Sandbox g19

Brain abscess

• Empiric antimicrobial therapy

• Brain abscess in otherwise healthy patients

• Preferred regimen

• Cefotaxime 8–12 g/day IV q4–6h OR Ceftriaxone 4 g/day IV q12h AND Metronidazole 30 mg/kg/day IV q6h

• Alternative regimen

• Meropenem 6 g/day IV q8h

• Brain abscess with comorbidities

• Otitis media, mastoiditis, or sinusitis

• Preferred regimen

• (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Metronidazole 30 mg/kg/day q6h

• Dental infection

• Preferred regimen

• Penicillin G 24 MU q4h AND Metronidazole 30 mg/kg/day q6h

• Penetrating trauma or post-neurosurgy

• Preferred regimen

• (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Vancomycin 30–45 mg/kg/day q8–12h

• Lung abscess, empyema, or bronchiectasis

• Preferred regimen

• Penicillin G 24 MU q4h AND Metronidazole 30 mg/kg/day q6h AND TMP-SMZ 10–20 mg/kg/day q6–12h

• Bacterial endocarditis

• Preferred regimen

• Vancomycin 30–45 mg/kg/day q8–12h AND Gentamicin 5 mg/kg/day IV q8h

• Congenital heart disease

• Preferred regimen

• Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h

• Transplant recipients

• Preferred regimen

• (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Metronidazole 30 mg/kg/day q6h AND Voriconazole 8 mg/kg/day q12h AND (TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h)

• Patients with HIV/AIDS

• Preferred regimen

• (Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h) AND Sulfadiazine 4–6 g/day q6h AND Pyrimethamine 25–100 mg/day qd

• Staphylococcus aureus coverage

• Preferred regimen

• Vancomycin 30–45 mg/kg/day q8–12h

• Mycobacterium tuberculosis coverage

• Preferred regimen

• Isoniazid 300 mg qd AND Rifampin 600 mg qd AND Pyrazinamide 15–30 mg qd AND Ethambutol 15 mg/kg/day qd

• Pathogen-directed antimicrobial therapy

• Bacteria

• Actinomyces

• Preferred regimen

• Penicillin G 24 MU q4h

• Bacteroides fragilis

• Preferred regimen

• Metronidazole 30 mg/kg/day q6h

• Enterobacteriaceae

• Preferred regimen

• Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h

• Fusobacterium

• Preferred regimen

• Metronidazole 30 mg/kg/day q6h

• Haemophilus

• Preferred regimen

• Cefotaxime 8–12 g/day q4–6h OR Ceftriaxone 4 g/day q12h

• Listeria monocytogenes

• Preferred regimen

• Ampicillin 12 g/day q4h OR Penicillin G 24 MU q4h

• Nocardia

• Preferred regimen

• TMP-SMZ 10–20 mg/kg/day q6–12h OR Sulfadiazine 4–6 g/day q6h

• Prevotella melaninogenica

• Preferred regimen

• Metronidazole 30 mg/kg/day q6h

• Pseudomonas aeruginosa

• Preferred regimen

• Ceftazidime 6 g/day q8h OR Cefepime 6 g/day q8h

• Methicillin-sensitive Staphylococcus aureus

• Preferred regimen

• Nafcillin 12 g/day q4h OR Oxacillin 12 g/day q4h

• Methicillin-resistant Staphylococcus aureus

• Preferred regimen

• Vancomycin 30–45 mg/kg/day q8–12h

• Streptococcus anginosus and other streptococci

• Preferred regimen

• Penicillin G 24 MU q4h