Sandbox sss: Difference between revisions
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{{ | __NOTOC__ | ||
{{Meningitis}} | |||
{{CMG}} | |||
<div class="mw-collapsible mw-collapsed"> | |||
====Streptococcus pneumoniae==== | ====Streptococcus pneumoniae==== | ||
<div class="mw-collapsible-content"> | |||
{| | {| | ||
|- | |- | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g)''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g)'''''<BR>''OR''<BR>▸ '''''[[Ampicillin]] 150–200 mg/kg IV q3-4h''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day''''' | ||
|- | |- | ||
|} | |} | ||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Penicillin]] MIC ≥0.12 μg/mL}} | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Penicillin]] MIC ≥0.12 μg/mL}}'' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Cefotaxime]] or [[Ceftriaxone]] MIC† <1.0 μg/mL}} | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Cefotaxime]] or [[Ceftriaxone]] MIC† <1.0 μg/mL}} | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Cefotaxime]] or [[Ceftriaxone]] MIC† >1.0 μg/mL}} | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|[[Cefotaxime]] or [[Ceftriaxone]] MIC† >1.0 μg/mL}} | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''AND'' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''AND'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' <BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)'''''<sup>‡<sup> | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' <BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)'''''<sup>‡</sup> | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''AND'' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''AND'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg po IV q24h '''''<sup>ɸ<sup> | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg po IV q24h '''''<sup>ɸ</sup> | ||
|- | |- | ||
|} | |} | ||
|} | |} | ||
</div></div> | |||
<div class="mw-collapsible mw-collapsed"> | |||
====Neisseria meningitidis==== | ====Neisseria meningitidis==== | ||
<div class="mw-collapsible-content"> | |||
{| | {| | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g)'''''<BR>''OR''<BR>▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR><BR><BR> | ||
|- | |- | ||
|} | |} | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup><BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h''''' | ||
|- | |- | ||
|} | |} | ||
|} | |} | ||
====Listeria Monocytogenes | </div></div> | ||
<div class="mw-collapsible mw-collapsed"> | |||
====Listeria Monocytogenes and Streptococcus agalactiae==== | |||
<div class="mw-collapsible-content"> | |||
{| | {| | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)'''''<sup>£</sup> | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)'''''<sup>£</sup> | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR> | ||
▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)'''''<BR>''OR''<BR>▸ '''''[[Vancomycin]] give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )''''' | |||
|- | |- | ||
|} | |} | ||
|} | |} | ||
</div></div> | |||
<div class="mw-collapsible mw-collapsed"> | |||
====Haemophilus influenzae==== | ====Haemophilus influenzae==== | ||
<div class="mw-collapsible-content"> | |||
{| | {| | ||
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! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Haemophilus influenzae <BR> β-lactamase negative}}'' | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Haemophilus influenzae <BR> β-lactamase negative}}'' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 0.25–0.5 g po q6h.150–200 mg/kg/day IV''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Aztreonam]] 1 g IV q8h–2 g IV q6h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup> | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|β-lactamase negative, ampicillin resistant}} | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|β-lactamase negative, ampicillin resistant}} | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolone]]''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup> | ||
|} | |} | ||
| valign=top | | | valign=top | | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Chloramphenicol]] 0.25–1 g po IV q6h to max. of 4 g/day'''''<BR>''OR''<BR>▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup> | ||
|- | |- | ||
|} | |} | ||
|} | |} | ||
</div></div> | |||
<div class="mw-collapsible mw-collapsed"> | |||
====Staphylococcus aureus==== | ====Staphylococcus aureus==== | ||
<div class="mw-collapsible-content"> | |||
{| | {| | ||
|- | |||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus aureus}} | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus aureus <BR> Meticillin sensitive}}'' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1–2 g IV/IM q4h | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1–2 g IV/IM q4h<BR>''OR''<BR>▸ '''''[[Oxacillin]] 1–2 g IV/IM q4h | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )'''''<BR>''OR''<BR>▸ '''''[[linezolid]] 600 mg IV/PO q12h<BR>''OR''<BR>▸ '''''[[Daptomycin]] 6 mg/kg IV q24h''''' | ||
|- | |- | ||
|} | |} | ||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus aureus | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus aureus <BR> Meticillin resistant}}<sup>₦</sup> | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trimethoprim-sulfamethoxazole]] 5–20 mg/kg/day q6-12h | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Trimethoprim-sulfamethoxazole]] 5–20 mg/kg/day q6-12h<BR>''OR''<BR>▸ '''''[[linezolid]] 600 mg IV/PO q12h<BR>''OR''<BR>▸ '''''[[Daptomycin]] 6 mg/kg IV q24h '''''<BR><BR><BR> | ||
|- | |- | ||
|} | |} | ||
|} | |} | ||
====Staphylococcus epidermidis and Acinetobacter baumannii<sup>Ω<sup>==== | </div></div> | ||
<div class="mw-collapsible mw-collapsed"> | |||
====Staphylococcus epidermidis and Acinetobacter baumannii<sup>Ω</sup>==== | |||
<div class="mw-collapsible-content"> | |||
{| | {| | ||
|- | |||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus epidermidis}}<sup>₦<sup> | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Staphylococcus epidermidis}}<sup>₦</sup> | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV/PO q12h | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV/PO q12h<BR><BR><BR><BR><BR> | ||
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| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] in US:2.5-5 mg/kg/day q6-12h( 6.7-13.3 mg/kg/day of colistimethate sodium (CMS),max 800 mg/day); Elsewhere: ≤60 kg, 50,000-75,000 IU/kg/day IV q8h (=4-6 mg/kg per day of CMS). >60 kg, 1-2 mill IU IV | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] <BR>in US:2.5-5 mg/kg/day q6-12h( 6.7-13.3 mg/kg/day of colistimethate sodium (CMS),max 800 mg/day); <BR>Elsewhere: ≤60 kg, 50,000-75,000 IU/kg/day IV q8h (=4-6 mg/kg per day of CMS). >60 kg, 1-2 mill IU IV q8h (= 80-160 mg IV tid).''''' <BR>''OR''<BR>▸ '''''[[Polymyxin B]] 15,000–25,000 units/kg/day q12h<sup>ǂ</sup> | ||
q8h (= 80-160 mg IV tid). ''''' | |||
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</div></div> | |||
<div class="mw-collapsible mw-collapsed"> | |||
====Enterobacteriaceae and Pseudomonas aeruginosa==== | ====Enterobacteriaceae and Pseudomonas aeruginosa==== | ||
<div class="mw-collapsible-content"> | |||
{| | {| | ||
|- | |||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em; height: 25em;" cellpadding="0" cellspacing="0"; | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Enterobacteriaceae}}<sup>Ω<sup> | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Enterobacteriaceae}}<sup>Ω</sup> | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1 g q8–12h to 2 g IV q4h'''''<BR>''OR''<BR> ▸ '''''[[Ceftriaxone]] 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h''''' <BR> ''OR'' <BR> ▸ '''''[[Fluoroquinolone]]'''''<sup>Δ</sup><BR> ''OR'' <BR> ▸ '''''[[Trimethoprim-sulfamethoxazole]] 5–20 mg/kg/day q6-12h''''' <BR> ''OR'' <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> ''OR'' <BR>▸ '''''[[Ampicillin]] 150–200 mg/kg/day IV''''' | ||
|- | |- | ||
|} | |} | ||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em" cellpadding="0" cellspacing="0"; | {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:39em; height: 25em;" cellpadding="0" cellspacing="0"; | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pseudomonas aeruginosa}} | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Pseudomonas aeruginosa}}'' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime ]] 1–2 g IV/IM q8–12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime ]] 1–2 g IV/IM q8–12h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 1–2 g IV q12h'''''<sup>£</sup> | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 1 g q8h–2 g IV q6h'''''<BR>''OR''<BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR>''OR''<BR> ▸ '''''[[Ciprofloxacin]] 500-750 mg po bid'''''<sup>£</sup><BR><BR><BR><BR><BR> | ||
|- | |- | ||
|} | |} | ||
|} | |} | ||
<BR><SMALL><sup>†</sup> MIC = minimum inhibitory concentration.‡Addition of rifampicin can be considered if the organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC of the pneumococcal isolate is >4.0 μg/mL organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC. | |||
<sup>Φ</sup> No clinical data exist for use of this agent in patients with pneumococcal meningitis; recommendation is based on cerebrospinal fluid penetration and in-vitro activity against S. pneumoniae. | |||
<sup>£</sup> Addition of an aminoglycoside should be considered; might need intraventricular or intrathecal administration in Gram-negative meningitis. | |||
<sup>ǁ</sup> Addition of rifampicin should be considered. | |||
<sup>Ω</sup> Choice of a specific agent should be based on in-vitro susceptibility testing. | |||
<sup>††</sup> Might also need to be administered by the intraventricular or intrathecal routes. | |||
<sup>ǂ</sup> Might also need to be administered by the intraventricular or intrathecal routes. | |||
<sup>₦</sup> Addition of rifampicin should be considered. | |||
<sup>Δ</sup> The fluoroquinolones gatifloxacin and moxifloxacin pene trate the CSF effectively and have greater in-vitro activity against Gram-positive bacteria than do their earlier counterparts (eg, ciprofloxacin). Findings from experi mental meningitis models suggested their efficacy in S. pneumoniae meningitis, including that caused by penicillin-resistant and cephalosporin-resistant strains. Although one controlled trial suggested the fluoroquinolone trovafl -oxacin mesilate to be as eff ective as ceftriaxone, with or without the addition of vancomycin, for paediatric bacterial meningitis, no clinical trials describe the use of gatifloxacin or moxifloxacin to treat bacterial meningitis in human beings. Trovafloxacin and gatifloxacin have been asso ciated with serious hepatic toxicity and dysglycaemia, respectively, and were with drawn from many markets. The IDSA guidelines recommend moxifloxacin as an alternative to third-generation cephalosporins plus vancomycin for meningitis caused by S. pneumoniae strains resistant to penicillin and third-generation cephalosporins, although some experts recom mend that this agent should not be used alone but rather should be combined with another drug (either vancomycin or a third-generation cephalosporin), because of the absence of clinical data supporting its use. | |||
</SMALL> | |||
</div></div> | |||
Latest revision as of 02:50, 27 January 2014
Meningitis Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Streptococcus pneumoniae
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Neisseria meningitidis
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Listeria Monocytogenes and Streptococcus agalactiae
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Haemophilus influenzae
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Staphylococcus aureus
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Staphylococcus epidermidis and Acinetobacter baumanniiΩ
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Enterobacteriaceae and Pseudomonas aeruginosa
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† MIC = minimum inhibitory concentration.‡Addition of rifampicin can be considered if the organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC of the pneumococcal isolate is >4.0 μg/mL organism is susceptible, the expected clinical or bacteriological response is delayed, or the cefotaxime/ceftriaxone MIC.
Φ No clinical data exist for use of this agent in patients with pneumococcal meningitis; recommendation is based on cerebrospinal fluid penetration and in-vitro activity against S. pneumoniae.
£ Addition of an aminoglycoside should be considered; might need intraventricular or intrathecal administration in Gram-negative meningitis.
ǁ Addition of rifampicin should be considered.
Ω Choice of a specific agent should be based on in-vitro susceptibility testing.
†† Might also need to be administered by the intraventricular or intrathecal routes.
ǂ Might also need to be administered by the intraventricular or intrathecal routes.
₦ Addition of rifampicin should be considered.
Δ The fluoroquinolones gatifloxacin and moxifloxacin pene trate the CSF effectively and have greater in-vitro activity against Gram-positive bacteria than do their earlier counterparts (eg, ciprofloxacin). Findings from experi mental meningitis models suggested their efficacy in S. pneumoniae meningitis, including that caused by penicillin-resistant and cephalosporin-resistant strains. Although one controlled trial suggested the fluoroquinolone trovafl -oxacin mesilate to be as eff ective as ceftriaxone, with or without the addition of vancomycin, for paediatric bacterial meningitis, no clinical trials describe the use of gatifloxacin or moxifloxacin to treat bacterial meningitis in human beings. Trovafloxacin and gatifloxacin have been asso ciated with serious hepatic toxicity and dysglycaemia, respectively, and were with drawn from many markets. The IDSA guidelines recommend moxifloxacin as an alternative to third-generation cephalosporins plus vancomycin for meningitis caused by S. pneumoniae strains resistant to penicillin and third-generation cephalosporins, although some experts recom mend that this agent should not be used alone but rather should be combined with another drug (either vancomycin or a third-generation cephalosporin), because of the absence of clinical data supporting its use.