Sandbox ID Central Nervous System: Difference between revisions
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::* [[Nipah virus]] | ::* [[Nipah virus]] | ||
:::* Preferred regimen: supportive {{and}} [[Ribavirin]] | :::* Preferred regimen: supportive {{and}} [[Ribavirin]] | ||
::* [[Nonpolio enteroviruses]] | ::* [[Non-Polio enterovirus infections|Nonpolio enteroviruses]] | ||
:::* Preferred regimen: supportive {{and}} Intraventricular γ-globulin (for chronic and/or severe disease) | :::* Preferred regimen: supportive {{and}} Intraventricular γ-globulin (for chronic and/or severe disease) | ||
::* [[Poliovirus]] | ::* [[Poliovirus]] | ||
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::* [[Rubella virus]] | ::* [[Rubella virus]] | ||
:::* Preferred regimen: supportive | :::* Preferred regimen: supportive | ||
::* | ::* St. Louis encephalitis virus | ||
:::* Preferred regimen: supportive | :::* Preferred regimen: supportive | ||
:::* Alternative regimen: IFN-a-2b | :::* Alternative regimen: IFN-a-2b | ||
::* | ::* Tickborne encephalitis virus | ||
:::* Preferred regimen: supportive | :::* Preferred regimen: supportive | ||
::* [[Vaccinia]] | ::* [[Vaccinia]] | ||
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::* [[Coxiella burnetii]] ([[Q fever]]) | ::* [[Coxiella burnetii]] ([[Q fever]]) | ||
:::* Preferred regimen: [[Doxycycline]] {{and}} [[Fluoroquinolone]] {{and}} [[Rifampin]] | :::* Preferred regimen: [[Doxycycline]] {{and}} [[Fluoroquinolone]] {{and}} [[Rifampin]] | ||
::* | ::* Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis) | ||
:::* Preferred regimen: [[Doxycycline]] | :::* Preferred regimen: [[Doxycycline]] | ||
::* [[Listeria monocytogenes]] | ::* [[Listeria monocytogenes]] | ||
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:* Fungi | :* Fungi | ||
::* [[Coccidioides]] | ::* [[Coccidioides posadasii|Coccidioides]] | ||
:::* Preferred regimen: [[Fluconazole]] | :::* Preferred regimen: [[Fluconazole]] | ||
:::* Alternative regimen: [[Itraconazole]] {{or}} [[Voriconazole]] {{or}} [[Amphotericin B]] (intravenous and intrathecal) | :::* Alternative regimen: [[Itraconazole]] {{or}} [[Voriconazole]] {{or}} [[Amphotericin B]] (intravenous and intrathecal) | ||
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:::* Preferred regimen: [[Pyrimethamine]] {{and}} [[Sulfadiazine]] {{or}} [[Clindamycin]] [[and}} [[Pyrimethamine]] | :::* Preferred regimen: [[Pyrimethamine]] {{and}} [[Sulfadiazine]] {{or}} [[Clindamycin]] [[and}} [[Pyrimethamine]] | ||
:::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]] | :::* Alternative regimen (1): [[Trimethoprim-sulfamethoxazole]] | ||
:::* Alternative regimen (2): [[Pyrimethamine]] {{and}} | :::* Alternative regimen (2): [[Pyrimethamine]] {{and}} atovaqone {{or}} [[Pyrimethamine]] {{and}} [[clarithromycin]] {{or}} Pyrimethamine {{and}} [[azithromycin]] {{or}} Pyrimethamine {{and}} [[dapsone]] | ||
::* [[Trypanosoma brucei gambiense]] ( | ::* [[Trypanosoma brucei gambiense]] (West African trypanosomiasis) | ||
:::* Preferred regimen: [[Eflornithine]] {{or}} [[Melarsoprol]] | :::* Preferred regimen: [[Eflornithine]] {{or}} [[Melarsoprol]] | ||
::* [[Trypanosoma brucei rhodesiense]] ( | ::* [[Trypanosoma brucei rhodesiense]] (East African trypanosomiasis) | ||
:::* Preferred regimen: [[Melarsoprol]] | :::* Preferred regimen: [[Melarsoprol]] | ||
:* Helminths | :* Helminths | ||
::* [[Baylisascaris procyonis]] | ::* [[Baylisascaris|Baylisascaris procyonis]] | ||
:::* Preferred regimen: [[Corticosteroids]] | :::* Preferred regimen: [[Corticosteroids]] | ||
:::* Alternative regimen: [[Albendazole]] {{and}} [[diethylcarbamazine]] | :::* Alternative regimen: [[Albendazole]] {{and}} [[diethylcarbamazine]] | ||
::* [[Gnathostoma]] | ::* [[Gnathostoma spinigerum|Gnathostoma]] | ||
:::* Preferred regimen: [[Albendazole]] {{or}} [[Ivermectin]] | :::* Preferred regimen: [[Albendazole]] {{or}} [[Ivermectin]] | ||
::* [[Taenia solium]] ([[cysticercosis]]) | ::* [[Taenia solium]] ([[cysticercosis]]) | ||
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:* Prion | :* Prion | ||
::* [[Human transmissible spongiform encephalopathy]] | ::* [[Transmissible spongiform encephalopathy|Human transmissible spongiform encephalopathy]] | ||
:::* Preferred regimen: supportive | :::* Preferred regimen: supportive | ||
Revision as of 14:42, 28 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/day 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/day PO in 2 divided doses (maximum, 100 mg per dose) for 14 (14–21) days OR Cefuroxime 30 mg/kg/day PO in 2 divided doses (maximum, 500 mg per dose) for 14 (14–21) days.
- Alternative regimen: Azithromycin 10 mg/kg/day 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/day 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 considered.
- 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/day 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/day 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 intolerant of β-lactam agents, Doxycycline 4–8 mg/kg per day PO/IV in 2 divided doses (maximum daily dosage of 200–400 mg) may be considered.
- 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/day 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/day 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/day 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 q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
- Alternative regimen: Doxycycline 100–200 mg BID for 14 days
- Pediatric dose: Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day in 2 divided doses, max 200 mg/dayose
- Any neurologic syndrome with CSF pleocytosis
- Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
- Alternative regimen: Doxycycline 100–200 mg BID for 14 days
- Pediatric dose: Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day in 2 divided doses, max 200 mg/dayose
- Peripheral nervous system disease (radiculopathy, diffuse neuropathy, mononeuropathy multiplex, cranial neuropathy; normal CSF)
- Preferred regimen: Doxycycline 100–200 mg BID for 14 days
- Alternative regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
- Pediatric dose: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day in 2 divided doses, max 200 mg/dayose; Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day in 2 divided doses, max 200 mg/dayose
- Encephalomyelitis
- Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
- Pediatric dose: Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day
- Encephalopathy
- Preferred regimen: Ceftriaxone 2 g IV q24h for 14 days OR Cefotaxime 2 g IV q8h for 14 days OR Penicillin G 18–24 MU/day q4h for 14 days
- Pediatric dose: Ceftriaxone 50–75 mg/kg/day in 1 dose, max 2 g; Cefotaxime 150–200 mg/kg/day in 3–4 divided doses, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day divided q4h, max 18–24 MU/day
- Post-treatment Lyme syndrome
- Preferred regimen: No antibiotics indicated; symptomatic management only
Encephalitis
- Viruses
-
- Preferred regimen: supportive
- prophylactic antiviral therapy after bite or scratch
- Preferred regimen: Valacyclovir
- established disease
- Preferred regimen: Valacyclovir OR Acyclovir OR Ganciclovir
- Preferred regimen: Ganciclovir AND foscarnet
- Preferred regimen: supportive
- Preferred regimen: supportive AND Corticosteroids
- Preferred regimen: supportive
- Preferred regimen: Ganciclovir OR Foscarnet
- Preferred regimen: HAART
- HSV-1 and -2
- Preferred regimen: Acyclovir
- Preferred regimen: Oseltamivir
- Preferred regimen: supportive
- Preferred regimen: supportive
- Preferred regimen: supportive
- Preferred regimen: supportive
- Preferred regimen: supportive AND Ribavirin
- Preferred regimen: supportive AND Intraventricular γ-globulin (for chronic and/or severe disease)
- Preferred regimen: supportive
- Preferred regimen: supportive
- postxposure prophylaxis
- Preferred regimen: rabies immunoglobulin AND vaccine
- after onset of disease
- Preferred regimen: supportive
- Preferred regimen: supportive
- St. Louis encephalitis virus
- Preferred regimen: supportive
- Alternative regimen: IFN-a-2b
- Tickborne encephalitis virus
- Preferred regimen: supportive
- Preferred regimen: supportive ± Corticosteroids
- Preferred regimen: supportive
- Preferred regimen: Acyclovir ± Corticosteroids
- Preferred regimen: Ganciclovir ± Corticosteroids
- Preferred regimen: supportive
- Preferred regimen: supportive
- Bacteria
-
- Preferred regimen: Doxycycline
- Preferred regimen: Chloramphenicol OR Ciprofloxacin] OR Doxycycline OR Ampicillin OR trimethoprim-sulfamethoxazole
- Preferred regimen: Doxycycline OR Azithromycin ± Rifampin
- preferred regimen: Ceftriaxone OR Cefotaxime OR Penicillin G
- Preferred regimen: Doxycycline AND Fluoroquinolone AND Rifampin
- Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)
- Preferred regimen: Doxycycline
- Preferred regimen: Ampicillin OR Trimethoprim-sulfamethoxazole AND Gentamicin
- with meningitis
- Preferred regimen: Dexamethasone
- without meningitis
- Preferred regimen: Isoniazid OR Rifampin OR Pyrazinamide OR Ethambutol
- Preferred regimen: Azithromycin OR Doxycycline OR Fluoroquinolone
- Preferred regimen: Doxycycline
- Alternative regimen: Chloramphenicol
- preferred regimen: Ceftriaxone OR Penicillin G
- Preferred regimen: Ceftriaxone for 2–4 weeks, followed by Trimethoprim-sulfamethoxazole OR Cefixime for 1–2 years
- Fungi
-
- Preferred regimen: Fluconazole
- Alternative regimen: Itraconazole OR Voriconazole OR Amphotericin B (intravenous and intrathecal)
- Preferred regimen: Amphotericin B deoxycholate AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks ORv Lipid formulation of amphotericin B AND flucytosine for 2 weeks, followed by fluconazole for 8 weeks OR Amphotericin B AND flucytosine for 6–10 weeks
- Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities
- Protozoa
-
- Preferred regimen: Trimethoprim-sulfamethoxazole AND rifampin AND ketoconazole OR Fluconazole AND sulfadiazine AND pyrimethamine
- Preferred regimen: Azithromycin OR Clarithromycin AND pentamidine AND flucytosine AND fluconazole AND sulfadiazine AND thioridazine OR trifluoperazine
- Preferred regimen: Amphotericin B (intravenous and intrathecal) AND rifampin AND azithromycin OR sulfisoxazole OR miconazole
- Preferred regimen: Quinine OR quinidine OR artesunate OR artemether
- Alternative regimen: Atovaquone OR proguanil OR Exchange transfusion (less than 10% parasitemia or cere- bral malaria)
- Preferred regimen: Pyrimethamine AND Sulfadiazine OR Clindamycin [[and}} Pyrimethamine
- Alternative regimen (1): Trimethoprim-sulfamethoxazole
- Alternative regimen (2): Pyrimethamine AND atovaqone OR Pyrimethamine AND clarithromycin OR Pyrimethamine AND azithromycin OR Pyrimethamine AND dapsone
- Trypanosoma brucei gambiense (West African trypanosomiasis)
- Preferred regimen: Eflornithine OR Melarsoprol
- Trypanosoma brucei rhodesiense (East African trypanosomiasis)
- Preferred regimen: Melarsoprol
- Helminths
-
- Preferred regimen: Corticosteroids
- Alternative regimen: Albendazole AND diethylcarbamazine
- Preferred regimen: Albendazole OR Ivermectin
- Preferred regimen: Albendazole OR Corticosteroids
- Alternative regimen: Praziquantel
- Prion
-
- Preferred regimen: supportive
Epidural abscess
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.