Sandbox g23

Encephalitis

• Empiric antimicrobial therapy

• Preferred regimen: Acyclovir 10 mg/kg IV q8h for 14–21 days

Note: Acyclovir should be initiated in all patients with sus- pected encephalitis, pending results of diagnostic studies

• Specific considerations

• Pathogen-directed antimicrobial therapy

• Viruses

• Adenovirus

• Preferred regimen: supportive

• B virus

prophylactic antiviral therapy after bite or scratch

• Preferred regimen: Valacyclovir

established disease

• Preferred regimen: Valacyclovir OR Acyclovir OR Ganciclovir

• CMV

• Preferred regimen: Ganciclovir AND foscarnet

• Eastern equine encephalitis virus

• Preferred regimen: supportive

• EBV

• Preferred regimen: supportive AND Corticosteroids

• Hendra virus

• Preferred regimen: supportive

• HHV-6

• Preferred regimen: Ganciclovir OR Foscarnet

• HIV

• Preferred regimen: HAART

• HSV-1 and HSV-2

• Preferred regimen: Acyclovir 10 mg/kg IV q8h for 14–21 days
• Preferred regimen (neonates): Acyclovir 20 mg/kg IV q8h for 21 days

• Influenza virus

• Preferred regimen: Oseltamivir

• Japanese encephalitis virus

• Preferred regimen: supportive

• JC virus

• Preferred regimen: Reversal or control of immunosuppression AND HAART in patients with AIDS

• La Crosse virus

• Preferred regimen: supportive

• Measles virus

life-threatening disease

• Preferred regimen: Ribavirin

SSPE

• Preferred regimen: Ribavirin intrathecal

• Mumps virus

• Preferred regimen: supportive

• Murray Valley encephalitis virus

• Preferred regimen: supportive

• Nipah virus

• Preferred regimen: supportive AND Ribavirin

• Nonpolio enteroviruses

• Preferred regimen: supportive AND Intraventricular γ-globulin (for chronic and/or severe disease)

• Poliovirus

• Preferred regimen: supportive

• Powassan virus

• Preferred regimen: supportive

• Rabies virus

postxposure prophylaxis

• Preferred regimen: rabies immunoglobulin AND vaccine

after onset of disease

• Preferred regimen: supportive

• Rubella virus

• Preferred regimen: supportive

• St. Louis encephalitis virus

• Preferred regimen: supportive
• Alternative regimen: IFN-a-2b

• Tickborne encephalitis virus

• Preferred regimen: supportive

• Vaccinia

• Preferred regimen: supportive ± Corticosteroids

• Venezuelan equine encephalitis virus

• Preferred regimen: supportive

• VZV

• Preferred regimen: Acyclovir 10–15 mg/kg IV q8h for 10-14 days ± Corticosteroids
• Alternative regimen: Ganciclovir ± Corticosteroids

• West Nile virus

• Preferred regimen: supportive

• Western equine encephalitis virus

• Preferred regimen: supportive

• Bacteria

• Anaplasma phagocytophilum (human granulocytotrophic ehrlichiosis)

• Preferred regimen: Doxycycline

• Bartonella bacilliformis (Oroya fever)

• Preferred regimen: Chloramphenicol OR Ciprofloxacin] OR Doxycycline OR Ampicillin OR trimethoprim-sulfamethoxazole

• Bartonella henselae (Cat scratch disease)

• Preferred regimen: Doxycycline OR Azithromycin ± Rifampin

• Borrelia burgdorferi (Lyme disease)

• preferred regimen: Ceftriaxone OR Cefotaxime OR Penicillin G

• Coxiella burnetii (Q fever)

• Preferred regimen: Doxycycline AND Fluoroquinolone AND Rifampin

• Ehrlichia chaffeensis (human monocytotrophic ehrlichiosis)

• Preferred regimen: Doxycycline

• Listeria monocytogenes

• Preferred regimen: Ampicillin OR Trimethoprim-sulfamethoxazole AND Gentamicin

• Mycobacterium tuberculosis

with meningitis

• Preferred regimen: Dexamethasone

without meningitis

• Preferred regimen: Isoniazid OR Rifampin OR Pyrazinamide OR Ethambutol

• Mycoplasma pneumoniae

• Preferred regimen: Azithromycin OR Doxycycline OR Fluoroquinolone

• Rickettsia rickettsii (Rocky Mountain spotted fever)

• Preferred regimen: Doxycycline
• Alternative regimen: Chloramphenicol

• Treponema pallidum (syphilis)

• preferred regimen: Ceftriaxone OR Penicillin G

• Tropheryma whipplei (Whipple's disease)

• Preferred regimen: Ceftriaxone for 2–4 weeks, followed by Trimethoprim-sulfamethoxazole OR Cefixime for 1–2 years

• Fungi

• Coccidioides

• Preferred regimen: Fluconazole
• Alternative regimen: Itraconazole OR Voriconazole OR Amphotericin B (intravenous and intrathecal)

• Cryptococcus neoformans

• 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

• Histoplasma capsulatum

• Preferred regimen: Liposomal amphotericin B for 4–6 weeks, followed by itraconazole for at least 1 year and until resolution of CSF abnormalities

• Protozoa

• Acanthamoeba

• Preferred regimen: Trimethoprim-sulfamethoxazole AND rifampin AND ketoconazole OR Fluconazole AND sulfadiazine AND pyrimethamine

• Balamuthia mandrillaris

• Preferred regimen: Azithromycin OR Clarithromycin AND pentamidine AND flucytosine AND fluconazole AND sulfadiazine AND thioridazine OR trifluoperazine

• Naegleria fowleri

• Preferred regimen: Amphotericin B (intravenous and intrathecal) AND rifampin AND azithromycin OR sulfisoxazole OR miconazole

• Plasmodium falciparum

• 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)

• Toxoplasma gondii

• 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

• Baylisascaris procyonis

• Preferred regimen: Corticosteroids
• Alternative regimen: Albendazole AND diethylcarbamazine

• Gnathostoma

• Preferred regimen: Albendazole OR Ivermectin

• Taenia solium (cysticercosis)

• Preferred regimen: Albendazole OR Corticosteroids
• Alternative regimen: Praziquantel

• Prion

• Human transmissible spongiform encephalopathy

• Preferred regimen: supportive