Sandbox ID Central Nervous System: Difference between revisions
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===Brain abscess=== | ===Brain abscess=== | ||
===='''Primary or contiguous source'''==== | |||
'''Post-surgical, post-traumatic''' | |||
'''HIV-1 infected (AIDS)''' | |||
---- | ---- | ||
| Line 399: | Line 403: | ||
===Subdural empyema=== | ===Subdural empyema=== | ||
:*In adult 60–90% are extension of sinusitis or otitis media | |||
:*Rx same as primary brain abscess | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 17:01, 1 June 2015
Brain abscess
Primary or contiguous source
Post-surgical, post-traumatic
HIV-1 infected (AIDS)
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
- Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)
- 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
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, max 500 mg/dose for 14 (14–21) days OR Doxycycline (for children aged ≥ 8 years) 4 mg/kg/day PO q12h, max 100 mg/dose for 14 (14–21) days OR Cefuroxime 30 mg/kg/day PO q12h, max 500 mg/dose for 14 (14–21) days
- Alternative regimen: Azithromycin 10 mg/kg/day PO, max 500 mg/dose for 7–10 days OR Clarithromycin 7.5 mg/kg PO bid, max 500 mg/dose for 14–21 days OR Erythromycin 12.5 mg/kg PO aid, max 500 mg/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 MU/day IV q4h for 14 (10–28) days
- Note: for nonpregnant adult patients intolerant of β-lactam agents, Doxycycline 200–400 mg/day PO/IV q12h may be considered.
- Meningitis or radiculopathy (pediatric)
- Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h, max 2 g/day for 14 (10–28) days
- Alternative regimen: Cefotaxime 150–200 mg/kg/day IV in 3–4 divided doses, max 6 g/day for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day for 14 (10–28) days
- Note: for children ≥ 8 years of age intolerant of β-lactam agents, Doxycycline 4–8 mg/kg/day PO/IV q12h, max 200–400 mg/day 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 MU/day IV q4h for 14 (10–28) days
- Central or peripheral nervous system disease (pediatric)
- Preferred regimen: Ceftriaxone 50–75 mg/kg IV q24h, max 2 g for 14 (10–28) days.
- Alternative regimen: Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day for 14 (10–28) days OR Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/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 IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
- 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 IV q4h for 14 days
- Alternative regimen: Doxycycline 100–200 mg BID for 14 days
- Pediatric dose: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
- 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 IV q4h for 14 days
- Pediatric dose: Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day; Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day; Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
- 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 IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV 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 IV q24h, max 2 g/day; Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day; Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day
- Post-treatment Lyme syndrome
- Preferred regimen: symptomatic management; antibiotics not indicated
Meningitis, bacteria
- Streptococcus pneumoniae (adult)
- Penicillin MIC
- <0.1 μg/mL
- Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR chloramphenicol 4-6g qid
- 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Cefepime 6g tid OR meropenem 6g tid
- ≥2.0 μg/mL
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND Ceftriaxone 4g bid/OD OR Vancomycin 30–45 mg/kg tid/bid AND cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND Ceftriaxone 4g bid/OD OR Vancomycin 30–45 mg/kg tid/bid AND cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Streptococcus pneumoniae (pediatric)
- Penicillin MIC
- <0.1 μg/mL
- Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children
- 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Cefepime 150 mg/kg tid for children OR meropenem 120 mg/kg tid for children
- ≥2.0 μg/mL
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND Ceftriaxone 80–100 mg/kg bid/OD for children OR Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND Ceftriaxone 80–100 mg/kg bid/OD for children OR Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Neisseria meningitidis (adult)
- Penicillin MIC
- <0.1 μg/mL
- Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR chloramphenicol 4-6g qid
- 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 6g tid
- Neisseria meningitidis (pediatric)
- Penicillin MIC
- <0.1 μg/mL
- Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- 0.1–1.0 μg/mL
- Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 120 mg/kg tid for children
- Listeria monocytogenes (adult)
- Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
- Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid {{or]} meropenem 6g tid
- Listeria monocytogenes (pediatric)
- Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Trimethoprim-sulfamethoxazole10–20 mg/kg bid-qid for children {{or]} meropenem 120 mg/kg tid for children
- Streptococcus agalactiae (adult)
- Preferred regimen: Penicillin G 24 mU 6 times per day OR ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Streptococcus agalactiae (pediatric)
- Preferred regimen: Penicillin G 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates; 0.3 mU/kg 4-6 times per day for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Escherichia coli and other Enterobacteriaceae (adult)
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Aztreonam 6–8 g tid/qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 6g tid OR Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid {{or]} ampicillin 12g 6 times per day
- Escherichia coli and other Enterobacteriaceae (pediatric)
- Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD OR meropenem 120 mg/kg tid for children OR Trimethoprim-sulfamethoxazole10–20 mg/kg bid-qid for children OR ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Pseudomonas aeruginosa (adult)
- Preferred regimen: Cefepime 6g tid OR ceftazidime 6g tid
- Alternative regimen: Aztreonam 6–8 g tid/qid OR ciprofloxacin 800–1200 mg bid/tid {or}} meropenem 6g tid
- Pseudomonas aeruginosa (pediatric)
- Preferred regimen: Cefepime 150 mg/kg tid for children OR ceftazidime 100–150 mg/kg tid/bid for 0-7 days neonates; 150 mg/kg tid for 8-28 days neonates; 150 mg/kg tid for children
- Alternative regimen: meropenem 120 mg/kg tid for children
- Haemophilus influenzae (adult)
- β-Lactamase negative
- Preferred regimen: ampicillin 12g 6 times per day
- Alternative regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day OR Cefepime 6g tid OR chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- β-Lactamase positive
- Preferred regimen: Ceftriaxone 4g bid/OD OR cefotaxime 8-12g 4-6 times per day
- Alternative regimen: Cefepime 6g tid OR chloramphenicol 4-6g qid OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Haemophilus influenzae (pediatric)
- β-Lactamase negative
- Preferred regimen:ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
- Alternative regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children OR Cefepime 150 mg/kg tid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- β-Lactamase positive
- Preferred regimen: Ceftriaxone 80–100 mg/kg bid/OD for children OR cefotaxime 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
- Alternative regimen: Cefepime 150 mg/kg tid for children OR chloramphenicol 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children OR Gatifloxacin 400 mg OD OR moxifloxacin 400 mg OD
- Staphylococcus aureus (adult)
- Methicillin susceptible
- Preferred regimen: Nafcillin 9–12 g 6 times per day OR oxacillin 9–12 g 6 times per day
- Alternative regimen: Vancomycin 30–45 mg/kg tid/bid OR meropenem 6g tid
- Methicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid
- Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid OR linezolid
- Staphylococcus aureus (pediatric)
- Methicillin susceptible
- Preferred regimen: Nafcillin 75 mg/kg bid/tid for 0-7 days neonates; 100–150 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children OR oxacillin 75 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children
- Alternative regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children OR meropenem 120 mg/kg tid for children
- Methicillin resistant
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
- Alternative regimen: Trimethoprim-sulfamethoxazole 10–20 mg/kg bid-qid for children OR linezolid
- Staphylococcus epidermidis (adult)
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid
- Alternative regimen: Linezolid
- Staphylococcus epidermidis (pediatric)
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
- Alternative regimen: Linezolid
- Enterococcus species (adult)
- Ampicillin susceptible
- Preferred regimen: ampicillin 12g 6 times per day AND gentamicin 5 mg/kg tid
- Ampicillin resistant
- Preferred regimen: Vancomycin 30–45 mg/kg tid/bid AND gentamicin 5 mg/kg tid
- Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid
- Enterococcus species (pediatric)
- Ampicillin susceptible
- Preferred regimen: ampicillin 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children AND gentamicin 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
- Ampicillin resistant
- Preferred regimen: Vancomycin 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children AND gentamicin 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
- Ampicillin and vancomycin resistant
- Preferred regimen: Linezolid
Meningitis, MRSA
- Preferred regimen: Vancomycin 15–20 mg/kg/dose IV every 8–12 h for 2 weeks
- Alternative regimen: linezolid 600 mg PO/IV bid OR TMP-SMX 5 mg/kg/dose IV every 8–12 h
- Pediatric regimen: Vancomycin 15 mg/kg/dose IV every 6 h OR linezolid 10 mg/kg/dose PO/IV every 8 h
NOTE: Some experts recommend the addition of rifampin 600 mg QD or 300–450 mg BID to vancomycin for adult patients. For children >12 years of age, linezolid 600 mg BID
Meningitis, tuberculous
- Preferred regimen: 2 months of Isoniazid 5 (4–6)mg/kg OD AND Rifampicin 10 (8–12)mg/kg OD AND Pyrazinamide 25 (20–30)mg/kg OD AND Streptomycin 15 (12–18)mg/kg OD followed by 7-10 months of Isoniazid 5 (4–6)mg/kg OD AND Rifampicin 10 (8–12)mg/kg OD
- Alternative regimen (1): 2 months of Isoniazid 5 (4–6)mg/kg OD AND Rifampicin 10 (8–12)mg/kg OD AND Pyrazinamide 25 (20–30)mg/kg OD AND Streptomycin 15 (12–18)mg/kg OD followed by 7-10 months of Isoniazid 10 (8–12)mg/kg 3 times per week AND Rifampicin 10 (8–12)mg/kg 3 times per week
- Alternative regimen (2): 2 months of Isoniazid 10 (8–12)mg/kg 3 times per week AND Rifampicin 10 (8–12)mg/kg 3 times per week AND Pyrazinamide 35 (30–40)mg/kg 3 times per week AND Streptomycina 15 (12–18)mg/kg 3 times per week followed by 7-10 months of Isoniazid 10 (8–12)mg/kg 3 times per week AND Rifampicin 10 (8–12)mg/kg 3 times per week
Septic thrombosis of cavernous or dural venous sinus
Cavernous Sinus
- Preferred regimen: (Vancomycin 13-20mcg/ml AND ceftriaxone 2mg IV q12h) AND metronidazole 500mg IV q8h (if dental/sinus source)
- Alternative regimen: (Daptomycin 8-12mg/kg IV q24h OR Linezolid 600mg IV q12h) AND metronidazole 500mg IV q8h (if dental/sinus source)
Lateral Sinus
- Preferred regimen: cefepime 2mg IV q8h AND metronidazole 500mg IV q8h AND vancomycin 15-20 mcg/ml
Superior Sagittal Sinus
- Preferred regimen: ceftriaxone 2 mg IV q12h AND vancomycin 15-20 mcg/ml AND dexamethasone
- Alternative regimen: meropenem 1-2mg IV q8h AND vancomycin 15-20 mcg/ml AND dexamethasone
Septic thrombosis of cavernous or dural venous sinus, MRSA
- Preferred regimen: Vancomycin 15–20 mg/kg/dose IV every 8–12 h OR Linezolid 600 mg PO/IV BID
- Alternative regimen: TMP-SMX 5 mg/kg/dose PO/IV every 8-12 h
- Pediatric regimen: Vancomycin 15 mg/kg/dose IV every 6 h OR Linezolid 10 mg/kg/dose PO/IV every 8 h
NOTE: Some experts recommend the addition of rifampin 600 mg QD or 300–450 mg BID to vancomycin for adult patients. For children >12 years of age, linezolid 600 mg BID
Subdural empyema
- In adult 60–90% are extension of sinusitis or otitis media
- Rx same as primary brain 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.