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| __NOTOC__ | | __NOTOC__ |
| {{CMG}} | | {{CMG}}; {{AE}} {{SS}} |
| {{Brain abscess}} | | {{Brain abscess}} |
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| == Treatment == | | ==Overview== |
| | The treatment of brain abscess includes prompt administration of antimicrobial therapy upon suspicion and occasionally drainage to reduce the mass effect. Empiric antimicrobial therapy among otherwise healthy individuals includes [[metronidazole]] and either [[cefotaxime]] or [[ceftriaxone]]. Patients with co-morbidities may require alternative antimicrobial therapies. Administration of steroid therapy is generally not recommended and is only indicated among patients who have brain abscesses with mass effect. |
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| Treatment is generally a team approach and most reliably depends on obtaining tissue via a stereotactic needle Bx. Although randomized, controlled trials have not been done, the consensus is that abscesses > 3cm should be drained (if accessible).
| | ==Medical Therapy== |
| | *Prompt administration of antimicrobial therapy is indicated among all patients with brain abscesses. |
| | *Neurosurgery should always be consulted upon diagnosis. The decision of whether to surgically drain, aspirate, or simply administer antimicrobial therapy depends on the number of abscesses, their size, and their location. To learn more about indications of surgical vs. aspiration drainage, click [[Brain abscess surgery|'''here''']]. |
| | *Stereotactic needle biopsy can be performed to obtain tissues for cultures. |
| | *A follow-up head CT scan or MRI is usually indicated at 2-4 weeks of follow-up. The improvement on imaging is often delayed compared to clinical improvement. |
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| The treatment includes lowering the increased intracranial pressure and starting intravenous [[antibiotic]]s (and meanwhile identifying the causative organism mainly by blood culture studies).
| | ==Antimicrobial Regimen== |
| | {{ID-Brain abscess}} |
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| Surgical drainage of the abscess remains part of the standard management of bacterial brain abscesses. The location and treatment of the primary lesion also crucial, as is the removal of any foreign material (bone, dirt, bullets, and so forth).
| | ==Other Pharmacologic Agents== |
| | | ===Steroids=== |
| There are a few exceptions to this rule: ''[[Haemophilus influenzae]]'' [[meningitis]] is often associated with subdural effusions that are mistaken for subdural empyemas. These effusions resolve with antibiotics and require no surgical treatment. [[Tuberculosis]] can produce brain abscesses that look identical to bacterial abscesses on [[CT]] imaging and surgical drainage or aspiration is often necessary to make the diagnosis, but once the diagnosis is made no further surgical intervention is necessary.
| | *Administration of glucocorticoids is generally not recommended. However, glucorticoids are only indicated when the brain abscess has a mass effect, as suggested by findings on imaging. |
| | | *Steroid regimen: |
| *Antibiotics: Brain abscesses are usually polymicrobial, with the most common bugs being microaerophilic ''[[streptococci]]'' (viridans) and anaerobic bacteria (bacteroides, anaerobic strep and [[fusobacterium]]).
| | :*Preferred regimen: [[Dexamethasone]] 10 mg IV loading dose {{then}} 4 mg q6h until the mass effect is no longer observed on imaging. |
| :* ''[[S. aureus]]'', and enterobacteriacae are also seen.
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| :* Bugs associated with [[trauma]] include ''[[S. aureus]]'' and ''[[clostridium]]'' sp.
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| :* Empiric Rx usually starts with high-dose PCN (10 – 20 million units / d), [[metronidazole]], +/- a 3rd gen [[cephalosporin]].
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| ::* Even if the abscess is associated with a dental procedure and other organisms are considered ([[actinomyces]] sp.) they generally respond to the above Rx.
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| ::* If extending from an [[otitis]], empiric Rx should also cover ''[[pseudomonas]]'' and enterobacteriacaea.
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| ::* If hematogenously spread, coverage depends on the original bug.
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| *The penetration of abx into an abscess does not necessarily equate with their penetration into the [[CSF]] (the blood-brain barrier is not the same as the blood-CSF barrier).
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| :* Drugs like [[vancomycin]], which have poor [[CSF]] levels (<10% of serum) have been shown to have good abscess levels (90% of serum).
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| * Most patients are treated parenterally for at least 8w.
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| :* Some authors also recommend an additional 2 – 3 month course of oral abx to clear up any ‘residual’ infection and to prevent relapses.
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| :* One study actually suggests that, when combined with surgical excision, 3w may be adequate.
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| :* Other studies have reported good outcomes with abx alone in patients with small lesions (<2cm), in well vascularized areas (cortex), who were poor surgical candidates.
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| * There have not been any studies reporting benefit from intra-thecal or intra-abscess abx.
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| * There seems to be consensus on obtaining q 2 – 4w f/u [[CT]]/[[MRI]] scans to document resolution.
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| | |
| ==== Adjuvants ==== | |
| :* Although steroids have not been studies in well-designed trials, many authors use them in patients with elevated ICP.
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| :* Some animal studies suggest interference with granulation tissue formation and bacterial clearance.
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| :* [[Anticonvulsant]]s are recommended prophylactically for the 1st 3m, though the data supporting this is lacking.
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| ==Bactria Brain Abscess <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Sanford Guide to Antimicrobial Therapy (2010)''; and J Neurosci Rural Pract. 2013 August; 4(Suppl 1): S67–S81<ref name="pmid3808066">Carpenter D, Jackson T, Hanley MR (1987) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3808066 Protein kinase Cs. Coping with a growing family.] ''Nature'' 325 (7000):107-8.[http://dx.doi.org/10.1038/325107a0 DOI:10.1038/325107a0] PMID: [http://pubmed.gov/3808066 3808066]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==
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| <font color="#FF4C4C">'''Click on the following categories to expand treatment regimens.'''</font>
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| {|
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| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Brain Abscess'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Primary Source'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Contiguous Source'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Post-Traumatic'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Post-Surgical'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Metastatic or Cryptogenic'''
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| </font>
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| </div>
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| | |
| <div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
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| <font color="#FFF">
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| ▸ '''Haematogenous Abscess'''
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| </font>
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| </div>
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| <div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
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| <font color="#FFF">
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| ▸ '''Immunocompromised'''
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| </font>
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| </div>
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| | |
| | valign=top |
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Primary Source}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 gm IV q4h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone ]] 2 gm IV q12h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 7.5 mg/kg q6h ''OR'' 5 mg/kg IV q12h'''''
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicllin G]] 3-4 million units IV q4h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 7.5 mg/kg q6h ''OR'' 15 mg/kg IV q12h'''''
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Contiguous source}}<sup>₳</sup>
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q6h'''''<BR>''OR''<BR>▸'''''[[Piperacillin]]/[[Tazobactam]] 4.5 g IV q6h'''''<sup>†</sup>
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Post-traumatic}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q6h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS OR NOT
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 10 mg/kg q24h
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
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| | valign=top |
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Post-surgical}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR>''OR''<BR>▸ '''''[[Vancomycin]] 15 mg/kg loading dose or 10-15 mg/kg q6h followed by 40-60 mg/kg/24 hourly continuously infusion'''''<sup>‡</sup>
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 10 mg/kg qd
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Meropenem]] 1.5 g q6h or 2 g q8h'''''<BR>''OR''<BR>▸'''''[[Piperacillin/Tazobactam]] 4.5 g q6h'''''
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| |-
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| |}
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|metastatic or cryptogenic}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefataxime]] 2 g IV q6h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS OR NOT
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg q8h <BR>''OR''<BR>[[Ampicillin/Sulbactam]]100/50 mg/kg q6h'''''
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| |}
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| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
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| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Haematogenous Abscess}}<sup>¶</sup>
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen<sup>#</sup>'''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim]]: 3.75-7.5 mg/kg IV/ po q6-12h
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfamethoxazole]]: 18.75-37.5 mg/kg/day IV/po q6-12h
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 2 gm IV q12h
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
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| | |
| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim]]: 3.75-7.5 mg/kg IV/ po q6-12h
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfamethoxazole]]: 18.75-37.5 mg/kg/day IV/po q6-12h
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amikacin]] 7.5 mg/kg q12h'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Imipenem-Cilastatin]] 500 mg IV q6h
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| |-
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| |}
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| |}
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| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Immunocompromised}}
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen(<small><small><small>for minimum of 6 wks after resolution of signs</small></small></small>)'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrimethamine]] 200 mg po qd then 75 mg/day po'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfadiazine]]: 1 gm po q6h if <60 kg, 1.5 gm po q6h if 60 kg
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Folinic acid]] 10–25 mg po qd
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen(<small><small><small>for 4–6 wks after resolution of signs</small></small></small>)'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrimethamine]] 200 mg po qd then 75 mg/day po'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Folinic acid]] 10–25 mg po qd
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600 mg po IV q6h'''''<BR>''OR''<BR>▸'''''[[TMP]]/[[SMX]] 5/25 mg/kg po qd or IV bid'''''<BR>''OR''<BR>▸ '''''[[Atovaquone]] 750 mg po q6h'''''
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| |-
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| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Suppression therapy'''''
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| |-
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Sulfadiazine]]: 2-4 g po q6-12h'''''<BR>''PLUS''<BR>▸'''''[[Pyrimethamine]] 25-50 mg po qd'''''<BR>''PLUS''<BR>▸ '''''[[Folinic acid]] 10–25 mg po qd'''''
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| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | OR
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| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole ]] 5/25 mg/kg po or IV q12h for 30 days'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
| | |
| | |
| | |
| <small><small><small><small><sup>₳</sup>:Mainly from paranasal sinuses,middle ear,dental infection.</small></small></small><small>
| |
| | |
| <small><small><small><small><sup>†</sup>:If Pseudomonas aeruginosa is suspected.</small></small></small><small>
| |
| | |
| <small><small><small><small><sup>‡</sup>:The aim is to keep the serum levels at 15-25mg/L</small></small></small><small>
| |
| | |
| <small><small><small><small><sup>¶</sup>:After 3-6 wks of IV therapy, switch to po therapy. Immunocompetent pts: TMP-SMX, minocycline or AM-CL x 3+months. Immunocompromised pts: Treat with 2 drugs for at least one year.</small></small></small><small>
| |
| | |
| <small><small><small><small><sup>#</sup>: If multiorgan involvement some add amikacin 7.5 mg/kg q12h.</small></small></small></small>
| |
| | |
| ==Brain Absecss Special Pathogen==
| |
| {|
| |
| | valign=top |
| |
| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
| |
| '''Bacteria Brain Abscess'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table01" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Actinomyces spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table02" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Bacteroides fragilis'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table03" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Enterobacteriaceae'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table04" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Fusobacterium spp.'''
| |
| </font>
| |
| </div>
| |
| <div class="mw-customtoggle-table05" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| | |
| <font color="#FFF">
| |
| ▸ '''Haemophilus spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table06" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Listeria monocytogenes'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table07" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Mycobacterium tuberculosis'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Nocardia spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Prevotella melaninogenica'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Pseudomonas aeruginosa'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Staphylococcus aureus'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Streptococcus anginosus'''
| |
| </font>
| |
| </div>
| |
| | |
| | valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Actinomyces spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 2 gm IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Bacteroides fragilis}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Bacteroides fragilis}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g PO q8h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Fusobacterium spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Haemophilus spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>
| |
| ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Listeria monocytogenes}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Mycobacterium tuberculosis}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Isoniazid]] 300 mg PO qd'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Rifampin]] 600 mg PO qd'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Pyrazinamide ]] 15-30 mg/kg PO qd'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS OR NOT
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ethambutol]] 15 mg/kg PO qd'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Nocardia spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-Sulfamethoxazole]] 10-20 mg/kg IV q6-12h''''''<BR>''OR''<BR>▸ '''''[[Sulfadiazine]] 1-1.5 g PO q6h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Minocycline]]'''''<BR>''OR''<BR>▸ '''''[[Imipenem]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g PO q8h'''''<BR>''OR''<BR>▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Amikacin]] 5 mg/kg IV q8h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Prevotella melaninogenica}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 500 mg/kg q8h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Clindamycin]] 600-1200 mg q6h'''''<BR>''OR''<BR>▸ '''''[[Cefotaxime]] 2 g IV q8h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Pseudomonas aeruginosa}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 2 g IV q8h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 6-8 g/day IV q6-8h'''''<BR>''OR''<BR>▸ '''''[[Fluoroquinolone]]'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Staphylococcus aureus;Methicillin-sensitive}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Nafcillin]] 1.5-2 g IV q4h'''''<BR>''OR''<BR>▸ '''''[[Oxacillin]] 1.5-2 g IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
| |
| |-
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Staphylococcus aureus;Methicillin-resistant}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Trimethoprim-sulfamethoxazole]] 10-20 mg/kg IV q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Streptococcus anginosus (milleri) group, other streptococci}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Penicillin G]] 4 million U IV q4h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 8-12 g/day IV q4-6h'''''<BR>''OR''<BR>▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR>''OR''<BR>▸ '''''[[Vancomycin]] 30-45 mg/kg IV q8-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
| ==Fungal Brain Abscess==
| |
| | |
| {|
| |
| | valign=top |
| |
| <div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
| |
| '''Fungal Brain Abscess'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Aspergillus spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Candida spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Cryptococcus neoformans'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Mucorales'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background:#4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Scedosporium spp.'''
| |
| </font>
| |
| </div>
| |
| | |
| | valign=top |
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Aspergillus spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Voriconazole]] Load with 6 mg/kg IV q12h for two doses then 4 mg/kg q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B deoxycholate]]'''''<BR>''OR''<BR>▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]]'''''<BR>''OR''<BR>▸ '''''[[Itraconazole]] 400 mg IV q12h '''''<BR>''OR''<BR>▸ '''''[[Posaconazole]] 200-400 mg q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Candida spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amphotericin B deoxycholate]]'''''<BR>''OR''<BR>
| |
| ▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]]'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Flucytosine]] 25 mg/kg PO q6h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Fluconazole]] 400-800 mg IV qd'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background:#FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Cryptococcus neoformans}}
| |
| |-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Amphotericin B deoxycholate]]'''''<BR>''OR''<BR>
| |
| ▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]]'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Flucytosine]] 25 mg/kg PO q6h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Fluconazole]] 400-800 mg IV qd'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background:#FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Mucorales}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸'''''[[Amphotericin B deoxycholate]]'''''<BR>''OR''<BR>
| |
| ▸ '''''[[Liposomal amphotericin B]] 5 mg/kg IV qd'''''<BR>''OR''<BR>▸ '''''[[Amphotericin B lipid complex]]'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Posaconazole]] 200-400 mg q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background:#FFFFFF;"
| |
| | valign=top |
| |
| {| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
| |
| ! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center |{{fontcolor|#FFF|Scedosporium spp.}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Voriconazole]] Load with 6 mg/kg IV q12h for two doses then 4 mg/kg q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center |'''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Itraconazole]] 400 mg IV q12h '''''<BR>''OR''<BR>▸ '''''[[Posaconazole]] 200-400 mg q6-12h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| |}
| |
|
| |
|
| ==References== | | ==References== |
| {{Reflist|2}} | | {{reflist|2}} |
|
| |
|
| [[Category:Disease]] | | [[Category:Disease]] |
| | [[Category:Up-To-Date]] |
| [[Category:Neurology]] | | [[Category:Neurology]] |
| | [[Category:Neurosurgery]] |
| | [[Category:Emergency medicine]] |
| [[Category:Infectious disease]] | | [[Category:Infectious disease]] |
| [[Category:Neurosurgery]]
| |
| [[Category:Needs overview]]
| |
|
| |
|
| |
| {{WH}}
| |
| {{WS}}
| |