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| ==Neutropenia and Cellular Immune Deficient Patients==
| | {| style="border: 0px; font-size: 90%; margin: 3px;" align=center |
| | | |+ |
| <SMALL><font color="#FF4C4C">'''▸ Click on the following categories to expand treatment regimens.'''</font></SMALL>
| | ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Tuberculin Rection}} |
| | | ! style="background: #4479BA; width: 450px;" | {{fontcolor|#FFF|Considered a Positive Result in:}} |
| {| | |
| | 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: 250px; background: #A1BCDD; text-align: center;">
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| <font color="#FFF">
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| '''Neutropenia'''
| |
| </font>
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| </div>
| |
| | |
| <div class="mw-customtoggle-table25" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
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| ▸ '''Gram-Negative Bacteria'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table26" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Gram-Positive Bacteria'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table27" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
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| ▸ '''Fungi'''
| |
| </font>
| |
| </div>
| |
| | |
| | |
| <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: 250px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
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| '''Cellular Immune Deficiency'''
| |
| </font>
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| </div>
| |
| | |
| <div style="border-radius: 0 0 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: 250px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
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| '''Bacteria'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table28" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
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| ▸ '''Nocardia spp'''
| |
| </font>
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| </div>
| |
| | |
| <div class="mw-customtoggle-table29" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
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| ▸ '''Atypical mycobacteria'''
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| </font>
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| </div>
| |
| | |
| <div style="border-radius: 0 0 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: 250px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
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| '''Fungi'''
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| </font>
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| </div>
| |
| | |
| <div class="mw-customtoggle-table30" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Cryptococcus spp'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table31" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Histoplasma spp'''
| |
| </font>
| |
| </div>
| |
| | |
| <div style="border-radius: 0 0 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: 250px; background: #A1BCDD; text-align: center;">
| |
| <font color="#FFF">
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| '''Viruses'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table32" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Varicella-zoster virus'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table33" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
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| ▸ '''Herpes simplex virus'''
| |
| </font>
| |
| </div>
| |
| | |
| <div class="mw-customtoggle-table34" 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: 250px; background: #4479BA;">
| |
| <font color="#FFF">
| |
| ▸ '''Cytomegalovirus'''
| |
| </font>
| |
| </div>
| |
| | |
| | |
| | valign=top | | |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table25" 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|Buccal Cellulitis <br> ''(H. influenzae)''}} | |
| |- | | |- |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen''''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 5 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *HIV-positive person |
| | *Recent contacts of TB case |
| | *Persons with nodular or fibrotic changes on CXR consistent with old healed TB |
| | *Patients with organ transplants and other immunosuppressed patients |
| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 1-2 g IV q24h''''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 10 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *Recent arrivals (less than 5 years) from high-prevalent countries |
| | *Injection drug users |
| | *Residents and employees of high-risk congregate settings (e.g., prisons, nursing homes, hospitals, homeless shelters, etc.) |
| | *Mycobacteriology lab personnel |
| | *Persons with clinical conditions that place them at high risk (e.g., diabetes, prolonged corticosteroid therapy, leukemia, end-stage renal disease, chronic malabsorption syndromes, low body weight, etc) |
| | *Children less than 4 years of age, or children and adolescents exposed to adults in high-risk categories |
| |- | | |- |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen''''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''≥ 15 mm ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | |
| | *Persons with no known risk factors for TB |
| |- | | |- |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Meropenem]] 0.5-1 g IV q8h (infuse over 15-30 min or in bolus over 3-5 min) ''''' <br> OR <br> ▸ '''''[[Imipenem/cilastatin]] 250-1000 mg IV (max: 50mg/kg/day)'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #F5F5F5;" align=left | <small>Adapted from N Engl J Med 2004;350:904-12.<ref>{{Cite journal
| |
| | author = [[Morton N. Swartz]]
| |
| | title = Clinical practice. Cellulitis
| |
| | journal = [[The New England journal of medicine]]
| |
| | volume = 350
| |
| | issue = 9
| |
| | pages = 904–912
| |
| | year = 2004
| |
| | month = February
| |
| | doi = 10.1056/NEJMcp031807
| |
| | pmid = 14985488
| |
| }}</ref></small>
| |
| |}
| |
| |}
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table26" 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|Orbital Cellulitis}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen 1'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<small> (trough 15—20 μg/mL)</small>
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ceftriaxone]] 2g IV q24h'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Metronidazole]] 1g IV q12h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen 2'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<small> (trough 15—20 μg/mL)</small>
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Piperacillin-tazobactam]] 4.5g IV q8h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''<br>(if penicillin or cephalosporin allergic)
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15-20 mg/kg IV q8-12h'''''<small> (trough 15—20 μg/mL)</small>
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''
| |
| |-
| |
| |}
| |
| |}
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table27" 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|Facial Cellulitis}}
| |
| |-
| |
| | 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]] 15-20 mg/kg IV q8-12h'''''<small> (trough 15—20 μg/mL)</small>
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Daptomycin]] 4 mg/kg IV q24h''''' <br> OR <br> ▸ '''''[[Linezolid]] 600mg IV q12h'''''
| |
| |}
| |
| |}
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table28" 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|Salt Water Wound Exposure <br> ''(Vibrio vulnificus)''}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Doxycycline]] 200 mg IV initial dose, then 50-100 mg 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 | ▸ '''''[[Cefotaxime]] 1-2 g IV/IM q8-12 (up to 2 g q4-6h)''''' <br> OR <br> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8-12h x 7-14 days'''''<br> OR <br> ▸ '''''[[Ciprofloxacin]] 500-750 mg PO q8-12h x 7-14 days'''''
| |
| |}
| |
| |}
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table29" 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|Fresh Water Wound Exposure <br> ''(Aeromonas 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 | ▸ '''''[[Ciprofloxacin]] 400mg IV q12h''''' <br> OR <br> ▸ '''''[[Ceftazidime]] 0.5 -2 g IV q8h''''' <BR> PLUS <BR>
| |
| ▸ '''''[[Gentamicin]] 3-5 mg/kg/day IV/IM divided q6-8h or 4-7 mg/kg IV q24h'''''
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Meropenem]] 0.5-1 g IV q8h (infuse over 15-30 min or in bolus over 3-5 min)''''' <br> OR <br> ▸ '''''[[Imipenem/cilastatin]] 250-1000 mg IV (max: 50mg/kg/day)'''''
| |
| |}
| |
| |}
| |
| {| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table30" 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|Butcher, Fisherman, Veterinarian <br> ''(Erysipelothrix rhusiopathiae)''}}
| |
| |-
| |
| | style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| |
| |-
| |
| | style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Amoxicillin]] 500 mg PO q8hr'''''
| |
| |-
| |
| | 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]] 1-2 g IV/IM q8-12 (up to 2 g q4-6h)''''' <br> OR <br> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8-12h x 7-14 days'''''<br> OR <br> ▸ '''''[[Ciprofloxacin]] 500-750 mg PO q8-12h x 7-14 days''''' <br> OR <br> ▸ '''''[[Imipenem]]-cilastatin 250-1000 mg IV (max: 50mg/kg/day)'''''
| |
| |}
| |
| |}
| |
| |} | | |} |