Sandbox ID Central Nervous System: Difference between revisions
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:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days. | :::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 14 (10–28) days. | ||
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days {{or}} [[Penicillin G]] 18–24 million U/24h IV divided every 4 h for 14 (10–28) days. | :::* Alternative regimen: [[Cefotaxime]] 2 g IV q8h for 14 (10–28) days {{or}} [[Penicillin G]] 18–24 million U/24h IV divided every 4 h for 14 (10–28) days. | ||
:::: Note: For nonpregnant adult patients intolerant of β-lactam agents, [[Doxycycline]] 200–400 mg/day PO/IV in 2 divided doses may be adequate. | |||
::* '''Meningitis or radiculopathy (pediatric)''' | ::* '''Meningitis or radiculopathy (pediatric)''' | ||
:::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h (maximum, 2 g) for 14 (10–28) days. | :::* Preferred regimen: [[Ceftriaxone]] 50–75 mg/kg IV q24h (maximum, 2 g) for 14 (10–28) days. | ||
:::* Alternative regimen: [[Cefotaxime]] 150–200 mg/kg/24h IV in 3–4 divided doses (maximum, 6 g per day) for 14 (10–28) days {{or}} [[Penicillin G]] 200,000–400,000 U/kg/24h IV divided every 4 h (not to exceed 18–24 million U per day for 14 (10–28) days. | :::* Alternative regimen: [[Cefotaxime]] 150–200 mg/kg/24h IV in 3–4 divided doses (maximum, 6 g per day) for 14 (10–28) days {{or}} [[Penicillin G]] 200,000–400,000 U/kg/24h IV divided every 4 h (not to exceed 18–24 million U per day for 14 (10–28) days. | ||
:::: Note: For children ≥ 8 years of age, the dosage of doxycycline for this indication is 4–8 mg/kg per day in 2 divided doses (maximum daily dosage of 200–400 mg). | |||
:* Late neurologic disease | :* Late neurologic disease | ||
| Line 51: | Line 53: | ||
:* '''Post-treatment Lyme syndrome''' | :* '''Post-treatment Lyme syndrome''' | ||
::* Preferred regimen: No antibiotics indicated; symptomatic management only | ::* Preferred regimen: No antibiotics indicated; symptomatic management only | ||
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Revision as of 05:20, 27 May 2015
Lyme neuroborreliosis
- Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines[1]
- Early neurologic disease
- Cranial nerve palsy (adult)
- Preferred regimen: Amoxicillin 500 mg PO tid for 14 (14–21) days OR Doxycycline 100 mg PO bid for 14 (14–21) days OR Cefuroxime 500 mg PO bid for 14 (14–21) days.
- Alternative regimen: Azithromycin 500 mg PO qd for 7–10 days OR Clarithromycin 500 mg PO bid for 14–21 days(not for pregnant) OR Erythromycin 500 mg PO qid for 14–21 days.
- Cranial nerve palsy (pediatric)
- Preferred regimen: Amoxicillin 50 mg/kg/24h PO in 3 divided doses (maximum, 500 mg per dose) for 14 (14–21) days OR Doxycycline (for children aged ≥ 8 years) 4 mg/kg/24h PO in 2 divided doses (maximum, 100 mg per dose) for 14 (14–21) days OR Cefuroxime 30 mg/kg/24h PO in 2 divided doses (maximum, 500 mg per dose) for 14 (14–21) days.
- Alternative regimen: Azithromycin 10 mg/kg/24h PO (maximum of 500 mg per day) for 7–10 days OR Clarithromycin 7.5 mg/kg PO bid (maximum of 500 mg per dose) for 14–21 days OR Erythromycin 12.5 mg/kg PO qid (maximum of 500 mg per dose) for 14–21 days.
- Meningitis or radiculopathy (adult)
- Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days.
- Alternative regimen: Cefotaxime 2 g IV q8h for 14 (10–28) days OR Penicillin G 18–24 million U/24h IV divided every 4 h for 14 (10–28) days.
- Note: For nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV in 2 divided doses may be adequate.
- Meningitis or radiculopathy (pediatric)
- Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (maximum, 2 g) for 14 (10–28) days.
- Alternative regimen: Cefotaxime 150–200 mg/kg/24h IV in 3–4 divided doses (maximum, 6 g per day) for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/24h IV divided every 4 h (not to exceed 18–24 million U per day for 14 (10–28) days.
- Note: For children ≥ 8 years of age, the dosage of doxycycline for this indication is 4–8 mg/kg per day in 2 divided doses (maximum daily dosage of 200–400 mg).
- Late neurologic disease
- Central or peripheral nervous system disease (adult)
- Preferred regimen: Ceftriaxone 2 g IV q24h for 14 (10–28) days.
- Alternative regimen: Cefotaxime 2 g IV q8h for 14 (10–28) days OR Penicillin G 18–24 million U/24h IV divided every 4 h for 14 (10–28) days.
- Central or peripheral nervous system disease (pediatric)
- Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h (maximum, 2 g) for 14 (10–28) days.
- Alternative regimen: Cefotaxime 150–200 mg/kg/24h IV in 3–4 divided doses (maximum, 6 g per day) for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/24h IV divided every 4 h (not to exceed 18–24 million U per day for 14 (10–28) days.
- American Academy of Neurology (AAN) Practice Parameter[2]
- Meningitis
- Preferred regimen: Ceftriaxone 2 g IV daily (pediatric: 50–75 mg/kg/d in 1 dose, max 2 g) for 14 days OR Cefotaxime 2 g IV Q8H (pediatric: 150–200 mg/kg/day in 3–4 divided doses; B max 6 g/day) for 14 days OR Penicillin G 18–24 MU/d Q4H (pediatric: 200–400,000 U/Kg/d divided Q4H, max 18–24 MU/day) for 14 days
- Alternative regimen: Doxycycline 100–200) mg BID (pediatric ≥ 8 yo: 4–8 mg/kg/d in 2 divided doses; B max 200 mg/dose) for 14 days
- Any neurologic syndrome with CSF pleocytosis
- Preferred regimen: Ceftriaxone 2 g IV daily (pediatric: 50–75 mg/kg/d in 1 dose, max 2 g) for 14 days OR Cefotaxime 2 g IV Q8H (pediatric: 150–200 mg/kg/day in 3–4 divided doses; B max 6 g/day) for 14 days OR Penicillin G 18–24 MU/d Q4H (pediatric: 200–400,000 U/Kg/d divided Q4H, max 18–24 MU/day) for 14 days
- Alternative regimen: Doxycycline 100–200) mg BID (pediatric ≥ 8 yo: 4–8 mg/kg/d in 2 divided doses; B max 200 mg/dose) for 14 days
- Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)
- Preferred regimen: Doxycycline 100–200) mg BID (pediatric ≥ 8 yo: 4–8 mg/kg/d in 2 divided doses; B max 200 mg/dose) for 14 days
- Alternative regimen: Ceftriaxone 2 g IV daily (pediatric: 50–75 mg/kg/d in 1 dose, max 2 g) for 14 days OR Cefotaxime 2 g IV Q8H (pediatric: 150–200 mg/kg/day in 3–4 divided doses; B max 6 g/day) for 14 days OR Penicillin G 18–24 MU/d Q4H (pediatric: 200–400,000 U/Kg/d divided Q4H, max 18–24 MU/day) for 14 days
- Encephalomyelitis
- Preferred regimen: Ceftriaxone 2 g IV daily (pediatric: 50–75 mg/kg/d in 1 dose, max 2 g) for 14 days OR Cefotaxime 2 g IV Q8H (pediatric: 150–200 mg/kg/day in 3–4 divided doses; B max 6 g/day) for 14 days OR Penicillin G 18–24 MU/d Q4H (pediatric: 200–400,000 U/Kg/d divided Q4H, max 18–24 MU/day) for 14 days
- Encephalopathy
- Preferred regimen: Ceftriaxone 2 g IV daily (pediatric: 50–75 mg/kg/d in 1 dose, max 2 g) for 14 days OR Cefotaxime 2 g IV Q8H (pediatric: 150–200 mg/kg/day in 3–4 divided doses; B max 6 g/day) for 14 days OR Penicillin G 18–24 MU/d Q4H (pediatric: 200–400,000 U/Kg/d divided Q4H, max 18–24 MU/day) for 14 days
- Post-treatment Lyme syndrome
- Preferred regimen: No antibiotics indicated; symptomatic management only
Encephalitis
- Viruses
- Adenovirus
- B virus
- CMV
- Eastern equine encephalitis virus
- EBV
- Hendra virus
- HHV-6
- HIV
- HSV
- Influenza virus
- Japanese encephalitis virus
- JC virus
- La Crosse virus
- Measles virus
- Mumps virus
- Murray Valley encephalitis virus
- Nipah virus
- Nonpolio enteroviruses
- Poliovirus
- Powassan virus
- Rabies virus
- Rubella virus
- St. Louis encephalitis virus
- Tickborne encephalitis virus
- Vaccinia
- Venezuelan equine encephalitis virus
- VZV
- West Nile virus
- Western equine encephalitis virus
- Bacteria
- Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)
- Bartonella bacilliformis (Oroya fever)
- Bartonella henselae (Cat scratch disease)
- Borrelia burgdorferi (Lyme disease)
- Coxiella burnetii (Q fever)
- Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
- Listeria monocytogenes
- Mycobacterium tuberculosis
- Mycoplasma pneumoniae
- Rickettsia rickettsii (Rocky Mountain spotted fever)
- Treponema pallidum (syphilis)
- Tropheryma whipplei (Whipple's disease)
- Fungi
- Coccidioides
- Cryptococcus neoformans
- Histoplasma capsulatum:* Protozoa
- Acanthamoeba
- Balamuthia mandrillaris
- Naegleria fowleri
- Plasmodium falciparum
- Toxoplasma gondii
- Trypanosoma brucei gambiense (West African trypanosomiasis)
- Trypanosoma brucei rhodesiense (East African trypanosomiasis)
- Helminths
- Baylisascaris procyonis
- Gnathostoma
- Taenia solium (cysticercosis)
- Prion
- Human transmissible spongiform encephalopathy
References
- ↑ Wormser, Gary P.; Dattwyler, Raymond J.; Shapiro, Eugene D.; Halperin, John J.; Steere, Allen C.; Klempner, Mark S.; Krause, Peter J.; Bakken, Johan S.; Strle, Franc; Stanek, Gerold; Bockenstedt, Linda; Fish, Durland; Dumler, J. Stephen; Nadelman, Robert B. (2006-11-01). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 43 (9): 1089–1134. doi:10.1086/508667. ISSN 1537-6591. PMID 17029130.
- ↑ Halperin, J. J.; Shapiro, E. D.; Logigian, E.; Belman, A. L.; Dotevall, L.; Wormser, G. P.; Krupp, L.; Gronseth, G.; Bever, C. T.; Quality Standards Subcommittee of the American Academy of Neurology (2007-07-03). "Practice parameter: treatment of nervous system Lyme disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology". Neurology. 69 (1): 91–102. doi:10.1212/01.wnl.0000265517.66976.28. ISSN 1526-632X. PMID 17522387.