV q6h
:* Preferred regimen (immunocomppromised host) (2): [[Ceftizoxime]] 4 g IV q8h
:* Preferred regimen (immunocomppromised host) (3): [[Piperacillin]] 3 g IV q4h
:* Preferred regimen (immunocomppromised host) (4): [[Imipenem]] 500 mg IV q6h
:* Preferred regimen (immunocomppromised host) (5): [[Imipenem]] 500 mg IV q6h
:* Preferred regimen (immunocomppromised host) (6): [[Gatifloxacin]] 400 mg IV q24h


:::*'''Child:'''
===Ludwig's angina===
::::* Preferred regimen: [[Fluconazole]] PO (Pediatric dose not established, 6 mg per kg q24h used)
* '''Ludwig's angina'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
::::* Alternative regimen: [[Amphotericin B]] IV as for pulmonary (above) + 0.1–0.3 mg daily intrathecal (intraventricular) via reservoir device {{OR}} itra 400–800 mg q24h {{OR}} [[Voriconazole]]
:* Causative pathogens
::* Viridans and other streptococci
::* Peptostreptococcus
::* Bacteroides
::* Other oral anaerobes
:* Preferred regimen (immunocompetent host) (1): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Tobramycin]] 2 mg/kg IV q8h)
:* Preferred regimen (immunocompetent host) (2): [[Ampicillin-Sulbactam]] 2 g IV q4h
:* Preferred regimen (immunocompetent host) (3): [[Clindamycin]] 600 mg IV q6h
:* Preferred regimen (immunocompetent host) (4): [[Doxycycline]] 200 mg IV q12h
:* Preferred regimen (immunocompetent host) (5): [[Cefoxitin]] 2 g IV q6h
:* Preferred regimen (immunocompetent host) (6): [[Cefotetan]] 2 g IV q12h
:* Preferred regimen (immunocomppromised host) (1): [[Cefotaxime]] 2 g IV q6h
:* Preferred regimen (immunocomppromised host) (2): [[Ceftizoxime]] 4 g IV q8h
:* Preferred regimen (immunocomppromised host) (3): [[Piperacillin]] 3 g IV q4h
:* Preferred regimen (immunocomppromised host) (4): [[Imipenem]] 500 mg IV q6h
:* Preferred regimen (immunocomppromised host) (5): [[Meropenem]] 1 g IV q8h
:* Preferred regimen (immunocomppromised host) (6): [[Gatifloxacin]] 200 mg IV q24h


===Parapharyngeal space infection===
* '''Parapharyngeal space infection'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
:* Causative pathogens
::* Viridans and other streptococci
::* Staphylococcus
::* Peptostreptococcus
::* Bacteroides
::* Other oral anaerobes
:* Preferred regimen (immunocompetent host) (1): ([[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Metronidazole]] 0.5 g IV q6h)
:* Preferred regimen (immunocompetent host) (2): [[Ampicillin-Sulbactam]] 2 g IV q4h
:* Preferred regimen (immunocompetent host) (3): [[Clindamycin]] 600 mg IV q6h
:* Preferred regimen (immunocomppromised host) (1): [[Cefotaxime]] 2 g IV q6h
:* Preferred regimen (immunocomppromised host) (2): [[Ceftizoxime]] 4 g IV q8h
:* Preferred regimen (immunocomppromised host) (3): [[Piperacillin]] 3 g IV q4h
:* Preferred regimen (immunocomppromised host) (4): [[Imipenem]] 500 mg IV q6h
:* Preferred regimen (immunocomppromised host) (5): [[Imipenem]] 500 mg IV q6h
:* Preferred regimen (immunocomppromised host) (6): [[Gatifloxacin]] 400 mg IV q24h


::* '''3.Special considerations for HIV/AIDS patients'''
===Pharyngitis, diphtheria===
:::* 3.1 Focal Pneumonia
*Diphtheria<ref>''The first version of this article was adapted from the [[Centers for Disease Control and Prevention|CDC]] document "Diphtheria - 1995 Case Definition" athttp://www.cdc.gov/epo/dphsi/casedef/diphtheria_current.htm. As a work of an agency of the U.S. Government without any other copyright notice it should be available as a public domain resource''.</ref>
:::* 3.1.1 Preferred regimen in mild Infections: [[Fluconazole]] 400 mg PO daily {{or}} [[Itraconazole]] 200 mg PO BID
:*The CDC recommends either:
:::* 3.1.2 Alternative regimen in mild infections for patients who failed to respond to fluconazole or itraconazole: [[Posaconazole]] 200 mg PO bid {{or}} [[Voriconazole]] 200 mg PO bid
::*Preferred regimen (1): [[Erythromycin]] (PO or by IV) for 14 days (40 mg/kg per day with a maximum of 2 g/d)
:::* Note: Itraconazole, posaconazole, and voriconazole may have significant interactions with certain ARV agents. These interactions are complex and can be bi-directional
::*Preferred regimen (2): [[Procaine penicillin G]] given IM for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg).
:::* 3.2 Preferred regimen in severe, Non-Meningeal Infection (Diffuse Pulmonary Infection or Severely Ill Patients with Extrathoracic, Disseminated Disease): [[Amphotericin B deoxycholate]] 0.7–1.0 mg/kg IV qd  Lipid formulation amphotericin B 4–6 mg/kg IV daily  Duration of therapy: continue until clinical improvement, then switch to an azole
:*Patients with allergies
:::* 3.3 Alternative regimen in severe, Non-Meningeal Infection (Diffuse Pulmonary Infection or Severely Ill Patients with Extrathoracic, Disseminated Disease): Some specialists will add a triazole (fluconazole or itraconazole, with itraconazole preferred for bone disease) 400 mg per day to amphotericin B therapy and continue triazole once amphotericin B is stopped
::*Preferred regimen (1): [[Penicillin G]]
:::* Note: Therapy should be continued indefinitely in patients with diffuse pulmonary or disseminated diseases because relapse can occur in 25%–33% of HIV-negative patients. It can also occur in HIV-infected patients with CD4 counts >250 cells/μL
::*Preferred regimen (2): [[Erythromycin]]
::*Preferred regimen (3): [[Eifampin]]
::*Preferred regimen (4): [[Clindamycin]]


:::* 3.4 Meningeal Infections
===Pharyngitis, streptococcal===
:::* Preferred regimen: Fluconazole 400–800 mg IV or PO daily
*Pharyngitis <ref name="Thomas-2000">{{Cite journal  | last1 = Thomas | first1 = M. | last2 = Del Mar | first2 = C. | last3 = Glasziou | first3 = P. | title = How effective are treatments other than antibiotics for acute sore throat? | journal = Br J Gen Pract | volume = 50 | issue = 459 | pages = 817-20 | month = Oct | year = 2000 | doi =  | PMID = 11127175 }}</ref><ref name="Spinks-2013">{{Cite journal  | last1 = Spinks | first1 = A. | last2 = Glasziou | first2 = PP. | last3 = Del Mar | first3 = CB. | title = Antibiotics for sore throat. | journal = Cochrane Database Syst Rev | volume = 11 | issue =  | pages = CD000023 | month =  | year = 2013 | doi = 10.1002/14651858.CD000023.pub4 | PMID = 24190439 }}</ref>
:::* Alternative regimen:Itraconazole 200 mg PO TID for 3 days, then 200 mg PO BID (BII), or Posaconazole 200 mg PO BID (BIII), or Voriconazole 200–400 mg PO BID (BIII), or Intrathecal amphotericin B deoxycholate, when triazole antifungals are ineffective.
:*Acute
:::*Note (1): Some patients with meningitis may develop hydrocephalus and require CSF shunting
::*Children:
:::*Note (2): Therapy should be lifelong in patients with meningeal infections because relapse occurs in 80% of HIV-infected patients after discontinuation of triazole therapy
*Preferred regimen: [[Pencillin V]] PO 250 mg twice daily or 3 times daily
:::* 3.5 Chronic Suppressive Therapy: 
::*Adolescents and adults:
:::* Preferred regimen: Fluconazole 400 mg PO daily (AII), or Itraconazole 200 mg PO BID
*Preferred regimen (1): [[Pencillin V]] PO 250 mg 4 times daily or 500 mg twice daily for 10 days  
:::* Alternative regimen: Posaconazole 200 mg PO BID or Voriconazole 200 mg PO BID
*Preferred regimen (2): [[Amoxicillin]] 50 mg/kg once daily (max = 1000 mg) alternate:25 mg/kg (max = 500 mg) twice daily for 10 days
*Preferred regimen (3): [[Penicillin G|Benzathine Penicillin G]] I.M 27 kg: 600 000 U; ≥27 kg: 1 200 000 U 1 dose only
*Preferred regimen (4): [[Cephalexin]] PO 20 mg/kg/dose twice daily (max = 500 mg/dose)for 10 days
*Alternate regimen (1): [[Cefadroxil]] PO 30 mg/kg OD (max = 1 g) for 10 days
*Alternate regimen (2): [[Clindamycin]] PO 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days
*Alternate regimen (3): [[Azithromycin]]PO 12 mg/kg once daily (max = 500 mg) for 5 days
*Alternate regimen (4): [[Clarithromycin]] PO 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days
:*Chronic
::*Preferred regimen (1): [[Clindamycin]] 20–30 mg/kg/d in 3 doses (max = 300 mg/dose) for 10 days
::*Preferred regimen (2): [[Penicillin]] {{and}} [[Rifampin]]; Penicillin V: 50 mg/kg/d in 4 doses × 10 d (max = 2000 mg/d) ;rifampin: 20 mg/kg/d in 1 dose × last 4 d of treatment (max = 600 mg/d) for 10 days {{and}} [[Amoxicillin–clavulanate]] 40 mg amoxicillin/kg/d in 3 doses (max = 2000 mg amoxicillin/d) for 10 days
::*Preferred regimen (3): [[Benzathine penicillin G]] IM 600 000 U for <27 kg and 1 200 000 U for ≥27 kg single dose {{and}} [[Rifampin]] PO 20 mg/kg/d in 2 doses (max = 600 mg/d) for 4 days


Duration of therapy: continue until clinical improvement, then switch to an azole (BIII)
===Sinusitis, Acute===
:::* 2.2.1 Preferred regimen: Amphotericin B deoxycholate 0.7–1.0 mg/kg IV daily (AII)Lipid formulation amphotericin B 4–6 mg/kg IV daily (AIII) Duration of therapy: continue until clinical improvement, then switch to an azole (BIII)
*Sinusitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:::* 2.2.2 Alternative regimen: Some specialists will add a triazole (fluconazole or itraconazole, with itraconazole preferred for bone disease) 400 mg per day to amphotericin B therapy and continue triazole once amphotericin B is stopped
:::* 2.3 Meningeal Infections:
:::* Preferred regimen: 


*Sinusitis (Pediatrics)
:*Preferred Regimen (1): [[Amoxicillin]] 90 mg / kg / day PO divided q12h
:*Preferred Regimen (2): [[Amoxicillin-clavulanate]] (extra strength) suspension, 90 mg / kg / day (based on Amox component), PO divided q12h for 10-14 days
::*If  non-type I hypersensitivity to penicillin :
:::*Preferred regimen (1): [[Cefuroxime axetil]] 30 mg / kg / day PO divided q12h for 10-14 days
:::*Alternate Regimen (1): [[Cefdinir]] 14 mg / kg / day PO divided q12-24h, max of 600 mg / day for 10-14 days
:::*Alternate Regimen (2):  [[Cefpodoxime]] 10 mg / kg / day PO divided q12h for 10-14 days
*Sinusitis (Adults)
:*Preferred Regimen (1): [[Amoxicillin]] 250-500 mg  q8h or 500-875 mg q12h or extended-release tablet 775 mg once daily
:*Preferred Regimen (2): [[Amoxicillin-clavulanate]] (extended release tabs) 1000 / 62.5 mg 2 tabs or 2000/125 mg 1 tab, PO q12h for 5-7 days


::*'''3. Meningingeal infections'''
:*Alternate Regimen 
:::* Preferrered regimen: Fluconazole 400–800 mg IV or PO daily
:::* Alternative regimen:
• Itraconazole 200 mg PO TID for 3 days, then 200 mg PO BID (BII), or


• Posaconazole 200 mg PO BID (BIII), or
::*If type 1 hypersensitivity to penicillin :
:*Preferred regimen (1): [[Levofloxacin]] 750 mg PO once daily for 5-7 days
:*Preferred regimen (2): [[Doxycycline]] 100 mg PO q12h for 5-7 days


• Voriconazole 200–400 mg PO BID (BIII), or
::*If type 2 hypersensitivity to penicillin :
:*Preferred regimen (1): [[Cefdinir]] 600 mg / day divided q12h or q24h for 5-7 days
:*Preferred regimen (2): [[Cefpodoxime]] 200 mg PO q12h for 5-7 days
:*Preferred regimen (3): [[Cefuroxime axetil]] 500 mg PO q12h for 5-7 days


• Intrathecal amphotericin B deoxycholate, when triazole antifungals are ineffective (AIII):::* Chonic suppressive therapy: Fluconazole 400 mg PO daily (AII), or Itraconazole 200 mg PO BID
===Sinusitis, Chronic===
*Sinusitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>


*Sinusitis (Pediatrics)
:*Preferred Regimen:[[Amoxicillin-clavulanate]] 45 mg/kg per day q12h
:*If penicillin allergy and patient is MRSA positive
::*[[Clindamycin]] 20 to 40 mg/kg per day orally divided every 6 to 8 hours
:*If anaerobes are involved
::*[[Metronidazole]] PLUS one of the following: [[cefuroxime axetil]], [[cefdinir]], [[cefpodoxime proxetil]],[[azithromycin]], [[clarithromycin]], or [[trimethoprim-sulfamethoxazole]] (TMP-SMX)


:::* Note (1): Monitor 5-FC levels and CBC to avoid bone marrow suppression.
*Sinusitis (Adults)
:*Preferred regimen (1): [[Amoxicillin-clavulanate]] 500 mg three times daily
:*Preferred regimen (2): [[Amoxicillin-clavulanate]] 875 mg twice daily
:*Preferred regimen (3): [[Amoxicillin-clavulanate]] two 1000 mg extended-release tablets twice daily)
:*If penicillin allergy and patient is MRSA positive
:*Preferred regimen (1): [[Clindamycin]] 300 mg four times daily or 450 mg three times daily)
:*If anaerobes are involved
:*Preferred regimen (1):[[Metronidazole]] {{and}} one of the following: [[cefuroxime axetil]], [[cefdinir]], [[cefpodoxime proxetil]], [[levofloxacin]] , [[azithromycin]], [[clarithromycin]]
:*Preferred regimen (2): [[trimethoprim-sulfamethoxazole]] (TMP-SMX)
:*Alternate regimen: [[Moxifloxacin ]](400 mg once daily)


:::*Alternative regimen: Above without flucytosine, but need to treat for 4-6 wks of ampho B or 12 wks of fluconazole 1200 mg/day (especially if neutropenic).
===Sinusitis, post-intubation===
:::*Fluconazole alternative: itraconazole (not as effective). Ampho B alternative liposomal AmB 4-6 mg/kg/day IV.
*Sinusitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:::*Maintenance phase: fluconazole 200 mg PO once daily life long or discontinue maintenance fluconazole when CD4 >200 × 6 mos and completed 10 wks rx minimum and asymptomatic. CSF pressure OP > 250 mm H2O: remove CSF fluid until pressure drops 50%, then daily LP with same rule until OP <200 mm H2O.
:*Preferred regimen (1): [[Imipenem]] 0.5 gm IV q6h
:*Preferred regimen (2): [[Meropenem]] 1 gm IV q8h,  MRSA suggestive on Gram - stain then add [[Vancomycin]] 1 gm IV q12h
:*Alternate Regimen (1): [[Ceftazidime]] 2 gm IV q8h {{and}} [[Vancomycin]] 1 gm IV q12h)
:*Alternate Regimen (2): [[Cefepime]] 2 gm IV q12h {{and}} [[Vancomycin]] 1 gm IV q12h)


===Sinusitis, treatment failure===
*Sinusitis (Pediatrics)  <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*If treatment failure then do a culture and treat accordingly or treatment in the absence of cultures and children failing [[Amoxicillin]]
::*[[Amoxicillin-clavulanate]] (extra strength) suspension 90 mg/kg/day (Amoxicllin component) PO divided q12h for 10-14 days.
:*Treatment in the absence of cultures and children failing [[Amoxicillin-clavulanate]]
::*[[Clindamycin]] 30-40 mg/kg/day divided q8h {{and}} third generation [[cephalosporin]] like [[Cefuroxime axetil]] 30 mg/kg/day PO divided q12h
Preferred regimen (1):  [[Cefdinir]] 14 mg/kg/day PO divided q12h or q24h
Preferred regimen (2):[[Cefpodoxime]] 10 mg/kg/day PO divided q12h


*Sinusitis (Adults)
:*If failure of treatment  even after 7 days of diagnosis
Preferred regimen (1): [[Amoxicillin-clavulanate]] 4g per day of amoxicillin equivalent
Preferred regimen (2): [[Levofloxacin]] 500 mg PO once daily
Preferred regimen (3): [[Moxifloxacin]]400 mg PO once daily


===Stomatitis, aphthous===
*Stomatitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*[[Topical steroids]] may decrease pain and swelling


===Stomatitis, herpetic===
*Stomatitis  <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*[[Acyclovir]] 15 mg/kg PO q5h For 7 days


===Submandibular space infection===
* '''Submandibular space infections including Ludwig angina'''<ref>{{cite book | last = Hall | first = Jesse | title = Principles of critical care | publisher = McGraw-Hill Education | location = New York | year = 2015 | isbn = 978-0071738811 }}</ref>
:* Causative pathogens
::* Viridans and other streptococci
::* Peptostreptococcus
::* Bacteroides
::* Other oral anaerobes
:* Preferred regimen (immunocompetent host) (1): [[Penicillin G]] 2–4 MU IV q4–6h {{and}} [[Tobramycin]] 2 mg/kg IV q8h)
:* Preferred regimen (immunocompetent host) (2): [[Ampicillin-Sulbactam]] 2 g IV q4h
:* Preferred regimen (immunocompetent host) (3): [[Clindamycin]] 600 mg IV q6h
:* Preferred regimen (immunocompetent host) (4): [[Doxycycline]] 200 mg IV q12h
:* Preferred regimen (immunocompetent host) (5): [[Cefoxitin]] 2 g IV q6h
:* Preferred regimen (immunocompetent host) (6): [[Cefotetan]] 2 g IV q12h
:* Preferred regimen (immunocomppromised host) (1): [[Cefotaxime]] 2 g IV q6h
:* Preferred regimen (immunocomppromised host) (2): [[Ceftizoxime]] 4 g IV q8h
:* Preferred regimen (immunocomppromised host) (3): [[Piperacillin]] 3 g IV q4h
:* Preferred regimen (immunocomppromised host) (4): [[Imipenem]] 500 mg IV q6h
:* Preferred regimen (immunocomppromised host) (5): [[Meropenem]] 1 g IV q8h
:* Preferred regimen (immunocomppromised host) (6): [[Gatifloxacin]] 200 mg IV q24h
===Tonsillitis===
*Tonsillitis <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*Preferred regimen:[[Penicillin V]] PO 10 days or if compliance unlikely, [[Benzathine penicillin]] IM single dose
:*Alternate regimen (1): [[Cephalosporins|2nd generation Cephalosporins]] PO for 4–6 days
:*Alternate regimen (2): [[Clindamycin]] or [[azithromycin]] for 5 days
:*Alternate regimen (3): [[Clarithromycin]] for 10 days
:*Alternate regimen (4): [[Erythromycin]] for 10 days. Extended-release [[amoxicillin]] is another (expensive) option
===Ulcerative gingivitis===
*Provide patient with specific oral hygiene instructions to use a prescription antibacterial mouthwash: [[Chlorhexidine]] 0.12% twice daily.<ref>{{Cite web | title =Managing Patients with Necrotizing Ulcerative Gingivitis
| url = http://www.jcda.ca/article/d46}}</ref>
*For any signs of systemic involvement, the recommended antibiotics are:
:*Preferred regimen: [[Amoxicillin]], 250 mg 3 x daily for 7 days {{withorwithout}} [[Metronidazole]], 250 mg 3 x daily for 7 days
===Vincent's angina===
*Vincent's angina  <ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
:*Preferred treatment:[[Penicillin G]] 4 million units IV q4h
:*Alternate treatment: [[Clindamycin]] 600 mg IV q8h


==References==
{{reflist}}
{{reflist}}

Latest revision as of 18:00, 30 July 2015

Epiglottitis

  • Epiglottitis [1]
  • Pediatrics
  • Adults

Jugular vein phlebitis

  • Septic jugular thrombophlebitis (Lemierre's syndrome)[2]
  • Causative pathogens
  • Fusobacterium
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Preferred regimen (immunocompetent host) (1): Penicillin G 2–4 MU IV q4–6h
  • Preferred regimen (immunocompetent host) (2): Metronidazole 0.5 g IV q6h)
  • Preferred regimen (immunocompetent host) (3): Ampicillin-Sulbactam 2 g IV q4h
  • Preferred regimen (immunocompetent host) (4): Clindamycin 600 mg IV q6h
  • Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
  • Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
  • Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
  • Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
  • Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
  • Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

Laryngitis

  • Antibiotic use is not associated with significant improvement of objective symptoms[3][4][5] and is not indicated in the treatment of acute laryngitis.[6]

Lemierre's syndrome

  • Septic jugular thrombophlebitis (Lemierre's syndrome)[7]
  • Causative pathogens
  • Fusobacterium
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Preferred regimen (immunocompetent host) (1): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h)
  • Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
  • Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
  • Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
  • Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
  • Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
  • Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
  • Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
  • Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

Ludwig's angina

  • Ludwig's angina[8]
  • Causative pathogens
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Preferred regimen (immunocompetent host) (1): (Penicillin G 2–4 MU IV q4–6h AND Tobramycin 2 mg/kg IV q8h)
  • Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
  • Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
  • Preferred regimen (immunocompetent host) (4): Doxycycline 200 mg IV q12h
  • Preferred regimen (immunocompetent host) (5): Cefoxitin 2 g IV q6h
  • Preferred regimen (immunocompetent host) (6): Cefotetan 2 g IV q12h
  • Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
  • Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
  • Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
  • Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
  • Preferred regimen (immunocomppromised host) (5): Meropenem 1 g IV q8h
  • Preferred regimen (immunocomppromised host) (6): Gatifloxacin 200 mg IV q24h

Parapharyngeal space infection

  • Parapharyngeal space infection[9]
  • Causative pathogens
  • Viridans and other streptococci
  • Staphylococcus
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Preferred regimen (immunocompetent host) (1): (Penicillin G 2–4 MU IV q4–6h AND Metronidazole 0.5 g IV q6h)
  • Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
  • Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
  • Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
  • Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
  • Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
  • Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
  • Preferred regimen (immunocomppromised host) (5): Imipenem 500 mg IV q6h
  • Preferred regimen (immunocomppromised host) (6): Gatifloxacin 400 mg IV q24h

Pharyngitis, diphtheria

  • The CDC recommends either:
  • Preferred regimen (1): Erythromycin (PO or by IV) for 14 days (40 mg/kg per day with a maximum of 2 g/d)
  • Preferred regimen (2): Procaine penicillin G given IM for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg).
  • Patients with allergies

Pharyngitis, streptococcal

  • Acute
  • Children:
  • Preferred regimen: Pencillin V PO 250 mg twice daily or 3 times daily
  • Adolescents and adults:
  • Preferred regimen (1): Pencillin V PO 250 mg 4 times daily or 500 mg twice daily for 10 days
  • Preferred regimen (2): Amoxicillin 50 mg/kg once daily (max = 1000 mg) alternate:25 mg/kg (max = 500 mg) twice daily for 10 days
  • Preferred regimen (3): Benzathine Penicillin G I.M 27 kg: 600 000 U; ≥27 kg: 1 200 000 U 1 dose only
  • Preferred regimen (4): Cephalexin PO 20 mg/kg/dose twice daily (max = 500 mg/dose)for 10 days
  • Alternate regimen (1): Cefadroxil PO 30 mg/kg OD (max = 1 g) for 10 days
  • Alternate regimen (2): Clindamycin PO 7 mg/kg/dose 3 times daily (max = 300 mg/dose) for 10 days
  • Alternate regimen (3): AzithromycinPO 12 mg/kg once daily (max = 500 mg) for 5 days
  • Alternate regimen (4): Clarithromycin PO 7.5 mg/kg/dose twice daily (max = 250 mg/dose) for 10 days
  • Chronic
  • Preferred regimen (1): Clindamycin 20–30 mg/kg/d in 3 doses (max = 300 mg/dose) for 10 days
  • Preferred regimen (2): Penicillin AND Rifampin; Penicillin V: 50 mg/kg/d in 4 doses × 10 d (max = 2000 mg/d) ;rifampin: 20 mg/kg/d in 1 dose × last 4 d of treatment (max = 600 mg/d) for 10 days AND Amoxicillin–clavulanate 40 mg amoxicillin/kg/d in 3 doses (max = 2000 mg amoxicillin/d) for 10 days
  • Preferred regimen (3): Benzathine penicillin G IM 600 000 U for <27 kg and 1 200 000 U for ≥27 kg single dose AND Rifampin PO 20 mg/kg/d in 2 doses (max = 600 mg/d) for 4 days

Sinusitis, Acute

  • Sinusitis (Pediatrics)
  • Preferred Regimen (1): Amoxicillin 90 mg / kg / day PO divided q12h
  • Preferred Regimen (2): Amoxicillin-clavulanate (extra strength) suspension, 90 mg / kg / day (based on Amox component), PO divided q12h for 10-14 days
  • If non-type I hypersensitivity to penicillin :
  • Preferred regimen (1): Cefuroxime axetil 30 mg / kg / day PO divided q12h for 10-14 days
  • Alternate Regimen (1): Cefdinir 14 mg / kg / day PO divided q12-24h, max of 600 mg / day for 10-14 days
  • Alternate Regimen (2): Cefpodoxime 10 mg / kg / day PO divided q12h for 10-14 days
  • Sinusitis (Adults)
  • Preferred Regimen (1): Amoxicillin 250-500 mg q8h or 500-875 mg q12h or extended-release tablet 775 mg once daily
  • Preferred Regimen (2): Amoxicillin-clavulanate (extended release tabs) 1000 / 62.5 mg 2 tabs or 2000/125 mg 1 tab, PO q12h for 5-7 days
  • Alternate Regimen
  • If type 1 hypersensitivity to penicillin :
  • Preferred regimen (1): Levofloxacin 750 mg PO once daily for 5-7 days
  • Preferred regimen (2): Doxycycline 100 mg PO q12h for 5-7 days
  • If type 2 hypersensitivity to penicillin :
  • Preferred regimen (1): Cefdinir 600 mg / day divided q12h or q24h for 5-7 days
  • Preferred regimen (2): Cefpodoxime 200 mg PO q12h for 5-7 days
  • Preferred regimen (3): Cefuroxime axetil 500 mg PO q12h for 5-7 days

Sinusitis, Chronic

  • Sinusitis (Pediatrics)
  • Clindamycin 20 to 40 mg/kg per day orally divided every 6 to 8 hours
  • If anaerobes are involved
  • Sinusitis (Adults)

Sinusitis, post-intubation

Sinusitis, treatment failure

  • Sinusitis (Pediatrics) [16]
  • If treatment failure then do a culture and treat accordingly or treatment in the absence of cultures and children failing Amoxicillin
  • Amoxicillin-clavulanate (extra strength) suspension 90 mg/kg/day (Amoxicllin component) PO divided q12h for 10-14 days.

Preferred regimen (1): Cefdinir 14 mg/kg/day PO divided q12h or q24h Preferred regimen (2):Cefpodoxime 10 mg/kg/day PO divided q12h

  • Sinusitis (Adults)
  • If failure of treatment even after 7 days of diagnosis

Preferred regimen (1): Amoxicillin-clavulanate 4g per day of amoxicillin equivalent Preferred regimen (2): Levofloxacin 500 mg PO once daily Preferred regimen (3): Moxifloxacin400 mg PO once daily

Stomatitis, aphthous

Stomatitis, herpetic

Submandibular space infection

  • Submandibular space infections including Ludwig angina[19]
  • Causative pathogens
  • Viridans and other streptococci
  • Peptostreptococcus
  • Bacteroides
  • Other oral anaerobes
  • Preferred regimen (immunocompetent host) (1): Penicillin G 2–4 MU IV q4–6h AND Tobramycin 2 mg/kg IV q8h)
  • Preferred regimen (immunocompetent host) (2): Ampicillin-Sulbactam 2 g IV q4h
  • Preferred regimen (immunocompetent host) (3): Clindamycin 600 mg IV q6h
  • Preferred regimen (immunocompetent host) (4): Doxycycline 200 mg IV q12h
  • Preferred regimen (immunocompetent host) (5): Cefoxitin 2 g IV q6h
  • Preferred regimen (immunocompetent host) (6): Cefotetan 2 g IV q12h
  • Preferred regimen (immunocomppromised host) (1): Cefotaxime 2 g IV q6h
  • Preferred regimen (immunocomppromised host) (2): Ceftizoxime 4 g IV q8h
  • Preferred regimen (immunocomppromised host) (3): Piperacillin 3 g IV q4h
  • Preferred regimen (immunocomppromised host) (4): Imipenem 500 mg IV q6h
  • Preferred regimen (immunocomppromised host) (5): Meropenem 1 g IV q8h
  • Preferred regimen (immunocomppromised host) (6): Gatifloxacin 200 mg IV q24h

Tonsillitis

Ulcerative gingivitis

  • Provide patient with specific oral hygiene instructions to use a prescription antibacterial mouthwash: Chlorhexidine 0.12% twice daily.[21]
  • For any signs of systemic involvement, the recommended antibiotics are:

Vincent's angina

  • Vincent's angina [22]
  1. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  2. ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
  3. ↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2005). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (1): CD004783. doi:10.1002/14651858.CD004783.pub2. PMID 15674965.
  4. ↑ Reveiz, L.; Cardona, AF.; Ospina, EG. (2007). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev (2): CD004783. doi:10.1002/14651858.CD004783.pub3. PMID 17443555.
  5. ↑ Reveiz, L.; Cardona, AF. (2013). "Antibiotics for acute laryngitis in adults". Cochrane Database Syst Rev. 3: CD004783. doi:10.1002/14651858.CD004783.pub4. PMID 23543536.
  6. ↑ Schwartz, SR.; Cohen, SM.; Dailey, SH.; Rosenfeld, RM.; Deutsch, ES.; Gillespie, MB.; Granieri, E.; Hapner, ER.; Kimball, CE. (2009). "Clinical practice guideline: hoarseness (dysphonia)". Otolaryngol Head Neck Surg. 141 (3 Suppl 2): S1–S31. doi:10.1016/j.otohns.2009.06.744. PMID 19729111. Unknown parameter |month= ignored (help)
  7. ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
  8. ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
  9. ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
  10. ↑ The first version of this article was adapted from the CDC document "Diphtheria - 1995 Case Definition" athttp://www.cdc.gov/epo/dphsi/casedef/diphtheria_current.htm. As a work of an agency of the U.S. Government without any other copyright notice it should be available as a public domain resource.
  11. ↑ Thomas, M.; Del Mar, C.; Glasziou, P. (2000). "How effective are treatments other than antibiotics for acute sore throat?". Br J Gen Pract. 50 (459): 817–20. PMID 11127175. Unknown parameter |month= ignored (help)
  12. ↑ Spinks, A.; Glasziou, PP.; Del Mar, CB. (2013). "Antibiotics for sore throat". Cochrane Database Syst Rev. 11: CD000023. doi:10.1002/14651858.CD000023.pub4. PMID 24190439.
  13. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  14. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  15. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  16. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  17. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  18. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  19. ↑ Hall, Jesse (2015). Principles of critical care. New York: McGraw-Hill Education. ISBN 978-0071738811.
  20. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
  21. ↑ "Managing Patients with Necrotizing Ulcerative Gingivitis".
  22. ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.
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